新辅助治疗反应对局部进展期直肠癌患者预后的影响

目的探究新辅助治疗反应对局部进展期直肠癌患者远期预后的影响。 方法回顾性收集中国医学科学院肿瘤医院218例接受术前新辅助放化疗的局部进展期直肠癌患者（LARC）的临床病理资料。根据Dowrak/R?del肿瘤退缩分级（TRG）标准将患者分为治疗反应良好（TRG3~4）和治疗反应不佳（TRG0~2）。采用Cox风险比例回归单因素和多因素分析确定无病生存（disease-free survival,DFS）和肿瘤总生存（overall survival,OS）影响因素。采用Kaplan-Meier法绘制生存曲线并利用Log-rank检验比较肿瘤生存差异。 结果本研究纳入患者218例,其中治疗反应良好126例,治疗反应不佳92例。单因素和多因素Cox回归分析确定新辅助治疗反应不佳是DFS（HR=3.85,95%CI：1.40~10.60;P=0.009）和OS（HR=3.81,95%CI：1.02~14.20;P=0.046）的独立危险因素。5年DFS分别为反应良好93.46%,反应不佳65.04%（χ²=28.23,P＜0.001）;5年OS分别为反应良好95.38%,反应不佳78.99%（χ²=18.51,P＜0.001）。 结论新辅助治疗反应是LARC患者DFS和OS的独立预后因素;良好的治疗反应预示着更好的肿瘤学预后,为进一步的临床研究风险分层提供了理论基础。     

Resection surgery with neoadjuvant chemoradiotherapy improves outcomes of patients with T4 esophageal carcinoma

The prognosis of patients with T4 esophageal carcinoma is poor, and thus an effective treatment needs to be established. The present study assessed the effect of chemoradiotherapy (CRT), postoperative morbidity and mortality, and survival time in 41 patients with T4 esophageal carcinoma. Of these, 24 received CRT followed by surgery (group A) and the remaining 17 were treated with CRT alone (group B). Postoperative complications in group A were compared with 251 patients (group C) who underwent surgery without CRT during the same period. Postoperative complications were more frequent in group A than group C (29.2% vs 8.4%, P < 0.05). The overall median survival of group A was statistically longer than that of group B (13.8 months and 3.3 months respectively, P < 0.001). Complete histologic response (grade 3) was documented in 4 group A patients (16.7%). The overall median survival of grade 3 patients was statistically longer than the rest of group A (38.9 months vs 8.8 months, P < 0.05). The data confirm that chemoradiotherapy creates tumor regression in some patients and allows resection surgery in T4 esophageal carcinoma. Moreover, surgery with CRT confers a survival advantage in T4 esophageal carcinoma.     

Assessment of the value of carcinoembryonic antigen reduction ratio as a prognosis factor in rectal cancer

Background

Carcinoembryonic antigen (CEA) is the most widely used tumor marker for colorectal cancer. This study aimed to investigate the role of CEA reduction ratio after preoperative chemoradiotherapy (CRT).

Methods

We enrolled 284 patients who underwent preoperative CRT followed by radical surgical resection. Patients were divided into 3 groups: serum CEA levels before CRT (pre-CRT CEA) less than 5 ng/mL (group 1); pre-CRT CEA of 5 ng/mL or more with CEA reduction ratio of 50% or more (group 2); and pre-CRT CEA of 5 ng/mL or more with CEA reduction ratio less than 50% (group 3).

Results

The 5-year disease-free survival (DFS) rate was not different between groups 1 (71.8%) and 2 (69.4%) but was signi?cantly lower in group 3 (49.5%). CEA group, lymph node status after CRT (ypN) stage, and histologic type were independent prognostic factors for DFS on multivariate analysis.

Conclusions

CEA reduction ratio might be an independent prognostic factor for DFS in rectal cancer patients treated with preoperative CRT and radical surgery.     

术前同步放化疗在晚期宫颈癌中的临床疗效评价

目的：研究术前同步放化疗在晚期宫颈癌中的临床疗效。方法：将晚期宫颈癌患者70例随机分为给予奈达铂同步放化疗的观察组和顺铂同步放化疗的对照组,每组35例;观察两组患者化疗后的TNM分期、化疗过程中的不良反应例数及远期生存情况。结果：观察组的TNM分期低于对照组;观察组患者发生厌食、恶心呕吐、白细胞减少、血小板减少、血肌酐升高、ALT升高和肺毒性的例数均少于对照组。术后1年、2年和3年的生存率分别为91.4%、82.8%和74.3%,均高于对照组。结论：以奈达铂为基础的同步放化疗能够更为有效的降低肿瘤分期、减少不良反应以及提高存活率具有积极的应用价值。     

Overall response of both intrahepatic tumor and portal vein tumor thrombosis is a good prognostic factor for hepatocellular carcinoma patients receiving concurrent chemoradiotherapy

This study investigated the prognostic significance of portal vein tumor thrombosis (PVTT) response in hepatocellular carcinoma (HCC) patients treated with localized concurrent chemoradiotherapy (CCRT). We retrospectively analyzed 100 patients treated with CCRT for UICC Stage T2–4N0M0 HCC with PVTT between 2002 and 2011. The radiotherapy (RT) volume included both primary tumor and PVTT, and the median radiation dose was 45 Gy. Treatment response was evaluated for up to 6 months after RT. With respect to PVTT response to treatment, complete response (CR) and partial response (PR) were achieved in 14% and 48% of patients, respectively, yielding an objective response (OR) rate of 62%. PVTT size (≤3cm diameter) was associated with a higher rate of a CR (P = 0.001). The median overall survival (OS) was 11.6 months. Independent prognostic factors for OS were OR of the tumor to RT and a CR of the PVTT. Achieving an OR in both the tumor and the PVTT demonstrated a significant correlation with improved survival (P = 0.002). Progression of intrahepatic metastasis was affected not by CCRT but by the clinical features of the PVTT, particularly the initial PVTT site. PVTT response following CCRT seems prognostically significant. CR of the PVTT was associated with improved survival. Achieving an OR in both the tumor and PVTT was also associated with improved survival.     

CT扫描所得食管癌肿瘤局部因素与患者预后的关系

目的 探讨基于CT扫描所得接受根治性放（化）疗的食管癌患者肿瘤局部因素指标与其预后的关系。方法 接受根治性放（化）疗且为临床N0期的食管鳞癌患者271例,分析其肿瘤局部因素与患者复发的关系,对影响患者长期预后的因素进行分析。结果 预测患者复发的最佳指标有GTV D、GTV L、GTV V、GTV V/L和X线造影长度,其判断复发的最佳界点值分别为3.5 cm、5.5 cm、28.7 cm3、4.8 cm2和3.5 cm。GTV D、GTV L、临床T分期、有无化疗和近期疗效均为影响患者生存率的独立因素;年龄、病变部位、GTV V/L、临床T分期和近期疗效均为影响患者局控率的独立因素。结论 食管癌肿瘤局部相关因素对接受根治性放（化）疗的临床N0食管鳞癌患者治疗后复发均有影响,其中GTV D、GTV L和GTV V/L为影响预后的独立因素。     

Neoadjuvant chemoradiotherapy plus surgery in the treatment of potentially resectable thoracic esophageal squamous cell carcinoma

BACKGROUNDIn recent years, neoadjuvant chemoradiotherapy (NCRT) combined with surgery has been gradually applied in patients with locally advanced thoracic esophageal cancer, but its effectiveness and safety remains unclear. In this clinical trial, we prospectively investigated the efficacy and safety of NCRT plus surgery in the treatment of thoracic esophageal squamous cell carcinoma (TESCC).AIMTo investigate the efficacy and safety of NCRT combined with surgery in the treatment of potentially resectable TESCC. METHODSThirty patients with advanced TESCC hospitalized in our hospital from July 2016 to June 2019 were prospectively studied. All patients received NCRT, which included intensity modulated conformal radiotherapy (40-44 Gy/20-22f, 2 Gy/f) and chemotherapy (paclitaxel 150-175 mg/m²d1, 22 + lobaplatin 25-30 mg/m²d2, 23 for two cycles). Surgery was performed after radiotherapy and chemotherapy. The effectiveness and safety of these treatments were observed. RESULTSAmong these 30 patients, complete response was achieved in two cases (6.7%) and partial response in 26 cases (86.7%), yielding an objective response rate of 100%. All patients underwent radical surgery successfully. The R0 resection rate was 100%, and the pathologic complete response rate was 33.3%. The incidence of grade III- IV granulocytopenia was 10% during the NCRT, and anastomotic leakage occurred in one patient after surgery. CONCLUSIONFor patients with potentially resectable TESCC, NCRT can effectively reduce the tumor size, increase R0 resection rate, and achieve obvious pathological degradation, with mild adverse reactions. Thus, it is worthy of wider clinical application.     

冬凌草滴丸对鼻咽癌患者同步放化疗疗效和毒副反应的影响

目的 观察冬凌草滴丸对鼻咽癌同步放化疗患者的临床疗效及毒副反应的影响。方法 选择78例鼻咽癌同步放化疗患者,随机分为治疗组和对照组。其中治疗组40例,采用同步放化疗,再配合冬凌草滴丸,一次24丸,一日3次,用温水送服,从放化疗开始连续服用至放化疗结束;对照组38例,采用同步放化疗治疗。以KPS行为状况评分标准,分别在治疗前后对患者进行评分,并分析两组临床疗效。结果 两组治疗后近期疗效比较,总有效率均高于90%,差异无统计学意义（P>0.05）。治疗组急性口腔黏膜炎程度较轻,对照组较重;放射性损伤高风险患者中,治疗组Ⅰ级急性口腔黏膜炎发生率高于对照组,而对照组Ⅳ级急性口腔黏膜炎发生率高于治疗组,差异均有统计学意义（P<0.05）。两组患者放射性唾液腺损伤均集中在Ⅰ-Ⅲ级,总发生率比较,差异有统计学意义（P<0.05）;两组患者其他不良反应发生率及治疗后KPS评分比较,差异均无统计学意义（P>0.05）。结论 冬凌草滴丸配合同步放化疗治疗鼻咽癌患者,能有效降低同步放化疗相关毒副反应,从而提高治疗效果。