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Biliary tract cancers (BTC) is a type of digestive tract malignant tumors that originate from biliary epithelial cells, is characterized by strong occult and highly invasive, and has a high mortality rate. Early detection and diagnosis are considered to be the key to obtaining radical surgical treatment. R0 resection is an effective measure to benefit patients with BTC. However, most of the patients present with local progression or associated distant metastasis, making it impossible to undergo radical surgical treatment. With existing diagnosis and treatment methods, the 5-year survival rate of patients is still very low. Therefore, how to improve the level of diagnosis and treatment of BTC, prolong survival, and improve the quality of life has become an urgent problem to be solved. In view of the characteristics of BTC and the continuous deepening of clinical pathological molecular research, adjuvant therapy, precisely targeted therapy, immunotherapy, and comprehensive treatment are currently considered to be standardized diagnosis and treatment models and research directions beyond surgery. Therefore, this article systematically analyzes the current research progress of BTC both domestically and internationally, aiming to provide strategies for the diagnosis and treatment of patients with BTC.
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Renal cell carcinoma (RCC) is the third most common malignant tumor of the genitourinary system. During disease progression, RCC can undergo local and/or distant metastasis, which seriously affects the prognosis of the patient. With the advancements in targeted therapy and immunotherapy for advanced RCC, treatment for locally advanced RCC has changed. Studies have focused on applying targeted therapy or immunotherapy in the perioperative period. This article aims to review progress on treatment of locally advanced RCC to offer references for novel treatment strategies.
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Clinical studies have established the clinical application of epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) adjuvant targeted therapy. Compared with chemotherapy, the high efficiency and low toxicity of targeted therapy increases the survival benefit of patients. Icotinib was the first EGFR-TKI with independent intellectual property rights in China and the third EGFR-TKI to be marketed in the world. In order to summarize the experience of icotinib and other EGFR-TKIs in the adjuvant treatment of non-small cell lung cancer and further standardize and guide the clinical application of icotinib, experts from the China International Exchange and Promotive Association for Medical and Health Care and the Guangdong Association of Thoracic Diseases have organized an expert consensus on the adjuvant treatment of non-small cell lung cancer with icotinib, which is expected to provide clinicians with evidence-based medical evidences for postoperative targeted drug using.
Subject(s)
Humans , Carcinoma, Non-Small-Cell Lung , Lung Neoplasms/surgery , Consensus , Mutation , ErbB Receptors/genetics , Crown Ethers/therapeutic use , Protein Kinase Inhibitors/therapeutic useABSTRACT
@#Introduction: Depression is a mental disorder that is increasingly common nowadays. It can emerge as morbidity in chronic diseases such as rheumatoid arthritis (RA). The leaf extract of Moringa oleifera (MO) has shown to be a complementary therapy in depression, besides its anti-inflammatory role. This study aimed to evaluate the effect of MO leaf extract on Depression in RA patients. Methods: This quasi-experimental study with a pretest-posttest control group design comprised 32 RA patients. The participants were divided into the control (n = 16) and intervention (n = 16) groups. The intervention group received two MO leaf extract-containing capsules b.i.d. for 28 days. The depression was evaluated by Beck Depression Inventory (BDI-II) and serum cortisol test. Statistical analyses used both paired and unpaired t-tests. Results: The posttest means comparison of BDI-II and serum cortisol showed a significant difference between groups (p = 0.031 and p = 0.015, respectively). The pretest-posttest difference within the control group did not show significant improvement in BDI-II and serum cortisol (p = 0.076 and p = 0.106). Meanwhile, significant BDI-II and serum cortisol improvement were found in the intervention group (p = 0.003 and p = 0.048, respectively). Conclusion: MO leaf extract reduces depression in RA patients based on BDI-II and serum cortisol assessment.
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Objective:To investigate the treatment efficacy of adjuvant anti-VEGF/VEGFR targeted therapy in patients with non-metastatic (cM 0) non-clear cell renal cell carcinoma and tumor thrombus (nccRCC-VTT). Methods:This retrospective study enrolled 26 patients who underwent radical nephrectomy combined with inferior vena cava tumor thrombectomy at Peking University Third Hospital from January 2014 to July 2021. Patients were divided into adjuvant therapy group (10 cases) and control group (16 cases)based on the use of postoperative targeted therapy. The distribution of baseline clinical characteristics in the adjuvant therapy group and the control group were as follows: gender (6 males and 4 females in the adjuvant therapy group, 12 males and 4 females in the control group, P=0.66), age (56.2±18.5 years old in the adjuvant therapy group; 54.6±14.5 years old in the control group; P=0.80), BMI(24.0±3.5 in the adjuvant therapy group; 24.3±3.3 in the control group; P=0.80), presence of clinical symptoms (8 cases in the adjuvant therapy group; 15 cases in the control group; P=0.54), tumor laterality(6 cases on the left and 4 cases on the right in the adjuvant therapy group; 6 cases on the left and 10 cases on the right in the control group; P=0.42), location of tumor thrombus (2 cases with renal vein tumor thrombus and 8 cases with inferior vena cava tumor thrombus in the adjuvant therapy group; 2 cases with renal vein tumor thrombus and 14 cases with inferior vena cava tumor thrombus in the control group; P=0.67), ASA classification (2 cases in ASA class 1 and 8 cases in ASA class 2 in the adjuvant therapy group; 2 cases in ASA class 1 and 14 cases in ASA class 2 in the control group; P=0.63), surgical approach (7 minimally invasive surgeries and 3 open surgeries in the adjuvant therapy group; 9 minimally invasive surgeries and 7 open surgeries in the control group; P=0.68), conversion to open surgery (2 cases in the adjuvant therapy group; 2 cases in the control group; P=0.63), operation time [287.5(222.2, 456.0) minutes in the adjuvant therapy group; 344.0(287.8, 482.5) minutes in the control group; P=0.34), blood loss [400.0(250.0, 600.0)ml in the adjuvant therapy group; 575.0(175.0, 800.0)ml in the control group; P=0.63), Clavien-Dindo classification of postoperative complications (8 cases with no postoperative complications, 2 cases with level 1-2 complications, and 0 cases with level ≥3 complications in the adjuvant therapy group; 10 cases with no postoperative complications, 4 cases with level 1-2 complications, and 2 cases with level ≥3 complications in the control group; P=0.68), postoperative hospital stay (8.5 [5.5, 11.5] days in the adjuvant therapy group; 7.5 [6.0, 13.0] days in the control group; P=1.00), maximum tumor diameter[ (9.2±2.7)cm in the adjuvant therapy group; (8.9±3.3)cm in the control group; P=0.81], sarcomatoid differentiation (0 cases in the adjuvant therapy group; 1 case in the control group; P=1.00), perinephric fat invasion (2 cases in the adjuvant therapy group; 7 cases in the control group; P=0.40), tumor necrosis (6 cases in the adjuvant therapy group; 5 cases in the control group; P=0.23), pathological subtype (1 case of PRCC type 1, 6 cases of PRCC type 2, and 3 cases of TFE3 rearrangement RCC in the adjuvant therapy group; 2 cases of PRCC type 1, 10 cases of PRCC type 2, and 1 case each of oncocytic PRCC, TFE3 rearrangement RCC, FH-deficient RCC, and unclassified RCC in the control group; P=0.72), WHO/ISUP nuclear grade (10 cases of grades 3-4 in the adjuvant therapy group; 4 cases of grades 1-2 and 12 cases of grades 3-4 in the control group; P=0.14), invasion of tumor thrombus into the vessel wall (5 cases in the adjuvant therapy group; 5 cases in the control group; P=0.43), T stage (1 case of T 3a, 3 cases of T 3b, 5 cases of T 3c, and 1 case of T 4 in the adjuvant therapy group; 1 case of T 3a, 4 cases of T 3b, 10 cases of T 3c, and 1 case of T 4 in the control group; P=1.00), and positive lymph nodes metastasis(3 cases in the adjuvant therapy group; 0 cases in the control group; P<0.05). The recommended doses for sunitinib, axitinib, and pazopanib are 50mg qd, 5mg q12h, and 800mg qd, respectively. The primary endpoint of this study was disease-free survival (DFS), and the secondary endpoint was overall survival (OS). Statistical analyses were performed using R v4.2.2. Confounding factors were adjusted using propensity score weighting. Results:The median follow-up time for DFS was 29 months in the adjuvant therapy group and not reached in the control group, while median follow-up time for OS was 28 and 26 months, respectively. In the univariate Cox regression analysis, there were no statistically significant difference in the impact of all baseline characteristics and exposure factors on DFS and OS between the two groups. In survival analysis, there were no significant difference between DFS and OS curves of patients in the adjuvant therapy group and the control group (DFS, P=0.62; OS, P=0.74). The median DFS of patients in the adjuvant therapy group and the control group were 17 and 19 months, respectively, while the median OS was 43 and 27 months. After adjusting for confounding factors, the median DFS of patients in the adjuvant therapy group and the control group were 26 and 12 months, respectively, and the median OS remained 43 and 27 months, with no significant difference (DFS, P=0.81; OS, P=0.40). Conclusion:There is currently a lack of definitive evidence for survival benefit from adjuvant anti-VEGF/VEGFR targeted therapy in patients with cM0 nccRCC-VTT after surgery.
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Intrahepatic cholangiocarcinoma (ICC) refers to adenocarcinoma originating from the secondary bile ducts and their branches within the liver, with high malignancy and poor prognosis. Radical surgical resection is currently the only possible way to cure ICC, but only some patients meet the surgical standards, and even with surgical resection, about 60% of patients will relapse within 1~2 years. Neoadjuvant therapy and adjuvant therapy are important perioperative treatment methods for ICC, with the aim of reducing postoperative recurrence and improving postoperative survival. This article aims to elaborate on the current status and research progress of neoadjuvant therapy and adjuvant therapy for ICC.
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Abstract Objective: This study aimed to investigate the demographic and clinicopathological characteristics, and survival outcomes of subglottic Squamous Cell Carcinoma (SCC) based on the Surveillance, Epidemiology, and End Results (SEER) database. Methods: Demographic and clinicopathological information, including age, sex, race, tumor size, histologic grade, clinical/TNM stage, tumor invasion extent, Lymph Node Metastasis (LNM) extent, size of metastatic lymph nodes, LNM ratio and treatment data, of 842 subglottic SCC patients diagnosed between 1996 and 2016 were acquired. Kaplan-Meier survival analyses were performed to assess the effects of clinicopathological characteristics, treatment modalities, surgical procedures, and adjuvant therapies on overall survival and cancer-specific survival. Results: Subglottic SCC was more frequent among males aged 60-70 years, with low-grade but locally advanced lesions without local or distant metastases. Age and several primary tumor/LNM related variables were independent risk factors for overall survival and cancer specific survival. Advanced-stage and high-grade disease led to unfavorable prognosis. The most common treatment modality and surgical procedure were surgery plus radiotherapy and total laryngectomy, respectively. Surgery plus radiotherapy provided favorable 5-year survival outcomes, while total laryngectomy had the worst. Surgery plus adjuvant therapy showed better survival outcomes than surgery alone. Conclusion: This study confirmed the rarity of subglottic SCC. Patients with subglottic SCCs suffered poor prognosis especially for those with advanced-stage or high-grade lesions. The prognosis of subglottic SCC remained poor over the years, despite recent progress in cancer therapies. Surgery plus adjuvant therapy improved the survival outcome. Although larynx preservation surgery was beneficial for early-stage disease, total laryngectomy was favored for patients with advanced tumors. Level of evidence: Level 4.
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Cervical cancer is still a common gynecolgical tumor in China. Radical surgery is often the first choice for the treatment of early stage cervical cancer (FIGO stage ⅠB-ⅡA), and postoperative pathological examination often has adverse prognostic factors affecting the survival. According to the NCCN guidelines, patients with cervical cancer who meet Sedlis criteria and have intermediate-risk factors (lymphatic vascular space involvement, tumor size or deep interstitial infiltration) are recommended to receive concurrent chemotherapy with postoperative pelvic external irradiation ± cisplatin. However, the diagnostic criteria, indications and methods of adjuvant therapy for patients with intermediate risk factors after early cervical cancer surgery are still controversial. In this article, research progress on the definition of intermediate risk factors for early cervical cancer after radical hysterectomy and adjuvant treatment was mainly reviewed.
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Surgery is still the first choice for the curation of early gallbladder cancer, and the surgical strategy is selected based on anatomic position of primary tumor, accurate preoperative stage, and strict indication assessment in order to achieve the optimal curative effect. However, most patients are in advanced stage or with distant metastasis at the first diagnosis, and the recurrence rate and 5-year survival rate are not satisfied even if they receive curative resection. Subsequently, it is urgent for the employment of more treatment strategies in the process management of gallbladder cancer patients, such as neoadjuvant therapy, postoperative therapy and first-line or second-line treatment of local advanced and metastatic patients. In recent years, application of molecular targeted agents and immunotherapy have brought greater hope and laid a vaster prospect for the treatment of gallbladder cancer. However, there is still lack of evidence-based medicine data on the prognostic results, and further researches are needed. By integrating the domestic and abroad new research achievements, the authors systematically summarize the current status and future trend on the management of gallbladder cancer, and hope to provide a macroscopic and systemic treatment chart, including necessary details.
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ASCO-GU is one of the landmark meetings of urogenital cancer. Within 2022 meeting, the extended follow up result of adjuvant pembrolizumab after nephrectomy in renal cell carcinoma as well as the efficacy and safety of neoadjuvant Axitinib and avelumab for local advanced renal cell carcinoma have been released. There were also explorations in local therapy for oligometastasis, novel combination system therapy and regiments alterations. The further research protocol of immunostimulatory IL-2 cytokine prodrug and PARP inhibitor for metastatic RCC were also disclosed.
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Objective:To retrospectively analyze prognostic factors and patterns of recurrence in locally advanced gastric cancer patients receiving chemoradiotherapy (CRT) after radical gastrectomy, aiming to provide reference for postoperative CRT of locally advanced gastric cancer.Methods:Clinical data of 171 patients with curatively resected gastric carcinoma who received postoperative CRT in our hospital between 2008 and 2020 were retrospectively analyzed. The disease-free survival and overall survival (OS) rates were calculated by Kaplan- Meier method. Univariate prognostic analysis was performed by log- rank test. Multivariate prognostic analysis was conducted by Cox model. Results:The median follow-up duration was 63 months. The follow-up rate was 93.6%. 31.0% and 66.7% of the enrolled patients were classified in pathological stage Ⅱ and Ⅲ. The acute grade 3 or 4 gastrointestinal and hematological toxicity rates were 8.8% and 9.9%, respectively. In total, 166 patients completed the entire CRT regimen. No toxicity-related death occurred. Regarding patterns of recurrence, 17 patients had locoregional recurrence, 29 had distant metastasis and 12 had peritoneal metastasis. The 1-, 3-and 5-year overall survival (OS) rates were 83.7%, 66.3%, and 60.0%, while the 1-, 3-and 5-year disease-free survival rates were 75.5%, 62.7%, and 56.5%, respectively. In the multivariate analysis, pathological T stage, perineural invasion and lymph node ratio (LNR) were found to be the independent predictors of OS.Conclusions:Postoperative intensity-modulated radiation therapy and chemotherapy are well tolerated, with acceptable toxicities and encouraging locoregional tumor control and long-term survival. LNR can be used as an independent prognostic indicator for OS. Adjuvant CRT should be considered for all patients with a high risk of locoregional recurrence.
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Gastric cancer is one of the common digestive tract malignant tumors. Locally advanced gastric cancer has a large tumor load, mostly small metastatic lesions, and a high risk of recurrence. The comprehensive treatment strategy of "radical operation with D 2 lymph node dissec-tion and perioperative treatment" has gradually become the standard treatment mode for locally advanced gastric cancer. In recent years, there have been breakthroughs in perioperative treatment of locally advanced gastric cancer by radiotherapy, targeted therapy and especially immunotherapy. In this article, the authors analyze the research progress of perioperative treatment of locally advanced gastric cancer at home and abroad, systematically describe the current status and prospect of perioperative treatment of locally advanced gastric cancer.
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Although the resection rate and surgical safety of pancreatic cancer has been significantly increased in recent years, however, the long-term prognosis of the patient remains dismal. In the era of multidisciplinary diagnosis and treatment, "surgery first", the traditional management strategy of pancreatic carcinoma, has been questioned and challenged because pancreatic carcinoma should be regarded as a systemic disease. For patients with locally advanced, borderline resectable or resectable tumors with high risks of recurrence, the option of "surgery last" should be advocated, which promotes systemic therapy. For patients with resectable tumors with better biological behaviors, the option of "surgery first" should be recommended.
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Hepatocellular carcinoma (HCC) greatly threatens the life and health of Chinese people. Most patients with HCC are already in the advanced stage when attending the hospital and are not eligible for radical treatment, and patients in the early stage of HCC who are eligible for radical treatment still face a high risk of recurrence after surgery. In recent years, immunotherapy based on immune checkpoint inhibitors (ICIs) has made great progress in the treatment of advanced HCC, and perioperative immunotherapy for HCC is attracting more and more attention. Immunotherapy in the perioperative period of HCC can improve the feasibility of hepatectomy, reduce the recurrence rate after hepatectomy, and prolong the survival of patients. This article discusses the application of ICIs-based immunotherapy in the perioperative period of HCC and the issues that need to be considered, so as to provide new ideas for perioperative immunotherapy for HCC.
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Though the coronavirus disease is still raging in 2021, clinical research on non-small cell lung cancer (NSCLC) did not stop. However, benefiting from advances in lung cancer treatment modality, NSCLC patients have experienced significant improvements in overall survival and quality of life. Currently, research advances on targeted therapy and immunotherapy have together transformed the status of postoperative adjuvant therapy and established a new standard treatment modality for resectable NSCLC. There are equally important research advances in locally advanced and advanced NSCLC, including new treatment modalities, new therapeutic agents, etc., all of which bringing more options for clinical treatment. These therapies will bring changes to NSCLC and will gradually lead to the chronicity of lung cancer in the foreseeable future. Therefore, this paper reviews important studies that will change clinical practice in NSCLC treatment and noteworthy research advances in 2021. .
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Humans , Carcinoma, Non-Small-Cell Lung/surgery , Combined Modality Therapy , Immunotherapy , Lung Neoplasms/surgery , Quality of LifeABSTRACT
Objective:To compare the adjuvant chemotherapy project and survival prognosis of patients with stage Ⅱ/Ⅲ colon cancer in different age groups.Methods:In this retrospective study, the clinical data of 770 colon cancer patients undergoing radical resection were collected in the First Affiliated Hospital of Soochow University from Jan 2013 to Dec 2017. Patients were categorized into 3 groups based on age at onset of colon cancer: young group (18-49 years old, 112 cases), middle-aged group (50-64 years old, 351 cases) and older group (65-75 years old, 307 cases).Results:The young group had fewer complications, and the probability of cancer deposit, vascular tumor thrombus and nerve invasion was lower than the middle-aged and older group (12.5% vs. 15.4% vs. 14.3%; 7.1% vs. 9.4% vs. 8.5%; 2.7% vs .8.8% vs. 5.5%), but the probability of signet-ring cell carcinoma and mucinous adenocarcinoma was higher (5.4% vs. 1.4% vs. 1.6%; 14.3% vs. 11.4% vs. 13.4%), the proportion of patients with stage Ⅲ was greater (49.1% vs. 45.0% vs. 47.2%), and they were more willing to receive postoperative chemotherapy (83.9% vs. 81.8% vs. 60.3%). Among patients with stage Ⅱ and Ⅲ colon cancer, the young group and the middle-aged group were 3-4 times more likely to receive adjuvant chemotherapy than the elderly group [ OR=4.153 (95% CI:1.964-8.785), 2.906 (95% CI:1.845-4.579), 3.120 (95% CI:1.310-7.429), 3.588 (95% CI: 1.964-6.556)]. Of those patients who received chemotherapy, young and middle-aged patients had a higher percentage of multiagent regimen use than older patients [ OR=2.050 (95% CI:0.937-4.488), 2.750 (95% CI:1.536-4.923)]. Among patients treated with surgery alone, no significant differences were observed in survival among age groups. Among patients who received surgery and adjuvant chemotherapy, a significantly better survival was observed for young and middle-aged patients with stage Ⅲ [ HR=0.284 (95% CI:0.127-0.632), 0.521 (95% CI:0.333-0.816)] than their older counterparts. Conclusions:Among patients with stage Ⅱ/Ⅲ colon cancer, young and middle-aged patients are more likely to undergo adjuvant chemotherapy and use more radical chemotherapy regimen. Young and middle-aged patients with stage Ⅱ colon cancer had overuse of chemotherapy, but did not result in expected survival improvement.
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Glioblastoma is a malignant tumor in central nervous system, which has strong invasion, poor prognosis and short survival time. At present, the main treatment strategy of glioblastoma is surgical excision, supplemented by radiotherapy and chemotherapy. However, due to incomplete resection and high recurrence rate, it is urgent to find novel therapeutic method for glioblastoma. Photodynamic therapy, as a promising non-surgical treatment, provides a new strategy for postoperative adjuvant therapy of glioblastoma. This review summarizes the mechanism and clinical application of photodynamic therapy mediated by various photosensitizers in glioblastoma, in order to provide help for the treatment of glioblastoma.
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Local advanced gastric cancer (LAGC) accounts for a large proportion of annual newly diagnosed gastric cancer patients in China. There is a general consensus for D2 radical gastrectomy followed by postoperative adjuvant chemotherapy for LAGC patients, and this therapeutic strategy has been confirmed by a series of clinical trials to obviously improve the patients' prognosis; however, the recurrence rate is still high (about 50%-80% in advanced stage), which makes it difficult to further improve the long-term survival. Perioperative therapy, especially whether preoperative neoadjuvant therapy (NAT) can improve the efficacy of patients with LAGC, has been paid more and more attention. NAT is mainly defined as a preoperative chemotherapy or chemoradiotherapy, aiming at increasing curative resection rate by downstaging tumor, eliminating micrometastases, and autologously testing of anti-cancer drug sensitivity etc. However, there are still some controversy whether LAGC patients could gain survival benefit from NAT and also lack of general consensus for this issue. In this paper, the author reviews and analyzes the current situation of perioperative therapies for LAGC patients, especially emphasize the results of neoadjuvant chemotherapy or chemoradiotherapy reported by various high-level clinical studies. The preliminary effect of perioperative chemotherapy combined with molecular targeted or immunotherapy has also aroused great interest and attention. While we continue to carry out NAT and look forward to more new high-level evidence trials on NAT, we must emphasize again that R0 gastrectomy remains the most important therapeutic modality for the patients with LAGC.
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Humans , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Chemoradiotherapy , Chemotherapy, Adjuvant , Combined Modality Therapy , Gastrectomy/methods , Lymph Node Excision , Neoadjuvant Therapy , Neoplasm Staging , Perioperative Care/trends , Stomach Neoplasms/therapyABSTRACT
Neonatal encephalopathy (NE) is one of the major causes of neonatal death and severe disability in childhood.The etiology of NE is complex, which can occur in prenatal or delivery, and some neonates may even have high risk factors in both prenatal and delivery.Prenatal maternal diseases, hereditary diseases and genetic predisposition, hypoxic-ischemic encephalopathy, infections, placental abnormalities, thrombosis, abnormal blood coagulation, and metabolic diseases can all directly cause NE.Some patients of NE have comorbidities such as neuromuscular diseases, congenital heart disease, severe anemia, and severe pulmonary diseases, which lead to the disturbance of extrauterine adjustment during delivery, and the occurrence of hypoxic-ischemia leading to NE.NE is a heterogeneous disease, and the selection of appropriate assessment based on the medical history and examination, identification of the etiology of NE and treatment for the etiology can improve the prognosis.
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OBJECTIVE@#To assess whether adjuvant Chinese patent medicines (CPMs) to standard treatment could reduce recurrent bleeding after variceal bleeding in cirrhotic patients.@*METHODS@#This study retrospectively collected 555 consecutive patients who recovered from variceal bleeding. A population-based cohort study was established depending on if adjuvant CPMs were administered to prevent rebleeding. A total of 139 patients who had taken ⩾28 cumulative defined daily doses (cDDDs) of CPMs were included in the CPMs cohort, and 416 patients who used 180 cDDDs of CPMs, respectively. The median rebleeding interval in the CPMs cohort was significantly larger compared with the non-CPMs cohort (113.5 vs. 93.0 days; P=0.008).@*CONCLUSION@#Adjuvant CPMs to standard therapy can significantly reduce the incidence of variceal rebleeding and delay the time to rebleeding.