ObjectiveTo understand the impact of preoperative nutritional status on the postoperative complications for patients with low/ultra-low rectal cancer undergoing extreme sphincter-preserving surgery following neoadjuvant therapy. MethodsThe patients with low/ultra-low rectal cancer who underwent extreme sphincter-preserving surgery following neoadjuvant therapy from January 2009 to December 2020 were retrospectively collected using the Database from Colorectal Cancer (DACCA), and then who were assigned into a nutritional risk group (the score was low than 3 by the Nutrition Risk Screening 2002) and non-nutritional risk group (the score was 3 or more by the Nutrition Risk Screening 2002). The postoperative complications and survival were analyzed for the patients with or without nutritional risk. The postoperative complications were defined as early-term (complications occurring within 30 d after surgery), middle-term (complications occurring during 30–180 d after surgery), and long-term (complications occurring at 180 d and more after surgery). The survival indicators included overall survival and disease-specific survival. ResultsA total of 680 patients who met the inclusion criteria for this study were retrieved from the DACCA database. Among them, there were 500 (73.5%) patients without nutritional risk and 180 (26.5%) patients with nutritional risk. The postoperative follow-up time was 0–152 months (with average 48.9 months). Five hundreds and forty-three survived, including 471 (86.7%) patients with free-tumors survival and 72 (13.3%) patients with tumors survival. There were 137 deaths, including 122 (89.1%) patients with cancer related deaths and 15 (10.9%) patients with non-cancer related deaths. There were 48 (7.1%) cases of early-term postoperative complications, 51 (7.5%) cases of middle-term complications, and 17 (2.5%) cases of long-term complications. There were no statistical differences in the incidence of overall complications between the patients with and without nutritional risk (χ2=3.749, P=0.053; χ2=2.205, P=0.138; χ2=310, P=0.578). The specific complications at different stages after surgery (excluding the anastomotic leakage complications in the patients with nutritional risk was higher in patients without nutritional risk, P=0.034) had no statistical differences between the two groups (P>0.05). The survival curves (overall survival and disease-specific survival) using the Kaplan-Meier method had no statistical differences between the patients with and without nutritional risk (χ2=3.316, P=0.069; χ2=3.712, P=0.054). ConclusionsFrom the analysis results of this study, for the rectal cancer patients who underwent extreme sphincter-preserving surgery following neoadjuvant therapy, the patients with preoperative nutritional risk are more prone to anastomotic leakage within 30 d after surgery. Although other postoperative complications and long-term survival outcomes have no statistical differences between patients with and without nutritional risk, preoperative nutritional management for them cannot be ignored.
ObjectiveTo evaluate the efficacy of multicycle neoadjuvant chemotherapy combined with apatinib in the treatment of advanced rectal cancer through the Database from Colorectal Cancer (DACCA).MethodsA total of 173 patients with advanced rectal cancer who underwent surgery after 2–4 cycles of neoadjuvant chemotherapy combined with apatinib were selected from the DACCA (Version January 20, 2019). The patients were grouped by treated cycle and clinical TNM (cTNM) stage, and the overall variation of clinical and pathological indicators before and after treatment were compared.ResultsAmong 173 cases, 63 cases (36.42%), 45 cases (26.01%), and 65 cases (37.57%) were respectively in the 2, 3, and 4-cycle group; 54 cases (31.21%), 91 cases (52.60%), and 28 cases (16.18%) in stage Ⅱ, Ⅲ, and Ⅳ-group. Clinical response degree: complete pathologic response (cPR) was observed in 23 cases (13.29%), and the rate of conversion resection was 100% (173/173). Clinical response grade: complete response (CR) in 58 cases (33.53%), partial response (PR) in 93 cases (53.76%), stable disease (SD) in 21 cases (12.14%), progressive disease (PD) in 1 cases (0.58%). Tumor regression grade: TRG0 in 21 cases (12.57%), TRG1 in 22 cases (13.17%), TRG2 in 84 cases (50.30%), TRG3 in 40 cases (23.95%). There was a statistical difference in CEA before and after the treatment (P<0.001). All cases underwent radical resection, and the successful rate of transformed resection was 100%. There was significant difference on the clinical response grade among the cases of different treatment cycle (H=18.513, P<0.001), and the longer treatment cycle was correlated with better clinical response (G=–0.474, P<0.001). In addition, there was significant difference on the cPR rate among the cases of different cTNM stage (χ2=6.450, P=0.040).ConclusionsMulticycle neoadjuvant chemotherapy combined with apatinib in treating patients with advanced rectal cancer is efficient. More treatment cycles lead to better efficacy. The lower cTNM stage maybe means more chance of achieving cPR and a satisfactory rate of conversion resection.
ObjectiveTo analyze the relationship between adverse reactions and curative effect in neoadjuvant chemotherapy, this study is to explore whether the adverse reactions of chemotherapy can indirectly predict the efficacy of chemotherapy, so as to give a new definition of adverse reactions of chemotherapy.MethodsThe clinical data of 64 patients with neoadjuvant chemotherapy for breast cancer (after 4 cycles of TAC regimen) were retrospectively analyzed. The adverse reactions (weakness, nausea, vomiting, alopecia, myelosuppression, cardiotoxicity) during chemotherapy were counted. At the same time, the evaluation of chemotherapy efficacy was carried out according to the RECIST1.1 standard, and the relationship between the degree of adverse reactions of chemotherapy and the curative effect was analyzed one by one. Then, according to the severity of adverse reactions, adopting the form of scoring to assign the value, and use Pearson correlation analysis to clarify the specific relationship between adverse reactions and curative effect. Finally, four subgroups of Luminal A, Luminal B, Her2+ and Sanyin were determined according to molecular typing, and the relationship between adverse reactions and therapeutic effects among different subgroups was analyzed.ResultsThere was no difference in the adverse reactions of chemotherapy in neoadjuvant chemotherapy patients of different ages (correlation coefficient r fluctuated between –0.079 and –0.164, P value fluctuated between 0.195 and 0.533). The patients with high scores of adverse reactions showed relatively good efficacy (r=0.587, P<0.01). There was no significant correlation between fatigue, nausea and vomiting and efficacy (r=0.199, P=0.144; r=0.127, P=0.144). Among the adverse reactions, there was a significant positive correlation between alopecia, myelosuppression, cardiotoxicity and efficacy (r=0.532, r=0.621, r=0.422, all P<0.01). The above correlation was verified in the Luminal A subgroup (r=0.559, P<0.007).ConclusionsThe severity of adverse reactions in neoadjuvant chemotherapy can predict the efficacy of chemotherapy. To a certain extent, the heavier adverse reactions, the better the chemotherapy effect. Hair loss, myelosuppression, and cardiotoxicity have a clearer effect on efficacy in several common adverse reactions.
This study reports a case of a 56-year-old female patient with BRAF-mutated non-small cell lung cancer (NSCLC) who successfully underwent curative surgery after neoadjuvant targeted therapy with the BRAF inhibitor dabrafenib combined with the MEK inhibitor trametinib. The chest drainage tube was removed 2 days postoperatively, and the patient was discharged smoothly. Postoperative pathology indicated invasive adenocarcinoma, moderately to highly differentiated, with 80% being lepidic type, and the maximum tumor diameter was 4 cm. No vascular invasion, nerve invasion, air cavity dissemination, pleural invasion, or lymph node metastasis were observed. The postoperative staging was ypT2aN0M0. The patient continued with adjuvant treatment with dabrafenib combined with trametinib postoperatively, and no signs of recurrence were found in the follow-up examination six months after surgery.
ObjectiveTo analyze the relation between the place of residence of patients with colorectal cancer (CRC) and patient compliance or regimen decision-making or outcomes for neoadjuvant therapy (NAT) in the current version of the Database from Colorectal Cancer (DACCA). MethodsThe version of DACCA selected for this analysis was updated on June 29, 2022. The patients were enrolled according to the established screening criteria and then assigned into inside and outside of Sichuan Province groups as well as inside and outside of Chengdu City groups. The differences in the patient compliance or regimen decision-making or outcomes (changes of symptom and imaging, and cancer marker carcinoembryonic antigen) for NAT were analyzed. ResultsA total of 3 574 data that met the screened criteria were enrolled, 3 142 (87.91%) and 432 (12.09%) were inside of Sichuan Province group and outside of Sichuan Province group, respectively; 1 340 (42.65%) and 1 802 (57.35%) were inside of Chengdu City group and outside of Chengdu City group in Sichuan Province, respectively. ① The constituent ratios of the patient compliance for NAT had no statistical differences between the inside and outside of Sichuan Province groups (χ2=0.299, P=0.585) as well as between the inside and outside of Chengdu City groups (χ2=3.109, P=0.078). ② In terms of the impact of the place of residence on the decision-making of NAT: For the patients with targeted therapy or not, there was a statistical difference between the inside and outside of Sichuan Province groups (χ2=5.047, P=0.025), but which had no statistical difference between the inside and outside of Chengdu City groups (χ2=0.091, P=0.762); For the patients with radiotherapy or not, there were no statistical differences in the constituent ratios of patients between the inside and outside of Sichuan Province groups as well as between the inside and outside of Chengdu City groups (χ2=2.215, P=0.137; χ2=2.964, P=0.085); For the neoadjuvant intensity, there was a statistical difference between the inside and outside of Sichuan Province groups (χ2=12.472, P=0.002), but which had no statistical difference between the inside and outside of Chengdu City groups (χ2=2.488, P=0.288). ③ The outcomes for NAT: The changes of carcinoembryonic antigen had no statistical differences between the inside and outside of Sichuan Province groups as well as between the inside and outside of Chengdu City groups (H=1.762, P=0.184; H=3.531, P=0.060); In the symptom changes, there was a statistical difference between the inside and outside of Sichuan Province groups (χ2=3.896, P=0.048), which had no statistical difference between the inside and outside of Chengdu City groups (χ2=0.016, P=0.900); In the image changes, the difference was statistically significant between the inside and outside of Chengdu City groups (χ2=7.975, P=0.005), but which had no statistical difference between the inside and outside of Sichuan Province groups (χ2=0.063, P=0.802). ConclusionsThrough data analysis in DACCA in this study, it is found that there are no statistical differences in compliance and carcinoembryonic antigen changes. However, decision-making of NAT for patients of inside and outside of Sichuan Province has different choices on whether to assist targeted therapy and chemotherapy intensity for NAT; Symptom changes of NAT in patients of inside of Sichuan Province has a better effect than in patients of outside of Sichuan Province; Imaging change of NAT in patients of inside of Chengdu City has a better effect than in patients of outside of Chengdu City.
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.
Objective To explore the tumor shrinking pattern, the image evaluation methods of the residual lesions after neoadjuvant chemotherapy, and the indications, the resection range, the surgical margins, the management of sentinel lymph node biopsy (SLNB) and axillary lymph nodes of breast conserving surgery after neoadjuvant chemotherapy. Methods Domestic and foreign literatures about the breast conserving surgery after neoadjuvant chemotherapy were collected and reviwed. Results Breast conserving surgery after neoadjuvant chemotherapy raised the rate of breast conserving surgery and improved the postoperative life quality of patients, while the overall survival rate had no significant difference compared with mastectomy. Tumor shrinking pattern and its related factors after neoadjuvant chemotherapy remain required further study. At present, the indications for breast conserving surgery after neoadjuvant chemotherapy still mainly refered to that for early stage breast cancer. Resection range was more recognized to the scope of residual tumor lesions after chemotherapy. The margins were more widely accepted as which were without tumor involved. Although there were some controversies about the use of SLNB and the management of axillary lymph nodes based on the results of SLNB in breast conserving surgery after neoadjuvant chemotherapy, it was still considered necessary at the basis of the accurate biopsy technique acquired. Conclusions At present, breast conserving treatment after neoadjuvant chemotherapy is considered safe and effective. However, it is necessary to proceed cautiously under the conditions of adequate communication of local recurrence rate, standardized local treatment, standard postoperative radiotherapy, systemic adjuvant therapy, and regular follow-up.
ObjectiveTo understand the progress of postmastectomy radiotherapy (PMRT) in patients with T1–2N1M0 breast cancer. MethodThe studies and the treatment guidelines relevant to PMRT in the patients with T1–2N1M0 breast cancer in recent years were analyzed and summarized. ResultsThe ability of PMRT to improve the prognosis of patients with T1–2N1M0 breast cancer remained controversial. Owing to the patients with T1–2N1M0 breast cancer were heterogeneous, and the indications for PMRT had not been standardized. With the increasing use of neoadjuvant chemotherapy for early-stage breast cancer, some studies had attempted to formulate decisions about PMRT based on changes in tumor characteristics before and after neoadjuvant chemotherapy, but the findings were currently controversial. ConclusionsWhether PMRT can improve prognosis and decision-making for patients with T1–2N1M0 breast cancer is still controversial. Some ongoing clinical trials may provide some references for the optimal decision-making of PMRT for patients with T1–2N1M0 breast cancer.
ObjectiveTo observe the accuracy of magnetic resonance imaging (MRI) for predicting pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) in breast cancer, and to analyze the cause of the prediction error.MethodsData from 157 breast cancer patients who underwent NAC before surgery in Mianyang Central Hospital from January 2017 to January 2019 were analyzed. MRI parameters before and after NAC and pCR conditions were collected to analyze the parameters that produced false positives and false negatives.ResultsOf the 157 patients, 37 (23.6%) achieved pCR after NAC, and 33 (21.0%) achieved radiation complete remission (rCR) after NAC. The accuracy of MRI prediction was 70.7% (111/157), the sensitivity was 82.5% (99/120), and the specificity was 32.4% (12/37). A total of 25 cases did not achieve rCR, but postoperative evaluation achieved pCR (false positive), 21 cases achieved rCR, but postoperative evaluation did not achieve pCR (false negative). Diameter of tumor, peritumoral oedema, and background parenchymal enhancement were associated with MRI false positive prediction (P<0.05); gland density and tumor rim enhancement were associated with MRI false negative prediction (P<0.05).ConclusionMRI can be used as an important method to predict pCR after NAC in breast cancer patients, and its accuracy may be related to diameter of tumor, peritumoral oedema, background parenchymal enhancement, gland density, and tumor rim enhancement.
ObjectiveTo analyze the association between nutritional and immune-related laboratory indices and pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) in breast cancer patients and focused on constructing a combination of laboratory indices to serve as a clinical predictor of pCR after NAC in breast cancer. MethodsRetrospectively collected the pre-NAC laboratory indices [albumin (ALB), total cholesterol, triglyceride, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol, apolipoprotein A- Ⅰ, apolipoprotein B, white blood cell, neutrophil, lymphocyte, monocyte (MON), and platelet ] and clinicopathologic data of 310 patients with invasive breast cancer who had received NAC in the Department of Breast Surgery, Affiliated Hospital of Southwest Medical University, from September 1, 2020 to October 31, 2022. Logistic regression analysis was conducted to determine the correlation between laboratory indices and post-NAC pCR. The combinations of laboratory indices were constructed by simple mathematical operation. The area under the receiver operating characteristic curve (AUC) was used to evaluate the efficacy of different combinations of laboratory indices in predicting pCR and to determine the optimal combination of liboratory indices. Multivariate logistic regression analysis was used to analysis the relevance between clinicopathologic features and post-NAC pCR in breast cancer patients and to determine the independent predictor of post-NAC pCR. ResultsAmong the 310 patients, 49.4% (153/310) of them achieved pCR after NAC. Logistic regression analysis revealed that ALB (Z=5.203, P<0.001) and HDL-C (Z=2.129, P=0.033) were positively correlated with post-NAC pCR, while MON (Z=–4.883, P<0.001) was negatively correlated with post-NAC pCR. The AUC analysis of 6 different combinations of laboratory indices showed that the ALB/MON combination (the optimal combination of liboratory indices) had the highest predictive performance (median AUC=0.708) and was determined to be the neoadjuvant therapy predictive index (NTPI). Multivariate logistic regression analysis showed that estrogen receptor (Z=–3.273, P=0.001), human epidermal growth factor 2 (Z=7.041, P<0.001), Ki-67 (Z=2.457, P=0.014), and NTPI (Z=4.661, P<0.001) were the independent predictors for post-NAC pCR. ConclusionNTPI could serve as a predictive index for post-NAC pCR in patients with breast cancer.