Successful conversion of advanced gastric cancer treated by immunotherapy combined with chemotherapy: A case report

Gastric cancer is one of the most common malignant tumors,for patients with advanced gastric cancer,the traditional treatment is mainly chemotherapy or combined targeted therapy;however,these have not achieved ideal efficacy.However,with the continuous deepening of research on molecular targeted drugs and immunosuppressants,the treatment of advanced gastric cancer patients has made new progress,and some new technologies have also been continuously emerged and applied,which brings hope for the treatment of advanced gastric cancer.Recently,several multicenter randomized controlled phase III studies on immunotherapy for advanced gastric cancer yielded encouraging results,demonstrating its superior efficacy in the treatment of advanced gastric cancer.However,prospective data to support the acceptance of surgery and the R0 removal rate following conversion therapy with immune checkpoint inhibitors are lacking.In this study,a 58-year-old woman with advanced gastric cancer and positive PD-L1 expression,negative HER-2 expression,and microsatellite stable status received immunochemotherapy combined with traditional Chinese medicine to achieve R0 resection and satisfactory efficacy.

The Chinese Society of Clinical Oncology (CSCO): Clinical guidelines for the diagnosis and treatment of gastric cancer, 2023

The 2023 update of the Chinese Society of Clinical Oncology(CSCO)Clini-cal Guidelines for Gastric Cancer focuses on standardizing cancer diagnosis and treatment in China,reflecting the latest advancements in evidence-based medicine,healthcare resource availability,and precision medicine.These updates address the differences in epidemiological characteristics,clinicopatho-logical features,tumor biology,treatment patterns,and drug selections between Eastern and Western gastric cancer patients.Key revisions include a structured template for imaging diagnosis reports,updated standards for molecular marker testing in pathological diagnosis,and an elevated recommendation for neoadju-vant chemotherapy in stage III gastric cancer.For advanced metastatic gastric cancer,the guidelines introduce new recommendations for immunotherapy,anti-angiogenic therapy and targeted drugs,along with updated management strategies for human epidermal growth factor receptor 2(HER2)-positive and deficient DNA mismatch repair(dMMR)/microsatellite instability-high(MSI-H)patients.Additionally,the guidelines offer detailed screening recommendations for hereditary gastric cancer and an appendix listing drug treatment regimens for various stages of gastric cancer.The 2023 CSCO Clinical Guidelines for Gastric Cancer updates are based on both Chinese and international clinical research and expert consensus to enhance their applicability and relevance in clinical practice,particularly in the heterogeneous healthcare landscape of China,while maintaining a commitment to scientific rigor,impartiality,and timely revisions.

药食同源中药治疗胃癌癌因性疲乏的用药规律

目的:通过对文献的数据挖掘,初步探讨干预胃癌癌因性疲乏(CRF)的药食同源中药用药规律,并结合CRF中医病机及现代药理学研究进行分析。方法:检索国家知识基础设施数据库(CNKI)、中国学术期刊数据库(CSPD),筛选自建立数据库开始至2022年4月10日期间治疗胃癌CRF的临床文献,借助Microsoft Excel 2021及SPSS Modeler 26.0统计软件,以2018年卫健委公布的110种药食同源中药为参考,对收集文献所涉及的药食同源中药进行频数频率、性味归经、药效分类、关联规则分析、聚类分析,根据统计结果探讨药食同源中药干预胃癌CRF的用药规律。结果:收集文献中共有药食同源中药43味(占2018年卫健委所公布110种药食同源中药的39.09%),出现频数376次(占文献全部165味中药出现频数的49.41%);频数≥10次的药食同源中药共14味,按频数降序排列依次为黄芪、茯苓、当归、甘草、党参等;干预胃癌CRF的药食同源中药四气以平、温为主,五味以甘味药为主,归经以归脾经最多;发掘出21组治疗胃癌CRF的药食同源中药组合,支持度最高的组合是黄芪-当归;聚类分析提取获得3个核心聚类群。结论:药食同源中药干预胃癌CRF以健脾和胃为基本治则,辅以补肺滋肾,养血生津,理气燥湿为法,常用药食同源中药为黄芪、茯苓、当归等,可将这些药食同源中药用于胃癌CRF的治疗及保健食品的开发中。

肺癌分子靶向治疗EGFR-TKI患者证候及中医处方用药研究进展

表皮生长因子受体酪氨酸激酶抑制剂(Epidermal growth factor receptor tyrosine kinase inhibitor,EGFR-TKI)是肺癌治疗领域的里程碑,中医药与分子靶向治疗EGFR-TKI相结合是肺癌综合治疗的新模式。辨证论治是中医的特色,中医药的精准配合,可以贯穿于分子靶向治疗EGFR-TKI的全程。通过查阅、归纳及分析近年来不同专家学者对分子靶向治疗EGFR-TKI相关肺癌患者不同治疗阶段的中医证候及中医处方用药研究的文献,总结肺癌分子靶向治疗EGFR-TKI患者在不同治疗阶段的证候分布及中医处方用药特点,促使中医辨证论治更加精准,旨在进一步提高临床上中医药配合分子靶向治疗EGFR-TKI的效果。

从“态靶辨治”角度分析蔡淦治疗脾虚瘀热型胃癌前病变经验

从“态靶辨治”角度介绍蔡淦教授治疗脾虚瘀热型胃癌前病变的经验。认为其基本病机为脾失健运,湿阻热蕴,气滞血瘀胶着于胃腑;临证强调“态靶辨治”,把握“基本态”、紧扣“疾病靶”、把控“症状靶”、参考“指标靶”;治疗时灵活运用经验方莪连颗粒健脾益气、化瘀清热以调态,并通过抗幽门螺杆菌、调节炎症因子及肿瘤指标表达水平、提高机体免疫力、影响相关信号通路等途径“精确打靶”,疗效突出。并附验案1则。

基于“土壅木郁”探讨消化道恶性肿瘤相关性抑郁的病机与治法

通过阐释“土壅木郁”的理论内涵,探讨消化道恶性肿瘤相关性抑郁的中医病机及治法。认为“土壅木郁”是消化道恶性肿瘤相关性抑郁的重要病机。治疗首当抗癌解毒、养正固本以断其源;治疗核心为疏土达木、调和肝脾,强调土壅疏之、木郁达之、运通中焦、和畅气机;治疗关键在于畅达情志、调摄精神。

中药通过细胞外信号调节激酶信号通路调控胃癌的研究进展

胃癌在我国发病率和死亡率较高,存在发现晚、5年生存率低的特点,手术切除仍然是临床治疗的主要方法。大鼠肉瘤蛋白(Ras)/迅速加速性纤维肉瘤蛋白(Raf)/丝裂原活化的细胞外信号调节激酶(MEK)/细胞外信号调节激酶(ERK)信号通路在调控细胞增殖、转移、凋亡等方面具有非常重要的作用,与胃癌的发生与发展密切相关。近年来,很多学者探索调控Ras/Raf/MEK/ERK信号通路治疗胃癌的作用机制,在信号转导机制研究、靶向抑制剂筛选、中医药治疗等方面取得大量成果,实验验证在胃癌的治疗中干预其信号传递具有良好的效果和应用前景。

中药联合分子靶向药物治疗非小细胞肺癌用药规律

目的:收集整理中药联合靶向治疗非小细胞肺癌文献数据,分析常用中药组方规律。方法:通过检索中国生物医学文献数据库、万方数据库、中国知网中中药联合靶向药物治疗非小细胞肺癌临床观察的文献,经筛选后运用古今医案云平台进行频次分析、聚类分析、关联规则分析、复杂网络分析等。结果:使用频次排名前3的药物为茯苓、白术、黄芪;功效以清热解毒最多见,中药四气、五味、归经以味甘、性平、归肺经为主;通过关联规则得出核心药对28个;聚类分析得到核心药组5类;复杂网络分析得出治疗非小细胞肺癌联合靶向治疗的核心处方共计11味药。结论:中药联合靶向药物治疗非小细胞肺癌核心中药为茯苓、白术、黄芪;治法以健脾益气为主,以六君子汤为基础方,同时配合燥湿化痰、清热解毒、养阴等治标。

健脾化瘀汤联合化疗对胃癌患者免疫功能及肿瘤标志物水平的影响

目的探讨健脾化瘀汤联合化疗对胃癌患者免疫功能及肿瘤标志物水平的影响。方法选取2021年1月—2022年12月收治的62例胃癌患者,以随机数字表法分为对照组(31例,接受替吉奥联合奥沙利铂治疗)和观察组(31例,在对照组基础上联合健脾化瘀汤治疗)。比较2组治疗效果。结果观察组治疗总有效率高于对照组(P<0.05);2组治疗后血清肿瘤标志物水平均降低,且观察组更低(P<0.05);2组治疗后免疫功能指标均上升,且观察组更高(P<0.05)。结论健脾化瘀汤联合化疗可抑制胃癌患者肿瘤细胞复制,增强免疫功能,临床疗效显著。

蒌贝二陈汤治疗胃癌术后胃食管反流病临床观察

目的观察蒌贝二陈汤治疗胃癌术后胃食管反流病的临床效果。方法选择胃癌术后胃食管反流病患者100例,随机分为观察组和对照组,各50例。对照组采用常规治疗,观察组采用蒌贝二陈汤治疗。比较2组患者的临床效果,胸骨后疼痛、烧心、反酸、胃胀、嗳气等症状评分以及随访治愈情况。结果治疗后,观察组总有效率为94.0%(47/50),高于对照组的70.0%(35/50)(P<0.05);观察组的胸骨后疼痛、烧心、反酸、胃胀、嗳气等症状评分均明显低于对照组(P<0.05);治疗结束3个月后,随访2组患者治愈情况,观察组治愈率为80.0%(40/50),高于对照组的50.0%(25/50)(P<0.05)。结论蒌贝二陈汤能够显著改善胃癌术后胃食管反流病患者的临床症状,疗效显著。

益胃消癌汤辅助化疗治疗进展期胃癌临床观察

目的深入细致地分析和研究益胃消癌汤辅助化疗治疗进展期胃癌的效果。方法选择2020年4月—2022年3月中国医科大学附属第一医院进展期胃癌患者96例,根据治疗方案随机分为常规治疗组(化疗治疗)和联合治疗组(益胃消癌汤辅助化疗治疗),每组48例,比较两组治疗结果。结果联合治疗组总有效率为93.75%(45/48),高于常规治疗组的79.17%(38/48)(P<0.05)。治疗后,两组红细胞计数、白细胞计数、癌胚抗原水平低于治疗前;联合治疗组红细胞计数、白细胞计数高于常规治疗组,癌胚抗原水平低于常规治疗组。治疗后,联合治疗组食欲不振、早饱、上腹胀、胃脘疼痛的中医证候评分低于常规治疗组(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论运用益胃消癌汤辅助化疗治疗进展期胃癌,效果较好,值得临床推广。

正念减压疗法联合中医情志护理对胃肠道癌术后患者知觉压力及遵医行为的影响

目的:探讨正念减压疗法联合中医情志护理在胃肠道癌术后的应用价值。方法:选取2021年2月—2023年2月384例胃肠道癌术后患者,按入院顺序分为常规组(n=192)、正念减压组(n=192),2组均行常规护理,常规组在常规护理基础上行中医情志护理,正念减压组在常规组基础上行正念减压疗法,2组均干预3个月。比较2组胃肠道功能、知觉压力[中文版知觉压力量表(CPSS)]、遵医行为、生活质量[生活质量量表(GQOL-74)]。结果:正念减压组肛门排气、肠鸣音恢复、排便、进食时间均短于常规组(P<0.05);与干预前比较,干预后各组CPSS评分明显降低,且正念减压组改善更为显著(P<0.05);干预后正念减压组遵医用药、健康饮食、适当运动、按时复诊等遵医行为评分升高幅度>常规组(P<0.05);与干预前比较,各组GQOL-74评分明显升高,且正念减压组改善更为显著(P<0.05)。结论:对胃肠道癌术后患者实施正念减压疗法联合中医情志护理,能减轻知觉压力、提高遵医行为、改善胃肠道功能、提高生活质量。

The Chinese Society of Clinical Oncology(CSCO):Clinical guidelines for the diagnosis and treatment of gastric cancer,2021

There exist differences in the epidemiological characteristics,clinicopathological features,tumor biological characteristics,treatment patterns,and drug selections between gastric cancer patients from the Eastern and Western countries.The Chinese Society of Clinical Oncology(CSCO)has organized a panel of senior experts specializing in all sub-specialties of gastric cancer to compile a clinical guideline for the diagnosis and treatment of gastric cancer since 2016 and renews it annually.Taking into account regional differences,giving full consideration to the accessibility of diagnosis and treatment resources,these experts have conducted expert consensus judgment on relevant evidence and made various grades of recommendations for the clinical diagnosis and treatment of gastric cancer to reflect the value of cancer treatment and meeting health economic indexes in China.The 2021 CSCO Clinical Practice Guidelines for Gastric Cancer covers the diagnosis,treatment,follow-up,and screening of gastric cancer.Based on the 2020 version of the CSCO Chinese Gastric Cancer guidelines,this updated guideline integrates the results ofmajor clinical studies from China and overseas for the past year,focused on the inclusion of research data from the Chinese population for more personalized and clinically relevant recommendations.For the comprehensive treatment of non-metastatic gastric cancer,attentions were paid to neoadjuvant treatment.The value of perioperative chemotherapy is gradually becoming clearer and its recommendation level has been updated.For the comprehensive treatment of metastatic gastric cancer,recommendations for immunotherapy were included,and immune checkpoint inhibitors fromthird-line to the first-line of treatment for different patient groups with detailed notes are provided.

The Chinese Society of Clinical Oncology(CSCO):clinical guidelines for the diagnosis and treatment of gastric cancer

China is one of the countries with the highest incidence of gastric cancer.There are differences in epidemiological characteristics,clinicopathological features,tumor biological characteristics,treatment patterns,and drug selection between gastric cancer patients from the Eastern and Western countries.Non-Chinese guidelines cannot specifically reflect the diagnosis and treatment characteristics for the Chinese gastric cancer patients.The Chinese Society of Clinical Oncology(CSCO)arranged for a panel of senior experts specializing in all sub-specialties of gastric cancer to compile,discuss,and revise the guidelines on the diagnosis and treatment of gastric cancer based on the findings of evidence-based medicine in China and abroad.By referring to the opinions of industry experts,taking into account of regional differences,giving full consideration to the accessibility of diagnosis and treatment resources,these experts have conducted experts’consensus judgement on relevant evidence and made various grades of recommendations for the clinical diagnosis and treatment of gastric cancer to reflect the value of cancer treatment and meeting health economic indexes.This guideline uses tables and is complemented by explanatory and descriptive notes covering the diagnosis,comprehensive treatment,and follow-up visits for gastric cancer.

Treatment of Middle/Late Stage Pri mary Hepatic Carci noma by Chinese Medicine Comprehensive Therapy:A Prospective Randomized Controlled Study

Objective：To observe the efficacy of Chinese medicine comprehensive therapeutic project in treating the middle/late stage primary hepatic carcinoma（PHC）.Methods：With prospective randomized controlled design, 97 patients with PHC were assigned to the test group（49 cases） treated with Chinese medicine comprehensive therapy using Oleum fructus bruceas intervention combining oral intake of Ganji Decoction（肝积方） and external application of Ailitong（癌理通）,and the control group（48 cases） treated with chemotherapeutic agents combining iodized oil chemo-embolization and analgesics.The immediate and long-term efficacy,adverse reaction,pain-relieving initial time（PRIT） and pain-relieving sustained time（PRST） of the treatment,as well as the change in patients＇ quality of life（QOL） were observed.Results：The difference between the two groups in illness control rate was statistically insignificant（P〉0.05）,but the adverse reaction occurence rate in the test group was lesser than that in the control group（P〈0.05）.PRIT was insignificantly different in the two groups（P〉0.05）,but the PRST was significantly superior in the test group than that in the control group（10.37±2.18 h vs 7.78±1.95 h,P〈0.01）.After treatment,the increased Karnofsky scores in the test group indicated that the patients＇ somatic activity,symptoms and QOL were improved significantly,which were significantly superior to those in the control group（P〈0.05）.The survival rate in the two groups was similar at the 3rd month after treatment,but the test group did show superiority in terms of half- and 1-year survival rate（65.9%vs 42.5%and 38.6%vs 18.1%,respectively,P〈0.05）.The median survival time in the test group was 8.9 months and that in the control group was 5.3 months.Conclusion：Chinese medicine comprehensive therapy is an effective treatment for the middle/late stage patients of PHC,and it could extend the PRST,improve the patients＇ QOL and long-term survival with less adverse reaction.

三棱消瘤合剂联合化疗治疗痰瘀互结型进展期胃癌的临床观察

目的观察三棱消瘤合剂联合化疗治疗痰瘀互结型进展期胃癌的临床疗效及安全性。方法将92例痰瘀互结型进展期胃癌患者根据意愿分为治疗组(n=44)和对照组(n=48),对照组给予化疗(以氟尿嘧啶为基础方案),治疗组在对照组治疗措施基础上加用三棱消瘤合剂。21 d为1个化疗周期,两组基本疗程均为4个周期,可视情况继续随访治疗至6~8个周期。基本疗程结束后,观察两组中医证候疗效、实体瘤疗效,比较卡氏功能状态(KPS)评分的变化情况;记录化疗周期,比较两组治疗前及治疗第22天、85天时中医证候积分的变化情况,以及基本疗程中的毒性反应发生情况。结果(1)治疗组、对照组中医证候总有效率分别为77.3%、50.0%;治疗组中医证候疗效优于对照组(P<0.05)。(2)两组实体瘤疗效比较,差异无统计学意义(P>0.05)。(3)治疗组治疗第22天时,胃脘痛、恶心呕吐、纳差、肢体困重积分及中医证候总积分减少(P<0.05),对照组仅中医证候总积分减少(P<0.05)。治疗第85天时组间比较,胃脘痛、恶心呕吐、纳差、肢体困重积分及中医证候总积分差异有统计学意义(P<0.05)。(4)治疗前后组内比较,治疗组KPS评分升高(P<0.05);组间治疗后比较,治疗组KPS评分高于对照组(P<0.05)。(5)两组完成化疗周期情况比较,差异无统计学意义(P>0.05)。(6)治疗组周围神经毒性反应发生率低于对照组(P<0.05),但两组血液毒性、胃肠道毒性反应发生率比较,差异无统计学意义(P>0.05)。结论三棱消瘤合剂联合化疗治疗痰瘀互结型进展期胃癌疗效满意,能有效改善患者的中医证候及生活质量,减轻化疗毒性反应。

八珍汤配合雷火灸对胃癌术后化疗患者骨髓抑制和营养状态的影响

目的 探讨八珍汤配合雷火灸对胃癌术后化疗患者骨髓抑制和营养状态的影响。方法 选取2020年1月-2021年2月中国医科大学第一附属医院94例胃癌术后患者,随机分为对照组(47例)和试验组(47例)。对照组给予XELOX方案(奥沙利铂+卡培他滨)化疗及常规治疗,试验组在对照组基础上给予八珍汤配合雷火灸治疗,2组均治疗10周。比较2组血常规、骨髓抑制情况发生率及营养指标。结果 与对照组比较,试验组治疗后白细胞计数(WBC)、血小板计数(PLT)、中性粒细胞计数(NEUT)及血红蛋白(Hb)水平较高,WBC减少、PLT减少、NEUT减少及Hb减少发生率较低,血清转铁蛋白(TRF)、白蛋白(ALB)、前白蛋白(PA)水平较高(P<0.05)。结论 八珍汤配合雷火灸能够有效减轻胃癌术后化疗引起的骨髓抑制,改善患者的营养状态,值得临床推广。

从整合医学的视角探讨慢性胃炎“炎⁃癌转化”的防治

整合医学强调以人为本,结合社会、环境和心理的现实,将医学各领域的知识理论和实践经验进行有机整合,多学科交叉,使之成为更加有利于人体健康和疾病治疗的新医学体系,是未来医学发展的重要方向。慢性胃炎“炎-癌转化”是横跨消化和肿瘤两个专科的问题,其多病因、多机制、多途径、多阶段的特点为本病的科学防治带来了困难与挑战,从整合医学的视角出发,整合多学科的技术和信息,将有助于解决这一问题,为延缓、阻断慢性胃炎“炎-癌转化”以及降低胃癌发病率提供方向与策略。从整合医学的视角探讨慢性胃炎“炎-癌转化”的防治,具体包括以下几个方面:①医患协同,从多方面进行生活方式管理;②动态防治,“防、筛、诊、治、康”分阶段全过程管理;③从“胃内微环境”的整合视角认识、指导慢性胃炎“炎-癌转化”的防治;④多学科交叉,共筑整合防治新战略,包括中西医结合、基础研究与临床诊疗的相互促进以及引入现代科学技术等。

基于数据挖掘及生物信息学探讨中医药治疗晚期胃癌的用药规律和作用机制

目的:通过数据挖掘技术联合网络药理学和基因芯片技术探索中医药治疗晚期胃癌受益患者的用药规律和作用机制。方法:收集135例中医治疗晚期胃癌受益患者病历,采用数据挖掘技术获取核心药物组合,通过网络药理学联合基因芯片技术获取药物和疾病共同靶点,同时探索相关作用机制。通过Oncomine和Kaplan-Meier Plotter数据库探究关键靶点在胃癌中的表达情况及其与胃癌生存期的关系。结果:135例晚期胃癌的受益患者中男性81例,女性54例,平均年龄为59.33岁。药物频数由高到低主要为黄芪、党参、半夏、陈皮、茯苓等;四气以温、平、寒为主,五味以甘、苦、辛为主;归经以脾经为主。“黄芪-党参-陈皮-半夏-茯苓”为135份处方的核心药物组合,包含77个有效活性成分。以GEO数据库中GSE63089和GSE118916数据集的胃癌样本组织为研究对象,共得到520个胃癌的差异基因,其中有58个药物和胃癌共同靶点,NTRK1、TP53、MCM2、CUL3、CDK2等为关键靶点。通过Oncomine数据库发现NTRK1、TP53、MCM2在胃癌组织和正常组织中的表达差异均有统计学意义(P<0.05),通过Kaplan-Meier Plotter数据库发现NTRK1、TP53、MCM2高表达组的总生存期(OS)和首次进展时间(FP)均低于低表达组,差异有统计学意义(P<0.05)。结论:治疗晚期胃癌的中药处方功效以健脾益气、理气化痰为主,核心处方为“黄芪-党参-陈皮-半夏-茯苓”;核心处方通过槲皮素、异鼠李素、山奈酚、木犀草素等活性成分调控NTRK1、TP53、MCM2、CUL3、CDK2等关键靶点以参与调控肿瘤细胞周期、炎症反应等过程,以及调控细胞周期、p53信号通路等发挥抗胃癌作用;其中NTRK1、TP53、MCM2在胃癌组织中均高表达,且三者表达水平越高,胃癌患者生存期越短。

中医药精准靶向治疗胃癌前病变及相关信号通路研究

胃癌前病变(precancerous lesions of gastric cancer,PLGC)是胃癌发展的关键阶段,尽早诊断、及时干预PLGC是预防胃癌发生的重点,如何减缓或逆转PLGC,降低人群中胃癌的发病率、病死率是现阶段消化领域研究的热点问题。当前西医主要采用抑酸、抗幽门螺杆菌(Helicobacter Pylori,HP)感染、内镜下治疗、定期随访等措施来治疗PLGC,但主要是针对病因及症状的治疗,对PLGC的逆转多无确切疗效。许多研究证实中医药治疗PLGC具有独特优势,辨证论治与辨病论治相结合,联合胃镜、组织病理学、血清学、基因组学表现精准靶向治疗PLGC,不仅能有效改善患者临床症状,且能不同程度逆转PLGC,减缓疾病进程,但具体机制尚未完全明确。该文就中医药精准靶向治疗PLGC及其相关信号通路进行概述,以期为中医药治疗该病提供理论基础及机制研究。