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@#Objective To investigate the short-term therapeutic effect of neoadjuvant immunotherapy combined with chemotherapy in the locally advanced esophageal squamous cell carcinoma. Methods The clinical data of patients with esophageal squamous cell carcinoma treated with neoadjuvant treatment in Gaozhou People's Hospital from August 2019 to October 2020 were retrospectively analyzed. According to the different treatments, the patients were divided into two groups: a neoadjuvant immunotherapy combined with chemotherapy group (NIC group) and a neoadjuvant chemoradiotherapy group (NC group). The baseline data, incidence of adverse events during treatment, perioperative indicators, postoperative pathological remission rate and incidence of postoperative complications were compared between the two groups. Results Totally 33 patients were enrolled, including 15 males and 18 females, with an average age of 62.37±7.99 years. There were 17 patients in the NIC group and 16 patients in the NC group. In the NIC group, the carcinoma was mainly located in the middle and lower esophagus, with 5 paitents in stage Ⅱ, 9 patients in stage Ⅲ, and 3 patients in stage Ⅳa. In the NC group, the carcinoma was mainly located in the upper-middle esophagus, with 1 patient in stage Ⅱ and 15 patients in stage Ⅲ. During the neoadjuvant treatment, there was no significant difference in the occurrence of bone marrow suppression or gastrointestinal reactions between the two groups (P>0.05). There were 4 immune-related rashes in the NIC group and 1 esophageal perforation in the NC group. Fourteen (82.35%) patients in the NIC group and 12 (75.00%) patients in the NC group completed the operation on schedule. The postoperative ICU stay time and chest tube indwelling time in the NIC group were shorter than those in the NC group (P<0.05). There were 5 patients of complete remission in the NIC group, and 6 patients in the NC group. There was no significant difference in the pathological regression grade or residual tumor cells between the two groups (P>0.05). There was no significant difference in the incidence of anastomotic fistula, thoracic gastric fistula, bronchial mediastinal fistula, abdominal distension, pulmonary infection, stroke, or hoarseness during the perioperative period between the two groups of patients who completed the operation (P>0.05). In the NC group, 2 patients died during the perioperative period because of thoracic gastric fistula complicated by severe infection. Conclusion Neoadjuvant immunotherapy combined with chemotherapy dose not significantly increase the occurrence of adverse events and shows a good rate of pathological remission, which indicates that the neoadjuvant immunotherapy combined with chemotherapy is a safe, feasible and potential new treatment model.
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Objective To evaluate the liver damage induced by chemotherapy in patients with cancer and positive for hepatitis B virus (HBV) markers.Methods From January 2005 to January 2012,913 cancer patients were treated by chemotherapy including HBV-positive patients (HBV-positive group,288 cases) and HBV-negative patients (HBV-negative group,625 cases).The changes of hepatic function after chemotherapy between two groups were compared.Results The incidence of hepatic toxicity in HBV-positive group was higher than that in HBV-negative group [24.0％ (69/288) vs.11.4％ (71/625)],and there was significant difference between two groups (P＜ 0.01).The incidence of degree 11Ⅲ-Ⅳ hepatic toxicity was 11.4％ (14/123) in HBV-DNA-positive patients and 0.6％ (4/625) in HBV-negative group.In a variety of chemotherapy,there was significant difference in the incidence of hepatic toxicity in TP(paclitaxel +cisplatin),CAF(cyclophosphamide + doxorubicin + fluorouracil),CHOP(cyclophosphamide + doxorubicin +vincristine + prednisone) between two groups (P ＜ 0.05).The incidence of hepatic toxicity was highest in TP,which was 34.6％ (18/52) in HBV-positive group and 16.5％ (20/121) in HBV-negative group.Conclusion HBV infection is associated with higher risk of hepatic toxicity in patients with cancer during chemotherapy.
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Objective To investigate the clinical efficacy of S-1 combined with cisplatin in the treatment of old patients with advanced gastric cancer.Methods 85 patients were randomly divided into two groups.Experimental group was treated by S-1 combined with cisplatin,while control group was treated by 5-FU and cisplatin.Short-term efficacy and adverse reactions were evaluated after four cycles.Results All patients had succcssfully accomplished chemotherapy.Compared with the control group ( RR =52.4％,DCR =81.0％ ),RR and DCR in experimental group ( RR =67.4％,DCR =93.0％ ) had statistically significant difference ( P ＜ 0.05 ).The top three of adverse reactions and complications in patients of the two groups were:nausea and vomiting,low WBC,low hemoglobin concentration.Compared with the control group,the toxicity in experimental group had no statistically significant difference ( P ＞0.05).All patients were followed up with a meau of( 15.5 - 2.7 ) months.The 1 year survival rate was 60.5％(26/43) in the experimental group; the 1 year survival rate was 52.4％ (21/42) in the control group.There was no statistically significant difference( P ＞ 0.05 ).Conclusion The S-1 combined with cisplatin had shown better efficacy in the treatment of old patients with advanced gastric carcinoma,and the toxicity was relatively mild and tolerable.