ObjectiveTo analyze the relation between the age 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). MethodsThe version of DACCA selected for this analysis was updated on January 5, 2022. The patients were enrolled according to the established screening criteria and then assigned to 3 age groups: ≤45, 45–65, and ≥65 years old groups. The differences in the NAT regimen decision-making and changes of symptom, imaging, and cancer markers in these 3 age groups were analyzed. ResultsA total of 4 882 data that met the screened criteria were enrolled. The results of statistical analysis showed that the difference in the constituent ratio of patients chosen NAT strategies among 3 age groups was not statistically significant (χ2=8.885, P=0.180). There was a statistical difference in the constituent ratio of patients chosen combined target drug among 3 age groups (χ2=8.530, P=0.014), it was found that the proportion of the patients with ≤45 years old adopting combined target drug regimen was higher. Although the changes of symptom (H=12.299, P=0.056), image (H=1.775, P=0.412), and cancer markers (H=11.351, P=0.183) had no statistical differences of the 3 age groups after NAT, it was found that the proportions of patients with ≥65 years old with progresses of symptom and imaging changes and elevated cancer markers after NAT were higher, and the proportions of patients with ≤45 years old with complete and partial remissions of symptom and imaging changes and with normal cancer markers after NAT were higher. ConclusionsThrough analysis of DACCA data, it is found that in the selection of NAT strategy for colorectal cancer, the lower age group, the higher proportion of patients adopting combined target drug regimen. Although it is not found that age is related to changes of symptoms, imaging, and cancer markers after NAT, it still shows a trend of better outcomes in younger patients.
There is still a lack of experience in the perioperative strategy for esophageal cancer patients in China during the epidemic of COVID-19. In December 2022, a 59-year-old male patient with esophageal cancer was admitted to our department. He received 2 cycles of neoadjuvant therapy before surgery, and developed COVID-19 perioperatively. After treatment, the infection symptoms of the patient were improved, and the postoperative recovery was satisfactory.
ObjectiveTo review and summarize the research progress of adenocarcinoma of esophagogastric junction (AEG) in staging, surgical treatment, endoscopic treatment and adjuvant therapy in recent years, so as to provide reference and help for the follow-up research and treatment of this disease.MethodLiterature review was used to review the literatures on AEG treatment in various databases.ResultsThe incidence of AEG had increased rapidly in recent years, with high malignancy and poor prognosis. Siewert typing had allowed researchers to gain insight into the disease, and treatments were increasingly diversified. At present, the main treatment was still radical surgery. Because AEG was adjacent to the esophagus and stomach, there were many controversies about its staging, surgical approach, resection range, digestive tract reconstruction, adjuvant treatment and so on, especially Siewert type Ⅱ.ConclusionsThe surgical approach, resection range, and laparoscopic surgery of Siewert typeⅡcan choose according to esophageal involvement distance judgment, pathological staging is uncertain, still need several studies to reach a consensus. With the application of laparoscopy and adjuvant therapy, how to select individualized treatment options that require multidisciplinary collaboration for further study.
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 analyze whether neoadjuvant chemoradiotherapy can impact patients’ anal function and quality of life after rectal cancer surgery.MethodThe domestic and international publications on the studies how the neoadjuvant chemoradiotherapy impacted patients’ anal function and quality of life were collected and reviewed.ResultsThe neoadjuvant chemoradiotherapy negatively impacted the patients’ anal function and quality of life, but which would be improved over time. The impact had no obvious difference between the long-course chemoradiotherapy and short-couse radiotherapy on the patients’ anal function and quality of life. Compared with the neoadjuvant chemoradiotherapy, the neoadjuvant chemotherapy might impact less on the anal function, but which still needed to evaluate the lower anterior resection syndrome (LARS) score. In present, it lacked evidence of a higher rate of anastomotic leakage caused by the neoadjuvant chemoradiotherapy, which might lead to the bowel dysfunction.ConclusionsNeoadjuvant chemoradiotherapy negatively impacts patients’ anal function and quality of life. Further studies are needed to figure out the best choice between long-course neoadjuvant chemoradiotherapy and short-couse radiotherapy. In long term, impact of neoadjuvant therapy can be improved over time and be accepted by patients. Some intervention treatments including medicine and operations are needed if major LARS occurs.
ObjectiveTo describe the constructive process of neoadjuvant therapy for colorectal cancer part in the West China Colorectal Cancer Database (DACCA).MethodWe used the form of text description.ResultsThe specific concept of neoadjuvant therapy for colorectal cancer including neoadjuvant treatment therapies, compliance of patients with neoadjuvant therapy, neoadjuvant therapy intensity scheme, the CEA value of patients during neoadjuvant therapy, changes of symptoms, changes of primary tumor size in colorectal cancer, and TRG grading of the DACCA in the West China Hospital were defined. Then the neoadjuvant therapies were detailed for their definition, label, structure, error correction, and update.ConclusionThrough detailed description and specification of neoadjuvant therapy for colorectal cancer in DACCA in West China Hospital, it can provide a reference for the standardized treatment of colorectal cancer and also provide experiences for the peers who wish to build a colorectal cancer database.
The progress of new therapies for solid tumors usually gradually transitions from late stage to early stage. Early treatment of Luminal breast cancer has entered the era of “endocrine therapy +”, with the strengthening of treatment duration and intensity, combined with targeted therapy and multi-gene detection, which still coexist with clinical parameters. For HER2-positive early breast cancer, neoadjuvant therapy has changed the treatment process, requiring exploration of precise strengthening and de-escalation of neoadjuvant therapy. “Neoadjuvant therapy changes adjuvant therapy, and early treatment affects recurrence treatment”. Although the early treatment of triple-negative breast cancer once showed a complicated state of “a hundred schools of thought contend”, today’s treatment strategy is far from focusing on the simple respond of those three negative markers. The core lies in precise diagnosis and classification for treatment! This article summarizes the progress of early breast cancer diagnosis and treatment, in order to provide valuable reference for clinicians’ practical application.
ObjectiveTo learn further the local immunity changes of rectal cancer after neoadjuvant therapy and improve the cognition of this project. MethodsSixty cases of paraffin-embedded sections of the excised specimen from the two groups of middle and low rectal cancer patients, with (therapy group) or without (control group) neoadjuvant therapy, were studied respectively. Tumor infiltrating lymphocytes (TIL) in the two groups were counted under microscope, and also, dendritic cells (DC) were counted and morphology and distribution of the DCs were recorded through immunohistochemistry stain with monoclonal antibody, S-100. ResultsTILs and DCs in the two groups mainly assembled in the pericancerous tissues. The positive rate of TIL in therapy group was 75.00% (45/60) and 90.00% (54/60) in control group (χ2=10.58, P=0.014). S-100 positive DCs were (36.85±11.17)/HPF versus (26.50±7.68)/HPF in the therapy group and control group, respectively (P=0.001). ConclusionNeoadjuvant therapy for rectal cancer can influence the local tumor immunity enviroment by reducing TILs and increasing DCs.
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.
Objective To discuss the performance of multi-disciplinary team (MDT) of colorectal cancer treatment within West China Hospital in Sichuan University. Methods To compare the therapeutic effect between groups of MDT model and non-MDT model by retrospectively analyzing the data of patients who diagnosed colorectal cancer and accepted in-hospital therapy during December 2006 and May 2007. Results The in-hospital days of the MDT model group during the perioperative period and in the surgical ward were less than that of the non-MDT model group ( Plt; 0. 05) , but there was no significant difference between the two groups about the total hospitalization time. And the MDT model group had a higher rate of cancer resection ( P lt; 0. 05) . Although the incidence of anastomotic leakage and bleeding as early postoperative complications didn’t show any variations between the two groups , the non-MDT model groupencountered more early postoperative ileus ( Plt; 0. 05) . During the 5－ 10 months follow-up , there came out less cancer recurrence rate in the MDT model group than the other ( P lt; 0. 05) . And the morbidity of anastomotic stricture and ileus didn’t show any statistical difference between the two groups. Conclusion The combined-therapy st rategy ofcolorectal cancer has showed a priority to routine ways , not only the more reasonable time arrangement for therapy , but also the more satisfied surgical outcomes. However , the factors correlated to the efficacy of the MDT model are not clear ; the MDT model still needs to be improved that a morereasonable and effective perioperative MDT model may come t rue.