ObjectiveTo analyze the relationship between occupational type of patients with colorectal cancer (CRC) and decision-making and curative effect of neoadjuvant therapy in the current version of the Database from Colorectal Cancer (DACCA). MethodsThe eligible CRC patients were collected from June 29, 2022 updated DACCA according to the screening criteria, in which the data items analyzed included: gender, age, BMI, blood type, marriage, occupation, neoadjuvant therapy, symptomatic changes, imaging changes, and tumor regression grade (TRG), and the occupations were classified into the mental labour group, physical labour group, and the unemployed and resident groups according to the type of labour, then compared the decision-making and curative effect of neoadjuvant therapy among the 3 groups. ResultsA total of 2 415 eligible data were screened, of which 1 160 (48.0%) were the most in the manual labour group, followed by 877 (36.3%) in the unemployed and resident group, and finally 378 (15.7%) in the mental labour group. The proportion of those who did not use targeted drugs was higher in both patients ≤60 years old and >60 years old [75.6% (958/1 267) vs. 82.5% (947/1 148)], with both differences being statistically significant (P=0.004 and P=0.019), and among patients >60 years old, the different occupational types were associated with symptomatic changes and imaging changes after neoadjuvant therapy, with the highest number of both changes to partial remission [71.5% (161/225) vs. 66.7% (148/222)], both differences being statistically significant (P=0.001 and P=0.017). ConclusionThe analysis results of DACCA data reveal that the occupational type of CRC patients was associated with the choice of neoadjuvant therapy, and that different occupational types were associated with changes in curative effect before and after neoadjuvant therapy in CRC patients >60 years old, which needs to be further analysis for the reasons.
ObjectiveTo explore the expression of alpha B-crystallin (CRYAB) in human gastric cancer tissue and the influence of chemotherapeutics on expression of CRYAB mRNA.Methods① The gastric cancer tissues and corresponding adjacent tissues of 76 patients underwent radical resection from April 2018 to March 2020 in The First Affiliated Hospital of Southwest Medical University and the Sichuan Mianyang 404 Hospital were collected, the expression of CRYAB protein in the gastric cancer tissues and corresponding adjacent tissues of 76 patients with gastric cancer were detected by immunohistochemistry SP technique. The relation between the expression of CRYAB protein and clinicopathologic features was analyzed. ② Twenty-one gastric tissues of patients accepted neoadjuvant chemotherapy and 26 gastric tissues of patients with no neoadjuvant chemotherapy in the The First Affiliated Hospital of Southwest Medical University were collected from November 2018 to March 2020, the expression of CRYAB mRNA was detected by real time-PCR.ResultsThe expression of CRYAB protein in gastric cancer tissues was positive in 51 cases (67.1%) and in the corresponding adjacent tissues was positive in 32 cases (42.1%), the positive rate was higher in gastric cancer tissues (χ2=9.581, P=0.002). The over-expression of CRYAB protein in the gastric cancer tissues was correlated with the TNM stage, Borrmann typing, degree of differentiation, lymph node metastasis, depth of invasion of the patients, and Lauren classification (P<0.05), but not correlated with the age, gender, tumor sitation, and diameter (P>0.05). The expression of CRYAB mRNA in the gastric cancer tissues with neoadjuvant chemotherapy was significantly higher than that in the gastric cancer tissues without neoadjuvant chemotherapy (t=8.37, P<0.001).ConclusionsThe over-expression of CRYAB protein is closely related to the invasion and progression of gastric cancer, they may be involved in the progression of gastric cancer and play a crucial role. Moreover, the expression of CRYAB mRNA increases after chemotherapy, it suggests that chemotherapy drugs can activate the self-protection mechanism of tumor cells to some extent, and influence the effect of chemotherapy by increasing expression of CRYAB protein.
ObjectiveTo investigate the relation between mammographic density (MD) and the efficacy of neoadjuvant chemotherapy (NACT) for patients with breast cancer. MethodsThe clinicopathologic data of patients diagnosed with breast cancer in the Affiliated Hospital of Southwest Medical University from January 2019 to December 2021 and met the inclusion and exclusion criteria of this study were collected. According to the 5th edition of the Breast Imaging-Reporting and Data System, the MD was classified into 4 categories: a, b, c, and d. Based on the pathological evaluation systems of Miller-Payne and Residual Cancer Burden, the new and improved pathological criteria was structured including the residual cancer cell and lymph node statuses to evaluate the pathological changes of breast cancer after NACT. After adjusting the factors affecting MD, the original model (only including MD categories as independent variables), the minimum adjustment model (adding age, body mass index, and menopausal status as independent variables), and the fully adjusted model (further including estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, Ki-67, axillary lymph node status at the initial diagnosis, and NACT regimen) were used to analyze the relation between MD and NACT effect. In the 3 models, the MD category a was used as the reference. ResultsA total of 287 patients with breast cancer were enrolled in this study. Thirty-eight, 76, 114, and 59 of whom with MD category a, b, c, and d respectively, and 14, 74, 117, and 82 of whom with grade L1, L2, L3, and L4 of NACT effect respectively. No matter in integrated patients or premenopausal patients, the results of the fully adjusted model showed that, the regression coefficient of MD classification was negative, and with the increase of MD classification, the odds ratio was <1 and showed a decreasing trend. ConclusionsFrom the results of this study, the increase of MD classification may have a negative impact on the effect of NACT. Namely, effect of NACT is poor in integrated patients or premenopausal patients of whom with higher MD. MD can be used as a predictor of NACT effect, so as to guide doctors in the selection and individual management of neoadjuvant therapy, and improve the prognosis of patients with breast cancer.
Objective To analyze the relation between the marital status of patients with colorectal cancer and neoadjuvant therapy (NAT) regimen decision-making and outcomes in the current version of the Database from Colorectal Cancer (DACCA). Methods The version of DACCA selected for this analysis was updated on June 29, 2022. The patients were enrolled according to the established screening criteria and then assigned to 5 groups: the unmarried, married, divorced, remarried and widowed groups. The differences in the NAT regimen decision-making and changes of symptom, imaging, and cancer markers in these 5 groups were analyzed. Results A total of 3 053 data that met the screened criteria were enrolled. The results of statistical analysis reflected that the difference in the constituent ratio of patients chosen NAT strategies among 5 groups was obviously statistically significant (χ2=27.944, P=0.004), showing that remarried patients were inclined to adopt combined target drug. No statistical differences were found in changes of symptom (H=5.717, P=0.221), image (H=8.551, P=0.073), and cancer markers (H=11.351, P=0.183) of the 5 groups after NAT. Conclusion Through analysis of DACCA data, it is found that in the selection of NAT strategy for colorectal cancer, more married and remarried patients tended to choose chemotherapy combined target drug regimen.
ObjectiveTo construct a multimodal imaging radiomics model based on enhanced CT features to predict tumor regression grade (TRG) in patients with locally advanced rectal cancer (LARC) following neoadjuvant chemoradiotherapy (NCRT). MethodsA retrospective analysis was conducted on the Database from Colorectal Cancer (DACCA) at West China Hospital of Sichuan University, including 199 LARC patients treated from October 2016 to October 2023. All patients underwent total mesorectal excision after NCRT. Clinical pathological information was collected, and radiomics features were extracted from CT images prior to NCRT. Python 3.13.0 was used for feature dimension reduction, and univariate logistic regression (LR) along with Lasso regression with 5-fold cross-validation were applied to select radiomics features. Patients were randomly divided into training and testing sets at a ratio of 7∶3 for machine learning and joint model construction. The model’s performance was evaluated using accuracy, sensitivity, specificity, and the area under the curve (AUC). Receiver operating characteristic curve (ROC), confusion matrices, and clinical decision curves (DCA) were plotted to assess the model’s performance. ResultsAmong the 199 patients, 155 (77.89%) had poor therapeutic outcomes, while 44 (22.11%) had good outcomes. Univariate LR and Lasso regression identified 8 clinical pathological features and 5 radiomic features, including 1 shape feature, 2 first-order statistical features, and 2 texture features. LR, support vector machine (SVM), random forest (RF), and eXtreme gradient boosting (XGBoost) models were established. In the training set, the AUC values of LR, SVM, RF, XGBoost models were 0.99, 0.98, 1.00, and 1.00, respectively, with accuracy rates of 0.94, 0.93, 1.00, and 1.00, sensitivity rates of 0.98, 1.00, 1.00, and 1.00, and specificity rates of 0.80, 0.67, 1.00, and 1.00, respectively. In the testing set, the AUC values of 4 models were 0.97, 0.92, 0.96, and 0.95, with accuracy rates of 0.87, 0.87, 0.88, and 0.90, sensitivity rates of 1.00, 1.00, 1.00, and 0.95, and specificity rates of 0.50, 0.50, 0.56, and 0.75. Among the models, the XGBoost model had the best performance, with the highest accuracy and specificity rates. DCA indicated clinical benefits for all 4 models. ConclusionsThe multimodal imaging radiomics model based on enhanced CT has good clinical application value in predicting the efficacy of NCRT in LARC. It can accurately predict good and poor therapeutic outcomes, providing personalized clinical surgical interventions.
ObjectiveTo analyze the relation between educational level of patients with colorectal cancer (CRC) and decision-making and curative effect of neoadjuvant therapy (NAT) in the current version of the Database from Colorectal Cancer (DACCA). MethodsThe eligible CRC patients were collected from June 29, 2022 updated DACCA according to the screening criteria and were assigned into 4 groups according to their educational level, namely, uneducated, primary educated, secondary educated, and tertiary educated. The differences in NAT decision-making, cancer marker change, symptomatic change, gross change, imaging change, and tumor regression grade (TRG) among the CRC patients with different educational levels were compared. ResultsA total of 2 816 data that met the screening criteria were collected, 138 of whom were uneducated, 777 of whom were primary educated, 1 414 of whom were secondary educated, and 487 of whom were tertiary educated. The analysis results revealed that the difference in the composition ratio of patients choosing NAT regimens by educational level was statistically significant (χ2=30.937, P<0.001), which was reflected that the composition ratio of choosing a simple chemotherapy regimen in the uneducated CRC patients was highest, while which of choosing combined targeted therapy regimen in the tertiary educated CRC patients was highest. In terms of treatment outcomes, the composition ratios of changes in cancer markers (H=4.795, P=0.187), symptoms (H=1.722, P=0.632), gross (H=2.524, P=0.471), imaging (H=2.843, P=0.416), and TRG (H=2.346, P=0.504) had no statistical differences. ConclusionsThrough data analysis in DACCA, it is found that the educational level of patients with CRC can affect the choice of NAT scheme. However, it is not found that the educational level is related to the changes in the curative effect of patients with CRC before and after NAT, and further analysis is needed to determine the reasons for this.
The incidence of esophagogastric junction adenocarcinoma is gradually increasing, and gastrointestinal surgery and thoracic surgery are paying more and more attention to its surgical treatment. “Chinese expert consensus on the surgical treatment of adenocarcinoma of esophagogastric junction (2018 edition)” discussed the core issues in the field of surgical treatment such as definition, classification, surgical approach, lymphadenectomy, digestive tract reconstruction, and neoadjuvant therapy for esophagogastric junction adenocarcinoma, and gave recommendations. However, there is still some controversy about these issues. The author discussed the consensus and controversial issues relevant to esophagogastric junction adenocarcinoma and related research progress in recent years.
Surgery remains as the primary definitive therapy for resectable non-small cell lung cancer (NSCLC) currently. However, quite a few NSCLC patients, especially in the later stage, suffered tumor recurrence after resection. Safer and more effective perioperative treatment is urgently needed to reduce the recurrence risk after NSCLC surgery. Immune checkpoint inhibitors can effectively prevent tumor immune evasion and have been shown to be a feasible, safe and effective neoadjuvant therapy for resectable NSCLC. Nevertheless, certain crucial problems, including the final effect on NSCLC recurrence, the selection of beneficial group and optimal treatment protocol are yet unsolved. Fortunately, several phase Ⅲ randomized controlled trials are ongoing to answer these questions and will hopefully provide stronger evidence.
The standard treatment for locally advanced rectal cancer is neoadjuvant chemoradiotherapy combined with surgery, but patients after the same treatment regimen show a large difference in outcomes. For patients with good response to neoadjuvant therapy, the waiting & observation scheme can be selected to avoid surgery and other complications. Therefore, accurate assessment of the response of patients with locally advanced rectal cancer after neoadjuvant therapy can better develop personalized treatment strategies. Current studies have found that blood sample detection, endoscopy, imaging examination and artificial intelligence have their own advantages and disadvantages in evaluating the response of neoadjuvant therapy. Therefore, this article reviews the application of different clinical tools in evaluating and predicting the response of neoadjuvant therapy for locally advanced rectal cancer, and looks forward to the future development direction.
ObjectiveTo explore the clinical protocols of neoadjuvant therapy for hepatocellular carcinoma and to provide a perspective on its future prospects. MethodLiterature search and review were conducted in CNKI, Wanfang, VIP, PubMed and other databases using keywords such as “hepatocellular carcinoma”, “neoadjuvant therapy”, “interventional therapy”, “radiotherapy”, “targeted therapy”, “immunotherapy”, etc in recent five years. ResultsNeoadjuvant therapy for hepatocellular carcinoma included neoadjuvant interventional therapy, radiotherapy, targeted therapy, and immunotherapy. Neoadjuvant interventional therapy and radiotherapy had significant advantages for hepatocellular carcinoma patients with portal vein tumor thrombus, while neoadjuvant targeted therapy and immunotherapy had achieved initial results in tumor pathological remission rate, providing more ideas for the diagnosis and treatment of patients with resectable hepatocellular carcinoma. ConclusionsNeoadjuvant therapy is an emerging treatment for hepatocellular carcinoma, which has shown great potential in clinical applications and is moving towards individualization, precision, and systematization. We believe that with in-depth research on the mechanism of immunotherapy for hepatocellular carcinoma and continuous clinical practice, a comprehensive treatment strategy based on immunotherapy will become the key to neoadjuvant therapy for hepatocellular carcinoma in the future.