Objective To determine the oncological outcomes following the intersphincteric resection (ISR) for lower rectal cancer and influencing factors. Methods Reviewed the reports on ISR for lower rectal cancer, and summarized the oncological outcomes and influencing factors. The oncological outcomes included local and distant recurrence rates, postoperative survival, and mortality rates. Tumor indicators, surgical techniques, and perioperative radiochemotherapy were included in the influencing factors. Results The recurrence, survival, and mortality rates following ISR resemble traditional operations. Higher stages, metastasis, and non-standard operations affect the oncological outcomes significantly. Preoperative radiochemotherapy could improve the efficacy, but probably at the cost of postoperative anal function. Conclusions The oncological outcomes following ISR are acceptable. The careful case selection and rational arrangements of radiochemotherapy will allow better outcomes.
Objective To summarize the research progress of transanal total mesorectal excision (TaTME) for rectal cancer. Methods The literatures about current status, limitations, and prospects of TaTME in China and abroad were collected to make an reviewe. Results TaTME is conformed to the principle of total mesorectal excision (TME), by using the ‘bottom-up’ approach and assisting in the laparoscopic technique platform, to ensure an adequate oncological distal margin, and it could improve the quality of the mesorectum specimens, reduce the circumferential margin involvement rate, afford more precise autonomic nerve preservation rate, and increase sphincter preservation rate. But it is also facing new complications, oncological and functional outcomes problems. Conclusions Although the experience with TaTME remains limited, the safety, feasibility, and short-term outcomes are acceptable. Nevertheless, there is a need for multicenter, large sample size, and long-term follow-up clinical studies focusing on the long-term outcomes to further improve the oncological safety of TaTME, before widespread application can be recommended.
Diffuse large B-cell lymphoma is highly heterogeneous and is diagnosed according to the 2016 World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissues. The decision of treatment should be upon age, International Prognostic Index score and the tolerability of chemotherapy. High-dose chemotherapy and autologous stem cell transplantation is the standard care for relapsed, chemotherapy sensitive patients. Clinical trials are recommended in specific conditions.
ObjectivesTo systematically review the efficacy of problem-based learning (PBL) model in clinical oncology teaching.MethodsPubMed, EMbase, CNKI, WanFang Data, CBM databases were electronically searched to collect randomized controlled trials (RCTs) of PBL model used in clinical oncology teaching in China from January, 2000 to March, 2019. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 and Stata 12.0 software.ResultsA total of 29 RCTs involving 2 238 subjects were included. The results of meta-analysis showed that: PBL model in clinical oncology teaching was superior to traditional lecture-based learning (LBL) model on the total score (MD=6.50, 95%CI 4.44 to 8.55, P<0.000 01), theoretical knowledge score (MD=4.58, 95%CI 3.38 to 5.78, P<0.000 01), case analysis score (MD=4.26, 95%CI 3.38 to 5.78, P<0.000 01), skill operation score (MD=6.10, 95%CI 4.77 to 7.43, P<0.000 01), overall course satisfaction (RR=1.74, 95%CI 1.34 to 2.27, P<0.000 01), increased learning interest (RR=1.52, 95%CI 1.28 to 1.81, P<0.000 1), improved teamwork cooperation (RR=1.67, 95%CI 1.39 to 2.01, P=0.002), and improved self-study ability (RR=1.51, 95%CI 1.20 to 1.90, P<0.000 1), the differences were statistically significant.ConclusionsCurrent evidence shows that the PBL model can improve clinical teaching effect of oncology and learning satisfaction. Due to limited quality and quantity of the included studies accumulated, more high quality studies are required to verify above conclusion.
With the increasing global burden of various cancer, an abundance of papers emerged every year in the research hotspots of oncology, covering a wide range of research types and topics. In order to facilitate interested readers to quickly grasp the frontier and hotspots of cancer research, it would be helpful to sort out and summarize the research topic in a timely manner. According to the classification of disciplines, we screened the Essential Science Indicators (ESI) hot papers released in 2019 for the ones in the oncology field, utilized methods such as bibliometrics, statistical description, hierarchical induction, analysis and interpretation to further reveal the context and characteristics of research in the field of oncology, summarized the latest progresses and future directions in the field, and provided information and hints for the trajectory of future research. A total of 549 papers were included, which were mainly from the field of clinical medicine; the country with the most publications was the United States, while China ranked the fourth in terms of contribution; the research institution with the highest number of published papers was University of Texas system; N Engl J Med published the most papers, with contribution also from highly influential journals in the field of oncology such as Lancet Oncol, J Clin Oncol, JAMA Oncol and Cancer Discov. Oncology remained the most popular research topic in the medical research and spanned a wide spectrum of sub-topics. In this study, we demonstrated and sorted out research frontiers in the field of oncology in 12 different research directions including the basic cancer research, cancer epidemiology, and various tumors types related to different systems and organs.
(1) Surgery is the first method to cure early stage non-small cell lung cancer (NSCLC). Ground glass nodule (GGO) like lung adenocarcinoma should be regarded as a new clinical issue to avoid over-treatment. The deep meaning of multidisciplinary pathological classification of lung adenocarcinoma should be fully understood to avoid over-diagnosis. The T staging of lung adenocarcinoma mixed with GGO components should be correctly understood to avoid over-staging. We should carefully understand the new data of relationship between sublobectomy and prognosis to avoid excessive resection. Attention should be paid to the research progress of minimal residual disease (MRD) to avoid insufficient treatment. (2) The treatment strategy of resectable stage Ⅲ NSCLC should be surgery with individualized systemic treatment. Locally advanced NSCLC dominated by Ⅲa-N2 NSCLC is a kind of disease with high multi-dimensional heterogeneity. In theory, preoperative treatment is superior to postoperative treatment, and molecular diagnosis should be made along with pretreatment staging, so as to select preoperative treatment. The patients with negative driver gene mutation obtained better pathological complete response/major pathological response (PCR/MPR) from immunotherapy compared to those from chemotherapy, and the better PCR/MPR is expected to be transformed into overall survival (OS). The data of preoperative treatment in patients with positive driver gene mutation are few, whereas the data of postoperative targeted treatment are much better than those of postoperative chemotherapy. (3) The effective systemic treatment strategy has "created" many long-term survivors with stage Ⅳ NSCLC, and has changed the original concept and population of "oligometastasis". Attention should be paid to the individual ineffective lesions in stage Ⅳ patients with long-term survival. It is also necessary to explore how to intervene in the resection of "oligometastasis" of stage Ⅳ NSCLC at an appropriate time and in an appropriate way, which may be one of the main tasks of lung cancer surgery in the future.
Cancer remains a great challenge for mankind. The complex and diverse phenotypes, mechanisms, as well as therapeutic responsiveness of cancer have gradually been understood since the second half of the 20th century, which was a representative of entering the molecular era of oncology research. In 2000, the groundbreaking review “Hallmarks of Cancer” came out and it had been updated to the third version with 14 characteristics of cancer in 2022. These series of reviews helped to distil the increasingly complicated concepts of oncology into a logical science, which contributed to a more comprehensive understanding of the mechanisms for cancer genesis and development and applying the knowledges to the diagnosis and treatment of tumors. Mastering, applying, and exploring the hallmarks of cancer will help us face the challenges of cancer more confidently in the future.
Objective To analyze the relationship between the residence and oncological characteristics of colorectal patients served by Sichuan University West China Hospital as a regional center in the current version of the Database from Colorectal Cancer (DACCA). Methods The DACCA version selected for this data analysis was the updated version on January 5, 2022. The data items analyzed included: residence, precancerous lesions, family history of cancer, tumor location, tumor morphology, tumor orientation, tumor pathology, tumor differentiation and preoperative TNM staging. According to the regional distribution of colorectal cancer patients' residence in the database, they were divided into Sichuan group and non-Sichuan group, and the Sichuan group was further divided into Sichuan-Chengdu group and Sichuan-non-Chengdu group. Results The DACCA database was filtered by conditions to obtain 7 232 valid data. ① The composition ratio of precancerous lesions in different places of residence: The difference between the Sichuan group and the non-Sichuan group was statistically significant (χ2=14.462, P=0.003), and the difference between the Sichuan-Chengdu group and the Sichuan-non-Chengdu group was not statistically significant (χ2=7.591, P=0.101). ② Composition ratio of family history of cancer in different places of residence: In the family history of cancer in oneself, the difference between Sichuan group and non-Sichuan group as well as between Sichuan-Chengdu group and Sichuan-non-Chengdu group were not statistically significant (χ2=1.121, P=0.606; χ2=1.047, P=0.621). In the family history of cancer in relatives, the differences in the composition ratio of different tumor histories between the Sichuan group and the non-Sichuan group, and between the Sichuan-Chengdu group and the Sichuan-non-Chengdu group were not statistically significant (χ2=0.813, P=0.692; χ2=2.696, P=0.262). ③ Tumor site composition ratios in different places of residence: The difference between Sichuan group and non-Sichuan group was not statistically significant (χ2=0.476, P=0.490), and the difference between Sichuan-Chengdu group and Sichuan-non-Chengdu group was statistically significant (χ2=36.216, P<0.001). ④ Tumor morphology composition ratio in different places of residence: The difference between Sichuan group and non-Sichuan group was statistically significant (χ2=19.560, P<0.001), and the difference between Sichuan-Chengdu group and Sichuan-non-Chengdu group was not statistically significant (χ2=5.377, P=0.247). ⑤ Composition ratio of tumor orientation in different places of residence: The differences in composition ratio of tumor orientation between Sichuan group and non-Sichuan group and between Sichuan-Chengdu group and Sichuan-non-Chengdu group were statistically significant (χ2=17.484, P=0.005; χ2=26.820, P<0.001). ⑥ Composition ratio of tumor pathological properties under different residence: The differences in the comparison of pathological properties between Sichuan group and non-Sichuan group as well as between Sichuan-Chengdu group and Sichuan-non-Chengdu group of CRC patients were not statistically significant (χ2=8.136, P=0.408; χ2=7.278, P=0.506). ⑦ Composition ratio of tumor differentiation degree under different residence groupings: the differences in the composition ratio of tumors with different degrees of differentiation were not statistically significant between Sichuan group and non-Sichuan group, and between Sichuan-Chengdu group and Sichuan-non-Chengdu group (H=0.289, P=0.591; H=0.156, P=0.693). ⑧ The composition ratio of TNM staging of tumors before operation in different places of residence: between the Sichuan group and the non-Sichuan group, the difference in the composition ratio of preoperative TNM staging of CRC patients was statistically significant (H=8.023, P=0.005); between the Sichuan-Chengdu group and the Sichuan-non-Chengdu group, the difference in the composition ratio of preoperative TNM staging of CRC patients was not statistically significant (H=0.218, P=0.640). Conclusions Data analysis in DACCA reveal multiple associations between the place of residence and oncological characteristics of CRC patients. There are differences in the composition of the types of precancerous lesions among CRC patients in different places of residence. The proportion of CRC is higher in the family history of cancer. In terms of the site of tumor occurrence, the proportion of tumors located in the rectum is higher than that in the colon. In the composition of tumor morphology in all regions, the ulcerative type is the most frequent. The composition of tumor orientation is different in patients with CRC, and those who has involved a circle of the intestinal wall are the most frequent. Most CRC patients are already in middle or late stage when the tumor is discovered, and the proportion of middle or late stage patients in non-Sichuan provinces was even higher.