ObjectiveTo analyze the details and efficacy of neoadjuvant therapy of colorectal cancer in the current version of Database from Colorectal Cancer (DACCA).MethodsThe DACCA version selected for this data analysis was the updated version on July 28th, 2020. The data items included “planned strategy of neoadjuvant therapy” “compliance of neoadjuvant therapy”, and “cycles of neoadjuvant therapy”. Item of “planned strategy of neoadjuvant therapy” included “accuracy of neoadjuvant therapy” and “once included in researches”. Item of “the intensity of neoadjuvant therapy” included “chemotherapy” “cycles of neoadjuvant therapy” “targeted drugs”, and “neoadjuvant radiotherapy”. Item of “effect of neoadjuvant therapy” included CEA value of “pre-neoadjuvant therapy” and “post-neoadjuvant therapy”“variation of tumor markers” “variation of symptom” “variation of gross” “variation of radiography”, and tumor regression grade (TRG). The selected data items were statistically analyzed.ResultsThe total number of medical records (data rows) that met the criteria was 7 513, including 2 539 (33.8%) valid data on the “accuracy of neoadjuvant therapy”, 498 (6.6%) valid data on “once included in researches”, 637 (8.5%) valid data on the “compliance of neoadjuvant therapy”, 2 077 (27.6%) valid data on “neoadjuvant chemotherapy”, 614 (8.2%) valid data on “cycles of neoadjuvant therapy”, 455 (6.1%) valid data on “targeted drugs”, 135 (1.8%) valid data on “neoadjuvant radiotherapy”, 5 022 (66.8%) valid data on “pre-neoadjuvant therapy CEA value”, 818 (10.9%) valid data on “post-neoadjuvant therapy CEA value ”, 614 (8.2%) valid data on “variation of tumor marker”, 464 (6.2%) valid data on “variation of symptom”, 478 (6.4%) valid data on “variation of gross”, 492 (6.5%) valid data on “variation of radiography”, and 459 (6.1%) valid data on TRG. During the correlation analysis, it appeared that “variation of tumor marker” and “variation of gross” (χ2=6.26, P=0.02), “variation of symptom” and “variation of gross”, “radiography” and TRG (χ2=53.71, P<0.01; χ2=38.41, P<0.01; χ2=8.68, P<0.01), “variation of gross” and “variation of radiography”, and TRG (χ2=44.41, P<0.01; χ2=100.37, P<0.01), “variation of radiography” and TRG (χ2=31.52, P<0.01) were related with each other.ConclusionsThe protocol choosing of neoadjuvant therapy has a room for further research and DACCA can provide data support for those who is willing to perform neoadjuvant therapy. The efficacy indicators of neoadjuvant therapy have association with each other, the better understand of it will provide more valuable information for the establishment of therapeutic prediction model.
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 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.
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 analyze the relation between educational level of patients with colorectal cancer (CRC) and decision-making and curative effect of neoadjuvant therapy (NAT) in the current version of the Database from Colorectal Cancer (DACCA). MethodsThe eligible CRC patients were collected from June 29, 2022 updated DACCA according to the screening criteria and were assigned into 4 groups according to their educational level, namely, uneducated, primary educated, secondary educated, and tertiary educated. The differences in NAT decision-making, cancer marker change, symptomatic change, gross change, imaging change, and tumor regression grade (TRG) among the CRC patients with different educational levels were compared. ResultsA total of 2 816 data that met the screening criteria were collected, 138 of whom were uneducated, 777 of whom were primary educated, 1 414 of whom were secondary educated, and 487 of whom were tertiary educated. The analysis results revealed that the difference in the composition ratio of patients choosing NAT regimens by educational level was statistically significant (χ2=30.937, P<0.001), which was reflected that the composition ratio of choosing a simple chemotherapy regimen in the uneducated CRC patients was highest, while which of choosing combined targeted therapy regimen in the tertiary educated CRC patients was highest. In terms of treatment outcomes, the composition ratios of changes in cancer markers (H=4.795, P=0.187), symptoms (H=1.722, P=0.632), gross (H=2.524, P=0.471), imaging (H=2.843, P=0.416), and TRG (H=2.346, P=0.504) had no statistical differences. ConclusionsThrough data analysis in DACCA, it is found that the educational level of patients with CRC can affect the choice of NAT scheme. However, it is not found that the educational level is related to the changes in the curative effect of patients with CRC before and after NAT, and further analysis is needed to determine the reasons for this.
ObjectiveTo describe the research progress of long non-coding RNA (lncRNA) and gastric cancer in recent years, and to make reasonable prospect for future research direction.MethodWe collected a large amount of literatures on lncRNA and gastric cancer at home and abroad, and sort out various kinds of lncRNA, to make an in-depth interpretation of the relationship between lncRNA and gastric cancer and the mechanism of action, and then clarified the latest research progress.ResultsAt present, the molecular mechanism of the occurrence and development of gastric cancer had not been fully elucidated, but current studies had shown that lncRNA (H19, HOTTIP, UCA1, MEG3, MALAT1, HULC, HOTAIR, GAPLINC, and so on) had regulatory effects at multiple levels such as epigenetics, transcription, translation, chemoresistance, and more and more lncRNA had been discovered closely related to gastric cancer.ConclusionlncRNA is closely related to the occurrence and development of gastric cancer and may be a key target for the treatment of gastric cancer in the future.
With the publication of several phase Ⅱ and Ⅲ clinical studies, the multidisciplinary diagnostic and therapeutic strategies for early resectable non-small cell lung cancer (rNSCLC) are rapidly evolving. These studies have elucidated the significant effects of neoadjuvant and adjuvant therapies on improving the prognosis of rNSCLC patients, while also highlighting the urgent need to revise and refine corresponding treatment protocols and clinical pathways. In response, the International Association for the Study of Lung Cancer has assembled a diverse, multidisciplinary international expert panel to evaluate current clinical trials related to rNSCLC and to provide diagnostic, staging, and treatment recommendations for rNSCLC patients in accordance with the 8th edition of the AJCC-UICC staging system. The consensus recommendations titled "Neoadjuvant and adjuvant treatments for early stage resectable non-small cell lung cancer: Consensus recommendations from the International Associationfor the Study of Lung Cancer" outline 20 recommendations, 19 of which received over 85% agreement from the experts. The recommendations indicate that early rNSCLC patients should undergo evaluation by a multidisciplinary team and complete necessary imaging studies. For stage Ⅱ patients, consideration should be given to either adjuvant therapy following surgery or direct neoadjuvant/perioperative treatment, while stage Ⅲ patients are recommended to receive neoadjuvant chemoimmunotherapy followed by surgery. Postoperatively, adjuvant immunotherapy should be considered based on the expression levels of programmed cell death ligand 1, along with testing for other oncogenic driver mutations. For patients with epidermal growth factor receptor or anaplastic lymphoma kinase mutations sensitive to tyrosine kinase inhibitors, corresponding adjuvant targeted therapy is recommended. These recommendations aim to provide personalized and precise treatment strategies for early rNSCLC patients to enhance the efficacy of neoadjuvant and adjuvant therapies. This article provides an in-depth interpretation of these consensus recommendations.
Objective To explore the predictive value of peripheral blood cells in the efficacy of neoadjuvant immunotherapy combined with chemotherapy for esophageal squamous cell carcinoma. Methods A retrospective study was conducted on patients with esophageal squamous cell carcinoma (clinical stages Ⅱ-Ⅳa) who underwent neoadjuvant immunotherapy combined with chemotherapy at the Department of Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College from April 2020 to November 2023. According to whether the pathology was completely relieved after treatment, patients were divided into a pathological complete remission group and a pathological incomplete remission group. According to the CAP criteria for tumor pathological regression grading after neoadjuvant therapy, patients were divided into groups (TRG=0, 1 defined as good efficacy, TRG=2, 3 defined as poor efficacy). Results A total of 92 patients with esophageal squamous cell carcinoma were included, including 72 males and 20 females. The average age was 65.86±7.66 years. The complete remission of pathology was closely related to the number of lymphocytes in the blood before treatment (P=0.019). The AUC for predicting complete remission of esophageal squamous cell carcinoma after neoadjuvant immunotherapy combined with chemotherapy was 0.678, the maximum Yoden index was 0.328, and the optimal cutoff value was 1.845. The incidence of postoperative pulmonary infection in the group with incomplete pathological remission (25% vs. 5.6%, P=0.030) was higher than that in the group with complete pathological remission. According to the optimal cutoff value classification, there was a statistically significant difference (P<0.05) in the pathological N stage and pathological TNM stage between the two groups. The efficacy response was closely related to the number of red blood cells in the blood before treatment (P=0.009). The AUC for predicting TRG response after neoadjuvant immunotherapy combined with chemotherapy in esophageal squamous cell carcinoma was 0.669, the maximum Yoden index was 0.385, and the optimal cutoff value was 4.235. There were significant differences in postoperative pathological T staging (P=0.000), N staging (P=0.041), and TNM staging (P=0.000). According to the optimal cutoff value classification, there was a statistically significant difference in age (P=0.000) and hypertension (P=0.022) between the two groups. Conclusion Before neoadjuvant therapy, lymphocyte absolute value≥1.845 and red blood cell count<4.235 have good predictive effects on pathological complete remission and pathological response of esophageal squamous cell carcinoma after neoadjuvant immunotherapy combined with chemotherapy.
ObjectiveTo analyze the relationship between occupational type of patients with colorectal cancer (CRC) and decision-making and curative effect of neoadjuvant therapy in the current version of the Database from Colorectal Cancer (DACCA). MethodsThe eligible CRC patients were collected from June 29, 2022 updated DACCA according to the screening criteria, in which the data items analyzed included: gender, age, BMI, blood type, marriage, occupation, neoadjuvant therapy, symptomatic changes, imaging changes, and tumor regression grade (TRG), and the occupations were classified into the mental labour group, physical labour group, and the unemployed and resident groups according to the type of labour, then compared the decision-making and curative effect of neoadjuvant therapy among the 3 groups. ResultsA total of 2 415 eligible data were screened, of which 1 160 (48.0%) were the most in the manual labour group, followed by 877 (36.3%) in the unemployed and resident group, and finally 378 (15.7%) in the mental labour group. The proportion of those who did not use targeted drugs was higher in both patients ≤60 years old and >60 years old [75.6% (958/1 267) vs. 82.5% (947/1 148)], with both differences being statistically significant (P=0.004 and P=0.019), and among patients >60 years old, the different occupational types were associated with symptomatic changes and imaging changes after neoadjuvant therapy, with the highest number of both changes to partial remission [71.5% (161/225) vs. 66.7% (148/222)], both differences being statistically significant (P=0.001 and P=0.017). ConclusionThe analysis results of DACCA data reveal that the occupational type of CRC patients was associated with the choice of neoadjuvant therapy, and that different occupational types were associated with changes in curative effect before and after neoadjuvant therapy in CRC patients >60 years old, which needs to be further analysis for the reasons.