胸段食管鳞癌不同新辅助治疗模式联合手术的生存分析

目的 比较新辅助放化疗(NCRT)和新辅助化疗(NCT)联合手术对食管癌生存的影响。方法 回顾分析2011-2015年确诊的行新辅助治疗联合手术治疗的胸段食管鳞癌275例资料。NCRT组70例,NCT组205例。采用Kaplan-Meier法计算生存率,Logrank法对比生存,Cox回归模型多因素分析。结果 中位随访时间32(3~84)个月。全组中位生存、中位无复发生存期分别为42(3~84)、30(3~84)个月,3、5年总生存率分别为56.8%、45.9%,3、5年无复发生存率分别为45.1%、38.9%。NCRT和NCT组患者中位生存期分别为46(7~84)个月和40(4~74)个月,中位无复发生存期分别为31(3~84)个月和28(3~69)个月;3、5年总生存率分别为59.1%、47.1%和56.3%、47.5%(P=0.515),3、5年无复发生存率分别为44.5%、40.1%和47%、39%(P=0.554)。多因素分析显示术后病理TNM分期是影响食管癌预后的独立因素(P=0.001)。结论 NCRT与NCT联合手术治疗生存结果相似,术后病理分期是独立的生存影响因素。     

胸段食管鳞癌不同新辅助治疗模式联合手术的生存分析

目的 比较新辅助放化疗(NCRT)和新辅助化疗(NCT)联合手术对食管癌生存的影响。方法 回顾分析2011-2015年确诊的行新辅助治疗联合手术治疗的胸段食管鳞癌275例资料。NCRT组70例,NCT组205例。采用Kaplan-Meier法计算生存率,Logrank法对比生存,Cox回归模型多因素分析。结果 中位随访时间32(3~84)个月。全组中位生存、中位无复发生存期分别为42(3~84)、30(3~84)个月,3、5年总生存率分别为56.8%、45.9%,3、5年无复发生存率分别为45.1%、38.9%。NCRT和NCT组患者中位生存期分别为46(7~84)个月和40(4~74)个月,中位无复发生存期分别为31(3~84)个月和28(3~69)个月;3、5年总生存率分别为59.1%、47.1%和56.3%、47.5%(P=0.515),3、5年无复发生存率分别为44.5%、40.1%和47%、39%(P=0.554)。多因素分析显示术后病理TNM分期是影响食管癌预后的独立因素(P=0.001)。结论 NCRT与NCT联合手术治疗生存结果相似,术后病理分期是独立的生存影响因素。     

Retrospective analysis of neoadjuvant chemotherapy followed by surgery versus definitive chemoradiotherapy with proton beam for locally advanced esophageal squamous cell carcinoma

International Journal of Clinical Oncology - This is the first study to compare the long-term outcomes between neoadjuvant chemotherapy?+?surgery and definitive chemoradiotherapy with...     

进展期食管鳞癌新辅助放化疗与新辅助化疗的Meta分析

目的 系统评价新辅助放化疗(NCRT)联合手术与新辅助化疗(NCT)联合手术治疗进展期食管鳞癌的疗效和安全性。方法 利用计算机检索PubMed、The Cochrane Library、EMbase、CBM、CNKI、WanFang、VIP数据库,搜集NCRT与NCT联合手术治疗食管鳞癌的临床对照研究,检索时限均从建库至2019年1月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果 共纳入8项临床对照研究,包括食管鳞癌患者995例。Meta分析结果显示NCRT对比NCT组,经手术治疗后无肿瘤细胞残存(R0)切除率更高(OR=2.14,95%CI为1.03~4.45,P=0.040)、病理完全缓解率(pCR)更高(OR=4.19,95%CI为1.71~10.28,P=0.002);两组术后并发症发生率(OR=1.37,95%CI为0.76~2.48,P=0.300)和围术期死亡风险(OR=1.28,95%CI为0.58~2.83,P=0.540)相近;NCRT组的食管鳞癌患者的远期生存情况更好(HR=0.77,95%CI为0.64~0.92,P=0.005)。结论 NCRT联合手术对比NCT联合手术治疗进展期食管鳞癌能够有更高的R0切除率、pCR率,并不会明显增加围术期并发症发生和围术期死亡风险,且能够更加明显的改善食管鳞癌患者的远期生存。     

新辅助化疗在老年中晚期口腔鳞状细胞癌治疗中的临床意义

目的：探讨分析新辅助化疗在治疗老年中晚期口腔鳞状细胞癌中的临床效果。方法收集46例老年中晚期口腔鳞状细胞癌行新辅助化疗患者作为研究组,选取同期收治的60例未行新辅助化疗老年中晚期口腔鳞状细胞癌患者作为对照组,统计入组患者新辅助化疗后临床有效率、病理有效率,对比新辅助化疗前后细胞凋亡及增殖指数,肿瘤组织Ki-67、EGFR、p53及RARβ的表达变化,并分析新辅助化疗后手术及生存情况,比较两组生存率差异。结果研究组化疗后临床有效率和病理有效率分别为80.43%和69.57%。化疗后细胞凋亡指数明显高于化疗前,细胞增殖指数低于化疗前,差异均具有统计学意义（P=0.007、0.015）。化疗后Ki-67、EGFR、p53均低于化疗前,RARβ高于化疗前,差异均具有统计学意义（P=0.004、0.027、0.021、0.013）。研究组患者的中位生存期为28个月,新辅助化疗3、4个疗程患者远期生存率高于2个疗程患者,差异有统计学意义（P=0.021、0.017）。3个疗程和4个疗程化疗患者远期生存率比较差异无统计学意义（P=0.117）。对照组患者中位生存期为17个月,两组患者生存率差异具有统计学意义（P=0.015）。结论新辅助化疗可从多方面改善老年中晚期口腔鳞状细胞癌的临床效果,应成为其综合治疗的重要组成部分。     

Prognostic variables in patients who have undergone radical cystectomy for transitional cell carcinoma of the bladder

OBJECTIVE: To evaluate whether several clinicopathological factors could be used as prognostic predictors in patients who have undergone radical cystectomy for transitional cell carcinoma (TCC) of the bladder. METHODS: Between January 1985 and June 2000, 154 patients underwent radical cystectomy and pelvic lymphadenectomy for TCC of the bladder at a single institution. Their clinicopathological findings were analyzed based on the criteria of the Japanese Urological Association. RESULTS: Histopathological examination revealed that the tumor grade was 1 or 2 in 22 patients and 3 in 132 patients; the pathological stage was pT1 or less in 30 patients, pT2 in 51 patients, pT3 in 53 patients and pT4 in 20 patients. Vascular involvement and lymph node metastasis were found in 85 and 33 patients, respectively. The cause-specific 5-year survival rate was 64.2% for all patients, 74.4% for patients with grade 1 or 2 tumors, 62.9% for those with grade 3 tumors; 90.9% for those with stage pT1 or less, 77.9% for those with stage pT2, 45.0% for those with stage pT3 and 29.2% for those with stage pT4 (p < 0.001); 83.2% for patients without vascular involvement and 42.0% for those with vascular invasion (p < 0.001); and 76.5% for patients without lymph node metastasis and 22.7% for those with lymph node metastasis (p < 0.001). Multivariate analysis revealed a strong independent correlation of the pathological stage and lymph node metastasis with poor prognosis and, furthermore, the incidence of lymph node metastasis was significantly related to the increase in pathological stage. CONCLUSIONS: In this series, the pathological stage, lymph node metastasis and vascular involvement, but not tumor grade, were significantly useful prognostic factors in patients who have undergone radical cystectomy for TCC and among them only pathological stage and lymph node metastasis could be used as independent predictors for poor prognosis.     

Docetaxel as neoadjuvant chemotherapy in patients with advanced cervical carcinoma

The purpose of this study was to evaluate the efficacy and toxicity of docetaxel as single-agent neoadjuvant chemotherapy in locoregionally advanced cervical carcinoma. Between April 1998 and August 2000, 38 untreated patients with International Federation of Gynecology and Obstetrics stages IIB to IVA were entered onto this study. The median age was 44 years (range: 25-66 years). Stages: IIB 22 patients, IIIB 15 patients, and IVA 1 pt. Treatment consisted of docetaxel 100 mg/m2 IV infusion during 1 hour. Standard premedication with dexamethasone, diphenhydramine, and ranitidine was used. Cycles were repeated every 3 weeks for three courses, followed by radical surgery when it was judged appropriate, or definitive radiotherapy. Both staging and response assessment were performed by a multidisciplinary team. 106 cycles of therapy were administered; all patients were evaluable for TX, whereas 35 were evaluable for response (3 patients refused further treatment after the first cycle of therapy). Complete response (CR): 1 patient (3%); partial response: 11 patients (31%), for an overall objective response rate of 34% (95% CI: 15-53%); no change (NC): 16 patients (46%); and progressive disease: 7 patients (20%). Six patients (17%) underwent surgery and a pathologic CR was confirmed in 1 of them. The median time to treatment failure and the median survival have not been reached yet. The limiting toxicity was leukopenia in 25 patients (69%) (G1-G2: 14 patients, G3: 10 patients, and G4: 1 patient). Neutropenia: 28 patients (78%) (G1-G2: 10 patients, G3: 8 and G4: 10). Myalgias: 17 patients (47%) (G1-G2: 15 patients and G3: 2 patients). Emesis: 21 patients (55%) (G1-G2: 19 patients and G3: 2 patients). Alopecia G3: 13 patients (36%); rash cutaneous 26 patients (68%) (G1-G2: 22 patients and G3: 4 patients). There were no hypersensitivity reactions or fluid-retention syndrome. The received dose intensity was 91% of that projected. Docetaxel is an active drug against advanced cervical carcinoma with moderate toxicity. Further evaluation in association with other agents is clearly justified.     

Prognostic factors in esophageal squamous cell carcinoma patients treated with neoadjuvant chemoradiation therapy

Background

Definitive evaluation of surgical specimens obtained after neoadjuvant chemoradiation therapy (CRT) is important for assessing additional treatment or prognosis in patients with esophageal squamous cell carcinoma (ESCC). In this study, we examined the histological prognostic factors for ESCC patients treated with CRT and determined an appropriate strategy for their evaluation.

Patients and methods

The present study involved 38 consecutive ESCC patients who underwent CRT followed by curative operation. CRT consisted of 5-fluorouracil plus cisplatin and 40 Gy of radiation. We examined histological variables as follows: CRT effect on primary tumor (T-effect: T-effective/T-ineffective), tumor depth (pT), lymph node metastases (pN: pN0/N1), number of lymph node metastases (number-pN), lymphatic invasion, and venous invasion. Univariate and multivariate analyses were performed to examine the independent prognostic factors. Survivals and mode of recurrence were then evaluated according to the independent prognostic factors.

Results

In the univariate analyses, T-effect, pN, number-pN, lymphatic invasion, and venous invasion were found to be prognostic factors with p < 0.01, and pT was a factor with p < 0.05. In the multivariate analysis, pN and T-effect were independent prognostic factors. The five-year survival rate of pN0 patients was more than 75%, even though the T-effect was poor. The 5-year survival rate of patients judged as pN1/T-effective was 50%, whereas all of the pN1/T-ineffective patients died within 2 years with relapse disease.

Conclusion

The evaluation method using both pN status and T-effect is useful for assessing prognosis of ESCC patients treated with neoadjuvant CRT.     

Prognosis of patients with esophageal squamous cell carcinoma undergoing surgery versus no surgery after neoadjuvant chemoradiotherapy: a retrospective cohort study

BackgroundEsophageal surgery is an invasive surgical method with high surgical risk, and seriously affects postoperative quality of life. This study compared the prognosis of patients with locally advanced esophageal squamous cell carcinoma (ESCC) treated with neoadjuvant chemoradiotherapy (Neo-CRT) plus surgery and Neo-CRT alone, in order to explore the necessity of continuing operation after Neo-CRT.MethodsWe retrospectively analyzed 223 patients who received Neo-CRT in Taizhou Hospital Affiliated to Wenzhou Medical University from June 2007 to December 2014. According to the treatment, the patients were divided into Neo-CRT plus surgery group (operation group, n=185) and single Neo-CRT group (non-operation group, n=38). Patients in both groups were followed up for a long time until death or deadline. The overall survival (OS), adverse reactions, recurrence and death results of the two groups were evaluated. The risk factors of poor prognosis were analyzed.ResultsThe two groups were comparable. The median follow-up time was 23.5 months in non-operation group and 112.9 months in operation group. The 1-year survival rate, 2-year survival rate and 5-year survival rate in non-operation group were 69.9%, 47.7% and 31.8%, respectively. The rates in operation group were 94.0%, 79.3% and 65.0%, respectively. The incidence of low hemoglobin was 73.7% (non-operation group) and 53.0% (operation group). The infection rates were 15.8% and 2.7%, respectively. There was no significant difference in the incidence of leukopenia, neutropenia and thrombocytopenia between the two groups. Multivariate analysis showed that recurrence and treatment were independent risk factors affecting the prognosis of patients.ConclusionsTo sum up, no matter in terms of recurrence rate or OS rate, the prognosis of patients in the operation group was better than that in the non-operation group. Therefore, Neo-CRT combined with esophagectomy is recommended for locally advanced ESCC with acceptable surgical risk.     

Liver resection for hepatocellular carcinoma in patients who have undergone prior renal transplantation

BACKGROUND AND OBJECTIVES: Because renal transplantation recipients require immunosuppressive drugs, they have a higher incidence of subsequent malignancies. Among them, hepatocellular carcinoma (HCC) is common. Although liver resection remains an option for curing HCC, the role of liver resection in renal transplantation recipients remains unclear. METHODS: A retrospective review of liver resection for newly diagnosed HCC in 680 patients was conducted. Among them, 18 patients had undergone prior renal transplantation (RT group). The patient background, tumor characteristics, early and long-term results after liver resection were compared with the other 662 patients who had not previously undergone renal transplantation (non-RT group). RESULTS: The patient's background characteristics were comparable between RT and non-RT group. The tumor characteristics, postoperative morbidity, and mortality were not significantly different between the two groups. The 5-year disease-free survival rates in RT and non-RT groups were 18.8% and 41.2%, respectively (P = 0.242), whereas 5-year actuarial survival rates in RT and non-RT groups were 59.1% and 58.3%, respectively (P = 0.738). Two patients lost their graft kidney 3 and 8 years after liver resection. CONCLUSION: With careful protection of the graft kidney, liver resection is still a justified treatment option for HCC in patients who have undergone renal transplantation.     

Ki-67抗原与子宫颈鳞癌新辅助化疗和放疗的敏感性研究

目的探讨Ki-67抗原与子宫颈鳞癌新辅助化疗（NACT）和放射治疗（RT）的敏感相关性。方法在新辅助化疗前后用免疫组化检测32例宫颈鳞癌组织Ki-67的表达。结果化疗前患者Ki-67的表达水平在不同年龄段组（〈45岁和≥45岁）、不同临床期别组（Ⅰb～Ⅱa和Ⅱb～Ⅲb）和不同病理分级组（高中分化和低分化）之间相互比较差异有统计学意义（P=0.008、0.009、0.000）。化疗后患者Ki-67表达水平与化疗前比较明显下降,差异有统计学意义（P=0.000）。化疗前Ki-67表达程度不同,化疗和化放疗的疗效明显不同,化疗疗效高表达组与低表达组比较差异有统计学意义（P=0.033）;化放疗疗效高表达组与低表达组比较差异无统计学意义（P=0.375）;高表达组、低表达组对化疗和化放疗的疗效比较差异均有统计学意义（P=0.001、0.000）。结论子宫颈鳞癌治疗前Ki-67表达强度与化疗敏感性呈正相关;虽然存在Ki-67阳性表达强度愈强、NACT＋RT的完全缓解率愈高的趋势,但未显示明显的放射敏感相关性;治疗前检测Ki-67表达可以为预测化疗和放疗敏感性提供客观依据,但Ki-67能否确定为预测子宫颈鳞癌新辅助化疗和放疗敏感性的可靠指标还需增加样本作进一步研究。     

Prognosis of patients with esophageal squamous cell carcinoma who achieve major histopathological response after neoadjuvant chemoradiotherapy

Background

The purpose of this study was to investigate the prognosis and its predictors in patients with esophageal squamous cell carcinoma (ESCC) who achieve major histopathological response (MaHR) after neoadjuvant chemoradiotherapy (nCRT).

Comparison of efficacy and safety between pembrolizumab combined with chemotherapy and simple chemotherapy in neoadjuvant therapy for esophageal squamous cell carcinoma

BackgroundImmunotherapy can activate the recognition of tumor antigen, build immune memory, and more and more clinical trials have taken the scheme of immunochemotherapy or immunoradiotherapy as a treatment strategy for esophageal squamous cell carcinoma (ESCC). Our objective was to compare the efficacy and safety between pembrolizumab combined with the chemotherapy group and simple chemotherapy in neoadjuvant therapy of ESCC.MethodsFifty-four ESCC patients with stage II–IVa were enrolled at the Fifth Affiliated Hospital of Sun Yat-sen University between January 2018 and December 2020, including 23 in the pembrolizumab combined with chemotherapy group (combined group), and 31 in the simple chemotherapy group. All patients received radical surgical treatment after two cycles of neoadjuvant therapy.ResultsThe pathological complete response (pCR) and objective response rate (ORR) in the combined group were significantly higher than that of the simple chemotherapy group (30.4% vs. 9.7%, P=0.048; 86.9% vs. 95.7%, P=0.017) as well as the score of tumor regression ≥2 (80.7% vs. 50.0%, P=0.013). And the complete rate of esophagectomy and R0 /R1 resection rate in the two groups were not statistically significant. Otherwise, the incidence of adverse events in the combined group was similar compared with the simple chemotherapy group.ConclusionsPembrolizumab combined with chemotherapy showed promising activity with a manageable safety profile. And it could offer a potential new neoadjuvant treatment approach for patients with ESCC.     

Radiation therapy for squamous cell carcinoma of the skin

Eighty-five squamous cell skin cancers treated with radiation therapy were reviewed, including 23 untreated primary tumors, 6 recurrent tumors, 16 synchronous or metachronous nodal metastases including 3 patients from the previous two groups, and 38 sites irradiated for microscopic residual cancer after surgery. The 5-year actuarial local controls were 0.54, 0.0, 0.42, and 0.79, respectively. No relationship between local control and either tumor size or radiation dose could be shown. Salvage treatment was attempted in 7 of 32 local failures, and has been successful in 4. Cancers arising in the settings of prior irradiation, renal transplant, hematopoietic malignancies, or chronic inflammation did not fare worse, and patients with parotid node metastases generally fared better with combined irradiation and surgery. Surgery followed by adjuvant irradiation confers a 5-year disease control probability of 0.79. Irradiation alone for untreated primary lesions, for recurrent primary lesions, or for untreated nodal metastases confers a disease control probability of approximately 0.50. Local or systemic predisposing factors do not confer an appreciably different prognosis. Parotid lymph node metastases are best served by combined modality treatment.     

新辅助放化疗联合手术治疗食管鳞癌预后因素分析

目的 分析影响食管鳞癌新辅助放化疗联合手术患者预后相关因素。方法 回顾分析2007—2014年行新辅助放化疗联合手术的74例T_3-4N_0-1M₀期食管鳞癌患者资料,Ⅱ期26例,Ⅲ期48例。Kaplan-Meier法计算OS率并Logrank法检验和单因素分析,Cox模型多因素分析。结果TRG₁,TRG₂,TRG₃级的1、3年OS率分别为86%、50%,85%、50%,94%、86%(P=0.049)。pCR和非pCR者1、3年OS率分别为94%、87%和85%、52%(P=0.015)。淋巴结阴性和阳性1、3年OS率分别为97%、61%和57%、36%(P=0.015)。降期和非降期1、3年OS率分别为93%、70%和67%、17%(P=0.000)。多因素分析显示淋巴结状态及是否降期是影响预后因素(P=0.028、0.015)。结论 术后肿瘤缓解反应分级与患者预后密切相关,尤其pCR者可明显提高患者生存。淋巴结状态及是否降期是影响患者生存因素。     

T-box 2 expression is a useful indicator of the response to neoadjuvant chemotherapy for patients with locally advanced uterine cervical squamous cell carcinoma

Platinum-based concurrent chemoradiotherapy is the standard treatment for patients with locally advanced uterine cervical squamous cell carcinoma. Reducing the tumor size by administering neoadjuvant chemotherapy (NAC) is beneficial for successful hysterectomy, resulting in a more favorable prognosis. Therefore, identifying biomarkers that predict the effectiveness of NAC in patients with cervical squamous cell carcinoma remains a priority. Cancer cells widely express T-box 2 (TBX2), which contributes to the resistance to DNA-damaging chemotherapeutic agents. The present study aimed to determine the association between TBX2 protein expression in tumor tissues and the efficacy of NAC in locally advanced uterine cervical squamous cell carcinoma using immunohistochemistry. Data from 46 patients with locally advanced uterine cervical squamous cell carcinoma were classified into two groups based on their effective or ineffective response to NAC treatment. In addition, the effect of small interfering RNA-mediated knockdown of TBX2 on the sensitivity of cervical cancer cells to cisplatin was investigated in vitro. The results revealed that there were no significant differences in patient clinicopathological features between the NAC effective and NAC ineffective groups. The overall survival of the NAC effective group was significantly improved compared with the NAC ineffective group (P=0.007). Tumors from the NAC effective group also had significantly downregulated TBX2 expression levels compared with those from the NAC ineffective group (P=0.0138). Of note, decreased TBX2 expression was indicated to be significantly associated with higher sensitivity to NAC (P=0.009). The low TBX2 expression group had a more favorable overall survival compared with the high TBX2 expression group (P=0.049). Furthermore, knockdown of TBX2 expression significantly increased cancer cell sensitivity to cisplatin in vitro. In conclusion, the results of the present study suggested that TBX2 expression may be a useful predictor of the response to NAC in patients with locally advanced uterine cervical squamous cell carcinoma.