BACKGROUND Chemotherapy and radiotherapy followed by durvalumab is currently the standard treatment for locally advanced node-positive non-small-cell lung cancer(NSCLC).We describe the case of a patient with locally a...BACKGROUND Chemotherapy and radiotherapy followed by durvalumab is currently the standard treatment for locally advanced node-positive non-small-cell lung cancer(NSCLC).We describe the case of a patient with locally advanced node-positive NSCLC(LA-NSCLC)treated in a phase II prospective protocol with chemotherapy,accelerated hypofractionated radiotherapy(AHRT)and surgery in the preimmunotherapy era.CASE SUMMARY A 69-year-old male,ex-smoker(20 PY),with a Karnofsky performance status of 90,was diagnosed with locally advanced squamous cell lung carcinoma.He was staged by total body computed tomography(CT)scanning,and integrated 18Ffluorodeoxyglucose positron emission tomography/CT scan[cT4 cN3 cM0,stage IIIC according to TNM(tumor-node-metastasis)8th edition]and received AHRT between chemotherapy cycles,in accordance with the study protocol(EudractCT registration 2008-006525-14).At the end of the study the patient underwent surgery,which was not part of the protocol,and showed a complete pathological response.CONCLUSION This case report confirms that AHRT can be used successfully to treat primary LA-NSCLC with bilateral mediastinal lymph node involvement.Our case is of particular interest because of the pathological response after AHRT and the lack of surgical complications.We hypothesize that this radiotherapeutic approach,with its proven efficacy,could be delivered as a short course reducing treatment costs,increasing patient compliance and reducing toxicity.We are currently investigating the possibility of combining hypofractionation,chemotherapy and immunotherapy for patients with LA-NSCLC.展开更多
BACKGROUND Neoadjuvant treatment(NT)with chemotherapy(Ch)is a standard option for resectable stage III(N2)NSCLC.Several studies have suggested benefits with the addition of radiotherapy(RT)to NT Ch.The International A...BACKGROUND Neoadjuvant treatment(NT)with chemotherapy(Ch)is a standard option for resectable stage III(N2)NSCLC.Several studies have suggested benefits with the addition of radiotherapy(RT)to NT Ch.The International Association for the Study of Lung Cancer(IASLC)published recommendations for the pathological response(PHR)of NSCLC resection specimens after NT.AIM To contribute to the IASLC recommendations showing our results of PHR to NT Ch vs NT chemoradiotherapy(ChRT).METHODS We analyzed 67 consecutive patients with resectable stage III NSCLC with positive mediastinal nodes treated with surgery after NT Ch or NT ChRT between 2013 and 2020.After NT,all patients were evaluated for radiological response(RR)according to Response Evaluation Criteria in Solid Tumours criteria and evaluated for surgery by a specialized group of thoracic surgeons.All histological samples were examined by the same two pathologists.PHR was evaluated by the percentage of viable cells in the tumor and the resected lymph nodes.RESULTS Forty patients underwent NT ChRT and 27 NT Ch.Fifty-six(83.6%)patients underwent surgery(35 ChRT and 21 Ch).The median time from ChRT to surgery was 6 wk(3-19)and 8 wk(3-21)for Ch patients.We observed significant differences in RR,with disease progression in 2.5%and 14.8%of patients with ChRT and Ch,respectively,and partial response in 62.5%ChRT vs 29.6%Ch(P=0.025).In PHR we observed≤10%viable cells in the tumor in 19(54.4%)and 2 cases(9.5%),and in the resected lymph nodes(RLN)30(85.7%)and 7(33.3%)in ChRT and Ch,respectively(P=0.001).Downstaging was greater in the ChRT compared to the Ch group(80%vs 33.3%;P=0.002).In the univariate analysis,NT ChRT had a significant impact on partial RR[odds ratio(OR)12.5;95%confidence interval(CI):1.21-128.61;P=0.034],a decreased risk of persistence of cancer cells in the tumor and RLN and an 87.5%increased probability for achieving downstaging(OR 8;95%CI:2.34-27.32;P=0.001).CONCLUSION We found significant benefits in RR and PHR by adding RT to Ch as NT.A longer follow-up is necessary to assess the impact on clinical outcomes.展开更多
BACKGROUND Gastric cancer is a malignant tumor with high morbidity and mortality worldwide.Neoadjuvant chemotherapy(NAC),defined as chemotherapy administered before the primary treatment(usually surgery)to reduce tumo...BACKGROUND Gastric cancer is a malignant tumor with high morbidity and mortality worldwide.Neoadjuvant chemotherapy(NAC),defined as chemotherapy administered before the primary treatment(usually surgery)to reduce tumor size and control micrometastases,has emerged as a crucial therapeutic strategy for locally advanced gastric cancer.Pathological complete response(pCR),characterized by the absence of viable tumor cells in the resected specimen after neoadjuvant treatment,is recognized as a strong predictor of favorable prognosis.However,the factors influencing the achievement of pCR remain incompletely understood.AIM To identify and analyze the predictive factors associated with achieving pCR after NAC in gastric cancer patients,thereby providing evidence-based guidance for clinical decision-making.METHODS A retrospective analysis was performed on 215 patients from Shandong Cancer Hospital and Tai’an Central Hospital with locally advanced gastric cancer who underwent NAC followed by radical surgery at our hospital between January 2015 and December 2023.Comprehensive clinical and pathological data were collected,including age,gender,tumor location,Lauren classification,clinical staging,chemotherapy regimens,number of chemotherapy cycles,and baseline hematological indicators.The baseline hematological indicators included neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio,albumin level,carcinoembryonic antigen(CEA),and carbohydrate antigen 19-9.Univariate and multivariate logistic regression analyses were employed to determine the independent predictive factors for pCR.RESULTS Among 215 gastric cancer patients,41(19.1%)achieved pCR after NAC.Multivariate analysis identified five independent predictive factors for pCR:Lauren intestinal type[odds ratio(OR)=3.28],lower clinical T stage(OR=2.75),CEA decrease≥70%after NAC(OR=3.42),pre-treatment NLR<2.5(OR=2.13),and≥4 chemotherapy cycles(OR=2.87).The fluorouracil,leucovorin,oxaliplatin,docetaxel regimen achieved the highest pCR rate(27.5%),and oxaliplatin-containing regimens were superior to cisplatin-containing regimens(22.3%vs 12.7%,P=0.034).Patients with both low NLR and platelet-to-lymphocyte ratio had the highest pCR rate(33.8%),while those with both high inflammatory markers had the lowest rate(10.7%).Earlier clinical stage disease(cT3N+vs cT4N+:28.6%vs 13.0%)and lower lymph node burden were associated with higher pCR rates.CONCLUSION The achievement of pCR after NAC in gastric cancer patients is closely associated with Lauren intestinal type,lower clinical T stage,a significant decrease in CEA after chemotherapy,low pre-treatment NLR,and an adequate number of chemotherapy cycles.展开更多
BACKGROUND 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 Colorectal cancer is currently the third most common malignant tumor and the second leading cause of cancer-related death worldwide.Neoadjuvant chemoradiotherapy(nCRT)is standard for locally advanced rectal...BACKGROUND Colorectal cancer is currently the third most common malignant tumor and the second leading cause of cancer-related death worldwide.Neoadjuvant chemoradiotherapy(nCRT)is standard for locally advanced rectal cancer(LARC).Except for pathological examination after resection,it is not known exactly whether LARC patients have achieved pathological complete response(pCR)before surgery.To date,there are no clear clinical indicators that can predict the efficacy of nCRT and patient outcomes.AIM To investigate the indicators that can predict pCR and long-term outcomes following nCRT in patients with LARC.METHODS Clinical data of 128 LARC patients admitted to our hospital between September 2013 and November 2022 were retrospectively analyzed.Patients were categorized into pCR and non-pCR groups.Univariate analysis(using the χ^(2) test or Fisher’s exact test)and logistic multivariate regression analysis were used to study clinical predictors affecting pCR.The 5-year disease-free survival(DFS)and overall survival(OS)rates were calculated using Kaplan-Meier analysis,and differences in survival curves were assessed with the log-rank test.RESULTS Univariate analysis showed that pretreatment carcinoembryonic antigen(CEA)level,lymphocyte-monocyte ratio(LMR),time interval between neoadjuvant therapy completion and total mesorectal excision,and tumor size were correlated with pCR.Multivariate results showed that CEA≤5 ng/mL(P=0.039),LMR>2.73(P=0.023),and time interval>10 wk(P=0.039)were independent predictors for pCR.Survival analysis demonstrated that patients in the pCR group had significantly higher 5-year DFS rates(94.7%vs 59.7%,P=0.002)and 5-year OS rates(95.8%vs 80.1%,P=0.019)compared to the non-pCR group.Tumor deposits(TDs)were significantly correlated with shorter DFS(P=0.002)and OS(P<0.001).CONCLUSION Pretreatment CEA,LMR,and time interval contribute to predicting nCRT efficacy in LARC patients.Achieving pCR demonstrates longer DFS and OS.TDs correlate with poor prognosis.展开更多
BACKGROUND Breast cancer ranks as one of the most prevalent malignant tumors among women,significantly endangering their health and lives.While radical surgery has been a pivotal method for halting disease progression...BACKGROUND Breast cancer ranks as one of the most prevalent malignant tumors among women,significantly endangering their health and lives.While radical surgery has been a pivotal method for halting disease progression,it alone is insufficient for enhancing the quality of life for patients.AIM To investigate the correlation between ultrasound characteristic parameters of breast cancer lesions and clinical efficacy in patients undergoing neoadjuvant chemotherapy(NAC).METHODS Employing a case-control study design,this research involved 178 breast cancer patients treated with NAC at our hospital from July 2019 to June 2022.According to the Miller-Payne grading system,the pathological response,i.e.efficacy,of the NAC in the initial breast lesion after NAC was evaluated.Of these,59 patients achieved a pathological complete response(PCR),while 119 did not(non-PCR group).Ultrasound characteristics prior to NAC were compared between these groups,and the association of various factors with NAC efficacy was analyzed using univariate and multivariate approaches.RESULTS In the PCR group,the incidence of posterior echo attenuation,lesion diameter≥2.0 cm,and Alder blood flow grade≥II were significantly lower compared to the non-PCR group(P<0.05).The area under the curve values for predicting NAC efficacy using posterior echo attenuation,lesion diameter,and Alder grade were 0.604,0.603,and 0.583,respectively.Also,rates of pathological stage II,lymph node metastasis,vascular invasion,and positive Ki-67 expression were significantly lower in the PCR group(P<0.05).Logistic regression analysis identified posterior echo attenuation,lesion diameter≥2.0 cm,Alder blood flow grade≥II,pathological stage III,vascular invasion,and positive Ki-67 expression as independent predictors of poor response to NAC in breast cancer patients(P<0.05).CONCLUSION While ultrasound characteristics such as posterior echo attenuation,lesion diameter≥2.0 cm,and Alder blood flow grade≥II exhibit limited predictive value for NAC efficacy,they are significantly associated with poor response to NAC in breast cancer patients.展开更多
Rectal cancer poses a major global health challenge,with neoadjuvant chemoradiotherapy improving outcomes in locally advanced cases by reducing tumor burden and recurrence risk.However,response variability,including o...Rectal cancer poses a major global health challenge,with neoadjuvant chemoradiotherapy improving outcomes in locally advanced cases by reducing tumor burden and recurrence risk.However,response variability,including only 15%-20%of patients achieving pathological complete response,underscores the urgent need for accurate predictive tools.This review explored current and emerging biomarkers to enhance neoadjuvant chemoradiotherapy response prediction and inform clinical practice.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 The potential of exercise as a concurrent therapy for actively treated primary tumors has been suggested by emerging preclinical and observational studies.However,clinical trials regarding this question are...Background The potential of exercise as a concurrent therapy for actively treated primary tumors has been suggested by emerging preclinical and observational studies.However,clinical trials regarding this question are scarce.Therefore,we conducted a randomized controlled trial investigating the effects of aerobic or resistance exercise concomitant to neoadjuvant chemotherapy(NACT)on tumor size.Methods In the BENEFIT study(German title:Bewegung bei neoadjuvanter chemotherapie zur verbesserung der fitness),patients with breast cancer scheduled for NACT were randomly assigned to supervised resistance training(RT,n=60)or aerobic training(AT,n=60)twice weekly during NACT or to a waitlist control group(WCG,n=60).The primary outcome,“change in tumor size”,as well as the secondary clinical outcomes pathologic complete response(pCR),type of surgery(breast conserving/mastectomy),axillary lymph node dissection(ALND,yes/no),premature discontinuation of chemotherapy(yes/no),and relative dose intensity(RDI)were derived from clinical records.Due to the highly skewed distribution,the primary outcome was categorized.Multiple(ordinal)logistic regression analyses were performed.Results Overall,there was no significant difference in post-intervention tumor size between RT or AT and WCG.However,there was a significant effect modification by hormone receptor(HR)status(P_(interaction)=0.030).Among patients with HR+tumors,results suggest a beneficial effect of AT on tumor shrinkage(odds ratio(OR)=2.37,95%confidence interval(95%CI):0.97‒5.78),on pCR(OR=3.21,95%CI:0.97‒10.61);and on ALND(OR=3.76,95%CI:0.78‒18.06)compared to WCG.The effects of RT were slightly less pronounced.For HR−subtypes,beneficial effects on RDI were found for AT(OR=3.71,95%CI:1.20‒11.50)and similarly for RT(OR=2.58,95%CI:0.88‒7.59).Both AT and RT had favorable effects on premature discontinuation of chemotherapy(OR(no vs.yes)=2.34,95%CI:1.10‒5.06),irrespective of tumor receptor status.Conclusion While there was no significant effect on the primary outcome in the overall group,aerobic and resistance exercise concomitant to NACT seem to beneficially affect tumor shrinkage and pCR,reduce the need for ALND among patients with HR+breast cancers,and prevent low RDI among patients with HR–breast cancers.These results warrant confirmation in further trials.展开更多
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:Pathological complete response(pCR)of axillary lymph nodes(ALNs)is frequently achieved in patients with clinically node-positive breast cancer after neoadjuvant chemotherapy(NAC),and ALN status is an import...Background:Pathological complete response(pCR)of axillary lymph nodes(ALNs)is frequently achieved in patients with clinically node-positive breast cancer after neoadjuvant chemotherapy(NAC),and ALN status is an important prognostic factor for breast cancer patients.This study aims to develop a new predictive clinical model to assess the ALN pCR rate after NAC.Methods:This was a retrospective series of 467 patients who had biopsy-proven positive ALNs at diagnosis and underwent ALN dissection from 2007 to 2014 at the National Cancer Center/Cancer Hospital of the Chinese Academy of Medical Sciences.We analyzed the clinicopathologic features of the patients and developed a nomogram to predict the probability of ALN pCR.A multivariable logistic regression stepwise model was used to construct a nomogram to predict ALN pCR in node-positive patients.The adjusted area under the receiver operating characteristic curve(AUC)was calculated to quantify the ability to rank patients by risk.Internal validation was performed using the 50/50 hold-out validation method.The nomogram was externally validated with prospective cohorts of 167 patients from 2016 to 2018 at the Cancer Hospital of the Chinese Academy of Medical Sciences and 114 patients from 2018 to 2020 at Beijing Tiantan Hospital.Results:In this retrospective study,115(24.6%)patients achieved ALN pCR after NAC.Multivariate analysis showed that clinical tumor stage(Odds ratio[OR]:0.321,95%confidence interval[CI]:0.121-0.856;P=0.023);primary tumor response(OR:0.189;95%CI:0.123-0.292;P<0.001),and estrogen receptor status(OR:0.530,95%CI:0.304-0.925;P=0.025)were independent predictors of ALN pCR.The nomogram was constructed based on the result of multivariate analysis.In the internal validation of performance of nomogram,the AUCs for the training and test sets were 0.719 and 0.753,respectively.The nomogram was validated in external cohorts with AUCs of 0.720,which demonstrated good discriminatory power in these data sets.Conclusion:We developed a nomogram to predict the likelihood of axillary pCR in node-positive breast cancer patients after NAC.The predictive model performed well in multicenter prospective external validation.This practical tool could provide information to surgeons regarding whether to perform additional ALN dissection after NAC.Trial registration:ChiCTR.org.cn,ChiCTR1800014968.展开更多
Background:To study the influence of pathological responses(PR)after transcatheter arterial chemoembolization(TACE)on incidences of microvascular invasion(MVI)and early recurrence in hepatocellular carcinoma(HCC)patie...Background:To study the influence of pathological responses(PR)after transcatheter arterial chemoembolization(TACE)on incidences of microvascular invasion(MVI)and early recurrence in hepatocellular carcinoma(HCC)patients.Methods:Between 2013 to 2015,consecutive HCC patients who underwent liver resection with“curative”intent at three hospitals were enrolled in this study.Patients with different areas of PR after preoperative TACE were compared with those without preoperative TACE on the incidences of MVI,early recurrence rates and patterns of recurrence before and after propensity score matching(PSM).Results:Of 1,970 patients,737 patients who received preoperative TACE were divided into three groups according to the areas of PR:≥90%(n=226),60-90%(n=447),and<60%(n=64).PR≥90%was an independent protective factor of incidences of MVI[odds ratio(OR),0.144;95%confidence interval(CI),0.082-0.245,P<0.001)and early recurrence(HR,0.742;95%CI,0.561-0.963,P=0.032);while PR<60%was an independent risk factor of incidences of MVI(OR,6.076;95%CI,3.004-11.728,P<0.001)and early recurrence(HR,1.428;95%CI,1.095-1.929;P=0.009).Furthermore,patients with PR<60%were significantly more likely to develop multiple intrahepatic recurrences involving multiple hepatic segments when compared with patients without preoperative TACE.Conclusions:This study indicated the area of PR after TACE was closely associated with the incidences of MVI and early tumor recurrence.Patients with PR<60%were at significantly higher risks of having more MVI,early and multiple tumor recurrences.展开更多
BACKGROUND For primary liver cancer,the key to conversion therapy depends on the effectiveness of drug treatment.Patient-derived tumor organoids have been demonstrated to improve the efficacy of conversion therapy by ...BACKGROUND For primary liver cancer,the key to conversion therapy depends on the effectiveness of drug treatment.Patient-derived tumor organoids have been demonstrated to improve the efficacy of conversion therapy by identifying individualtargeted effective drugs,but their clinical effects in liver cancer remain unknown.CASE SUMMARY We described a patient with hepatocellular carcinoma(HCC)who achieved pathologic complete response(pCR)to conversion therapy guided by the patientderived organoid(PDO)drug sensitivity testing.Despite insufficiency of the remaining liver volume after hepatectomy,the patient obtained tumor reduction after treatment with the PDO-sensitive drugs and successfully underwent radical surgical resection.Postoperatively,pCR was observed.CONCLUSION PDOs contributes to screening sensitive drugs for HCC patients to realize the personalized treatment and improve the conversion therapy efficacy.展开更多
BACKGROUND Survival benefit of neoadjuvant chemotherapy(NAC)for advanced gastric cancer(AGC)is a debatable issue.Studies have shown that the survival benefit of NAC is dependent on the pathological response to chemoth...BACKGROUND Survival benefit of neoadjuvant chemotherapy(NAC)for advanced gastric cancer(AGC)is a debatable issue.Studies have shown that the survival benefit of NAC is dependent on the pathological response to chemotherapy drugs.For those who achieve pathological complete response(pCR),NAC significantly prolonged prolapsed-free survival and overall survival.For those with poor response,NAC yielded no survival benefit,only toxicity and increased risk for tumor progression during chemotherapy,which may hinder surgical resection.Thus,predicting pCR to NAC is of great clinical significance and can help achieve individualized treatment in AGC patients.AIM To establish a nomogram for predicting pCR to NAC for AGC patients.METHODS Two-hundred and eight patients diagnosed with AGC who received NAC followed by resection surgery from March 2012 to July 2019 were enrolled in this study.Their clinical data were retrospectively analyzed by logistic regression analysis to determine the possible predictors for pCR.Based on these predictors,a nomogram model was developed and internally validated using the bootstrap method.RESULTS pCR was confirmed in 27 patients(27/208,13.0%).Multivariate logistic regression analysis showed that higher carcinoembryonic antigen level,lymphocyte ratio,lower monocyte count and tumor differentiation grade were associated with higher pCR.Concordance statistic of the established nomogram was 0.767.CONCLUSION A nomogram predicting pCR to NAC was established.Since this nomogram exhibited satisfactory predictive power despite utilizing easily available pretreatment parameters,it can be inferred that this nomogram is practical for the development of personalized treatment strategy for AGC patients.展开更多
Anthracycline-Taxane chemotherapy is widely used in neoadjuvant treatment for breast cancers. However, there is limited data reported in patients with triple negative breast cancer （TNBC）. Here, we evaluated the pat...Anthracycline-Taxane chemotherapy is widely used in neoadjuvant treatment for breast cancers. However, there is limited data reported in patients with triple negative breast cancer （TNBC）. Here, we evaluated the pathologic responses and survival of neoadjuvant epirubicin and taxanes chemotherapy in patients with locally advanced TNBC to provide some useful information for clinical practice. A total of 43 patients with locally advanced TNBC were enrolled in this study. Patients were administered with epirubicin 75 mg/m^2 plus paclitaxel 175 mg/m^2 or docetaxel 75 mg/m^2 every 3 weeks for at least 2 cycles. The primary endpoint was pathologic complete response （pCR）, which was defined as no residual invasive cancer, or only carcinoma in situ in both the excised breast and axillary lymph node, while relapse-free survival （RFS） and overall survival （OS） were secondary endpoints. Thirty-nine （90.7%） patients were at clinical stages II B-IIIC. Thirty-seven （86%） completed 4-6 cycles of preop- erative chemotherapy, and objective response rate （ORR） was 81.4% （35/43）. Forty-two patients un- derwent radical surgery subsequently. The pCR rate was 14.3% （6/42）. The most common adverse events in neoadjuvant chemotherapy were nausea/vomiting （88.4%, 38/43） and neutropenia （88.4%）. After a median follow-up period of 34.0 months, 3-year RFS and OS rate was 53.6% and 80.1%, respectively. All events of recurrence and death occurred in non-pCR patients, in whom the 3-year RFS and OS rates were 44.3% and 76.6%, respectively. This study suggest that neoadjuvant chemotherapy with epirubicin plus taxanes has a relatively low pCR rate and high early recurrence risk in locally ad- vanced TNBC, which indicates the necessity for more efficacious treatment. Further study is needed to validate these results.展开更多
BACKGROUND The pathological complete response(ypCR)rate following neoadjuvant chemotherapy for advanced gastric cancer remains low and lacks a universally accepted treatment protocol.Immunotherapy has achieved breakth...BACKGROUND The pathological complete response(ypCR)rate following neoadjuvant chemotherapy for advanced gastric cancer remains low and lacks a universally accepted treatment protocol.Immunotherapy has achieved breakthrough progress.CASE SUMMARY We report two female patients with gastric cancer defined as clinical stage cT4N1-2M0.Detection of mismatch repair protein showed mismatch repair function defect,and perioperative treatment with programmed death protein 1 inhibitor combined with S-1+oxaliplatin achieved ypCR.Surprisingly,the patients underwent clinical observation after surgery but developed different degrees of metastasis at~6 mo after surgery.CONCLUSION PD-1 inhibitor combined with chemotherapy provides a more strategic choice for comprehensive perioperative treatment of gastric cancer.展开更多
Background:Non-small cell lung cancer(NSCLC)is the cancer with the highest incidence and mortality rate worldwide.This study aimed to investigate the predictive value of clinicopathological and radiological characteri...Background:Non-small cell lung cancer(NSCLC)is the cancer with the highest incidence and mortality rate worldwide.This study aimed to investigate the predictive value of clinicopathological and radiological characteristics for event-free survival(EFS),major pathological response(MPR),and pathological complete response(pCR)in patients with NSCLC undergoing neoadjuvant chemoimmunotherapy.Methods:A retrospective analysis was performed on the clinical data of 180 patients with NSCLC who received neoadjuvant chemoimmunotherapy between October 2019 and December 2023.The primary endpoint was EFS,and the secondary endpoint was the pathological response rate.Fisher exact test and the nonparametricMann-Whitney U test were used to compare categorical and continuous data between the pCR/MPR and non-pCR/non-MPR groups.The Kaplan-Meier method was used to estimate EFS curves,and Cox regression analysis was performed to compare the differences in EFS between patients with or without pCR or MPR.Results:Sex(p=0.004),smoking history(p=0.025),and clinical stage(p=0.002)were identified as predictors of pCR and MPR.In our study,pCR was observed in 38.12%and MPR in 44.75%of the patients.Through the multivariate logistic regression model,age and pathological response were found to predict the 1-and 2-year EFS rates,demonstrating satisfactory predictive power(area under the curve,0.866 and 0.736,respectively).Patients with pCR or MPR exhibited longer EFS compared with those without pCR or MPR,as determined by Cox analysis.Conclusions:Sex,smoking history,and clinical stage were identified as predictors of pCR and MPR in patients with NSCLC.Survival analysis revealed that age and pathological response were key prognostic factors for EFS.展开更多
AIM To analyze the homogeneity of pathologic response to preoperative chemotherapy(PRPC) after chemotherapy in patients with multiple liver metastases(LM).METHODS From September 2011 to August 2014,patients with at le...AIM To analyze the homogeneity of pathologic response to preoperative chemotherapy(PRPC) after chemotherapy in patients with multiple liver metastases(LM).METHODS From September 2011 to August 2014,patients with at least two LM undergoing preoperative chemotherapy prior to resection were included in this retrospective,single-center study. The endpoints were PRPC homogeneity(according to both the Rubbia-Brandt and MD Anderson classifications),the impact of PRPC on the MDT decision,factors associated with homogeneous PRPC and overall survival of patients with vs. without homogeneous PRPC.RESULTS seventy-three patients with a total of 88 liver resections(including 15 two-stage procedures) were included in the study. The homogeneous PRPC rate was 55% according to the Rubbia-Brandt classification and 53% according to the MD Anderson classification. The MDT decision was modified by the PRPC in only 2.7% of patients(n = 2). CONCLUSION The PRPC was homogeneous in only one half of patients and had very little influence on the MDT decision.展开更多
Background:Transarterial chemoembolization(TACE)based neoadjuvant therapy was proven effective in hepatocellular carcinoma(HCC).Recently,tyrosine kinase inhibitors(TKIs)and immune checkpoint inhibitors(ICIs)also showe...Background:Transarterial chemoembolization(TACE)based neoadjuvant therapy was proven effective in hepatocellular carcinoma(HCC).Recently,tyrosine kinase inhibitors(TKIs)and immune checkpoint inhibitors(ICIs)also showed promise in HCC treatment.However,the prognostic benefits associated with these treatments remain uncertain.This study aimed to explore the relationship between pathologic response and prognostic features in HCC patients who received neoadjuvant therapy.Methods:HCC patients who received TACE either with or without TKIs/ICIs as neoadjuvant therapy before liver resection were retrospectively collected from the First Affiliated Hospital,Zhejiang University School of Medicine in China.Pathologic response was determined by calculating the proportion of non-viable area within the tumor.Major pathologic response(MPR)was defined as the presence of non-viable tumor cells reaching a minimum of 90%.Complete pathologic response(CPR)was characterized by the absence of viable cells observed in the tumor.Results:A total of 481 patients meeting the inclusion criteria were enrolled,with 76 patients(15.8%)achieving CPR and 179(37.2%)reaching MPR.The median recurrence-free survival(m RFS)in the CPR+MPR group was significantly higher than the non-MPR group(31.3 vs.25.1 months).The difference in 3-year overall survival(OS)rate was not significant.Multivariate Cox regression analysis identified failure to achieve MPR(hazard ratio=1.548,95%confidence interval:1.122–2.134;P=0.008),HBs Ag positivity(HR=1.818,95%CI:1.062–3.115,P=0.030),multiple lesions(HR=2.278,95%CI:1.621–3.195,P<0.001),and baseline tumor size>5 cm(HR=1.712,95%CI:1.031–2.849,P=0.038)were independent risk factors for RFS.Subgroup analysis showed that 67 of 93(72.0%)patients who received the combination of TACE,TKIs,and ICIs achieved MPR+CPR.Conclusions:In individuals who received TACE-based neoadjuvant therapy for HCC,failure to achieve MPR emerges as an independent risk factor for RFS.Notably,the combination of TACE,TKIs,and ICIs demonstrated the highest rate of MPR.展开更多
The Zhang et al’s study addresses an important clinical question of timing and role of salvage surgery post-downstaging procedures in patients with advanced hepatocellular carcinoma wherein different modalities like ...The Zhang et al’s study addresses an important clinical question of timing and role of salvage surgery post-downstaging procedures in patients with advanced hepatocellular carcinoma wherein different modalities like trans arterial chemoembolization,tyrosine kinase inhibitors,and anti-programmed cell death 1 antibodies have been used as downstaging procedure.Although proper selection of patients is a pre-requisite for salvage related liver failure.展开更多
文摘BACKGROUND Chemotherapy and radiotherapy followed by durvalumab is currently the standard treatment for locally advanced node-positive non-small-cell lung cancer(NSCLC).We describe the case of a patient with locally advanced node-positive NSCLC(LA-NSCLC)treated in a phase II prospective protocol with chemotherapy,accelerated hypofractionated radiotherapy(AHRT)and surgery in the preimmunotherapy era.CASE SUMMARY A 69-year-old male,ex-smoker(20 PY),with a Karnofsky performance status of 90,was diagnosed with locally advanced squamous cell lung carcinoma.He was staged by total body computed tomography(CT)scanning,and integrated 18Ffluorodeoxyglucose positron emission tomography/CT scan[cT4 cN3 cM0,stage IIIC according to TNM(tumor-node-metastasis)8th edition]and received AHRT between chemotherapy cycles,in accordance with the study protocol(EudractCT registration 2008-006525-14).At the end of the study the patient underwent surgery,which was not part of the protocol,and showed a complete pathological response.CONCLUSION This case report confirms that AHRT can be used successfully to treat primary LA-NSCLC with bilateral mediastinal lymph node involvement.Our case is of particular interest because of the pathological response after AHRT and the lack of surgical complications.We hypothesize that this radiotherapeutic approach,with its proven efficacy,could be delivered as a short course reducing treatment costs,increasing patient compliance and reducing toxicity.We are currently investigating the possibility of combining hypofractionation,chemotherapy and immunotherapy for patients with LA-NSCLC.
文摘BACKGROUND Neoadjuvant treatment(NT)with chemotherapy(Ch)is a standard option for resectable stage III(N2)NSCLC.Several studies have suggested benefits with the addition of radiotherapy(RT)to NT Ch.The International Association for the Study of Lung Cancer(IASLC)published recommendations for the pathological response(PHR)of NSCLC resection specimens after NT.AIM To contribute to the IASLC recommendations showing our results of PHR to NT Ch vs NT chemoradiotherapy(ChRT).METHODS We analyzed 67 consecutive patients with resectable stage III NSCLC with positive mediastinal nodes treated with surgery after NT Ch or NT ChRT between 2013 and 2020.After NT,all patients were evaluated for radiological response(RR)according to Response Evaluation Criteria in Solid Tumours criteria and evaluated for surgery by a specialized group of thoracic surgeons.All histological samples were examined by the same two pathologists.PHR was evaluated by the percentage of viable cells in the tumor and the resected lymph nodes.RESULTS Forty patients underwent NT ChRT and 27 NT Ch.Fifty-six(83.6%)patients underwent surgery(35 ChRT and 21 Ch).The median time from ChRT to surgery was 6 wk(3-19)and 8 wk(3-21)for Ch patients.We observed significant differences in RR,with disease progression in 2.5%and 14.8%of patients with ChRT and Ch,respectively,and partial response in 62.5%ChRT vs 29.6%Ch(P=0.025).In PHR we observed≤10%viable cells in the tumor in 19(54.4%)and 2 cases(9.5%),and in the resected lymph nodes(RLN)30(85.7%)and 7(33.3%)in ChRT and Ch,respectively(P=0.001).Downstaging was greater in the ChRT compared to the Ch group(80%vs 33.3%;P=0.002).In the univariate analysis,NT ChRT had a significant impact on partial RR[odds ratio(OR)12.5;95%confidence interval(CI):1.21-128.61;P=0.034],a decreased risk of persistence of cancer cells in the tumor and RLN and an 87.5%increased probability for achieving downstaging(OR 8;95%CI:2.34-27.32;P=0.001).CONCLUSION We found significant benefits in RR and PHR by adding RT to Ch as NT.A longer follow-up is necessary to assess the impact on clinical outcomes.
文摘BACKGROUND Gastric cancer is a malignant tumor with high morbidity and mortality worldwide.Neoadjuvant chemotherapy(NAC),defined as chemotherapy administered before the primary treatment(usually surgery)to reduce tumor size and control micrometastases,has emerged as a crucial therapeutic strategy for locally advanced gastric cancer.Pathological complete response(pCR),characterized by the absence of viable tumor cells in the resected specimen after neoadjuvant treatment,is recognized as a strong predictor of favorable prognosis.However,the factors influencing the achievement of pCR remain incompletely understood.AIM To identify and analyze the predictive factors associated with achieving pCR after NAC in gastric cancer patients,thereby providing evidence-based guidance for clinical decision-making.METHODS A retrospective analysis was performed on 215 patients from Shandong Cancer Hospital and Tai’an Central Hospital with locally advanced gastric cancer who underwent NAC followed by radical surgery at our hospital between January 2015 and December 2023.Comprehensive clinical and pathological data were collected,including age,gender,tumor location,Lauren classification,clinical staging,chemotherapy regimens,number of chemotherapy cycles,and baseline hematological indicators.The baseline hematological indicators included neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio,albumin level,carcinoembryonic antigen(CEA),and carbohydrate antigen 19-9.Univariate and multivariate logistic regression analyses were employed to determine the independent predictive factors for pCR.RESULTS Among 215 gastric cancer patients,41(19.1%)achieved pCR after NAC.Multivariate analysis identified five independent predictive factors for pCR:Lauren intestinal type[odds ratio(OR)=3.28],lower clinical T stage(OR=2.75),CEA decrease≥70%after NAC(OR=3.42),pre-treatment NLR<2.5(OR=2.13),and≥4 chemotherapy cycles(OR=2.87).The fluorouracil,leucovorin,oxaliplatin,docetaxel regimen achieved the highest pCR rate(27.5%),and oxaliplatin-containing regimens were superior to cisplatin-containing regimens(22.3%vs 12.7%,P=0.034).Patients with both low NLR and platelet-to-lymphocyte ratio had the highest pCR rate(33.8%),while those with both high inflammatory markers had the lowest rate(10.7%).Earlier clinical stage disease(cT3N+vs cT4N+:28.6%vs 13.0%)and lower lymph node burden were associated with higher pCR rates.CONCLUSION The achievement of pCR after NAC in gastric cancer patients is closely associated with Lauren intestinal type,lower clinical T stage,a significant decrease in CEA after chemotherapy,low pre-treatment NLR,and an adequate number of chemotherapy cycles.
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 Natural Science Foundation of China,No.82073476the National Key R&D Program of China,No.2022YFC2503700 and No.2022YFC2503703+1 种基金Jiangsu Provincial Medical Key Discipline,No.ZDXK202235Innovation Research Project of Medical and Industrial Cooperation in Suzhou,No.SLJ2021005.
文摘BACKGROUND Colorectal cancer is currently the third most common malignant tumor and the second leading cause of cancer-related death worldwide.Neoadjuvant chemoradiotherapy(nCRT)is standard for locally advanced rectal cancer(LARC).Except for pathological examination after resection,it is not known exactly whether LARC patients have achieved pathological complete response(pCR)before surgery.To date,there are no clear clinical indicators that can predict the efficacy of nCRT and patient outcomes.AIM To investigate the indicators that can predict pCR and long-term outcomes following nCRT in patients with LARC.METHODS Clinical data of 128 LARC patients admitted to our hospital between September 2013 and November 2022 were retrospectively analyzed.Patients were categorized into pCR and non-pCR groups.Univariate analysis(using the χ^(2) test or Fisher’s exact test)and logistic multivariate regression analysis were used to study clinical predictors affecting pCR.The 5-year disease-free survival(DFS)and overall survival(OS)rates were calculated using Kaplan-Meier analysis,and differences in survival curves were assessed with the log-rank test.RESULTS Univariate analysis showed that pretreatment carcinoembryonic antigen(CEA)level,lymphocyte-monocyte ratio(LMR),time interval between neoadjuvant therapy completion and total mesorectal excision,and tumor size were correlated with pCR.Multivariate results showed that CEA≤5 ng/mL(P=0.039),LMR>2.73(P=0.023),and time interval>10 wk(P=0.039)were independent predictors for pCR.Survival analysis demonstrated that patients in the pCR group had significantly higher 5-year DFS rates(94.7%vs 59.7%,P=0.002)and 5-year OS rates(95.8%vs 80.1%,P=0.019)compared to the non-pCR group.Tumor deposits(TDs)were significantly correlated with shorter DFS(P=0.002)and OS(P<0.001).CONCLUSION Pretreatment CEA,LMR,and time interval contribute to predicting nCRT efficacy in LARC patients.Achieving pCR demonstrates longer DFS and OS.TDs correlate with poor prognosis.
文摘BACKGROUND Breast cancer ranks as one of the most prevalent malignant tumors among women,significantly endangering their health and lives.While radical surgery has been a pivotal method for halting disease progression,it alone is insufficient for enhancing the quality of life for patients.AIM To investigate the correlation between ultrasound characteristic parameters of breast cancer lesions and clinical efficacy in patients undergoing neoadjuvant chemotherapy(NAC).METHODS Employing a case-control study design,this research involved 178 breast cancer patients treated with NAC at our hospital from July 2019 to June 2022.According to the Miller-Payne grading system,the pathological response,i.e.efficacy,of the NAC in the initial breast lesion after NAC was evaluated.Of these,59 patients achieved a pathological complete response(PCR),while 119 did not(non-PCR group).Ultrasound characteristics prior to NAC were compared between these groups,and the association of various factors with NAC efficacy was analyzed using univariate and multivariate approaches.RESULTS In the PCR group,the incidence of posterior echo attenuation,lesion diameter≥2.0 cm,and Alder blood flow grade≥II were significantly lower compared to the non-PCR group(P<0.05).The area under the curve values for predicting NAC efficacy using posterior echo attenuation,lesion diameter,and Alder grade were 0.604,0.603,and 0.583,respectively.Also,rates of pathological stage II,lymph node metastasis,vascular invasion,and positive Ki-67 expression were significantly lower in the PCR group(P<0.05).Logistic regression analysis identified posterior echo attenuation,lesion diameter≥2.0 cm,Alder blood flow grade≥II,pathological stage III,vascular invasion,and positive Ki-67 expression as independent predictors of poor response to NAC in breast cancer patients(P<0.05).CONCLUSION While ultrasound characteristics such as posterior echo attenuation,lesion diameter≥2.0 cm,and Alder blood flow grade≥II exhibit limited predictive value for NAC efficacy,they are significantly associated with poor response to NAC in breast cancer patients.
文摘Rectal cancer poses a major global health challenge,with neoadjuvant chemoradiotherapy improving outcomes in locally advanced cases by reducing tumor burden and recurrence risk.However,response variability,including only 15%-20%of patients achieving pathological complete response,underscores the urgent need for accurate predictive tools.This review explored current and emerging biomarkers to enhance neoadjuvant chemoradiotherapy response prediction and inform clinical practice.
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.
基金supported by an intramural proof of concept grant of the NCT Heidelberg.
文摘Background The potential of exercise as a concurrent therapy for actively treated primary tumors has been suggested by emerging preclinical and observational studies.However,clinical trials regarding this question are scarce.Therefore,we conducted a randomized controlled trial investigating the effects of aerobic or resistance exercise concomitant to neoadjuvant chemotherapy(NACT)on tumor size.Methods In the BENEFIT study(German title:Bewegung bei neoadjuvanter chemotherapie zur verbesserung der fitness),patients with breast cancer scheduled for NACT were randomly assigned to supervised resistance training(RT,n=60)or aerobic training(AT,n=60)twice weekly during NACT or to a waitlist control group(WCG,n=60).The primary outcome,“change in tumor size”,as well as the secondary clinical outcomes pathologic complete response(pCR),type of surgery(breast conserving/mastectomy),axillary lymph node dissection(ALND,yes/no),premature discontinuation of chemotherapy(yes/no),and relative dose intensity(RDI)were derived from clinical records.Due to the highly skewed distribution,the primary outcome was categorized.Multiple(ordinal)logistic regression analyses were performed.Results Overall,there was no significant difference in post-intervention tumor size between RT or AT and WCG.However,there was a significant effect modification by hormone receptor(HR)status(P_(interaction)=0.030).Among patients with HR+tumors,results suggest a beneficial effect of AT on tumor shrinkage(odds ratio(OR)=2.37,95%confidence interval(95%CI):0.97‒5.78),on pCR(OR=3.21,95%CI:0.97‒10.61);and on ALND(OR=3.76,95%CI:0.78‒18.06)compared to WCG.The effects of RT were slightly less pronounced.For HR−subtypes,beneficial effects on RDI were found for AT(OR=3.71,95%CI:1.20‒11.50)and similarly for RT(OR=2.58,95%CI:0.88‒7.59).Both AT and RT had favorable effects on premature discontinuation of chemotherapy(OR(no vs.yes)=2.34,95%CI:1.10‒5.06),irrespective of tumor receptor status.Conclusion While there was no significant effect on the primary outcome in the overall group,aerobic and resistance exercise concomitant to NACT seem to beneficially affect tumor shrinkage and pCR,reduce the need for ALND among patients with HR+breast cancers,and prevent low RDI among patients with HR–breast cancers.These results warrant confirmation in further trials.
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.
基金This research was supported by grants from the National Key Research and Development Program of China(No.2019YFE0110000)the CAMS Innovation Fund for Medical Sciences(CIFMS)(Nos.2016-I2M-1-001,2017-I2M-3-004)+3 种基金the National Natural Science Foundation of China(No.82072097)the Youth Research Fund of Beijing Tiantan Hospital(No.2017-YQN-09)the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences(Nos.2018PT32013,2017PT32001,and 2016ZX310178)the Beijing Hope Run Special Fund of Cancer Foundation of China(No.LC2020A18)。
文摘Background:Pathological complete response(pCR)of axillary lymph nodes(ALNs)is frequently achieved in patients with clinically node-positive breast cancer after neoadjuvant chemotherapy(NAC),and ALN status is an important prognostic factor for breast cancer patients.This study aims to develop a new predictive clinical model to assess the ALN pCR rate after NAC.Methods:This was a retrospective series of 467 patients who had biopsy-proven positive ALNs at diagnosis and underwent ALN dissection from 2007 to 2014 at the National Cancer Center/Cancer Hospital of the Chinese Academy of Medical Sciences.We analyzed the clinicopathologic features of the patients and developed a nomogram to predict the probability of ALN pCR.A multivariable logistic regression stepwise model was used to construct a nomogram to predict ALN pCR in node-positive patients.The adjusted area under the receiver operating characteristic curve(AUC)was calculated to quantify the ability to rank patients by risk.Internal validation was performed using the 50/50 hold-out validation method.The nomogram was externally validated with prospective cohorts of 167 patients from 2016 to 2018 at the Cancer Hospital of the Chinese Academy of Medical Sciences and 114 patients from 2018 to 2020 at Beijing Tiantan Hospital.Results:In this retrospective study,115(24.6%)patients achieved ALN pCR after NAC.Multivariate analysis showed that clinical tumor stage(Odds ratio[OR]:0.321,95%confidence interval[CI]:0.121-0.856;P=0.023);primary tumor response(OR:0.189;95%CI:0.123-0.292;P<0.001),and estrogen receptor status(OR:0.530,95%CI:0.304-0.925;P=0.025)were independent predictors of ALN pCR.The nomogram was constructed based on the result of multivariate analysis.In the internal validation of performance of nomogram,the AUCs for the training and test sets were 0.719 and 0.753,respectively.The nomogram was validated in external cohorts with AUCs of 0.720,which demonstrated good discriminatory power in these data sets.Conclusion:We developed a nomogram to predict the likelihood of axillary pCR in node-positive breast cancer patients after NAC.The predictive model performed well in multicenter prospective external validation.This practical tool could provide information to surgeons regarding whether to perform additional ALN dissection after NAC.Trial registration:ChiCTR.org.cn,ChiCTR1800014968.
基金the Institutional Ethics Committees of the Eastern Hepatobiliary Surgery Hospital,940 Hospital of PLA Joint Logistic Support Force,and Hai Nan Hospital of Chinese PLA General Hospital(No.EHBHKY2020-K-056)。
文摘Background:To study the influence of pathological responses(PR)after transcatheter arterial chemoembolization(TACE)on incidences of microvascular invasion(MVI)and early recurrence in hepatocellular carcinoma(HCC)patients.Methods:Between 2013 to 2015,consecutive HCC patients who underwent liver resection with“curative”intent at three hospitals were enrolled in this study.Patients with different areas of PR after preoperative TACE were compared with those without preoperative TACE on the incidences of MVI,early recurrence rates and patterns of recurrence before and after propensity score matching(PSM).Results:Of 1,970 patients,737 patients who received preoperative TACE were divided into three groups according to the areas of PR:≥90%(n=226),60-90%(n=447),and<60%(n=64).PR≥90%was an independent protective factor of incidences of MVI[odds ratio(OR),0.144;95%confidence interval(CI),0.082-0.245,P<0.001)and early recurrence(HR,0.742;95%CI,0.561-0.963,P=0.032);while PR<60%was an independent risk factor of incidences of MVI(OR,6.076;95%CI,3.004-11.728,P<0.001)and early recurrence(HR,1.428;95%CI,1.095-1.929;P=0.009).Furthermore,patients with PR<60%were significantly more likely to develop multiple intrahepatic recurrences involving multiple hepatic segments when compared with patients without preoperative TACE.Conclusions:This study indicated the area of PR after TACE was closely associated with the incidences of MVI and early tumor recurrence.Patients with PR<60%were at significantly higher risks of having more MVI,early and multiple tumor recurrences.
基金Chongqing Natural Science Foundation Project,No.CSTB2022NSCQ-MSX0172and Incubation Project for Talented Young People,No.2022YQB031.
文摘BACKGROUND For primary liver cancer,the key to conversion therapy depends on the effectiveness of drug treatment.Patient-derived tumor organoids have been demonstrated to improve the efficacy of conversion therapy by identifying individualtargeted effective drugs,but their clinical effects in liver cancer remain unknown.CASE SUMMARY We described a patient with hepatocellular carcinoma(HCC)who achieved pathologic complete response(pCR)to conversion therapy guided by the patientderived organoid(PDO)drug sensitivity testing.Despite insufficiency of the remaining liver volume after hepatectomy,the patient obtained tumor reduction after treatment with the PDO-sensitive drugs and successfully underwent radical surgical resection.Postoperatively,pCR was observed.CONCLUSION PDOs contributes to screening sensitive drugs for HCC patients to realize the personalized treatment and improve the conversion therapy efficacy.
基金Supported by the Guangzhou Science and Technology Project,No.201803010040Natural Science Foundation of Guangdong Province,No.2016A030310187Nation Key Clinical Discipline。
文摘BACKGROUND Survival benefit of neoadjuvant chemotherapy(NAC)for advanced gastric cancer(AGC)is a debatable issue.Studies have shown that the survival benefit of NAC is dependent on the pathological response to chemotherapy drugs.For those who achieve pathological complete response(pCR),NAC significantly prolonged prolapsed-free survival and overall survival.For those with poor response,NAC yielded no survival benefit,only toxicity and increased risk for tumor progression during chemotherapy,which may hinder surgical resection.Thus,predicting pCR to NAC is of great clinical significance and can help achieve individualized treatment in AGC patients.AIM To establish a nomogram for predicting pCR to NAC for AGC patients.METHODS Two-hundred and eight patients diagnosed with AGC who received NAC followed by resection surgery from March 2012 to July 2019 were enrolled in this study.Their clinical data were retrospectively analyzed by logistic regression analysis to determine the possible predictors for pCR.Based on these predictors,a nomogram model was developed and internally validated using the bootstrap method.RESULTS pCR was confirmed in 27 patients(27/208,13.0%).Multivariate logistic regression analysis showed that higher carcinoembryonic antigen level,lymphocyte ratio,lower monocyte count and tumor differentiation grade were associated with higher pCR.Concordance statistic of the established nomogram was 0.767.CONCLUSION A nomogram predicting pCR to NAC was established.Since this nomogram exhibited satisfactory predictive power despite utilizing easily available pretreatment parameters,it can be inferred that this nomogram is practical for the development of personalized treatment strategy for AGC patients.
文摘Anthracycline-Taxane chemotherapy is widely used in neoadjuvant treatment for breast cancers. However, there is limited data reported in patients with triple negative breast cancer （TNBC）. Here, we evaluated the pathologic responses and survival of neoadjuvant epirubicin and taxanes chemotherapy in patients with locally advanced TNBC to provide some useful information for clinical practice. A total of 43 patients with locally advanced TNBC were enrolled in this study. Patients were administered with epirubicin 75 mg/m^2 plus paclitaxel 175 mg/m^2 or docetaxel 75 mg/m^2 every 3 weeks for at least 2 cycles. The primary endpoint was pathologic complete response （pCR）, which was defined as no residual invasive cancer, or only carcinoma in situ in both the excised breast and axillary lymph node, while relapse-free survival （RFS） and overall survival （OS） were secondary endpoints. Thirty-nine （90.7%） patients were at clinical stages II B-IIIC. Thirty-seven （86%） completed 4-6 cycles of preop- erative chemotherapy, and objective response rate （ORR） was 81.4% （35/43）. Forty-two patients un- derwent radical surgery subsequently. The pCR rate was 14.3% （6/42）. The most common adverse events in neoadjuvant chemotherapy were nausea/vomiting （88.4%, 38/43） and neutropenia （88.4%）. After a median follow-up period of 34.0 months, 3-year RFS and OS rate was 53.6% and 80.1%, respectively. All events of recurrence and death occurred in non-pCR patients, in whom the 3-year RFS and OS rates were 44.3% and 76.6%, respectively. This study suggest that neoadjuvant chemotherapy with epirubicin plus taxanes has a relatively low pCR rate and high early recurrence risk in locally ad- vanced TNBC, which indicates the necessity for more efficacious treatment. Further study is needed to validate these results.
基金Supported by This work was sponsored by Tianjin Key Medical Discipline(Specialty)Construction Project,No.TJYXZDXK-035ATianjin Science and Technology Project,No.21JCYBJC01590.
文摘BACKGROUND The pathological complete response(ypCR)rate following neoadjuvant chemotherapy for advanced gastric cancer remains low and lacks a universally accepted treatment protocol.Immunotherapy has achieved breakthrough progress.CASE SUMMARY We report two female patients with gastric cancer defined as clinical stage cT4N1-2M0.Detection of mismatch repair protein showed mismatch repair function defect,and perioperative treatment with programmed death protein 1 inhibitor combined with S-1+oxaliplatin achieved ypCR.Surprisingly,the patients underwent clinical observation after surgery but developed different degrees of metastasis at~6 mo after surgery.CONCLUSION PD-1 inhibitor combined with chemotherapy provides a more strategic choice for comprehensive perioperative treatment of gastric cancer.
基金Supported by a grant from Beijing Municipal PublicWelfare Development and Reform Pilot Project for Medical Research Institutes(PWD&RPP-MRI,No.JYY2023-14).
文摘Background:Non-small cell lung cancer(NSCLC)is the cancer with the highest incidence and mortality rate worldwide.This study aimed to investigate the predictive value of clinicopathological and radiological characteristics for event-free survival(EFS),major pathological response(MPR),and pathological complete response(pCR)in patients with NSCLC undergoing neoadjuvant chemoimmunotherapy.Methods:A retrospective analysis was performed on the clinical data of 180 patients with NSCLC who received neoadjuvant chemoimmunotherapy between October 2019 and December 2023.The primary endpoint was EFS,and the secondary endpoint was the pathological response rate.Fisher exact test and the nonparametricMann-Whitney U test were used to compare categorical and continuous data between the pCR/MPR and non-pCR/non-MPR groups.The Kaplan-Meier method was used to estimate EFS curves,and Cox regression analysis was performed to compare the differences in EFS between patients with or without pCR or MPR.Results:Sex(p=0.004),smoking history(p=0.025),and clinical stage(p=0.002)were identified as predictors of pCR and MPR.In our study,pCR was observed in 38.12%and MPR in 44.75%of the patients.Through the multivariate logistic regression model,age and pathological response were found to predict the 1-and 2-year EFS rates,demonstrating satisfactory predictive power(area under the curve,0.866 and 0.736,respectively).Patients with pCR or MPR exhibited longer EFS compared with those without pCR or MPR,as determined by Cox analysis.Conclusions:Sex,smoking history,and clinical stage were identified as predictors of pCR and MPR in patients with NSCLC.Survival analysis revealed that age and pathological response were key prognostic factors for EFS.
文摘AIM To analyze the homogeneity of pathologic response to preoperative chemotherapy(PRPC) after chemotherapy in patients with multiple liver metastases(LM).METHODS From September 2011 to August 2014,patients with at least two LM undergoing preoperative chemotherapy prior to resection were included in this retrospective,single-center study. The endpoints were PRPC homogeneity(according to both the Rubbia-Brandt and MD Anderson classifications),the impact of PRPC on the MDT decision,factors associated with homogeneous PRPC and overall survival of patients with vs. without homogeneous PRPC.RESULTS seventy-three patients with a total of 88 liver resections(including 15 two-stage procedures) were included in the study. The homogeneous PRPC rate was 55% according to the Rubbia-Brandt classification and 53% according to the MD Anderson classification. The MDT decision was modified by the PRPC in only 2.7% of patients(n = 2). CONCLUSION The PRPC was homogeneous in only one half of patients and had very little influence on the MDT decision.
基金supported by grants from the National Natural Science Foundation of China(82270682)the Natural Science Foundation of Zhejiang Province(LQ21H030007 and LQ20H30006)。
文摘Background:Transarterial chemoembolization(TACE)based neoadjuvant therapy was proven effective in hepatocellular carcinoma(HCC).Recently,tyrosine kinase inhibitors(TKIs)and immune checkpoint inhibitors(ICIs)also showed promise in HCC treatment.However,the prognostic benefits associated with these treatments remain uncertain.This study aimed to explore the relationship between pathologic response and prognostic features in HCC patients who received neoadjuvant therapy.Methods:HCC patients who received TACE either with or without TKIs/ICIs as neoadjuvant therapy before liver resection were retrospectively collected from the First Affiliated Hospital,Zhejiang University School of Medicine in China.Pathologic response was determined by calculating the proportion of non-viable area within the tumor.Major pathologic response(MPR)was defined as the presence of non-viable tumor cells reaching a minimum of 90%.Complete pathologic response(CPR)was characterized by the absence of viable cells observed in the tumor.Results:A total of 481 patients meeting the inclusion criteria were enrolled,with 76 patients(15.8%)achieving CPR and 179(37.2%)reaching MPR.The median recurrence-free survival(m RFS)in the CPR+MPR group was significantly higher than the non-MPR group(31.3 vs.25.1 months).The difference in 3-year overall survival(OS)rate was not significant.Multivariate Cox regression analysis identified failure to achieve MPR(hazard ratio=1.548,95%confidence interval:1.122–2.134;P=0.008),HBs Ag positivity(HR=1.818,95%CI:1.062–3.115,P=0.030),multiple lesions(HR=2.278,95%CI:1.621–3.195,P<0.001),and baseline tumor size>5 cm(HR=1.712,95%CI:1.031–2.849,P=0.038)were independent risk factors for RFS.Subgroup analysis showed that 67 of 93(72.0%)patients who received the combination of TACE,TKIs,and ICIs achieved MPR+CPR.Conclusions:In individuals who received TACE-based neoadjuvant therapy for HCC,failure to achieve MPR emerges as an independent risk factor for RFS.Notably,the combination of TACE,TKIs,and ICIs demonstrated the highest rate of MPR.
文摘The Zhang et al’s study addresses an important clinical question of timing and role of salvage surgery post-downstaging procedures in patients with advanced hepatocellular carcinoma wherein different modalities like trans arterial chemoembolization,tyrosine kinase inhibitors,and anti-programmed cell death 1 antibodies have been used as downstaging procedure.Although proper selection of patients is a pre-requisite for salvage related liver failure.
