ObjectiveTo summarize advances in immunotherapy for gastric cancer.MethodThe relevant literatures about immunotherapy for gastric cancer in recent years were reviewed.ResultsRecently, the immunotherapy for the tumors mainly included the immune checkpoint blocking, tumor vaccine, and adoptive immunotherapy. There were many studies on the immune checkpoint blocking, mainly targeting the antibodies of programmed death receptor 1 (PD-1) and cytotoxic T-lymphocyte associated antigen 4 (CTLA-4). A series of studies had shown that the pembrolizumab was effective in the patients with advanced gastric cancer who expressed PD-1 ligand positive. The nivolumab had become the first immune checkpoint inhibitor approved for the treatment of advanced gastric cancer in Asia, and the patients with mismatch repair defects could benefit more from the PD-1 treatment. Although the CTLA-4 targeted immune checkpoint blocking therapy had been reported, some studies had found that the patients with advanced gastric cancer didn’t benefit from the treatment of CTLA-4 monoclonal antibody ipilimumab. The tumor vaccine therapy in the gastric cancer had been reported. Due to the high heterogeneity of tumor cells in the gastric cancer, the tumor vaccine efficacy of autoantibody was not stable, based on the high- throughput sequencing of neoantigens identification and screening process was complex, the vaccine preparation needed the longer period, how to individualized screening the neoantigen, and the selection of antigens that could effectively activate the T cells to recognize and kill the tumor cells still needed to be overcame.ConclusionsTumor immunotherapy has received worldwide attention. Anti-PD-1 and its ligand as representative immune checkpoint statin therapy in treatment of advanced gastric cancer has showed great potential, but at present there are still many problems need to be solved, such as number of applicable patients of immunotherapy is small, curative effect of immune checkpoint inhibitor screening index also is not clear, tumor vaccine and adoptive cell therapy are promising but there is lack of evidence from clinical research data, combined use of existing treatments and immunotherapy on curative effect still needs more clinical trials to explore.
Colorectal cancer is the third most frequently diagnosed cancer and the second leading cause of cancer death worldwide. In recent years, with the development and change of society and economy, the epidemiological characteristics of colorectal cancer related to geographic economy and health resources have caused its incidence to show a trend of regional differentiation. At present, the diagnosis, treatment, prevention and control of colorectal cancer in China are still facing great challenges, therefore, summarizing the risk factors related to the incidence of colorectal cancer in China from the global epidemiological characteristics of colorectal cancer can further guide the prevention, control and clinical diagnosis and treatment of colorectal cancer in China, and is of great significance to improve the heavy burden of colorectal cancer. Therefore, this paper discusses the epidemiological characteristics of colorectal cancer in recent years and the screening policies in different regions based on the report of the International Agency for Research on Cancer and related studies, so as to provide the relevant basis for the prevention and control of colorectal cancer in the new situation in the future.
ObjectiveTo analyze the risk factors for early mortality in patients with stage Ⅳ colorectal cancer, and further construct and validate Nomogram prediction model for early mortality in stage Ⅳ colorectal cancer. MethodsA retrospective analysis was conducted on the clinical and pathological data of stage Ⅳ colorectal cancer patients from the Surveillance, Epidemiology, and End Results (SEER) database in the United States from 2018 to 2020. The study data was randomly divided into a training cohort and a validation cohort at a ratio of 8∶2. Multivariate logistic regression analysis was performed in the training cohort to screen for risk factors for early mortality in stage Ⅳ colorectal cancer patients, and Nomogram prediction model was further constructed. Receiver operating characteristic curve (ROC), calibration curve, and clinical decision curve analysis (DCA) were plotted. ResultsAge (50–70 group, OR=1.984, P=0.007; >70 group, OR=1.997, P=0.008), unmarried (OR=1.342, P=0.025), primary tumor differentiation of G3+G4 (OR=1.817, P<0.001), T4 stage (OR=1.434, P=0.009), N2 stage (OR=1.621, P<0.001), M1c stage (OR=1.439, P=0.036), no chemotherapy (OR=21.820, P<0.001), bone metastasis (OR=2.000, P=0.042), brain metastasis (OR=6.715, P=0.001) and liver metastasis (OR=1.886, P<0.001) were risk factors for all-cause early death in stage Ⅳ colorectal cancer patients. Age（50–70 group, OR=2.025, P=0.008; >70 group, OR=1.925, P=0.017), primary tumor differentiation grade of G3+G4 (OR=1.818, P<0.001), T4 stage (OR=1.424, P=0.013), N2 stage (OR=1.637, P<0.001), M1c stage (OR=1.541, P=0.016), no chemotherapy (OR=21.832, P<0.001), brain metastasis (OR=6.089, P=0.001), liver metastasis (OR=2.100, P<0.001) were factors for cancer-specific early death of stages Ⅳ colorectal cancer patients. Based on these variables, we constructed two Nomogram prediction models for all-cause early death and cancer-specific early death in stage Ⅳ colorectal cancer patients. The area under curve (AUC) value of the all-cause early death prediction model in the training queue was 0.874 [95% CI (0.855, 0.893)], and the AUC value of the cancer specific early death prediction model was 0.874 [95%CI (0.855, 0.894)]; the AUC value of the all-cause early death prediction model in the validation queue was 0.868 [95%CI (0.829, 0.907)], and the AUC value of the cancer specific early death prediction model was 0.867 [95%CI (0.827, 0.907)], indicating that the model had good predictive ability. The calibration curve showed that the predictive models had good consistency with the actual results for predicting early mortality in stage Ⅳ colorectal cancer, and the DCA curve showed that the models could provide patients with higher clinical benefits. ConclusionThe predictive models established in this study have good predictive performance for early mortality in stage Ⅳ colorectal cancer patients, which is helpful for clinical physicians to identify high-risk patients in the early stage and develop personalized treatment plans in clinical practice.