Objective To explore the clinical effect of neo-adjuvant/adjuvant chemotherapy combined with operation on colorectal cancer patients in the multi-disciplinary team (MDT). Methods The data were collected retrospectively from January to December in 2007. The patients were classified as non-adjuvant chemotherapy group and adjuvant chemotherapy group according to the treatment strategy. Non-adjuvant chemotherapy group had accepted only surgery followed by preoperative neo-adjuvant chemotherapy, and adjuvant chemotherapy group had taken postoperative adjuvant chemotherapy after preoperative neo-adjuvant chemotherapy and operation. The clinical effect of two groups were compared. Results Totally 789 patients were treated among 2007, and 195 patients who were firstly diagnosed as colorectal cancer were included, and there were 109 males and 86 females, 59 colonic cancers and 136 rectal cancers. Average age was 59.98 years old. All of the included patients were followed up for 5-17 months. Three cases missed, no recurrence and no death happened. The baseline between non-adjuvant chemotherapy and adjuvant chemotherapy group was nearly same. There were no differences between two groups about the internal medicine complications, the cancer related obstruction, preoperative transfusion or not (P＞0.05). Whether the patients were transfused or not during the procedure and Dukes stage were significantly different between two groups(P＜0.05), while the other surgical and pathological index didnt show any statistical significance (P＞0.05). After operation, more patients in non-adjuvant chemotherapy group had accepted transfusion (P＜0.05). However, the postoperative rehabilitative indexes during hospitalization were not different between two groups. And the differences about the postoperative complications and defecation were not significant (P＞0.05). The values of CEA and CA19-9 were greatly different between two groups in the 1st and 3rd month follow-up. Conclusion The strategy of neo-adjuvant chemotherapy/operation/adjuvant chemotherapy didnt affect the rehabilitation and increase the risk of complications, however, more researches were necessary to prove whether the clinical effect were improved or not.
ObjectiveTo assess the effect of adjuvant chemotherapy for patients with rectal cancer. MethodsThe related randomized controlled trials comparing patients underwent radical surgery for rectal cancer with (adjuvant chemotherapy group) or without (surgery alone group) adjuvant chemotherapy, were retrieved from the databases such as PubMed, Cochrane Library, EMBAS, CBM, CNKI, WanFang, and VIP, then using RevMan 5.2 software to conduct the Meta-analysis. ResultsA total of 8 articles involving 3 654 patients were included. The results of Meta-analysis showed that:①for all patients with rectal cancer, the 2-(OR=1.28, 95% CI: 1.05-1.57, P=0.020), 3-(OR=1.28, 95% CI: 1.09-1.51, P=0.003), and 5-year (OR=1.21. 95% CI: 1.05-1.40, P=0.008) survival rates of adjuvant chemotherapy group were higher than those of surgery alone group, respectively.②For patients with rectal cancer ofⅡstaging, compared with surgery alone group, the 5-year survival rate was higher in adjuvant chemotherapy group (OR=1.39, 95% CI: 1.09-1.78, P=0.009), but 5-year recurrence rate was lower in adjuvant chemotherapy group (OR=0.65, 95% CI: 0.49-0.87, P=0.003).③For patients with rectal cancer ofⅢstaging, compared with surgery alone group, the 5-year recurrence rate was lower in adjuvant chemotherapy group (OR=0.40, 95% CI: 0.26-0.64, P=0.000 1), but there was no significant difference on the 5-year survival rate (OR=1.27, 95% CI: 1.00-1.61, P=0.050). ConclusionCompared with radical surgery, radical surgery combined with postoperative adjuvant chemotherapy can improve the survival and reduce the recurrence for patients with rectal cancer.
ObjectiveTo investigate the guidance of preoperative nutritional risk screening in perioperative nutrition support for colon cancer, in order to provide evidence for the rationally clinical application of nutrition support. MethodsNutritional risk screening was carried out in 95 hospitalized patients with colon cancer who were treated in the Liao He Oil Center Hospital from Jul. 2012 to Jul. 2014, with the nutritional risk screening 2002 score summary table. Patients were divided into nutritional risk group and non-nutritional risk group according to the screening results, and postoperative bowel function recovery and nutritional indicators were compared between patients who received perioperative nutrition support according to the screening results and those who did not. ResultsThere were 29 patients received perioperative nutrition support among 53 patients at nutritional risk and 19 patients received perioperative nutrition support among 42 patients without nutritional risk. Among 53 patients at nutritional risk, the time to first flatus, time to first defecation, hospital stay, postoperative complications rate, and postoperative recurrence/metastasis rate of patients who received perioperative nutrition support were shorter or lower than those of patients who didn't receive perioperative nutrition support (P<0.05), but there was no significant difference in mortality (P≥0.05); in addition, the levels of albumin, prealbumin, and transferring on 7-day after surgery were all higher in patients received perioperative nutrition support (P<0.05). Among 42 patients without nutritional risk, there was no significant difference in time to first flatus, time to first defecation, hospital stay, postoperative complications rate, postoperative recurrence/metastasis rate, and levels of albumin, prealbumin, and transferring on 1- and 7-day after surgery between patients received perioperative nutrition support and those who did not (P>0.05). ConclusionsIt is important to evaluate the nutritional risk in hospitalized patients with colon cancer. Nutritional support is benefical to the patients with nutritional risk, but it isn't necessary to patients without nutritional risk.
ObjectiveTo investigate expression levels of thymidylate synthase (TS), excision repair cross-comple-menting gene 1 (ERCC1), β-tubulin 3 (TUBB3), ribonucleotide reductase subunit 1 (RRM1)in different pathological types of non-small cell lung cancer (NSCLC), and evaluate detection strategies of above genes for individualized chemotherapy of NSCLC. MethodsWe retrospectively analyzed clinical data of 94 NSCLC patients who underwent radical resection in Department of Thoracic Surgery of Beijing Friendship Hospital from February 2010 to October 2012. Messenger ribonu-cleic acid (mRNA)expression levels of TS, ERCC1, TUBB3 and RRM1 were examined by immunohistochemistry. ResultsThere were 91 patients (96.81%)with low mRNA expression of TS, 90 patients (95.74%)with low mRNA expression of ERCC1, 59 patients (62.77%)with low mRNA expression of TUBB3, and 48 patients (51.06%)with low mRNA expression of RRM1. There was no statistical difference in mRNA expression levels of TS, ERCC1, TUBB3 or RRM1 between adenocarcinoma and non-adenocarcinomas (P > 0.05). The percentage of low mRNA expression of TUBB3 in adenocarcinoma was significantly lower than that in non-adenocarcinomas (58.21% vs. 74.07%). Among patients with same pathological types of NSCLC, mRNA expression levels of TS, ERCC1 and TUBB3 were all positively correlated with mRNA expression of RRM1 (correlation coefficient all greater than 0.80). ConclusionFor individualized chemotherapy of NSCLC, when selecting gene detection, mRNA expression levels of ERCC1 and TS need not be detected and can be considered as low expression by experience, mRNA expression levels of TUBB3 in adenocarcinoma and RRM1 in all pathological types of NSCLC should be routinely examined. For non-adenocarcinoma patients, whether or not to examine mRNA expression level of TUBB3 can be decided in a comprehensive manner.
ObjectiveTo systematically review the influence of postoperative adjuvant chemotherapy for pancreatic cancer on survival. MethodsWe comprehensively searched databases including The Cochrane Library (Issue 11, 2013), PubMed, EMbase, CBM, CNKI, VIP and WanFang Data from inception to December 2013 to collect randomized controlled trials (RCTs) about the influencing on survival of postoperative adjuvant chemotherapy for pancreatic cancer patients after operation. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Then meta-analysis was conducted using RevMan 5.2 software. ResultsA total of 7 RCTs involving 1 079 patients were included (544 cases and 535 controls). The results of meta-analysis showed that, compared with single radical correction, the patients with adjuvant chemotherapy were better in prolonging total survival time (WMD=5.45, 95%CI 2.52 to 8.39, P=0.000 3), and increasing 2-year (RR=1.17, 95%CI 1.01 to 1.35, P=0.03) as well as 5-year survival rates (RR=1.80, 95%CI 1.24 to 2.62, P=0.002) with significant differences. But for 1-year survival rates, no significant difference was found between the two groups (RR=1.02, 95%CI 0.94 to 1.11, P=0.65). ConclusionCurrent evidence shows that postoperative adjuvant chemotherapy should be applied after resection of pancreatic cancer.
Objective To assess the impact of adjuvant chemotherapy (ACH) on the survival of patients with pT3 urothelial carcinoma of the bladder (UCB) after radical cystectomy (RC). Methods We retrospectively analyzed the clinical and follow-up data of 223 UCB patients who underwent RC between January 2005 and June 2015. None of the patients received neoadjuvant chemotherapy. Of all the patients, 75 (33.6%) were diagnosed as pT3 cancer (including 32 pT3a and 43 pT3b patients). The follow-up data were up to June 2015. Kaplan-Meier method with log-rank test was used to estimate and compare overall survival (OS) and cancer-specific survival (CSS) between groups. Multivariate Cox proportional hazard models were used to identify predictors of OS and CSS. Results The short-term total effective rate of gemcitabine and cisplatin assisted chemotherapy in the treatment of pT3 UCB was 60.0%. Five-year OS rate (47.9%vs. 43.3%) and CSS rate (57.4%vs. 57.6%) were similar in the pT3a and pT3b groups (P=0.682 and 0.796, respectively). In pT3 patients, adjuvant chemotherapy was an independent predictor for OS (P=0.032). On multivariate analysis, according to the pT3 sub-stage, ACH was significantly associated with improved OS [hazard ratio (HR) =0.37; 95% confidence interval (CI) (0.15, 0.68),P=0.006] and CSS [HR=0.34, 95%CI (0.12, 0.86),P=0.022] in the pT3b group only. Conclusion Because pT3b cancer is characterized by macroscopic peri-vesical tissue invasion, patients may obtain an OS benefit from the administration of adjuvant chemotherapy.