BACKGROUND Preoperative anxiety is a significant concern for patients,as it affects surgical outcomes,satisfaction,and pain perception.Although both anxiety and pain are common in surgical settings,their relationship ...BACKGROUND Preoperative anxiety is a significant concern for patients,as it affects surgical outcomes,satisfaction,and pain perception.Although both anxiety and pain are common in surgical settings,their relationship with personality traits has not been previously investigated in the Lebanese population.AIM To examine the prevalence of preoperative anxiety,pain perception,and personality traits among Lebanese surgical patients,and to assess the associations between these factors.METHODS A descriptive cross-sectional study was conducted between April 2024 and January 2025 across Lebanese hospitals.A total of 392 adult patients were recruited through convenience sampling.Data were collected using a questionnaire that included sociodemographic,clinical,and surgical variables,the Amsterdam Preoperative Anxiety and Information Scale for anxiety,the Visual Analog Scale and Numerical Pain Rating Scale for preoperative pain,and the Ten-Item Personality Inventory for personality traits.Ethical approval was obtained from the Institutional Review Boards of Makassed General Hospital and Hammoud University Medical Center.RESULTS Overall,25%of participants experienced preoperative anxiety,and 34.5%reported moderate pain.Personality assessment showed that the majority of participants had moderate extraversion(84.1%),moderate emotional stability(65.1%),high conscientiousness(61%),high agreeableness(54.1%),and moderate openness(49.2%).High conscientiousness was significantly associated with higher pain perception(P<0.05),while high emotional stability was associated with lower levels of anxiety(P<0.05).No significant association was found between preoperative anxiety and pain(P>0.05).CONCLUSION This study challenges the assumption that preoperative anxiety and pain are directly correlated and highlights the role of personality traits in shaping patient experience.These findings support the potential value of integrating psychological profiling into preoperative care and lay the groundwork for developing personalized interventions to improve patient-centered surgical outcomes.展开更多
BACKGROUND Early screening,preoperative staging,and diagnosis of lymph node metastasis are crucial for improving the prognosis of gastric cancer(GC).AIM To evaluate the diagnostic value of combined multidetector compu...BACKGROUND Early screening,preoperative staging,and diagnosis of lymph node metastasis are crucial for improving the prognosis of gastric cancer(GC).AIM To evaluate the diagnostic value of combined multidetector computed tomography(MDCT)and gastrointestinal endoscopy for GC screening,preoperative staging,and lymph node metastasis detection,thereby providing a reference for clinical diagnosis and treatment.METHODS In this retrospective study clinical and imaging data of 134 patients with suspected GC who were admitted between January 2023 and October 2024 were initially reviewed.According to the inclusion and exclusion criteria,102 patients were finally enrolled in the analysis.All enrolled patients had undergone both MDCT and gastrointestinal endoscopy examinations prior to surgical intervention.Preoperative clinical staging and lymph node metastasis findings were compared with pathological results.RESULTS The combined use of MDCT and gastrointestinal endoscopy demonstrated a sensitivity of 98.53%,specificity of 97.06%,accuracy of 98.04%,positive predictive value of 98.53%,and negative predictive value of 97.06%for diagnosing GC.These factors were all significantly higher than those of MDCT or endoscopy alone(P<0.05).The accuracy rates of the combined approach for detecting clinical T and N stages were 97.06%and 92.65%,respectively,outperforming MDCT alone(86.76% and 79.41%)and endoscopy alone(85.29% and 70.59%)(P<0.05).Among 68 patients with confirmed GC,50(73.53%)were pathologically diagnosed with lymph node metastasis.The accuracy for detecting lymph node metastasis was 66.00%with endoscopy,76.00%with MDCT,and 92.00% with the combined approach,all with statistically significant differences(P<0.05).CONCLUSION The combined application of MDCT and gastrointestinal endoscopy enhanced diagnostic accuracy for GC,provided greater consistency in preoperative staging,and improved the detection of lymph node metastasis,thereby demonstrating significant clinical utility.展开更多
Objective: This study aimed to develop a nomogram to predict the 1-year survival of patients with pancreatic cancer who underwent pancreatectomy following neoadjuvant treatment with preoperatively detectable clinical ...Objective: This study aimed to develop a nomogram to predict the 1-year survival of patients with pancreatic cancer who underwent pancreatectomy following neoadjuvant treatment with preoperatively detectable clinical parameters. Extended pancreatectomy is necessary to achieve complete tumor removal in borderline resectable and locally advanced pancreatic cancer. However, it increases postoperative morbidity and mortality rates, and should be balanced with potential benefit of long-term survival.Methods: The medical records of patients who underwent pancreatectomy following neoadjuvant treatment from January 2005 to December 2016 at Severance Hospital were retrospectively reviewed. Medical records were collected from five international institutions from Japan and Singapore for external validation.Results: A total of 113 patients were enrolled. The nomogram for predicting 1-year disease-specific survival was created based on 5 clinically detectable preoperative parameters as follows: age(year), symptom(no/yes), tumor size at initial diagnostic stage(cm), preoperative serum carbohydrate antigen(CA) 19-9 level after neoadjuvant treatment(<34/≥34 U/m L), and planned surgery [pancreaticoduodenectomy(PD)(pylorus-preserving PD)/distal pancreatectomy(DP)/total pancreatectomy]. Model performance was assessed for discrimination and calibration.The calibration plot showed good agreement between actual and predicted survival probabilities;the the Greenwood-Nam-D’Agostino(GND) goodness-of-fit test showed that the model was well calibrated(χ~2=8.24,P=0.5099). A total of 84 patients were used for external validation. When correlating actual disease-specific survival and calculated 1-year disease-specific survival, there were significance differences according to the calculated probability of 1-year survival among the three groups(P=0.044).Conclusions: The developed nomogram had quite acceptable accuracy and clinical feasibility in the decision-making process for the management of pancreatic cancer.展开更多
BACKGROUND The incidence of breast cancer in China is increasing while its mortality rate is decreasing.The annual breast cancer incidence in China is 39.2 million,accounting for two-thirds of the urban population.In ...BACKGROUND The incidence of breast cancer in China is increasing while its mortality rate is decreasing.The annual breast cancer incidence in China is 39.2 million,accounting for two-thirds of the urban population.In China,breast cancer is the fifth most common malignant tumor overall and the most common in women,accounting for 17%of female malignant tumors.AIM To investigate the accuracy of strain ultrasound elastography(SUE)on the evaluation of preoperative neoadjuvant chemotherapy(NAC)in breast cancer.METHODS Overall,90 patients with breast cancer treated at our hospital between January 2018 and February 2019 were selected for this study.The patients received six cycles of NAC with docetaxel,epirubicin,and cyclophosphamide.Surgical treatment was also performed,and pathological reactivity was assessed.The patients were evaluated using conventional ultrasonography and SUE before biopsy.The differences between groups were analyzed to calculate the mean and standard deviation with significance measured using a t-test,while multivariate analysis was performed using logistic regression analysis.RESULTS Of the patients analyzed,20 had a pathological complete remission(pCR)while 70 did not achieve pCR after NAC.The ratio of the elastic strain ratio(SR)and elastic score of 4–5 in patients with pCR were 5.5±1.16 and 15.00%,respectively;these were significantly lower than those in patients without pCR(85%)and significantly higher than in patients without pCR(14%).SR and elastic score 4–5 were independent factors influencing NAC efficacy(OR=0.644,1.426 and 1.366,respectively,P<0.05).SR was positively correlated with elasticity score(rs=0.411,P<0.05).The area under the receiver operator characteristic curve of SR and SR combined with elastic score in predicting patients without pCR was 0.822 and 0.891,respectively(P<0.05).CONCLUSION Strain ultrasonic elastography may be used to evaluate the effects of preoperative NAC in patients with breast cancer.展开更多
Colorectal cancer liver metastasis(CRLM)presents a clinical challenge,and optimizing treatment strategies is crucial for improving patient outcomes.Surgical resection,a key element in achieving prolonged survival,is o...Colorectal cancer liver metastasis(CRLM)presents a clinical challenge,and optimizing treatment strategies is crucial for improving patient outcomes.Surgical resection,a key element in achieving prolonged survival,is often linked to a heightened risk of recurrence.Acknowledging the potential benefits of preoperative neoadjuvant chemotherapy in managing resectable liver metastases,this approach has gained attention for its role in tumor downsizing,assessing biological behavior,and reducing the risk of postoperative recurrence.However,the use of neoadjuvant chemotherapy in initially resectable CRLM sparks ongoing debates.The balance between tumor reduction and the risk of hepatic injury,coupled with concerns about delaying surgery,necessitates a nuanced approach.This article explores recent research insights and draws upon the practical experiences at our center to address critical issues regarding considerations for initially resectable cases.Examining the criteria for patient selection and the judicious choice of neoadjuvant regimens are pivotal areas of discussion.Striking the right balance between maximizing treatment efficacy and minimizing adverse effects is imperative.The dynamic landscape of precision medicine is also reflected in the evolving role of gene testing,such as RAS/BRAF and PIK3CA,in tailoring neoadjuvant regimens.Furthermore,the review emphasizes the need for a multidisciplinary approach to navigate the comp-lexities of CRLM.Integrating technical expertise and biological insights is crucial in refining neoadjuvant strategies.The management of progression following neoadjuvant chemotherapy requires a tailored approach,acknowledging the diverse biological behaviors that may emerge.In conclusion,this review aims to provide a comprehensive perspective on the considerations,challenges,and advancements in the use of neoadjuvant chemotherapy for initially resectable CRLM.By combining evidencebased insights with practical experiences,we aspire to contribute to the ongoing discourse on refining treatment paradigms for improved outcomes in patients with CRLM.展开更多
Objective: To investigate the effect of preoperative paclitaxel + cisplatin neoadjuvant chemotherapy on the proliferation and invasion of cancer cells in esophageal cancer. Methods: A total of 106 patients with esopha...Objective: To investigate the effect of preoperative paclitaxel + cisplatin neoadjuvant chemotherapy on the proliferation and invasion of cancer cells in esophageal cancer. Methods: A total of 106 patients with esophageal cancer who underwent radical operation for esophageal cancer in our hospital between September 2014 and March 2017 were divided into the neoadjuvant chemotherapy group (n=54, receiving preoperative paclitaxel + cisplatin neoadjuvant chemotherapy) and the normal group (n=52, receiving no preoperative neoadjuvant chemotherapy) according the therapeutic regimen. The differences in the expression of proliferation genes and invasion genes in the postoperative lesion tissue specimens were compared between the two groups. Results: The proliferation genes MACC1, Nucleostemin, TRAF4 and USP39 mRNA expression in lesion tissue of neoadjuvant chemotherapy group were lower than those in lesion tissue of normal group whereas DEC1, PTPN14, KLF4 and LATS1 mRNA expression were higher than those in lesion tissue of normal group;invasion genes EphA2, MACC1, MMP-9, PFN2, Snail and SphK1 mRNA expression in lesion tissue of neoadjuvant chemotherapy group were lower than those in lesion tissue of normal group whereas PTEN and RACK1 mRNA expression were higher than those in lesion tissue of normal group. Conclusion: The paclitaxel + cisplatin neoadjuvant chemotherapy before esophageal cancer surgery can effectively inhibit the proliferation and invasion activity of esophageal cancer cells.展开更多
Objective:To study the effect of preoperative Xiaoaiping combined with TEC neoadjuvant chemotherapy on malignant biological behaviors of breast cancer cells.Methods:The patients with breast cancer who received neoadju...Objective:To study the effect of preoperative Xiaoaiping combined with TEC neoadjuvant chemotherapy on malignant biological behaviors of breast cancer cells.Methods:The patients with breast cancer who received neoadjuvant chemotherapy in Renshou County People's Hospital between June 2014 and December 2017 were chosen as the research subjects and randomly divided into the combined group who accepted preoperative Xiaoaiping combined with TEC neoadjuvant chemotherapy and the control group who accepted TEC neoadjuvant chemotherapy. After surgical resection, the breast cancer lesion was taken to determine the mRNA expression of proliferation genes and invasion genes as well as the protein levels of angiogenesis molecules.Results: After surgical resection, USP39, CyclinD1, c-myc, Sema4D, CatB, ADAM17 and uPA mRNA expression as well as VEGF, Ang-2 and bFGF protein levels in breast cancer lesions of combined group were significantly lower than those of control group whereas TCEAL17, MFN2, TIMP1 and E-cadherin mRNA expression as well as MMRN2 and PEDF protein levels were significantly higher than those of control group.Conclusion:Xiaoaiping combined with TEC neoadjuvant chemotherapy before breast cancer surgery can be more effective than TEC neoadjuvant chemotherapy alone to inhibit the proliferation, invasion and angiogenesis of cancer cells.展开更多
Objective: To investigate the effects of preoperative neoadjuvant chemotherapy on malignant biological characteristics in the lesions of patients with ⅠB-ⅡB cervical cancer. Methods:Patients who were diagnosed with ...Objective: To investigate the effects of preoperative neoadjuvant chemotherapy on malignant biological characteristics in the lesions of patients with ⅠB-ⅡB cervical cancer. Methods:Patients who were diagnosed with ⅠB-ⅡB cervical cancer and underwent surgical treatment in Navy General Hospital of PLA between February 2015 and May 2017 were selected as the research subjects and randomly divided into the neoadjuvant chemotherapy group who underwent preoperative neoadjuvant chemotherapy and the control group who underwent routine preoperative preparation. After surgical resection, the mRNA expression of tumor suppressor genes, proliferation genes as well as migration and invasion genes in cervical cancer tissue were determined by fluorescence quantitative PCR. Results: After surgical resection, tumor suppressor genes THBS2, PTEN, LAST1 and eIF4E3 mRNA expression in cervical cancer tissue of adjuvant chemotherapy group were significantly higher than those of routine surgery group whereas proliferation genes RUNX2, CyclinD1, ALEX1, ALDH1 and ABCG2 as well as migration and invasion genes CXCL12, CXCR4, MMP9, S100A6 and N-cadherin mRNA expression were significantly lower than those of routine surgery group. Conclusion:Preoperative neoadjuvant chemotherapy can inhibit the proliferation, migration and invasion of cancer cells within the lesions of patients with ⅠB-ⅡB cervical cancer.展开更多
Objective:To study the effect of preoperative neoadjuvant chemotherapy on the expression of malignant molecules in colon cancer tissue and the degree of trauma caused by radical operation.Methods: Patients who were di...Objective:To study the effect of preoperative neoadjuvant chemotherapy on the expression of malignant molecules in colon cancer tissue and the degree of trauma caused by radical operation.Methods: Patients who were diagnosed with colon cancer in Fengrun People's Hospital between March 2014 and February 2017 were selected and randomly divided into the XELOX group who accepted XELOX neoadjuvant chemotherapy combined with radical operation for colon cancer and the control group who accepted radical operation for colon cancer alone. Surgically removed colon cancer tissue was collected to test the expression of proliferation, apoptosis and invasion genes, and serum was collected to detect the contents of liver and kidney function indicators as well as inflammatory factors.Results: Rac1, PLD2, CHD1L, Snail, Vimentin and N-cadherin mRNA expression levels in surgically removed colon cancer lesions of XELOX group were significantly lower than those of control group while MS4A12 and ASPP2 mRNA expression levels were significantly higher than those of control group;serum ALT, AST,β2-MG, Cys-C, sICAM-1, sVCAM-1, sTM and sE-selectin contents were not significantly different between the two groups of patients 1 day and 3 days after surgery.Conclusion: Preoperative neoadjuvant chemotherapy can inhibit the proliferation, apoptosis and invasion gene expression in colon cancer tissues without increasing the trauma of operation.展开更多
Background:Neoadjuvant/preoperative therapy(NAT)involves the administration of chemotherapy,with or without radiation,prior to surgical resection.This approach is commonly used for locally advanced tumors to reduce tu...Background:Neoadjuvant/preoperative therapy(NAT)involves the administration of chemotherapy,with or without radiation,prior to surgical resection.This approach is commonly used for locally advanced tumors to reduce tumor volume,improve resectability,and minimize the need for extensive surgical procedures.While NAT has been shown to be effective in inducing local anti-tumor immunity in potentially resectable solid tumors,the underlying molecular mechanisms remain poorly understood.Methods:Cohort samples from pancreatic cancer patients who underwent NAT(n=26)and those who did not(n=20)were analyzed.Changes in the immune microenvironment induced by NAT were assessed using stratified bioinformatic approaches,including heatmap analysis of immunerelated genes selected via Gene Ontology,Gene Set Enrichment Analysis(GSEA)with the immunologic signature database,and Ingenuity Pathway Analysis(IPA).Findings were further validated through immunohistochemical analysis.Results:A comprehensive,stratified evaluation integrating pathological and bioinformatic approaches revealed that NAT induced the upregulation of 212 genes,including DC-SIGN(CD209),and activated 13 immuneassociated pathways,such as T-cell receptor(TCR)signaling.Additionally,NAT promoted an increased shift toward CD8(+)T-cell populations through the upregulation of MAL(T-cell differentiation protein).Immunohistochemical analysis further confirmed a significant accumulation of DC-SIGN(+)dendritic cells and MAL(+)lymphocytes in NAT-treated patients.Conclusions:NAT enhances anti-tumor immunity by promoting CD8(+)T-cell generation through the activation of DC-SIGN(+)dendritic cells and MAL(+)lymphocytes.This study is the first to report an increase in MAL(+)lymphocytes following NAT.Given its potential significance,further investigation in other solid tumors treated with NAT is warranted.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)remains a leading cause of cancer-related mortality worldwide.Despite improvements in surgical techniques and systemic therapies,long-term outcomes after liver resection are lim...BACKGROUND Hepatocellular carcinoma(HCC)remains a leading cause of cancer-related mortality worldwide.Despite improvements in surgical techniques and systemic therapies,long-term outcomes after liver resection are limited by high recurrence rates.While adjuvant strategies have shown limited benefit,the role of neoadjuvant immunotherapy in resectable HCC is still under investigation.AIM To assess the efficacy,feasibility,and safety of neoadjuvant immunotherapy in resectable HCC through a meta-analysis of current literature.METHODS A systematic search was conducted across PubMed,Web of Science,EMBASE,Cochrane Library,and Scopus for studies published in the past five years evaluating neoadjuvant immunotherapy in resectable HCC.Primary endpoints included major pathological response(MPR),pathological complete response(pCR),overall response rate(ORR),resection rate,and grade 3-4 treatment-related adverse events(TRAEs).A random-effects meta-analysis was conducted using log odds ratios(ORs)and pooled event rates were calculated to provide absolute estimates of clinical endpoints.RESULTS Twelve studies were included in the final analysis.The pooled ORs were 0.28(95%CI:0.19-0.41)for MPR,0.54(95%CI:0.25-1.14)for ORR,0.26(95%CI:0.11-0.66)for pCR,5.37(95%CI:2.70-10.66)for resection rate,and 0.33(95%CI:0.22-0.50)for grade 3-4 TRAEs.Corresponding pooled event rates were 19%for MPR,35%for ORR,22%for pCR,81%for resection feasibility,and 19%for severe TRAEs.CONCLUSION Neoadjuvant immunotherapy appears to be a feasible and safe approach in patients with resectable HCC,achieving moderate pathological responses and high resection rates.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
BACKGROUND Rectal cancer management is currently evolving with the advent of different neoadjuvant treatment strategies and organ preservation strategies.A significant proportion of patients could achieve complete cli...BACKGROUND Rectal cancer management is currently evolving with the advent of different neoadjuvant treatment strategies and organ preservation strategies.A significant proportion of patients could achieve complete clinical response after neoadjuvant treatment,which often translates to pathologic complete response(pCR)as assessed on surgical specimens after curative intent surgery.Endoscopy plays a significant role in assessing treatment response to neoadjuvant therapies.AIM To explore the role of endoscopy in predicting subsequent pCR after neoadjuvant treatment in rectal cancer patients.METHODS An extensive literature review was undertaken to identify the criteria used for assessment of endoscopic response and their ability to predict pCR.RESULTS Fifteen studies were identified through literature review.The most commonly used endoscopic criteria for evaluation included the presence of a flat white scar and the absence of nodularity or telangiectasia.Information on the timing of endoscopic assessment in relation to neoadjuvant treatment protocols were also extracted from the studies.In most studies,the diagnostic accuracy for predicting pCR exceeded 0.8.The main limitations identified were the retrospective design of included studies included and a moderate risk of bias.CONCLUSION Endoscopy can be a key prognostic factor in predicting pCR to neoadjuvant treatment in rectal cancer despite significant limitations in currently available data.展开更多
BACKGROUND Neoadjuvant therapy(NAT)for pancreatic cancer(PC)is becoming standardized,with neoadjuvant chemoradiotherapy(NACRT)showing proven effectiveness.However,the optimal endoscopic biliary drainage approach durin...BACKGROUND Neoadjuvant therapy(NAT)for pancreatic cancer(PC)is becoming standardized,with neoadjuvant chemoradiotherapy(NACRT)showing proven effectiveness.However,the optimal endoscopic biliary drainage approach during NAT remains controversial.In this single-center retrospective case series,we report the use of a novel multi-hole self-expandable metallic stent(MH-SEMS)for preoperative biliary drainage during NACRT in patients with PC.AIM To assess the feasibility of endoscopic biliary drainage using MH-SEMS during NACRT in patients with malignant distal biliary obstruction secondary to resectable and borderline resectable PC.METHODS We included 14 patients—10 with resectable,2 with borderline resectable,and 2 with unresectable locally advanced disease—who had undergone surgery after biliary drainage using MH-SEMS(diameter:10 mm).Clinical and technical success was achieved in all patients,with a median interval of 105 days between stent placement and surgery.RESULTS A partial response was observed in five patients(35.7%),whereas nine patients(64.3%)exhibited stable disease.Only one patient(7.1%)developed moderate cholangitis from recurrent biliary obstruction caused by sludge 337 days after stent placement during systemic chemotherapy,requiring MH-SEMS replacement.Pathological examination of postoperative specimens revealed tumor shrinkage in many cases,and no stent migration was observed.Adverse events included mild pancreatitis in two patients(14.3%)and moderate pancreatitis in one patient(7.1%),as defined by the Tokyo Criteria 2024.CONCLUSION No cases of cholecystitis,liver abscess,or hemorrhage were reported.No disadvantages in surgical procedures or postoperative complications related to MH-SEMS placement were observed.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
Objective:The use of technology is growing rapidly.It can also be used in nursing interventions.A technology pack can support nursing interventions.An application called guided imagery in Indonesian(GIANESIA)has been ...Objective:The use of technology is growing rapidly.It can also be used in nursing interventions.A technology pack can support nursing interventions.An application called guided imagery in Indonesian(GIANESIA)has been developed to reduce anxiety in preoperative patients.Methods:A total of 42 participants joined this research.The respondents were those who would undergo surgery.We used the numeric visual analog anxiety scale(NVAAS)as the instrument to measure their anxiety levels.The participants were first given informed consent.Then,they open the application that has been installed.The process begins with participants choosing their initial anxiety score.Later,they start the therapy session,and immediately after finishing it,a pop-up bar prompts them to enter their final,posttherapy anxiety score.Results:This study shows the effectiveness of therapy given by GIANESIA in reducing anxiety in preoperative patients with p-value=0.000(a<0.05).Also,61.9%of the participants had decreased anxiety levels after therapy with GIANESIA.Conclusions:This study proves that providing therapy via a mobile application is effective in easing uncomfortable feelings,especially anxiety,in preoperative patients.Moving forward,the app can and should be expanded with new features and further developmental goals.展开更多
Objective:To evaluate nurses’levels of knowledge and practice regarding preoperative hair removal and prevention of surgical site infection(SSI).Methods:The descriptive and cross-sectional research was conducted betw...Objective:To evaluate nurses’levels of knowledge and practice regarding preoperative hair removal and prevention of surgical site infection(SSI).Methods:The descriptive and cross-sectional research was conducted between February 2023 and May 2023 in a public hospital in northern Turkey with 123 nurses who agreed to participate in the study.Results:The results showed that 64.2%of the nurses thought that preoperative hair removal should be done by shaving with a razor,74%thought that hair removal should be performed the night before the operation,and 70.7%thought that the patient/patient’s relative should perform preoperative hair removal.Conclusions:This study found that nurses’levels of knowledge and practice regarding preoperative hair removal and prevention of SSI were not at the desired level.Following current resources and improving their levels of knowledge and practices are considered to be important for nurses.展开更多
BACKGROUND Gastric cancer(GC)remains a major global health burden,particularly in East Asia,due to its high incidence,aggressive progression,and poor prognosis in advanced stages.Although surgery is the mainstay of cu...BACKGROUND Gastric cancer(GC)remains a major global health burden,particularly in East Asia,due to its high incidence,aggressive progression,and poor prognosis in advanced stages.Although surgery is the mainstay of curative treatment,outcomes for locally advanced cases remain unsatisfactory despite perioperative chemotherapy.In recent years,immune checkpoint inhibitors,especially anti-PD-1 antibodies like sintilimab,have shown promise in improving survival when combined with chemotherapy.However,the comparative efficacy and safety of SOX plus sintilimab vs established regimens such as P-SOX and SOX alone in the neoadjuvant setting have not been fully explored.AIM To compare the efficacy and safety of three neoadjuvant chemotherapy regimens—SOX combined with sintilimab(SOX+PD-1),albumin-bound paclitaxel plus oxaliplatin and S-1(P-SOX),and SOX—in patients with advanced GC.METHODS A retrospective analysis was conducted on 299 patients with advanced GC who received both neoadjuvant and adjuvant chemotherapy along with standard D2 radical gastrectomy.Among them,81 patients received SOX plus sintilimab,118 received the P-SOX regimen,and 100 received the SOX regimen.All patients were randomly assigned to training(70%)or validation(30%)cohorts using the R software sample function.Short-term efficacy,long-term survival outcomes,and adverse events were assessed across the three groups.Additionally,clinical factors associated with progression-free survival(PFS)were further investigated.RESULTS In terms of short-term efficacy,the SOX+sintilimab group had higher objective response rates[91.4%and 70.4%according to the tumor regression grade(TRG)and Response Evaluation Criteria in Solid Tumors(RECIST)1.1 criteria,respectively]than did the P-SOX(88.1%and 59.3%)and SOX groups(84.0%and 55.0%),although the intergroup differences were not statistically significant(P=0.167).For long-term outcomes,the SOX+sintilimab group demonstrated significantly better OS rates at 1 year(98.8%),18 months(92.6%),2 years(84.0%),and 3 years(48.1%)than did the P-SOX(93.2%,86.4%,71.2%,30.5%)and SOX(91.0%,84.0%,72.0%,29.0%)groups,with the 3-year overall survival(OS)difference being statistically significant(P=0.007).Similarly,PFS rates in the SOX+sintilimab group(1 year:92.6%;18 months:77.8%;2 years:65.4%;3 years:35.8%)were significantly greater than those in the P-SOX(82.2%,68.6%,53.4%,26.3%)and SOX(77.0%,66.0%,43.0%,27.0%)groups,with significant differences at 1 year(P=0.021)and 2 years(P=0.011).In terms of safety,grade 1-2 gastrointestinal reactions,peripheral neuropathy,and alopecia were the main TRAEs across groups.The P-SOX group had a significantly greater incidence of alopecia(54.2%vs 53.0%vs 23.5%,P=0.009)and more cases of grade 2 alopecia(6.8%vs 1.2%),potentially due to the accumulation of triple-agent toxicity.No significant intergroup differences were observed in hematologic toxicity or liver dysfunction(all P>0.05).CONCLUSION Compared with the SOX and P-SOX regimens,the SOX plus sintilimab combination demonstrated significantly improved short-and long-term efficacy with favorable safety,with superior advantages in terms of 2-and 3-year OS and early PFS,suggesting that this combination is a more promising therapeutic option for patients with advanced GC.Patients who achieved good perioperative chemotherapy responses(meeting the TRG and RECIST 1.1 criteria)and had tumor diameters≤2 cm,well-differentiated histology,earlier cTNM stages,and no lymph node metastasis had a better prognosis.展开更多
Background:Neoadjuvant chemotherapy(NAC)significantly enhances clinical outcomes in patients with triple-negative breast cancer(TNBC);however,chemoresistance frequently results in treatment failure.Consequently,unders...Background:Neoadjuvant chemotherapy(NAC)significantly enhances clinical outcomes in patients with triple-negative breast cancer(TNBC);however,chemoresistance frequently results in treatment failure.Consequently,understanding the mechanisms underlying resistance and accurately predicting this phenomenon are crucial for improving treatment efficacy.Methods:Ultrasound images from 62 patients,taken before and after neoadjuvant therapy,were collected.Mitochondrial-related genes were extracted from a public database.Ultrasound features associated with NAC resistance were identified and correlated with significant mitochondrial-related genes.Subsequently,a prognostic model was developed and evaluated using the GSE58812 dataset.We also assessed this model alongside clinical factors and its ability to predict immunotherapy response.Results:A total of 32 significant differentially expressed genes in TNBC across three groups indicated a strong correlation with ultrasound features.Univariate and multivariate Cox regression analyses identified six genes as independent risk factors for TNBC prognosis.Based on these six mitochondrial-related genes,we constructed a TNBC prognostic model.The model’s risk scores indicated that high-risk patients generally have a poorer prognosis compared to low-risk patients,with the model demonstrating high predictive performance(p=0.002,AUC=0.745).This conclusion was further supported in the test set(p=0.026,AUC=0.718).Additionally,we found that high-risk patients exhibited more advanced tumor characteristics,while low-risk patients were more sensitive to common chemotherapy drugs and immunotherapy.The signature-related genes also predicted immunotherapy response with a high accuracy of 0.765.Conclusion:We identified resistance-related features from ultrasound images and integrated them with genomic data,enabling effective risk stratification of patients and prediction of the efficacy of neoadjuvant chemotherapy and immunotherapy in patients with TNBC.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
文摘BACKGROUND Preoperative anxiety is a significant concern for patients,as it affects surgical outcomes,satisfaction,and pain perception.Although both anxiety and pain are common in surgical settings,their relationship with personality traits has not been previously investigated in the Lebanese population.AIM To examine the prevalence of preoperative anxiety,pain perception,and personality traits among Lebanese surgical patients,and to assess the associations between these factors.METHODS A descriptive cross-sectional study was conducted between April 2024 and January 2025 across Lebanese hospitals.A total of 392 adult patients were recruited through convenience sampling.Data were collected using a questionnaire that included sociodemographic,clinical,and surgical variables,the Amsterdam Preoperative Anxiety and Information Scale for anxiety,the Visual Analog Scale and Numerical Pain Rating Scale for preoperative pain,and the Ten-Item Personality Inventory for personality traits.Ethical approval was obtained from the Institutional Review Boards of Makassed General Hospital and Hammoud University Medical Center.RESULTS Overall,25%of participants experienced preoperative anxiety,and 34.5%reported moderate pain.Personality assessment showed that the majority of participants had moderate extraversion(84.1%),moderate emotional stability(65.1%),high conscientiousness(61%),high agreeableness(54.1%),and moderate openness(49.2%).High conscientiousness was significantly associated with higher pain perception(P<0.05),while high emotional stability was associated with lower levels of anxiety(P<0.05).No significant association was found between preoperative anxiety and pain(P>0.05).CONCLUSION This study challenges the assumption that preoperative anxiety and pain are directly correlated and highlights the role of personality traits in shaping patient experience.These findings support the potential value of integrating psychological profiling into preoperative care and lay the groundwork for developing personalized interventions to improve patient-centered surgical outcomes.
文摘BACKGROUND Early screening,preoperative staging,and diagnosis of lymph node metastasis are crucial for improving the prognosis of gastric cancer(GC).AIM To evaluate the diagnostic value of combined multidetector computed tomography(MDCT)and gastrointestinal endoscopy for GC screening,preoperative staging,and lymph node metastasis detection,thereby providing a reference for clinical diagnosis and treatment.METHODS In this retrospective study clinical and imaging data of 134 patients with suspected GC who were admitted between January 2023 and October 2024 were initially reviewed.According to the inclusion and exclusion criteria,102 patients were finally enrolled in the analysis.All enrolled patients had undergone both MDCT and gastrointestinal endoscopy examinations prior to surgical intervention.Preoperative clinical staging and lymph node metastasis findings were compared with pathological results.RESULTS The combined use of MDCT and gastrointestinal endoscopy demonstrated a sensitivity of 98.53%,specificity of 97.06%,accuracy of 98.04%,positive predictive value of 98.53%,and negative predictive value of 97.06%for diagnosing GC.These factors were all significantly higher than those of MDCT or endoscopy alone(P<0.05).The accuracy rates of the combined approach for detecting clinical T and N stages were 97.06%and 92.65%,respectively,outperforming MDCT alone(86.76% and 79.41%)and endoscopy alone(85.29% and 70.59%)(P<0.05).Among 68 patients with confirmed GC,50(73.53%)were pathologically diagnosed with lymph node metastasis.The accuracy for detecting lymph node metastasis was 66.00%with endoscopy,76.00%with MDCT,and 92.00% with the combined approach,all with statistically significant differences(P<0.05).CONCLUSION The combined application of MDCT and gastrointestinal endoscopy enhanced diagnostic accuracy for GC,provided greater consistency in preoperative staging,and improved the detection of lymph node metastasis,thereby demonstrating significant clinical utility.
基金supported by a faculty research grant of Yonsei University College of Medicine for 6-2015-0053.
文摘Objective: This study aimed to develop a nomogram to predict the 1-year survival of patients with pancreatic cancer who underwent pancreatectomy following neoadjuvant treatment with preoperatively detectable clinical parameters. Extended pancreatectomy is necessary to achieve complete tumor removal in borderline resectable and locally advanced pancreatic cancer. However, it increases postoperative morbidity and mortality rates, and should be balanced with potential benefit of long-term survival.Methods: The medical records of patients who underwent pancreatectomy following neoadjuvant treatment from January 2005 to December 2016 at Severance Hospital were retrospectively reviewed. Medical records were collected from five international institutions from Japan and Singapore for external validation.Results: A total of 113 patients were enrolled. The nomogram for predicting 1-year disease-specific survival was created based on 5 clinically detectable preoperative parameters as follows: age(year), symptom(no/yes), tumor size at initial diagnostic stage(cm), preoperative serum carbohydrate antigen(CA) 19-9 level after neoadjuvant treatment(<34/≥34 U/m L), and planned surgery [pancreaticoduodenectomy(PD)(pylorus-preserving PD)/distal pancreatectomy(DP)/total pancreatectomy]. Model performance was assessed for discrimination and calibration.The calibration plot showed good agreement between actual and predicted survival probabilities;the the Greenwood-Nam-D’Agostino(GND) goodness-of-fit test showed that the model was well calibrated(χ~2=8.24,P=0.5099). A total of 84 patients were used for external validation. When correlating actual disease-specific survival and calculated 1-year disease-specific survival, there were significance differences according to the calculated probability of 1-year survival among the three groups(P=0.044).Conclusions: The developed nomogram had quite acceptable accuracy and clinical feasibility in the decision-making process for the management of pancreatic cancer.
文摘BACKGROUND The incidence of breast cancer in China is increasing while its mortality rate is decreasing.The annual breast cancer incidence in China is 39.2 million,accounting for two-thirds of the urban population.In China,breast cancer is the fifth most common malignant tumor overall and the most common in women,accounting for 17%of female malignant tumors.AIM To investigate the accuracy of strain ultrasound elastography(SUE)on the evaluation of preoperative neoadjuvant chemotherapy(NAC)in breast cancer.METHODS Overall,90 patients with breast cancer treated at our hospital between January 2018 and February 2019 were selected for this study.The patients received six cycles of NAC with docetaxel,epirubicin,and cyclophosphamide.Surgical treatment was also performed,and pathological reactivity was assessed.The patients were evaluated using conventional ultrasonography and SUE before biopsy.The differences between groups were analyzed to calculate the mean and standard deviation with significance measured using a t-test,while multivariate analysis was performed using logistic regression analysis.RESULTS Of the patients analyzed,20 had a pathological complete remission(pCR)while 70 did not achieve pCR after NAC.The ratio of the elastic strain ratio(SR)and elastic score of 4–5 in patients with pCR were 5.5±1.16 and 15.00%,respectively;these were significantly lower than those in patients without pCR(85%)and significantly higher than in patients without pCR(14%).SR and elastic score 4–5 were independent factors influencing NAC efficacy(OR=0.644,1.426 and 1.366,respectively,P<0.05).SR was positively correlated with elasticity score(rs=0.411,P<0.05).The area under the receiver operator characteristic curve of SR and SR combined with elastic score in predicting patients without pCR was 0.822 and 0.891,respectively(P<0.05).CONCLUSION Strain ultrasonic elastography may be used to evaluate the effects of preoperative NAC in patients with breast cancer.
文摘Colorectal cancer liver metastasis(CRLM)presents a clinical challenge,and optimizing treatment strategies is crucial for improving patient outcomes.Surgical resection,a key element in achieving prolonged survival,is often linked to a heightened risk of recurrence.Acknowledging the potential benefits of preoperative neoadjuvant chemotherapy in managing resectable liver metastases,this approach has gained attention for its role in tumor downsizing,assessing biological behavior,and reducing the risk of postoperative recurrence.However,the use of neoadjuvant chemotherapy in initially resectable CRLM sparks ongoing debates.The balance between tumor reduction and the risk of hepatic injury,coupled with concerns about delaying surgery,necessitates a nuanced approach.This article explores recent research insights and draws upon the practical experiences at our center to address critical issues regarding considerations for initially resectable cases.Examining the criteria for patient selection and the judicious choice of neoadjuvant regimens are pivotal areas of discussion.Striking the right balance between maximizing treatment efficacy and minimizing adverse effects is imperative.The dynamic landscape of precision medicine is also reflected in the evolving role of gene testing,such as RAS/BRAF and PIK3CA,in tailoring neoadjuvant regimens.Furthermore,the review emphasizes the need for a multidisciplinary approach to navigate the comp-lexities of CRLM.Integrating technical expertise and biological insights is crucial in refining neoadjuvant strategies.The management of progression following neoadjuvant chemotherapy requires a tailored approach,acknowledging the diverse biological behaviors that may emerge.In conclusion,this review aims to provide a comprehensive perspective on the considerations,challenges,and advancements in the use of neoadjuvant chemotherapy for initially resectable CRLM.By combining evidencebased insights with practical experiences,we aspire to contribute to the ongoing discourse on refining treatment paradigms for improved outcomes in patients with CRLM.
文摘Objective: To investigate the effect of preoperative paclitaxel + cisplatin neoadjuvant chemotherapy on the proliferation and invasion of cancer cells in esophageal cancer. Methods: A total of 106 patients with esophageal cancer who underwent radical operation for esophageal cancer in our hospital between September 2014 and March 2017 were divided into the neoadjuvant chemotherapy group (n=54, receiving preoperative paclitaxel + cisplatin neoadjuvant chemotherapy) and the normal group (n=52, receiving no preoperative neoadjuvant chemotherapy) according the therapeutic regimen. The differences in the expression of proliferation genes and invasion genes in the postoperative lesion tissue specimens were compared between the two groups. Results: The proliferation genes MACC1, Nucleostemin, TRAF4 and USP39 mRNA expression in lesion tissue of neoadjuvant chemotherapy group were lower than those in lesion tissue of normal group whereas DEC1, PTPN14, KLF4 and LATS1 mRNA expression were higher than those in lesion tissue of normal group;invasion genes EphA2, MACC1, MMP-9, PFN2, Snail and SphK1 mRNA expression in lesion tissue of neoadjuvant chemotherapy group were lower than those in lesion tissue of normal group whereas PTEN and RACK1 mRNA expression were higher than those in lesion tissue of normal group. Conclusion: The paclitaxel + cisplatin neoadjuvant chemotherapy before esophageal cancer surgery can effectively inhibit the proliferation and invasion activity of esophageal cancer cells.
文摘Objective:To study the effect of preoperative Xiaoaiping combined with TEC neoadjuvant chemotherapy on malignant biological behaviors of breast cancer cells.Methods:The patients with breast cancer who received neoadjuvant chemotherapy in Renshou County People's Hospital between June 2014 and December 2017 were chosen as the research subjects and randomly divided into the combined group who accepted preoperative Xiaoaiping combined with TEC neoadjuvant chemotherapy and the control group who accepted TEC neoadjuvant chemotherapy. After surgical resection, the breast cancer lesion was taken to determine the mRNA expression of proliferation genes and invasion genes as well as the protein levels of angiogenesis molecules.Results: After surgical resection, USP39, CyclinD1, c-myc, Sema4D, CatB, ADAM17 and uPA mRNA expression as well as VEGF, Ang-2 and bFGF protein levels in breast cancer lesions of combined group were significantly lower than those of control group whereas TCEAL17, MFN2, TIMP1 and E-cadherin mRNA expression as well as MMRN2 and PEDF protein levels were significantly higher than those of control group.Conclusion:Xiaoaiping combined with TEC neoadjuvant chemotherapy before breast cancer surgery can be more effective than TEC neoadjuvant chemotherapy alone to inhibit the proliferation, invasion and angiogenesis of cancer cells.
文摘Objective: To investigate the effects of preoperative neoadjuvant chemotherapy on malignant biological characteristics in the lesions of patients with ⅠB-ⅡB cervical cancer. Methods:Patients who were diagnosed with ⅠB-ⅡB cervical cancer and underwent surgical treatment in Navy General Hospital of PLA between February 2015 and May 2017 were selected as the research subjects and randomly divided into the neoadjuvant chemotherapy group who underwent preoperative neoadjuvant chemotherapy and the control group who underwent routine preoperative preparation. After surgical resection, the mRNA expression of tumor suppressor genes, proliferation genes as well as migration and invasion genes in cervical cancer tissue were determined by fluorescence quantitative PCR. Results: After surgical resection, tumor suppressor genes THBS2, PTEN, LAST1 and eIF4E3 mRNA expression in cervical cancer tissue of adjuvant chemotherapy group were significantly higher than those of routine surgery group whereas proliferation genes RUNX2, CyclinD1, ALEX1, ALDH1 and ABCG2 as well as migration and invasion genes CXCL12, CXCR4, MMP9, S100A6 and N-cadherin mRNA expression were significantly lower than those of routine surgery group. Conclusion:Preoperative neoadjuvant chemotherapy can inhibit the proliferation, migration and invasion of cancer cells within the lesions of patients with ⅠB-ⅡB cervical cancer.
文摘Objective:To study the effect of preoperative neoadjuvant chemotherapy on the expression of malignant molecules in colon cancer tissue and the degree of trauma caused by radical operation.Methods: Patients who were diagnosed with colon cancer in Fengrun People's Hospital between March 2014 and February 2017 were selected and randomly divided into the XELOX group who accepted XELOX neoadjuvant chemotherapy combined with radical operation for colon cancer and the control group who accepted radical operation for colon cancer alone. Surgically removed colon cancer tissue was collected to test the expression of proliferation, apoptosis and invasion genes, and serum was collected to detect the contents of liver and kidney function indicators as well as inflammatory factors.Results: Rac1, PLD2, CHD1L, Snail, Vimentin and N-cadherin mRNA expression levels in surgically removed colon cancer lesions of XELOX group were significantly lower than those of control group while MS4A12 and ASPP2 mRNA expression levels were significantly higher than those of control group;serum ALT, AST,β2-MG, Cys-C, sICAM-1, sVCAM-1, sTM and sE-selectin contents were not significantly different between the two groups of patients 1 day and 3 days after surgery.Conclusion: Preoperative neoadjuvant chemotherapy can inhibit the proliferation, apoptosis and invasion gene expression in colon cancer tissues without increasing the trauma of operation.
基金supported by JSPS KAKENHI,grant number 18K16377(KN).
文摘Background:Neoadjuvant/preoperative therapy(NAT)involves the administration of chemotherapy,with or without radiation,prior to surgical resection.This approach is commonly used for locally advanced tumors to reduce tumor volume,improve resectability,and minimize the need for extensive surgical procedures.While NAT has been shown to be effective in inducing local anti-tumor immunity in potentially resectable solid tumors,the underlying molecular mechanisms remain poorly understood.Methods:Cohort samples from pancreatic cancer patients who underwent NAT(n=26)and those who did not(n=20)were analyzed.Changes in the immune microenvironment induced by NAT were assessed using stratified bioinformatic approaches,including heatmap analysis of immunerelated genes selected via Gene Ontology,Gene Set Enrichment Analysis(GSEA)with the immunologic signature database,and Ingenuity Pathway Analysis(IPA).Findings were further validated through immunohistochemical analysis.Results:A comprehensive,stratified evaluation integrating pathological and bioinformatic approaches revealed that NAT induced the upregulation of 212 genes,including DC-SIGN(CD209),and activated 13 immuneassociated pathways,such as T-cell receptor(TCR)signaling.Additionally,NAT promoted an increased shift toward CD8(+)T-cell populations through the upregulation of MAL(T-cell differentiation protein).Immunohistochemical analysis further confirmed a significant accumulation of DC-SIGN(+)dendritic cells and MAL(+)lymphocytes in NAT-treated patients.Conclusions:NAT enhances anti-tumor immunity by promoting CD8(+)T-cell generation through the activation of DC-SIGN(+)dendritic cells and MAL(+)lymphocytes.This study is the first to report an increase in MAL(+)lymphocytes following NAT.Given its potential significance,further investigation in other solid tumors treated with NAT is warranted.
文摘BACKGROUND Hepatocellular carcinoma(HCC)remains a leading cause of cancer-related mortality worldwide.Despite improvements in surgical techniques and systemic therapies,long-term outcomes after liver resection are limited by high recurrence rates.While adjuvant strategies have shown limited benefit,the role of neoadjuvant immunotherapy in resectable HCC is still under investigation.AIM To assess the efficacy,feasibility,and safety of neoadjuvant immunotherapy in resectable HCC through a meta-analysis of current literature.METHODS A systematic search was conducted across PubMed,Web of Science,EMBASE,Cochrane Library,and Scopus for studies published in the past five years evaluating neoadjuvant immunotherapy in resectable HCC.Primary endpoints included major pathological response(MPR),pathological complete response(pCR),overall response rate(ORR),resection rate,and grade 3-4 treatment-related adverse events(TRAEs).A random-effects meta-analysis was conducted using log odds ratios(ORs)and pooled event rates were calculated to provide absolute estimates of clinical endpoints.RESULTS Twelve studies were included in the final analysis.The pooled ORs were 0.28(95%CI:0.19-0.41)for MPR,0.54(95%CI:0.25-1.14)for ORR,0.26(95%CI:0.11-0.66)for pCR,5.37(95%CI:2.70-10.66)for resection rate,and 0.33(95%CI:0.22-0.50)for grade 3-4 TRAEs.Corresponding pooled event rates were 19%for MPR,35%for ORR,22%for pCR,81%for resection feasibility,and 19%for severe TRAEs.CONCLUSION Neoadjuvant immunotherapy appears to be a feasible and safe approach in patients with resectable HCC,achieving moderate pathological responses and high resection rates.
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.
文摘BACKGROUND Rectal cancer management is currently evolving with the advent of different neoadjuvant treatment strategies and organ preservation strategies.A significant proportion of patients could achieve complete clinical response after neoadjuvant treatment,which often translates to pathologic complete response(pCR)as assessed on surgical specimens after curative intent surgery.Endoscopy plays a significant role in assessing treatment response to neoadjuvant therapies.AIM To explore the role of endoscopy in predicting subsequent pCR after neoadjuvant treatment in rectal cancer patients.METHODS An extensive literature review was undertaken to identify the criteria used for assessment of endoscopic response and their ability to predict pCR.RESULTS Fifteen studies were identified through literature review.The most commonly used endoscopic criteria for evaluation included the presence of a flat white scar and the absence of nodularity or telangiectasia.Information on the timing of endoscopic assessment in relation to neoadjuvant treatment protocols were also extracted from the studies.In most studies,the diagnostic accuracy for predicting pCR exceeded 0.8.The main limitations identified were the retrospective design of included studies included and a moderate risk of bias.CONCLUSION Endoscopy can be a key prognostic factor in predicting pCR to neoadjuvant treatment in rectal cancer despite significant limitations in currently available data.
文摘BACKGROUND Neoadjuvant therapy(NAT)for pancreatic cancer(PC)is becoming standardized,with neoadjuvant chemoradiotherapy(NACRT)showing proven effectiveness.However,the optimal endoscopic biliary drainage approach during NAT remains controversial.In this single-center retrospective case series,we report the use of a novel multi-hole self-expandable metallic stent(MH-SEMS)for preoperative biliary drainage during NACRT in patients with PC.AIM To assess the feasibility of endoscopic biliary drainage using MH-SEMS during NACRT in patients with malignant distal biliary obstruction secondary to resectable and borderline resectable PC.METHODS We included 14 patients—10 with resectable,2 with borderline resectable,and 2 with unresectable locally advanced disease—who had undergone surgery after biliary drainage using MH-SEMS(diameter:10 mm).Clinical and technical success was achieved in all patients,with a median interval of 105 days between stent placement and surgery.RESULTS A partial response was observed in five patients(35.7%),whereas nine patients(64.3%)exhibited stable disease.Only one patient(7.1%)developed moderate cholangitis from recurrent biliary obstruction caused by sludge 337 days after stent placement during systemic chemotherapy,requiring MH-SEMS replacement.Pathological examination of postoperative specimens revealed tumor shrinkage in many cases,and no stent migration was observed.Adverse events included mild pancreatitis in two patients(14.3%)and moderate pancreatitis in one patient(7.1%),as defined by the Tokyo Criteria 2024.CONCLUSION No cases of cholecystitis,liver abscess,or hemorrhage were reported.No disadvantages in surgical procedures or postoperative complications related to MH-SEMS placement were observed.
文摘BACKGROUND Neutrophil extracellular traps(NETs)are associated with an immunosuppressive tumor microenvironment and may influence the efficacy of immune-based therapies.However,their role in neoadjuvant chemotherapy combined with immunotherapy(NACI)for locally advanced gastric cancer(LAGC)remains unclear.AIM To investigate the prognostic and predictive value of NET density in LAGC patients undergoing NACI.METHODS We enrolled 31 LAGC patients treated with NACI.NET density was assessed through dual immunofluorescence staining of citrullinated histone H3 and myeloperoxidase in pretreatment biopsy and post-treatment surgical specimens.Patients were stratified into high and low pre-NACI NET groups based on median NET density.Pathological complete response(pCR)and overall response rates were evaluated in relation to NET density.Logistic regression analyses were performed to identify independent predictors of treatment outcomes.Dynamic changes in NET density during NACI were also analyzed.RESULTS Patients with low pre-NACI NET density demonstrated significantly higher rates of pCR(40%vs 6%,P=0.037)and overall response(53%vs 12%,P=0.023)compared to those with high NET density.Low pre-NACI NET density and higher programmed death protein ligand 1 expression were identified as independent protective factors for achieving pCR and better response rates.NACI increased NET density;however,this increase was primarily observed in non-pCR and nonresponder groups.Patients in the pCR and responder groups showed stable NET density before and after treatment.Higher post-NACI NET density was associated with poorer respond to NACI.High post-NACI NET density was associated with increased infiltration of immunosuppressive FOXP3+T regulatory cells(P=0.025)and CD68+macrophages(P=0.038).CONCLUSION Pre-NACI NET density serves as a prognostic and predictive biomarker for NACI efficacy in LAGC patients.Low pretreatment NET density is associated with favorable outcomes,while increased post-treatment NET density correlates with poorer response.Targeting NET formation may represent a novel therapeutic strategy to enhance NACI efficacy in LAGC.
基金supported by Ministry of Research and Technology/National Research and Innovation Agency Program scheme PDP(Research for Beginner Lecturers)2021(No.B/112/E3/RA.00/2021).
文摘Objective:The use of technology is growing rapidly.It can also be used in nursing interventions.A technology pack can support nursing interventions.An application called guided imagery in Indonesian(GIANESIA)has been developed to reduce anxiety in preoperative patients.Methods:A total of 42 participants joined this research.The respondents were those who would undergo surgery.We used the numeric visual analog anxiety scale(NVAAS)as the instrument to measure their anxiety levels.The participants were first given informed consent.Then,they open the application that has been installed.The process begins with participants choosing their initial anxiety score.Later,they start the therapy session,and immediately after finishing it,a pop-up bar prompts them to enter their final,posttherapy anxiety score.Results:This study shows the effectiveness of therapy given by GIANESIA in reducing anxiety in preoperative patients with p-value=0.000(a<0.05).Also,61.9%of the participants had decreased anxiety levels after therapy with GIANESIA.Conclusions:This study proves that providing therapy via a mobile application is effective in easing uncomfortable feelings,especially anxiety,in preoperative patients.Moving forward,the app can and should be expanded with new features and further developmental goals.
文摘Objective:To evaluate nurses’levels of knowledge and practice regarding preoperative hair removal and prevention of surgical site infection(SSI).Methods:The descriptive and cross-sectional research was conducted between February 2023 and May 2023 in a public hospital in northern Turkey with 123 nurses who agreed to participate in the study.Results:The results showed that 64.2%of the nurses thought that preoperative hair removal should be done by shaving with a razor,74%thought that hair removal should be performed the night before the operation,and 70.7%thought that the patient/patient’s relative should perform preoperative hair removal.Conclusions:This study found that nurses’levels of knowledge and practice regarding preoperative hair removal and prevention of SSI were not at the desired level.Following current resources and improving their levels of knowledge and practices are considered to be important for nurses.
基金Supported by Qinghai Provincial Science and Technology Plan,No.2023-ZJ-787.
文摘BACKGROUND Gastric cancer(GC)remains a major global health burden,particularly in East Asia,due to its high incidence,aggressive progression,and poor prognosis in advanced stages.Although surgery is the mainstay of curative treatment,outcomes for locally advanced cases remain unsatisfactory despite perioperative chemotherapy.In recent years,immune checkpoint inhibitors,especially anti-PD-1 antibodies like sintilimab,have shown promise in improving survival when combined with chemotherapy.However,the comparative efficacy and safety of SOX plus sintilimab vs established regimens such as P-SOX and SOX alone in the neoadjuvant setting have not been fully explored.AIM To compare the efficacy and safety of three neoadjuvant chemotherapy regimens—SOX combined with sintilimab(SOX+PD-1),albumin-bound paclitaxel plus oxaliplatin and S-1(P-SOX),and SOX—in patients with advanced GC.METHODS A retrospective analysis was conducted on 299 patients with advanced GC who received both neoadjuvant and adjuvant chemotherapy along with standard D2 radical gastrectomy.Among them,81 patients received SOX plus sintilimab,118 received the P-SOX regimen,and 100 received the SOX regimen.All patients were randomly assigned to training(70%)or validation(30%)cohorts using the R software sample function.Short-term efficacy,long-term survival outcomes,and adverse events were assessed across the three groups.Additionally,clinical factors associated with progression-free survival(PFS)were further investigated.RESULTS In terms of short-term efficacy,the SOX+sintilimab group had higher objective response rates[91.4%and 70.4%according to the tumor regression grade(TRG)and Response Evaluation Criteria in Solid Tumors(RECIST)1.1 criteria,respectively]than did the P-SOX(88.1%and 59.3%)and SOX groups(84.0%and 55.0%),although the intergroup differences were not statistically significant(P=0.167).For long-term outcomes,the SOX+sintilimab group demonstrated significantly better OS rates at 1 year(98.8%),18 months(92.6%),2 years(84.0%),and 3 years(48.1%)than did the P-SOX(93.2%,86.4%,71.2%,30.5%)and SOX(91.0%,84.0%,72.0%,29.0%)groups,with the 3-year overall survival(OS)difference being statistically significant(P=0.007).Similarly,PFS rates in the SOX+sintilimab group(1 year:92.6%;18 months:77.8%;2 years:65.4%;3 years:35.8%)were significantly greater than those in the P-SOX(82.2%,68.6%,53.4%,26.3%)and SOX(77.0%,66.0%,43.0%,27.0%)groups,with significant differences at 1 year(P=0.021)and 2 years(P=0.011).In terms of safety,grade 1-2 gastrointestinal reactions,peripheral neuropathy,and alopecia were the main TRAEs across groups.The P-SOX group had a significantly greater incidence of alopecia(54.2%vs 53.0%vs 23.5%,P=0.009)and more cases of grade 2 alopecia(6.8%vs 1.2%),potentially due to the accumulation of triple-agent toxicity.No significant intergroup differences were observed in hematologic toxicity or liver dysfunction(all P>0.05).CONCLUSION Compared with the SOX and P-SOX regimens,the SOX plus sintilimab combination demonstrated significantly improved short-and long-term efficacy with favorable safety,with superior advantages in terms of 2-and 3-year OS and early PFS,suggesting that this combination is a more promising therapeutic option for patients with advanced GC.Patients who achieved good perioperative chemotherapy responses(meeting the TRG and RECIST 1.1 criteria)and had tumor diameters≤2 cm,well-differentiated histology,earlier cTNM stages,and no lymph node metastasis had a better prognosis.
基金supported by Wu Jieping Medical Foundation(320.6750.2022-19-40 and 320.6750.2024-18-41)Guangxi University Young and Middle-Aged Teachers Research Basic Ability Improvement Project(2024KY0510)Guangxi Health Commission Self-Funded Research Project(Z-C20231002).
文摘Background:Neoadjuvant chemotherapy(NAC)significantly enhances clinical outcomes in patients with triple-negative breast cancer(TNBC);however,chemoresistance frequently results in treatment failure.Consequently,understanding the mechanisms underlying resistance and accurately predicting this phenomenon are crucial for improving treatment efficacy.Methods:Ultrasound images from 62 patients,taken before and after neoadjuvant therapy,were collected.Mitochondrial-related genes were extracted from a public database.Ultrasound features associated with NAC resistance were identified and correlated with significant mitochondrial-related genes.Subsequently,a prognostic model was developed and evaluated using the GSE58812 dataset.We also assessed this model alongside clinical factors and its ability to predict immunotherapy response.Results:A total of 32 significant differentially expressed genes in TNBC across three groups indicated a strong correlation with ultrasound features.Univariate and multivariate Cox regression analyses identified six genes as independent risk factors for TNBC prognosis.Based on these six mitochondrial-related genes,we constructed a TNBC prognostic model.The model’s risk scores indicated that high-risk patients generally have a poorer prognosis compared to low-risk patients,with the model demonstrating high predictive performance(p=0.002,AUC=0.745).This conclusion was further supported in the test set(p=0.026,AUC=0.718).Additionally,we found that high-risk patients exhibited more advanced tumor characteristics,while low-risk patients were more sensitive to common chemotherapy drugs and immunotherapy.The signature-related genes also predicted immunotherapy response with a high accuracy of 0.765.Conclusion:We identified resistance-related features from ultrasound images and integrated them with genomic data,enabling effective risk stratification of patients and prediction of the efficacy of neoadjuvant chemotherapy and immunotherapy in patients with TNBC.
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.
