目的 评价凋亡相关基因bcl-2、p53的表达与乳腺癌新辅助化学疗法（化疗）疗效的关系。 方法 计算机检索Cochrane、Pubmed、Embase、中国知网、万方、维普等数据库，2003年4月－2013年4月bcl-2、p53蛋白与乳腺癌新辅助化疗的病例对照研究，应用RevMan 4.2统计软件进行定量分析。 结果 共纳入15篇病例对照研究，bcl-2与乳腺癌新辅助化疗6篇，治疗有效279例，其中bcl-2表达阳性159例；治疗无效115例，其中bcl-2表达阳性57例。p53与乳腺癌新辅助化疗13篇，治疗有效679例，其中p53表达阳性249例；治疗无效341例，其中p53表达阳性195例。Meta分析结果显示，bcl-2表达的阳性率与乳腺癌新辅助化疗疗效无统计学意义[OR=1.40，95%CI（0.89，2.18），P=0.14]，而p53表达的阳性率与乳腺癌新辅助化疗疗效有统计学意义[OR=0.46，95%CI（0.26，0.80），P=0.007]。 结论 p53可以作为乳腺癌新辅助化疗疗效敏感性的一个指标，对乳腺癌新辅助化疗有提示作用。
【Abstract】Objective Through using neoadjuvant chemotherapy of different circles combined colorectal cancer operations under multi-disciplinary team (MDT), we evaluate effective treatment strategies that suit to colorectal cancer patients in this country. Methods The retrospective study reviewed patients with colorectal cancer treated in general surgery department Ⅲ in West China Hospital of Sichuan University from October 2006 to April 2007. According to the circle times of neoadjuvant chemotherapy, the patients were divided into single-circle group, double-circle group and triple-circle group. And comparing the difference of treatment time, effect index of neoadjuvant chemotherapy and operative results used these stratagies. Results The difference between the time from the end of neoadjuvant chemotherapy to the operation in three groups had no statistical significance （Pgt;0.05）, which were （5.64±2.00） d in single-circle group, (5.80±3.74） d in double-circle group, （6.22±2.76） d in triple-circle group. According to the treatment effects, CEA value decreased during pre- and post-neoadjuvant chemotherapy in each groups （Plt;0.01）. Subjective reception such as hemafecia, anal tenemus and defecation obstruction in double-circle group and triple-circle group were obviously improved than that in single-circle group （Plt;0.01）. Evaluating the tumor condition, the ratio of CR and PR in double-circle group and triple-circle group was higher than that in single-circle group （Plt;0.01）. According to the adverse effect, WBC value of double-circle group and triple-circle group decreased during pre- and post-neoadjuvant chemotherapy, their difference had statistical significance （Plt;0.01）. The difference of WBC pre- and post- neoadjuvant chemotherapy in single-circle group decreased fewer than that in double-circle group and triple-circle group （Plt;0.01）. Nausea and vomit response in triple-circle group were obviously more serious than that in single-circle group and double-circle group （Plt;0.01）. But abdominal distention and diarrhea response had no difference among three groups （Pgt;0.05）. Through our survey, used different neoadjuvant chemotherapy circle, patients in single-circle group and double-circle group were completely accepted within full confidence; but receptance of strategy in triple-circle group was 66.7％(12/18）. All operations were successful. The difference of postoperative aerofluxus time between single-circle group and double-circle group had statistical significance （Plt;0.05）. The difference of postoperative intake time, between triple-circle group and single-circle group, between triple-circle group and double-circle group, had statistical significance （Plt;0.05）. But wound recover time among three groups had no obvious difference （Pgt;0.05）. Conclusion Analyzing neoadjuvant chemotherapy circles, time between neoadjuvant chemotherapy and operation, treatment effect and operation results, it is a feasible and secure colorectal cancer multi-discipinary strategy for patients in West China that choose the treatment of neoadjuvant chemotherapy with double-circle and short preparation time.
ObjectiveTo summarize recent research on the surgical treatment of breast cancer after neoadjuvant chemotherapy (NAC) and to review the impact of NAC on the surgical treatment of breast cancer. MethodRelevant studies on NAC and surgical treatment of breast cancer from both domestic and international sources were reviewed. The literatures were analyzed, summarized, and discussed. ResultsFollowing NAC, the survival outcomes and risk of local recurrence in patients undergoing breast-conserving surgery were similar to those undergoing mastectomy. The using of image-guided minimally invasive biopsy accurately predicted pathological complete remission (pCR) of breast lesions after NAC, potentially allowed some breast cancer patients to undergo only radiation therapy after NAC, thus avoiding breast surgery. For patients with positive axillary lymph nodes, techniques such as dual-tracer, triple-tracer, and targeted axillary lymph node dissection had achieved clinical requirements in terms of detection rate and false-negative rate of sentinel lymph node biopsy, provided a safe alternative to axillary lymph node dissection. ConclusionsNAC is an important component of comprehensive breast cancer treatment. However, there is still controversy regarding the local treatment of the primary breast lesion and axillary lymph nodes after NAC. Currently, individualized treatment based on the specific circumstances of the patient remains the approach in clinical practice, aiming to achieve the optimal control of local recurrence and survival benefits for patients.
ObjectiveTo explore the expression of alpha B-crystallin (CRYAB) in human gastric cancer tissue and the influence of chemotherapeutics on expression of CRYAB mRNA.Methods① The gastric cancer tissues and corresponding adjacent tissues of 76 patients underwent radical resection from April 2018 to March 2020 in The First Affiliated Hospital of Southwest Medical University and the Sichuan Mianyang 404 Hospital were collected, the expression of CRYAB protein in the gastric cancer tissues and corresponding adjacent tissues of 76 patients with gastric cancer were detected by immunohistochemistry SP technique. The relation between the expression of CRYAB protein and clinicopathologic features was analyzed. ② Twenty-one gastric tissues of patients accepted neoadjuvant chemotherapy and 26 gastric tissues of patients with no neoadjuvant chemotherapy in the The First Affiliated Hospital of Southwest Medical University were collected from November 2018 to March 2020, the expression of CRYAB mRNA was detected by real time-PCR.ResultsThe expression of CRYAB protein in gastric cancer tissues was positive in 51 cases (67.1%) and in the corresponding adjacent tissues was positive in 32 cases (42.1%), the positive rate was higher in gastric cancer tissues (χ2=9.581, P=0.002). The over-expression of CRYAB protein in the gastric cancer tissues was correlated with the TNM stage, Borrmann typing, degree of differentiation, lymph node metastasis, depth of invasion of the patients, and Lauren classification (P<0.05), but not correlated with the age, gender, tumor sitation, and diameter (P>0.05). The expression of CRYAB mRNA in the gastric cancer tissues with neoadjuvant chemotherapy was significantly higher than that in the gastric cancer tissues without neoadjuvant chemotherapy (t=8.37, P<0.001).ConclusionsThe over-expression of CRYAB protein is closely related to the invasion and progression of gastric cancer, they may be involved in the progression of gastric cancer and play a crucial role. Moreover, the expression of CRYAB mRNA increases after chemotherapy, it suggests that chemotherapy drugs can activate the self-protection mechanism of tumor cells to some extent, and influence the effect of chemotherapy by increasing expression of CRYAB protein.
ObjectiveTo explore the relation between the molecular subtypes and efficacy of neoadjuvant chemotherapy with docetaxel together with epirubicin(TE) in breast cancer. MethodsAccording to the inclusion and exclusion criteria, 239 patients with breast cancer who at least received 3 cycles of TE-based neoadjuvant chemotherapy from May 2011 to December 2012 in this hospital were included. Molecular subtypes were categorized into luminal A, luminal B, human epidermal growth factor receptor 2(HER-2) positive, and triple negative by the immunohistochemical results of estrogen receptor(ER), progesterone receptor(PR), HER-2, and Ki-67 status. The relevant indicators of the different molecular subtypes of breast cancer patients, such as pathological complete response(pCR) rate, age, and menstruation, etc. were analyzed. ResultsThere were 67(28.03%) patients with luminal A, 84(35.15%) luminal B, 21(8.79%) HER-2, and 67(28.03%) triple negative in these 239 patients with breast cancer. The differences of age, menstruation, axillary lymph node status etc. among the four molecular subtypes were not statistically significant(P > 0.05). The pCR rate of triple negative breast cancer(14.93%) was the highest among four subtypes, followed by luminal B(7.14%), HER-2 positive(4.76%) and luminal A(1.49%), there was a significant difference(P=0.027). ConclusionsComparing with luminal A, luminal B, and HER-2 positive breast cancers, triple negative breast cancer is the most sensitive to TE neoadjuvant chemotherapy, and it has the highest pCR rate. Therefore, different treatment should be selected according to molecular subtypes of breast cancer.
Objective To explore the intervention effect on colorectal cancer operation by neo-adjuvant chemotherapy in multi-disciplinary team. Methods To analyze retrospectively the data of patients diagnosed definitely as colorectal cancer in the West China Hospital of Sichuan University from July 2007 to December 2007, and the planned and actual operative strategy were compared between MDT group and non-MDT group. Results According to the inclusion criteria, 251 colorectal cancer patients were included which had 183 rectal cancer and 68 colon cancer. The baseline between MDT group and non-MDT group was equal, and there was no difference of planned operative strategy between two groups. For patients planned undergoing standard ano-saving radical procedure, the ratio of actual procedure same to the planned and the ratio of radical procedure changed to expansive ano-saving radical procedure showed no significant differences between MDT group and non-MDT group (Pgt;0.05), whereas the difference of the ratio of radical procedure changed to local radical procedure between two groups was statistically significant (Plt;0.01). And the constituent ratio of actual procedure between two groups for patients which planned accepted non-ano-saving procedure didn’t have any significant difference (Pgt;0.05). For the cancer focus, the relief differences of complete remission and partial remission were statistically significant between two groups (P＜0.01), but the difference of the constituent ratio of T staging change was not statistically significant (Pgt;0.05). Conclusion The value of neo-adjuvant chemotherapy should not be limited to decrease the stage of cancer, and it is important to pay more attention to the high quality of combined therapy. Further research should be carried out to find the contribution of neo-adjuvant chemotherapy to mini-invasive surgery.
Objective To investigate the advances and clinical efficacy evaluation method on neoadjuvant chemotherapy in patients with gastric cancer. Methods Literatures on the advances and clinical efficacy evaluation method on neoadjuvant chemotherapy in patients with gastric cancer were reviewed and analyzed. The agreement between computed tomography (CT), endoscopic ultrasound (EUS), magnetic resonance imaging (MRI) and positron emission tomography (PET) and the results of histopathology and survival was analyzed.Results CT and EUS were the method of efficacy evaluation commonly used at present, but the evaluation indexes and criteria were controversial, and the criteria for solid tumors seemed to be not feasible for gastric cancer. Diffusionweighted imaging (DWI) method needed more investigation, while PET held advantage in early selection of patients without response accurately.Conclusion There is no uniform standard for clinical efficacy evaluation yet, so an integration of diverse imaging methods may be the best choice to improve the accuracy of neoadjuvant chemotherapy in patients with gastric cancer.
ObjectiveTo investigate the factors of breast cancer patients who met breast-conserving conditions after neoadjuvant chemotherapy when choosing surgical mode.MethodsA questionnaire survey was conducted on 228 breast cancer patients who met breast-conserving conditions after neoadjuvant chemotherapy. Chi square test, nonparametric rank sum test and binary logistic regression were used to analyze the factors affecting the choice of surgical mode.ResultsUnivariate analysis showed that age, clinical stage, family history of cancer, molecular type, neoadjuvant chemotherapy effect, surgeon’s recommendation, chemotherapy side effects, and surgical complications were the factors affecting patient’s chose for breast-conserving surgery (P<0.05). Multivariate analysis showed that the effect of neoadjuvant chemotherapy [OR=0.312, 95%CI (0.255, 0.662), P<0.001] and the surgeon’s recommendation [OR=53.947, 95%CI (4.570, 6.239), P=0.002] were independent factors that affected the choice of surgery.ConclusionsThe decision of the surgical mode is a process in which doctors and patients participate together. Individualized neoadjuvant chemotherapy improves the remission rate and the progress of the surgeon’s comprehensive treatment strategy can play a role in improving the breast-conserving rate and the rate of breast-conserving success. Doctors should give positive guidance in accordance with the specific situation of the patient to make the best choice.
Objective To summarize the progress of biological indexes which could predict the efficiency of neoadjuvant chemotherapy for breast cancer. Methods Various related researches were collected to make a review. Results Many indexes linked to the efficiency of neoadjuvant chemotherapy for breast cancer according to several studies. According to many studies, indexes such as human epidermal growth factor receptor-2 (HER-2) gene, estrogen receptor (ER), progesterone receptor (PR), Ki-67, P53 gene, neutrophil to lymphocyte ratio (NLR), platelet level, and mean platelet volume (MPV) may have association with the outcome of neoadjuvant chemotherapy in treatment of breast cancer, and these factors maybe individual biomarkers to predict the efficiency of the treatment, but no coincident conclusion has been reached for these indexes. Conclusion The value of these indexes that predict the efficiency of neoadjuvant chemotherapy is not sure, further study need to be done to solve this topic.