新辅助化疗在进展期食管癌中的疗效分析

目的 :探讨新辅助化疗在进展期食管癌治疗中的意义。方法:回顾性研究272例进展期食管癌患者,其中112例行新辅助化疗+手术治疗,160例行单纯手术治疗,比较围手术期并发症发生率、手术切除率及术后生存期。 结果 :新辅助化疗组术后并发症发生率为34.8%（39/112）,单纯手术组术为29.4%（47/160）,P=0.50;两组5年生存率分别为:35.7%和29.4%,P < 0.05。化疗效果PR组和SD/PD组5年生存率分别为38.5%和30.1%,P < 0.01。 结论 :新辅助化疗未增加食管癌患者围手术期并发症的发生率,是安全可行的;新辅助化疗能提高进展期食管癌患者的生存率;化疗有效组患者预后好于化疗无效组。      

局部进展期胃癌新辅助治疗的现状与未来

胃癌是中国常见的恶性肿瘤之一。目前,手术切除是可以治愈胃癌的唯一方法,然而局部进展期胃癌（locally advanced gastric cancer,LAGC）患者单纯接受手术疗效较差,术后复发风险较高。新辅助治疗可使部分患者的肿瘤降期、提高R0切除率,降低局部及远处复发的风险,延长患者的生存期,现已成为LAGC治疗中的重要组成部分。随着新辅助治疗的不断发展,各类临床试验和新的治疗理念不断涌现,其治疗模式也从曾经单一的化疗,转变为新辅助放化疗、新辅助化疗联合靶向治疗、新辅助化疗联合免疫治疗等新型治疗模式。本文就LAGC的新辅助治疗进展及目前存在的争议进行综述。      

化疗后乳癌患者围术期血流动力学、cTnI、CRP 变化的研究简

目的：通过检测新辅助化疗后乳腺癌患者与术前未化疗的乳腺癌患者在行全静脉麻醉时术前、术中、术后的血流动力学、心肌肌钙蛋白I、C-反应蛋白的变化,分析新辅助化疗以及麻醉对血流动力学及心肌肌钙蛋白I、C-反应蛋白的影响。方法：选取术前经新辅助化疗乳腺癌患者与未经化疗直接手术乳癌患者各30例,采用统一浓度麻醉药物的血浆靶控,详细观测、记录实验组与对照组在术中的心功能指标,检测两组患者术前、术中、术后心肌肌钙蛋白I、C-反应蛋白血清水平。结果：两组患者在麻醉诱导后的短时间内（诱导后5分钟一切皮）均有血压下降和心率减慢。手术结束时和术后1d、3d,实验组心肌肌钙蛋白l水平高于对照组（P〈0．05）。术后1d、3d、5d,实验组C-反应蛋白高于对照组（P〈0．05）。结论：新辅助化疗后乳癌病人在接受全麻和手术治疗时,血流动力学变化明显,围术期心肌肌钙蛋白I升高快速、明显,C-反应蛋白的变化明显,恢复时间延长。     

改良FOLFOX6新辅助化疗与术后化疗治疗进展期胃癌的临床疗效比较

目的对改良FOLFOX6新辅助化疗与术后化疗治疗进展期胃癌的临床疗效进行对比分析。方法选取200例进展期胃癌患者,并将其随机分为2组,改良FOLFOX6新辅助化疗组和改良FOLFOX6术后辅助化疗组,以进行单纯手术的100例为对照组,对比观察术后的临床疗效以及围术期并发症情况。结果改良FOLFOX6新辅助化疗组治疗后患者的总有效率(87.00%)明显高于改良FOLFOX6术后辅助化疗组患者的总有效率(57.00%),统计学上有意义(P<0.05)。同时,改良FOLFOX6新辅助化疗组患者的手术后围术期并发症发生率(22.00%)明显低于单纯手术治疗组并发症发生率(49.00%),差异在统计学上有意义(P<0.05)。结论改良FOLFOX6新辅助化疗对进展期胃癌的临床治疗效果较改良FOLFOX6术后辅助化疗的治疗效果显著,围术期并发症较少,安全可靠,可以在临床上广泛应用。     

手术前新辅助化疗联合放射治疗治疗局部晚期宫颈癌的临床分析

目的探讨手术前新辅助化疗联合放射治疗治疗局部晚期宫颈癌的疗效。方法分析35例Ⅰb2期～Ⅱb2期术前新辅助化疗联合放射治疗（观察组）与32例单纯手术（对照组）的局部晚期宫颈癌患者的临床资料,评价观察组和对照组患者的近期疗效,并比较两组患者术中出血量、手术时间、术后病理特征与疗效。结果观察组患者治疗总有效率为80.9%,高于对照组的9.3%（P〈0.05）。两组患者手术时间、术中出血量、脉管受侵以及阴道切缘癌残留率比较,差异无统计学意义（P〉0.05）,观察组患者宫旁浸润率及淋巴结转移率低于手术组（P〈0.05）。结论手术前新辅助化疗联合放射治疗可以缩小局部肿瘤,使宫旁浸润消退,可提高局部晚期宫颈癌的疗效。     

紫杉醇联合顺铂新辅助化疗对Ⅲ期食管癌手术风险及预后的影响

目的 探讨紫杉醇联合顺铂新辅助化疗对Ⅲ期食管癌患者实施手术的风险及对预后的影响。方法 回顾分析2009年1月至2012年6月收治的140例Ⅲ期食管癌患者,根据治疗情况分为单纯手术组（n=78）和新辅助化疗组（n=62）。单纯手术组仅接受手术治疗。新辅助化疗组于术前给予紫杉醇联合顺铂化疗,具体方案为：紫杉醇135 mg／m2静滴,d1;顺铂30 mg／m2静滴,d1～d3,21天为1周期,化疗2个周期。化疗结束后4周行手术治疗。比较两组的手术切除根治率、术后并发症和总生存期（OS）。结果 62例接受新辅助化疗患者中,获CR 4例、PR 34例、SD 21例、PD 3例,有效率为61.3％。化疗的主要不良反应为白细胞减少、肝肾功能损伤、消化道反应和脱发,均为1～2级。新辅助化疗组的根治性切除率为91.9％（57／62）,高于单纯手术组的69.2％（54／78）,差异有统计学意义（P=0.001）;两组围手术期均无1例死亡,新辅助化疗组的术后并发症发生率为30.6％,单纯手术组为25.6％,两组差异无统计学意义（P=0.512）。新辅助化疗组的中位OS为17.8个月（95％CI：14.5～21.1个月）,单纯手术组为14.2个月（95％CI：11.6～16.8个月）,两组差异有统计学意义（P=0.016）。结论 针对Ⅲ期食管癌患者,术前采用新辅助化疗有助于提高肿瘤切除率,且不增加并发症发生率,有效提高患者的OS,值得临床推广应用。     

胃癌辅助治疗现状和进展

多学科综合治疗是局限期胃癌现代诊疗的模式,选择何种治疗方案应根据患者的特征而个体化选择。接受了标准D2术后胃癌患者,Ⅱ期患者可选择口服S-1或者XELOX联合化疗,而Ⅲb期及以上给与同步放化疗。单纯术前新辅助化疗可能不是一个理想的提高生存的策略,而围手术辅助化疗更为合理。目前尚无证据证明胃癌术前新辅助化疗/围手术化疗较单纯术后化疗有更好的生存,新辅助化疗的价值更多体现在降期和使不可R0切除的局部晚期肿瘤转化为可切除肿瘤。术前同步放化疗因降期和转化效率高而在不可切除局限期胃癌中更具探索价值。      

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。     

新辅助化疗联合手术治疗直肠腹膜返折部癌84例

[目的]探讨新辅助化疗联合手术治疗直肠腹膜返折部癌的临床疗效。[方法]回顾性研究2007年1月至2009年5月146例直肠腹膜返折部癌患者的资料,146例患者分为综合治疗组（新辅助化疗＋手术治疗）（n=84）和单纯手术组（n=62）,比较两组临床疗效。[结果]两组手术类型、肿瘤缓解度、术中出血量、手术前后CEA值、并发症情况及术后首次排气、排便、下床活动时间均无统计学差异（P〉0.05）。两组环周切缘均阴性。综合治疗组的手术时间较单纯手术组短（P〈0.05）;综合治疗组盆腹膜充血率较单纯手术组高（P〈0.05）。综合治疗组的复发率低于单纯手术组（P〈0.05）。[结论]新辅助化疗联合手术治疗直肠腹膜返折部癌具有良好的围手术期安全性,可以改善临床远期疗效,降低术后局部复发率。     

新辅助化疗治疗进展期胃癌的临床疗效及影响因素

目的探讨新辅助化疗治疗进展期胃癌的临床疗效及影响因素。方法选择进展期胃癌患者60例,随机分为治疗组和对照组,每组30例。对照组患者直接给予手术治疗,治疗组患者进行2个周期的新辅助化疗,随后进行手术治疗,观察两组患者并发症及术后生存率情况。结果治疗组患者根治切除术的比例明显高于对照组,姑息性切除术比例明显低于对照组,差异均有统计学意义（P〈0．05）。11IA期和肿瘤〈6cm的患者有效率高于ⅢB期和肿瘤≥6cm的患者有效率,但差异无统计学意义（P〉0．05）。结论新辅助化疗治疗进展期胃癌是一个有效且副作用较小的方案,肿瘤分期及肿瘤大小可能是影响新辅助化疗的因素。     

Imaging of the axilla before preoperative chemotherapy: Implications for postmastectomy radiation

Postmastectomy radiation therapy (PMRT) improves breast cancer survival in many women with lymph node‐positive disease who undergo surgery followed by adjuvant chemotherapy. The role of PMRT after women receive neoadjuvant chemotherapy (NAC) is less clear. The available data suggest that clinical extent of disease at presentation before NAC, pathologic residual disease (especially pathologically involved lymph nodes) after NAC, and response to NAC are key prognostic factors for locoregional recurrence. Therefore, accurate axillary staging before the initiation of NAC and assessment of response to chemotherapy are critically important. Here, the authors review the literature addressing the radiotherapy management of patients with breast cancer who received NAC and underwent mastectomy with a special focus on the imaging modalities used to assess axillary lymph node status. Cancer 2015;121:1187–1194. © 2014 American Cancer Society.     

围手术期麻醉对肿瘤患者预后影响的研究进展

超过80%恶性肿瘤患者在肿瘤诊断和治疗过程中需要麻醉,且超过半数患者需要行手术治疗。因此,明确围手术期麻醉对肿瘤的作用及其机制,对临床上麻醉方式和麻醉镇痛药物的选择具有重要意义。现阶段基础研究证实麻醉相关药物可从肿瘤微环境(tumor microenvironment,TME)、上皮-间质转化(epithelial-mesenchymal transition,EMT)以及肿瘤干细胞(cancer stem cell,CSC)等方面发挥其抑制或促进肿瘤复发转移的作用。基于上述研究结果,本文汇总了围手术期麻醉对肿瘤患者预后影响的相关临床研究结果和进展,比较了围手术期不同麻醉方式及麻醉镇痛药物对肿瘤患者预后的影响,为临床中肿瘤患者围手术期麻醉的管理提供理论基础。     

麻醉处理对蒽环类抗肿瘤药物心脏毒性影响的研究进展

蒽环类抗肿瘤药物是一类对造血系统和实体肿瘤具有高效作用的广谱抗癌药物，是临床化疗方案中常用的药物之一。该类药物有一个严重的不良反应，即随着剂量的增加会产生显著的心脏毒性。临床上应用具有心肌保护作用的药物是安全使用蒽环类药物的重要策略之一。很多癌症患者在化疗期间还要进行手术治疗，全身麻醉是患者手术时主要的麻醉方法。对术前已行蒽环类药物化疗的患者实施全麻手术时，可能正处于蒽环类药物所致心肌损害的急性或慢性期，而麻醉药物对蒽环类药物所致心脏毒性的影响，将对患者术后心肺功能的恢复产生重要作用。目前，有关麻醉药物对蒽环类药物心脏毒性的影响已开始受到关注，本文即从蒽环类抗肿瘤药物的心脏毒性、心肌保护以及麻醉药物对其心脏毒性影响的研究现况进行综述。      

新辅助化疗对晚期上皮性卵巢癌患者预后的影响

目的 探讨新辅助化疗对Ⅲc～Ⅳ期上皮性卵巢癌患者预后的影响.方法 回顾性分析160例Ⅲc～Ⅳ期上皮性卵巢癌患者的临床病理资料,其中42例患者行新辅助化疗后再行肿瘤细胞减灭术(NAC组),118例患者先行初次肿瘤细胞减灭术(PCS)再行化疗(PCS组),比较两组患者的生存情况及与预后相关的因素.结果新辅助化疗的总有效率为69.1%.在手术时间、术中出血量和输血量等方面,NAC组与PCS组的差异无统计学意义(P＞0.05).NAC组肿瘤细胞减灭术的满意率为88.1%,明显高于PCS组(71.2%,P＜0.05).NAC组和PCS组的复发率分别为43.2%和56.0%,差异无统计学意义(P＞0.05).NAC组的中位无瘤生存时间和中位疾病无进展生存时间分别为7个月和8个月,低于PCS组的13个月和18个月(P＜0.05);但是NAC组和PCS组的中位总生存时间分别为34个月和43个月,差异无统计学意义(P＞0.05).NAC组有37例患者行满意的肿瘤细胞减灭术(OCS),中位总生存时间为34个月;PCS组有84例患者行OCS,中位总生存时间为48个月,两组差异无统计学意义(P＞0.05).结论 新辅助化疗可以提高Ⅲc-Ⅳ期上皮性卵巢癌患者肿瘤细胞减灭术的满意率,但未降低患者治疗后的复发率,也未延长患者的总生存时间.     

肺癌合并严重冠心病同期外科手术治疗经验

背景与目的临床上肺癌合并严重冠心病患者逐年增多,本文旨在总结同期心肺手术治疗这类患者的临床经验,为临床诊治工作提供参考。方法回顾性分析2003年-2012年我科完成18例同期手术的临床资料。男性16例,女性2例,平均年龄66.11岁。临床TNM分期多为Ⅰ期/Ⅱ期病例,心肺功能良好。结果本组病例无手术死亡及新发心肌梗塞。病理诊断鳞癌10例,腺癌8例,病理TNM分期Ia期2例,Ⅰb期8例,Ⅱa期3例,Ⅱb期3例,Ⅲa期2例。术后常见并发症为心律失常、肺不张、肺部感染。手术时间、术后引流量、带管时间及输血量腔镜组均较开胸组有明显下降,两组生存率无统计学差异(P=0.187)。结论同期手术治疗肺癌合并严重冠心病安全、有效。胸腔镜使用创伤小,效果较确切。     

乳腺癌新辅助化疗疗效评估方法的研究进展

 乳腺癌新辅助化疗（NAC）是指对乳腺癌患者进行手术治疗前的药物治疗，可以提高病理完全缓解率和生存率，使保乳成为可能。乳腺癌NAC疗效评估方法一直是学科讨论的热点，现对其研究进展进行综述。     

Impact of neoadjuvant chemotherapy on the survival of patients with stage IIIc and IV epithelial ovarian cancer

OBJECTIVE: To compare the survival of patients with stage IIc or IV epithelial ovarian cancer treated either with neoadjuvant chemotherapy (NAC) followed by cytoreductive surgery or primary cytoreductive surgery (PCS) followed by adjuvant chemotherapy. METHODS: The clinical and pathological data of 160 patients with stage IIIc or IV epithelial ovarian cancer diagnosed pathologically between 1997 and 2005 were retrospectively reviewed. Forty-two patients were treated with NAC followed by cytoreductive surgery (NAC group) and 118 patients with PCS followed by adjuvant chemotherapy (PCA group). RESULTS: The overall response rate of NAC group was 69.1%. No significant difference was observed between the NAC group and PCS group in operating time, intra-operative blood loss and units of blood-transfusion (P > 0.05). Optimal cytoreductive surgery was performed in 88.1% of NAC group versus in 71.2% of PCS group (P < 0.05). In those who had optimal cytoreductive surgery, the recurrent rate was 43.2% in NAC group versus 56.0% in PCS group without significant difference between two groups (P > 0.05). The disease-free survival and progression-free survival was 7 and 8 months in NAC group, which were significantly shorter than 13 and 18 months in PCS group (P < 0.05), however, the median overall survival (OS) was 34 months in NAC group versus 43 months in PCS group without significant difference (P > 0.05). In the patients with optimal cytoreductive surgery, it was 34 months in NAC group versus 48 months in PCS group without significant difference either between two groups (P > 0.05). CONCLUSION: Neoadjuvant chemotherapy followed by cytoreductive surgery can improve the rate of optimal cytoreductive surgery for the patients with stage IIIc or IVepithelial ovarian cancer, but this regimen may neither reduce the recurrent rate nor prolong the survival when compared with the patients treated with primary cytoreductive surgery followed by adjuvant chemotherapy.     

Effect of Neoadjuvant Chemotherapy on Axillary Lymph Node Positivity and Numbers in Breast Cancer Cases

Background: The aim of this study is to compare the numbers of axillary lymph nodes (ALN) taken out by dissection between patients with breast cancer operated on after having neoadjuvant chemotherapy (NAC) treatment and otherswithout having neoadjuvant chemotherapy, and to investigate factors affecting lymph node positivity. Materials and Methods: A total of 49 patients operated due to advanced breast cancer after neoadjuvant chemotherapy and 144 patients with a similar stage of the cancer having primary surgical treatment without chemotherapy at the general surgery clinic of Ondokuz Mayis University Medicine Faculty between the dates 01.01.2006 and 31.10.2012 were included in the study. The total number of lymph nodes taken out by axillary dissection (ALND) was categorized as the number of positive lymph nodes and divided into variables to be compared were analysed using the program SPSS 15.0 with PResults: Median number of dissected lymph nodes from the patient group having neoadjuvant chemotherapy was 16 (16-33) while it was 20 (5-55) without chemotherapy. The respective median numbers of positive lymph nodes were 5 ( 0-19) and 10 (0-51). In 8 out of 49 neoadjuvant chemotherapy patients (16.3%), the number of dissected lymph nodes was below 10, and it was below 10 in 17 out of 144 primary surgery patients. Differences in numbers of dissected total and positive lymph nodes between two groups were significant, but this was not the case for numbers of breast cancer having neoadjuvant chemotherapy may be less than without chemotherapy. This may not always be attributed to an inadequate axillary dissection. More research to evaluate the numbers of positive lymph nodes are required in order to increase the reliability of staging in the patients with breast cancer undergoing neoadjuvant chemotherapy.     

Changes in treatment patterns and their influence on long‐term survival in patients with stages I–III gastric cancer in The Netherlands

Studies investigating perioperative chemotherapy and/or radiotherapy changed the treatment of curable gastric cancer in The Netherlands. These changes were evaluated including their influence on survival. Data on patients diagnosed with gastric cancer from 1989 to 2009 were obtained from The Netherlands Cancer Registry. Changes over time in surgery and administration of perioperative chemotherapy, 30‐day mortality, 5‐year survival and adjusted relative excess risk (RER) of dying were analyzed with multivariable regression for cardia and noncardia cancer. In stages I and II disease, most patients underwent surgery. Since 2005, more patients are treated with (neo)adjuvant chemotherapy. Postoperative mortality ranged from 1% to 7% and 0.4% to 12.2% in cardia and noncardia cancer (<55 to 75+ years). Five‐year survival for cardia cancer and noncardia cancer stages I–III and X (unknown stage) was 33% and 50% (2005–2008). The RER of dying was associated with period of diagnosis, age, gender, region, stage, (neo)adjuvant chemotherapy in case of cardia cancer and type of gastric resection in case of noncardia cancer. Administration of (neo)adjuvant chemotherapy has increased. No improvement in long‐term survival could yet be seen, though it is still too early to expect an improvement in survival as a result of the use of chemotherapy.     

Ovarian cancer

The current standard treatment for advanced ovarian cancer is primary debulking surgery (PDS) followed by postsurgical chemotherapy. We can expect a better prognosis in cases of optimal debulking (residual disease<1 cm). Unfortunately, optimal debulking in the PDS can be achieved in only about 40% of stage III/IV ovarian cancers as a rule. Neoadjuvant chemotherapy (NAC) has been recognized as an alternative treatment to primary surgical debulking for patients with apparently unresectable bulky tumors or poor performance status. Retrospective analyses revealed that overall survival was comparable between patients treated with NAC followed by interval debulking surgery (IDS) and those treated with PDS, though the former group had more advanced disease and poorer performance status.Based on these favorable results of NAC for patients with advanced disease or poor performance status, the target disease was extended to all cases of advanced disease, including patients without apparently unresectable tumors and good performance status in prospective studies. The European Organization for Research and Treatment of Cancer (EORTC) and The Japan Clinical Oncology Group (JCOG) is now conducting a phase III study comparing neoadjuvant setting treatment with standard treatment for advanced mullerian cancer, such as ovarian, tubal or peritoneal cancer. These prospective studies are expected to reveal the role of NAC for advanced müllerian cancer.