直肠癌新辅助治疗后临床完全缓解的评估

新辅助治疗已成为局部晚期直肠癌的标准治疗模式。新辅助治疗后对肿瘤反应进行评估及再分期对于制定患者后续的治疗策略和预测肿瘤的预后至关重要。有一部分患者在新辅助治疗后能达到临床完全缓解甚至病理完全缓解,而在病理未明确之前如何评估临床缓解一直是目前国内外专家关注的焦点。本文就直肠癌新辅助治疗后的最佳评估时间和评估方法的进展进行综述。     

直肠癌同步放化疗临床CR与病理CR分析

目的 对同步放化疗后达到cCR)及术后pCR患者影像学资料进行分析,以评价核磁及直肠超声在预测pCR中的作用。方法 回顾分析42例同步放化疗联合手术治疗的局部进展期直肠癌患者的临床资料,对获得临床完全缓解及病理完全缓解的患者进行核磁、超声及病理比较。结果 同步放化疗后12例患者达到cCR,7例患者达pCR。MRI评估的cCR与EUS一致率为3/12(25%),与pCR一致率为4/12(33%),MRI联合EUS与pCR一致率为5/12(42%)。结论 直肠超声联合MRI不能完全预测pCR,对于watch-and-wait的患者临床评估还需要更精确的检测手段。     

直肠癌新辅助放化疗临床效果的评估

直肠癌是常见的恶性肿瘤，直肠癌发病率近年有上升趋势。全直肠系膜切除术（total mesorectal excision ，TME ）是直肠癌的最主要治疗手段，但局部进展期直肠癌患者术后局部复发率高、保肛率低，新辅助放化疗成为局部晚期直肠癌的优选治疗手段。直肠癌新辅助治疗后的临床效果是临床医生关注的焦点。直肠癌新辅助治疗效果的预测及评估关系到后续治疗方案的选择，影响患者的生存期及生活质量。      

直肠癌新辅助放化疗的ESMO临床实践指南解读

目前新辅助放化疗已经逐渐变成局部进展期直肠癌的标准治疗手段之一。新辅助放化疗能使肿瘤降期,提高病理缓解率和保肛率,减少局部复发率。欧洲肿瘤内科学会（ European society for medical oncology , ESMO ）针对局部进展期直肠癌新辅助放化疗制定了治疗指南,并作了相关推荐［1］。     

直肠癌新辅助放化疗疗效预测指标研究进展

目前新辅助放化疗联合手术逐渐成为局部进展期直肠癌的推荐治疗或标准治疗方案.但直肠癌患者对术前同步放化疗敏感性存在明显差异,部分患者可获得病理完全缓解(pCR),而部分患者对治疗不敏感,导致肿瘤进展,延误手术时机.因此,对直肠癌患者新辅助治疗敏感性预测指标的相关研究成为热点.本文就局部晚期直肠癌患者新辅助放化疗疗效预测评价指标研究进展作一综述,为临床个体化方案制定提供参考.     

直肠癌经新辅助治疗后达到临床完全缓解的评估策略及观察和等待策略

术前新辅助放化疗联合全直肠系膜切除术已成为局部晚期直肠癌患者治疗的金标准。临床上部分患者经放化疗治疗后达到病理完全缓解,并与不全缓解患者相比局部复发率显著降低,生存期延长。为了避免手术相关并发症、改善患者生活质量（造瘘和保肛问题）,一些机构尝试对放化疗后临床完全缓解患者采用非手术方案—“观察和等待策略”。然而,临床完全缓解并不总是预示病理完全缓解,需要综合评估策略更准确地预测哪些患者已经达到病理完全缓解来安全行“观察和等待策略”。本文就目前关于非手术方案的数据作一综述并讨论与此方案相关的持续争议。     

局部进展期直肠癌新辅助化疗后病理完全缓解及肿瘤降期的预测因素分析

目的:探索局部进展期直肠癌(LARC)经新辅助化疗后病理完全缓解（pCR）和肿瘤降期（ypT0-1）的预测因素。方法:回顾性分析71例经新辅助化疗后进行全直肠系膜切除术的局部进展期直肠癌患者的临床资料,分析其临床特征,筛选经新辅助化疗后达到pCR及肿瘤降期（ypT0-1）的预测因子。结果:单因素分析结果显示肿瘤占肠腔＜1/2周（P＜0.001）、基线CEA≤5 ng/mL（P=0.001）、基线临床N分期为N0期（P=0.019）以及新辅助治疗2周期后影像评估为缓解（P=0.002）与直肠癌新辅助化疗后的高pCR率有关;肿瘤占肠腔＜1/2周（P＜0.001）、基线CEA≤5 ng/mL（P=0.029）以及新辅助治疗2周期后影像评估为缓解（P=0.007）与直肠癌新辅助化疗后的高肿瘤降期率（ypT0-1）有关。多因素Logistic回归分析结果显示,肿瘤占肠腔环周大小（P=0.013）、基线CEA水平（P=0.042）以及基线临床N分期（P=0.038）是影响直肠癌新辅助化疗后pCR的独立预测因子;肿瘤占肠腔环周大小（P=0.001）是影响直肠癌新辅助化疗后肿瘤降期（ypT0-1）的独立预测因子。结论:初始诊断时肿瘤占肠腔环周大小、基线CEA水平及淋巴结是否阳性对局部进展期直肠癌新辅助化疗后pCR有预测作用,肿瘤占肠腔环周大小对局部进展期直肠癌新辅助化疗后肿瘤降期（ypT0-1）有预测作用。     

局部晚期直肠癌新辅助放化疗研究进展

【摘要】直肠癌是最常见的恶性肿瘤之一,近年来发病率及死亡率日趋升高。患者确诊时大多为中晚期,新辅助放化疗可有效提高局部晚期直肠癌患者的局部控制率、保肛率及病理缓解率,进而改善患者预后。局部晚期直肠癌异质性明显,多项研究对新辅助治疗的具体方案进行探索,如何优化新辅助治疗模式是进一步研究的热点。文章对近年来局部晚期直肠癌新辅助放化疗的研究进展做一综述,为局部晚期直肠癌的精准化医疗提供了参考。     

靶向治疗联合新辅助放化疗在局部进展期直肠癌中的应用

目前新辅助放化疗联合全直肠系膜切除术（TME）是局部进展期直肠癌（LARC）的标准治疗模式.靶向药物在LARC新辅助治疗中耐受性及安全性良好,但与常规新辅助放化疗相比较,病理完全缓解（pCR）率并无提高,仍需大样本随机对照研究证实其在LARC新辅助治疗中的作用.     

局部进展期直肠癌新辅助治疗后器官保留策略进展

新辅助放化疗联合全直肠系膜切除术为分期T3-T4期或N+的局部进展期直肠癌(LARC)的标准治疗,但往往会带来一系列术后并发症,尤其是接受腹会阴联合直肠癌根治术(Mile′s术)不能保留肛门者,严重影响生活质量。对于新辅助治疗后肿瘤(近)临床完全缓解者,器官保留策略在与根治性手术达到相似治疗疗效的同时,可保留肛门及其功能、保证患者的生活质量。本文对LARC新辅助治疗后器官保留策略、联合局部治疗疗效、再生/复发模式及挽救治疗等方面作总结。     

Significance and problems in evaluations of pathological responses to neoadjuvant therapy for Breast Cancer

Neoadjuvant therapy consists of systemic drug treatments before surgery for a primary cancer. Currently, several neoadjuvant therapy regimens for breast cancer that use various cytotoxic as well as endocrine-therapeutic and molecular-targeting agents have been performed in clinical practice and/or studies. In neoadjuvant therapy, pre-treatment pathological examination using materials obtained by a core needle biopsy (CNB) is necessary, and pathological diagnosis and evaluation of the biological status, such as hormone receptors and HER-2 over-expression are confirmed. In addition, CNB in the inter-phase of chemotherapy is also thought to be useful for assessment of therapeutic effects before regimens have been completed. After surgery, the therapeutic effects of neoadjuvant therapy have been mainly evaluated on the basis of pathological findings and a pathological complete response (pCR) is considered to be the main target of neoadjuvant therapy. Results of most of clinical studies including NSABP protocol B-18 and B-27 have confirmed the prognostic significance of pCR in neoadjuvant therapy and indicated the significance of pathological evaluation. However, universally accepted pathological response criteria have not been established, but evaluations of the main invasive tumor, intraductal components and regional lymph nodes are thought to be necessary. Additionally, evaluation of the effects below pCR also need examining in a study using a mild anti-cancer drug, such as hormone-therapeutic agent, and the survival outcomes of patients below pCR need to be examined and compared between each grade.     

Increased pathological complete response rate after a long-term neoadjuvant letrozole treatment in postmenopausal oestrogen and/or progesterone receptor-positive breast cancer

Background:

The objective of this study was to determine the optimal scheduling of 2.5 mg daily letrozole in neoadjuvant breast cancer patients to obtain pathological complete response (pathCR) and assess Ki-67 expression as an early predictor of response.

Patients and methods:

This single institution study comprised 120 oestrogen receptor (ER)-positive postmenopausal women with primary breast cancer (clinical stage ⩾T2, N0–1), from three sequential cohorts (cohort A of 40, cohort B of 40 and cohort C of 40 patients, respectively) based on different duration of the neoadjuvant letrozole. Biological markers such as ER, progesterone receptor, HER2 and Ki-67 expression were tested at diagnosis and at definitive surgery.

Results:

A total of 89 patients (75.4%) achieved an objective response with 44 (37.3%) clinical CRs and 45 (38.1%) partial responses. The clinical CRs were significantly observed in cohort C (23 out of 40 patients, 57.5%) and B (16 out of 38 patients, 42.1%) compared with cohort A (5 out of 40 patients, 12.5%) (P-value for trend <0.001). Letrozole induced a similar significant reduction in Ki-67 index after treatment in all cohorts. The pathCR rate was significantly more frequent in cohort C (7 out of 40 patients, 17.5%) than in cohort A (1 out of 40 patients, 2.5%) and B (2 out of 40 patients, 5.0%) (P-value for trend <0.04).

Conclusion:

One-year neoadjuvant letrozole therapy leads to a higher pathCR rate and may be the optimal length of drug exposure.     

Clinical Outcomes of Single Versus Double Hormone Receptor–Positive Breast Cancer Patients Treated With Neoadjuvant Chemotherapy

Purpose

To compare tumor response rates and survival outcomes between single and double hormone receptor (HR)-positive breast cancer (BC) patients treated with neoadjuvant chemotherapy.

Metastatic sweat gland carcinoma: response to 5-fluorouracil infusion

A 78-year-old white male presented with metastatic sweat gland carcinoma involving regional lymph nodes, pleura, pericardium, and chest wall. A complete response of three months duration was achieved by using a 96-hour infusion of 5-fluorouracil. This is the first report of a complete response to systemic chemotherapy in metastatic sweat gland carcinoma.     

乳腺癌患者新辅助化疗后病理完全缓解的相关影响因素分析及列线图预测模型的构建

目的:建立关于乳腺癌新辅助化疗后病理完全缓解的综合预测模型,预测新辅助化疗后病理缓解,指导临床上诊疗方案的选择。方法:回顾分析2015年1月至2020年3月148例乳腺癌新辅助化疗患者的临床资料、化疗前核磁共振资料及病理资料,根据术后病理分为pCR组与npCR组。采用χ2检验对两组指标先行单因素分析;将P＜0.05的指标及考虑可能有临床意义的指标纳入多因素Logistic回归分析。应用多因素分析考虑有统计学意义(P＜0.05)及临床意义的指标构建乳腺癌新辅助化疗后病理缓解综合预测模型的列线图,并运用ROC曲线评价此模型的效能。结果:单因素分析表明腺体背景强化类型、最长径、病理分型对乳腺癌是否达到病理完全缓解具有预测作用;多因素分析表明,腺体背景强化类型、最长径、病理分型均是新辅助化疗后病理完全缓解的独立预测因素(P＜0.05)。乳腺癌新辅助化疗后病理缓解的预测模型的曲线下面积为0.769,特异度为65.5%,敏感度为78.9%。结论:乳腺癌新辅助化疗后病理完全缓解的综合预测模型对病理缓解状态有较好的预测能力,此模型可为乳腺癌新辅助化疗后患者选择手术方式提供参考。     

Improved response rate in patients with prognostically poor locally advanced rectal cancer after treatment with induction chemotherapy and chemoradiotherapy when compared with chemoradiotherapy alone: A matched case-control study

IntroductionThe addition of induction chemotherapy (ICT) to neoadjuvant chemoradiotherapy (CRT) has the potential to improve outcomes in patients with locally advanced rectal cancer (LARC). However, patient selection is essential to prevent overtreatment. This study compared the complete response (CR) rate after treatment with and without ICT of LARC patients with prognostically poor characteristics.MethodsAll LARC patients who were treated with neoadjuvant CRT, whether or not preceded by ICT, and who underwent surgery or were considered for a wait-and-see strategy between January 2016 and March 2020 in the Catharina Hospital Eindhoven, were retrospectively selected. LARC was defined as any T4 tumour, or a T2/T3 tumour with extramural venous invasion and/or tumour deposits and/or N2 lymph node status, and/or mesorectal fascia involvement (T3 tumours only). Case-control matching was performed based on the aforementioned characteristics.ResultsOf 242 patients, 178 (74%) received CRT (CRT-group) and 64 patients (26%) received ICT followed by CRT (ICT-group). In the ICT-group, 3 patients (5%) did not receive the minimum of three cycles. In addition, in this selected cohort, compliance with radiotherapy was 100% in the ICT-group and 97% in the CRT-group. The CR rate was 30% in the ICT-group and 15% in the CRT-group (p = 0.011). After case-control matching, the CR rate was 28% and 9%, respectively (p = 0.013).ConclusionTreatment including ICT seemed well tolerated and resulted in a high CR rate. Hence, this treatment strategy may facilitate organ preservation and improve survival in LARC patients with prognostically poor characteristics.     

局部晚期食管鳞癌新辅助放化疗联合手术治疗的临床疗效分析

目的 探讨新辅助放化疗联合手术治疗局部晚期食管鳞癌的临床疗效,并分析临床完全缓解率(cCR)与病理完全缓解率(pCR)的关系。方法 回顾性选取2001—2013年局部晚期胸段食管鳞癌患者 158例,全组均采用术前同期放化疗联合手术方式,化疗采用以铂类为基础化疗方案,放疗剂量为40 Gy,2.0 Gy/次,5 次/周。Kaplan-Meier法计算OS和DFS,Logrank法检验并单因素预后分析,Cox模型多因素预后分析。结果 全组患者的pCR率为41.1%。新辅助放化疗后 44例cCR患者中 32例(73%)达pCR,114例非cCR患者中 33例(28.9%)达pCR (P=0.000)。cCR预测pCR的敏感性、特异性分别为49.2%、87.1%,阳性、阴性预测值分别为72.7%、71.1%。3年总样本数为 53例。全组 3年OS、DFS分别为53.9%、48.6%,cCR的显著高于非cCR的(P=0.012、P=0.026),pCR的显著高于非pCR的(P=0.000、0.000)。多因素分析显示放化疗后病理反应和化疗方案是影响OS的因素。最常见≥3级急性不良反应为白细胞减少(34.2%)。结论 新辅助放化疗联合手术治疗局部晚期食管鳞癌可获得较高pCR率且不良反应可耐受,放化疗后cCR率与pCR率、OS密切相关。