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Guru Sonpavde MD Bryan H. Goldman MD V. O. Speights MD Seth P. Lerner MD David P. Wood MD Nicholas J. Vogelzang MD Donald L. Trump MD Ronald B. Natale MD H. Barton Grossman MD E. David Crawford MD 《Cancer》2009,115(18):4104-4109
BACKGROUND:
In a retrospective study of Southwestern Oncology Group (SWOG)‐S8710/INT‐0080 (radical cystectomy [RC] alone vs 3 cycles of neoadjuvant chemotherapy [NC] with methotrexate, vinblastine, doxorubicin, and cisplatin before RC for bladder cancer), factors found to be associated with improved overall survival (OS) included pathologic complete response, defined as P0; treatment with NC; completion of RC with negative surgical margins; and ≥10 pelvic lymph nodes (LNs) removed.METHODS:
The authors used stratified Cox regression to retrospectively study the association of quality of pathologic response after RC with OS in the subset of S8710 patients who received NC and RC with negative surgical margins.RESULTS:
Of 154 patients who received NC, 68 (44.2%) were <P2 (P0, Pa, P1, or carcinoma in situ [CIS]) at RC, 46 (29.9%) were P0, and the remainder had P2+ disease or did not undergo RC. In 115 patients who had RC with negative surgical margins, compared with P0 patients, those with residual Pa, P1, or CIS appeared to have worse OS (P = .054); OS was significantly worse for patients with residual P2+ disease (P = .0006). LN–positive (LN+) disease was found to be associated with worse OS than LN–negative (LN?) disease (P = .0005). Patients with LN? disease (ie, those with <10 LNs removed) appeared to have inferior OS compared with those with 10+ LNs removed (P = .079). The combination of pre‐NC clinical stage and post‐RC pathologic stage was found to be predictive of OS (P < .0001).CONCLUSIONS:
NC and RC with negative surgical margins for bladder cancer followed by pathologic P0 and LN? disease were found to correlate with improved OS. A combination of baseline clinical stage and post‐RC pathologic stage may better predict OS. Cancer 2009. © 2009 American Cancer Society. 相似文献6.
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The efficacy of systematic lymph node dissection in advanced epithelial ovarian cancer during interval debulking surgery performed after neoadjuvant chemotherapy 下载免费PDF全文
Kyung Jin Eoh MD Jung Won Yoon MD Inok Lee MD Jung‐Yun Lee Sunghoon Kim MD PhD Sang Wun Kim MD PhD Young Tae Kim MD PhD Eun Ji Nam MD PhD 《Journal of surgical oncology》2017,116(3):329-336
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With the increasing use of neoadjuvant chemotherapy, it has also become apparent that some patients will require a less extensive interval cytoreductive surgery which could be performed as a minimally invasive procedure. This observation, and expertise with minimally invasive surgery for other indications in gynecologic oncology, has driven surgeons in the United States and other countries to perform an increasing portion of interval cytoreductive surgery using minimally invasive techniques. Further observational and trial data will continue to inform which patients are best suited for this approach. 相似文献
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M Tanioka C Shimizu K Yonemori K Yoshimura K Tamura T Kouno M Ando N Katsumata H Tsuda T Kinoshita Y Fujiwara 《British journal of cancer》2010,103(3):297-302
Background:
Although a pathologic complete response (pCR) after neoadjuvant chemotherapy is associated with favourable outcomes, a small proportion of patients with pCR have recurrence. This study was designed to identify factors predictive of recurrence in patients with pCR.Methods:
A total of 449 breast cancer patients received neoadjuvant chemotherapy, and 88 evaluable patients had a pCR, defined as no evidence of invasive carcinoma in the breast at surgery. The clinical stage was II in 61 patients (69%), III in 27 (31%). All patients received taxanes and 92% received anthracyclines. Among 43 patients with HER2-positive tumours, 27 received trastuzumab. Cox regression analyses were performed to identify predictors of recurrence.Results:
Median follow-up was 46.0 months. There were 12 recurrences, including 8 distant metastases. The rate of locoregional recurrence was 10.4% after breast-conserving surgery, as compared with 2.5% after mastectomy. Multivariate analysis revealed that axillary metastases (hazard ratio (HR), 13.6; P<0.0001) and HER2-positive disease (HR, 5.0; P<0.019) were significant predictors of recurrence. Five of six patients with both factors had recurrence. Inclusion of trastuzumab was not an independent predictor among patients with HER2-positive breast cancer.Conclusion:
Our study results suggest that HER2 status and axillary metastases are independent predictors of recurrence in patients with pCR. 相似文献10.
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目的探讨间歇性肿瘤细胞减灭术(IDS)与初始肿瘤细胞减灭术(PDS)对晚期上皮性卵巢癌(EOC)的疗效。方法根据手术方法的不同将132例晚期EOC患者分为PDS组(n=87例)和IDS组(n=45)。PDS组患者行PDS手术后接受6~8个疗程的化疗。IDS组患者行PDS手术后接受3个疗程的化疗,然后再行IDS手术后化疗3~5个疗程。观察两组患者的PDS切除范围,比较两组患者的减瘤满意率、疗效、血清CA125水平和不良反应发生情况。结果IDS组患者的PDS切除范围明显小于PDS组(P﹤0.01)。IDS组患者的减瘤满意率高于PDS组(P﹤0.05)。IDS组患者的临床疗效明显优于PDS组(P﹤0.01)。术前和第3次化疗后,两组患者的血清CA125水平比较,差异均无统计学意义(P﹥0.05)。IDS组患者PDS后的血清CA125水平高于PDS组,完成化疗后的血清CA125水平低于PDS组(P﹤0.05)。IDS组患者的不良反应总发生率低于PDS组(P﹤0.05)。结论IDS有助于提高晚期EOC患者的手术减瘤满意率和近期疗效,且不会显著增加不良反应。 相似文献
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G.C. Zhang Y.F. Zhang F.P. Xu X.K. Qian Z.B. Guo C.Y. Ren M. Yao 《Current oncology (Toronto, Ont.)》2013,20(3):e180-e192
Background
Our retrospective study in breast cancer patients evaluated whether integrating subtype and pathologic complete response (pcr) information into axillary lymph node restaging after neoadjuvant chemotherapy (nac) adds significance to its prognostic values.Methods
Patients included in the analysis had stage ii or iii disease, with post-nac axillary lymph node dissection (alnd), without sentinel lymph node biopsy before completion of nac, with definitive subtyping data and subtype-oriented adjuvant treatments. The ypN grading system was used to restage axillary lymph node status, and ypN0 was adjusted by pcr in both breast and axilla into ypN0(pcr) and ypN0(non-pcr). Univariate and multivariate survival analyses were performed.Results
Among the 301 patients analyzed, 145 had tumours that were hormone receptor–positive (hr+) and negative for the human epidermal growth factor receptor (her2–), 101 had tumours that were positive for her2 (her2+), and 55 had tumours that were triple-negative. The rate of pcr in both breast and axilla was 11.7%, 43.6%, and 25.5% respectively for the 3 subtypes. Compared with the non-pcr patients, the pcr patients had better disease-free survival (dfs) and overall survival (os): p = 0.002 for dfs and p = 0.011 for os. In non-pcr patients, dfs and os were similar in the ypN0(non-pcr) and ypN1 subgroups, and in the ypN2 and ypN3 subgroups. We therefore grouped the ypN grading results into ypN0(pcr) (n = 75), ypN0– 1(non-pcr) (n = 175), and ypN2–3 (n = 51). In those groups, the 3-year dfs was 98%, 91%, and 56%, and the 3-year os was 100%, 91%, and 82% respectively. The differences in dfs and os between those three subgroups were significant (all p < 0.05 in paired comparisons). Multivariate Cox regression showed that subtype and ypN staging adjusted by pcr were the only two independent factors predicting dfs.Conclusions
Axillary lymph node status after nac, adjusted for pcr in breast and axilla, predicts differential dfs in patients without prior sentinel lymph node biopsy. 相似文献13.
Distance to the anal verge is associated with pathologic complete response to neoadjuvant therapy in locally advanced rectal cancer 下载免费PDF全文
Sunil V. Patel MD MSc Campbell S. Roxburgh MD Efsevia Vakiani MD PhD Jinru Shia MD J. Joshua Smith MD PhD Larissa K. Temple MD Philip Paty MD Julio Garcia‐Aguilar MD PhD Garrett Nash MD MPH Jose Guillem MD MPH Abraham Wu MD Marsha Reyngold MD PhD Martin R. Weiser MD 《Journal of surgical oncology》2016,114(5):637-641
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目的 评价局部晚期直肠癌新辅助治疗后pCR的相关影响因素。方法 回顾分析2011—2013年间收治的265例AJCC分期Ⅱ、Ⅲ期直肠癌患者资料。所有患者均接受新辅助治疗±等待手术间期化疗, 而后手术。运用单因素和二元Logistic回归多因素分析影响pCR的预测因素, 并根据预测危险因素进行归类后分为无风险组(无因素)、低风险组(1个因素)、高风险组(2个因素)。建立临床风险评估模型。因素分析运用二元Logistic回归模型。结果 达pCR者50例(18.9%)。单因素分析中新辅助治疗前CEA、放化疗前T分期、同期放化疗结束至手术间隔时间和放化疗前肿瘤最大厚度对pCR有影响(P=0.017、0.001、0.000、0.040), 多因素分析显示新辅助治疗前CEA水平和同期放化疗结束至手术间隔时间是pCR影响因素(P=0.021、0.001), 进一步分层分析表明只有非吸烟组中新辅助治疗前低水平CEA对pCR有影响(P=0.044)。临床风险评估模型诊断pCR的敏感性为80.5%, 特异性为46.0%, AUC为0.690, 阳性预测值为35.49%, 阴性预测值为86.5%, 准确性为73.9%。结论 新辅助治疗能使部分局部晚期直肠癌患者达pCR。新辅助治疗前低水平CEA和更长的同期放化疗结束至手术间隔时间是局部晚期直肠癌新辅助治疗pCR的预测因素, 而新辅助治疗前低水平CEA对pCR预测只在非吸烟人群中有效。根据新辅助治疗前CEA>5 ng/ml和同期放化疗结束至手术间隔时间≤8周的危险因素建立的临床风险评估模型可用于预测局部晚期直肠癌新辅助治疗pCR率。 相似文献
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CT体积测量在进展期胃癌患者新辅助化疗疗效评价中的应用价值研究 总被引:3,自引:0,他引:3
目的探讨多层螺旋CT体积测量技术对于进展期胃癌患者新辅助化疗疗效评价的应用价值。方法对31例胃镜病理确诊胃癌的患者(男性24例,女性7例,平均年龄57岁)进行化疗前64层螺旋CT增强扫描,所有患者接受胃癌新辅助化疗(Folfox6方案)3个疗程,化疗后再行64层螺旋CT增强扫描,1周内所有患者手术切除肿瘤,并取得病理作对照,分为病理无效组和有效组。以门脉期重建图像测量肿瘤厚度及体积,分析肿瘤厚度和体积变化与病理评价疗效的关系。结果CT测量肿瘤厚度较测量肿瘤体积重复性差。CT肿瘤厚度减少率与病理分级的相关性r=0.540(P=0.002)。CT肿瘤体积减少率与病理分级的相关系数为0.570(P=0.001),呈中度相关。如果将肿瘤体积减少率37.2%作为的评价化疗有效的阈值,其预测病理评价有效的敏感性是73%,特异性80%。结论CT测量肿瘤厚度减少率和体积减少率可以帮助预测进展期胃癌患者化疗疗效,但CT肿瘤体积测量更客观,与化疗疗效的相关性更好。 相似文献
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