简介：AbstractThe management of pancreatic cancer has dramatically changed since the first major randomized trial published in 2001 by the European Study Group for Pancreatic Cancer (ESPAC) stimulated the development of multimodality oncosurgical therapies. ESPAC-1 demonstrated a survival improvement from upfront surgery of only 8%, increasing to 21% 5-year survival for 5-fluorouracil/folinic acid but only 10.8% for chemoradiotherapy. ESPAC-4 has shown a 5-year survival rate of 30% for all patients without restriction of 30% using a combination of gemcitabine and capecitabine, rising to 40% in those with an R0 resection margin, or nearly 50% in those with N0 lymph node status. In selected patients with favorable prognostic features mFOLFIRINOX can produce a 50% 5-year survival rate but with added toxicity. While a positive resection margin is associated with an increased likelihood of local recurrence, this of itself is not the contributor to reduced survival, but rather reflects the increased probability of systemic disease. Thus, strategies aimed at local control, may reduce subsequent local progression, but will not improve overall survival. Neoadjuvant chemotherapy is increasingly utilized in cases of borderline resectable or locally advanced pancreatic cancer, but there is still a lack of proof of concept studies. High-quality evidence from randomized controlled trials to identify the indications and benefits of neoadjuvant therapy in pancreatic cancer are required. The use of patient-derived tumor organoids may predict response to chemotherapy which could open a new opportunity in pancreatic cancer treatment, stratifying patients into treatment groups based on their response to these therapies in the laboratory.

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简介：AbstractPancreatic ductal adenocarcinoma (PDAC) is an aggressive cancer with poor survival. Local control through surgical resection paired with radiotherapy and chemotherapy comprise the primary tenets of treatment. Debate exists regarding the timing of treatment and ordering of systemic therapy and resection in the management of early stage disease. The goal of this study was to review the literature and describe the contemporary evidence basis for the role of neoadjuvant therapy (NAT) in the setting of upfront resectable (UP-R) PDAC. Five databases were searched in parallel to identify relevant original articles investigating neoadjuvant therapy where at least 1 study arm contained UP-R PDAC; studies with only borderline resectable or locally advanced disease were excluded. Due to the diversity in NAT regimens and study design between trials, qualitative analyses were performed to investigate patient selection, impact on perioperative and survival outcomes, safety, and cost effectiveness. Thirty-five studies met inclusion criteria, of which 24 unique trials are discussed here in detail. These studies included those trials using single agents as well as more recent trials comparing modern multiagent therapies, and several large database analyses. Overall the data suggest that NAT is safe, may confer survival benefit for appropriately selected patients, is cost effective, and is an appropriate approach for UP-R PDAC. Nevertheless, the risk for disease progression during upfront medical therapy, requires appropriate patient identification and close monitoring, and emphasizes the need for further discovery of more effective chemotherapeutics, useful biomarkers or molecular profiles, and additional prospective comparative studies.

简介：比较在主要debulking外科(PDS)和neoadjuvant化疗之间的幸存和perioperative病态的目的在与先进上皮的卵巢的癌症(EOC)对待病人由间隔debulking外科(NAC/IDS)列在后面。我们回顾地与阶段IIIC或IVEOC考察了67个病人的方法从2006年1月在北京大学癌症医院对待到2009年6月。在那里，37和30个病人分别地经历了PDS和NAC/标志。结果在全面幸存(OS)或没有前进的幸存(PFS)的差别都没在NAC/IDS组和PDS组之间被观察(OS：41.2对39.1个月，P=0.23；PFS：27.1对24.3个月，P=0.37)。最佳的debulking率在NAC/IDS组是60%，它在PDS组(32.4%)(P=0.024)比那显著地高。NAC/IDS组显著地有比PDS的肠的功能的估计的血损失和输送，更低的nasogastricintubation率，和更早的移动和恢复组织的更少的intraoperative(P<0.05)。结论NAC/IDS不比PDS侵略，并且关于最佳的cytoreduction率，intraoperative血损失，和手术后的恢复提供优点，没有显著地损害与在对待有阶段IIIC或IVEOC的病人的PDS相比的幸存。因此，NAC/IDS可以是为EOC病人的一种珍贵治疗选择。

简介：Objective:Theaimofthisprospective,single-armphaseIItrialwastoconfirmthesafetyandefficacyofneoadjuvantchemotherapy(NAC)usingoxaliplatinpluscapecitabine(CapOX)forpatientswithoperablelocallyadvancedcoloncancer(CC).Methods:Patientswithcomputedtomography-definedT4orlymphnode-positiveCCswereenrolled.Afterradiologicalstaging,patientsweretreatedwithatleast2cyclesofNACconsistingof130mg/m2oxaliplatinond1,plus1,000mg/m2capecitabinetwicedailyfor14devery3weeks,followedbysurgery,andthenwiththerestcyclesofadjuvantchemotherapy.Radiologicalresponsewasevaluatedafter2cyclesofNAC.Tumorresponse,treatmenttoxicity,andsurgicalcomplicationswererecorded.Thepathologicalresponsetotherapywasevaluatedaccordingtothetumorregressiongrade(TRG)score.Theprimaryendpointwaspathologictumorresponse.ThistrialisregisteredinClinicalTrials.gov(No:NCT02415829).Results:Forty-sevenpatientswereenrolledinthestudy.Forty-twopatientscompletedtheplannedtreatments.Thetotalradiologicalresponseratewas68%(32/47),includingcompleteandpartialresponseratesof2%(1/47)and66%(31/47),respectively.Stablediseasewasobservedin32%(15/47)andprogressivediseasewasobservedinnone.Completepathologicresponse,majorregression,andatleastmoderateregressionwereachievedin1(2%),2(4%),and29(62%)patients,respectively.Fourpatientsdevelopedgrade3treatmenttoxicities.Onepatientwithwoundinfectionoccurredafteroperation(1/47,2%).Therewasnotreatment-relateddeath.Conclusions:OurresultssuggestthatNACwithCapOXisaneffectiveandsafetreatmentoptionforpatientswithlocallyadvancedCCs.

简介：AbstractBackground:The neoadjuvant chemotherapy is increasingly used in advanced gastric cancer, but the effects on safety and survival are still controversial. The objective of this meta-analysis was to compare the overall survival and short-term surgical outcomes between neoadjuvant chemotherapy followed by surgery (NACS) and surgery alone (SA) for locally advanced gastric cancer.Methods:Databases (PubMed, Embase, Web of Science, Cochrane Library, and Google Scholar) were explored for relative studies from January 2000 to January 2021. The quality of randomized controlled trials and cohort studies was evaluated using the modified Jadad scoring system and the Newcastle-Ottawa scale, respectively. The Review Manager software (version 5.3) was used to perform this meta-analysis. The overall survival was evaluated as the primary outcome, while perioperative indicators and post-operative complications were evaluated as the secondary outcomes.Results:Twenty studies, including 1420 NACS cases and 1942 SA cases, were enrolled. The results showed that there were no significant differences in overall survival (P = 0.240), harvested lymph nodes (P = 0.200), total complications (P = 0.080), and 30-day post-operative mortality (P = 0.490) between the NACS and SA groups. However, the NACS group was associated with a longer operation time (P < 0.0001), a higher R0 resection rate (P = 0.003), less reoperation (P = 0.030), and less anastomotic leakage (P = 0.007) compared with SA group.Conclusions:Compared with SA, NACS was considered safe and feasible for improved R0 resection rate as well as decreased reoperation and anastomotic leakage. While unbenefited overall survival indicated a less important effect of NACS on long-term oncological outcomes.

简介：AbstractBackground:Pathological complete response (pCR) of axillary lymph nodes (ALNs) is frequently achieved in patients with clinically node-positive breast cancer after neoadjuvant chemotherapy (NAC), and ALN status is an important prognostic factor for breast cancer patients. This study aims to develop a new predictive clinical model to assess the ALN pCR rate after NAC.Methods:This was a retrospective series of 467 patients who had biopsy-proven positive ALNs at diagnosis and underwent ALN dissection from 2007 to 2014 at the National Cancer Center/Cancer Hospital of the Chinese Academy of Medical Sciences. We analyzed the clinicopathologic features of the patients and developed a nomogram to predict the probability of ALN pCR. A multivariable logistic regression stepwise model was used to construct a nomogram to predict ALN pCR in node-positive patients. The adjusted area under the receiver operating characteristic curve (AUC) was calculated to quantify the ability to rank patients by risk. Internal validation was performed using the 50/50 hold-out validation method. The nomogram was externally validated with prospective cohorts of 167 patients from 2016 to 2018 at the Cancer Hospital of the Chinese Academy of Medical Sciences and 114 patients from 2018 to 2020 at Beijing Tiantan Hospital.Results:In this retrospective study, 115 (24.6%) patients achieved ALN pCR after NAC. Multivariate analysis showed that clinical tumor stage (Odds ratio [OR]: 0.321, 95% confidence interval [CI]: 0.121-0.856; P = 0.023); primary tumor response (OR: 0.189; 95% CI: 0.123-0.292; P < 0.001), and estrogen receptor status (OR: 0.530, 95% CI: 0.304-0.925; P = 0.025) were independent predictors of ALN pCR. The nomogram was constructed based on the result of multivariate analysis. In the internal validation of performance of nomogram, the AUCs for the training and test sets were 0.719 and 0.753, respectively. The nomogram was validated in external cohorts with AUCs of 0.720, which demonstrated good discriminatory power in these data sets.Conclusion:We developed a nomogram to predict the likelihood of axillary pCR in node-positive breast cancer patients after NAC. The predictive model performed well in multicenter prospective external validation. This practical tool could provide information to surgeons regarding whether to perform additional ALN dissection after NAC.Trial registration:ChiCTR.org.cn, ChiCTR1800014968.

简介：AbstractBackground:After neoadjuvant chemotherapy (NAC), non-pathological complete response of breast cancer patients can benefit from tailored adjuvant chemotherapy. However, it is difficult to select patients with poorer prognosis for additional adjuvant chemotherapy to maximize the benefits. Our study aimed to explore whether the subtypes of tumor-infiltrating lymphocytes (TILs) in residual tumors (RT) is related to the prognosis of triple-negative breast cancer (TNBC) after NAC.Methods:Data from patients with primary TNBC consecutively diagnosed at the Breast Disease Center of Peking University First Hospital from 2008 to 2014 were retrieved, and the cases with RT in the breast after NAC were enrolled. TILs subtypes in RT were observed by double-staining immunohistochemistry, and counted with the median TILs value per square millimeter as the cut-off to define high versus low TILs density in each subtype. The relationships between the TIL density of each subgroup and the clinicopathological characteristics of the RT after NAC patients were analyzed by Fisher exact test. Disease-free survival (DFS) and overall survival (OS) were analyzed by the Kaplan-Meier method and log-rank statistics.Results:A total of 37 eligible patients were included in this study, and the median follow-up period was 50 months (range 17–106 months). There was no significant correlation between the infiltrate density of CD4+, CD8+, CD20+, and CD68+ lymphocytes and clinic-pathological characteristics. Significantly better prognosis was observed in patients with high CD4+-TILs (DFS: P = 0.005, OS: P = 0.021) and high CD8+-TILs (DFS: P = 0.018) and low CD20+-TILs (OS: P = 0.042). Further analysis showed that patients with CD4+/CD20+ ratio greater than 1 (DFS: P = 0.001, OS: P = 0.002) or CD8+/CD20+ ratio greater than 1 (DFS: P = 0.009, OS: P = 0.022) had a better prognosis.Conclusions:Subtypes of TILs in RT is a potential predictive biomarker of survival in TNBC patients after NAC.

简介：客观：为了探索病理和临床的反应率的变化，为非小的房间肺癌症与MVP政体由neoadjuvant化疗对待。方法：这是在有阶段I-IIIa的病人的使随机化的研究。在他们之中，46个病人在neoadjuvant注册了1鈥对待的化疗吗？功课MVP政体。MMC被给6mg/M2由静脉内(I.V)day1上的注入，VDS2.5鈥吗？day1,8或day15上的mg/M2I.V，day1上的DDP90mg/M2I.V。治疗每28天被再循环。评估与的临床的RR标准。所有外科的样品与病理被分类。结果：在2功课化疗的全面反应率在1堂功课比那好(P<0.01)。有病理等级的病人的数字我在2功课化疗的鈥揑I比那高嗨1堂功课(P<0.01)。但是RR不能完全翻译了成病理等级我鈥揑I。病理等级我鈥揑I仔细与肿瘤参与(T)被联系(P<0.01)然而并非与地区性的淋巴节点转移(N)密切相关。和PCR使用RR判定化疗反应是合理的。NR病人不能作为化疗失败是问候。不服务毒性和外科的死亡被观察。结论：MVP政体是为I-IIIaNSCLC的有效neoadjuvant治疗政体。

简介：AlkylatingagentsarechemicallyreactivedrugsthatreactwithDNAtoformcovalentbonds,causingsingle-strandordouble-strandDNAbreaksthatleadtointerstrandandintrastrandDNAcross-linking.Theseagentsareusedextensivelyincancerchemotherapy.Theyhaveasteepdose-responsecurveandarethereforeusefulindoseintensificationstrategies(e,g.inbonemarrowtransplantation).Thesubclassesofalkylatingagentsareasfollows.

简介：Mostcytotoxicchemotherapydrugsexerttheireffectbyinhibitingoneormoreoftheprocessesinvolvedincelldivision.Itappearsthatthefateofcellsdamagedbychemotherapyistodieprimarilybyinductionofapoptosis(prograrmnedcelldeath).Chemotherapyisgenerallyusedtotreatcanceratanadvancedorearlystage.

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简介：Epithelialovariancancerisprimarilyadiseaseofolderwomen.Advancedageisriskfactorfordecreasedsurvival.Optimalsurgeryandthesafeandeffectiveadministrationofchemotherapyareessentialforprolongedprogression-freeandoverallsurvival(OS).Inthisarticle,theavailableregimensinboththeprimarytreatmentandrelapsedsettingarereviewed.

简介：Objective:Theexpressionoftumorbiomarkersmaychangeafterchemotherapy.However,whethersecretedproteinacidicandrichincysteine(SPARC)expressionchangesafterchemotherapyingastriccancer(GC)isunclear.ThisstudyinvestigatedtheinfluenceofchemotherapyonSPARCexpressioninGC.Methods:ImmunohistochemistrywasusedtoanalyzeSPARCexpressionin132GCcases(including54caseswithpreoperativechemotherapyand78caseswithoutpreoperativechemotherapy).SPARCexpressionofpostoperativespecimenswithandwithoutpreoperativechemotherapywasassessedtoanalyzetheinfluenceofchemotherapyonSPARCexpression.Results:SPARCwashighlyexpressedinGCcomparedwiththedesmoplasticstromasurroundingtumorcellsandnoncanceroustissues.HighSPARCexpressionwascorrelatedwithinvasiondepth,lymphnode,andTNMstage.Afterchemotherapy,alowerproportionofhighSPARCexpressionwasobservedinpatientswithpreoperativechemotherapythaninthecontrols.For54patientswithpreoperativechemotherapy,grosstype,histology,depthofinvasion,lymphnode,TNMstage,andSPARCexpressionwererelatedtooverallsurvival.Furthermultivariateanalysisshowedthatlymphnode,histology,andSPARCexpressionafterchemotherapywereindependentprognosticfactors.Conclusion:SPARCexpressionmaychangeafterchemotherapyinGC.SPARCexpressionshouldbereassessedforpatientswithGCafterchemotherapy.

简介：客观化疗是治疗乳癌的一个有效工具，并且癌症特定的replicative侵入人体气管粘膜的病菌也是最近的年里的一个有希望的反肿瘤代理人。我们表明那个CNHK300罐头的调查目的调停选择的反肿瘤功效并且在HER-2过去表示的乳癌上与化疗生产协同的细胞毒性。我们由把E1A基因放在人的hTERT倡导者的控制下面设计了telomerase依赖的replicative侵入人体气管粘膜的病菌CNHK300的方法。由E1A表示的分析，我们在telomerase积极的乳癌房间然而并非在正常成纤维细胞房间在侵入人体气管粘膜的病菌染色体和E1A的选择表示证明了hTERT倡导者的忠实。由增长测试，我们进一步在正常成纤维细胞房间与显然稀释的增长在乳癌房间显示出CNHK300的有效复制。最后，我们由那个CNHK300病毒引起了有势力细胞溶解并且在正常细胞上与稀释细胞毒性在乳癌房间与化疗生产了协同的细胞毒性的MTT方法示威了。在这个病毒的结果，E1A基因成功地被放在人的hTERT倡导者的控制下面。象野类型的侵入人体气管粘膜的病菌一样高效地复制并且引起了集中的房间在HER-2过去表示的乳癌房间在试管内杀死的CNHK300病毒。相反，telomerase否定的正常成纤维细胞房间，没表示hTERT活动，不能支持CNHK300复制。有paclitaxel的CNHK300的联合治疗在癌症房间上改进了细胞毒性。我们结束那CNHK300的结论能生产选择的反肿瘤功效并且在表示乳癌上在HER-2上提高化疗的在试管内反应。

简介：AbstractGastric cancer, which has a high incidence and poor prognosis, remains a therapeutic challenge. Recently, neoadjuvant therapy has attracted increasing attention due to high recurrence rate and low survival rate after resection in most patients with advanced stage. Clinical trials show that neoadjuvant approaches confer a significant survival advantage for resectable locally advanced gastric cancer. The specific advantages of chemoradiotherapy compared with chemotherapy have not been clarified; optimal regimens and cycles, particularly in the preoperative setting, should be studied further; and trials aimed at determining the role of targeted and immunological therapies should be conducted.

简介：目的：研究以黄芪注射液穴位注射配合艾灸疗法对化疗后白细胞减少症患者白细胞数量及细胞免疫的影响。方法：将恶性肿瘤化疗后白细胞减少症患者86例，随机分为黄芪注射液穴位注射配合艾条温和灸治疗组（治疗组）、西药口服组（对照组），分别进行对照治疗，以治疗前后临床症状、外周血白细胞数量、T淋巴细胞亚群CD3^＋、CD4^＋、CD8^＋含量的变化为指标进行实验观察。结果：黄芪注射液穴位注射配合艾条温和灸较升白药口服有明显提高外周血白细胞数的作用；前者能提高肿瘤患者外周血T细胞亚群CD3^＋、CD4^＋含量、使CD4^＋／CD8^＋比值升高，两组比较有显著性差异（P〈0．01）；并且能明显改善全身虚损症状。结论：黄芪注射液穴位注射配合艾条温和灸能有效升高白细胞，改善恶性肿瘤患者的全身症状。

简介：Incomparisonwiththenormalpeoplegroup,valuesofbloodCD2+andCD4+inpa-tientswithmallgnanttumorstreatedwithradiotherapyandchemotherapyweresignificantlylowerandtheratioofCD助+andCD8+decreasedobviously（allP<0.001）;CD8+hadnoapparentchange（P>0.05）.Followingacupuncturaltreatment,valuesofCD2+,CD4+andtheratioofCD4+toCD8+increasedobviously（allP<0.001）;whilethoseofthemedicinalcontrolgrouphadnosignificantchangeaftertreatment（P>0.05）.ValuesofIgG,IgAandIgMinpatients’serumpresentedanabnormalde-creasingorincreasingtendency,andC3inminorityofpatientswereraised.ResultsindicatedthattherewasabiphasicregulatoryeffectofacupunctureonthedisturbanceofhumoralimmunityandcouldcorrectthedeviationofC3level;anditseffectwasbetterthanorsimilartothatofthemedicinecontrolgroup.Itdemonstratesthatacupuncturecanenhanceandregulate.theimmunefunctionofpa-tientstreatedwithradiotherapya

简介：AIM:Toinvestigatetheefficacyofneoadjuvantchemoradiotherapy(NACRT)forresectabilityoflocallyadvancedgastriccancer(LAGC).METHODS:BetweenNovember2007andJanuary2014,29patientswithLAGC(clinicallyT3withdistalesophagusinvasion/T4orbulkyregionalnodemetastasis)thatweretreatedwithNACRTfollowedbyD2gastrectomywereincludedinthisstudy.ResectabilitywasevaluatedwithradiologicandendoscopicexamsbeforeandafterNACRT.Usingthreedimensionalconformalradiotherapy,patientsreceived45Gy,withadailydoseof1.8Gy.Theentiretumorextentandtheregionalmetastaticlymphnodeswereincludedinthegrosstumorvolume.PatientspresentingwitharesectabletumorafterNACRTreceivedatotalorsubtotalgastrectomywithD2dissection.ThepathologictumorresponsewasevaluatedusingJapaneseGastricCancerAssociationhistologicevaluationcriteria.PostoperativemorbiditywasevaluatedusingtheNationalCancerInstitute-CommonTerminologyCriteriaforAdverseEventsversion4.0.Overallsurvival(OS)andprogression-freesurvival(PFS)rateswereestimatedusingaKaplan-Meieranalysisandcomparedusingthelog-ranktest.RESULTS:Allpatientswereassessedasunresectablecases.Twenty-fourpatients(24/29;82.8%)showedLAGConpositronemissiontomography-computedtomography(CT)andcontrast-enhancedCT,whereasfourpatients(4/29;13.8%)withvagueinvasionorabutmenttoanadjacentorganunderwentdiagnosticlaparoscopy.Onepatient(1/29;3.4%),initiallyassessedasaresectablecase,underwentan'openandclosure'afterthetumorwasfoundtobeunresectable.Abutmenttoanadjacentorgan(34.5%)wasthemostcommonreasonforNACRT.TheclinicalresponserateonemonthafterNACRTwas44.8%.AfterNACRT,69%(20/29)ofpatientshadaresectabletumor.Ofthe20patientswitharesectabletumor,18patients(62.1%)underwentaD2gastrectomy.TheR0resectionratewas94.4%andtwopatients(2/18;11.1%)showedacompleteresponse.Themedianfollow-updurationwas13.5mo.Theone-yearOSandPFS

简介：Objective:Survivalandtreatmentofpatientswithmicroinvasivebreastcancer(MIBC)remaincontroversial.Inthispaper,weevaluatedwhetheradjuvantchemotherapyisnecessaryforpatientswithMIBCtoidentifyriskfactorsinfluencingitsprognosisanddecidetheindicationforadjuvantchemotherapy.Methods:Inthisretrospectivestudy,108patientswithMIBCwererecruitedaccordingtoseventheditionofthestagingmanualoftheAmericanJointCommitteeonCancer(AJCC).Thesubjectsweredividedintochemotherapyandnon-chemotherapygroups.Wecomparedthe5-yeardisease-freesurvival(DFS)andoverallsurvival(OS)ratesbetweengroups.Furthermore,weanalyzedthefactorsrelatedtoprognosisforpatientswithMIBCusingunivariateandmultivariateanalyses.Wealsoevaluatedtheimpactofadjuvantchemotherapyontheprognosticfactorsbysubgroupanalysisaftermedianfollow-uptimeof33months(13-104months).Results:The5-yearDFSandOSratesforthechemotherapygroupwere93.7%and97.5%,whereasthoseforthenonchemotherapygroupwere89.7%and100%.Resultsindicatethat5-yearDFSwassuperior,butOSwasinferior,intheformergroupcomparedwiththelattergroup.However,nostatisticalsignificancewasobservedinthe5-yearDFS(P=0.223)orOS(P=0.530)rateofthetwogroups.Mostrelevantpoor-prognosticfactorswereKi-67overexpressionandnegativehormonalreceptors.Cumulativesurvivalwas98.2%vs.86.5%betweenlowKi-67(≤20%)andhighKi-67(>20%).ThehazardratioofpatientswithhighKi-67was16.585[95%confidenceinterval(CI),1.969-139.724;P=0.010].Meanwhile,ER(-)/PR(-)patientswithMIBChadcumulativesurvivalof79.3%comparedwith97.5%forER(+)orPR(+)patientswithMIBC.ThehazardratioforER(-)/PR(-)patientswithMIBCwas19.149(95%CI,3.702-99.057;P<0.001).SubgroupanalysisshowedthatchemotherapycouldimprovetheoutcomesofER(-)/PR(-)patients(P=0.014),butnotthosewhooverexpressKi-67(P=0.105).Conclusions:PatientswithMIBCwhooverexpressKi-67and