Adjuvant Treatment for High-Risk Operable Prostate Cancer

Patients who have undergone a radical prostatectomy may have to face high risks of recurrence. The risk of recurrence is elevated due to probable occult metastatic disease at the time of diagnosis. A rationale for using multimodal approach in order to minimize the chance of disease recurrence and to improve the survival of high risk patients is emerging from preclinical and clinical studies. New molecular and genetics assays, may help to select patients most likely to benefit from these approaches. In this review, we will especially discuss the potential benefits of adjuvant therapy after radical prostatectomy. This paper presents the identification of these high-risk patients;the explanation of an adjuvant treatment of residual disease after a radical prostatectomy;the clinical studies with adjuvant androgen deprivation, radiotherapy and/or chemotherapy and the microarrays analysis. This review highlights the importance of these new adjuvant treatments that aims at targeting the factor which triggers metastatic disease following a radical

Shanghai Score： A Prognostic and Adjuvant Treatment-evaluating System Constructed for Chinese Patients with Hepatocellular Carcinoma after Curative Resection

Background： For Chinese patients with hepatocellular carcinoma （HCC）, surgical resection is the most important treatment to achieve long-term survival for patients with an early-stage tumor, and yet the prognosis after surgery is diverse. We aimed to construct a scoring system （Shanghai Score） for individualized prognosis estimation and adjuvant treatment evaluation. Methods： A multivariate Cox proportional hazards model was constructed based on 4166 HCC patients undergoing resection during 2001-2008 at Zhongshan Hospital. Age, hepatitis B surface antigen, hepatitis B e antigen, partial thromboplastin time, total bilirubin, alkaline phosphatase, y-glutamyltransferase, a-fetoprotein, tumor size, cirrhosis, vascular invasion, differentiation, encapsulation, and tumor number were finally retained by a backward step-down selection process with the Akaike information criterion. The Harrell＇s concordance index （C-index） was used to measure model performance. Shanghai Score is calculated by summing the products of the 14 variable values times each variable＇s corresponding regression coefficient. Totally 1978 patients from Zhongshan Hospital undergoing resection during 2009-2012, 808 patients from Eastern Hepatobiliary Surgery Hospital during 2008-2010, and 244 patients from Tianjin Medical University Cancer Hospital during 2010-2011 were enrolled as external validation cohorts. Shanghai Score was also implied in evaluating adjuvant treatment choices based on propensity score matching analysis.Results： Shanghai Score showed good calibration and discrimination in postsurgical HCC patients. The bootstrap-corrected C-index （confidence interval [CI]） was 0.74 for overall survival （OS） and 0.68 for recurrence-free survival （RFS） in derivation cohort （4166 patients）, and in the three independent validation cohorts, the CIs for OS ranged 0.70 0.72 and that for RFS ranged 0.63 0.68. Furthermore, Shanghai Score provided evaluation for adjuvant treatment choices （transcatheter arterial chemoembolization or interferon-a）. The identified subset of patients at low risk could be ideal candidates for curative surgery, and subsets of patients at moderate or high risk could be recommended with possible adjuvant therapies after surgery. Finally, a web server with individualized outcome prediction and treatment recommendation was constructed. Conclusions： Based on the largest cohort up to date, we established Shanghai Score - an individualized outcome prediction system specifically designed for Chinese HCC patients after surgery. The Shanghai Score web server provides an easily accessible tool to stratify the prognosis of patients undergoing liver resection for HCC.

Adjuvant treatment strategy after curative resection for hepatocellular carcinoma

Hepatic resection represents the first-line treatment for patients with resectable hepatocellular carcinoma(HCC).However,the 5-year recurrence rates of HCC after surgery have been reported to range from 50%to 70%.In this review,we evaluated the available evidence for the efficiency of adjuvant treatments to prevent HCC recurrence after curative liver resection.Antiviral therapy has potential advantages in terms of reducing the recurrence rate and improving the overall survival(OS)and/or disease-free survival of patients with hepatitisrelated HCC.Postoperative adjuvant transarterial chemoembolization can significantly reduce the intrahepatic recurrence rate and improve OS,especially for patients with a high risk of recurrence.The efficacy of molecular targeted drugs as an adjuvant therapy deserves further study.Adjuvant adoptive immunotherapy can significantly improve the clinical prognosis in the early stage.Randomized controlled trial(RCT)studies evaluating adjuvant immune checkpoint inhibitors are ongoing,and the results are highly expected.Adjuvant hepatic artery infusion chemotherapy might be beneficial in patients with vascular invasion.Huaier granule,a traditional Chinese medicine,has been proved to be effective in prolonging the recurrence-free survival and reducing extrahepatic recurrence.The efficiency of other adjuvant treatments needs to be further confirmed by large RCT studies.

Postoperative adjuvant therapy for hepatocellular carcinoma with microvascular invasion

Hepatocellular carcinoma(HCC)is one of the most lethal tumors in the world.Liver resection(LR)and liver transplantation(LT)are widely considered as radical treatments for early HCC.However,the recurrence rates after curative treatment are still high and overall survival is unsatisfactory.Microvascular invasion(MVI)is considered to be one of the important prognostic factors affecting postoperative recurrence and long-term survival.Unfortunately,whether HCC patients with MVI should receive postoperative adjuvant therapy remains unknown.In this review,we summarize the therapeutic effects of transcatheter arterial chemoembolization,hepatic arterial infusion chemotherapy,tyrosine protein kinase inhibitor-based targeted therapy,and immune checkpoint inhibitors in patients with MVI after LR or LT,aiming to provide a reference for the best adjuvant treatment strategy for HCC patients with MVI after LT or LR.

High-risk endometrial cancer may be benefit from adjuvant radiotherapy plus chemotherapy

Objective： To present patterns of practice and outcomes in the adjuvant treatment of intermediate- and high-risk endometrial cancer. Methods： Retrospective data on 224 women with intermediate-risk and high-risk endometrial cancer from 1999 to 2006 were reviewed. All patients underwent surgical staging. Patterns of adjuvant treatment, consisting of pelvic radiotherapy, chemotherapy, and radiotherapy plus chemotherapy, were assessed. The 3- and 5-year disease-specific survival （DSS） rates were calculated using the Kaplan-Meier method. Results： The difference in 5-year DSS rate was statistically significant between adjuvant group and non-adjuvant group （80.65% vs. 63.80%, P=0.040）. In 110 high-risk patients who underwent adjuvant treatment, both 5-year DSS rate and recurrent rate were significantly different in combined radiotherapy and chemotherapy group compared with radiotherapy alone and chemotherapy alone groups （DSS rate, P=0.049; recurrent rate, P=0.047）. In 83 intermediate-risk women who underwent adjuvant treatment, there was no significant difference in 5-year DSS rate and recurrence rate among the combined radiotherapy and chemotherapy, radiotherapy alone and chemotherapy alone groups （DSS rate, P=0.776; recurrent rate, P=0.937）.

Evolving treatment landscape for early and advanced pancreatic cancer

Pancreatic ductal adenocarcinoma is an infrequent cancer with a high disease related mortality rate, even in the context of early stage disease. Until recently, the rate of death from pancreatic cancer has remained largely similar whereby gemcitabine monotherapy was the mainstay of systemic treatment for most stages of disease. With the discovery of active multiagent chemotherapy regimens, namely FOLFIRINOX and gemcitabine plus nab-paclitaxel, the treatment landscape of pancreatic cancer is slowly evolving. FOLFIRINOX and gemcitabine plus nab-paclitaxel are now considered standard first line treatment options in metastatic pancreatic cancer. Studies are ongoing to investigate the utility of these same regimens in the adjuvant setting. The potential of these treatments to downstage disease is also being actively examined in the locally advanced context since neoadjuvant approaches may improve resection rates and surgical outcomes. As more emerging data become available, the management of pancreatic cancer is anticipated to change significantly in the coming years.

Role of adjuvant chemoradiotherapy and chemotherapy in patients with resected gallbladder carcinoma: a multiinstitutional analysis (KROG 19-04)

Objective:The effectiveness of adjuvant treatments for resected gallbladder carcinoma(GBC)has remained unclear due to lack of randomized controlled trials;thus,the aim of present study was to evaluate the role of adjuvant treatments,including chemoradiotherapy(CRT)and/or chemotherapy(CTx),in patients with resected GBC.Methods:A total of 733 GBC patients who received curative-intent surgical resection were identified in a multi-institutional database.Of 733 patients,372(50.8%)did not receive adjuvant treatment,whereas 215(29.3%)and 146(19.9%)received adjuvant CTx and CRT,respectively.The locoregional recurrence-free survival(LRFS),recurrence-free survival(RFS),and overall survival(OS)of the adjuvant treatment groups were compared according to tumor stage(stage II vs.stage III–IV).Results:In stage II disease(n=381),the 5-year LRFS,RFS,and OS were not significantly different among the no-adjuvant therapy,CTx,and CRT groups,and positive resection margin,presence of perineural invasion,and Nx classification were consistently associated with worse LRFS,RFS,and OS in the multivariate analysis(P<0.05).For stage III–IV(n=352),the CRT group had significantly higher 5-year LRFS,RFS,and OS than the no-adjuvant therapy and CTx groups(67.8%,45.2%,and 56.9%;37.9%,28.8%,and 35.4%;and 45.0%,30.0%,and 45.7%,respectively)(P<0.05).Conclusions:CRT has value as adjuvant treatment for resected GBC with stage III–IV disease.Further study is needed for stage II disease with high-risk features.

Role of adjuvant chemoradiotherapy in treatment of resectable esophageal carcinoma： a meta-analysis

Background The effectiveness and influence of surgery followed by adjuvant chemoradiotherapy （CRT） on the survival of patients with resectable esophageal carcinoma are still under debate. The outcomes of clinical trials have not been consistent. This study aimed to perform a meta-analysis of eligible published clinical trials to compare CRT with surgery without adjuvant chemoradiotherapy （non-CRT） for resectable esophageal carcinoma. Methods Computerized bibliographic and manual searches were undertaken to identify all eligible literature between 1990 and 2012. PubMed, EMBASE, Chinese National Knowledge Infrastructure, and Wanfang databases were our primary sources for published clinical trials. The quality of the methodology and reliability of the data from all of the clinical trials were assessed. All data were extracted by three independent researchers. Results Seven studies that included a total of 523 patients were selected. It was found that CRT significantly improved survival. The odds ratio （OR） in comparing CRT and non-CRT groups was 1.75 （95% confidence intervals （CI）： 1.17-2.60, P=0.006） for 1-year survival, 2.07 （95% CI： 1.45-2.96, P 〈0.0001） for 3-year survival, and 2.17 （95% CI： 1.45-3.26, P=0.0002） for 5-year survival. There have been no CRT treatment-related deaths reported in the literature. The incidence of related complications was high in the cases with CRT. Patients treated with CRT had a lower incidence of local-regional cancer recurrence （OR： 0.49, 95% CI： 0.31-0.76, P=0.002） and a similar incidence of distant cancer recurrence （OR： 0.90, 95% CI： 0.60-1.34, P=0.60）. Conclusions It was found that patients with resectable esophageal carcinoma could gain a survival benefit from CRT. However, CRT was associated with a high incidence of related complications.

Prognostic significance of primary tumor localization in stage Ⅱ and Ⅲ colon cancer

IM To investigate the effects of tumor localization on disease free survival(DFS) and overall survival(OS) in patients with stage Ⅱ-Ⅲ colon cancer.METHODS This retrospective study included 942 patients with stage Ⅱ and Ⅲ colon cancer, which were followed up in our clinics between 1995 and 2017. The tumors from the caecum to splenic flexure were defined as right colon cancer(RCC) and those from splenic flexure to the sigmoid colon as left colon cancer(LCC).RESULTS The median age of the patients was 58 years(range: 19-94 years). Male patients constituted 54.2%. The rates of RCC and LCC were 48.4%(n = 456) and 51.6%(n = 486), respectively. During the median follow-up of 90 mo(range: 6-252 mo), 14.6% of patients developed recurrence and 9.1% of patients died. In patients with stage Ⅱ and Ⅲ disease with or without adjuvant therapy, DFS was similar in terms of primary tumor localization(stage Ⅱ; P = 0.547 and P = 0.481, respectively; stage Ⅲ; P = 0.976 and P = 0.978, respectively). In patients with stage Ⅱ and Ⅲ disease with or without adjuvant therapy, OS was not statistically significant with respect to primary tumor localization(stage Ⅱ; P = 0.381 and P = 0.947, respectively; stage Ⅲ; P = 0.378 and P = 0.904, respectively). The difference between median OS of recurrent RCC(26 ± 6.2 mo) and LCC(34 ± 4.9 mo) cases was eight months(P = 0.092).CONCLUSION Our study showed no association of tumor localization with either DFS or OS in patients with stage Ⅱ or Ⅲ colon cancer managed with or without adjuvant therapy. However, post-recurrence OS appeared to be worse in RCC patients.

Clinical Research progress of traditional Chinese medicine in treating esophageal cancer

Esophageal cancer is one of the most common malignant tumors in the world. In recent years, the incidence and mortality of esophageal cancer have increased year by year, which has seriously threatened human health. Surgery, chemotherapy and radiotherapy, as the primary treatments of Western medicine, have achieved specific results in the clinic, but each has its limitations, this is mainly related to their side effects. The diversified treatment methods of traditional Chinese medicine have visible clinical effects, especially in terms of reducing toxicity and increasing efficiency. This present review reviews the research progress of esophageal cancer in terms of traditional Chinese medicine treatment, including the application of Chinese medicine extract, Chinese herbal compound, Chinese patent medicine and TCM external treatment in clinical practice, may provide valuable information for the adjuvant treatment of esophageal cancer with traditional Chinese medicine.

Male metaplastic breast cancer with poor prognosis:A case report

BACKGROUND Metaplastic breast cancer(MBC)is a rare subtype of breast cancer.They constitute less than 1%of breast cancer cases and are much rarer in males.There are few reports of MBC because of its rarity.MBC,an aggressive type of cancer,is refractory to common treatment modalities of breast cancer and has a poor prognosis.CASE SUMMARY We report a case of MBC in a 78-year-old man.He visited our clinic with a palpable mass on the left breast with no masses in the axillary areas.He had previously undergone robot-assisted laparoscopic radical prostatectomy for prostate cancer,but there was no family history of malignancy.The breast mass was visible on ultrasonography,mammography,and magnetic resonance imaging,and chest computed tomography revealed a lung mass in the posterior basal segment of the right lower lobe.The patient was diagnosed with metaplastic carcinoma on core needle biopsy with lung metastasis.Total mastectomy with sentinel lymph node biopsy and video-assisted segmentectomy of the right lung was performed.However,multiple metastases appeared 3 mo after surgery in the brain,chest,and abdomen,and the patient died 5 mo after the initial diagnosis.CONCLUSION MBC is an aggressive and extremely rare breast cancer type.Further case reports are needed to determine the optimal treatment.

Analysis of risk factors of surgical site infections in breast cancer

Background Adjuvant chemotherapy has become an important component of standard therapy for breast cancer. However, until now, there have been few reports on the surgical site infections （SSI） after breast cancer surgery, specially after adjuvent chemotherapy. To study the risk factors of SSI of breast cancer, we analyzed patients diagnosed with breast cancer and treated with surgery. Methods Fifty-five patients diagnosed with breast cancer and received breast conserving or modified radical operations in our hospital during January 2008 to March 2008 were selected. Factors （patients＇ age, body mass index （BMI）, diabetes mellitus, no or administered adjuvant chemotherapy, with or without onset of myelosuppression and the degree, surgical approaches, duration of operation, postoperative drainage duration and total drainage volume） associated with SSI were retrospectively reviewed and statistically analyzed by single factor analysis. Results Five patients suffered SSI （5/55, 9.1%）; nineteen receiving adjuvant chemotherapy experienced Grade III＋ myelosuppression, among which 4 had SSI; only 1 out of the remaining 36 patients without adjuvant chemotherapy had SSI. The difference between the two groups was significant （P=-0.043）. The incidence of SSI in patients with postoperative drainage tube indwelling longer than 10 days was 5/21, whereas no SSI occurred in that less than 10 days （P=0.009）. In our study, there was no significient difference in other associated factors. Conclusions Concurrent Grade III＋ myelosuppression after adjuvant chemotherapy is an important risk factor of SSI in breast cancer and needs further study. No SSI was detected with indwelling time of post operative drainage less than 10 days.