BACKGROUND The TRIANGLE operation involves the removal of all tissues within the triangle bounded by the portal vein-superior mesenteric vein,celiac axis-common hepatic artery,and superior mesenteric artery to improve...BACKGROUND The TRIANGLE operation involves the removal of all tissues within the triangle bounded by the portal vein-superior mesenteric vein,celiac axis-common hepatic artery,and superior mesenteric artery to improve patient prognosis.Although previously promising in patients with locally advanced pancreatic ductal adenocarcinoma(PDAC),data are limited regarding the long-term oncological outcomes of the TRIANGLE operation among resectable PDAC patients undergoing pancreaticoduodenectomy(PD).AIM To evaluate the safety of the TRIANGLE operation during PD and the prognosis in patients with resectable PDAC.METHODS This retrospective cohort study included patients who underwent PD for pancreatic head cancer between January 2017 and April 2023,with or without the TRIANGLE operation.Patients were divided into the PD_(TRIANGLE)and PD_(non-TRIANGLE)groups.Surgical and survival outcomes were compared between the two groups.Adequate adjuvant chemotherapy was defined as adjuvant chemotherapy≥6 months.RESULTS The PD_(TRIANGLE)and PD_(non-TRIANGLE) groups included 52 and 55 patients,respectively.There were no significant differences in the baseline characteristics or perioperative indexes between the two groups.Furthermore,the recurrence rate was lower in the PD_(TRIANGLE) group than in the PD_(non-TRIANGLE) group(48.1%vs 81.8%,P<0.001),and the local recurrence rate of PDAC decreased from 37.8%to 16.0%.Multivariate Cox regression analysis revealed that PD_(TRIANGLE)(HR=0.424;95%CI:0.256-0.702;P=0.001),adequate adjuvant chemotherapy≥6 months(HR=0.370;95%CI:0.222-0.618;P<0.001)and margin status(HR=2.255;95%CI:1.252-4.064;P=0.007)were found to be independent factors for the recurrence rate.CONCLUSION The TRIANGLE operation is safe for PDAC patients undergoing PD.Moreover,it reduces the local recurrence rate of PDAC and may improve survival in patients who receive adequate adjuvant chemotherapy.展开更多
BACKGROUND Lung cancer(LC)is a global medical,social and economic problem and is one of the most common cancers and the leading cause of mortality from malignant neoplasms.LC is characterized by an aggressive course,a...BACKGROUND Lung cancer(LC)is a global medical,social and economic problem and is one of the most common cancers and the leading cause of mortality from malignant neoplasms.LC is characterized by an aggressive course,and in the presence of disease recurrence risk factors,patients,even at an early stage,may be indicated for adjuvant therapy to improve survival.However,combined treatment does not always guarantee a favorable prognosis.In this regard,establishing predictors of LC recurrence is highly important both for determining the optimal treatment plan for the patients and for evaluating its effectiveness.AIM To establish predictors of disease recurrence after radical resection and adjuvant chemotherapy in patients with stage IIb-IIIa lung squamous cell carcinoma(LSCC).METHODS A retrospective case-control cohort study included 69 patients with LSCC who underwent radical surgery at the Orenburg Regional Clinical Oncology Center from 2009 to 2018.Postoperatively,all patients received adjuvant chemotherapy.Histological samples of the resected lung were stained with Mayer's hematoxylin and eosin and examined under a light microscope.Univariate and multivariate analyses were used to identify predictors associated with the risk of disease recurrence.Receiver operating characteristic curves were constructed to discriminate between patients with a high risk of disease recurrence and those with a low risk of disease recurrence.Survival was analyzed using the Kaplan-Meier method.The log-rank test was used to compare survival curves between patient subgroups.Differences were considered to be significant at P<0.05.RESULTS The following predictors of a high risk of disease recurrence in patients with stage IIb-IIa LSCC were established:a low degree of tumor differentiation[odds ratio(OR)=7.94,95%CI=1.08-135.81,P=0.049];metastases in regional lymph nodes(OR=5.67,95%CI=1.09-36.54,P=0.048);the presence of loose,fine-fiber connective tissue in the tumor stroma(OR=21.70,95%CI=4.27-110.38,P=0.0002);and fragmentation of the tumor solid component(OR=2.53,95%CI=1.01-12.23,P=0.049).The area under the curve of the predictive model was 0.846(95%CI=0.73-0.96,P<0.0001).The sensitivity,accuracy and specificity of the method were 91.8%,86.9%and 75.0%,respectively.In the group of patients with a low risk of LSCC recurrence,the 1-,2-and 5-year disease-free survival(DFS)rates were 84.2%,84.2%and 75.8%,respectively,while in the group with a high risk of LSCC recurrence the DFS rates were 71.7%,40.1%and 8.2%,respectively(P<0.00001).Accordingly,in the first group of patients,the 1-,2-and 5-year overall survival(OS)rates were 94.7%,82.5%and 82.5%,respectively,while in the second group of patients,the OS rates were 89.8%,80.1%and 10.3%,respectively(P<0.00001).CONCLUSION The developed method allows us to identify a group of patients at high risk of disease recurrence and to adjust to ongoing treatment.展开更多
Gastric cancer is one of the most common malignant tumours worldwide, with a high degree of malignancy and a poor prognosis. While early gastric cancer can be cured by surgical treatment, locally advanced gastric canc...Gastric cancer is one of the most common malignant tumours worldwide, with a high degree of malignancy and a poor prognosis. While early gastric cancer can be cured by surgical treatment, locally advanced gastric cancer requires neoadjuvant therapy to shrink the tumour, suppress potential metastases, achieve down-staging, and provide patients with the opportunity for radical surgery to prolong their survival. This article reviews the current status and progress of neoadjuvant chemotherapy for locally advanced gastric cancer.展开更多
BACKGROUND Owing to rarity of disease and lack of prospective studies, data supporting the role of adjuvant chemotherapy in ampulla of Vater(AoV) carcinoma is limited.AIM To evaluate whether adjuvant chemotherapy case...BACKGROUND Owing to rarity of disease and lack of prospective studies, data supporting the role of adjuvant chemotherapy in ampulla of Vater(AoV) carcinoma is limited.AIM To evaluate whether adjuvant chemotherapy cases for AoV carcinoma had better disease-free survival(DFS) rates than cases of observation following curative surgery.METHODS We retrospectively analyzed the association between adjuvant chemotherapy and DFS and overall survival(OS) in patients with stage IB-Ⅲ AoV carcinoma who underwent curative surgical resection. Fluorouracil-based adjuvant chemotherapy was administered after surgery at the discretion of the physician. Adjusted multivariate regression models were used to evaluate the association between adjuvant chemotherapy and survival outcomes.RESULTS Of the total 104 patients who underwent curative surgery, 52 received adjuvant chemotherapy. Multivariate analysis revealed that higher histologic grade [hazard ratio(HR) = 2.24, P = 0.046], advanced tumor stage(HR = 1.85, P = 0.030), and vascular invasion(HR = 2.14, P = 0.010) were associated with shorter DFS. Adjuvant chemotherapy improved DFS compared to the observation group(HR =0.50, P = 0.015) and tended to be associated with a longer OS, although the difference was not statistically significant(HR = 0.58, P = 0.098).CONCLUSION Among patients with resected AoV carcinoma, the adjuvant chemotherapy group was not associated with a significant survival benefit compared to the observation group. However, on multivariate analysis adjusting for prognostic factors, adjuvant chemotherapy following surgery was an independent prognostic factor for DFS in patients with resected AoV carcinoma. Further studies are needed to investigate the effectiveness of adjuvant chemotherapy according to histologic phenotype.展开更多
Objective The aim of this study was to investigate the effect of adjuvant chemotherapy (AC) on theprognosis of patients with ypT0-3N0 rectal cancer undergoing neoadjuvant chemoradiotherapy.Methods The study participan...Objective The aim of this study was to investigate the effect of adjuvant chemotherapy (AC) on theprognosis of patients with ypT0-3N0 rectal cancer undergoing neoadjuvant chemoradiotherapy.Methods The study participants were 110 patients with locally advanced rectal cancer. Thirty-fourpatients did not receive postoperative AC treatment, and the other 76 patients received postoperative ACtreatment. The differences in the 5-year overall survival (OS) and disease-free survival (DFS) between thetwo groups were compared.Results Age was an important determinant of the patients’ decision to undergo postoperative treatment.Patients who did not receive AC treatment were significantly older than those who received AC treatment(P < 0.05). The tumor location (distance above anal margin) in the AC group was significantly larger thanthat in the non-AC group (P < 0.05). Moreover, there was no significant difference in the 5-year DFS andOS between the two groups. Postoperative AC did not significantly improve the prognosis of patients withrectal cancer. Age, tumor differentiation, and the number of resected lymph nodes were independent factorsaffecting the OS of patients (P < 0.05). Older patients, patients with lower degree of tumor differentiation,and patients with <12 resected lymph nodes showed worse prognosis (P < 0.05).Conclusion Patients with rectal cancer whose ypT0-3N0 stage is reduced after neoadjuvantchemoradiotherapy, especially those without adverse prognostic factors, do not need AC after surgery.展开更多
Objective: Adjuvant chemotherapy(AC) after curative resection is known to improve the survival of patients with non-small cell lung cancer(NSCLC); however, few studies have reported the correlation between the time to...Objective: Adjuvant chemotherapy(AC) after curative resection is known to improve the survival of patients with non-small cell lung cancer(NSCLC); however, few studies have reported the correlation between the time to initiation of AC(TTAC) and survival in NSCLC patients.Methods: The clinical data of 925 NSCLC patients who received curative resection and post-operative AC at the Cancer Hospital of Chinese Academy of Medical Sciences between 2003 and 2013 were retrospectively analyzed.TTAC was measured from the date of surgery to the initiation of AC. Disease-free survival(DFS) was defined as the duration from surgery to the time of tumor recurrence or last follow-up evaluation. The optimal cut-off value of TTAC was determined by maximally selected log-rank statistics. The DFS curve was estimated using the Kaplan-Meier method, and the Cox proportional hazards regression model was used to identify risk factors independently associated with DFS. Propensity score matching(PSM) was performed for survival analysis using the match data.Results: The optimal discriminating cut-off value of TTAC was set at d 35 after curative resection based on which the patients were assigned into two groups: group A(≤35 d) and group B(>35 d). There was no significant difference in the DFS between the two groups(P=0.246), indicating that the TTAC is not an independent prognostic factor for DFS. A further comparison continued to show no significant difference in the DFS among 258 PSM pairs(P=0.283).Conclusions: There was no significant correlation between the TTAC and DFS in NSCLC patients. Studies with larger samples are needed to further verify this conclusion.展开更多
Postoperative adjuvant chemotherapy(ACT)confers superior gastric cancer(GC)survival in the Eastern cohort.However,is the current standard of ACT already excessive,or is it still necessary to increase its intensity for...Postoperative adjuvant chemotherapy(ACT)confers superior gastric cancer(GC)survival in the Eastern cohort.However,is the current standard of ACT already excessive,or is it still necessary to increase its intensity for specific subgroups?Tailored ACT strategies for GC depend on gradual exploration by clinical trials in selected patients.Thus,understanding the implications of previous and current research can help us respond wisely and design effective,rational trials,save medical resources and make better decisions in clinical practice.After reviewing and analyzing studies on ACT for GC patients undergoing curative resection,we found that research strategies for conducting"addition""ACT for specific stages of the disease have achieved great progress in making ACT more tailored and personalized in consideration of pathology stages.Furthermore,trials indicate that"addition"ACT strategies for GC patient subgroups based on histological characteristics might be helpful to move toward a more specific tailored and personalized management approach.Designing ACT research focused on different node statuses should also be conducted according to the biological specificity of lymph node(LN)metastasis.Therefore,future trials designed to determine tailored treatment based on histological and biological characteristics for specific subgroups are urgently needed and conducted as the theme of the 2019 American Society of Clinical Oncology(ASCO):Caring for Every Patient,Learning from Every Patient.展开更多
Objective:The objective of this open-label,randomized study was to compare dose-dense paclitaxel plus carboplatin(PCdd)with dose-dense epirubicin and cyclophosphamide followed by paclitaxel(ECdd-P)as an adjuvant chemo...Objective:The objective of this open-label,randomized study was to compare dose-dense paclitaxel plus carboplatin(PCdd)with dose-dense epirubicin and cyclophosphamide followed by paclitaxel(ECdd-P)as an adjuvant chemotherapy for early triple-negative breast cancer(TNBC).Methods:We included Chinese patients with high recurrence risk TNBC who underwent primary breast cancer surgery.They were randomly assigned to receive PCdd[paclitaxel 150 mg/m2 on d 1 and carboplatin,the area under the curve,(AUC)=3 on d 2]or ECdd-P(epirubicin 80 mg/m2 divided in 2 d and cyclophosphamide 600 mg/m2 on d 1 for 4 cycles followed by paclitaxel 175 mg/m2 on d 1 for 4 cycles)every 2 weeks with granulocyte colony-stimulating factor(G-CSF)support.The primary endpoint was 3-year disease-free survival(DFS);the secondary endpoints were overall survival(OS)and safety.Results:The intent-to-treat population included 143 patients(70 in the PCdd arm and 73 in the ECdd-P arm).Compared with the ECdd-P arm,the PCdd arm had significantly higher 3-year DFS[93.9%vs.79.1%;hazard ratio(HR)=0.310;95%confidence interval(95%CI),0.137-0.704;log-rank,P=0.005]and OS(98.5%vs.92.9%;HR=0.142;95%CI,0.060-0.825;log-rank,P=0.028).Worse neutropenia(grade 3/4)was found in the ECdd-P than the PCdd arm(47.9%V5.21.4%,P=0.001).Conclusions:PCdd was superior to ECdd-P as an adjuvant chemotherapy for early TNBC with respect to improving the 3-year DFS and OS.PCdd also yielded lower hematological toxicity.Thus,PCdd might be a preferred regimen for early TNBC patients with a high recurrence risk.展开更多
BACKGROUND For Siewert type Ⅱ/Ⅲ adenocarcinoma of gastroesophageal junction(AGE), the efficacy of adjuvant chemoradiotherapy(CRT) after D2/R0 resection remains uncertain.AIM To determine whether CRT was superior to ...BACKGROUND For Siewert type Ⅱ/Ⅲ adenocarcinoma of gastroesophageal junction(AGE), the efficacy of adjuvant chemoradiotherapy(CRT) after D2/R0 resection remains uncertain.AIM To determine whether CRT was superior to chemotherapy(CT) alone after D2/R0 resection for locally advanced Siewert type Ⅱ/Ⅲ AGE.METHODS We identified 316 locally advanced Siewert type Ⅱ/Ⅲ AGE patients who were treated with D2/R0 resection at National Cancer Center from 2011 to 2018.57 patients received adjuvant CRT and 259 patients received adjuvant CT.We followed patients for overall survival(OS), relapse-free survival, and recurrence pattern.RESULTS Five-year OS rates of the CRT group and the CT group for all patients were 66.7% and 41.9%(P = 0.010).Five-year OS rates of the CRT group and the CT group for Siewert type Ⅲ AGE patients were 65.7% and 43.9%(P = 0.006).Among the 195 patients whose recurrence information could be obtained, 18 cases(34.6%) and 61 cases(42.7%) were diagnosed as recurrence in the CRT group and CT group, respectively.The local and regional recurrence rates in the CRT group were lower than that in the CT group(22.2% vs 24.6%, 27.8% vs 39.3%).Multivariable cox regression analysis showed that vascular invasion, nerve invasion, and adjuvant CRT were important prognostic factors for Siewert type Ⅲ AGE.CONCLUSION For locally advanced Siewert type Ⅲ AGE, adjuvant CRT may prolong OS and reduce the regional recurrence rate.展开更多
Colon cancer represents one of the most common cancers diagnosed in older adults worldwide.The standard of care in resected stage II and stage III colon cancer continues to evolve.While there is unequivocal evidence t...Colon cancer represents one of the most common cancers diagnosed in older adults worldwide.The standard of care in resected stage II and stage III colon cancer continues to evolve.While there is unequivocal evidence to suggest both disease free and overall survival benefits with the use of combination chemotherapy in patients with stage III colon cancer,data regarding its use in patients with stage II colon cancer are less clear.Further,although colon cancer is a disease that affects older adults,there is considerable debate on the value of adjuvant chemotherapy in the aging population.In particular,many older patients are undertreated when compared to their younger counterparts.In this review,we will describe the clinical trials that contributed to the current adjuvant chemotherapy approach in colon cancer,discuss representation of older adults in trials and the specific challenges associated with the management of this subpopulation,and highlight the role of comprehensive geriatric assessments.We will also review how real-world evidence complements the data gaps from clinical trials of early stage colon cancer.展开更多
BACKGROUND The adjuvant treatment for patients with resected pancreatic cancer(PC)is not yet standardized.Because the prognosis differs according to the American Joint Committee on Cancer(AJCC)stage,a tailored approac...BACKGROUND The adjuvant treatment for patients with resected pancreatic cancer(PC)is not yet standardized.Because the prognosis differs according to the American Joint Committee on Cancer(AJCC)stage,a tailored approach to establish more aggressive treatment plans in high-risk patients is necessary.However,studies comparing the efficacy of adjuvant treatment modalities according to the AJCC stage are largely lacking.AIM To compare the efficacy of chemotherapy and chemoradiation therapy according to AJCC 8th staging system in patients with PC who underwent surgical resection.METHODS A total of 335 patients who underwent surgical resection and adjuvant treatment for PC were included.Patients were divided into three groups:Chemoradiation therapy(CRT)group,systemic chemotherapy(SCT)group and combined treatment of chemoradiation plus chemotherapy therapy(CRT-SCT)group.The primary outcomes were differences in overall survival(OS)between the three groups.The secondary outcomes were differences in recurrence-free survival,recurrence pattern and adverse events between the three groups.RESULTS Patients received CRT(n=65),SCT(n=62)and CRT-SCT(n=208).Overall median OS was 33.3 mo(95%confidence interval(CI):27.4-38.6).In patients with stage I/II,the median OS was 27.0 mo(95%CI:2.06-89.6)in the CRT group,35.8 mo(95%CI:26.9-NA)in the SCT group and 38.6 mo(95%CI:33.3-55.7)in the CRT SCT group.Among them,there was no significant difference in OS between the three groups.In 59 patients with stage III,median OS in the SCT group[19.0 mo(95%CI:12.6-NA)]and the CRT-SCT group[23.4 mo(95%CI:22.0-44.4)]was significantly longer than that in the CRT group[17.7 mo(95%CI:6.8-NA);P=0.011 and P<0.001,respectively].There were no significant differences in incidence of locoregional and distant recurrences between the three groups(P=0.158 and P=0.205,respectively).Incidences of grade 3 or higher hematologic adverse events were higher in the SCT and CRT-SCT groups than in the CRT group.CONCLUSION SCT and CRT-SCT showed significantly longer OS and recurrence-free survival than CRT in patients with AJCC stage III,while there was no significant difference in OS between the CRT,SCT and CRT-SCT groups in patients with AJCC stage I/II.Different adjuvant therapy according to AJCC stage can be applied in patients with PC.展开更多
BACKGROUND At present,there is insufficient medical evidence to determine whether adjuvant chemotherapy is necessary for T2N0M0 gastric cancer.AIM To obtain a risk score to assess the need for adjuvant chemotherapy in...BACKGROUND At present,there is insufficient medical evidence to determine whether adjuvant chemotherapy is necessary for T2N0M0 gastric cancer.AIM To obtain a risk score to assess the need for adjuvant chemotherapy in patients with T2N0M0 gastric cancer.METHODS We identified 325 patients with pathological T2N0M0 stage primary gastric cancer at the National Cancer Center between 2011 and 2018.Univariate and multivariate Cox regression analyses were performed to predict factors affecting prognosis.Vascular invasion,tumor site,and body mass index were assessed,and a scoring system was established.We compared the survival outcomes and benefits of adjuvant chemotherapy between the different subgroups.RESULTS Five-year survival rates of the score 0,1,2,and 3 groups were 92%,95%,80%,and 50%,respectively(P<0.001).In the score 2-3 group,five-year survival rates for patients in the adjuvant chemotherapy group and postoperative observation group were 95%and 61%,respectively(P=0.021).CONCLUSION For patients with T2N0M0 stage gastric cancer and two or more risk factors,adjuvant chemotherapy after D2 gastrectomy may have a survival benefit.展开更多
Objective:To determine whether adjuvant chemotherapy improves the prognoses in women with stage IC1 epithelial ovarian cancer(EOC).Methods:All eligible women diagnosed with stage IC1 EOC from 2003 to 2019 in Tongji Ho...Objective:To determine whether adjuvant chemotherapy improves the prognoses in women with stage IC1 epithelial ovarian cancer(EOC).Methods:All eligible women diagnosed with stage IC1 EOC from 2003 to 2019 in Tongji Hospital were included.Patient characteristics,tumor features,surgical types,and chemotherapeutic treatments were collected.Kaplan-Meier analysis and Cox regression analysis were performed to evaluate progression-free survival(PFS)and overall survival(OS).展开更多
Objective:To quantify the potential benefit of adjuvant chemotherapy(ACT)with respect to survival,and to identify factors for predicting prognoses in early gastric cancer patients.Methods:Patients with pT1 gastric can...Objective:To quantify the potential benefit of adjuvant chemotherapy(ACT)with respect to survival,and to identify factors for predicting prognoses in early gastric cancer patients.Methods:Patients with pT1 gastric cancer(GC)who underwent radical resection with D2 lymphadenectomy were retrospectively analyzed.Based on lymph node metastasis(LNM)status and treatment regimens,patients were classified into groups,and clinicopathological variables,overall survival(OS),and disease-specific survival(DSS)were compared.Results:Of 1,050 enrolled patients,151 patients(14.4%)had a positive LNM status.Submucosal invasion,undifferentiated state,tumor size>2 cm,ulceration,and lymphovascular invasion were independent risk factors for LNM using multivariate analyses.The 5-year OS of all patients was 96.4%.HER2 positive,perineural invasion,and LNM were independent factors for worse survival.Patients with pT1N3 GC had a worse 5-year OS and DSS than pT1N0,pT1N1,and pT1N2 patients(P<0.001).The 5-year OS and DSS for pT1N1 patients showed no significant difference between ACT and surgery only patients.For pT1N2 patients,the 5-year OS and DSS showed no significant difference between S-1 and Xelox treatments.For pT1N3 patients,7(36.8%)received S-1,while 12(63.2%)received Xelox treatment.Patients receiving Xelox treatment showed a better 5-year OS(75.0%vs.14.3%)and DSS(81.8%vs.20.0%)than patients receiving S-1(P<0.05).Conclusions:Curative surgery only was adequate for patients with pT1N0 and pT1N1.Xelox showed no survival benefits for pT1N2 patients.Therefore,S-1 is the optimal choice for pT1N2 patients,when considering adverse effects.Xelox is recommended for pT1N3 patients.展开更多
BACKGROUND Adjuvant chemotherapy(ACTx)is recommended in rectal cancer patients after preoperative chemoradiotherapy(PCRT),but its efficacy in patients in the early post-surgical stage who have a favorable prognosis is...BACKGROUND Adjuvant chemotherapy(ACTx)is recommended in rectal cancer patients after preoperative chemoradiotherapy(PCRT),but its efficacy in patients in the early post-surgical stage who have a favorable prognosis is controversial.AIM To evaluate the long-term survival benefit of ACTx in patients with ypT0–1 rectal cancer after PCRT and surgical resection.METHODS We identified rectal cancer patients who underwent PCRT followed by surgical resection at the Asan Medical Center from 2005 to 2014.Patients with ypT0–1 disease and those who received ACTx were included.The 5-year overall survival(OS)and 5-year recurrence-free survival(RFS)were analyzed according to the status of the ACTx.RESULTS Of 520 included patients,413 received ACTx(ACTx group)and 107 did not(no ACTx group).No significant difference was observed in 5-year RFS(ACTx group,87.9%vs no ACTx group,91.4%,P=0.457)and 5-year OS(ACTx group,90.5%vs no ACTx group,86.2%,P=0.304)between the groups.cT stage was associated with RFS and OS in multivariate analysis[hazard ratio(HR):2.57,95%confidence interval(CI):1.07–6.16,P=0.04 and HR:2.27,95%CI:1.09–4.74,P=0.03,respectively].Furthermore,ypN stage was associated with RFS and OS(HR:4.74,95%CI:2.39–9.42,P<0.00 and HR:4.33,95%CI:2.20–8.53,P<0.00,respectively),but only in the radical resection group.CONCLUSION Oncological outcomes of patients with ypT0–1 rectal cancer who received ACTx after PCRT showed no improvement,regardless of the radicality of resection.Further trials are needed to evaluate the efficacy of ACTx in these group of patients.展开更多
Background:The efficacy of adjuvant chemotherapy(AC)on survival outcomes of patients with stage I gastric cancer(GC)after curative resection remains controversial.We aimed to determine whether these patients would ben...Background:The efficacy of adjuvant chemotherapy(AC)on survival outcomes of patients with stage I gastric cancer(GC)after curative resection remains controversial.We aimed to determine whether these patients would benefit from AC.Methods:This retrospective study included patients with pathologically confirmed stage I GC who underwent curative resection between November 2010 and December 2020.Patients were divided into AC and non-AC groups,then a 1:1 propensity score matching(PSM)analysis was performed to minimize the selection bias.Potential risk factors including age,pN stage,pT stage,lymphovascular invasion,perineural invasion,tumor size,histological type,and carcinoembryonic antigen level were used as matching covariates.The recurrence-free survival(RFS)and disease-specific survival(DSS)were compared between groups using the Kaplan–Meier method.Results:A total of 902 consecutive patients were enrolled and 174(19.3%)patients were treated with AC.PSM created 123 pairs of patients.Before PSM,patients receiving AC had lower 10-year RFS rates(90%vs 94.6%,P=0.035)than those who did not receive AC;the two groups had similar 10-year DSS rates(93.8%vs 95.0%,P=0.240).After PSM,there were no statistical differences in the 10-year RFS(90.9%vs 93.0%,P=0.507)or DSS rates(93.5%vs 93.6%,P=0.811)between the two groups.Similar results were found in the stage IA and IB subgroups.Moreover,these findings were not affected by AC cycles.Conclusions:The addition of AC could not provide survival benefits for patients with stage I GC after surgery and follow-up is thus recommended.However,large-scale randomized clinical trials are required.展开更多
AIM:To illustrate clinicopathological features of orbital non-rhabdomyosarcoma soft tissue sarcoma(NRSTS),and to compare the treatment outcome between postoperative radiotherapy(RT) and chemotherapy in a retrospective...AIM:To illustrate clinicopathological features of orbital non-rhabdomyosarcoma soft tissue sarcoma(NRSTS),and to compare the treatment outcome between postoperative radiotherapy(RT) and chemotherapy in a retrospective analysis nearly 20y.METHODS:A retrospective cohort study of 56 patients with orbital NRSTS were reviewed,34 of whom received postoperative RT,and 22 received postoperative chemotherapy.The clinicopathological features,local recurrence,metastases,and survival data were recorded.Survival analysis was performed using the Kaplan-Meier method.RESULTS:During follow-up(111.8mo,ranged 8-233mo) for 56 patients,19 patients of them developed local recurrence,and 7 patients developed distant metastases.Fifteen patients died during follow-up period.Overall survival rates considering the whole study group was 78.57% at 5y,and 72.16% at 10y after the initial diagnosis.Compared with chemotherapy,RT was associated with lower risk of local recurrence [hazard ratio for RT vs chemotherapy,0.263,95% confidence interval(CI),0.095-0.728,P=0.0015];with lower risk of distant metastasis(hazard ratio for RT vs chemotherapy,0.073,95%CI,0.015-0.364,P=0.0014);and with lower risk of death from disease(hazard ratio for RT vs chemotherapy,0.066,95%CI,0.022-0.200,P<0.0001).The 5-year survival rate in RT group was 97.06% compared to 50% in chemotherapy group.CONCLUSION:In patients with orbital NRSTS,postoperative RT provides better control of local recurrence,distant metastasis,and death from disease than chemotherapy.RT is the more preferrable adjuvant therapy compared to chemotherapy possibly.展开更多
Background:Intrahepatic cholangiocarcinoma(ICC)is rare with limited evidence-based guidelines.This retrospective study evaluates the use of chemotherapy in patients with resected ICC.Methods:The Surveillance Epidemiol...Background:Intrahepatic cholangiocarcinoma(ICC)is rare with limited evidence-based guidelines.This retrospective study evaluates the use of chemotherapy in patients with resected ICC.Methods:The Surveillance Epidemiology and End Results(SEER)program database was used to identify patients with resected ICC.Patients were stratified by date of diagnosis(2000-2004,2005-2009,2010-2014),T,and N stage.Multivariable logistic regression models identified predictors of chemotherapy use.Kaplan-Meier and Cox proportional hazard models were used to identify survival trends.Results:One thousand and two hundred twenty-three patients met inclusion criteria.Chemotherapy utilization increased over time(33%to 41%,P≤0.05).Chemotherapy use increased in lymph node(LN)positive patients[32%to 60%in 2010-2014;(P≤0.05)and T3/T4 disease(40%to 60%in 2010-2014;P≤0.01)],but not in patients with LN negative or T1/T2 disease.LN positivity was associated with utilization of chemotherapy in 2005-2009 and 2010-2014.Overall survival increased from 32 to 41 months(P≤0.05).In LN positive patients,chemotherapy was associated with a decreased hazard ratio of death(P≤0.05)and T3/T4 disease was associated with an increased hazard ratio of death(P≤0.05).Conclusions:Adjuvant chemotherapy use in ICC has increased.More LN positive or patients with T3/T4 tumors are receiving chemotherapy,which may explain the improvement in overall survival.展开更多
Background:Although colorectal oligometastases to the liver can potentially be cured with aggressive local abla-tion,the efficacy of adjuvant chemotherapy(ACT)for such metastasis remains unclear.The present study expl...Background:Although colorectal oligometastases to the liver can potentially be cured with aggressive local abla-tion,the efficacy of adjuvant chemotherapy(ACT)for such metastasis remains unclear.The present study explored the effects of ACT on patients with colorectal liver oligometastases(CLO)after curative resections and aimed to iden-tify patients who could benefit from ACT.Methods:We retrospectively analyzed 264 eligible patients with CLO who underwent curative resection between September 1999 and June 2015.Recurrence-free survival(RFS)and overall survival(OS)were analyzed using the Kaplan-Meier method and log-rank test;prognostic factors were a by Cox regression modeling.Results:Among 264 patients,200(75.8%)patients received ACT and 64(24.2%)did not receive ACT.These two groups did not significantly differ in clinicopathologic characteristics,and had comparable 3-year OS and RFS rates(RFS:42.1%vs.45.7%,P=0.588;OS:69.7%vs.62.7%,P=0.446)over a median follow-up duration of 35.5 months,irrespective of preoperative chemotherapy.ACT markedly improved 3-year OS in high-risk patients with Memorial Sloan-Kettering Cancer Center clinical risk scores(MSKCC-CRS)of 3-5(68.2%vs.33.8%,P=0.015),but presented no additional benefit in patients with MSKCC-CRS of 0-2(72.2%vs.78.6%,P=0.834).In multivariate analysis,ACT was independently associated with improved OS in patients with MSKCC-CRS of 3-5.Conclusions:ACT might offer a prognostic benefit in high-risk patients with CLOs after curative liver resection,but not in low-risk patients.Therefore,patients’risk status should be determined before ACT administration to optimize postoperative therapeutic strategies.展开更多
Aim:Triple negative breast cancer(TNBC)is known as aggressive subtype and have no identified targeted therapies.We examined the relationship of neoadjuvant chemotherapy response to genetic variations of TNBC.Methods:T...Aim:Triple negative breast cancer(TNBC)is known as aggressive subtype and have no identified targeted therapies.We examined the relationship of neoadjuvant chemotherapy response to genetic variations of TNBC.Methods:The tumors used in this study were collected from Showa University Hospital,Japan.Thirteen formalin-fixed paraffin-embedded tumors from Japanese TNBC patients who underwent neoadjuvant chemotherapy were used for analysis.Of these,eight surgically resected tumors showed progressive disease and/or recurrence after treatment(PD/REC),and biopsy tissues from five patients showing pathological complete response(pCR)were analyzed.DNA extracted from tissue sample were analyzed.The Miseq system and Trusight Tumor Sequence panel kit were used to sequence 174 amplicons over 82 exons of 26 cancer-related genes to identify genetic mutations.Results:Seven somatic non-synonymous variants were detected in three genes(FOXL2,PIK3CA,and TP53)in all five pCR patients,and six somatic non-synonymous variants in two genes(PTEN and TP53)were detected in six of eight PD/REC patients.Eight of 13 TNBC tumors were found to have TP53 pathogenic variants,in both pCR and PD/REC cases.Conclusion:Although TP53 variation was detected in both pCR and PD/REC cases,each location and type of the variant were different.We could not identify genetic mutations associated with chemotherapy response and recurrence.展开更多
基金Supported by Shanghai Science and Technology Commission of Shanghai Municipality,No.20Y11908600Shanghai Municipal Health Commission,No.20194Y0195Medical Engineering Jiont Fund of Fudan University,No.XM03231533.
文摘BACKGROUND The TRIANGLE operation involves the removal of all tissues within the triangle bounded by the portal vein-superior mesenteric vein,celiac axis-common hepatic artery,and superior mesenteric artery to improve patient prognosis.Although previously promising in patients with locally advanced pancreatic ductal adenocarcinoma(PDAC),data are limited regarding the long-term oncological outcomes of the TRIANGLE operation among resectable PDAC patients undergoing pancreaticoduodenectomy(PD).AIM To evaluate the safety of the TRIANGLE operation during PD and the prognosis in patients with resectable PDAC.METHODS This retrospective cohort study included patients who underwent PD for pancreatic head cancer between January 2017 and April 2023,with or without the TRIANGLE operation.Patients were divided into the PD_(TRIANGLE)and PD_(non-TRIANGLE)groups.Surgical and survival outcomes were compared between the two groups.Adequate adjuvant chemotherapy was defined as adjuvant chemotherapy≥6 months.RESULTS The PD_(TRIANGLE)and PD_(non-TRIANGLE) groups included 52 and 55 patients,respectively.There were no significant differences in the baseline characteristics or perioperative indexes between the two groups.Furthermore,the recurrence rate was lower in the PD_(TRIANGLE) group than in the PD_(non-TRIANGLE) group(48.1%vs 81.8%,P<0.001),and the local recurrence rate of PDAC decreased from 37.8%to 16.0%.Multivariate Cox regression analysis revealed that PD_(TRIANGLE)(HR=0.424;95%CI:0.256-0.702;P=0.001),adequate adjuvant chemotherapy≥6 months(HR=0.370;95%CI:0.222-0.618;P<0.001)and margin status(HR=2.255;95%CI:1.252-4.064;P=0.007)were found to be independent factors for the recurrence rate.CONCLUSION The TRIANGLE operation is safe for PDAC patients undergoing PD.Moreover,it reduces the local recurrence rate of PDAC and may improve survival in patients who receive adequate adjuvant chemotherapy.
文摘BACKGROUND Lung cancer(LC)is a global medical,social and economic problem and is one of the most common cancers and the leading cause of mortality from malignant neoplasms.LC is characterized by an aggressive course,and in the presence of disease recurrence risk factors,patients,even at an early stage,may be indicated for adjuvant therapy to improve survival.However,combined treatment does not always guarantee a favorable prognosis.In this regard,establishing predictors of LC recurrence is highly important both for determining the optimal treatment plan for the patients and for evaluating its effectiveness.AIM To establish predictors of disease recurrence after radical resection and adjuvant chemotherapy in patients with stage IIb-IIIa lung squamous cell carcinoma(LSCC).METHODS A retrospective case-control cohort study included 69 patients with LSCC who underwent radical surgery at the Orenburg Regional Clinical Oncology Center from 2009 to 2018.Postoperatively,all patients received adjuvant chemotherapy.Histological samples of the resected lung were stained with Mayer's hematoxylin and eosin and examined under a light microscope.Univariate and multivariate analyses were used to identify predictors associated with the risk of disease recurrence.Receiver operating characteristic curves were constructed to discriminate between patients with a high risk of disease recurrence and those with a low risk of disease recurrence.Survival was analyzed using the Kaplan-Meier method.The log-rank test was used to compare survival curves between patient subgroups.Differences were considered to be significant at P<0.05.RESULTS The following predictors of a high risk of disease recurrence in patients with stage IIb-IIa LSCC were established:a low degree of tumor differentiation[odds ratio(OR)=7.94,95%CI=1.08-135.81,P=0.049];metastases in regional lymph nodes(OR=5.67,95%CI=1.09-36.54,P=0.048);the presence of loose,fine-fiber connective tissue in the tumor stroma(OR=21.70,95%CI=4.27-110.38,P=0.0002);and fragmentation of the tumor solid component(OR=2.53,95%CI=1.01-12.23,P=0.049).The area under the curve of the predictive model was 0.846(95%CI=0.73-0.96,P<0.0001).The sensitivity,accuracy and specificity of the method were 91.8%,86.9%and 75.0%,respectively.In the group of patients with a low risk of LSCC recurrence,the 1-,2-and 5-year disease-free survival(DFS)rates were 84.2%,84.2%and 75.8%,respectively,while in the group with a high risk of LSCC recurrence the DFS rates were 71.7%,40.1%and 8.2%,respectively(P<0.00001).Accordingly,in the first group of patients,the 1-,2-and 5-year overall survival(OS)rates were 94.7%,82.5%and 82.5%,respectively,while in the second group of patients,the OS rates were 89.8%,80.1%and 10.3%,respectively(P<0.00001).CONCLUSION The developed method allows us to identify a group of patients at high risk of disease recurrence and to adjust to ongoing treatment.
文摘Gastric cancer is one of the most common malignant tumours worldwide, with a high degree of malignancy and a poor prognosis. While early gastric cancer can be cured by surgical treatment, locally advanced gastric cancer requires neoadjuvant therapy to shrink the tumour, suppress potential metastases, achieve down-staging, and provide patients with the opportunity for radical surgery to prolong their survival. This article reviews the current status and progress of neoadjuvant chemotherapy for locally advanced gastric cancer.
文摘BACKGROUND Owing to rarity of disease and lack of prospective studies, data supporting the role of adjuvant chemotherapy in ampulla of Vater(AoV) carcinoma is limited.AIM To evaluate whether adjuvant chemotherapy cases for AoV carcinoma had better disease-free survival(DFS) rates than cases of observation following curative surgery.METHODS We retrospectively analyzed the association between adjuvant chemotherapy and DFS and overall survival(OS) in patients with stage IB-Ⅲ AoV carcinoma who underwent curative surgical resection. Fluorouracil-based adjuvant chemotherapy was administered after surgery at the discretion of the physician. Adjusted multivariate regression models were used to evaluate the association between adjuvant chemotherapy and survival outcomes.RESULTS Of the total 104 patients who underwent curative surgery, 52 received adjuvant chemotherapy. Multivariate analysis revealed that higher histologic grade [hazard ratio(HR) = 2.24, P = 0.046], advanced tumor stage(HR = 1.85, P = 0.030), and vascular invasion(HR = 2.14, P = 0.010) were associated with shorter DFS. Adjuvant chemotherapy improved DFS compared to the observation group(HR =0.50, P = 0.015) and tended to be associated with a longer OS, although the difference was not statistically significant(HR = 0.58, P = 0.098).CONCLUSION Among patients with resected AoV carcinoma, the adjuvant chemotherapy group was not associated with a significant survival benefit compared to the observation group. However, on multivariate analysis adjusting for prognostic factors, adjuvant chemotherapy following surgery was an independent prognostic factor for DFS in patients with resected AoV carcinoma. Further studies are needed to investigate the effectiveness of adjuvant chemotherapy according to histologic phenotype.
基金Supported by a grant from the National Natural Science Foundation of China(No.31572512).
文摘Objective The aim of this study was to investigate the effect of adjuvant chemotherapy (AC) on theprognosis of patients with ypT0-3N0 rectal cancer undergoing neoadjuvant chemoradiotherapy.Methods The study participants were 110 patients with locally advanced rectal cancer. Thirty-fourpatients did not receive postoperative AC treatment, and the other 76 patients received postoperative ACtreatment. The differences in the 5-year overall survival (OS) and disease-free survival (DFS) between thetwo groups were compared.Results Age was an important determinant of the patients’ decision to undergo postoperative treatment.Patients who did not receive AC treatment were significantly older than those who received AC treatment(P < 0.05). The tumor location (distance above anal margin) in the AC group was significantly larger thanthat in the non-AC group (P < 0.05). Moreover, there was no significant difference in the 5-year DFS andOS between the two groups. Postoperative AC did not significantly improve the prognosis of patients withrectal cancer. Age, tumor differentiation, and the number of resected lymph nodes were independent factorsaffecting the OS of patients (P < 0.05). Older patients, patients with lower degree of tumor differentiation,and patients with <12 resected lymph nodes showed worse prognosis (P < 0.05).Conclusion Patients with rectal cancer whose ypT0-3N0 stage is reduced after neoadjuvantchemoradiotherapy, especially those without adverse prognostic factors, do not need AC after surgery.
文摘Objective: Adjuvant chemotherapy(AC) after curative resection is known to improve the survival of patients with non-small cell lung cancer(NSCLC); however, few studies have reported the correlation between the time to initiation of AC(TTAC) and survival in NSCLC patients.Methods: The clinical data of 925 NSCLC patients who received curative resection and post-operative AC at the Cancer Hospital of Chinese Academy of Medical Sciences between 2003 and 2013 were retrospectively analyzed.TTAC was measured from the date of surgery to the initiation of AC. Disease-free survival(DFS) was defined as the duration from surgery to the time of tumor recurrence or last follow-up evaluation. The optimal cut-off value of TTAC was determined by maximally selected log-rank statistics. The DFS curve was estimated using the Kaplan-Meier method, and the Cox proportional hazards regression model was used to identify risk factors independently associated with DFS. Propensity score matching(PSM) was performed for survival analysis using the match data.Results: The optimal discriminating cut-off value of TTAC was set at d 35 after curative resection based on which the patients were assigned into two groups: group A(≤35 d) and group B(>35 d). There was no significant difference in the DFS between the two groups(P=0.246), indicating that the TTAC is not an independent prognostic factor for DFS. A further comparison continued to show no significant difference in the DFS among 258 PSM pairs(P=0.283).Conclusions: There was no significant correlation between the TTAC and DFS in NSCLC patients. Studies with larger samples are needed to further verify this conclusion.
基金supported by the National Natural Science Foundation of China (No. 81872013)National Key Research and Development Program (No.2017YFC 0108300)+1 种基金National Key Clinical Specialty Discipline Construction Program of China (No. [2012]121)Science and Technology Planning Project of Guangdong Province (No.2017B020226005)
文摘Postoperative adjuvant chemotherapy(ACT)confers superior gastric cancer(GC)survival in the Eastern cohort.However,is the current standard of ACT already excessive,or is it still necessary to increase its intensity for specific subgroups?Tailored ACT strategies for GC depend on gradual exploration by clinical trials in selected patients.Thus,understanding the implications of previous and current research can help us respond wisely and design effective,rational trials,save medical resources and make better decisions in clinical practice.After reviewing and analyzing studies on ACT for GC patients undergoing curative resection,we found that research strategies for conducting"addition""ACT for specific stages of the disease have achieved great progress in making ACT more tailored and personalized in consideration of pathology stages.Furthermore,trials indicate that"addition"ACT strategies for GC patient subgroups based on histological characteristics might be helpful to move toward a more specific tailored and personalized management approach.Designing ACT research focused on different node statuses should also be conducted according to the biological specificity of lymph node(LN)metastasis.Therefore,future trials designed to determine tailored treatment based on histological and biological characteristics for specific subgroups are urgently needed and conducted as the theme of the 2019 American Society of Clinical Oncology(ASCO):Caring for Every Patient,Learning from Every Patient.
基金This work was supported by National Key Research and Development Program of China(No.2O18YFC13121O1)Chinese Academy of Medical Science Initiative for Innovative Medicine(No.CAMS-2016-I2M-1-010).
文摘Objective:The objective of this open-label,randomized study was to compare dose-dense paclitaxel plus carboplatin(PCdd)with dose-dense epirubicin and cyclophosphamide followed by paclitaxel(ECdd-P)as an adjuvant chemotherapy for early triple-negative breast cancer(TNBC).Methods:We included Chinese patients with high recurrence risk TNBC who underwent primary breast cancer surgery.They were randomly assigned to receive PCdd[paclitaxel 150 mg/m2 on d 1 and carboplatin,the area under the curve,(AUC)=3 on d 2]or ECdd-P(epirubicin 80 mg/m2 divided in 2 d and cyclophosphamide 600 mg/m2 on d 1 for 4 cycles followed by paclitaxel 175 mg/m2 on d 1 for 4 cycles)every 2 weeks with granulocyte colony-stimulating factor(G-CSF)support.The primary endpoint was 3-year disease-free survival(DFS);the secondary endpoints were overall survival(OS)and safety.Results:The intent-to-treat population included 143 patients(70 in the PCdd arm and 73 in the ECdd-P arm).Compared with the ECdd-P arm,the PCdd arm had significantly higher 3-year DFS[93.9%vs.79.1%;hazard ratio(HR)=0.310;95%confidence interval(95%CI),0.137-0.704;log-rank,P=0.005]and OS(98.5%vs.92.9%;HR=0.142;95%CI,0.060-0.825;log-rank,P=0.028).Worse neutropenia(grade 3/4)was found in the ECdd-P than the PCdd arm(47.9%V5.21.4%,P=0.001).Conclusions:PCdd was superior to ECdd-P as an adjuvant chemotherapy for early TNBC with respect to improving the 3-year DFS and OS.PCdd also yielded lower hematological toxicity.Thus,PCdd might be a preferred regimen for early TNBC patients with a high recurrence risk.
基金Supported by National Natural Science Foundation of China,No.82072734.
文摘BACKGROUND For Siewert type Ⅱ/Ⅲ adenocarcinoma of gastroesophageal junction(AGE), the efficacy of adjuvant chemoradiotherapy(CRT) after D2/R0 resection remains uncertain.AIM To determine whether CRT was superior to chemotherapy(CT) alone after D2/R0 resection for locally advanced Siewert type Ⅱ/Ⅲ AGE.METHODS We identified 316 locally advanced Siewert type Ⅱ/Ⅲ AGE patients who were treated with D2/R0 resection at National Cancer Center from 2011 to 2018.57 patients received adjuvant CRT and 259 patients received adjuvant CT.We followed patients for overall survival(OS), relapse-free survival, and recurrence pattern.RESULTS Five-year OS rates of the CRT group and the CT group for all patients were 66.7% and 41.9%(P = 0.010).Five-year OS rates of the CRT group and the CT group for Siewert type Ⅲ AGE patients were 65.7% and 43.9%(P = 0.006).Among the 195 patients whose recurrence information could be obtained, 18 cases(34.6%) and 61 cases(42.7%) were diagnosed as recurrence in the CRT group and CT group, respectively.The local and regional recurrence rates in the CRT group were lower than that in the CT group(22.2% vs 24.6%, 27.8% vs 39.3%).Multivariable cox regression analysis showed that vascular invasion, nerve invasion, and adjuvant CRT were important prognostic factors for Siewert type Ⅲ AGE.CONCLUSION For locally advanced Siewert type Ⅲ AGE, adjuvant CRT may prolong OS and reduce the regional recurrence rate.
文摘Colon cancer represents one of the most common cancers diagnosed in older adults worldwide.The standard of care in resected stage II and stage III colon cancer continues to evolve.While there is unequivocal evidence to suggest both disease free and overall survival benefits with the use of combination chemotherapy in patients with stage III colon cancer,data regarding its use in patients with stage II colon cancer are less clear.Further,although colon cancer is a disease that affects older adults,there is considerable debate on the value of adjuvant chemotherapy in the aging population.In particular,many older patients are undertreated when compared to their younger counterparts.In this review,we will describe the clinical trials that contributed to the current adjuvant chemotherapy approach in colon cancer,discuss representation of older adults in trials and the specific challenges associated with the management of this subpopulation,and highlight the role of comprehensive geriatric assessments.We will also review how real-world evidence complements the data gaps from clinical trials of early stage colon cancer.
基金Supported by Seoul National University College of Medicine Research Fund(2017).
文摘BACKGROUND The adjuvant treatment for patients with resected pancreatic cancer(PC)is not yet standardized.Because the prognosis differs according to the American Joint Committee on Cancer(AJCC)stage,a tailored approach to establish more aggressive treatment plans in high-risk patients is necessary.However,studies comparing the efficacy of adjuvant treatment modalities according to the AJCC stage are largely lacking.AIM To compare the efficacy of chemotherapy and chemoradiation therapy according to AJCC 8th staging system in patients with PC who underwent surgical resection.METHODS A total of 335 patients who underwent surgical resection and adjuvant treatment for PC were included.Patients were divided into three groups:Chemoradiation therapy(CRT)group,systemic chemotherapy(SCT)group and combined treatment of chemoradiation plus chemotherapy therapy(CRT-SCT)group.The primary outcomes were differences in overall survival(OS)between the three groups.The secondary outcomes were differences in recurrence-free survival,recurrence pattern and adverse events between the three groups.RESULTS Patients received CRT(n=65),SCT(n=62)and CRT-SCT(n=208).Overall median OS was 33.3 mo(95%confidence interval(CI):27.4-38.6).In patients with stage I/II,the median OS was 27.0 mo(95%CI:2.06-89.6)in the CRT group,35.8 mo(95%CI:26.9-NA)in the SCT group and 38.6 mo(95%CI:33.3-55.7)in the CRT SCT group.Among them,there was no significant difference in OS between the three groups.In 59 patients with stage III,median OS in the SCT group[19.0 mo(95%CI:12.6-NA)]and the CRT-SCT group[23.4 mo(95%CI:22.0-44.4)]was significantly longer than that in the CRT group[17.7 mo(95%CI:6.8-NA);P=0.011 and P<0.001,respectively].There were no significant differences in incidence of locoregional and distant recurrences between the three groups(P=0.158 and P=0.205,respectively).Incidences of grade 3 or higher hematologic adverse events were higher in the SCT and CRT-SCT groups than in the CRT group.CONCLUSION SCT and CRT-SCT showed significantly longer OS and recurrence-free survival than CRT in patients with AJCC stage III,while there was no significant difference in OS between the CRT,SCT and CRT-SCT groups in patients with AJCC stage I/II.Different adjuvant therapy according to AJCC stage can be applied in patients with PC.
基金the National Natural Science Foundation of China,No.82072734.
文摘BACKGROUND At present,there is insufficient medical evidence to determine whether adjuvant chemotherapy is necessary for T2N0M0 gastric cancer.AIM To obtain a risk score to assess the need for adjuvant chemotherapy in patients with T2N0M0 gastric cancer.METHODS We identified 325 patients with pathological T2N0M0 stage primary gastric cancer at the National Cancer Center between 2011 and 2018.Univariate and multivariate Cox regression analyses were performed to predict factors affecting prognosis.Vascular invasion,tumor site,and body mass index were assessed,and a scoring system was established.We compared the survival outcomes and benefits of adjuvant chemotherapy between the different subgroups.RESULTS Five-year survival rates of the score 0,1,2,and 3 groups were 92%,95%,80%,and 50%,respectively(P<0.001).In the score 2-3 group,five-year survival rates for patients in the adjuvant chemotherapy group and postoperative observation group were 95%and 61%,respectively(P=0.021).CONCLUSION For patients with T2N0M0 stage gastric cancer and two or more risk factors,adjuvant chemotherapy after D2 gastrectomy may have a survival benefit.
基金This study was supported by grants from the National Key Technology R&D Program of China(No.2019YFC1005200,No.2019YFC1005202 and2018YFC1002103)。
文摘Objective:To determine whether adjuvant chemotherapy improves the prognoses in women with stage IC1 epithelial ovarian cancer(EOC).Methods:All eligible women diagnosed with stage IC1 EOC from 2003 to 2019 in Tongji Hospital were included.Patient characteristics,tumor features,surgical types,and chemotherapeutic treatments were collected.Kaplan-Meier analysis and Cox regression analysis were performed to evaluate progression-free survival(PFS)and overall survival(OS).
基金This work was financed by the Medical Engineering Cross Research Fund of Shanghai Jiao Tong University(Grant No.YG2021QN14)the Multicenter Clinical Trial of Shanghai Jiao Tong University of Medicine(Grant No.DLY201602).
文摘Objective:To quantify the potential benefit of adjuvant chemotherapy(ACT)with respect to survival,and to identify factors for predicting prognoses in early gastric cancer patients.Methods:Patients with pT1 gastric cancer(GC)who underwent radical resection with D2 lymphadenectomy were retrospectively analyzed.Based on lymph node metastasis(LNM)status and treatment regimens,patients were classified into groups,and clinicopathological variables,overall survival(OS),and disease-specific survival(DSS)were compared.Results:Of 1,050 enrolled patients,151 patients(14.4%)had a positive LNM status.Submucosal invasion,undifferentiated state,tumor size>2 cm,ulceration,and lymphovascular invasion were independent risk factors for LNM using multivariate analyses.The 5-year OS of all patients was 96.4%.HER2 positive,perineural invasion,and LNM were independent factors for worse survival.Patients with pT1N3 GC had a worse 5-year OS and DSS than pT1N0,pT1N1,and pT1N2 patients(P<0.001).The 5-year OS and DSS for pT1N1 patients showed no significant difference between ACT and surgery only patients.For pT1N2 patients,the 5-year OS and DSS showed no significant difference between S-1 and Xelox treatments.For pT1N3 patients,7(36.8%)received S-1,while 12(63.2%)received Xelox treatment.Patients receiving Xelox treatment showed a better 5-year OS(75.0%vs.14.3%)and DSS(81.8%vs.20.0%)than patients receiving S-1(P<0.05).Conclusions:Curative surgery only was adequate for patients with pT1N0 and pT1N1.Xelox showed no survival benefits for pT1N2 patients.Therefore,S-1 is the optimal choice for pT1N2 patients,when considering adverse effects.Xelox is recommended for pT1N3 patients.
文摘BACKGROUND Adjuvant chemotherapy(ACTx)is recommended in rectal cancer patients after preoperative chemoradiotherapy(PCRT),but its efficacy in patients in the early post-surgical stage who have a favorable prognosis is controversial.AIM To evaluate the long-term survival benefit of ACTx in patients with ypT0–1 rectal cancer after PCRT and surgical resection.METHODS We identified rectal cancer patients who underwent PCRT followed by surgical resection at the Asan Medical Center from 2005 to 2014.Patients with ypT0–1 disease and those who received ACTx were included.The 5-year overall survival(OS)and 5-year recurrence-free survival(RFS)were analyzed according to the status of the ACTx.RESULTS Of 520 included patients,413 received ACTx(ACTx group)and 107 did not(no ACTx group).No significant difference was observed in 5-year RFS(ACTx group,87.9%vs no ACTx group,91.4%,P=0.457)and 5-year OS(ACTx group,90.5%vs no ACTx group,86.2%,P=0.304)between the groups.cT stage was associated with RFS and OS in multivariate analysis[hazard ratio(HR):2.57,95%confidence interval(CI):1.07–6.16,P=0.04 and HR:2.27,95%CI:1.09–4.74,P=0.03,respectively].Furthermore,ypN stage was associated with RFS and OS(HR:4.74,95%CI:2.39–9.42,P<0.00 and HR:4.33,95%CI:2.20–8.53,P<0.00,respectively),but only in the radical resection group.CONCLUSION Oncological outcomes of patients with ypT0–1 rectal cancer who received ACTx after PCRT showed no improvement,regardless of the radicality of resection.Further trials are needed to evaluate the efficacy of ACTx in these group of patients.
基金from Hunan Cancer Hospital Climb Plan[2020NSFC-A004]and Changsha Municipal Natural Science Foundation[Kq2208151]The funders had no role in study design,data collection and analysis,preparation of the manuscript,or decision to publish.
文摘Background:The efficacy of adjuvant chemotherapy(AC)on survival outcomes of patients with stage I gastric cancer(GC)after curative resection remains controversial.We aimed to determine whether these patients would benefit from AC.Methods:This retrospective study included patients with pathologically confirmed stage I GC who underwent curative resection between November 2010 and December 2020.Patients were divided into AC and non-AC groups,then a 1:1 propensity score matching(PSM)analysis was performed to minimize the selection bias.Potential risk factors including age,pN stage,pT stage,lymphovascular invasion,perineural invasion,tumor size,histological type,and carcinoembryonic antigen level were used as matching covariates.The recurrence-free survival(RFS)and disease-specific survival(DSS)were compared between groups using the Kaplan–Meier method.Results:A total of 902 consecutive patients were enrolled and 174(19.3%)patients were treated with AC.PSM created 123 pairs of patients.Before PSM,patients receiving AC had lower 10-year RFS rates(90%vs 94.6%,P=0.035)than those who did not receive AC;the two groups had similar 10-year DSS rates(93.8%vs 95.0%,P=0.240).After PSM,there were no statistical differences in the 10-year RFS(90.9%vs 93.0%,P=0.507)or DSS rates(93.5%vs 93.6%,P=0.811)between the two groups.Similar results were found in the stage IA and IB subgroups.Moreover,these findings were not affected by AC cycles.Conclusions:The addition of AC could not provide survival benefits for patients with stage I GC after surgery and follow-up is thus recommended.However,large-scale randomized clinical trials are required.
基金Supported by the National Natural Science Foundation of China (No.82171099,No.82000940,No.81970835,No.81800867)the Natural Science Foundation of Shanghai (No.20ZR1409500)。
文摘AIM:To illustrate clinicopathological features of orbital non-rhabdomyosarcoma soft tissue sarcoma(NRSTS),and to compare the treatment outcome between postoperative radiotherapy(RT) and chemotherapy in a retrospective analysis nearly 20y.METHODS:A retrospective cohort study of 56 patients with orbital NRSTS were reviewed,34 of whom received postoperative RT,and 22 received postoperative chemotherapy.The clinicopathological features,local recurrence,metastases,and survival data were recorded.Survival analysis was performed using the Kaplan-Meier method.RESULTS:During follow-up(111.8mo,ranged 8-233mo) for 56 patients,19 patients of them developed local recurrence,and 7 patients developed distant metastases.Fifteen patients died during follow-up period.Overall survival rates considering the whole study group was 78.57% at 5y,and 72.16% at 10y after the initial diagnosis.Compared with chemotherapy,RT was associated with lower risk of local recurrence [hazard ratio for RT vs chemotherapy,0.263,95% confidence interval(CI),0.095-0.728,P=0.0015];with lower risk of distant metastasis(hazard ratio for RT vs chemotherapy,0.073,95%CI,0.015-0.364,P=0.0014);and with lower risk of death from disease(hazard ratio for RT vs chemotherapy,0.066,95%CI,0.022-0.200,P<0.0001).The 5-year survival rate in RT group was 97.06% compared to 50% in chemotherapy group.CONCLUSION:In patients with orbital NRSTS,postoperative RT provides better control of local recurrence,distant metastasis,and death from disease than chemotherapy.RT is the more preferrable adjuvant therapy compared to chemotherapy possibly.
文摘Background:Intrahepatic cholangiocarcinoma(ICC)is rare with limited evidence-based guidelines.This retrospective study evaluates the use of chemotherapy in patients with resected ICC.Methods:The Surveillance Epidemiology and End Results(SEER)program database was used to identify patients with resected ICC.Patients were stratified by date of diagnosis(2000-2004,2005-2009,2010-2014),T,and N stage.Multivariable logistic regression models identified predictors of chemotherapy use.Kaplan-Meier and Cox proportional hazard models were used to identify survival trends.Results:One thousand and two hundred twenty-three patients met inclusion criteria.Chemotherapy utilization increased over time(33%to 41%,P≤0.05).Chemotherapy use increased in lymph node(LN)positive patients[32%to 60%in 2010-2014;(P≤0.05)and T3/T4 disease(40%to 60%in 2010-2014;P≤0.01)],but not in patients with LN negative or T1/T2 disease.LN positivity was associated with utilization of chemotherapy in 2005-2009 and 2010-2014.Overall survival increased from 32 to 41 months(P≤0.05).In LN positive patients,chemotherapy was associated with a decreased hazard ratio of death(P≤0.05)and T3/T4 disease was associated with an increased hazard ratio of death(P≤0.05).Conclusions:Adjuvant chemotherapy use in ICC has increased.More LN positive or patients with T3/T4 tumors are receiving chemotherapy,which may explain the improvement in overall survival.
基金funded by the National Natural Science Foundation of China(No.81772595)Sun Yat-sen University Clinical Research 5010 Program(2015024)+1 种基金Sun Yat-sen University Clinical Research 5010 Program(2013013)Science and Technology Planning Project of Guangdong Province(Grant No.2013B021800146).
文摘Background:Although colorectal oligometastases to the liver can potentially be cured with aggressive local abla-tion,the efficacy of adjuvant chemotherapy(ACT)for such metastasis remains unclear.The present study explored the effects of ACT on patients with colorectal liver oligometastases(CLO)after curative resections and aimed to iden-tify patients who could benefit from ACT.Methods:We retrospectively analyzed 264 eligible patients with CLO who underwent curative resection between September 1999 and June 2015.Recurrence-free survival(RFS)and overall survival(OS)were analyzed using the Kaplan-Meier method and log-rank test;prognostic factors were a by Cox regression modeling.Results:Among 264 patients,200(75.8%)patients received ACT and 64(24.2%)did not receive ACT.These two groups did not significantly differ in clinicopathologic characteristics,and had comparable 3-year OS and RFS rates(RFS:42.1%vs.45.7%,P=0.588;OS:69.7%vs.62.7%,P=0.446)over a median follow-up duration of 35.5 months,irrespective of preoperative chemotherapy.ACT markedly improved 3-year OS in high-risk patients with Memorial Sloan-Kettering Cancer Center clinical risk scores(MSKCC-CRS)of 3-5(68.2%vs.33.8%,P=0.015),but presented no additional benefit in patients with MSKCC-CRS of 0-2(72.2%vs.78.6%,P=0.834).In multivariate analysis,ACT was independently associated with improved OS in patients with MSKCC-CRS of 3-5.Conclusions:ACT might offer a prognostic benefit in high-risk patients with CLOs after curative liver resection,but not in low-risk patients.Therefore,patients’risk status should be determined before ACT administration to optimize postoperative therapeutic strategies.
基金This work was supported in part by a Grant-in-Aid for the High-Technology Research Center Project from the Ministry of Education,Culture,Sports,Science and Technology of Japan.
文摘Aim:Triple negative breast cancer(TNBC)is known as aggressive subtype and have no identified targeted therapies.We examined the relationship of neoadjuvant chemotherapy response to genetic variations of TNBC.Methods:The tumors used in this study were collected from Showa University Hospital,Japan.Thirteen formalin-fixed paraffin-embedded tumors from Japanese TNBC patients who underwent neoadjuvant chemotherapy were used for analysis.Of these,eight surgically resected tumors showed progressive disease and/or recurrence after treatment(PD/REC),and biopsy tissues from five patients showing pathological complete response(pCR)were analyzed.DNA extracted from tissue sample were analyzed.The Miseq system and Trusight Tumor Sequence panel kit were used to sequence 174 amplicons over 82 exons of 26 cancer-related genes to identify genetic mutations.Results:Seven somatic non-synonymous variants were detected in three genes(FOXL2,PIK3CA,and TP53)in all five pCR patients,and six somatic non-synonymous variants in two genes(PTEN and TP53)were detected in six of eight PD/REC patients.Eight of 13 TNBC tumors were found to have TP53 pathogenic variants,in both pCR and PD/REC cases.Conclusion:Although TP53 variation was detected in both pCR and PD/REC cases,each location and type of the variant were different.We could not identify genetic mutations associated with chemotherapy response and recurrence.
