The discrepancy between the surgical technique and the type of adjuvant chemotherapy used in clinical trials and patient outcomes in terms of overall survival rates has led to the generation of different adjuvant trea...The discrepancy between the surgical technique and the type of adjuvant chemotherapy used in clinical trials and patient outcomes in terms of overall survival rates has led to the generation of different adjuvant treatment protocols in distinct parts of the world.The adjuvant treatment recommendation is generally chemoradiotherapy in the United States,perioperative chemotherapy in the United Kingdom and parts of Europe,and chemotherapy in Asia.These options mainly rely on the United States Intergroup-0116,United Kingdom British Medical Research Council Adjuvant Gastric Infusional Chemotherapy,and the Asian Adjuvant Chemotherapy Trial of S-1 for Gastric Cancer and Capecitabine and Oxaliplatin Adjuvant Study in Stomach Cancer trials.However,the benefits were evident for only certain patients,which were not very homogeneous regarding the type of surgery,chemotherapy regimens,and stage of disease.Whether the dissimilarities in survival are attributable to surgical technique or intrinsic biological differences is a subject of debate.Regardless of the extent of surgery,multimodal therapy may offer modest survival advantage at least for diseases with lymph node involvement.Moreover,in the era of individualized treatment for most of the other cancer types,identification of special subgroups comprising those who will derive more or no benefit from adjuvant therapy merits further investigation.The aim of this review is to reveal the historical evolution and future reflections of adjuvant treatment modalities for resected gastric cancer patients.展开更多
AIM: To evaluate the prognostic significance of CD24 expression in patients undergoing adjuvant chemoradiotherapy for extrahepatic bile duct (EHBD) cancer. METHODS: Eighty-four patients with EHBD cancer who underwent ...AIM: To evaluate the prognostic significance of CD24 expression in patients undergoing adjuvant chemoradiotherapy for extrahepatic bile duct (EHBD) cancer. METHODS: Eighty-four patients with EHBD cancer who underwent curative resection followed by adjuvant chemoradiotherapy were enrolled in this study. Postoperative radiotherapy was delivered to the tumor bed and regional lymph nodes up to a median of 40 Gy (range: 40-56 Gy). All patients also received fluoropyrimidine chemotherapy for radiosensitization during radiotherapy. CD24 expression was assessed with immunohistochemical staining on tissue microarray. Clinicopathologic factors as well as CD24 expression were evaluated in multivariate analysis for clinical outcomes including loco-regional recurrence, distant metastasisfree and overall survival. RESULTS: CD24 was expressed in 36 patients (42.9%). CD24 expression was associated with distant metastasis, but not with loco-regional recurrence nor with overall survival. The 5-year distant metastasis-free survival rates were 55.1% and 29.0% in patients with negative and positive expression, respectively (P=0.0100). On multivariate analysis incorporating N stage, histologic differentiation and CD24 expression, N stage was the only significant factor predicting distant metastasis-free survival (P=0.0089), while CD24 expression had borderline significance (P=0.0733). In subgroup analysis, CD24 expression was significantly associated with 5-year distant metastasis-free survival in node-positive patients (38.4% with negative expression vs 0% with positive expression, P=0.0110), but not in nodenegative patients (62.0% with negative expression vs 64.0% with positive expression,P=0.8599). CONCLUSION: CD24 expression was a significant predictor of distant metastasis for patients undergoing curative resection followed by adjuvant chemoradiotherapy especially for node-positive EHBD cancer.展开更多
Objective This study aimed to compare the effectiveness of adjuvant chemoradiotherapy(CRT)and adjuvant chemotherapy(ChT)for T3–4/N+gastric cancer(GC)following D2/R0 dissection,and identify the specific subgroups that...Objective This study aimed to compare the effectiveness of adjuvant chemoradiotherapy(CRT)and adjuvant chemotherapy(ChT)for T3–4/N+gastric cancer(GC)following D2/R0 dissection,and identify the specific subgroups that could benefit from adjuvant CRT.Methods All eligible patients were divided into the CRT group and ChT group.We assessed the survival outcomes and patterns of recurrence for each group,and determined the prognostic factors for survival by performing Cox proportional risk regression analyses.Results A total of 192 gastric cancer patients were included in the study.The estimated 3-year and 5-year disease-free survival(DFS)probabilities in the CRT and ChT groups were 52.9%vs.36.7%(P=0.024)and 41.2%vs.31.1%(P=0.148),respectively,and the estimated 3-year and 5-year overall survival(OS)probabilities were 82.4%vs.70.0%(P=0.044)and 52.0%vs.35.6%(P=0.022).Patients in the CRT group had a lower risk of locoregional recurrence than those in the ChT group(20.6%vs.34.4%;P=0.031).The subset analyses revealed that patients with stage N1–2 disease were more likely to benefit from adjuvant CRT than from adjuvant ChT(DFS:53.1%vs.36.4%;P=0.039;OS:53.1%vs.38.6%;P=0.036).Conclusion For locally advanced gastric cancer patients with LN+,adjuvant CRT showed superior survival benefits compared with adjuvant ChT alone.Patients with N1–2 achieved better survival from adjuvant CRT.展开更多
目的系统评价Ⅲ期结直肠癌患者首次术后化疗(PAC)的最佳时间间隔点,并探讨术后并发症对间隔点的影响。方法检索Cochrane Library,PubMed,Web of Sience,China National Knowledge Internet(CNKI)数据库。用森林图法系统性分析不同时间起...目的系统评价Ⅲ期结直肠癌患者首次术后化疗(PAC)的最佳时间间隔点,并探讨术后并发症对间隔点的影响。方法检索Cochrane Library,PubMed,Web of Sience,China National Knowledge Internet(CNKI)数据库。用森林图法系统性分析不同时间起始PAC与Ⅲ期结直肠癌患者临床预后的关联,统计相关的总体存活率(OS),无复发存活率(RFS),并讨论术后并发症对首次PAC时间间隔的影响。结果共11篇文献纳入研究,总计47 775例患者(男26 499例;女21 276例)。发现以8周为分界,PAC时间间隔>8周时OS明显下降(OR=1.75,95%CI=1.35-2.25,P<0.01)。以不同的PAC时间间隔为界,OS同样会随着PAC的延长而明显下降(OR=1.55,95%CI=1.23~1.93,P=0.01),但RFS不会随之下降(P=0.10)。术后并发症成为起始PAC延期的关键因素之一(OR=2.45,95%CI=1.19~5.01,P=0.01)。结论Ⅲ期结直肠癌患者术后首次PAC应在8周内进行。延期PAC会导致不良的OS,而对RFS没有明显影响。对于术后并发症的良好控制,是保证PAC按时进行的必要条件。展开更多
文摘The discrepancy between the surgical technique and the type of adjuvant chemotherapy used in clinical trials and patient outcomes in terms of overall survival rates has led to the generation of different adjuvant treatment protocols in distinct parts of the world.The adjuvant treatment recommendation is generally chemoradiotherapy in the United States,perioperative chemotherapy in the United Kingdom and parts of Europe,and chemotherapy in Asia.These options mainly rely on the United States Intergroup-0116,United Kingdom British Medical Research Council Adjuvant Gastric Infusional Chemotherapy,and the Asian Adjuvant Chemotherapy Trial of S-1 for Gastric Cancer and Capecitabine and Oxaliplatin Adjuvant Study in Stomach Cancer trials.However,the benefits were evident for only certain patients,which were not very homogeneous regarding the type of surgery,chemotherapy regimens,and stage of disease.Whether the dissimilarities in survival are attributable to surgical technique or intrinsic biological differences is a subject of debate.Regardless of the extent of surgery,multimodal therapy may offer modest survival advantage at least for diseases with lymph node involvement.Moreover,in the era of individualized treatment for most of the other cancer types,identification of special subgroups comprising those who will derive more or no benefit from adjuvant therapy merits further investigation.The aim of this review is to reveal the historical evolution and future reflections of adjuvant treatment modalities for resected gastric cancer patients.
基金Supported by Seoul National University Hospital Research Fund, No. 04-2010-0940
文摘AIM: To evaluate the prognostic significance of CD24 expression in patients undergoing adjuvant chemoradiotherapy for extrahepatic bile duct (EHBD) cancer. METHODS: Eighty-four patients with EHBD cancer who underwent curative resection followed by adjuvant chemoradiotherapy were enrolled in this study. Postoperative radiotherapy was delivered to the tumor bed and regional lymph nodes up to a median of 40 Gy (range: 40-56 Gy). All patients also received fluoropyrimidine chemotherapy for radiosensitization during radiotherapy. CD24 expression was assessed with immunohistochemical staining on tissue microarray. Clinicopathologic factors as well as CD24 expression were evaluated in multivariate analysis for clinical outcomes including loco-regional recurrence, distant metastasisfree and overall survival. RESULTS: CD24 was expressed in 36 patients (42.9%). CD24 expression was associated with distant metastasis, but not with loco-regional recurrence nor with overall survival. The 5-year distant metastasis-free survival rates were 55.1% and 29.0% in patients with negative and positive expression, respectively (P=0.0100). On multivariate analysis incorporating N stage, histologic differentiation and CD24 expression, N stage was the only significant factor predicting distant metastasis-free survival (P=0.0089), while CD24 expression had borderline significance (P=0.0733). In subgroup analysis, CD24 expression was significantly associated with 5-year distant metastasis-free survival in node-positive patients (38.4% with negative expression vs 0% with positive expression, P=0.0110), but not in nodenegative patients (62.0% with negative expression vs 64.0% with positive expression,P=0.8599). CONCLUSION: CD24 expression was a significant predictor of distant metastasis for patients undergoing curative resection followed by adjuvant chemoradiotherapy especially for node-positive EHBD cancer.
文摘Objective This study aimed to compare the effectiveness of adjuvant chemoradiotherapy(CRT)and adjuvant chemotherapy(ChT)for T3–4/N+gastric cancer(GC)following D2/R0 dissection,and identify the specific subgroups that could benefit from adjuvant CRT.Methods All eligible patients were divided into the CRT group and ChT group.We assessed the survival outcomes and patterns of recurrence for each group,and determined the prognostic factors for survival by performing Cox proportional risk regression analyses.Results A total of 192 gastric cancer patients were included in the study.The estimated 3-year and 5-year disease-free survival(DFS)probabilities in the CRT and ChT groups were 52.9%vs.36.7%(P=0.024)and 41.2%vs.31.1%(P=0.148),respectively,and the estimated 3-year and 5-year overall survival(OS)probabilities were 82.4%vs.70.0%(P=0.044)and 52.0%vs.35.6%(P=0.022).Patients in the CRT group had a lower risk of locoregional recurrence than those in the ChT group(20.6%vs.34.4%;P=0.031).The subset analyses revealed that patients with stage N1–2 disease were more likely to benefit from adjuvant CRT than from adjuvant ChT(DFS:53.1%vs.36.4%;P=0.039;OS:53.1%vs.38.6%;P=0.036).Conclusion For locally advanced gastric cancer patients with LN+,adjuvant CRT showed superior survival benefits compared with adjuvant ChT alone.Patients with N1–2 achieved better survival from adjuvant CRT.
文摘目的系统评价Ⅲ期结直肠癌患者首次术后化疗(PAC)的最佳时间间隔点,并探讨术后并发症对间隔点的影响。方法检索Cochrane Library,PubMed,Web of Sience,China National Knowledge Internet(CNKI)数据库。用森林图法系统性分析不同时间起始PAC与Ⅲ期结直肠癌患者临床预后的关联,统计相关的总体存活率(OS),无复发存活率(RFS),并讨论术后并发症对首次PAC时间间隔的影响。结果共11篇文献纳入研究,总计47 775例患者(男26 499例;女21 276例)。发现以8周为分界,PAC时间间隔>8周时OS明显下降(OR=1.75,95%CI=1.35-2.25,P<0.01)。以不同的PAC时间间隔为界,OS同样会随着PAC的延长而明显下降(OR=1.55,95%CI=1.23~1.93,P=0.01),但RFS不会随之下降(P=0.10)。术后并发症成为起始PAC延期的关键因素之一(OR=2.45,95%CI=1.19~5.01,P=0.01)。结论Ⅲ期结直肠癌患者术后首次PAC应在8周内进行。延期PAC会导致不良的OS,而对RFS没有明显影响。对于术后并发症的良好控制,是保证PAC按时进行的必要条件。
