ObjectiveTo study value of long noncoding RNA H19 and HOTTIP in plasma in predicting efficacy of neoadjuvant chemotherapy (NAC) for resectable locally advanced gastric cancer. MethodsForty patients with T3–4aN+M0 gastric cancer and 40 patients with benign gastric diseases treated in the Yantai Yuhuangding Hospital Affiliated to Qingdao University from August 2020 to May 2021 were prospectively included. The expressions of H19 and HOTTIP in the plasma of gastric cancer and benign gastric diseases patients without any treatment after admission were detected before treatment (CAPEOX regimen was used in the patients with gastric cancer), then which were detected after 2 NAC courses for patients with gastric cancer. Meanwhile, some clinical items were detected and the efficacy of NAC was evaluated. The complete remission (CR) and partial remission (PR) were classified as objective remission, CR, PR, and disease stability were classified as disease control. The expressions of H19 and HOTTIP between the different patients were compared and the receiver operating characteristic (ROC) curve was used to evaluate their values in the diagnosis of resectable locally advanced gastric cancer. ResultsThere were 13 cases of T downstaging and 27 cases of T non-downstaging and 25 cases of objective remission and 35 disease control after NAC. The median relative expression levels of H19 and HOTTIP before NAC in the patients with gastric cancer were higher than those in the patients with benign gastric diseases (H19: 1.42 versus 0.98, Z=–3.835, P<0.001; HOTTIP: 2.15 versus 1.04, Z=–5.062, P<0.001), and which were in the patients with T downstaging and disease control were lower than those in the patients with T non-downstaging and 5 cases of disease progression (For T staging, H19: 1.12 versus 1.54, Z=–2.960, P=0.002; HOTTIP: 1.49 versus 2.30, Z=–2.310, P=0.019. For efficacy of NAC, H19: 1.39 versus 2.48, Z=–3.211, P<0.001; HOTTIP: 1.96 versus 3.25, Z=–2.393, P=0.014). The median relative expressions of H19 and HOTTIP after NAC were lower than those before NAC in the patients with gastric cancer (H19: 1.12 versus 1.42, Z=–3.965, P<0.001; HOTTIP: 1.30 versus 2.15, Z=–4.839, P<0.001). There were no significant differences in the changes of H19 and HOTTIP before and after NAC between the patients with T downstaging and T non-downstaging, and between disease control and disease progression (P>0.05). The areas of ROC curve of H19, HOTTIP, and combination of H19 and HOTTIP in diagnosis of resectable locally advanced gastric cancer were higher than 0.7. ConclusionsLncRNA H19 and HOTTIP might be potential tumor markers in gastric cancer, and their diagnostic values for resectable locally advanced gastric cancer are higher. Gastric cancer patients with low expressions of H19 and HOTTIP in plasma might be more sensitive to NAC.
Objective To explore the accuracy of contrast-enhanced magnetic resonance imaging (MRI) in predicting pathological complete remission (pCR) in breast cancer patients after neoadjuvant therapy (NAC). Methods The clinicopathological data of 245 patients with invasive breast cancer who had completed the surgical resection after NAC in the Affiliated Hospital of Southwest Medical University from March 2020 to April 2022 were collected retrospectively. According to the results of hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) detected by immunohistochemistry, all patients were divided into four subgroups: HR+/HER2–, HR+/HER2+, HR–/HER2+ and HR–/HER2–. The value of MRI in evaluating the efficacy of NAC was analyzed by comparing the postoperative pathological results as the gold standard with the residual tumor size assessed by preoperative MRI. Meanwhile, the sensitivity, specificity and positive predictive value (PPV) of pCR predicted by the evaluation results of enhanced MRI were analyzed, and further analyzed its predictive value for pCR of different subtypes of breast cancer. Results There were 88 cases (35.9%) achieved radiological complete response (rCR) and 106 cases (43.3%) achieved pCR in 245 patients. Enhanced MRI in assessing the size of residual tumors overestimated and underestimated 12.7% (31/245) and 9.8% (24/245) of patients, respectively. When setting rCR as the MRI assessment index the specificity, sensitivity and PPV were 84.2% (117/139), 62.3% (66/106) and 75.0% (66/88), respectively. When setting near-rCR as the MRI assessment index the specificity, sensitivity and PPV were 70.5% (98/139), 81.1% (86/106), and 67.7% (86/127), respectively. The positive predictive value of both MRI-rCR and MRI-near-rCR in evaluating pCR of each subtype subgroup of breast cancer was the highest in the HR–/HER2+ subgroup (91.7% and 83.3%, respectively). In each subgroup, compared with rCR, the specificity of near-rCR to predict pCR decreased to different degrees, while the sensitivity increased to different degrees. Conclusions Breast contrast-enhanced MRI can more accurately evaluate the efficacy of localized breast lesions after NAC, and can also more accurately predict the breast pCR after NAC. The HR–/HER2+ subgroup may be a potentially predictable population with pCR exemption from breast surgery. However, the accuracy of the evaluation of pCR by breast enhancement MRI in HR+/HER2– subgroup is low.
Objective To compare the clinical effect between neo-adjuvant chemotherapy combined with operation and simple operation under multi-disciplinary team in rectal cancer. Methods A survey of 72 patients with rectal cancer from Nov. 2007 to Mar. 2008 were studied. Patients were divided into two groups using a simple random method: 33 cases in combined therapy group were treated with single period neo-adjuvant chemotherapy as well as operation and 39 cases in control group received operation only. To compare the differences of perioperative period indexes between two groups. Results During the differences of indexes of age, gender, differentiation degree, clinicopathologic stage as well as the distance to dentate line of tumor, there was no statistical significance between combined therapy group and control group (Pgt;0.05). And at the same time, the operative type, operative time and bleeding quantity in operation had no statistically significant difference between two groups (Pgt;0.05). As for the postoperative rehabilitation indexes, the time of vent to normal in combined therapy group was earlier than that in control group, but the intake time was later than that in control group （Plt;0.05）. Falling range from preoperative CEA to postoperative CEA was larger in combined therapy group than that in control group （Plt;0.05）; and the falling range from preoperative WBC to postoperative WBC had no significant difference between two groups （Pgt;0.05）. Conclusion The clinical effect of combined therapy is obviously superior to simple operation, suggesting that neo-adjuvant chemotherapy combined with operation is feasible and safe.
Objective To explore the clinical effect of neo-adjuvant/adjuvant chemotherapy combined with operation on colorectal cancer patients in the multi-disciplinary team (MDT). Methods The data were collected retrospectively from January to December in 2007. The patients were classified as non-adjuvant chemotherapy group and adjuvant chemotherapy group according to the treatment strategy. Non-adjuvant chemotherapy group had accepted only surgery followed by preoperative neo-adjuvant chemotherapy, and adjuvant chemotherapy group had taken postoperative adjuvant chemotherapy after preoperative neo-adjuvant chemotherapy and operation. The clinical effect of two groups were compared. Results Totally 789 patients were treated among 2007, and 195 patients who were firstly diagnosed as colorectal cancer were included, and there were 109 males and 86 females, 59 colonic cancers and 136 rectal cancers. Average age was 59.98 years old. All of the included patients were followed up for 5-17 months. Three cases missed, no recurrence and no death happened. The baseline between non-adjuvant chemotherapy and adjuvant chemotherapy group was nearly same. There were no differences between two groups about the internal medicine complications, the cancer related obstruction, preoperative transfusion or not (P＞0.05). Whether the patients were transfused or not during the procedure and Dukes stage were significantly different between two groups(P＜0.05), while the other surgical and pathological index didnt show any statistical significance (P＞0.05). After operation, more patients in non-adjuvant chemotherapy group had accepted transfusion (P＜0.05). However, the postoperative rehabilitative indexes during hospitalization were not different between two groups. And the differences about the postoperative complications and defecation were not significant (P＞0.05). The values of CEA and CA19-9 were greatly different between two groups in the 1st and 3rd month follow-up. Conclusion The strategy of neo-adjuvant chemotherapy/operation/adjuvant chemotherapy didnt affect the rehabilitation and increase the risk of complications, however, more researches were necessary to prove whether the clinical effect were improved or not.
Objective To evaluate the safety and efficacy of neoadjuvant therapy followed by minimally invasive esophagectomy (MIE) for locally advanced esophageal cancer. Methods We retrospectively analyzed clinical data of 56 consecutive patients with locally advanced esophageal cancer treated by neoadjuvant therapy followed by surgery in our hospital between January 2015 and December 2016. There were 51 males and 5 females. The patients were divided into 2 groups. Neoadjuvant therapy followed by open surgery esophagectomy group was as an OE group with 25 patients aged 61 (50-73) years. And neoadjuvant therapy followed by MIE was as a MIE group with 31 patients aged 60 (55-79) years. Results The pathologic complete response (pCR) rate of 28 patients with neoadjuvant concurrent chemoradiotherapy was significantly higher than that of 28 patients with neoadjuvant chemotherapy (21.4% vs. 10.7%, P<0.05). The operation time, intraoperative blood loss, R2 rate and the number of lymph nodes dissection in the MIE group were obviously better than those of the OE group with statistical differences (P<0.05). However, there was no significant difference in the number of resected lymph nodes along the bilateral recurrent laryngeal nerves and lymph node metastasis rate (P>0.05) between the two groups. The incidence of postoperative respiratory complications in the MIE group was lower than that of the OE group (P=0.041). There was no significant difference between the two groups in the incidence of other complications, re-operation, re-entry to ICU, median length of stay or perioperative deaths (P>0.05). There was only one patient with neoadjuvant concurrent chemoradiotherapy in the OE group died due to gastric fluid asphyxia caused by trachea-esophageal fistula. Conclusion Neoadjuvant therapy followed by MIE for locally advanced esophageal cancer is safe and feasible. The oncological outcomes seem comparable regardless of OE.
【Abstract】Objective Through using neoadjuvant chemotherapy of different circles combined colorectal cancer operations under multi-disciplinary team (MDT), we evaluate effective treatment strategies that suit to colorectal cancer patients in this country. Methods The retrospective study reviewed patients with colorectal cancer treated in general surgery department Ⅲ in West China Hospital of Sichuan University from October 2006 to April 2007. According to the circle times of neoadjuvant chemotherapy, the patients were divided into single-circle group, double-circle group and triple-circle group. And comparing the difference of treatment time, effect index of neoadjuvant chemotherapy and operative results used these stratagies. Results The difference between the time from the end of neoadjuvant chemotherapy to the operation in three groups had no statistical significance （Pgt;0.05）, which were （5.64±2.00） d in single-circle group, (5.80±3.74） d in double-circle group, （6.22±2.76） d in triple-circle group. According to the treatment effects, CEA value decreased during pre- and post-neoadjuvant chemotherapy in each groups （Plt;0.01）. Subjective reception such as hemafecia, anal tenemus and defecation obstruction in double-circle group and triple-circle group were obviously improved than that in single-circle group （Plt;0.01）. Evaluating the tumor condition, the ratio of CR and PR in double-circle group and triple-circle group was higher than that in single-circle group （Plt;0.01）. According to the adverse effect, WBC value of double-circle group and triple-circle group decreased during pre- and post-neoadjuvant chemotherapy, their difference had statistical significance （Plt;0.01）. The difference of WBC pre- and post- neoadjuvant chemotherapy in single-circle group decreased fewer than that in double-circle group and triple-circle group （Plt;0.01）. Nausea and vomit response in triple-circle group were obviously more serious than that in single-circle group and double-circle group （Plt;0.01）. But abdominal distention and diarrhea response had no difference among three groups （Pgt;0.05）. Through our survey, used different neoadjuvant chemotherapy circle, patients in single-circle group and double-circle group were completely accepted within full confidence; but receptance of strategy in triple-circle group was 66.7％(12/18）. All operations were successful. The difference of postoperative aerofluxus time between single-circle group and double-circle group had statistical significance （Plt;0.05）. The difference of postoperative intake time, between triple-circle group and single-circle group, between triple-circle group and double-circle group, had statistical significance （Plt;0.05）. But wound recover time among three groups had no obvious difference （Pgt;0.05）. Conclusion Analyzing neoadjuvant chemotherapy circles, time between neoadjuvant chemotherapy and operation, treatment effect and operation results, it is a feasible and secure colorectal cancer multi-discipinary strategy for patients in West China that choose the treatment of neoadjuvant chemotherapy with double-circle and short preparation time.
ObjectiveTo explore the clinical application of oncoplastic surgery in breast-conserving surgery after neoadjuvant chemotherapy.MethodsFrom May 2016 to May 2018, 32 breast cancer patients (cT2–3N0–3M0) who were scheduled for neoadjuvant chemotherapy (NAC) and agreed to accept breast-conserving surgery after NAC in the Henan Tumor Hospital were enrolled into the retrospective study. These patients were originally unable to perform traditional breast conserving surgery because of the size or location of the tumor. We observed the success rate, safety and cosmetic effects of breast-conserving therapy, which were applicated of tumor down-staging after neoadjuvant chemotherapy combined with oncoplastic surgery.ResultsIn this study, after neoadjuvant chemotherapy, 31 patients achieved CR or PR, and 1 patient had SD. All 32 patients underwent breast-conserving surgery successfully, 3 patients underwent breast-conserving combined with volume replacement, and 29 patients underwent breast-conserving combined with volume displacement. One patient was not satisfied with the cosmetic effects, the other patients were satisfied or basically satisfied with the cosmetic effects. The median follow-up was 18 months (5–24 months), and no local recurrence or distant metastasis was found in 32 patients.ConclusionsBy tumor down-staging after neoadjuvant chemotherapy combined with oncoplastic surgery, we can make some patients who are originally not suitable for breast conserving due to tumor size and tumor location succeed in breast-conserving therapy, and the safety and cosmetic effect are basically satisfied.
ObjectiveTo analyze the risk factors influencing major postoperative complications (MPC) after minimally invasive radical gastrectomy for gastric cancer following neoadjuvant chemotherapy (NACT), and to construct a nomogram for accurately predicting MPC risk factors, and provide a reference for clinical decision-making. MethodsThe gastric cancer patients who underwent minimally invasive radical gastrectomy in the Department of General Surgery of the First Medical Center of the Chinese PLA General Hospital from February 2012 to December 2022 and met the inclusion criteria of this study were retrospectively collected. The univariate and multivariate logistic regression model were used to evaluate the risk factors influencing MPC and a nomogram model was constructed. The MPC were defined as Clavien-Dindo classification grade Ⅱ and beyond. The area under the receiver operating characteristic curve (AUC) and the calibration curve were used to evaluate the discrimination and accuracy of the nomogram model. ResultsA total of 362 patients were included in this study, among whom 65 cases (18.0%) experienced MPC. The multivariate logistic regression analysis showed that the age ≥58 years old, body mass index (BMI) ≥25 kg/m2, tumor long diameter ≥30 mm, operative time ≥300 min, and preoperative neutrophil-to-lymphocyte ratio (NLR) ≥3.7 were the risk factors influencing MPC. The nomogram model constructed using the above variables showed that the AUC (95%CI) was 0.731 (0.662, 0.801) in predicting the risk of MPC. The calibration curves showed that the prediction curve of the nomogram in predicting the MPC was agree well with the actual MPC (Hosmer-Lemeshow test: χ2=9.293, P=0.056). ConclusionFrom the results of this study, nomogram model constructed by combining age, BMI, tumor long diameter, operative time, and preoperative NLR can distinguish between patients with and without MPC after minimally invasive radical gastrectomy for gastric cancer following NACT, and has a better accuracy.
ObjectiveTo analyze the relationship between adverse reactions and curative effect in neoadjuvant chemotherapy, this study is to explore whether the adverse reactions of chemotherapy can indirectly predict the efficacy of chemotherapy, so as to give a new definition of adverse reactions of chemotherapy.MethodsThe clinical data of 64 patients with neoadjuvant chemotherapy for breast cancer (after 4 cycles of TAC regimen) were retrospectively analyzed. The adverse reactions (weakness, nausea, vomiting, alopecia, myelosuppression, cardiotoxicity) during chemotherapy were counted. At the same time, the evaluation of chemotherapy efficacy was carried out according to the RECIST1.1 standard, and the relationship between the degree of adverse reactions of chemotherapy and the curative effect was analyzed one by one. Then, according to the severity of adverse reactions, adopting the form of scoring to assign the value, and use Pearson correlation analysis to clarify the specific relationship between adverse reactions and curative effect. Finally, four subgroups of Luminal A, Luminal B, Her2+ and Sanyin were determined according to molecular typing, and the relationship between adverse reactions and therapeutic effects among different subgroups was analyzed.ResultsThere was no difference in the adverse reactions of chemotherapy in neoadjuvant chemotherapy patients of different ages (correlation coefficient r fluctuated between –0.079 and –0.164, P value fluctuated between 0.195 and 0.533). The patients with high scores of adverse reactions showed relatively good efficacy (r=0.587, P<0.01). There was no significant correlation between fatigue, nausea and vomiting and efficacy (r=0.199, P=0.144; r=0.127, P=0.144). Among the adverse reactions, there was a significant positive correlation between alopecia, myelosuppression, cardiotoxicity and efficacy (r=0.532, r=0.621, r=0.422, all P<0.01). The above correlation was verified in the Luminal A subgroup (r=0.559, P<0.007).ConclusionsThe severity of adverse reactions in neoadjuvant chemotherapy can predict the efficacy of chemotherapy. To a certain extent, the heavier adverse reactions, the better the chemotherapy effect. Hair loss, myelosuppression, and cardiotoxicity have a clearer effect on efficacy in several common adverse reactions.
ObjectiveTo evaluate clinical effect of neoadjuvant chemotherapy combined with laparoscopic gastrectomy in treatment of local advanced gastric cancer. MethodsThe clinical data of 24 patients with local advanced gastric cancer undergoing 2 courses of FLEEOX neoadjuvant chemotherapy from July 2012 to July 2015 were analyzed. The efficacy of neoadjuvant chemotherapy based on radiographic results was evaluated. The gastrectomy was performed on week 2 after neoadjuvant chemotherapy. Patients were treated with XELOX regimen as adjuvant chemotherapy after laparoscopic gastrectomy. Results① Complete response occurred in 4 cases (16.6%), partial response in 18 cases (75.0%), stable disease in 1 case (4.2%), disease progressive in 1 case (4.2%). The total effective rate of neoadjuvant chemotherapy was 91.6% (22/24). ② The serum tumor markers CEA, CA19-9, and CA125 levels after neoadjuvant chemotherapy were significantly lower than those before neoadjuvant chemotherapy (P < 0.001) and reached normal levels. ③ Two courses of neoadjuvant chemotherapy and laparoscopic exploration were completed successfully in these 24 patients. Two patients with intraabdominal metastasis were underwent palliative gastrojejunostomy, the other 22 patients were underwent laparoscopic D2 radical gastrectomy. The operative time was (236±45) min, the intraoperative blood loss was (150±50) mL, the number of lymph node dissected was 17.4 ± 5.3, the postoperative gastrointestinal function recovery time was (3.1±0.8) d. ④ There was no death due to surgery. One case suffered anastomotic leakage, 1 case intestinal obstruction, and 1 case pulmonary infection after surgery. The postoperative complications were cured by conservative treatment. ⑤ The haematological adverse events included anemia (9 patients), leukopenia (14 patients), thrombocytopenia (8 patients), aminotransferase abnormality (5 in elevated ALT, 6 in elevated AST), the most common toxicity was nausea (19 patients), 10 patients suffered nerve toxicity. All the patients were relieved after treatment. ⑥ The patients were followed up for 4-39 months, 1 case died of cachexia as the result of extensive abdominal metastasis, 1 case died of liver failure as the result of multiple liver metastases, 1 case was death as the result of brain metastasis, 1 case was death as the result of the other cause, the other 20 patients were alive. ConclusionsThe preliminary results of limited cases in this study show that FLEEOX neoadjuvant chemotherapy combined with laparoscopic gastrectomy for local advanced gastric cancer is safe and effective. It has advantages of minimal invasion and fast recovery.