Different Survival Benefits of Chinese Medicine for Pancreatic Cancer:How to Choose?

Objective：To assess the efficacy of Chinese medicine（CM） on patients with pancreatic cancer（PC） in a retrospective population-based study.Methods：Between January 1,2013,and August 30,2016,according to whether received Western medicine treatment,the patients were included into either integrative medicine（IM） group or CM group.All enrolled patients were orally administrated with Gexia Zhuyu Decoction（膈下逐瘀汤） or Liujun Ermu Decoction（六君二母汤） by syndrome differentiation,twice a day,last for at least 2 months.The primary end point was overall survival（OS）.Results：A total of 174 patients with PC were enrolled in this study.In stage Ⅰ/Ⅱ,the median OS was 20.5 months in the IM group [95% confidence interval（CI）,12.499 to 28.501] and 11.17 months in the CM group（95% CI,5.160 to 17.180,P=0.015）.The 1-and 2-year survival rates for the two groups were 47.0%,40.0% and 21.0%,21.0%,respectively.In stage Ⅲ/Ⅳ,median OS was 13.53 months（95% CI,8.665 to 18.395） in the IM group versus 6.4 months（95% CI,0.00 to 15.682） in the CM group,respectively（P=0.32）.The 1-and 2-year survival rate for the IM and CM groups were 27.0%,7.0% and 20.0%,2.0%,respectively.Conclusions：Intervention of CM contributes to the different survival benefits for PC in different stages.Multimodality treatment might be a promising strategy for PC patients in early stage.While,in advanced stage,CM might be an alternative candidate for PC patients.

Radical resection of pancreatic cancer

BACKGROUND: Pancreatic adenocarcinoma (PCa) is a disease with dismal prognosis, and the only possibility of cure, albeit small, is based on the combination of complete resection with negative histopathological margins (R0 resection) with adjuvant treatment. Therefore, a lot of effort has been made during the last decade to assess the role of extensive surgery in both local recurrence and survival of patients with PCa. DATA SOURCES: Medline search and manual cross- referencing were utilized to identify published evidence- based data for PCa surgery between 1973 and 2006, with emphasis to feasibility, efficacy, long-term survival, disease free survival, recurrence rates, pain relief and quality of life. RESULTS: Extended surgery is safe and feasible in high volume surgical centers with comparable short-term results. Organ preserving surgery is a main goal because of quality of life reasons and is performed whenever possible from the tumor extent. Concerning long-term survival major vein resection does not adversely affect outcome. To date, there are no changes in long-term survival attributed to the extended lymph node dissection. However, there is a benefit in locoregional control with fewer local recurrences and extended lymphadenectomy allows better staging for the disease. CONCLUSIONS: Extended PCa surgery is safe and feasible despite the inconclusive results in patient’s survival benefit. In the future, appropriately powered randomized trials of standard vs. extended resections may show improved outcomes for PCa patients.

Low body mass index is an independent predictor of poor long-term prognosis among patients with resectable gastric cancer

BACKGROUND The association between body mass index(BMI)and clinical outcomes remains unclear among patients with resectable gastric cancer.AIM To investigate the relationship between BMI and long-term survival of gastric cancer patients.METHODS This retrospective study included 2526 patients who underwent radical gastrectomy for gastric cancer between September 2013 and June 2018.The patients were divided into four groups:Group A(low BMI,<18.5 kg/m2),group B(normal BMI,18.5-24.9 kg/m2),group C(overweight,25-29.9 kg/m2),and group D(obese,≥30 kg/m2).Clinicopathological findings and survival outcomes were recorded and analyzed.RESULTS Preoperative weight loss was more common in the low-BMI group,while diabetes was more common in the obese group.Upper-third gastric cancer accounted for a large proportion of cases in the higher BMI groups.Major perioperative complications tended to increase with BMI.The 5-year overall survival rates were 66.4%for group A,75.0%for group B,77.1%for group C,and 78.6%for group D.The 5-year overall survival rate was significantly lower in group A than in group C(P=0.008)or group D(P=0.031).Relative to a normal BMI value,a BMI of<18.5 kg/m^(2)was associated with poor survival(hazard ratio:1.558,95%confidence interval:1.125-2.158,P=0.008).CONCLUSION Low BMI,but not high BMI,independently predicted poor survival in patients with resectable gastric cancer.