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 To discuss incidence of the complications in the rectal cancer patients ’ early postoperative being treated with neoadjuvant chemotherapy combined with surgical intervention. Methods The rectal cancer patients under surgical therapy being diagnosed definitely, with neoadjuvant chemotherapy under multi-disciplinary team (MDT) or without and firstly being discovered from April to October of 2007 were studied. The complication conditions of these patients 1 month after operation were studied and observed, and the differences between MDT group and non-MDT group were compared. Results According to the condition, 189 rectal cancer patients were internalized. Among all the patients, the distance of tumor to the dentate line were lt;3 cm 38 cases, 3 ～ 7 cm 86 cases, ≥ 7 cm 65 cases; pathological stage were Ⅰ stage 5 cases ， Ⅱstage 122 cases， Ⅲstage 50 cases， Ⅳstage 12 cases. There were 181 cases laparotomy, 8 cases laparoscopic operation; 33 cases stoma operation, 156 cases non-stoma operation. The total incidence of postoperative complication was 27.0% （51/189）. Of all, incision bleeding was 1 case, abdominal (deep) bleeding were 4 cases, anastomosis bleeding were 5 cases, pulmonary infection was 1 case, wound infection were 7 cases, urinary tract infection were 3 cases, abdominal (deep) infection was 1 case, unknown fever were 19 cases, superficial layer wound dehiscence was 1 case, wound co-liquation were 15 cases, anastomosis leakage were 3 cases, rectovaginal fistula were 2 cases; intestinal obstruction were 7 cases, urinary retention were 7 cases, stress ulcer were 2 cases. Follow-up in 2-10 months after operation, there was no death case. The baseline between MDT group and non-MDT group was equal. The ratio of postoperative blood transfusion of MDT group was obviously less than that of non-MDT group （P＜0.05）. Moreover, the operation time of MDT group was obviously shorter than that of non-MDT group, and the difference was statistically significant （P＜0.05）. But the ratio of laparotomy and laparoscopic operation, of stoma operation and non-stoma operation, as well as the types of radical excision operation of rectal cancer didn’t show any statistical difference between two groups (Pgt;0.05). The postoperative venting time, defecation time, intake time didn’t show any statistical difference between two groups too. But the postoperative out-of-bed activity time and the postoperative in-hospital days of MDT group was obviously shorter than that of non-MDT group, and the difference was statistically significant （P＜0.05）. In MDT group the postoperative total complication rate was less than non-MDT group, and the difference was statistically significant （P＜0.05）. Among all the complications, the MDT group had a lower rate of wound infection, wound co-liquation and urinary retention （P＜0.05）. Using multifactorial logistic regression analysis, the risk factor which influenced the postoperative complication rate in MDT group were: postoperative intake time and postoperative hospitalization time. But the risk factor in non-MDT group was only according to postoperative hospitalization time. Conclusion The patients who were treated by MDT, definite operative method combining neoadjuvant chemotherapy or not didn’t increase the postoperative complication rate and risk. So it could be believed that such a composite treatment was feasible and safe in early postoperative stage. But it needs further studies to evaluate the medium- and long-term clinical effect.
Objective To investigate the impacts of neoadjuvant chemotherapy on the expression of insulin-like growth factor-1 receptor (IGF-1R) and on operation procedure and the significance of prognosis. Methods The expression of IGF-1R in 40 patients with breast cancer before and after neoadjuvant chemotherapy was measured by immunohistochemistry. The diagnosis was proved by core biopsy. All the patients took the TAC chemotherapy regimen. Modified radical operation was performed after two chemotherapy cycles and the IGF-1R expression was measured again. The clinical effect of neoadjuvant chemotherapy was assessed according to WHO criterion by measuring the size of tumor by physical examination and B type ultrasound. Results After neoadjuvant chemotherapy the tumor size shrank in 29 patients, there was no CR (complete response) or PD (progressed disease) to be documented. IGF-1R expression could be downregulated in 25 patients. Conclusion Neoadjuvant chemotherapy can inhibit the tumor growth by downregulation of the expression of IGF-1R.
ObjectiveTo explore the clinical application of oncoplastic surgery in breast-conserving surgery after neoadjuvant chemotherapy.MethodsFrom May 2016 to May 2018, 32 breast cancer patients (cT2–3N0–3M0) who were scheduled for neoadjuvant chemotherapy (NAC) and agreed to accept breast-conserving surgery after NAC in the Henan Tumor Hospital were enrolled into the retrospective study. These patients were originally unable to perform traditional breast conserving surgery because of the size or location of the tumor. We observed the success rate, safety and cosmetic effects of breast-conserving therapy, which were applicated of tumor down-staging after neoadjuvant chemotherapy combined with oncoplastic surgery.ResultsIn this study, after neoadjuvant chemotherapy, 31 patients achieved CR or PR, and 1 patient had SD. All 32 patients underwent breast-conserving surgery successfully, 3 patients underwent breast-conserving combined with volume replacement, and 29 patients underwent breast-conserving combined with volume displacement. One patient was not satisfied with the cosmetic effects, the other patients were satisfied or basically satisfied with the cosmetic effects. The median follow-up was 18 months (5–24 months), and no local recurrence or distant metastasis was found in 32 patients.ConclusionsBy tumor down-staging after neoadjuvant chemotherapy combined with oncoplastic surgery, we can make some patients who are originally not suitable for breast conserving due to tumor size and tumor location succeed in breast-conserving therapy, and the safety and cosmetic effect are basically satisfied.
【摘要】 目的 评价早期巨块型宫颈癌患者术前行新辅助化学疗法的近期疗效。 方法 回顾分析2005年10月-2010年6月收治的Ⅰb~Ⅱa期巨块型宫颈癌患者90例患者的临床资料。根据术前是否行化学疗法将患者分为两组；新辅助化学疗法（neoadjuvant chemotherapy，NACT）组50例，术前予静脉化学疗法或子宫动脉灌注化学疗法治疗1～3个疗程;直接手术组40例，直接行根治性手术。比较新辅助化学疗法前后病灶大小变化，化学疗法不良反应，手术情况及术后病理情况。 结果 NACT组总有效率86%（43/50），鳞癌疗效优于腺癌，动脉与静脉化学疗法近期有效率比较，两组差异无统计学意义（Pgt;0.05）。NACT不良反应小。NACT组术中出血少于直接手术组，两者差异有统计学意义（Plt;0.05）。两组深肌层浸润、淋巴结转移、脉管浸润差异均无统计学意义（Pgt;0.05），NACT组宫旁浸润率低于直接手术组。 结论 术前NACT对早期巨块型宫颈癌患者近期疗效显著。【Abstract】 Objective To evaluate the short-term curative effect of preoperative neoadjuvant chemotherapy on the early-stage bulky cervical carcinoma. Methods We retrospectively analyzed the clinical data of 70 patients with bulky ⅠB-ⅡA cervical carcinoma treated in our hospital between October 2005 and June 2010. Based on whether the patients received chemotherapy, they were divided into two groups: neoadjuvant chemotherapy group (NACT group) and direct surgery group. In the former group, there were 50 patients who underwent surgery after 1 to 3 cycles of preoperative chemotherapy by uterus artery infusion or intravenous chemoembolization. For the 40 patients in the latter group, direct radical surgery was performed. The size of the tumor before and after chemotherapy, the operation conditions and the postoperative pathological conditions of patients between the two groups were compared and the adverse reactions of neoadjuvant chemotherapy were analyzed as well. Results The total effective rate of NACT group was 86% (43/50). The response to chemotherapy in squamous cell caner was significantly higher than adenocarcinoma. There was no statistical difference between arterial and venous chemotherapy in terms of immediate effect (Pgt;0.05). The incidence of adverse reactions of neoadjuvant chemotherapy was low. There was significant difference between the NACT group and the direct surgery group in intraoperative bleeding (Plt;0.05). There were no significant differences between the above two groups in deep muscularis infiltration rate, lymph node metastasis rate and vascular invasion rate. However, the parametrial infiltration rate for the NACT group was lower than that for the direct surgery group. Conclusion Preoperative neoadjuvant chemotherapy on patients with early-stage bulky cervical carcinoma has a remarkable immediate curative effect.
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 explore the clinical value of preoperative neoadjuvant chemotherapy (NAC) combined with laparoscopic pancreatoduodenectomy (LPD) with multiple surgical approaches in the treatment of borderline resectable pancreatic head cancer. Methods The clinicopathologic data of 35 patients with critical resectable pancreatic head carcinoma admitted to the Department of Hepatobiliary and Pancreatic Surgery of Luoyang Central Hospital Affiliated to Zhengzhou University and the Department of Hepatobiliary and Pancreatic Surgery of the Fifth Affiliated Hospital of Zhengzhou University from January 2017 to June 2022 were retrospectively analyzed. All patients received NAC before operation (AG protocol). At the end of the course of treatment, according to the type of borderline resectable pancreatic cancer (BRPC) [venous invasion type (BRPC-V type) and arterial invasion type (BRPC-A type)], take the individualized surgical approach for LPD (BRPC-V type: inferior mesenteric vein approach; BRPC-A type: left posterior approach, medial uncinate process approach, anterior approach, or lower mesocolon approach). The intraoperative condition, R0/R1 resection rate, lymph node dissection, postoperative complications, average hospital stay, recovery, follow-up and survival were recorded. Results① Efficacy evaluation of NAC: 13 patients were partially relieved , 17 patients were stable and 5 patients were progressive after 4 weeks of treatment. Five progressive patients continued to receive comprehensive internal medicine treatment, and the remaining 30 patients underwent LPD. ② Intraoperative situation: LPD were successfully completed in 30 patients, 2 patients underwent extended pancreaticoduodenectomy combined with superior mesenteric vein (or) portal vein reconstruction among them. Among the 30 patients with LPD, there were 10 cases of inferior mesenteric vein approach, 10 cases of left posterior approach, 6 cases of medial uncinate process approach, 1 case of left posterior approach+medial uncinate process approach, 2 cases of anterior approach, and 1 case of inferior mesocolon approach. The mean operative time was (379.4±77.3) min, the intraoperative blood loss was (436.9±95.1) mL. ③ Postoperative situation: The incidence rate of postoperative surgery-related complications was 33.3% (10/30), including 4 cases of Clavien-Dindo grade Ⅰ [biliary fistula in 1 case (3.3%), A-grade pancreatic fistula in 1 case (3.3%), gastric draining dysfunction in 1 case (3.3%), diarrhea in 1 case (3.3%)], 5 cases of grade Ⅱ [pulmonary infection in 2 cases (6.6%), B-grade pancreatic fistula in 2 cases (6.6%), abdominal infection in 1 case (3.3%)], and 1 case of grade Ⅲ [gastroduodenal artery stump bleeding (3.3%)]. Among the 10 patients with complications, 9 cases recovered after symptomatic treatment, and 1 case died, with a fatality rate of 3.3% (1/30). The mean postoperative hospital stay was (17.3±5.5) days. ④ Excision rate and pathological results: R0 resection rate was 90.0% (9/10) in 10 patients with BR-PV type LPD, and R1 resection was performed in 1 patient. R0 resection rate was 75.0% (15/20) in 20 patients with BR-A type, and R1 resection was performed in 5 patients (2 patients with medial uncinate process approach; Left posterior approach in 2 cases; Submesocolon approach was used in 1 case). In 30 patients with LPD, the total R0 removal rate was 80.0% (24/30), the number of lymph nodes dissected was (11±5). Pathological type: There were 26 cases (86.7%) of ductal adenocarcinoma in 30 patients, 1 case of adeno-squamous carcinoma (3.3%), 1 case of mucinous carcinoma (3.3%), 2 cases of acinocytic cell carcinoma (6.7%). 23 cases (76.7%) of medium-high differentiation and 5 cases (16.6%) of low differentiation, two cases (6.7%) were undifferentiated. ⑤ Postoperative follow-up and survival: 30 patients were completely followed-up for 6-39 months, with a median follow-up time of 17 months. The median survival time of BRPC-V and BRPC-A patients was 24.0 months and 17.0 months, respectively. The overall survival rates of 30 patients at 1, 2 and 3 years after operation were 77.3%、46.5% and 13.7%, respectively. Conclusion The selection of preoperative NAC combined with individualized surgical approach for patients with borderline resectable pancreatic head cancer is beneficial to improve the radical resection rate and clinical therapeutic effect, and has good clinical application value.
Radical surgical resection is still the only potentially curative treatment for pancreatic cancer. With the update of minimally invasive concepts, the laparoscopic and robotic platform has been introduced to pancreatic surgery practice. The recent studies have demonstrated that minimally invasive procedure achieved similar or improved perioperative outcomes compared to the standard open approach. Neo-adjuvant chemotherapy is increasingly being applied in pancreatic surgery, making surgical resection more challenging. Numbers of patients undergoing minimally invasive resection following neo-adjuvant chemotherapy remain low. The author consulted the latest literatures at home and abroad and described the current situation of minimally invasive treatment of pancreatic cancer after neo-adjuvant chemotherapy.
ObjectiveTo study value of long noncoding RNA H19 and HOTTIP in plasma in predicting efficacy of neoadjuvant chemotherapy (NAC) for resectable locally advanced gastric cancer. MethodsForty patients with T3–4aN+M0 gastric cancer and 40 patients with benign gastric diseases treated in the Yantai Yuhuangding Hospital Affiliated to Qingdao University from August 2020 to May 2021 were prospectively included. The expressions of H19 and HOTTIP in the plasma of gastric cancer and benign gastric diseases patients without any treatment after admission were detected before treatment (CAPEOX regimen was used in the patients with gastric cancer), then which were detected after 2 NAC courses for patients with gastric cancer. Meanwhile, some clinical items were detected and the efficacy of NAC was evaluated. The complete remission (CR) and partial remission (PR) were classified as objective remission, CR, PR, and disease stability were classified as disease control. The expressions of H19 and HOTTIP between the different patients were compared and the receiver operating characteristic (ROC) curve was used to evaluate their values in the diagnosis of resectable locally advanced gastric cancer. ResultsThere were 13 cases of T downstaging and 27 cases of T non-downstaging and 25 cases of objective remission and 35 disease control after NAC. The median relative expression levels of H19 and HOTTIP before NAC in the patients with gastric cancer were higher than those in the patients with benign gastric diseases (H19: 1.42 versus 0.98, Z=–3.835, P<0.001; HOTTIP: 2.15 versus 1.04, Z=–5.062, P<0.001), and which were in the patients with T downstaging and disease control were lower than those in the patients with T non-downstaging and 5 cases of disease progression (For T staging, H19: 1.12 versus 1.54, Z=–2.960, P=0.002; HOTTIP: 1.49 versus 2.30, Z=–2.310, P=0.019. For efficacy of NAC, H19: 1.39 versus 2.48, Z=–3.211, P<0.001; HOTTIP: 1.96 versus 3.25, Z=–2.393, P=0.014). The median relative expressions of H19 and HOTTIP after NAC were lower than those before NAC in the patients with gastric cancer (H19: 1.12 versus 1.42, Z=–3.965, P<0.001; HOTTIP: 1.30 versus 2.15, Z=–4.839, P<0.001). There were no significant differences in the changes of H19 and HOTTIP before and after NAC between the patients with T downstaging and T non-downstaging, and between disease control and disease progression (P>0.05). The areas of ROC curve of H19, HOTTIP, and combination of H19 and HOTTIP in diagnosis of resectable locally advanced gastric cancer were higher than 0.7. ConclusionsLncRNA H19 and HOTTIP might be potential tumor markers in gastric cancer, and their diagnostic values for resectable locally advanced gastric cancer are higher. Gastric cancer patients with low expressions of H19 and HOTTIP in plasma might be more sensitive to NAC.