Objective To explore the clinical value, latest research progress, and clinical controversy of total neoadjuvant therapy (TNT) in locally advanced rectal cancer (LARC). Method We searched and reviewed on the latest literatures about studies of the clinical research of TNT in LARC. Results TNT could make the tumor downstage rapidly and improve the patients’ treatment compliance. In terms of organ preservation rate, 3-year disease-free survival and pathological complete remission rate, TNT had advantages and was a especial potential treatment strategy compared with traditional methods. Conclusions TNT decreases local recurrence rate and improves the long-term survival. For LARC patients with strong desire for organ preservation, TNT is a good treatment choice and has the value of clinical promotion.
ObjectiveTo describe the constructive process of neoadjuvant therapy for colorectal cancer part in the West China Colorectal Cancer Database (DACCA).MethodWe used the form of text description.ResultsThe specific concept of neoadjuvant therapy for colorectal cancer including neoadjuvant treatment therapies, compliance of patients with neoadjuvant therapy, neoadjuvant therapy intensity scheme, the CEA value of patients during neoadjuvant therapy, changes of symptoms, changes of primary tumor size in colorectal cancer, and TRG grading of the DACCA in the West China Hospital were defined. Then the neoadjuvant therapies were detailed for their definition, label, structure, error correction, and update.ConclusionThrough detailed description and specification of neoadjuvant therapy for colorectal cancer in DACCA in West China Hospital, it can provide a reference for the standardized treatment of colorectal cancer and also provide experiences for the peers who wish to build a colorectal cancer database.
Objective To summarize the current value of neoadjuvant chemotherapy (NAC) for potentially resectable gastric cancer. Methods The recent 5-year literatures searched through the PubMed with the key words: stomach neoplasm, gastric cancer/carcinoma, neoadjuvant therapy/chemotherapy and preoperative therapy/chemotherapy as well as the relevant reports presented in the ASCO Annual Meeting in 2007 and 2008 were analyzed. The present status of NAC for advanced gastric cancer was summarized, the necessity and feasibility were evaluated, and the patients features for selecting, the predictors for response, the mainly existing problems and development trend of NAC were analyzed. Results At present, there were 7 randomized control trails (RCT) published, and among them 3 were phase Ⅲ. It was safe, effective and feasible to most of trails in NAC for gastric cancer. However, it was still little to obtain survival benefit for NAC RCT, and short of randomized trial comparing strict preoperative chemotherapy to surgery alone or perioperative chemotherapy to surgery plus adjuvant chemotherapy. It remained lots of problems such as how to select the appropriate patients, the effective induced regimes and the predicted factors, the evaluated indices for response. Conclusion NAC is a safe, feasible and efficient method to potentially resectable gastric cancer, but strict phase Ⅲ randomized trials are needed. In the future, substantial improvements of treatment outcome will likely depend on the novel drugs and molecular biological targeted therapies.
ObjectiveTo analyze the factors influencing axillary pathological complete response (pCR) after neoadjuvant therapy (NAT) and to provide the possibility of exempting axillary surgery for patients with better pathological efficacy of primary breast lesions after NAT. MethodsAccording to the inclusion and exclusion criteria, the patients with breast cancer admitted to the Department of Breast Surgery, Affiliated Hospital of Southwest Medical University from January 1, 2020 to June 30, 2022 were retrospectively analyzed. All patients were diagnosed with ipsilateral axillary lymph node metastasis of breast cancer and the NAT cycle was completed according to standards. All patients underwent axillary lymph node dissection (ALND) after NAT. The therapeutic effect of primary breast lesions was evaluated by Miller-Payne (MP) grading system. The axillary pCR was judged according to whether there was residual positive axillary lymph nodes after ALND. The unvariate and multivariate logistic regressions were used to analyze the risk factors affecting the axillary pCR. At the same time, the possibility of exempting axillary surgery after NAT in the MP grade 5 or in whom without ductal carcinoma in situ (DCIS) was evaluated. The ALND was considered to exempt when the negative predictive value was 90% or more and false negative <10% or almost same. ResultsA total of 111 eligible patients with breast cancer were gathered in the study, 64 of whom with axillary pCR. There were 43 patients of MP grade 5 without DCIS after NAT, 41 of whom were axillary pCR. The univariate analysis results showed that the estrogen receptor and progesterone receptor statuses, molecular type, NAT regimen, and MP grade were associated with the axillary pCR after NAT, then the logistic regression multivariate analysis results showed that the MP grade ≤3 and MP grade 4 decreased the probability of axillary pCR as compared with the MP grade 5 [OR=0.105, 95%CI (0.028, 0.391), P=0.001; OR=0.045, 95%CI (0.012, 0.172), P<0.001]. There were 51 patients of MP grade 5 after NAT, 46 of whom were axillary pCR. The negative predictive value and the false negative rate of MP grade 5 on predicting the postoperative residual axillary lymph nodes were 90.2% [95%CI (81.7%, 98.6%)] and 10.6% [95%CI (1.5%, 19.8%)], respectively, which of MP grade 5 without DCIS were 95.3% [95%CI (88.8%, 101.9%)] and 4.3% [95%CI (–1.7%, 10.2%)] , respectively. ConclusionsThe probability of axillary pCR for the patient with higher MP grade of breast primary after NAT is higher. It is probable of exempting axillary surgery when MP grade is 5 after NAT.
Objective To discuss the performance of multi-disciplinary team (MDT) of colorectal cancer treatment within West China Hospital in Sichuan University. Methods To compare the therapeutic effect between groups of MDT model and non-MDT model by retrospectively analyzing the data of patients who diagnosed colorectal cancer and accepted in-hospital therapy during December 2006 and May 2007. Results The in-hospital days of the MDT model group during the perioperative period and in the surgical ward were less than that of the non-MDT model group ( Plt; 0. 05) , but there was no significant difference between the two groups about the total hospitalization time. And the MDT model group had a higher rate of cancer resection ( P lt; 0. 05) . Although the incidence of anastomotic leakage and bleeding as early postoperative complications didn’t show any variations between the two groups , the non-MDT model groupencountered more early postoperative ileus ( Plt; 0. 05) . During the 5－ 10 months follow-up , there came out less cancer recurrence rate in the MDT model group than the other ( P lt; 0. 05) . And the morbidity of anastomotic stricture and ileus didn’t show any statistical difference between the two groups. Conclusion The combined-therapy st rategy ofcolorectal cancer has showed a priority to routine ways , not only the more reasonable time arrangement for therapy , but also the more satisfied surgical outcomes. However , the factors correlated to the efficacy of the MDT model are not clear ; the MDT model still needs to be improved that a morereasonable and effective perioperative MDT model may come t rue.
We reported three cases of stageⅢ/N2 non-small cell lung cancer (NSCLC) treated with neoadjuvant immunotherapy and stereotactic body radiation therapy (SBRT) in our hospital, including 2 males and 1 female with a mean age of 65.7 years. The patients received two doses of the programmed cell death protein-1 inhibitor toripalimab after 1 week of SBRT. Thereafter, surgery was planned 4-6 weeks after the second dose. One patient achieved pathologic complete response, one achieved major pathologic response (MPR), and one did not achieve MPR with 20% residual tumor. There were few side effects of toripalimab combined with SBRT as a neoadjuvant treatment, and the treatment did not cause a delay of surgery.
In this paper, systematic reviews, randomized controlled trials and other relevant studies on surgical and adjuvant therapy following operative therapy in renal cancer were identified by searching the Guidelines International Network, ACP Journal Club, the Cochrane Library （Issue 3, 2005 ） , MEDLINE, EMBASE and CBMdisc （ from 1996 to Sept. 2005）. In operative therapy, we found no study comparing operative therapy with no treatment or adjuvant therapy alone; A meta-analysis of cytoreductive nephrectomy in patients with metastatic renal cancer showed adjuvant therapy following nephrectomy was more effective than adjuvant therapy alone; a review comparing radical nephrectomy with nephron-sparing surgery in small-volume renal tumors found similar effectiveness between the two procedures. In the adjuvant therapy following nephrectomy, ten RCTs found adjuvant cytokine therapy （Interferon and Interleukin-2 ） and 5-FU not effective in the adjuvant setting, and could increase adverse reaction; Four RCTs found adjuvant vaccine therapy effective in the adjuvant setting with only a few side effects.
Objective To analyze the relation between the marital status of patients with colorectal cancer and neoadjuvant therapy (NAT) regimen decision-making and outcomes in the current version of the Database from Colorectal Cancer (DACCA). Methods The version of DACCA selected for this analysis was updated on June 29, 2022. The patients were enrolled according to the established screening criteria and then assigned to 5 groups: the unmarried, married, divorced, remarried and widowed groups. The differences in the NAT regimen decision-making and changes of symptom, imaging, and cancer markers in these 5 groups were analyzed. Results A total of 3 053 data that met the screened criteria were enrolled. The results of statistical analysis reflected that the difference in the constituent ratio of patients chosen NAT strategies among 5 groups was obviously statistically significant (χ2=27.944, P=0.004), showing that remarried patients were inclined to adopt combined target drug. No statistical differences were found in changes of symptom (H=5.717, P=0.221), image (H=8.551, P=0.073), and cancer markers (H=11.351, P=0.183) of the 5 groups after NAT. Conclusion Through analysis of DACCA data, it is found that in the selection of NAT strategy for colorectal cancer, more married and remarried patients tended to choose chemotherapy combined target drug regimen.
ObjectiveTo summarize the current research progress in the prediction of the efficacy of neoadjuvant therapy of breast cancer based on the application of artificial intelligence (AI) and radiomics. MethodThe researches on the application of AI and radiomics in neoadjuvant therapy of breast cancer in recent 5 years at home and abroad were searched in CNKI, Google Scholar, Wanfang database and PubMed database, and the related research progress was reviewed. ResultsAI had developed rapidly in the field of medical imaging, and molybdenum target, ultrasound and magnetic resonance imaging combined with AI had been deepened and expanded in different degrees in the application research of breast cancer diagnosis and treatment. In the research of molybdenum target combined with AI, the high sensitivity of molybdenum target to microcalcification was mostly used to improve the accuracy of early detection and diagnosis of breast cancer, so as to achieve the clinical purpose of early detection and diagnosis. However, in terms of prediction of neoadjuvant efficacy research of breast cancer, ultrasound and magnetic resonance imaging combined with AI were more prevalent, and their popularity remained unabated. ConclusionIn the monitoring of neoadjuvant therapy for breast cancer, the use of properly designed AI and radiomics models can give full play to its role in the predicting the curative effect of neoadjuvant therapy, and help to guide doctors in clinical diagnosis and treatment and evaluate the prognosis of breast cancer patients.
Bladder cancer is one of the most common cancers of the urinary system. Baesd on the involvement of the blandder muscle or not, bladder cancer can be generally classified into muscule-invasive bladder cancer (MIBC) and non-MIBC. Cisplatin-based neoadjuvant chemotherapy followed by radical cystectomy is the standard treament recommended by current guidelines for MIBC. Based on the good efficacy of immunocheckpoint inhibitors in advanced bladder cancer. More and more studies have explored the safety and efficacy of immunotherapy in MIBC neoadjuvant therapy, and analyzed biomarkers to explore the benefit groups. This article reviews the latest progress of various neoadjuvant immunomonotherapy in MIBC, and prospect the future direction of development.