Objective To investigate the risk factors of liver metastasis in patients with middle and low rectal cancer of Ⅱ–Ⅲ stage after preoperative short course radiotherapy combined with chemotherapy. MethodsThe clinical data of 89 patients with middle and low rectal cancer of Ⅱ–Ⅲ stage admitted to the Dongnan Hospital of Xiamen University from January 2019 to June 2020 were retrospectively analyzed. All patients were treated with short-course radiotherapy combined with chemotherapy before operation. The risk factors of postoperative liver metastasis were analyzed by multivariate logistic regression. ResultsThe 89 patients were followed up for 7–53 months, with a median follow-up time of 33 months. During the follow-up period, 25 patients developed liver metastasis, the onset time was 7–35 months, and the median time of liver metastasis was 17 months. Among them, 5 patients (5.6%) developed liver metastasis in the first year after surgery, 15 patients (16.8%) developed liver metastasis at the second year after surgery, 5 patients (5.6%) developed liver metastasis at the 3rd year after surgery. Multivariate logistic regression results showed that lymph node metastasis [OR=3.550, 95%CI (1.425, 8.953), P=0.041], vascular invasion [OR=3.335, 95%CI (1.011, 11.001), P=0.048], maximum tumor diameter ≥5 cm [OR=4.477, 95%CI (1.273, 15.743), P=0.019], and peri-tumor diameter ≥1/2 [OR=4.633, 95%CI (1.387, 15.475), P=0.013] were risk factors for liver metastasis. ConclusionsLymph node metastasis, vascular invasion, maximum tumor diameter ≥5 cm, and circumferential tumor diameter ≥1/2 are risk factors for liver metastasis in patients with middle and low rectal cancer of Ⅱ–Ⅲ stage after preoperative short course radiotherapy combined with chemotherapy.
Colorectal cancer (CRC) is a prevalent malignant tumor worldwide. With the development of medical technology, the treatment strategies of CRC are constantly improving and updating. The aim of treating CRC is not only to improve outcomes but also to maintain organ function and enhance quality of life. For patients with locally advanced rectal cancer, a variety of neoadjuvant treatment options are available and it is important to choose an individualized strategy. Immune checkpoint inhibitors have become an important part of the first- and posterior-line treatment for patients with deficient mis-match repair or high microsatellite instability colorectal cancer in metastatic colorectal cancer, and the emergence of new targets and drugs has further improved treatment efficacy and long-term survival. Furthermore, an increasing number of studies have confirmed the potential the value of predicting and guiding treatment for minimal residual disease. This article summarizes the representative research results, guideline updates, and important academic conference reports in the field of colorectal cancer.
ObjectiveTo study the value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in predicting and evaluating the efficacy of neoadjuvant chemoradiotherapy (NCRT) in the middle-low locally advanced rectal cancer (LARC).MethodsThe patients were included prospectively who were clinically diagnosed as the LARC and were scheduled to undergo the NCRT and total mesorectal excision (TME) in the Sichuan Provincial People’s Hospital from February 2018 to November 2019. The routine MRI and DCE-MRI were performed before and after the NCRT, then the TME was performed. According to the score of tumor regression grade (TRG), the patients with TGR score of 0, 1 or 2 were classified as the response to NCRT group, and those with TRG score of 3 were classified as the non-response to NCRT group; in addition, the patients with TGR score of 0 or 1 were classified as the good-response group, with TRG score of 2 or 3 were classified as the poor-response group. The differences of quantitative perfusion parameters of DCE-MRI between two groups were compared, including the volume transfer constant (Ktrans), flux rate constant (Kep), and extravascular extracellular volume fraction (Ve) and the change rates of these parameters (ΔKtrans, ΔKep, and ΔVe).ResultsForty-one patients who met the inclusion criteria were included in this study, including 27 cases in the response to NCRT group and 14 cases in the non-response to NCRT group; 11 cases in the the good-response group and 30 cases in the poor-response group. ① The values of Ktrans before the NCRT and the ΔKtrans in the response to NCRT group were higher than those in the non-response to NCRT (P<0.05), while the other indexes had no significant differences between these two groups (P>0.05). The area under the receiver operating characteristic curve (AUCs) of Ktrans and ΔKtrans in predicting the efficacy of NCRT were 0.954 and 0.709, respectively. When the optimal thresholds of Ktrans and ΔKtrans were 0.122/min and –24.2%, the specificity and sensitivity were 85.7%, 96.3% and 100%, 51.7%, respectively. ② The Ktrans value in the good-response group was higher before NCRT and which was lower after NCRT as compared with the poor-response group (P<0.05). The absolute value of the the ΔKtrans and ΔKep in the good-response group were higher than those in the poor-response group (P<0.05). The other indexes had no significant differences between these two groups (P>0.05). The AUC of Ktrans before NCRT in predicting the efficacy of NCRT was 0.953. When the optimal thresholds of Ktrans before NCRT was 0.158 /min, the specificity and sensitivity were 88.7% and 90.9%, respectively. The AUC of ΔKtrans in predicting the efficacy of NCRT was higher than that of the ΔKep (0.952 versus 0.764, Z=2.063, P=0.039). When the optimal threshold of ΔKtrans was –38.8%, the specificity and sensitivity were 76.7% and 100%, respectively.ConclusionsDCE-MRI can predict and evaluate the effect of NCRT in patients with middle-low LARC, especially Ktrans and ΔKtrans (change rate before and after NCRT) have a high diagnostic efficiency.
Objective To evaluate the efficacy and safety of neoadjuvant chemotherapy (a CRTS group) plus surgery versus surgery alone (a SA group) in the treatment of resectable esophageal neoplasms. Methods PubMed, Ovid Technologies, SCI, CBM Database, CNKI Database, VIP Database and Wanfang Database were searched to identify all published or unpublished RCTs those compared neoadjuvant chemotherapy plus surgery with surgery alone for resectable esophageal neoplasms up to August 1, 2015. Meta-analysis was conducted by using Stata12.0 software. Results Twenty-six RCTs included 3 252 patients (1 606 in the CRTS group, 1 646 in the SA group) were selected. There was a significant difference between the CRTS group and the SA group in 3-year survival rate, 5-year survival rate, R0 resection rate, local recurrence rate, local recurrence and distant metastasis rate with relative risk (RR) value and 95%CI at 1.24 (1.13–1.36, P<0.000 1), 1.29 (1.10–1.50,P=0.001), 1.13 (1.05–1.212, P=0.001), 0.67 (0.52–0.85, P=0.001), 0.60 (0.40–0.90, P=0.013). And there was no significant difference between the CRTS group and the SA group in 1-year survival rate and distant metastasis with RR (95%CI) of 1.05 (0.99–1.12, P=0.103) and 0.84 (0.70–1.00, P=0.053). There was no significant difference in postoperative complications, 30-days mortality, pulmonary infections, anastomotic leakage, anastomotic stricture, cardiac complications, chylothorax between the two groups with RR (95%CI) at 1.09 (0.96–1.24, P=0.166), 1.32 (0.96–1.83, P=0.485), 1.45 (0.94–2.23, P=0.091), 0.89 (0.63–1.25, P=0.485), 0.93 (0.64–1.35, P=0.731), 1.24(0.84–1.87, P=0.283), and 1.62 (0.85–3.07, P=0.142). Conclusion CRTS significantly benefits to survival rate, R0 rescetion rate, and local recurrence rate compared to SA. Additionally there is no increased postoperative complication for patients with resectable esophageal neoplasms.
Objective To summarize the application and advancement of neoadjuvant therapy combined with transanal resection in stage T2-3 rectal cancer. Methods Domestic and abroad publications on the studies of neoadjuvant therapy combined with transanal resection in stage T2-3 rectal cancer in recent years were collected and reviewed. Results In selected patients with stage T2-3 rectal cancer, neoadjuvant therapy combined with transanal resection was efficacious in sphincter preservation and complications prevention. Compared with modality without chemoradiation, the recurrence rate had decreased from 17%-62% to 0-20%. Conclusion Selected patients with stage T2-3 rectal cancer can benefit from neoadjuvant chemoradiation combined with transanal resection.
Objective To evaluate the efficacy of preoperative concurrent chemoradiotherapy combined with total mesorectal excision （TME） in treatment for locally advanced lower rectal cancer. Methods The clinical data of 31 patients with locally advanced lower rectal cancer received concurrent chemoradiotherapy from January 2009 to December 2011 in this hospital were analyzed retrospectively. Conventional fraction radiotherapy with total dose 50 Gy and chemotherapy with mFOLFOX6 or CapeOX regimen were taken. The efficacy was assessed by recording results of clinical and pathological examination. The function of sphincter was also recorded. Results All 31 patients underwent TME operation. The complication morbidity and mortality was 12.9% （4/31） and 3.2% （1/31），respectively. As a result of the preoperative management，the tumor was reduced by an average of 21.9%， down-regulation of T stage was observed in 48.4% （15/31） patients，the frequency of lymph node metastasis decreased from 83.9% （26/31） to 38.7% （12/31）. Pathological complete response was observed in 5 patients （16.1%） and the total response rate was 74.2% （23/31），grade 3/4 toxicity was occurred in 2 （6.5%） patients. 84.6% （22/26） of patients underwent sphincter preservation surgery reserved good function of sphincter. Conclusions Preoperative concurrent chemoradiotherapy combined with TME in treatment for locally advanced lower rectal cancer is effective and safe，which can lead to pathological complete response，decrease the tumor stage and the rate of lymph node metastasis，and can also increase the efficacy of operation.
Objective To discuss the important role of preoperative chemoradiotherapy in the treatment of mid-low rectal cancer. Methods From the surgical point of view, the evidences from clinic trials in literatures of recent years and also from the results of our single institution were analyzed. Results Preoperative radiotherapy with total dosage of 50 Gy had showed more and more advantages in the past two decades. Preoperative radiotherapy with concomitant chemotherapy had definite effects in downing stage and improving local control, while its role in sphincter preserving kept in controversy. However, this combined preoperative therapies had not improved long-term survival in rectal cancer. By now, there were no proper indicators to predict the effects of therapies. Conclusion Preoperative chemoradiotherapy is still the only way to improve the rate of R0 resection and decrease the rate of local currence after surgery for patients with mid-low advanced rectal cancer.
ObjectiveTo analyze the clinical predictive factors of tumor pathological response to preoperative chemoradiotherapy for rectal cancer. MethodsOne hundred and seven patients treated with preoperative capecitabine and pelvic conformal radiotherapy and underwent total mesorectal excision from January 2005 to December 2012 in this hospital were analyzed retrospectively.Tumor response according to tumor regression grade was evaluated.The correlation of clinicopathologic factors with tumor response was analyzed by logistic regression analysis. ResultsThe single factor analysis results showed that the age, gender, distance of tumor from anal verge, differentiation degree of tumor, infiltration depth of tumor, and pretreatment CA19-9 level were not correlated with rectal cancer pathological response to preoperative chemoradiotherapy (P > 0.05).The tumor circumferential extent, tumor mobilit, lymph node metastasis, pretreatment carcinoembryonic antigen (CEA) level, and pretreatment hemoglobin level were correlated with it (P < 0.05).The logistic regression analysis results showed that non-fixed tumor (P=0.015), pretreatment CEA level≤5.0μg/L (P=0.012), and pretreatment hemoglobin level > 10 g/L (P=0.007) independently predicted a good pathologic response rate. ConclusionTumor mobility, pretreatment CEA level, and hemoglobin level are important predictors of pathological response to preoperative chemoradiotherapy in rectal cancer.
【摘要】 目的 探讨颅内原发生殖细胞瘤的临床特征。方法 收集华西医院脑外科2000年1月—2009年3月119例颅内原发生殖细胞瘤的临床资料进行回顾性分析。结果 发病率约占同期颅内肿瘤的 1.1%。男〖DK〗∶女=1.64〖DK〗∶1,平均发病年龄15.4岁。临床表现主要为颅内高压症状及视力视野改变,分别为61、56例；肿瘤主要来源于松果体区及鞍区；64例患者行放疗或放疗加化疗,随访45例。55例患者行手术治疗(其中术后行单纯放疗19例,放疗加化疗5例),随访36例。随访时间3~94个月,平均29.7个月。行放疗和放化疗的患者3、5年生存率明显高于单纯行手术治疗的患者。结论 颅内原发生殖细胞瘤多见于儿童及青少年,男性多见,肿瘤大多位于松果体区及鞍区。临床表现位于松果体区者主要为颅内高压症状等,位于鞍区者主要为视力视野改变、尿崩等。放疗联合化疗是主要治疗手段。