En bloc pancreaticoduodenectomy and right hemicolectomy for locally advanced right-sided colon cancer

AIM To assess the usefulness of en bloc right hemicolectomy with pancreaticoduodenectomy(RHCPD) for locally advanced right-sided colon cancer(LARCC).METHODS We retrospectively reviewed the database of Saitama Medical Center, Jichi Medical University, between January 2009 and December 2016. During this time, 299 patients underwent radical right hemicolectomy for right-sided colon cancer. Among them, 5 underwent RHCPD for LARCC with tumor infiltration to adjacent organs. Preoperative computed tomography(CT) was routinely performed to evaluate local tumor infiltration into adjacent organs. During the operation, we evaluated the resectability and the amount of infiltration into the adjacent organs without dissecting the adherent organs from the cancer. When we confirmed that radical resection was feasible and could lead to R0 resection, we performed RHCPD. The clinical data were carefully reviewed, and the demographic variables, intraoperative data, and postoperative parameters were recorded.RESULTS The median age of the 5 patients who underwent RHCPD for LARCC was 70 years. The tumors were located in the ascending colon(three patients) and transverse colon(two patients). Preoperative CT revealed infiltration of the tumor into the duodenum in all patients, the pancreas in four patients, the superior mesenteric vein(SMV) in two patients, and tumor thrombosis in the SMV in one patient. We performed RHCPD plus SMV resection in three patients. Major postoperative complications occurred in 3 patients(60%) as pancreatic fistula(grade B and grade C, according to International Study Group on Pancreatic Fistula Definition) and delayed gastric empty. None of the patients died during their hospital stay. A histological examination confirmed malignant infiltration into the duodenum and/or pancreas in 4 patients(80%), and no patients showed any malignant infiltration into the SMV. Two patients were histologically confirmed to have tumor thrombosis in the SMV. All of the tumors had clear resection margins(R0). The median follow-up time was 77 mo. During this period, two patients with tumor thrombosis died from liver metastasis. The overall survival rates were 80% at 1 year and 60% at 5 years. All patients with node-negative status(n = 2) survived for more than seven years.CONCLUSION This study showed that the long-term survival is possible for patients with LARCC if RHCPD is performed successfully, particularly in those with node-negative status.

Outcomes of preoperative chemoradiotherapy followed by surgery in patients with unresectable locally advanced sigmoid colon cancer

Background: Complete resection of locally advanced sigmoid colon cancer(LASCC) is sometimes difficult. Patients with LASCC have a dismal prognosis and poor quality of life, which has encouraged the evaluation of alternative multimodality treatments. This prospective study aimed to assess the feasibility and efficacy of neoadjuvant chemora?diotherapy(neo CRT) followed by surgery as treatment of selected patients with unresectable LASCC.Methods: We studied the patients with unresectable LASCC who received neo CRT followed by surgery between October 2010 and December 2012. The neoadjuvant regimen consisted of external?beam radiotherapy to 50 Gy and capecitabine?based chemotherapy every 3 weeks. Surgery was scheduled 6–8 weeks after radiotherapy.Results: Twenty?one patients were included in this study. The median follow?up was 42 months(range, 17–57 months). All patients completed neo CRT and surgery. Resection with microscopically negative margins(R0 resection) was achieved in 20 patients(95.2%). Pathologic complete response was observed in 8 patients(38.1%). Multivisceral resection was necessary in only 7 patients(33.3%). Two patients(9.5%) experienced grade 2 postopera?tive complications. No patients died within 30 days after surgery. For 18 patients with pathologic M0(yp M0) disease, the cumulative probability of 3?year local recurrence?free survival, disease?free survival and overall survival was 100.0%, 88.9% and 100.0%, respectively. For all 21 patients, the cumulative probability of 3?year overall survival was 95.2% and bladder function was well preserved.Conclusion: For patients with unresectable LASCC, preoperative chemoradiotherapy and surgery can be performed safely and may result in an increased survival rate.

Effect of immunotherapy combined with intravenous chemotherapy on the tumor load,immune function and cancer cell proliferation activity in patients with advanced colon cancer

Objective: To study the effect of immunotherapy combined with intravenous chemotherapy on the tumor load, immune function and cancer cell proliferation activity in patients with advanced colon cancer. Methods: A total of 90 patients with advanced colon cancer who were treated in Second People's Hospital of Yibin between December 2014 and January 2017 were collected and divided into control group (n=45) and observation group (n=45) by random number table. Control group received routine intravenous chemotherapy, and the observation group received immunotherapy combined with intravenous chemotherapy. The levels of specific tumor markers and Th17/Treg cytokines in serum as well as proliferation gene expression in the lesion tissue were determined. Results: Before treatment, the differences in levels of specific tumor markers and Th17/Treg cytokines in serum as well as proliferation gene expression in lesion tissue were not statistically significant between the two groups. After treatment, PTN, CCSA-1, IL-17 and IL-23 levels in serum as well as GTPBP4 and PIK3CB mRNA expression in lesion tissue of both groups of patients were lower than those before treatment while IL-10 and IL-35 levels in serum as well as FAM96B, MS4A12 and FRAT1 mRNA expression in lesion tissue were higher than those before treatment, and PTN, CCSA-1, IL-17 and IL-23 levels in serum as well as GTPBP4 and PIK3CB mRNA expression in lesion tissue of observation group were lower than those of control group while IL-10 and IL-35 levels in serum as well as FAM96B, MS4A12 and FRAT1 mRNA expression in lesion tissue were higher than those of control group. Conclusion: Immunotherapy combined with intravenous chemotherapy can effectively reduce the tumor load, optimize cellular immune function and inhibit tumor cell proliferation in patients with advanced colon cancer.

Smaller tumor size is associated with poor survival in T4b colon cancer

AIM: To hypothesize that in patients with colon cancer showing heavy intestinal wall invasion without distant metastasis(T4b N0-2M0), small tumor size would correlate with more aggressive tumor behaviors and therefore poorer cancer-specific survival(CSS).METHODS: We analyzed T4 b N0-2M0 colon cancer patients in the Surveillance, Epidemiology and End Results(SEER) database. A preliminary analysis of T4 b N0-2M0 colon cancer patients at the Fudan University Shanghai Cancer Center is also presented.RESULTS: A total of 1734 T4 b N0-2M0 colon cancer patients from the SEER database were included. Kaplan-Meier analysis revealed decreasing CSS with decreasing tumor size(P < 0.001). Subgroup analysis showed a significant association between poorer CSS with smaller tumor size in T4 b N0 patients(P = 0.024), and a trend of association in T4 b N1(P = 0.182) and T4 b N2 patients(P = 0.191). Multivariate analysis identified tumor size as an independent prognostic factor for CSS in T4 b N0-2M0 patients(P = 0.024). Preliminary analysis of Fudan University Shanghai Cancer Center samples suggested the 5-year CSS was 50.0%, 72.9% and 77.1% in patients with tumors ≤ 4.0 cm, 4.0-7.0 cm and ≥ 7.0 cm.CONCLUSION: Smaller tumor size is associated with poorer CSS in the T4 b N0-2M0 subset of colon cancer, particularly in the T4 b N0M0 subgroup.

Colonoscopy surveillance for high risk polyps does not always prevent colorectal cancer

AIM To determine the frequency and risk factors for colorectal cancer(CRC) development among individuals with resected advanced adenoma(AA)/traditional serrated adenoma(TSA)/advanced sessile serrated adenoma(ASSA). METHODS Data was collected from medical records of 14663 subjects found to have AA, TSA, or ASSA at screening or surveillance colonoscopy. Patients with inflammatory bowel disease or known genetic predisposition for CRC were excluded from the study. Factors associated with CRC developing after endoscopic management of high risk polyps were calculated in 4610 such patients who had at least one surveillance colonoscopy within 10 years following the original polypectomy of the incident advanced polyp. RESULTS84/4610(1.8%) patients developed CRC at the polypectomy site within a median of 4.2 years(mean 4.89 years), and 1.2%(54/4610) developed CRC in a region distinct from the AA/TSA/ASSA resection site within a median of 5.1 years(mean 6.67 years). Approximately, 30%(25/84) of patients who developed CRC at the AA/TSA/ASSA site and 27.8%(15/54) of patients who developed CRC at another site had colonoscopy at recommended surveillance intervals. Increasing age; polyp size; male sex; right-sided location; high degree of dysplasia; higher number of polyps resected; and piecemeal removal were associated with an increased risk for CRC developmentat the same site as the index polyp. Increasing age; right-sided location; higher number of polyps resected and sessile endoscopic appearance of the index AA/TSA/ASSA were significantly associated with an increased risk for CRC development at a different site. CONCLUSION Recognition that CRC may develop following AA/TSA/ASSA removal is one step toward improving our practice efficiency and preventing a portion of CRC related morbidity and mortality.

Rectosigmoid findings are not associated with proximal colon cancer: Analysis of 6 196 consecutive cases undergoing total colonoscopy

AIM: To review the risk of proximal colon cancer in patients undergoing colonoscopy.METHODS: We estimated the risk of advanced proximal adenomas and cancers in 6 196 consecutive patients that underwent colonoscopy (mean age 60 years, 65% males,without prior history of colorectal examination). Neoplasms were classified as diminutive adenoma (5 mm or less),small adenoma (6-9 mm), advanced adenoma (10 mm or more, with villous component or high-grade dysplasia)and cancer (invasive adenocarcinoma). The sites of neoplasms were defined as rectosigmoid (rectum and sigmoid colon) and proximal colon (from cecum to descending colon).RESULTS: The trend of the prevalence of advanced proximal adenoma was to increase with severe rectosigmoid findings, while the prevalence of proximal colon cancer did not increase with severe rectosigmoid findings. Among the 157 patients with proximal colon cancer, 74% had no neoplasm in the rectosigmoid colon. Multivariate logisticregression analysis revealed that age was the main predictor of proximal colon cancer and existence of rectosigmoid adenoma was not a predictor of proximal colon cancer.CONCLUSION: Sigmoidoscopy is inadequate for colorectal cancer screening, especially in older populations.

对局部进展期结肠癌新辅助化疗FOxTROT Ⅲ期临床试验的评价

目前,在局部进展期结肠癌新辅助化疗方面仍处于空白。FOxTROT研究是首个评估局部进展期结肠癌新辅助化疗策略的Ⅲ期试验,填补了该领域的空白。FOxTROT研究结果表明,术前6周的新辅助化疗具有合理性,显著降低了组织病理学分期、提高了R0切除率、降低了结肠癌术后2年复发率。由于FOxTROT研究存在局限性,还不能代表局部进展期结肠癌新辅助化疗的新标准,而应该是一种选择。

纳武利尤单抗联合伊匹木单抗治疗MSI-H晚期结肠癌1例报道

本文报告1例晚期结肠癌患者,既往术后标本免疫组化结果提示错配修复完整(proficient mismatch repair, pMMR),予术后化疗等全身治疗后病情进展。随后行二代测序(next-generation sequencing, NGS)提示该患者微卫星高度不稳定(microsatellite instability-high, MSI-H)以及高水平的肿瘤突变负荷值(tumor mutation burden, TMB)。

Outcomes of endoscopic submucosal dissection in cirrhotic patients: First American cohort

BACKGROUND Among patients with cirrhosis and pre-malignant or early malignant mucosal lesions,surgical intervention carries a much higher bleeding risk.When such lesions are discovered,endoscopic submucosal dissection(ESD)may offer curative therapy with lower risks than surgery and improved outcomes compared to traditional endoscopic resection.AIM To evaluate the outcomes of ESD in patients with cirrhosis.METHODS Patients with cirrhosis undergoing ESD between July 2015 and August 2022 were retrospectively matched in 1:2 fashion to controls based on lesion location,size,and anticoagulation use.Procedural outcomes were compared between groups.RESULTS A total of 64 Lesions from 59 patients were included(16 cirrhosis,43 control).There were no differences in patient or lesion characteristics between groups.En bloc and curative resection was achieved in 84.21%,78.94%of the cirrhosis group and 88.89%,68.89%of controls,respectively,with no significant differences.Cirrhotic patients had significantly higher rates of intra-procedural coagulation grasper use for control of bleeding(47.37%vs 20%;P=0.02).There were otherwise no significant differences in adverse event rates.In the 29 patients with follow up,we found higher rates of recurrence in the cirrhosis group compared to controls(40%vs 5.26%;P=0.019),however this effect did not persist on multivariable analysis controlling for known confounders.CONCLUSION ESD may be safe and effective in patients with cirrhosis.Most procedure related outcomes were not significantly different between groups.Intra-procedural bleeding requiring use of the coagulation grasper use was expectedly higher in the cirrhosis group given the known effects of liver disease on hemostasis.

香砂六君子汤联合XELOX化疗及贝伐珠单抗靶向治疗对晚期结肠癌患者近期疗效及肿瘤标志物的影响

目的:探讨香砂六君子汤联合XELOX化疗及贝伐珠单抗靶向治疗对晚期结肠癌患者近期疗效及肿瘤标志物的影响。方法:选取2020年1月—2023年10月南平市人民医院收治的105例晚期结肠癌患者作为研究对象,随机分为观察组(n=54)和对照组(n=51)。对照组采用XELOX化疗及贝伐珠单抗靶向治疗,观察组在对照组基础上联合香砂六君子汤治疗。比较两组近期疗效、免疫功能、肿瘤标志物[糖类抗原242(CA242)、糖类抗原199(CA199)、癌胚抗原(CEA)]水平及不良反应发生情况。结果:观察组客观缓解率(ORR)、疾病控制率(DCR)分别为51.85%、68.52%,均高于对照组的31.37%、49.02%,差异有统计学意义(P<0.05)。治疗后,两组CD3^(+)、CD4^(+)水平低于治疗前,CD8^(+)水平高于治疗前,但观察组CD3^(+)、CD4^(+)水平高于对照组,CD8^(+)水平低于对照组,差异有统计学意义(P<0.05)。治疗后,两组CA242、CA199、CEA水平均低于治疗前,且观察组CA242、CA199、CEA水平均低于对照组,差异有统计学意义(P<0.05)。观察组胃肠道反应发生率为37.04%,低于对照组的56.86%,差异有统计学意义(P<0.05);两组脱发、贫血、周围神经毒性及肝肾功能损伤发生率比较,差异无统计学意义(P>0.05)。结论:香砂六君子汤联合XELOX化疗及贝伐珠单抗靶向治疗可提高晚期结肠癌近期效果,减轻机体免疫功能损伤,降低肿瘤标志物表达水平,且安全性良好。

节拍化疗在卡培他滨+奥沙利铂+贝伐珠单抗治疗晚期结肠癌中的应用研究

目的探讨节拍化疗在卡培他滨+奥沙利铂+贝伐珠单抗治疗晚期结肠癌中的运用价值。方法将92例晚期结肠癌患者随机分为观察组和对照组,每组46例。对照组采用传统给药方法的卡培他滨+奥沙利铂+贝伐珠单抗治疗,观察组采用卡培他滨节拍化疗+奥沙利铂+贝伐珠单抗治疗,疗程21 d。对比两组的近期疗效、不良反应、免疫功能指标、血清肿瘤标志物和生活质量。结果两组近期疗效差异无统计学意义(P>0.05)。观察组白细胞降低、胃肠道反应、血小板降低、手足综合征的程度均明显轻于对照组(P<0.05)。观察组治疗后的CD^(3+)、CD^(4+)、CD^(4+)/CD^(8+)、NK均明显高于对照组(P<0.01或0.05)。观察组治疗后的CEA、CA19-9和CCSA-1均明显低于对照组(P<0.05)。与对照组相比,观察组治疗后的功能领域评分明显高,症状领域评分明显低(P<0.05)。结论节拍化疗应用于卡培他滨+奥沙利铂+贝伐珠单抗中治疗晚期结肠癌可降低不良反应发生率和血清肿瘤标志物水平,减轻免疫功能的损伤,提高患者的生活质量。

小剂量阿帕替尼联合XELOX方案治疗晚期结肠癌的疗效

目的探讨小剂量阿帕替尼联合奥沙利铂+卡培他滨(XELOX)方案治疗晚期结肠癌的疗效。方法将108例晚期结肠癌患者根据治疗方案的不同分为对照组(n=52)与观察组(n=56)。对照组采用XELOX方案治疗,观察组采用小剂量阿帕替尼联合XELOX方案治疗。比较两组患者的治疗效果、血清肿瘤标志物[糖类抗原72-4(CA72-4)、基质金属蛋白酶9(MMP9)]与血管内皮生长因子(VEGF)水平、肠道菌群水平、不良反应发生情况。结果观察组患者客观缓解率与疾病控制率分别为57.14%(32/56)、76.79%(43/56),均高于对照组患者的36.54%(19/52)、57.69%(30/52),差异均有统计学意义(P﹤0.05)。治疗后,两组患者CA72-4、MMP9与VEGF水平均较治疗前降低,且观察组患者CA72-4、MMP9与VEGF水平均低于对照组,差异均有统计学意义(P﹤0.05)。治疗后,两组患者双歧杆菌、乳杆菌水平均较治疗前升高,大肠杆菌水平均较治疗前降低,且观察组患者双歧杆菌、乳杆菌水平均高于对照组,大肠杆菌水平低于对照组,差异均有统计学意义(P﹤0.05)。两组患者不良反应总发生率比较,差异无统计学意义(P﹥0.05)。结论晚期结肠癌患者采用小剂量阿帕替尼联合XELOX方案治疗可有效提高晚期结肠癌患者的临床疗效,降低血清肿瘤标志物与VEGF水平。

贝伐单抗联合Xelox方案治疗局部晚期结肠癌患者的效果观察

目的:观察贝伐单抗联合Xelox方案(奥沙利铂^(+)卡培他滨)在局部晚期结肠癌患者治疗中的应用效果。方法:选取2021年1月—2023年5月临沂市中心医院肿瘤科收治的局部晚期结肠癌患者中60例,采用随机数字表法分为对照组与观察组各30例。对照组患者静脉滴注奥沙利铂,并口服卡培他滨片治疗;观察组患者在对照组治疗的基础上口服贝伐珠单抗治疗。比较两组临床疗效、血清免疫指标、血清肿瘤标志物水平及不良反应。结果:观察组治疗总有效率高于对照组,差异有统计学意义(P<0.05)。治疗后,两组CD4^(+)及CD4^(+)/CD8^(+)水平均高于治疗前,且观察组CD4^(+)及CD4^(+)/CD8^(+)水平均高于对照组,差异有统计学意义(P<0.05);两组血清癌胚抗原(CEA)及糖类抗原199(CA199)水平低于治疗前,且观察组CEA、CA199水平均低于对照组,差异有统计学意义(P<0.05)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论:贝伐单抗联合Xelox方案可有效提升局部晚期结肠癌患者的临床疗效,改善患者的血清免疫指标,调节血清肿瘤标志物,且安全性较好。

Pyogenic liver abscess as initial presentation in locally advanced right colon cancer invading the liver,gallbladder,and duodenum

Locally advanced colorectal cancer complicated with adjacent organic invasion may remain confined to the local area with minimal metastasis.In the present paper,we report on a patient with advanced right colon cancer,including liver,gallbladder,and duodenal invasion behind the scene of liver abscess.En bloc resection was performed on the patient,with right-hemicolectomy,cholecystectomy,partial duodental resection,and hepatectomy.Postoperative management was administered,including nutritional support in the early postoperative period,effective anti-infection treatment,and adjuvant chemotherapy(FOLFOX4).The patient survived for 16 months after the operation.Common clinical manifestations of colorectal cancer were digestive symptoms and changes in defecation.However,the clinical manifestation of locally advanced colon cancer was extremely complicated.Extended or multivisceral resection may offer patients a chance to survive an acute crisis and allow for treatment with adjuvant therapy.

结肠癌新辅助治疗研究进展与思考

随着新辅助治疗在直肠癌中取得巨大成功以及术前治疗对可切除肝转移性结肠癌病人带来生存获益,术前治疗在局部进展期结肠癌中的应用也开始受到重视。传统认为外科手术联合辅助治疗是局部进展期结肠癌的主要治疗模式,是否需行新辅助治疗争议较大,近年来FOxTROT和OPTICAL等临床试验相继显示局部进展期结肠癌病人可从新辅助化疗中显著获益。此文通过回顾已发表的和正在开展的局部进展期结肠癌新辅助治疗研究,浅谈结肠癌新辅助治疗在临床应用方面的最新进展及治疗要点。

中晚期结肠癌患者应用消癌平联合化疗治疗的疗效分析

目的 :分析中晚期结肠癌患者应用消癌平联合化疗治疗的疗效分析。方法 :将80例中晚期结肠癌患者随机分为对照组与研究组,各40例。对照组给予FOLFOX4方案化疗,研究组在此基础上加用消癌平治疗。比较两组临床疗效及血清肿瘤标志物水平。结果 :治疗后,研究组的总有效率高于对照组;各项血清肿瘤标志物水平降低幅度优于对照组(P <0.05)。结论 :消癌平联合化疗治疗中晚期结肠癌能取得良好效果,能降低血清肿瘤标志物水平,有一定的临床应用价值。

贝伐珠单抗联合化疗对晚期结肠癌患者血清指标水平的影响

目的探讨贝伐珠单抗联合化疗对晚期结肠癌患者血清指标水平的影响。方法选择2018年6月至2022年6月广州医科大学附属第六医院收治的50例晚期结肠癌患者作为研究对象,采用随机数字表法分为对照组和观察组,每组25例。对照组患者采用常规化疗,观察组患者在对照组的基础上加用贝伐珠单抗。比较两组患者的临床治疗效果、癌胚抗原(CEA)、糖类抗原19-9(CA19-9)、糖类抗原242(CA242)、卡氏功能状态(KPS)评分以及不良反应总发生率。结果观察组患者的治疗总有效率高于对照组,差异有统计学意义(P<0.05)。治疗前,两组患者的CEA、CA19-9、CA242水平比较,差异无统计学意义(P>0.05);治疗后,两组患者的CEA、CA19-9、CA242水平低于本组治疗前,且观察组患者的CEA、CA19-9、CA242水平低于对照组,差异有统计学意义(P<0.05)。治疗前,两组患者的KPS评分比较,差异无统计学意义(P>0.05);治疗后,两组患者的KPS评分高于本组治疗前,且观察组患者的KPS评分高于对照组,差异有统计学意义(P<0.05)。观察组患者的不良反应总发生率低于对照组,差异有统计学意义(P<0.05)。结论晚期结肠癌患者采用贝伐珠单抗联合化疗治疗的效果较好,利于改善患者血清指标,提升患者的功能状态,且能减少不良反应的发生,值得临床广泛应用。

腹腔热灌注联合静脉化疗治疗进展期右半结肠癌疗效观察

目的 探讨腹腔热灌注联合静脉化疗治疗进展期右半结肠癌的临床疗效。方法 选择2021年1月至2022年1月南阳市中心医院收治的进展期右半结肠癌患者70例为研究对象。随机将患者分为对照组(n=35)和观察组(n=35),对照组患者给予静脉化疗,观察组患者给予腹腔热灌注联合静脉化疗。分别于治疗前后采用流式细胞仪检测2组患者血清中CD3^(+)、CD4^(+)、CD8^(+)淋巴细胞占比,并计算CD4^(+)/CD8^(+)水平;比较2组患者治疗过程中不良反应发生率;采用生活质量测定量表评估2组患者治疗后的生活质量;比较2组患者随访1~2 a的预后情况。结果 治疗前,2组患者血清中CD3^(+)、CD4^(+)、CD8^(+)淋巴细胞占比及CD4^(+)/CD8^(+)比较差异无统计学意义(P>0.05)。2组患者治疗后血清中CD3^(+)、CD4^(+)淋巴细胞占比及CD4^(+)/CD8^(+)显著高于治疗前,CD8^(+)淋巴细胞占比显著低于治疗前(P<0.05)。治疗后,观察组患者血清中CD3^(+)、CD4^(+)淋巴细胞占比及CD4^(+)/CD8^(+)显著高于对照组,CD8^(+)淋巴细胞占比显著低于对照组(P<0.05)。对照组患者治疗过程中静脉炎、胃肠道反应、白细胞降低、肌酐轻度增高、肝功能异常发生率分别为17.1%(6/35)、20.0%(7/35)、14.3%(5/35)、11.4%(4/35)、11.4%(4/35),观察组患者治疗过程中静脉炎、胃肠道反应、白细胞降低、肌酐轻度增高、肝功能异常发生率分别为2.9%(1/35)、2.9%(1/35)、0.0%(0/35)、0.0%(0/35)、0.0%(0/35);对照组患者治疗过程中静脉炎、胃肠道反应、白细胞降低、肌酐轻度增高、肝功能异常等不良反应发生率均显著高于观察组(χ^(2)=11.202、14.420、15.401、12.089、12.089,P<0.05)。观察组患者的躯体功能、角色功能、情绪功能、社会功能评分均显著高于对照组(P<0.05)。对照组患者治疗后1、2 a生存率分别为54.3%(19/35)、22.9%(8/35),复发率分别为20.0%(7/35)、34.3%(12/35);观察组患者治疗后1、2 a生存率分别为97.1%(34/35)、71.4%(25/35),复发率分别为2.9%(1/35)、14.3%(5/35);观察组患者治疗后1、2 a的生存率显著高于对照组(χ^(2)=49.792、47.198,P<0.05),复发率显著低于对照组(χ^(2)=14.420、10.873,P<0.05)。观察组患者的平均生存时间长于对照组(t=7.995,P<0.05)。结论 腹腔热灌注联合静脉化疗治疗进展期右半结肠癌的效果优于单独静脉化疗,且能够有效改善患者身体免疫功能,降低不良反应发生率,进一步提高患者的生活质量。

贝伐珠单抗联合化疗治疗KRAS突变型晚期左、右半结肠癌疗效的对比分析

目的:对比分析姑息一线应用贝伐珠单抗联合化疗治疗KRAS突变型晚期左、右半结肠癌的临床疗效。方法:回顾性分析我院于2016年09月至2020年09月收治的83例一线应用贝伐珠单抗联合化疗治疗KRAS突变型晚期左、右半结肠癌患者,比较KRAS突变型左、右半结肠癌患者的临床特征、客观缓解率(ORR)、疾病控制率(DCR)、无进展生存时间(PFS)、18个月生存率、总生存时间(OS)。结果:KRAS突变型晚期右半结肠癌(RSCC)患者合并不完全肠梗阻及体重减轻>5 kg所占比例更高(P=0.369、P=0.009),KRAS突变型晚期左半结肠癌(LSCRC)患者更易合并中重度以上的贫血(P=0.154)。KRAS突变型LSCRC患者发生腹腔种植转移及远处器官转移的患者比例高于RSCC患者(P>0.05)。KRAS突变型LSCRC患者与RSCC患者ORR分别为29.3%和28.6%(P=0.944),DCR分别为87.8%和90.5%(P=0.696)。18个月生存率LSCRC组为80.05%,RSCC组为76.2%,差异无统计学意义(P=0.635)。KRAS突变型LSCRC患者中位PFS差于RSCC患者(8个月vs 9.8个月,P=0.004),KRAS突变型LSCRC患者中位OS优于KRAS突变型RSCC患者中位OS(22.8个月vs 21个月,P=0.001)。结论:姑息一线应用贝伐珠单抗联合化疗治疗KRAS基因突变型mCRC患者,左、右半结肠癌的远期疗效存在差异。

结直肠癌机会性筛查的临床应用探讨

目的探讨结直肠癌机会性筛查(OS)的临床应用,旨在为进一步完善大肠癌筛查流程和提高筛查效率提供依据。方法回顾性分析2019年1月-2020年12月该院3398例结直肠癌OS阳性,并完成全结肠镜检查的患者的临床资料。完成高危因素问卷调查(HRFQ)和粪便免疫化学检测(FIT)后,建议对两种筛查方法中,任意一种结果呈阳性的患者,进行结肠镜检查。统计受检者的年龄、性别、病变检出情况和病变部位,根据初筛结果,比较不同筛查方法结直肠肿瘤检出率的情况。结果3398例受检者中,HRFQ(-)FIT(+)组进展期腺瘤和结直肠癌检出率高于HRFQ(+)FIT(-)组,差异均有统计学意义(P<0.05)。在非进展期腺瘤检出率方面,HRFQ(-)FIT(+)组明显低于HRFQ(+)FIT(+)组,差异有统计学意义(P<0.05)。FIT对结直肠肿瘤的敏感度总体上优于HRFQ,且FIT对远端结直肠肿瘤的敏感度高于近端,差异均有统计学意义(P<0.05)。结论HRFQ与FIT组合,比FIT或HRFQ单独使用,能筛选出更多的高危人群,从而检测出更多的结直肠肿瘤,通过及时的内镜下治疗或外科手术切除,可有效提高患者的5年生存率,降低人群的结直肠癌发病率和死亡率。