Introduction:Preoperative chemoradiotherapy(CRT),followed by total mesorectal excision,has become the standard of care for patients with clinical stages II and III rectal cancer.Patients with pathologic complete respo...Introduction:Preoperative chemoradiotherapy(CRT),followed by total mesorectal excision,has become the standard of care for patients with clinical stages II and III rectal cancer.Patients with pathologic complete response(pCR) to preoperative CRT have been reported to have better outcomes than those without pCR.However,the factors that predict the response to neoadjuvant CRT have not been well defined.In this study,we aimed to investigate the impact of clinical parameters on the development of pCR after neoadjuvant chemoradiation for rectal cancer.Methods:A total of 323 consecutive patients from a single institution who had clinical stage II or III rectal cancer and underwent a long-course neoadjuvant CRT,followed by curative surgery,between 2005 and 2013 were included.Patients were divided into two groups according to their responses to neoadjuvant therapy:the pCR and non-pCR groups.The clinical parameters were analyzed by univariate and multivariate analyses,with pCR as the dependent variable.Results:Of the 323 patients,75(23.2%) achieved pCR.The two groups were comparable in terms of age,sex,body mass index,tumor stage,tumor location,tumor differentiation,radiation dose,and chemotherapy regimen.On multivariate analysis,a pretreatment carcinoembryonic antigen(CEA) level of <5 ng/mL[odds ratio(OR) = 2.170,95%confidence interval(CI) = 1.195-3.939,P = 0.011]and an interval of >7 weeks between the completion of chemoradiation and surgical resection(OR = 2.588,95%CI = 1.484-4.512,P = 0.001) were significantly associated with an increased rate of pCR.Conclusions:The pretreatment CEA level and neoadjuvant chemoradiotherapy-surgery interval were independent clinical predictors for achieving pCR.These results may help clinicians predict the prognosis of patients and develop adaptive treatment strategies.展开更多
AIM:To investigate the predictive factors of selfexpandable metallic stent patency after stent placement in patients with inoperable malignant gastroduodenal obstruction. METHODS:A total of 116 patients underwent sten...AIM:To investigate the predictive factors of selfexpandable metallic stent patency after stent placement in patients with inoperable malignant gastroduodenal obstruction. METHODS:A total of 116 patients underwent stent placements for inoperable malignant gastroduodenal obstruction at a tertiary academic center. Clinical success was defined as acceptable decompression of the obstructive lesion within the malignant gastroduodenal neoplasm. We evaluated patient comorbidities and clinical statuses using the World Health Organization's scoring system and categorized patient responses to chemotherapy using the Response Evaluation Criteria in Solid Tumors criteria. We analyzed the relationships between possible predictive factors and stent patency. RESULTS:Self-expandable metallic stent placement was technically successful in all patients(100%),and the clinical success rate was 84.2%. In a multivariate Cox proportional hazards model,carcinoembryonic antigen(CEA) levels were correlated with a reduction in stent patency [P = 0.006; adjusted hazard ratio(a HR)= 2.92,95%CI:1.36-6.25]. Palliative chemotherapy was statistically associated with an increase in stent patency(P = 0.009; a HR = 0.27,95%CI:0.10-0.72).CONCLUSION:CEA levels can easily be measured at the time of stent placement and may help clinicians to predict stent patency and determine the appropriate stent procedure.展开更多
文摘Introduction:Preoperative chemoradiotherapy(CRT),followed by total mesorectal excision,has become the standard of care for patients with clinical stages II and III rectal cancer.Patients with pathologic complete response(pCR) to preoperative CRT have been reported to have better outcomes than those without pCR.However,the factors that predict the response to neoadjuvant CRT have not been well defined.In this study,we aimed to investigate the impact of clinical parameters on the development of pCR after neoadjuvant chemoradiation for rectal cancer.Methods:A total of 323 consecutive patients from a single institution who had clinical stage II or III rectal cancer and underwent a long-course neoadjuvant CRT,followed by curative surgery,between 2005 and 2013 were included.Patients were divided into two groups according to their responses to neoadjuvant therapy:the pCR and non-pCR groups.The clinical parameters were analyzed by univariate and multivariate analyses,with pCR as the dependent variable.Results:Of the 323 patients,75(23.2%) achieved pCR.The two groups were comparable in terms of age,sex,body mass index,tumor stage,tumor location,tumor differentiation,radiation dose,and chemotherapy regimen.On multivariate analysis,a pretreatment carcinoembryonic antigen(CEA) level of <5 ng/mL[odds ratio(OR) = 2.170,95%confidence interval(CI) = 1.195-3.939,P = 0.011]and an interval of >7 weeks between the completion of chemoradiation and surgical resection(OR = 2.588,95%CI = 1.484-4.512,P = 0.001) were significantly associated with an increased rate of pCR.Conclusions:The pretreatment CEA level and neoadjuvant chemoradiotherapy-surgery interval were independent clinical predictors for achieving pCR.These results may help clinicians predict the prognosis of patients and develop adaptive treatment strategies.
基金Supported by Technology Innovation Program(or Industrial Strategic technology development program),No.10049743,Establishing a medical device development open platform,as a hub for accelerating close firm-hospital communication)funded By the Ministry of Trade,industry and Energy(MI,South Korea)
文摘AIM:To investigate the predictive factors of selfexpandable metallic stent patency after stent placement in patients with inoperable malignant gastroduodenal obstruction. METHODS:A total of 116 patients underwent stent placements for inoperable malignant gastroduodenal obstruction at a tertiary academic center. Clinical success was defined as acceptable decompression of the obstructive lesion within the malignant gastroduodenal neoplasm. We evaluated patient comorbidities and clinical statuses using the World Health Organization's scoring system and categorized patient responses to chemotherapy using the Response Evaluation Criteria in Solid Tumors criteria. We analyzed the relationships between possible predictive factors and stent patency. RESULTS:Self-expandable metallic stent placement was technically successful in all patients(100%),and the clinical success rate was 84.2%. In a multivariate Cox proportional hazards model,carcinoembryonic antigen(CEA) levels were correlated with a reduction in stent patency [P = 0.006; adjusted hazard ratio(a HR)= 2.92,95%CI:1.36-6.25]. Palliative chemotherapy was statistically associated with an increase in stent patency(P = 0.009; a HR = 0.27,95%CI:0.10-0.72).CONCLUSION:CEA levels can easily be measured at the time of stent placement and may help clinicians to predict stent patency and determine the appropriate stent procedure.
