31例乳腺癌术前新辅助化疗疗效观察

目的观察乳腺癌术前新辅助胡化疗的疗效。方法31例可手术乳腺癌患者（Ⅱ-Ⅲa期）,术前给予CEF或TE方案化疗3个周期。结果CR 2例,PR 20例,总有效率为70.9%,无进展病例。不良反应主要表现为胃肠道反应和骨髓抑制,经对症治疗后均缓解。结论对于可手术乳腺癌患者术前给予新辅助化疗（NCT）可以使原发灶明显缩小,降低手术复杂性,缩小手术范围。     

多西紫杉醇联合阿霉素在老年晚期乳腺癌新辅助化疗中的应用

新辅助化疗又称术前化疗，对于治疗许多较大但可切除的晚期乳腺癌能够防止微小转移灶的发生，术前应用足量的化疗能使原发瘤缩小，从而提高手术效果，降低手术的风险，通过疗效判断，可对术后化疗具有指导性意义。晚期乳腺癌患者中相当一部分为老年人，生理机能差，伴发的疾病多，更增加了治疗的困难。多西紫杉醇联合蒽环类抗肿瘤药阿霉素应用疗效好，且毒副作用较轻。我们用多西紫杉醇联合阿霉素（AT方案）对44例晚期老年乳腺癌进行术前化疗进行了观察。     

Ki-67在新辅助化疗乳腺癌中的表达及意义

目的探讨Ki-67在新辅助化疗乳腺癌中的表达及意义。方法采用新辅助化疗TE方案对42例Ⅱa～Ⅲb期乳腺癌患者治疗2周期,化疗前（粗针穿刺）、化疔后（手术切除标本）获取乳腺癌组织进行病理诊断,同时用免疫组化方法检测Ki-67表达。结果Ki-67表达阳性者化疗有效率为71．9％,阴性者化疗有效率为28．1％,二者比较有统计学差异（P〈0．05）;化疗前Ki-67阳性表达率61．9％（26／42）,化疗后为35．7％（15／42）（P〈0．05）。结论Ki-67表达水平是乳腺癌TE方案新辅助化疗疗效的重要预测因子,阴性者对TE方案疗效欠佳。     

粗针穿刺活检对乳腺癌新辅助化疗疗效的价值

正新辅助化疗已成为可手术乳腺癌及局部晚期乳腺癌规范化治疗的方法之一〔1〕。因新辅助化疗在手术以前,所以为临床上观察疗效提供了更直接的平台,但临床评价很难准确评价出癌灶的真实情况。文献〔2〕报道,乳腺癌新辅助化疗达到完全缓解率为3%～30%。病理学检查作为评价化疗后肿瘤反应的"金标准",诊断准确性强,但需在新辅助化疗结束及手术后,获     

高频超声检查在乳腺癌新辅助化疗疗效评估中的应用价值

对52例乳腺癌患者（58个肿瘤）在新辅助化疗后应用高频超声检查进行评估，并与临床评估和术后病理结果对照分析。化疗后超声测量的残余癌最大直径与术后病理测量的残余癌最大直径显著相关（r=0．894，P〈0．01），较临床触诊测量的残余癌最大直径与病理残余癌最大直径相关性（r=0．646，P〈0．01）更为密切。超声评估原发肿瘤缓解的总有效率（79．31％），与病理结果（79．31％）相符；而临床评估总有效率为93．10％，高估率为13．79％。认为应用高频超声对乳腺癌新辅助化疗患者进行疗效评估，较临床评估更方便、准确，有助于临床优化治疗方案。     

TEC方案在乳腺癌新辅助化疗中的疗效

目的探讨TEC方案在乳腺癌新辅助化疗中的近期疗效及毒副反应。方法选取63例局部晚期乳腺癌患者,全部给予TEC方案,行新辅助化疗,观察化疗后的临床效果及毒副反应。结果新辅助化疗后临床完全缓解(CR)9例,部分缓解(PR)34例,稳定(SD)16例,疾病进展(PD)4例。毒副反应主要有骨髓抑制、胃肠道反应、心肌损伤、肝功能损伤、脱发等,所有患者经过对症处理后均可耐受。结论 TEC方案在新辅助化疗中疗效显著,毒副反应均可耐受。     

乳腺癌患者血清p53抗体检测在新辅助化疗研究中的应用

乳腺癌是女性中最常见的恶性肿瘤之一。近些年来在国内的一些大城市中，乳腺癌的发病几率一直呈上升趋势。新辅助化疗（neoadjuvant chemotherapy，NAC）目前被临床广泛应用于晚期乳腺癌的系统治疗。NAC能够显著降低肿瘤分期，提高保乳手术几率。蒽环类药物是一种常用的NAC治疗方案，能够通过与癌细胞内拓扑异构酶Ⅱ的相互作用而阻碍DNA的转录，进而达到抑制癌细胞增殖的目的。近些年来，对血清p53抗体的研究成为p53研究中的一个新热点。血清p53抗体是癌细胞内p53蛋白（通常是突变性p53蛋白）进入血液内，发生自身免疫而产生的抗体。目前，国内外对血清p53抗体对NAC的预测价值方面报道较少见。本实验研究了36例晚期乳腺癌患者化疗前p53抗体表达量与化疗后客观缓解（objective response，OR）率的关系，结果报告如下。     

新辅助化疗TEC方案治疗晚期乳腺癌的临床观察

目的 探讨新辅助化疗TEC方案对晚期乳腺癌的治疗效果.方法 对28例Ⅲ、Ⅳ期乳腺癌患者行TEC新辅助化疗方案(多西紫杉醇75 mg/m2静脉滴入d1,表阿霉素60 mg/m2静脉滴入d1,环磷酰胺500 mg/m2静脉注射d1),21 d为1周期,共2周期,并与未行任何术前治疗可手术的24例Ⅲa期患者作对比分析.结果 新辅助化疗组的总有效率为82.14%(23/28),有64.28%(18/28)的患者分期降低.新辅助化疗组的平均无病生存期为49.6个月,明显高于未行化疗组的40.2个月(P<0.05),新辅助化疗组的50个月随访期无病生存率为32.14%,对照组为29.16%,差异无统计学意义.结论 新辅助化疗能降低晚期乳腺癌患者的分期,为手术创造最佳机会,减少或延缓肿瘤的复发、转移,并可延长晚期乳腺癌患者的无病生存期.     

TAC、TEC方案新辅助化疗治疗乳腺癌效果比较

目的比较TAC、TEC两种新辅助化疗方案治疗乳腺癌的疗效。方法 139例原发性乳腺癌患者,随机分为TAC组71例和TEC组68例,分别采用TAC（多西他赛＋吡柔比星＋环磷酰胺）方案及TEC（多西他赛＋表柔比星＋环磷酰胺）方案进行4~6周期的新辅助化疗,观察肿瘤、腋窝淋巴结的变化以及不良反应发生情况。结果 TAC组总有效率（RR）、病理完全缓解率（pCR）、临床完全缓解率（cCR）、临床部分缓解率（cPR）以及病情稳定（SD）率分别为88.7%、11.3%、28.2%、60.6%和11.3%,TEC组分别为86.8%、10.3%、26.5%、60.3%和13.2%,两组相比P均〉0.05。化疗过程中两组白细胞下降、血小板减少、便秘、心脏毒性、肝肾功能异常发生率相比P均〉0.05。TAC组胃肠道反应（恶心或呕吐）发生率为46.5%,低于TEC组的66.2%（P〈0.05）。两组手术切除率均达100%。结论用TAC、TEC方案行乳腺癌新辅助化疗疗效满意,不良反应少。     

乳腺癌新辅助化疗前后病理组织学的变化

目的 观察乳腺癌新辅助化疗前后的病理组织学改变.方法 选择经粗针穿刺确诊的乳腺癌患者56例,采用FEC方案行新辅助化疗,完成2～3周期后再行手术治疗.手术后通过肿瘤分级、肿瘤坏死、炎细胞浸润、间质出血、纤维化等指标对化疗前后组织学标本进行比较评价.结果 新辅助化疗后肿瘤完全消失1例,肿瘤实质细胞呈不同程度的蜕变,如肿瘤细胞坏死、原位癌结构形成、瘤巨细胞形成、肿瘤细胞胞浆空泡化.间质变化包括间质水肿、坏死、出血、玻璃样变性、钙化、纤维化和炎细胞浸润等.结论 新辅助化疗不仅产生肿瘤细胞的坏死,也可导致瘤巨细胞形成.新辅助化疗对肿瘤间质也有明显的影响.     

局部进展期直肠癌新辅助放化疗后病理完全缓解临床相关因素探究

目的探讨局部进展期直肠癌新辅助放化疗后病理完全缓解（pCR）的临床相关因素。 方法回顾性分析2013年1月至2018年5月期间四川省肿瘤医院肠道外科病区收治的117例局部进展期直肠癌新辅助放化疗及手术的临床资料,采用单因素分析及logistic二分类多因素回归分析法研究pCR的临床相关因素。 结果117例患者全部完成新辅助放化疗及根治手术,其中19例（16.24%）患者达到pCR。单因素分析结果显示,性别为女性（P=0.024）,年龄较年轻（P=0.042）,放疗前CEA<5 ug/L（P=0.015）,无吸烟史（P=0.008）,无饮酒史（P=0.037）,肿瘤距肛缘距离大于6 cm（P=0.048）和局部进展期直肠癌新辅助放化疗后高pCR率有关。多因素回归分析结果显示,放疗前CEA<5 ug/L（P=0.039）和肿瘤距肛缘距离>6 cm（P=0.043）是影响局部进展期直肠癌新辅助放化疗后pCR率的独立因素。 结论放疗前CEA水平和肿瘤距肛缘距离是影响局部进展期直肠癌新辅助放化疗后pCR率的相关临床因素。     

Optical imaging of breast cancer oxyhemoglobin flare correlates with neoadjuvant chemotherapy response one day after starting treatment

Approximately 8-20% of breast cancer patients receiving neoadjuvant chemotherapy fail to achieve a measurable response and endure toxic side effects without benefit. Most clinical and imaging measures of response are obtained several weeks after the start of therapy. Here, we report that functional hemodynamic and metabolic information acquired using a noninvasive optical imaging method on the first day after neoadjuvant chemotherapy treatment can discriminate nonresponding from responding patients. Diffuse optical spectroscopic imaging was used to measure absolute concentrations of oxyhemoglobin, deoxyhemoglobin, water, and lipid in tumor and normal breast tissue of 24 tumors in 23 patients with untreated primary breast cancer. Measurements were made before chemotherapy, on day 1 after the first infusion, and frequently during the first week of therapy. Various multidrug, multicycle regimens were used to treat patients. Diffuse optical spectroscopic imaging measurements were compared with final postsurgical pathologic response. A statistically significant increase, or flare, in oxyhemoglobin was observed in partial responding (n = 11) and pathologic complete responding tumors (n = 8) on day 1, whereas nonresponders (n = 5) showed no flare and a subsequent decrease in oxyhemoglobin on day 1. Oxyhemoglobin flare on day 1 was adequate to discriminate nonresponding tumors from responding tumors. Very early measures of chemotherapy response are clinically convenient and offer the potential to alter treatment strategies, resulting in improved patient outcomes.     

CAF短周期密集方案新辅助化疗在乳腺癌中的应用

目的探讨CAF方案在乳腺癌短周期密集新辅助化疗中的安全性、近期疗效以及对手术方式的影响。方法36例乳腺癌患者采用短周期密集CAF方案化疗2周期。结果完全缓解2例,部分缓解26例,总有效率77·8%,毒副作用主要为不同程度的脱发、胃肠道反应,如恶心、呕吐,骨髓抑制主要是白细胞下降,对症治疗后缓解,不影响手术治疗。结果CAF方案在乳腺癌短周期新辅助化疗中,可以使肿块明显缩小,提高手术切除率,增加化疗的敏感性,指导术后化疗,毒副作用可为患者所耐受,由于周期较短,可减少外科手术治疗前的时间。     

Activation of nuclear factor-kappa B is linked to resistance to neoadjuvant chemotherapy in breast cancer patients

The nuclear factor (NF)-kappaB system is a promising anticancer target due to its role in oncogenesis and chemoresistance in preclinical models. To provide evidence in a clinical setting on the role of NF-kappaB in breast cancer, we aimed to study the value of basal NF-kappaB/p65 in predicting resistance to neoadjuvant chemotherapy, and to characterise the pharmacodynamic changes in NF-kappaB/p65 expression following chemotherapy in patients with locally advanced breast cancer. Pre- and post-chemotherapy tumour specimens from 51 breast cancer patients treated with anthracycline- and/or taxane-containing neoadjuvant chemotherapy were assayed by immunohistochemistry for NF-kappaB/p65 subcellular expression. We studied NF-kappaB/p65, a well-characterised member of the NF-kappaB family that undergoes nuclear translocation when NF-kappaB is activated. Activation of NF-kappaB (i.e. nuclear NF-kappaB/p65 staining in pre-therapy specimens) was linked to chemoresistance. Patients with NF-kappaB/p65 nuclear staining in pre-treatment samples had a 20% clinical response rate, while patients with undetected nuclear staining had a 91% response rate to chemotherapy (P = 0.002). Notably, four patients achieved a complete histological response and none of them had pre-treatment NF-kappaB/p65 nuclear staining. Moreover, the number of patients with NF-kappaB/p65 activation increased after chemotherapy exposure. It is concluded that NF-kappaB/p65 activation assayed by immunohistochemistry is a predictive factor of resistance to neoadjuvant chemotherapy in breast cancer patients. Moreover, NF-kappaB activation was inducible following chemotherapy in a proportion of breast cancer patients. These novel clinical findings strengthen the rationale for the use of NF-kappaB inhibitors to prevent or overcome chemoresistance in breast cancer.     

直肠癌新辅助治疗后病理完全缓解情况及预测因素分析

目的探讨进展期直肠癌患者新辅助治疗（NAT）疗效,寻找可以有效预测NAT后病理完全缓解的临床和病理因素。 方法回顾性分析2018年6月~2020年12月期间在山西省肿瘤医院行NAT并行全直肠系膜切除术的进展期直肠癌患者129例,根据其NAT后的反应（术后病理结果）,分为病理完全缓解（pCR）和非病理完全缓解（non-pCR）两组,对性别、年龄、肿瘤距肛缘距离、术前T分期、N分期、治疗前CEA水平、肿瘤最大直径、微卫星状态、术前联合放疗等几项指标进行统计学分析。 结果共纳入129例患者,其中NAT后pCR患者15例（11.6%）。单因素分析显示,术前CEA水平低的患者NAT后pCR的比例（21.3%）明显高于CEA水平高者（2.9%）,术前联合放化疗的患者pCR比例（23.1%）明显高于术前单纯化疗的患者（6.7%）（χ²=5.623,P＜0.05）;微卫星状态稳定的患者pCR比例（12.3%）在数值上高于微卫星状态不稳定的患者（6.7%）,差异无统计学意义（P＞0.05）。Logistic回归分析显示,治疗前CEA水平高（OR=12.570,95%CI：2.515~62.830）和术前联合放化疗（OR=6.319,95%CI：1.850~21.580）,是NAT后达到pCR的独立因素。通过ROC曲线发现Logistic回归模型预测pCR率最佳截断值为0.87,灵敏度为0.82,特异度为0.87,AUC值为0.885。术前CEA＜2.315 μg/L是预测NAT达到pCR的有效指标。 结论治疗前CEA水平和术前联合放化疗可以作为临床评估NAT疗效的参考指标。     

Four-Tier Pathologic Tumor Regression Grading System Predicts the Clinical Outcome in Patients Who Undergo Surgical Resection for Locally Advanced Pancreatic Cancer after Neoadjuvant Chemotherapy

Background/AimsNeoadjuvant chemotherapy is increasingly utilized in patients with borderline or locally advanced pancreatic cancer (LAPC). However, the pathologic evaluation of tumor regression is not routinely performed or well established. We aimed to evaluate the prognostic value of three tumor regression grading systems frequently used in LAPC and to determine the correlation between pathologic and clinical response.MethodsWe included a total of 38 patients with LAPC who were treated with neoadjuvant chemotherapy and subsequent resection. Pathologic tumor regression was graded based on the College of American Pathologists (CAP), Evans, and MD Anderson grading systems.ResultsOne out of 38 patients (2.6%) achieved a pathologic complete response. Unlike other grading systems (Evans, p=0.063; MD Anderson, p=0.110), the CAP grading system was a significant prognostic factor for overall survival (p=0.043). Pathologic N stage (p=0.023), margin status (p=0.044), and radiologic response (p=0.016) correlated with overall survival. In the multivariate analysis, CAP 3 was an independent predictor of shorter overall survival (p=0.026). The CAP grading system correlated with the radiologic response (p=0.007) but not the carbohydrate antigen 19-9 level (p=0.333).ConclusionsThe four-tier CAP pathologic tumor regression grading system predicted the clinical outcome in LAPC patients who underwent resection after neoadjuvant chemotherapy. Therefore, a more comprehensive pathologic evaluation is warranted in these patients.     

Efficacy and safety of neoadjuvant chemotherapy and immunotherapy in locally resectable advanced esophageal squamous cell carcinoma

BackgroundEsophageal squamous cell cancer (ESCC) patients with the potentially resectable disease most would experience relapse after surgery. Immunotherapy has been reported to improve the prognosis of advanced esophageal cancer and may be a new strategy to prevent this urgent condition’s recurrence. We first evaluated the efficacy and safety of neoadjuvant chemotherapy combined with immunotherapy in patients with resectable ESCC.MethodsAll patients with resectable locally advanced ESCC (clinical stage III–IVB). Received at least 1 cycle of neoadjuvant chemotherapy combined with immunotherapy (NACI), and the interval between each cycle and the operation should be at least 3 weeks. All patients were treated with standard surgery. The tumor imaginations were obtained at baseline and within a week before surgery. The efficacy endpoint was the rate of major pathologic response (MPR, 10% viable tumor cells). Expression of immunohistochemical-related molecules was investigated in surgical samples.ResultsA total of 38 patients with ESCC were included (36 males, median age 61 years), and most of them used Pembrolizumab (55.26%) and Camrelizumab (31.58%). We analyzed 19 patients and found that 13 patients (68.42%) achieved radiological partial response (PR) by CT images. R0 resection was performed in 35 patients (92.11%), and 10 patients (26.32%) developed postoperative complications. Through postoperative pathology, we found 13 (34.21%) patients had complete pathologic response (cPR), and 16 (42.11%) patients achieved MPR. We also found that none of the factors had a statistically significant impact on MPR. Still, the regression rate of Sum of lesion diameter (SLD) was significantly positively correlated with the pathological remission rate (P=0.012, r=0.565).ConclusionsThe rate of MPR in ESCC patients reached 42.11%. The use of the NACI regimen did not increase the occurrence of complications in neoadjuvant treatment and operation, and the SLD regression rate has a certain guiding significance for the effect of immunotherapy.     

Neoadjuvant chemotherapy with S-1 and CDDP in advanced gastric cancer

Purpose This retrospective study evaluated the effects of neoadjuvant chemotherapy in advanced gastric cancer.Methods Between 2002 and 2005, we treated 14 patients with advanced gastric cancer (involvement of more than five nodes or tumor invasion into pancreas) and 25 patients with Stage III gastric cancer. The group of 14 patients with advanced gastric cancer received combination chemotherapy with S-1 and cis-diamminedichloroplatinum (CDDP) as a neoadjuvant chemotherapy (NAC). This regimen was repeated every 5 weeks for a total of 2–5 cycles. The 25 patients with Stage III gastric cancer was carried surgery alone (SA). All patients underwent extensive surgery, including gastrectomy, and D2 lymphadenectomy. The rate of response and overall survival in the two groups were compared.Results All patients of NAC group completed the planned regimens of chemotherapy and surgery. Patients of the NAC group had a response rate of 78.6% (95% confidence interval 57.1–100.0%). The most common adverse effect was leukocytopenia (42.9%). However, only four patients (28.6%) had upper Grade 2 leukocytopenia, and all recovered promptly. Postoperative complications were not significant differentiated between NAC and SA group of patients (7.2 vs. 4.0%). Patients in the NAC group had a significantly better survival than those in the SA group (P = 0.03). The median survival has not been reached after 26.9 months of median follow-up for patients in the NAC group. 1-, 2-, and 3-year survival rates were 92.3, 92.3, and 61.5%, respectively. NAC was identified as an independent prognostic factor in all patients (P = 0.018).Conclusion Neoadjuvant chemotherapy with TS-1 + CDDP improves the survival in patients with advanced gastric cancer.     

Locally advanced breast carcinoma treated with neoadjuvant chemotherapy: are the changes in serum levels of YKL-40, MMP-2 and MMP-9 correlated with tumor response?

Serum levels of YKL-40, MMP-2 and MMP-9 in 27 patients with locally advanced breast carcinoma received neoadjuvant chemotherapy were measured. All patients underwent neoadjuvant chemotherapy named as FAC protocol (5-Fluorouracil, Doxorubicin and Cyclophosphamide) with 21 days interval. There was 26,7% decrease in mean serum YKL-40 levels (from 146,4 microg/ml to 107,3 microg/ml) in clinically responsive group. This level was almost unchanged in non-responsive group (P>0, 05). There was 42, 1% decrease in mean serum YKL-40 levels (from 173,1 microg/ml to 98, 8 microg/ml) in pathologically responsive group. This decrease was more dramatic in patients with complete pathological response (70, 2%). However, this level was slightly increased in non-responsive group. Changes in serum levels of MMP-2 and MMP-9 were not found to be associated with tumor response. Serum measurement of YKL-40 can be a helpful tool to predict pathological tumor response in breast cancer patients with neoadjuvant chemotherapy but not MMP-2 and MMP-9.     

进展期胃癌新辅助化疗后超声内镜下TN分期准确率及化疗前后TN期变化与术后病理反应程度相关性的研究

目的评估超声内镜判断进展期胃癌患者新辅助化疗后TN,分期的准确率并探讨化疗前后TN分期变化与胃癌根治术后病理反应程度的相关性。方法2007年6月至2009年12月间22例进展期胃癌患者在签署知情同意书后首先接受了新辅助化疗,其中男15例i女7例,年龄36—80岁,平均64岁。采取Folfox6化疗方案治疗3个疗程,治疗结束后3～4周全部接受胃癌根治术（R0切除）治疗,化疗前1—2周和手术前1～2周分别对患者行内镜超声检查术（EUS）,并进行超声内镜下TN分期判断,以手术病理TN分期为金标准,统计胃癌新辅助化疗后超声内镜下TN分期的准确率,同时对化疗前后超声内镜下TN分期变化与手术后病理反应程度（根据瘤床内出现退变或坏死影响的肿瘤细胞的比例分级,分别计作0、1a和lb、2、3,从0到3表示反应程度逐渐变好）行相关性分析。结果胃癌新辅助化疗后超声内镜下T分期的总体准确率为63．6％（14／22）,无一例诊断不足,但存在8例（36．4％,8／22）过度诊断;N分期的总体准确率为54．5％（12／22）,有4例（18．2％,4／22）过度诊断和6例（27．3％,6／22）诊断不足。新辅助化疗后有10例超声内镜下TN分期发生降期（以T期＋N期降期例数进行统计,同时发生T期和N期降期时只计作1例）,包括9例T期（4例T3期降为T2期,5例T4期降为r乃期）和4例N期（4例N1期降为N0期）降期,发生TN期降期的患者手术后病理反应程度大多较好,其中7例降期患者术后病理反应程度为2,l例降期患者术后病理反应程度为3。结论进展期胃癌新辅助化疗后超声内镜下TN分期的准确率并不高,但化疗后出现超声内镜下TN分期降期的患者手术后病理反应程度大多较好。