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 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.
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 understand the progress of postmastectomy radiotherapy (PMRT) in patients with T1–2N1M0 breast cancer. MethodThe studies and the treatment guidelines relevant to PMRT in the patients with T1–2N1M0 breast cancer in recent years were analyzed and summarized. ResultsThe ability of PMRT to improve the prognosis of patients with T1–2N1M0 breast cancer remained controversial. Owing to the patients with T1–2N1M0 breast cancer were heterogeneous, and the indications for PMRT had not been standardized. With the increasing use of neoadjuvant chemotherapy for early-stage breast cancer, some studies had attempted to formulate decisions about PMRT based on changes in tumor characteristics before and after neoadjuvant chemotherapy, but the findings were currently controversial. ConclusionsWhether PMRT can improve prognosis and decision-making for patients with T1–2N1M0 breast cancer is still controversial. Some ongoing clinical trials may provide some references for the optimal decision-making of PMRT for patients with T1–2N1M0 breast cancer.
ObjectiveTo investigate the differences between indocyanine green (ICG) plus methylene blue and radioactive nuclide plus methylene blue for sentinel lymph node biopsy (SLNB) after Neoadjuvant chemotherapy (NAC) in breast cancer patients. Methods A total of 77 breast cancer patients who accepted SLNB and axillary lymph node dissection (ALND) after NAC from June 2017 to February 2019 were involved, among them, 46 breast cancer patients accepted SLNB by ICG plus methylene blue and 31 breast cancer patients accepted SLNB by radioactive nuclide plus methylene blue, pathological and clinical data were collected and analyzed.ResultsThere were 43 patients in the ICG plus methylene blue group and 30 patients in radioactive nuclide plus methylene blue group, which totally 73 patients were detected at least one sentinel lymph node in all the 77 patients, and the detection rate was 94.80%. The SLN detected rate, SLN detected numbers, sensitivity, false negative rate, and accuracy of the ICG plus methylene blue group were 93.48% (43/46), 2.32 per case, 82.61% (19/23), 17.39% (4/23), and 90.70% (39/43) respectively, as well as 96.77% (30/31), 2.6 per case, 83.33% (10/12), 16.67% (2/10), and 93.33% (28/30) in the radioactive nuclide plus methylene blue group. There was no significant difference between the ICG plus methylene blue group and radioactive nuclide plus methylene blue group in terms of SLN detected rate, SLN detected numbers, sensitivity, false negative rate, and accuracy (P>0.05).ConclusionICG plus methylene blue showed similar SLN detection rate, SLN detected numbers, sensitivity, false negative rate, and accuracy as radioactive nuclide plus methylene blue for SLNB in breast cancer patients after NAC, and both of them can be performed easily and conveniently.
Objective To summarize the progress of biological indexes which could predict the efficiency of neoadjuvant chemotherapy for breast cancer. Methods Various related researches were collected to make a review. Results Many indexes linked to the efficiency of neoadjuvant chemotherapy for breast cancer according to several studies. According to many studies, indexes such as human epidermal growth factor receptor-2 (HER-2) gene, estrogen receptor (ER), progesterone receptor (PR), Ki-67, P53 gene, neutrophil to lymphocyte ratio (NLR), platelet level, and mean platelet volume (MPV) may have association with the outcome of neoadjuvant chemotherapy in treatment of breast cancer, and these factors maybe individual biomarkers to predict the efficiency of the treatment, but no coincident conclusion has been reached for these indexes. Conclusion The value of these indexes that predict the efficiency of neoadjuvant chemotherapy is not sure, further study need to be done to solve this topic.
Objective To investigate the effect of radiotherapy after neoadjuvant chemotherapy and modified radical surgery on breast cancer specific survival (BCSS) of patients with stage cT1–2N1M0 breast cancer. Methods A total of 917 cT1–2N1M0 stage breast cancer patients treated with neoadjuvant chemotherapy and modified radical surgery from 2010 to 2017 were extracted from the The Surveillance, Epidemiology, and End Results (SEER) database. Of them 720 matched patients were divided into radiotherapy group (n=360) and non-radiotherapy group (n=360) by using propensity score matching (PSM). Cox proportional hazard regression model was used to explore the factors affecting BCSS. Results Patients were all interviewed for a median follow-up of 65 months, and the 5-year BCSS was 91.9% in the radiotherapy group and 93.2% in the non-radiotherapy group, there was no significant difference between the 2 groups (χ2=0.292, P=0.589). The results were the same in patients with no axillary lymph node metastasis, one axillary lymphnode metastasis, two axillary lymph node metastasis and 3 axillary lymph node metastasis group (χ2=0.139, P=0.709; χ2=0.578, P=0.447; χ2=2.617, P=0.106; χ2=0.062, P=0.803). The result of Cox proportional hazard regression analysis showed that, after controlling for Grade grade, time from diagnosis to treatment, efficacy of neoadjuvant chemotherapy, number of positive axillary lymph nodes, molecular typing, and tumor diameter at first diagnosis, radiotherapy had no statistically significant effect on BCSS [HR=1.048, 95%CI (0.704, 1.561), P=0.817]. Conclusions The effect of radiotherapy on the BCSS of patients with stage cT1–2N1M0 breast cancer who have received neoadjuvant chemotherapy and modified radical surgery with 0 to 3 axillary lymph nodes metastases is limited, but whether to undergo radiotherapy should still be determined according to the comprehensive risk of individual tumor patients.