Impact of baseline steroids on the efficacy of neoadjuvant immunochemotherapy in locally advanced esophageal squamous cell carcinoma

BACKGROUND Immunochemotherapy involving the combination of programmed cell death 1/programmed cell death ligand 1 inhibitors with chemotherapy has advanced the treatment of locally advanced esophageal squamous cell carcinoma(ESCC).The use of corticosteroids as pretreatment might reduce immunotherapy efficacy.AIM To investigate the impact of baseline corticosteroid use on neoadjuvant immunochemotherapy(nIC)outcomes in locally advanced ESCC patients.METHODS Patients with locally advanced ESCC who received nIC at Sun Yat-sen University Cancer Center and the Third Affiliated Hospital of Sun Yat-sen University were included.Patients were divided into dexamethasone and antihistamine groups on the basis of the administered pretreatment.Antiallergic efficacy and safety were evaluated,as well as its impact on short-term efficacy[complete pathological response(pCR),major pathological response(MPR)]and long-term efficacy[overall survival(OS),progression-free survival(PFS)]of nIC.RESULTS From September 2019 to September 2023,142 patients were analyzed.No severe treatment-related adverse events or deaths were observed.Allergy occurrence was greater in the antihistamine group(P=0.014).Short-term efficacy was not significantly different:The pCR rates were 29.9%and 40.0%,and the MPR rates were 57.9%and 65.7%in the dexamethasone and antihistamine groups,respectively.The long-term efficacy was not significantly different:The 2 years OS rates were 95.2%and 93.5%,and the 2 years PFS rates were 90.3%and 87.8%.Subgroup analysis revealed no difference in OS between the 20 mg dexamethasone group and the<20 mg dexamethasone group,but PFS was significantly greater in the 20 mg dexamethasone group(93.9%vs 56.4%,P=0.001).CONCLUSION Dexamethasone or antihistamines can be used before nIC in locally advanced ESCC without affecting short-or long-term efficacy.Administering 20 mg dexamethasone before nIC may improve PFS in ESCC.

Neoadjuvant chemoradiotherapy plus surgery in the treatment of potentially resectable thoracic esophageal squamous cell carcinoma

BACKGROUNDIn recent years, neoadjuvant chemoradiotherapy (NCRT) combined with surgeryhas been gradually applied in patients with locally advanced thoracic esophagealcancer, but its effectiveness and safety remains unclear. In this clinical trial, weprospectively investigated the efficacy and safety of NCRT plus surgery in thetreatment of thoracic esophageal squamous cell carcinoma (TESCC).AIMTo investigate the efficacy and safety of NCRT combined with surgery in thetreatment of potentially resectable TESCC.METHODSThirty patients with advanced TESCC hospitalized in our hospital from July2016 to June 2019 were prospectively studied. All patients received NCRT, whichincluded intensity modulated conformal radiotherapy (40-44 Gy/20-22f, 2 Gy/f)and chemotherapy (paclitaxel 150-175 mg/m2d1, 22 + lobaplatin 25-30 mg/m2d2,23 for two cycles). Surgery was performed after radiotherapy and chemotherapy.The effectiveness and safety of these treatments were observed.RESULTSAmong these 30 patients, complete response was achieved in two cases (6.7%) andpartial response in 26 cases (86.7%), yielding an objective response rate of 100%.All patients underwent radical surgery successfully. The R0 resection rate was100%, and the pathologic complete response rate was 33.3%. The incidence ofgrade III- IV granulocytopenia was 10% during the NCRT, and anastomoticleakage occurred in one patient after surgery.CONCLUSIONFor patients with potentially resectable TESCC, NCRT can effectively reduce thetumor size, increase R0 resection rate, and achieve obvious pathologicaldegradation, with mild adverse reactions. Thus, it is worthy of wider clinicalapplication.

Phase Ib trial of camrelizumab combined with chemotherapy and apatinib for neoadjuvant treatment of locally advanced thoracic esophageal squamous cell carcinoma

Objective:This is a prospective,single-arm,phase Ib study to evaluate the safety and efficacy of camrelizumab combined with chemotherapy and apatinib as neoadjuvant therapy for locally advanced thoracic esophageal squamous cell carcinoma(ESCC).Methods:The regimen encompassed 2-4 cycles of neoadjuvant camrelizumab,nab-paclitaxel,nedaplatin,and apatinib to treatment-naive patients with resectable locally advanced ESCC.The treatment was repeated every 14 days.Initially,six patients were planned to receive two cycles of neoadjuvant therapy as safety assessment,and then 24 patients received four cycles of neoadjuvant therapy,followed by esophagectomy after 4-8 weeks.The primary endpoint was safety.The key secondary endpoints were pathologic complete response(pCR)and major pathologic response(MPR).Results:This study enrolled 30 patients,among whom,five patients received two cycles of neoadjuvant therapy,and one patient missed the second cycle of therapy due to grade 3 elevated alanine transaminase(ALT)level.The remaining 24 patients received four planned cycles of neoadjuvant therapy.Eleven patients(36.7%)devel-oped grade 3 neoadjuvant treatment-related adverse events(TRAEs).No patient developed grade 4 or 5 TRAEs.Neutropenia(23.3%)was the most common grade 3 TRAE.Twenty-nine patients underwent esophagectomy af-ter neoadjuvant therapy.Among them,15 patients(51.7%)achieved MPR,including seven patients with pCR(24.1%).Radiographic analyses established a significant correlation between maximal standardized uptake value(SUV max)reduction and pathologic regression(P=0.00095).Conclusions:Neoadjuvant camrelizumab combined with chemotherapy plus apatinib demonstrated a manageable safety profile for patients with locally advanced ESCC,and an encouraging efficacy was observed in most of the treated patients.A decrease in SUV max of the primary tumor may be a predictor of pathologic response to neoadjuvant camrelizumab combined with chemotherapy plus apatinib in ESCC.

Neoadjuvant Treatment for Esophageal Cancer

Because the con?icting data currently available from the performed randomized trials it is very di?cult to provide strict guidelines for the treatment of patients with locoregional advanced esophageal cancers. Surgery however, remains the standard of care for potentially resectable disease. Preoperative chemotherapy is still controversial with two large randomized trials resulting in two di?erent conclusions regarding the survival bene?t. Preoperative chemoradiation is also controversial since only one randomized trial showed a clear survival bene?t however, the patients treated with surgery alone in this trial had an unusually poor outcome. And the study by Urba et al was not powered enough to show a clear survival bene?t for patients treated with neoadjuvant chemoradiation. The results of three metaanalysis of these randomized studies show lower rate of resection, higher rate of R0-resection, more often postoperative mortality and better prognosis for patients with neoadjuvant radiochemotherapy. As a consequence one may consider o?ering neoadjuvant chemotherapy or neoadjuvant radiochemotherapy to patients with locally- advanced disease under the premise that patients have a good performance status and understand the controversies about this therapeutic option. Larger trials with su?cient power to clearly detect survival bene?ts for patients treated with neoadjuvant chemotherapy or radiochemotherapy are necessary before this therapeutic option will be the standard of care.

Covered nitinol stents for the treatment of esophageal strictures and leaks

AIM:To compare 2 different types of covered esophageal nitinol stents(Ultraflex and Choostent) in terms of efficacy,complications,and long-term outcome.METHODS:A retrospective review of a consecutive series of 65 patients who underwent endoscopic placement of an Ultraflex stent(n = 33) or a Choostent(n = 32) from June 2001 to October 2009 was conducted.RESULTS:Stent placement was successful in all patients without hospital mortality.No significant differences in patient discomfort and complications were observed between the Ultraflex stent and Choostent groups.The median follow-up time was 6 mo(interquartile range 3-16 mo).Endoscopic reintervention was required in 9 patients(14%) because of stent migration or food obstruction.No significant difference in the rate of reintervention between the 2 groups was observed(P = 0.8).The mean dysphagia score 1 mo after stent placement was 1.9 ± 0.3 for the Ultraflex stent and 2.1 ± 0.4 for the Choostent(P = 0.6).At 1-mo follow-up endoscopy,the cover membrane of the stent appeared to be damaged more frequently in the Choostent group(P = 0.34).Removal of the Choostent was possible up to 8 wk without difficulty.CONCLUSION:Ultraflex and Choostent proved to be equally reliable for palliation of dysphagia and leaks.Removal of the Choostent was easy and safe under mild sedation.

Metastasized pancreatic carcinoma with neoadjuvant FOLFIRINOX therapy and R0 resection

Patients with metastasized carcinoma of the pancreas have a very poor prognosis, and long-term survival cannot be expected. This case report describes two patients with an initial diagnosis of metastatic pancreatic cancer, both with hepatic metastases and one with an additional peritoneal carcinomatosis. Initially, both patients were treated intravenously with the FOLFIRINOX chemotherapy regimen, consisting of 5-FU, folinic acid, irinotecan and oxaliplatin. Surprisingly, the FOLFIRINOX treatment resulted in complete resolution of the hepatic metastases in both patients, with no lesions detectable by computed tomography scan. Furthermore, treatment response included decreased diameter of the primary tumor in the tail of the pancreas and disappearance of the additional peritoneal carcinomatosis. Both patients were discussed by our multidisciplinary tumor board, which recommended surgical resections of the carcinoma. The R0 resection of the primary tumor was successful in both cases and, interestingly, the resected tissues showed no evidence of the hepatic metastases intraoperatively. In the first case, the patient received a postoperative 6-mo course of adjuvant chemotherapy with gemcitabine. In the second case, the patient continued to receive the FOLFIRINOX regimen for an additional 6 mo postoperatively. At 12 mo after the operation, a nonresectable retroperitoneal lymph node metastasis was detected in the first patient, whereas the second patient remained in complete remission at the time of this report(5 mo after the adjuvant therapy was discontinued). This case report is the first of its kind to describe two cases of hepatic metastatic pancreatic carcinoma that were resectable following treatment with FOLFIRINOX. Further studies are required to examine the role of FOLFIRINOX as a neoadjuvant treatment option in subgroups of patients with initially metastasized pancreatic carcinoma.

Medical expenditure for esophageal cancer in China:a 10-year multicenter retrospective survey(2002-2011)

Background: Esophageal cancer is associated with substantial disease burden in China, and data on the economic burden are fundamental for setting priorities in cancer interventions. The medical expenditure for the diagnosis and treatment of esophageal cancer in China has not been fully quantified. This study aimed to examine the medical expenditure of Chinese patients with esophageal cancer and the associated trends.Methods: From 2012 to 2014, a hospital-based multicenter retrospective survey was conducted in 37 hospitals in 13 provinces/municipalities across China as a part of the Cancer Screening Program of Urban China. For each esophageal cancer patient diagnosed between 2002 and 2011, clinical information and expense data were extracted by using structured questionnaires. All expense data were reported in Chinese Yuan(CNY; 1 CNY = 0.155 USD) based on the2011 value and inflated using the year-specific health care consumer price index for China.Results: A total of 14,967 esophageal cancer patients were included in the analysis. It was estimated that the overall average expenditure per patient was 38,666 CNY, and an average annual increase of 6.27% was observed from 2002(25,111 CNY) to 2011(46,124 CNY). The average expenditures were 34,460 CNY for stage Ⅰ,39,302 CNY for stage Ⅱ,40,353 CNY for stage Ⅲ, and 37,432 CNY for stage IV diseases(P < 0.01). The expenditure also differed by the therapy type, which was 38,492 CNY for surgery, 27,933 CNY for radiotherapy, and 27,805 CNY for chemotherapy(P < 0.05).Drugs contributed to 45.02% of the overall expenditure.Conclusions: These conservative estimates suggested that medical expenditures for esophageal cancer in China substantially increased in the last 10 years, treatment for early-stage esophageal cancer costs less than that for advanced cases, and spending on drugs continued to account for a considerable proportion of the overall expenditure.

Radiotherapy combined with nimotuzumab for elderly esophageal cancer patients:A phaseⅡclinical trial

Objective:To investigate the safety and efficacy of nimotuzumab combined with radiotherapy for elderly patients with non-resectable esophageal carcinoma(EC).Methods:Eligible patients were aged 70 years or older and had treatment-naive,histologically proven inoperable locally advanced EC.Enrolled patients received radiotherapy with a total dose of 50-60 Gy in 25-30 fractions,concurrent with weekly infusion of nimotuzumab.The primary end point was the rate of more than grade 3 toxicities.Results:From June 2011 to July 2016,46 patients with stageⅡ-IV EC with a median age of 76.5 years were enrolled.There were 10,28 and 8 patients with stageⅡ,III and IV disease,respectively.The common acute toxicities included esophagitis(grade 1-2,75.4%;grade 3,8.7%),pneumonitis(grade 1,4.3%;grade 2,6.5%;grade3,2.2%),leukopenia(grade 1-2,60.9%;grade 3-4,4.4%),gastrointestinal reaction(grade 1-2,17.3%;grade 3,2.2%),thrombocytopenia(grade 1-2,21.7%;grade 3,2.2%),and radiothermitis(grade 1-2,39.2%).The incidence of grade 3-4 adverse effects was 17.4%.No grade 5 toxicities were observed.Clinical complete response,partial response,stable disease,and progressive disease were observed in 1(2.2%),31(67.4%),12(26.1%),and 2(4.3%)patients,respectively.The median overall survival(OS)and progression-free survival(PFS)were 17 and 10 months,respectively.The 2-,3-,and 5-year OS and PFS rates were 30.4%,21.7%,19.6%,and 26.1%,19.6%,19.6%,respectively.Conclusions:Nimotuzumab combined with radiotherapy is a safe and effective therapy for elderly patients who are not surgical candidates.Further studies are warranted to confirm its therapeutic effects in elderly EC patients.

Neoadjuvant chemotherapy for locally advanced gastric cancer:With or without radiation

The role of perioperative chemotherapy for gastric cancer has been established for gastric cancers in their advanced stage.In most parts of the world,even in Japan and Korea,local recurrence of gastric cancer following curative resection remains a problem.Should radiation be added to chemotherapy to achieve better local and regional control? What is the current evidence? What are the concerns regarding neoadjuvant chemoradiation in terms of safety,efficacy and survival benefit? After a serious review of the literature,the authors conclude that it is still too early to get a definitive answer but radiation seems promising.It may bring a higher pathological response rate.Rationally,more high level clinical trials are needed to confirm the role of radiotherapy in the neoadjuvant setting or to ascertain subsets of patients who may benefit from it.It is of note that surgeons should pay attention to possible complicated circumstances following radiotherapy,maintain proper nutrition status and minimize the occurrence of postoperative complications.As few data are available in Japan and Korea,interpretation and implementation of neoadjuvant radiation or chemoradiation should be done with caution.

pN_(0)期食管鳞癌患者胸腹两野术后2年内复发的因素分析

目的:探讨胸腹两野术后pN_(0)期食管鳞癌患者2年内复发的因素及其特点。方法:收集自2013年01月至2018年12月在我院接受手术治疗且符合入组条件的食管癌术后患者共467例,分析其生存情况、2年内复发的影响因素和复发模式等,应用SPSS 25.0统计软件进行统计分析。结果:全组患者1、3、5年总生存率分别为88.4%、71.9%和62.9%;55例患者2年内出现复发,其1、3、5年总生存率显著性低于其他患者(χ^(2)=103.258,P=0.000)。2年内复发患者的复发时间为1.2~24.0个月,中位9.0个月。单因素分析结果显示胸上段食管癌患者在2年内复发的比率为21.3%,显著性高于胸中/下段癌患者(χ^(2)=7.045,P=0.030);术中粘连程度越高则复发率越高(χ^(2)=6.653,P=0.036);pT分期越晚的患者其复发的风险也显著性增加(χ^(2)=15.975,P=0.001)。多因素分析结果显示食管病变部位和T分期为影响本组患者2年内复发的独立性因素(P=0.011、0.000)。单纯纵隔内淋巴结复发26例(47.3%),为本组2年内复发患者的主要复发部位。结论:pN_(0)期胸段食管鳞癌患者其2年内有较高的局部复发率,且复发模式主要以纵隔淋巴结复发为主,病理T分期和病变部位为影响其2年内复发的独立性影响因素,临床医师应对胸上段食管癌和pT分期较晚的患者进行积极随访观察和必要的辅助治疗。

EGFR突变可切除的NSCLC围手术期辅助靶向治疗研究进展及问题探讨

肺癌在全球范围内仍是导致癌症死亡的首要原因,非小细胞肺癌(non-small cell lung cancer,NSCLC)是肺癌的主要病理类型,占80%左右。在所有NSCLC患者中,约30%初诊时为可切除的早中期NSCLC。近期表皮生长因子受体-酪氨酸激酶抑制剂(epidermal growth factor receptor-tyrosine kinase inhibitors,EGFR-TKIs)在EGFR突变可切除的NSCLC围手术期辅助靶向治疗中取得重大突破,并被指南推荐应用于临床。本文在总结EGFR突变可切除NSCLC围手术期辅助靶向治疗临床研究进展的基础上,针对临床研究中的关键问题进行探讨。

不同疗程糖皮质激素对食管黏膜下剥离术后食管狭窄预防的效果

目的对比分析糖皮质激素不同疗程及减药方式对内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)术后预防食管狭窄的效果。方法回顾性收集2017年1月至2023年1月在我科因食管早癌和癌前病变行ESD手术,术后采取口服激素的方式预防食管狭窄的患者共67例,依据术后口服糖皮质激素的方式分别纳入3周组、8周组、12周组。对比不同组别的食管狭窄情况、狭窄后行球囊扩张的次数、激素相关并发症等情况。结果3周组、8周组、12周组的ESD术后食管狭窄率分别为23.8%(5/21)、22.9%(8/35)、18.2%(2/11),差异无统计学意义(P>0.05)。狭窄后应用内镜下球囊扩张的平均次数分别为3周组(2.80±0.84)次、8周组(2.25±0.71)次、12周组(2.50±0.71)次,差异无统计学意义(P>0.05)。激素相关不良反应的发生率分别为0,5.7%(2/35),27.3%(3/11),其中,3周组与8周组的激素相关不良反应发生率差异无统计学意义(P>0.05),而3周组与12周组(P=0.012)、8周组与12周组激素相关不良反应发生率(P=0.045)差异有统计学意义。结论口服糖皮质激素可预防食管大面积ESD术后狭窄。3周疗法、8周疗法、12周疗法在预防狭窄及狭窄后球囊扩张次数上具有相似效果,但短期、小剂量激素应用其不良反应最少,安全性高。

能谱CT碘基值预测局部进展期胃腺癌新辅助化疗疗效

目的:探讨基线期能谱CT碘基值预测局部进展期胃腺癌新辅助化疗(NAC)后病理学反应的应用价值。方法:2021年1月至2021年12月间,前瞻性对拟行新辅助化疗联合手术治疗的局部进展期胃腺癌患者于治疗前1周内行能谱CT动脉期、静脉期和延迟期三期增强扫描。收集患者临床病理信息,测量增强各期胃癌病灶的碘基值(IC),并除以主动脉碘基值得到标化碘基值(nIC)。根据术后AJCC肿瘤退缩分级(TRG)标准分为病理缓解良好组(TRG=0+1)和病理缓解不良组(TRG=2+3)。比较两组间临床指标和碘基值的差异,采用多因素回归方法筛选胃癌NAC疗效的独立预测因素,采用受试者工作特征曲线和曲线下面积(AUC)评估IC值的预测效能。结果:筛选出符合条件的患者70例,其中男55例,女15例,年龄范围30~71岁,中位年龄59岁。病理缓解良好22例,缓解不良48例。缓解良好组的静脉期标化碘基值(nICVP)、延迟期标化碘基值(nICDP)值低于缓解不良组,差异有统计学意义(t=2.391、2.270,P均<0.05);回归分析结果显示nICVP和CT报告淋巴结状态是胃癌NAC疗效的独立预测指标,联合两者的诺模图预测胃癌NAC后病理学反应的AUC为0.821(95%CI:0.711~0.902),依次高于nICVP、联合nICVP和nICDP、nICDP(Z=2.306、2.161、2.228,P均<0.05),以诺模图分数>0.684为诊断阈值,其预测病理缓解不良的敏感度、特异度、阳性预测值、阴性预测值分别为75.00%、81.80%、65.58%、87.71%。结论:基线期胃癌病灶nICVP和nICDP能鉴别新辅助化疗后不同病理缓解状态,nICVP和CT报告淋巴结状态是预测新辅助化疗疗效的独立风险因素,联合两者能进一步提高预测效能。

多模态超声动态评估乳腺癌新辅助化疗疗效

目的观察多模态超声动态评估新辅助化疗(NACT)用于乳腺癌效果的价值。方法回顾性分析50例接受术前NACT的单发乳腺癌患者,根据术后病理将其分为组织学显著反应(MHR)组(n=26)及组织学非显著反应(NMHR)组(n=24);对比观察组间NACT前,以及NACT前、中、后期超声指标变化,以及组间、组内定量指标在接受NACT过程中的缩小率。结果完成NACT后,组间病灶最大径、最大杨氏模量值(E_(max))变化及平均杨氏模量值(E_(mean))变化差异均有统计学意义(P均<0.05),病灶缩小方式及血流分级差异均无统计学意义(P均>0.05)。NACT前、中、后期,MHR组病灶最大径渐进缩小率(PRR)逐渐降低,而NMHR组呈“中期缩小-后期增大”趋势;2组组内最大径≥2 cm病灶(n=3、9)总缩小率(TRR)及各期PRR均高于最大径<2 cm病灶(n=23、15,P均<0.05)。NACT前、中、后期,2组E_(max)及E_(mean)的PRR均呈逐渐增高趋势,组内E_(max)降低≥30%病灶(n=14、5)TRR及各期PRR均高于E_(max)降低<30%病灶(n=12、19),E_(mean)降低≥30%病灶(n=18、7)TRR及各期PRR均高于E_(mean)降低<30%病灶(n=8、17,P均<0.05)。结论多模态超声可用于动态评估NACT用于乳腺癌效果,进而指导制定个体化治疗方案。

LAR与晚期食管鳞癌病人新辅助放化疗预后的关系

目的分析乳酸脱氢酶(LDH)和清蛋白(ALB)及其比值(LAR)与晚期食管鳞癌病人新辅助放化疗预后的关系,以及影响预后的危险因素。方法选取2021年12月—2022年12月在临汾市中心医院接受新辅助放化疗的86例晚期食管鳞癌病人为研究对象,并依据预后结果分为预后不良组和预后良好组。比较两组病人治疗后LDH、ALB和LAR;分析LAR与预后的关系及其评估价值,以及影响预后的危险因素。结果预后良好组LDH和LAR显著低于预后不良组,而ALB显著高于预后不良组(t=11.584~14.984,P<0.05);LDH、ALB及LAR评估晚期食管鳞癌病人新辅助放化疗预后的受试者工作特征曲线下面积分别为0.832、0.744和0.919。预后不良组肿瘤为低分化和浸润深度≥5 mm的构成比均显著高于预后良好组(χ^(2)=8.524、10.223,P<0.05)。Logistic回归分析显示,肿瘤分化程度低、浸润深度≥5 mm和LAR≥8.4是影响晚期食管鳞癌病人新辅助放化疗预后不良的危险因素(OR=3.043~4.604,95%CI=(1.468~1.801)^(6.310~11.773),P<0.05)。结论肿瘤分化程度、浸润深度和LAR是影响晚期食管鳞癌病人新辅助放化疗预后的危险因素,对晚期食管鳞癌病人新辅助放化疗预后有一定评估效能。

卡瑞利珠单抗联合安罗替尼对晚期食管癌患者疗效及淋巴细胞亚群的影响

目的观察和分析晚期食管癌患者联合应用卡瑞丽珠单抗及安罗替尼的临床疗效以及对淋巴细胞亚群产生的影响。方法将自2020年1月至2023年3月进行治疗的晚期食管癌患者116例分为2组,均应用紫衫醇和紫杉醇^(+)顺铂(TP)方案,采用随机数字表法为分组工具,对照组联合应用卡瑞丽珠单抗注射液治疗,观察组联合应用卡瑞丽珠单抗及安罗替尼治疗,比较近期临床疗效、预后情况以及术后并发症情况。结果观察组患者客观缓解率及临床总有效率均高于对照组(P<0.05)。2组治疗前CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)及NK细胞水平差异无统计学意义(P>0.05),治疗后观察组CD4^(+)、CD4^(+)/CD8^(+)、NK细胞水平均高于对照组,CD8^(+)低于对照组(P<0.05)。治疗前2组鳞状细胞瘤相关抗原(SCC-Ag)、高迁移率蛋白B1(HMGB1)、癌胚抗原(CEA)水平差异无统计学意义(P>0.05),治疗后观察组各项血清肿瘤标志物水平均较对照组低(P<0.05)。观察组Ⅲ级声音嘶哑率、Ⅲ级肺炎率及Ⅲ级气胸率高于对照组(P<0.05)。结论晚期食管癌患者联合应用卡瑞丽珠单抗、安罗替尼对于促进近期临床疗效提升有重要意义,能够促进肿瘤标志物水平降低并可有效减轻对免疫力造成的影响。

Spleen and pancreatic tail thorax translocation facilitating residual stomach esophagus anastomosis

Objective:To investigate the value of spleen and pancreatic tail thorax translocation on the residual stomach esophagus anastomosis.Methods:10 patients with esophageal carcinoma after gastrectomy were enrolled in this study. Lesions were removed through left thoracotomy and residual stomach was fully mobilized,with short gastric artery being re- served.Spleen and pancreatic tail were dissected from the back of peritoneum and transposed into thorax.Residual stomach esophagus anastomosis was performed.Results:All the operation went favorably.Patients were recovered rapidly and a relatively good prognosis was acquired.Late leakage and pleural effusion happened in one case respectively,but these com- plications were cured through conservative management without operation death.Conclusion:Residual stomach is an ideal candidate for the replacement of esophagus and residual stomach esophagus anastomosis is a simple operative alternative with few trauma and good results for the treatment of esophageal carcinoma after gastrectomy.

新辅助化疗联合手术治疗食管癌的效果

目的探讨新辅助化疗联合手术治疗食管癌的效果。方法将2022年1—12月龙岩市第二医院收治的30例行新辅助化疗联合手术治疗的食管癌患者作为研究组,并选取同期仅行单纯手术治疗的另30例食管癌患者作为对照组。比较两组患者治疗前后的血管新生指标、肿瘤标志物水平,评价治疗效果并统计患者术后的并发症发生情况。结果治疗后,两组血管新生指标、肿瘤标志物水平较治疗前下降,且研究组低于对照组(P<0.05)。研究组患者治疗疾病控制率(disease control rate,DCR)、客观缓解率(overall response rate,ORR)均高于对照组,差异有统计学意义(P<0.05)。研究组患者并发症总发生率稍高于对照组,但差异无统计学意义(P>0.05)。结论新辅助化疗联合手术治疗食管癌术后,可显著地改善患者的血清血管新生指标、肿瘤标志物水平,获得理想的DCR、ORR,虽增加术后发生吻合口瘘及肺部感染风险,但影响不大。

食管癌围术期治疗的争议与共识

食管癌是全球排名第七的恶性肿瘤,在癌症相关的死亡原因中排名第六。手术治疗是可切除食管癌的主要治疗方式,但对于局部晚期食管癌患者,单纯手术治疗后,局部复发和远处转移缩短了患者的生存期,因此除极早期肿瘤外,所有患者推荐术前行新辅助放化疗或新辅助化疗。但是仍然有一部分患者未能在术前行新辅助治疗,这就需要术后辅助治疗来改善患者预后。本文系统回顾了食管癌围术期治疗的研究进展,包括新辅助治疗和辅助治疗,并结合指南对食管癌围术期的治疗方案进行了总结。

放射治疗在食管癌综合治疗中的作用进展

食管癌具有独特的解剖学特征和生物学行为,因此综合治疗中的各个手段在疾病的不同阶段均可能发挥重要作用。放射治疗(以下简称放疗)是食管癌的主要治疗手段之一。随着研究的深入,以及设备和技术的进步,除了可切除局部晚期食管癌的术前放疗、术后辅助放疗以及不可切除食管癌的根治性放疗等标准治疗模式之外,放疗在当前的综合治疗模式下逐渐展现出更多的作用,机制也日趋复杂。本文将就食管癌综合治疗中放疗作用的相关进展进行综述,主要按照不同分期展开,包括放疗在早期食管癌中与内镜下治疗联合应用;在可切除局部晚期食管癌中,放疗与免疫治疗联合用于新辅助治疗的研究,并且在器官保留方面进行了根治性放疗加挽救治疗的初步探索;以及放疗在复发/转移性食管癌中也显示出良好的治疗潜力等内容。今后,应基于更加紧密的多学科协作,结合新理念、新技术,进一步提高食管癌精准放疗的个体化水平。