腹腔化疗港在胃癌腹膜转移中应用的安全性分析

目的:腹腔化疗可将药物直接作用于腹膜转移病灶,正逐渐被应用于胃癌腹膜转移的治疗。通过腹腔化疗港可反复多次进行腹腔化疗,而化疗港的顺利使用是腹腔化疗持续进行的关键。本研究将探讨在胃癌腹膜转移患者留置腹腔化疗港的安全性。方法:回顾性分析2015年6月至2018年6月于北京大学肿瘤医院行腹腔化疗港留置术患者的临床资料,分析腹腔化疗港在胃癌腹膜转移中应用的过程、注意事项及安全性,探讨并发症发生原因及预防处理方式。结果:共有54例患者植入55个化疗港,平均使用时间为8.4(0.8～32.0)个月,共13例出现并发症(23.6%),发生率从高到低依次为堵塞(7.3%)、严重疼痛(5.5%)、感染(3.6%)、反流(3.6%)、置针困难(1.8%)及皮下硬结(1.8%)。并发症发生的中位时间为化疗港放置后2.1个月。分析未发现与并发症相关的高危因素(P>0.05)。结论:通过规范与细致的操作,腹腔化疗港在胃癌腹膜转移中的应用安全可行。

胃癌腹膜转移的外科诊治观

随着诊断性腹腔镜的普及、晚期胃癌转化治疗概念的兴起,以及腹腔化疗港、腹腔热灌注化疗等技术的应用,胃癌腹膜转移的诊断与治疗取得新的进展。然而,胃癌腹膜转移预后差,治疗依旧缺乏高级别证据,在实践过程中应注意规范化诊断与评效,在患者筛选、手术指征、术后化疗等重要问题上进行多学科讨论决策。药物治疗的进展仍是未来提高胃癌腹膜转移预后的关键。

Oxaliplatin plus S-1 or capecitabine as neoadjuvant or adjuvant chemotherapy for locally advanced gastric cancer with D2lymphadenectomy: 5-year follow-up results of a phase II-III randomized trial

Objective： To compare the effect of neoadjuvant chemotherapy （NACT） with adjuvant chemotherapy （ACT） using oxaliplatin plus S-1 （sex） or capecitabine （CapeOX） on gastric cancer patients with D2 lymphadenectomy. Methods： This was a two-by-two factorial randomized phase Ⅱ-Ⅲ trial, and registered on ISRCTN registry （No. ISRCTN12206108）. Locally advanced gastric cancer patients were randomized to neoadjuvant sex, neoadjuvant CapeOX, adjuvant sex, or adjuvant CapeOX arms. Primary analysis was performed on an intention- to-treat （ITT） basis using overall survival （OS） as primary endpoint. Results： This trial started in September 2011 and closed in December 2012 with 100 patients enrolled. Treatment completion rate was 56%, 52%, 38% and 30% in the four arms, respectively. NACT group had fewer dropouts due to unacceptable toxicity （P=0.042）. Surgical complication rate did not differ by the four groups （P=0.986）. No survival signifcant difference was found comparing NACT with ACT （P=0.664; 5-year-OS： 70% vs. 74% respectively）, nor between the sex and CapeOX groups （P=0.252; 5-year-OS： 78% vs. 66% respectively）. Subgroup analysis showed sex significantly improved survival in patents with diffuse type （P=0.048）. Conclusions： No significant survival difference was found between NACT and ACT. sex and CapeOX had good safety and efficacy as neoadjuvant regimens. Diffuse type patients may survive longer due to sex.

Laparoscopic vs.open lower mediastinal lymphadenectomy for Siewert typeⅡ/Ⅲadenocarcinoma of esophagogastric junction:An exploratory,observational,prospective,IDEAL stage2b cohort study(CLASS-10 study)

Objective:This study aims to verify the feasibility and efficacy of laparoscopic lower mediastinal lymphadenectomy for Siewert typeⅡ/Ⅲadenocarcinoma of esophagogastric junction(AEG).Setting:An exploratory,observational,prospective,cohort study will be carried out under the Idea,Development,Exploration,Assessment and Long-term Follow-up(IDEAL)framework(stage 2 b).Paritcipants:The study will recruit 1,036 patients with cases of locally advanced AEG(Siewert typeⅡ/Ⅲ,clinical stage cT2-4 aN0-3 M0),and 518 will be assigned to either the laparoscopy group or the open group.Interventions:Patients will receive lower mediastinal lymphadenectomy along with either total or proximal gastrectomy.Primary and secondary outcome measures:The primary endpoint is the number of lower mediastinal lymph nodes retrieved,and the secondary endpoints are the surgical safety and prognosis,including intraoperative and postoperative lower-mediastinal-lymphadenectomy-related morbidity and mortality,rate of rehospitalization,R0 resection rate,3-year local recurrence rate,and 3-year overall survival.Conclusions:The study will provide data for the guidance and development of surgical treatment strategies for AEG.Trial registration number:The study has been registered in ClinicalTrials.gov(No.NCT04443478).

Utilizing local anti-cancer treatment and online medical service during the COVID-19 pandemic

Since the first outbreak of the coronavirus disease(COVID-19)in the winter of 2019,this pandemic has resulted in significant global social and economic disruption,as well as global public health and medical crises[1].Climate,weather conditions,and even latitude have now been acknowledged to be directly associated with COVID-19 outbreaks[2-4].It was reported that 60%of the confirmed cases of COVID-19 occurred in areas where the air temperature ranged from 5℃to 15℃[4].These earlier research results strongly implied that the COVID-19 pandemic might spread cyclically and outbreaks might recur in large cities in the mid-latitudes(for example,the northern part of China)in autumn 2020[4],which has now been confirmed by the third wave of the pandemic.With quarantines and other restrictive legislations and control measures being put in action to contain the spread of the disease[5],the pandemic has also manifested additional obstacles in the treatment of other diseases.For example,a median dose delay of 14(6-20)days was found in patients who received one cycle of gastric chemotherapy in our department from the first outbreak till the spring festival of 2020(n=79).

中国胃癌肝转移患者临床诊疗特征及预后分析:全国多中心队列研究(RECORD研究)

Despite surgical improvements and pharmacological advances,management of late-stage gastric cancer patients,especially those with hepatic metastasis remains challenging[1–3].Although nationwide registry data from SEER(Surveillance,Epidemiology,and End Results)[4]and the Nordic database[5]in Western countries have provided epidemiological information for patients with gastric cancer liver metastasis(GCLM),little is known about the detailed clinical characteristics.