The standard treatment for locally advanced rectal cancer is neoadjuvant chemoradiotherapy combined with surgery, but patients after the same treatment regimen show a large difference in outcomes. For patients with good response to neoadjuvant therapy, the waiting & observation scheme can be selected to avoid surgery and other complications. Therefore, accurate assessment of the response of patients with locally advanced rectal cancer after neoadjuvant therapy can better develop personalized treatment strategies. Current studies have found that blood sample detection, endoscopy, imaging examination and artificial intelligence have their own advantages and disadvantages in evaluating the response of neoadjuvant therapy. Therefore, this article reviews the application of different clinical tools in evaluating and predicting the response of neoadjuvant therapy for locally advanced rectal cancer, and looks forward to the future development direction.
ObjectiveTo analyze the details and efficacy of neoadjuvant therapy of colorectal cancer in the current version of Database from Colorectal Cancer (DACCA).MethodsThe DACCA version selected for this data analysis was the updated version on July 28th, 2020. The data items included “planned strategy of neoadjuvant therapy” “compliance of neoadjuvant therapy”, and “cycles of neoadjuvant therapy”. Item of “planned strategy of neoadjuvant therapy” included “accuracy of neoadjuvant therapy” and “once included in researches”. Item of “the intensity of neoadjuvant therapy” included “chemotherapy” “cycles of neoadjuvant therapy” “targeted drugs”, and “neoadjuvant radiotherapy”. Item of “effect of neoadjuvant therapy” included CEA value of “pre-neoadjuvant therapy” and “post-neoadjuvant therapy”“variation of tumor markers” “variation of symptom” “variation of gross” “variation of radiography”, and tumor regression grade (TRG). The selected data items were statistically analyzed.ResultsThe total number of medical records (data rows) that met the criteria was 7 513, including 2 539 (33.8%) valid data on the “accuracy of neoadjuvant therapy”, 498 (6.6%) valid data on “once included in researches”, 637 (8.5%) valid data on the “compliance of neoadjuvant therapy”, 2 077 (27.6%) valid data on “neoadjuvant chemotherapy”, 614 (8.2%) valid data on “cycles of neoadjuvant therapy”, 455 (6.1%) valid data on “targeted drugs”, 135 (1.8%) valid data on “neoadjuvant radiotherapy”, 5 022 (66.8%) valid data on “pre-neoadjuvant therapy CEA value”, 818 (10.9%) valid data on “post-neoadjuvant therapy CEA value ”, 614 (8.2%) valid data on “variation of tumor marker”, 464 (6.2%) valid data on “variation of symptom”, 478 (6.4%) valid data on “variation of gross”, 492 (6.5%) valid data on “variation of radiography”, and 459 (6.1%) valid data on TRG. During the correlation analysis, it appeared that “variation of tumor marker” and “variation of gross” (χ2=6.26, P=0.02), “variation of symptom” and “variation of gross”, “radiography” and TRG (χ2=53.71, P<0.01; χ2=38.41, P<0.01; χ2=8.68, P<0.01), “variation of gross” and “variation of radiography”, and TRG (χ2=44.41, P<0.01; χ2=100.37, P<0.01), “variation of radiography” and TRG (χ2=31.52, P<0.01) were related with each other.ConclusionsThe protocol choosing of neoadjuvant therapy has a room for further research and DACCA can provide data support for those who is willing to perform neoadjuvant therapy. The efficacy indicators of neoadjuvant therapy have association with each other, the better understand of it will provide more valuable information for the establishment of therapeutic prediction model.
ObjectiveTo summarize the current treatment status and progress of neoadjuvant chemotherapy for pancreatic cancer in order to improve the understanding of neoadjuvant chemotherapy and to guide clinical work.MethodThe relevant literatures at home and abroad on neoadjuvant chemotherapy for pancreatic cancer were readed and reviewed.ResultsNeoadjuvant chemotherapy could reduce tumor lesions, increase R0 resection rate, decrease postoperative complication rate, and improve patients’ survival, however, there was currently no high quality evidence-based medicine proof. At present, there was no unified neoadjuvant chemotherapy regimens for pancreatic cancer in the world. FOLFIRINOX, gemcitabine plus S-1, and gencitabine plus Nab-paclitaxel were the three common regimens we used. In addition, the neoadjuvant chemotherapy of pancreatic cancer had no uniform standard, and there were insufficient methods for evaluating therapeutic effects.ConclusionAlthough there are still some core problems need to be solved in neoadjuvant chemotherapy for pancreatic cancer, however, it’s curative effect is gradually recognized and widely used by clinicians, which is beneficial to provide a better prognosis for pancreatic cancer patients.
ObjectiveTo analyze the relation between the age 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). MethodsThe version of DACCA selected for this analysis was updated on January 5, 2022. The patients were enrolled according to the established screening criteria and then assigned to 3 age groups: ≤45, 45–65, and ≥65 years old groups. The differences in the NAT regimen decision-making and changes of symptom, imaging, and cancer markers in these 3 age groups were analyzed. ResultsA total of 4 882 data that met the screened criteria were enrolled. The results of statistical analysis showed that the difference in the constituent ratio of patients chosen NAT strategies among 3 age groups was not statistically significant (χ2=8.885, P=0.180). There was a statistical difference in the constituent ratio of patients chosen combined target drug among 3 age groups (χ2=8.530, P=0.014), it was found that the proportion of the patients with ≤45 years old adopting combined target drug regimen was higher. Although the changes of symptom (H=12.299, P=0.056), image (H=1.775, P=0.412), and cancer markers (H=11.351, P=0.183) had no statistical differences of the 3 age groups after NAT, it was found that the proportions of patients with ≥65 years old with progresses of symptom and imaging changes and elevated cancer markers after NAT were higher, and the proportions of patients with ≤45 years old with complete and partial remissions of symptom and imaging changes and with normal cancer markers after NAT were higher. ConclusionsThrough analysis of DACCA data, it is found that in the selection of NAT strategy for colorectal cancer, the lower age group, the higher proportion of patients adopting combined target drug regimen. Although it is not found that age is related to changes of symptoms, imaging, and cancer markers after NAT, it still shows a trend of better outcomes in younger patients.
Neoadjuvant therapy has become the standard treatment for locally advanced resectable esophageal cancer, significantly improving long-term survival compared to surgery alone. Neoadjuvant therapy has evolved to include various strategies, such as concurrent chemoradiotherapy, chemotherapy, immunotherapy, or targeted combination therapy. This enriches clinical treatment options and provides a more personalized and scientific treatment approach for patients. This article aims to comprehensively summarize current academic research hot topics, review the rationale and evaluation measures of neoadjuvant therapy, discuss challenges in restaging methods after neoadjuvant therapy, and identify the advantages and disadvantages of various neoadjuvant therapeutic strategies.
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 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 summarize recent research on the surgical treatment of breast cancer after neoadjuvant chemotherapy (NAC) and to review the impact of NAC on the surgical treatment of breast cancer. MethodRelevant studies on NAC and surgical treatment of breast cancer from both domestic and international sources were reviewed. The literatures were analyzed, summarized, and discussed. ResultsFollowing NAC, the survival outcomes and risk of local recurrence in patients undergoing breast-conserving surgery were similar to those undergoing mastectomy. The using of image-guided minimally invasive biopsy accurately predicted pathological complete remission (pCR) of breast lesions after NAC, potentially allowed some breast cancer patients to undergo only radiation therapy after NAC, thus avoiding breast surgery. For patients with positive axillary lymph nodes, techniques such as dual-tracer, triple-tracer, and targeted axillary lymph node dissection had achieved clinical requirements in terms of detection rate and false-negative rate of sentinel lymph node biopsy, provided a safe alternative to axillary lymph node dissection. ConclusionsNAC is an important component of comprehensive breast cancer treatment. However, there is still controversy regarding the local treatment of the primary breast lesion and axillary lymph nodes after NAC. Currently, individualized treatment based on the specific circumstances of the patient remains the approach in clinical practice, aiming to achieve the optimal control of local recurrence and survival benefits for patients.
ObjectiveTo explore the predictive value of the pre-treatment systemic immune-inflammation index (SII) for major pathological response (MPR) after neoadjuvant immunochemotherapy (nICT) in esophageal cancer, and to construct a clinical prediction model combined with relevant clinical characteristics. Methods Retrospective collection of clinical data from patients with locally advanced esophageal cancer who received nICT followed by radical surgery at the First People’s Hospital of Jining from January 2022 to June 2023. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of pre-treatment SII and neutrophil-lymphocyte ratio (NLR) for the efficacy of nICT in esophageal cancer. The optimal cut-off value was determined based on the maximum Youden index. Further, univariate and multivariate logistic regression analyses were employed to identify predictors for MPR after nICT in esophageal cancer and to construct a nomogram model. The model was evaluated using the area under the ROC curve (AUC), and internal validation was conducted using the Bootstrap method. ResultsA total of 63 patients were included, with 38 males and 25 females, and a median age of 67 (49-79) years. The ROC curve indicated that the optimal cut-off value for pre-treatment SII was 521.7, with an AUC of 0.701 [95%CI (0.564, 0.838)] for predicting MPR after nICT in esophageal cancer. The ROC curve showed that the optimal cut-off value for pre-treatment NLR was 2.32, with an AUC of 0.681 [95%CI (0.544, 0.818)]. Multivariate logistic regression analysis results revealed cT stage [OR=0.232, 95%CI (0.071, 0.759), P=0.016] and SII [OR=5.477, 95%CI (1.584, 18.939), P=0.007] as independent predictors for MPR after nICT in esophageal cancer. Based on the multivariate logistic regression results, a clinical prediction model was constructed, with an AUC of 0.767 on the ROC curve. The calibration plot showed a good agreement between the prediction curve and the ideal curve. ConclusionPre-treatment SII can serve as an independent predictive indicator for MPR in patients with esophageal cancer after nICT. The clinical model, established in combination with cT stage, can better predict the efficacy of nICT in esophageal cancer.
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.
