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。
目的：探讨ⅢA-N2期非小细胞肺癌（NSCLC）完全切除术后三维适形放疗联合辅助化疗疗效。方法:对48例ⅢA-N2期NSCLC完全切除术后患者，术后病理为腺癌18例、鳞癌27例、腺鳞癌3例，按信封法随机分为放疗组（24例）与非放疗组（24例）。放疗组采用术后三维适形放疗，4～5个非共面野，以90%～95%等剂量曲线包绕PTV，每次2 Gy，1次/日，5次/周，共照射25次，总剂量DT 50 Gy，放疗后予TP方案化疗3~4周期；非放疗组术后予TP方案化疗3~4周期。结果：放疗组1、2、3年生存率分别为95.8%、79.2%、62.5%，非放疗组分别为91.7%、58.3%、37.5%；放疗组1、2、3年无病生存率分别75.0%、58.3%、45.8%，非放疗组分别为54.2%、41.7%、25.0%；放疗组与非放疗组3年胸腔内复发分别12.5%和37.5%；放疗组与非放疗组中位生存时间分别为28个月和18个月；放疗组白细胞减少、急性放射性肺炎、气管炎发生率分别为25.0%、8.3%、12.5%，均为Ⅰ或Ⅱ级；Ⅰ级急性放射性食管炎发生率为20.8%。结论：ⅢA-N2期非小细胞肺癌完全切除术后三维适形放疗联合辅助化疗，可以降低患者胸腔内肿瘤复发、提高术后生存率。
ObjectiveTo evaluate the efficacy and toxicity of TEC and CEF regimen in preoperative chemotherapy for patients with breast cancer. MethodsA total of one hundred breast cancer patients undergoing preoperative chemotherapy were divided into TEC group (n=50) and CEF group (n=50) by the pairgroup method and received surgical therapy after three courses of chemotherapy. The efficacy and toxicity of preoperative chemotherapy of patients in two groups were analyzed. ResultsFour patients with stage ⅢB breast cancer quit from CEF group after two courses of treatment because of the worse satisfaction. Clinical complete remission (cCR) was 7 cases, clinic partial remission (cPR) was 34 cases, stable disease (SD) was 9 cases, therefore, the remission rate (RR) was 82.0% (41/50), and reduction rate of tumor was 64.0% (32/50) in TEC group. cCR was 2 cases, cPR was 32 cases, SD was 12 cases, thus the RR was 680% (34/50), and reduction rate of tumor was 40.0% (20/50) in CEF group. The clinical efficacy and reduction rate of tumor of patients in TEC group were significantly superior than those in CEF group (Plt;0.05). The negative conversion ratio of lymph nodes were 54.1% (20/37) and 57.1% (20/35) in TEC group and CEF group, which was not statistically different (Plt;0.05). The occurrence of hair loss and leukopenia of patients in TEC group were significantly higher than those in CEF group (Plt;0.05), while the differences in thrombocytopenia, low concentration of hemoglobin, nausea, vomiting, diarrhea, cardiac toxicity, and neurotoxicity were not significant (Pgt;0.05). ConclusionTEC regimen is better than CEF regimen in the efficacy and safety of neo-adjuant therapy for patients with breast cancer, and well tolerated.
Objective To investigate the effect of radiotherapy after neoadjuvant chemotherapy and modified radical surgery on breast cancer specific survival (BCSS) of patients with stage cT1–2N1M0 breast cancer. Methods A total of 917 cT1–2N1M0 stage breast cancer patients treated with neoadjuvant chemotherapy and modified radical surgery from 2010 to 2017 were extracted from the The Surveillance, Epidemiology, and End Results (SEER) database. Of them 720 matched patients were divided into radiotherapy group (n=360) and non-radiotherapy group (n=360) by using propensity score matching (PSM). Cox proportional hazard regression model was used to explore the factors affecting BCSS. Results Patients were all interviewed for a median follow-up of 65 months, and the 5-year BCSS was 91.9% in the radiotherapy group and 93.2% in the non-radiotherapy group, there was no significant difference between the 2 groups (χ2=0.292, P=0.589). The results were the same in patients with no axillary lymph node metastasis, one axillary lymphnode metastasis, two axillary lymph node metastasis and 3 axillary lymph node metastasis group (χ2=0.139, P=0.709; χ2=0.578, P=0.447; χ2=2.617, P=0.106; χ2=0.062, P=0.803). The result of Cox proportional hazard regression analysis showed that, after controlling for Grade grade, time from diagnosis to treatment, efficacy of neoadjuvant chemotherapy, number of positive axillary lymph nodes, molecular typing, and tumor diameter at first diagnosis, radiotherapy had no statistically significant effect on BCSS [HR=1.048, 95%CI (0.704, 1.561), P=0.817]. Conclusions The effect of radiotherapy on the BCSS of patients with stage cT1–2N1M0 breast cancer who have received neoadjuvant chemotherapy and modified radical surgery with 0 to 3 axillary lymph nodes metastases is limited, but whether to undergo radiotherapy should still be determined according to the comprehensive risk of individual tumor patients.
ObjectiveTo study the latest progress of neoadjuvant chemotherapy in breast cancer. MethodsLiteratures of neoadjuvant chemotherapy in breast cancer, involving with theoretical basis, clinical significance, indications, drugs, predictors, and its relationship of breastconserving surgery, sentinel lymph node biopsy were reviewed. ResultsNeoadjuvant chemotherapy could reduce the clinical stage, increase opportunity of breast-conserving surgery, learn the sensitivity of drugs, prevent distant metastases, but the impact of the sentinel lymph node biopsy was still in dispute. ConclusionNeoadjuvant chemotherapy is an important part of a systemic treatment for breast cancer, but how to select sensitive drugs, develop individualized treatment programs and forecast the outcome needs further study.
ObjectiveTo evaluate the effect of neoadjuvant chemotherapy and find the mechanism of multidrug resistance. MethodsTwenty patients with gastric cancer and 31 patients with colorectal cancer underwent neoadjuvant chemotherapy and then operations. The preoperative specimens were stained by immunohistochemical techniques for testing p53,multidrug resistanceassociated protein (MRP), glutathione S transferase（GST）, telomerase. Resection specimens were evaluated for chemotherapy effect by routine histology; at the same time, the postoperative morbidity and mortality were observed. ResultsIn 51 patients, the response rate of neoadjuvant chemotherapy was 27.45%(14/51),so multidrug resistance was a kind of common phenomena in gastrointestinal carcinomas. The postoperative morbidity was 15.69%(8/15), the main operation complication was infection,the mortality was 1.96%(1/51),only one person died from severe infection.The expression rate of p53, MRP, GST, telomerase was 58.0%,51.0%,66.7%,74.0%respectively, the location of p53 was at cell nucleus,location of MRP,GST was at cell memberane and cytoplasm,location of telomerase was at cytoplasm.The response rate had nothing to do with age, sex and metastasis. But it was related with p53 and telomerase expression. ConclusionNeoadjuvant chemotherapy is an effective, safe therapy. But the rate of drug resistance is high in gastrointestinal carcinomas, and the response rate is related to p53, telomerase expression.
Objective To study the long-term effect of neoadjuvant chemotherapy on advanced breast cancer. Methods The CAF neoadjuvant chemotherapy 〔CTX 500 mg/m2（1st day, 8th day), 5-FU 500 mg/m2（1st day, 8th day), and ADM 30 mg/m2 (1st day) every 3 weeks〕 was carried out in 31 breast cancer patients (stageⅢ,Ⅳ) for 2 cycles before operation, compared with 30 patients (stage Ⅲa) whose therapies were never done and operations could be feasible. Results The overall response rate was 87.1%(27/31). The stages of 19 patients among 31 (61.3%) declined (6 patients to stage Ⅲa, 8 to stageⅡb, 4 to stageⅡa, 1 to stage 0, 1 to complete response and none to pathological complete response). The diseasefree survival time of the patients was 56.3 months which was obviously longer than that of the patients without neoadjuvant chemotherapy (43.5 months, P＜0.05). The 5-year diseasefree survival rate of the patients with neoadjuvant chemotherapy was 38.7% which was a little higher than that (33.3%) of the patients without the chemotherapy, and the two groups had no significant difference. Conclusion The neoadjuvant chemotherapy can reduce the stages of patients with advanced breast cancer, obviously prolong the diseasefree survival time of patients, and reduce or delay recurrence or metastasis.
【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.