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 analyze the characteristics of adjuvant treatment of colorectal cancer in the Database from Colorectal Cancer (DACCA).MethodsThe informations in the DACCA database were screened, including adjuvant therapy (adjuvant strategy, compliance), adjuvant chemotherapy (indication selection, acceptance, actual cycles of chemotherapy, effect, and standardized application), adjuvant radiotherapy (indication selection, acceptance, and effect), and targeted therapy (uses of oral and intravenous targeted drugs). The data that at least one of items must not be “empty” were selected.ResultsA total of 3 955 data items were analyzed for colorectal cancer adjuvant therapy. ① The highest data composition ratio of “planned strategy of adjuvant therapy” and “compliance of adjuvant therapy” was “adjuvant therapy” (35.6%, 929/2 611) and “coordination” (28.1%, 664/2362), respectively. ② The highest data composition ratios of “indication of chemotherapy”, “acceptance of chemotherapy”, “cycles of chemotherapy”, “effect of chemotherapy”, and “chemotherapy based guidelines” were “must” (38.6%, 1 140/2 963), “rejection” (53.1%, 1 373/2 586), “6-cycle adjuvant chemotherapy” (12.4%, 338/2 722), “stability” (59.9%, 618/1031), and “standardization” (78.6%, 903/1 149). There was an obvious relationship between the planned strategy of adjuvant chemotherapy and the final acceptance of chemotherapy (χ2=505.262, P<0.001), that was, when the planned strategy of adjuvant chemotherapy was “optional”, the proportion of final rejection was very high (89.0%, 137/154). ③ The highest data composition ratios of “indication of radiation”, “acceptance of radiation”, and “effect of radiation” were “unnecessary” (49.1%, 1 423/2 915), “rejection” (93.8%, 2 629/2 803), and “stability” (38.1%, 45/118). There was a correlation between the planned strategy of adjuvant radiotherapy and the final acceptance of radiotherapy (χ2=139.593, P<0.001), that was, when the patients who should receive radiotherapy had not high acceptance (10.6%, 127/1 194), and the patients who should select optional radiotherapy all refused radiotherapy (100%).④ The data composition ratios of “none” of oral and intravenous targeted therapy drugs in targeted therapy were the highest, at 84.2% (2 121/2 520) and 73.3% (206/281), respectively. ConclusionBy expounding the characteristics of the current adjuvant treatment of colorectal cancer in DACCA, it provides a reference for the adjuvant treatment of colorectal cancer.
ObjectiveTo summarize the progress of research on the interaction between bariatric surgery and intestinal flora at home and abroad in recent years, in order to provide new ideas for promoting recovery after bariatric surgery. MethodThe domestic and international literature of intestinal flora changes after bariatric surgery was searched and reviewed. ResultsThe main changes of the intestinal flora after bariatric surgery showed that the abundance of thick-walled bacteria was decreased and the numbers of Bacteroides and Aspergillus were increased. Some common complications after bariatric surgery such as anastomotic fistula, nutritional deficiencies, and inflammation were related to the intestinal flora imbalance. Supplementation with probiotics, prebiotics, dietary interventions, or fecal microbial transplantation were expected to reduce the incidence of complications after bariatric surgery. ConclusionsBariatric surgery is a durable and effective method for treating obesity and its comorbidities. Changes in individual intestinal flora after bariatric surgery have an impact on both weight loss outcomes and postoperative complications, and it is important to find ways to reduce postoperative complications after bariatric surgery by improving intestinal flora.
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 understand the impact of preoperative nutritional status on the postoperative complications for patients with low/ultra-low rectal cancer undergoing extreme sphincter-preserving surgery following neoadjuvant therapy. MethodsThe patients with low/ultra-low rectal cancer who underwent extreme sphincter-preserving surgery following neoadjuvant therapy from January 2009 to December 2020 were retrospectively collected using the Database from Colorectal Cancer (DACCA), and then who were assigned into a nutritional risk group (the score was low than 3 by the Nutrition Risk Screening 2002) and non-nutritional risk group (the score was 3 or more by the Nutrition Risk Screening 2002). The postoperative complications and survival were analyzed for the patients with or without nutritional risk. The postoperative complications were defined as early-term (complications occurring within 30 d after surgery), middle-term (complications occurring during 30–180 d after surgery), and long-term (complications occurring at 180 d and more after surgery). The survival indicators included overall survival and disease-specific survival. ResultsA total of 680 patients who met the inclusion criteria for this study were retrieved from the DACCA database. Among them, there were 500 (73.5%) patients without nutritional risk and 180 (26.5%) patients with nutritional risk. The postoperative follow-up time was 0–152 months (with average 48.9 months). Five hundreds and forty-three survived, including 471 (86.7%) patients with free-tumors survival and 72 (13.3%) patients with tumors survival. There were 137 deaths, including 122 (89.1%) patients with cancer related deaths and 15 (10.9%) patients with non-cancer related deaths. There were 48 (7.1%) cases of early-term postoperative complications, 51 (7.5%) cases of middle-term complications, and 17 (2.5%) cases of long-term complications. There were no statistical differences in the incidence of overall complications between the patients with and without nutritional risk (χ2=3.749, P=0.053; χ2=2.205, P=0.138; χ2=310, P=0.578). The specific complications at different stages after surgery (excluding the anastomotic leakage complications in the patients with nutritional risk was higher in patients without nutritional risk, P=0.034) had no statistical differences between the two groups (P>0.05). The survival curves (overall survival and disease-specific survival) using the Kaplan-Meier method had no statistical differences between the patients with and without nutritional risk (χ2=3.316, P=0.069; χ2=3.712, P=0.054). ConclusionsFrom the analysis results of this study, for the rectal cancer patients who underwent extreme sphincter-preserving surgery following neoadjuvant therapy, the patients with preoperative nutritional risk are more prone to anastomotic leakage within 30 d after surgery. Although other postoperative complications and long-term survival outcomes have no statistical differences between patients with and without nutritional risk, preoperative nutritional management for them cannot be ignored.
ObjectiveTo investigate the value of a predictive model for sentinel lymph node (SLN) metastasis after neoadjuvant therapy (NAT) based on the radiomic features from multi-modality magnetic resonance imaging (MRI) in combination with clinicopathologic data. MethodsThe clinical data and MRI images of breast cancer patients (initially diagnosed with cN0, all underwent NAT and surgical treatment) from two hospitals (Affiliated Hospital of Southwest Medical University and Suining Central Hospital) from January 2018 to September 2024, were retrospectively collected. The radiomic features from the multi-modality images, including T2-weighted short tau inversion recovery (T2STIR), diffusion-weighted imaging (DWI), dynamic contrast-enhanced (DCE), were extracted and selected. The predictive models for SLN metastasis after NAT were constructed using four algorithms: LightGBM, XGBoost, support vector machine (SVM), and logistic regression (LR), in combination with clinicopathologic data. The models were evaluated for performance and interpretability using receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis, and Shapley additive explanation (SHAP) analysis. ResultsA total of 236 breast cancer patients were enrolled in this study. Among them, 216 patients from the Southwest Medical University were subdivided in an 8∶2 ratio into a training set (n=173) and internal validation set (n=43), while 20 patients from the Suining Central Hospital served as the external validation set. The multivariate logistic regression analysis showed that the lymphovascular invasion [OR (95%CI)=21.215 (4.404, 102.202), P ＜0.001] and perineural invasion [OR (95%CI)=25.867 (1.870, 357.790), P=0.002] were the risk factors, while high Ki-67 expression [OR (95%CI)=0.119 (0.035, 0.404), P＜0.001] was the protective factor of SLN metastasis after NAT. The predictive models utilizing multi-modality MRI and clinicopathologic data yielded area under the ROC curve values of the internal and external validation sets of 0.750 [95%CI=(0.395, 1.000)] / 0.625 [95%CI=(0.321, 0.926)] for LightGBM, 0.878 [95%CI=(0.707, 1.000)] / 0.778 [95%CI=(0.525, 0.986)] for XGBoost, 0.641 [95%CI=(0.488, 0.795)] / 0.681 [95%CI=(0.345, 1.000)] for SVM, and 0.667 [95%CI=(0.357, 0.945)] / 0.583 [95%CI=(0.196, 0.969)] for LR. The XGBoost demonstrated the best predictive performance. Further SHAP analysis revealed that the lymphovascular invasion, T2STAR-MRI_FIRSTORDER_Minimum, and platelet were the key features influencing the predictions of the models. ConclusionThe findings of this study suggest that XGBoost prediction model based on radiomic features derived from multi-modality MRI (T2STIR, DWI, and DCE) in combination with clinicopathologic data is able to predict SLN metastasis after NAT in patients with breast cancer.
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.
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.
Surgery remains as the primary definitive therapy for resectable non-small cell lung cancer (NSCLC) currently. However, quite a few NSCLC patients, especially in the later stage, suffered tumor recurrence after resection. Safer and more effective perioperative treatment is urgently needed to reduce the recurrence risk after NSCLC surgery. Immune checkpoint inhibitors can effectively prevent tumor immune evasion and have been shown to be a feasible, safe and effective neoadjuvant therapy for resectable NSCLC. Nevertheless, certain crucial problems, including the final effect on NSCLC recurrence, the selection of beneficial group and optimal treatment protocol are yet unsolved. Fortunately, several phase Ⅲ randomized controlled trials are ongoing to answer these questions and will hopefully provide stronger evidence.
ObjectiveTo analyze the relation between educational level of patients with colorectal cancer (CRC) and decision-making and curative effect of neoadjuvant therapy (NAT) in the current version of the Database from Colorectal Cancer (DACCA). MethodsThe eligible CRC patients were collected from June 29, 2022 updated DACCA according to the screening criteria and were assigned into 4 groups according to their educational level, namely, uneducated, primary educated, secondary educated, and tertiary educated. The differences in NAT decision-making, cancer marker change, symptomatic change, gross change, imaging change, and tumor regression grade (TRG) among the CRC patients with different educational levels were compared. ResultsA total of 2 816 data that met the screening criteria were collected, 138 of whom were uneducated, 777 of whom were primary educated, 1 414 of whom were secondary educated, and 487 of whom were tertiary educated. The analysis results revealed that the difference in the composition ratio of patients choosing NAT regimens by educational level was statistically significant (χ2=30.937, P<0.001), which was reflected that the composition ratio of choosing a simple chemotherapy regimen in the uneducated CRC patients was highest, while which of choosing combined targeted therapy regimen in the tertiary educated CRC patients was highest. In terms of treatment outcomes, the composition ratios of changes in cancer markers (H=4.795, P=0.187), symptoms (H=1.722, P=0.632), gross (H=2.524, P=0.471), imaging (H=2.843, P=0.416), and TRG (H=2.346, P=0.504) had no statistical differences. ConclusionsThrough data analysis in DACCA, it is found that the educational level of patients with CRC can affect the choice of NAT scheme. However, it is not found that the educational level is related to the changes in the curative effect of patients with CRC before and after NAT, and further analysis is needed to determine the reasons for this.
