高龄食管癌患者的围手术期治疗

本组研究总结我院 1995年 1月 -2 0 0 2年 6月间收治的 70岁以上经手术和病理证实的高龄食管癌患者 68例 ,旨在探讨高龄食管癌患者的围手术期的治疗特点。1　临床资料1.1　一般资料　本组 68例 ,男 42例 ,女 2 6例 ,年龄 70岁～ 86岁 ,其中 70岁～ 75岁 52例 ,75岁～ 85岁 15例 ,年龄最大 86岁 1例。病史 1个月～ 9个月 ,平均 3 .2个月。住院时间 15天～ 96天 ,平均 2 0 .5天。合并疾病 :慢性支气管炎 15例 ,肺气肿 1例 ,高血压 9例 ,冠心病 11例 ,心律失常 9例 ,陈旧性心肌梗死 2例 ,肺心病 3例 ,糖尿病 7例 ,肝硬化 2例 ,陈旧性脑梗死 1例…     

新辅助化疗对食管癌围手术期影响的临床研究

目的:探讨新辅助化疗对食管癌围手术期的影响,并对化疗后手术时机进行探讨.方法:将扬州大学附属泰兴市人民医院同一手术组医生施行食管癌切除术的食管癌160例,按时间段分成新辅助化疗组(NC组)和常规手术组(对照组),NC组化疗后1-3天手术,对照组直接常规手术.按照UICC标准进行临床病理分期.比较两组的术前一般情况、手术时间、术中出血量、术后胸管引流量、术后并发症发生率和住院时间.结果:两组病人术前一般情况差异无显著性.NC组术中出血量略多,但无统计学意义 ,两组的手术时间、住院天数等差异无统计学意义,术后引流量、感染、心律失常等并发症发生率不高于对照组.结论:新辅助化疗不增加手术并发症及治疗相关死亡率,化疗后立即手术是可行的.     

高龄食管癌患者切除术的围手术期治疗

1995年1月～2003年4月，我们共收治37例行手术切除的70岁以上的高龄食管癌患，现将其围术期治疗体会总结如下：     

食管癌围术期治疗的争议与共识

食管癌是全球排名第七的恶性肿瘤,在癌症相关的死亡原因中排名第六。手术治疗是可切除食管癌的主要治疗方式,但对于局部晚期食管癌患者,单纯手术治疗后,局部复发和远处转移缩短了患者的生存期,因此除极早期肿瘤外,所有患者推荐术前行新辅助放化疗或新辅助化疗。但是仍然有一部分患者未能在术前行新辅助治疗,这就需要术后辅助治疗来改善患者预后。本文系统回顾了食管癌围术期治疗的研究进展,包括新辅助治疗和辅助治疗,并结合指南对食管癌围术期的治疗方案进行了总结。     

局部进展期胃癌围手术期治疗研究进展

对于初始不可切除的局部进展期胃癌患者,东西方治疗方法不尽相同,以手术为基础的多学科综合诊疗是目前的基本治疗策略。在西方国家,围手术期化疗或术后辅助放化疗是首选治疗方式;而亚洲胃D2切除术后辅助化疗是标准治疗方案,近年来,亚洲也在积极开展关于胃癌围手术期治疗的研究,虽然围手术期化疗的疗效已得到保障,但是否联合放疗、是否联合靶向治疗或免疫治疗仍未有统一标准,如何优化治疗模式和疗效预测仍是急需解决的问题。本文综述了局部进展期胃癌围手术期治疗的研究现状,并对其存在的问题及未来的发展前景进行了展望。     

Ⅲ期黑色素瘤围手术期治疗的现状与展望

黑色素瘤是一种恶性程度极高的肿瘤,早期黑色素瘤经手术切除多可治愈,但对于高危型病例（ⅡB~Ⅳ期）,辅助治疗是延长患者生命、改善预后的重要手段。近年来随着系统治疗药物的蓬勃发展,对于Ⅲ期可切除病例的围手术期治疗理念不断发生变化。本文着眼于外科手术规范及对预后的影响、术后辅助治疗选择、新辅助治疗的进展等热点问题进行梳理,并结合来源于中国患者的治疗数据进行分析讨论,希望为中国Ⅲ期黑色素瘤的围手术期治疗选择提供新的思路。     

老年人食管癌的手术与围手术期治疗

目的：分析老年人食管癌的临床特点及手术和围手术期治疗的重要性。方法：回顾性分析1996年2月至2001年8月经外科治疗的60岁以上食管癌98例临床资料，结果：术前的合并症53．1％，以心血管，呼吸系统为主，手术切除订91．8％，术后并发症40．8％，大多数与术前合并症有关（P＜0．05），手术死亡率1．0％，术后1年、3年、5年生存率分别为86．7％、52．0％，16．2％，未切除肿瘤1年生存率为0。结论：老年人食管癌症状较轻，肿瘤发展相对缓慢，应争取外科治疗，但处理好围手术期并发症是手术成功的关键。     

34例食管癌合并糖尿病患者围手术期的治疗体会

回顾性总结了食管癌合并糖尿病围手术期的治疗经验，其要点包括：术前常规查血糖，术后用末梢血糖检测仪监测血糖，尿糖试纸监测尿糖，应用胰岛素调整血糖，给予充足的热量，预防酸碱平衡失调及电解质紊乱，采取妥善的处理方法可减少食管癌的术后并发症。     

老年人食管癌的手术与围手术期治疗

目的　分析老年人食管癌的临床特点及手术和围手术期治疗的重要性。方法　回顾性分析 1996年 2月至 2 0 0 1年 8月经外科治疗的 60岁以上食管癌 98例临床资料。结果　术前的合并症 5 3 1% ,以心血管、呼吸系统为主 ,手术切除率 91 8% ,术后并发症 40 8% ,大多数与术前合并症有关 (P <0 0 5 ) ,手术死亡率 1 0 %。术后 1年、3年、5年生存率分别为 86 7%、5 2 0 %、16 2 %。未切除肿瘤者 1年生存率为 0。结论　老年人食管癌症状较轻 ,肿瘤发展相对缓慢 ,应争取外科治疗 ,但处理好围手术期并发症是手术成功的关键。     

路径式营养管理在食管癌患者围术期的应用研究

目的 探讨路径式营养管理在食管癌围术期患者中的应用效果。方法 选取2018年1月至2018年7月在四川省肿瘤医院胸外科接受食管癌根治手术治疗的患者156例,随机分为干预组（n=78）和对照组（n=78）,干预组采用路径式营养管理,对照组采用常规营养管理,比较两组患者在术后7d血红蛋白、前白蛋白、体质指数（BMI）、预后营养指数（PNI）等营养指标、术后并发症发生率及术后住院时间。结果 干预组患者术后7d血红蛋白（126.09±16.69）g/L、前白蛋白（208.74±38.51）mg/L、BMI（22.28±2.05）kg/m2、PNI（46.62±4.03）优于对照组,差异有统计学意义（P<0.05）;干预组患者胸腔积液发生率低于对照组,差异有统计学意义（t=4.02,P=0.04）;干预组患者住院时间短于对照组,差异有统计学意义（t=6.53,P=0.03）。结论 路径式营养管理能有效改善食管癌围术期患者营养状况、降低并发症发生率、缩短术后住院时间。     

Improved prognosis with induction chemotherapy in pathological complete responders after trimodality treatment for esophageal squamous cell carcinoma: Hypothesis generating for adjuvant treatment

PurposeTo compare the locations of recurrences and survival outcomes in esophageal squamous cell carcinoma (ESCC) patients with pathological complete response (pCR) after neoadjuvant concurrent chemoradiotherapy (CCRT) with or without preceding induction chemotherapy (IC) followed by esophagectomy.MethodsAmong 276 patients with locally advanced ESCC undergoing trimodality treatment during 2004–2014, 94 (34.1%) with pCR were eligible. The cohort included 26 patients undergoing IC before CCRT (IC group), and 68 patients who did not receive IC (non-IC group).ResultsAt a median follow-up of 51.4 months (95% confidence interval; 42.9–62.1), 19 patients experienced recurrences. There was a trend toward fewer distant failures in the IC group (0% vs.14.7%, p = 0.057), while locoregional recurrence was similar (7.7% vs. 7.4%). IC was associated with significantly improved survivals with the 5-year RFS and OS rates for the IC group of 85.1% and 90.5%, respectively, compared to of 46.2% and 48.1% for the non-IC group (p = 0.008 for RFS, and p = 0.015 for OS). By multivariable analyses, IC remained the only significant factor associated with survivals (HR:0.18 for RFS, p = 0.020 and HR:0.18 for OS, p = 0.025). The effect of IC in the whole cohort, irrespective of pathological response, was also assessed. Patients with non-pCR in the IC group had a trend toward worse survivals compared to the non-IC groupConclusionsIn ESCC patients with pCR after trimodality treatment, IC was associated with favorable survivals. The benefits of IC might be a hypothesis generation for adjuvant treatment for patients with pCR.     

食管癌分期与治疗的共识、争议和建议

目前食管癌的治疗模式仍是以外科为主的综合治疗.但到目前为止,仍在食管癌分期、手术治疗模式选择、手术入路选择、淋巴结清扫方式、术前和术后辅助治疗等方面存在较多争议,本文在复习大量国内外临床研究文献之后,对上述各问题不同观点进行了总结和评述,依据目前的临床循证医学证据形成了一些共识,并对仍有争议之处提出了未来需要进一步研究的相关建议.     

Current status of adjuvant chemotherapy for gastric cancer

Although radical gastrectomy is a standard treatment for advanced gastric cancer, recurrence remains high. After several large-scale controlled studies have shown the beneficial effects of adjuvant chemotherapy, that treatment emerged as a standard option for advanced gastric cancer after gastrectomy. However, various guidelines from different countries have suggested different adjuvant chemotherapies. Understanding the differences between guidelines is very important for investigating further therapeutic strategies. Fortunately, because there are many ongoing studies about new regimens for adjuvant treatment, it is expected that patients with gastric cancer after surgery will have better outcome.     

Current status of adjuvant therapy for pancreatic cancer

In this article, we review the rationale for and outcomes associated with the use of adjuvant and neoadjuvant therapy for resectable and borderline resectable cancer of the pancreatic head and uncinate process. Localized pancreatic cancer is a systemic disease that requires nonoperative therapies to minimize the local and systemic recurrences that almost invariably occur in the absence of such therapy, even following complete surgical resection. A well-defined role exists for the systemic administration of gemcitabine or 5-fluorouracil in the postoperative setting. Although the survival benefit associated with adjuvant chemoradiation has not been as rigorously defined, its use is supported by extensive historic experience; chemoradiation should be considered particularly for patients at high risk for local recurrence. Delivery of chemotherapy and/or chemoradiation prior to surgery has multiple potential advantages, although the superiority of neoadjuvant therapy over standard postoperative therapy has yet to be demonstrated. Neoadjuvant therapy may be particularly beneficial among patients with borderline resectable cancers. Although the existing literature is confusing, and indeed controversial, available evidence suggests that systemic chemotherapy and/or chemoradiation should be offered to all patients with pancreatic cancer who undergo potentially curative resection. Well-designed prospective trials are needed to define the optimal adjuvant or neoadjuvant therapy strategy for these patients.     

High-risk bladder cancer: improving outcomes with perioperative chemotherapy

Despite treatment with radical cystectomy and pelvic lymph node dissection, muscle invasive bladder cancer has a relapse rate of 50%. Patients can develop regionally advanced or metastatic disease that ultimately leads to death. The addition of neoadjuvant or adjuvant chemotherapy to reduce the risk of relapse and death has been extensively studied over the past two decades. Two contemporary trials coupled with a recent meta-analysis evaluating neoadjuvant chemotherapy demonstrated a modest but real improvement in overall survival. This has made neoadjuvant chemotherapy a standard of care. Clinical trials evaluating adjuvant chemotherapy in patients with high-risk disease have been plagued with statistical flaws and have, therefore, been unable to define the survival impact of this approach. It is hoped that ongoing adjuvant trials that are powered to detect small but meaningful clinical differences will clarify the benefit of chemotherapy after cystectomy. Since there are theoretical advantages and disadvantages to each of these approaches, both are widely used in North America. The evidence behind each approach and potential future developments in this field will be described.     

Chemoradiotherapy for esophageal cancer: current status and perspectives

The optimal role of chemoradiotherapy in the multimodality treatment of esophageal cancer is still controversial. According to a series of clinical trials, definitive chemoradiotherapy is considered the standard of care for patients with medically inoperable or surgically unresectable esophageal cancer. This modality provides survivals comparable to those in Western series of surgery alone and is one of the standards of care even for resectable-stage disease. Recent reports of primary chemoradiotherapy from Japan suggest survival comparable to that of surgery in Japanese patients with stage I disease, but radical surgery is still the standard treatment for T2–3NanyM0 disease in Japan. However, it is clear that this approach has limitations in treatment outcomes. Trimodality therapy, i.e., preoperative chemoradiotherapy followed by surgery, is more favored than surgery alone in clinical practice, particularly in patients with adenocarcinoma, although current data from randomized trials are insufficient to support this approach. To improve the local control rate of chemoradiotherapy, intensification of the radiation dose has been attempted, but this has failed to demonstrate any superiority in terms of local control or survival. The addition of new agents, including molecular targeting agents, to the current standard chemoradiotherapy has shown more promising results and warrants further investigations in future studies. Salvage treatment for patients who do not achieve a complete response (CR) is necessary to improve the overall treatment results. Salvage surgery, as well as endoscopic resection, in selected patients, may provide an improvement in survival. Until high rates of local control can be consistently achieved with chemoradiotherapy alone, these salvage treatments will be an integral component of multimodality treatment for esophageal cancer, and should be active areas for clinical investigations.     

Role of sirtuins in esophageal cancer: Current status and future prospects

Esophageal cancer (EC) is a malignant cancer that still has a poor prognosis, although its prognosis has been improving with the development of multidisciplinary treatment modalities such as surgery, chemotherapy and radiotherapy. Therefore, identifying specific molecular markers that can be served as biomarkers for the prognosis and treatment response of EC is highly desirable to aid in the personalization and improvement of the precision of medical treatment. Sirtuins are a family of nicotinamide adenine dinucleotide (NAD+)-dependent proteins consisting of seven members (SIRT1-7). These proteins have been reported to be involved in the regulation of a variety of biological functions including apoptosis, metabolism, stress response, senescence, differentiation and cell cycle progression. Given the variety of functions of sirtuins, they are speculated to be associated in some manner with cancer progression. However, while the role of sirtuins in cancer progression has been investigated over the past few years, their precise role remains difficult to characterize, as they have both cancer-promoting and cancer-suppressing properties, depending on the type of cancer. These conflicting characteristics make research into the nature of sirtuins all the more fascinating. However, the role of sirtuins in EC remains unclear due to the limited number of reports concerning sirtuins in EC. We herein review the current findings and future prospects of sirtuins in EC.     

Paclitaxel-based chemoradiotherapy in the treatment of patients with operable esophageal cancer

PURPOSE: To compare a neoadjuvant regimen of cisplatin/5-fluorouracil (5-FU) and concurrent radiation therapy (RT) with paclitaxel-based regimens and RT in the management of operable esophageal (EC)/gastroesophageal junction (GEJ) cancer. METHODS AND MATERIALS: All patients receiving neoadjuvant chemotherapy (CT) and RT for EC/GEJ cancer at Duke University between January 1995 and December 2004 were included. Clinical end points were compared for patients receiving paclitaxel-based regimens (TAX) vs. alternative regimens (non-TAX). Local control (LC), disease-free survival (DFS), and overall survival (OS) were estimated using the Kaplan-Meier method. Chi-square analysis was performed to test the effect of TAX on pathologic complete response (pCR) rates and toxicity. RESULTS: A total of 109 patients received CT-RT followed by esophagectomy (95 M; 14 F). Median RT dose was 45 Gy (range, 36-66 Gy). The TAX and non-TAX groups comprised 47% and 53% of patients, respectively. Most (83%) TAX patients received three drug regimens including platinum and a fluoropyrimidine. In the non-TAX group, 89% of the patients received cisplatin and 5-FU. The remainder received 5-FU or capecitabine alone. Grade 3-4 toxicity occurred in 41% of patients receiving TAX vs. 24% of those receiving non-TAX (p = 0.19). Overall pCR rate was 39% (39% with TAX vs. 40% with non-TAX, p = 0.9). Overall LC, DFS, and OS at 3 years were 80%, 34%, and 37%, respectively. At 3 years, there were no differences in LC (75% vs. 85%, p = 0.33) or OS (37% vs. 37%, p = 0.32) between TAX and non-TAX groups. CONCLUSIONS: In this large experience, paclitaxel-containing regimens did not improve pCR rates or clinical end points compared to non-paclitaxel-containing regimens.