Great progress has been made in immunotherapy for esophageal squamous cell carcinoma in recent years. However, for thoracic surgeons, immunotherapy is still a new thing and they lack enough experience. Therefore, this paper attempts to discuss some hot issues of immunotherapy, including the indications, side effects, clinical efficacy and evaluation of efficacy. The author hopes that this article will help and attract the attention of thoracic surgeons.
Patients with thoracic malignancy have a high incidence of perioperative venous thromboembolism (VTE), but its onset is insidious, often asymptomatic or atypical, and is easily overlooked. Early identification and standardized prevention of VTE can effectively reduce the risk of VTE. "Guideline for the prevention and management of perioperative venous thromboembolism in thoracic malignancies in China (2022 version)" has been officially released recently. This article closely follows the context, significance, core implications, and the impact of future VTE prevention in thoracic surgery. It is hoped that through our joint efforts, we can reduce the incidence of perioperative VTE and mortality of thoracic surgery, and strive to improve the long-term survival of patients with lung cancer and esophageal cancer.
Organ preservation after neoadjuvant therapy for esophageal cancer has gained significant attention. While the CROSS trial established neoadjuvant chemoradiotherapy (nCRT) followed by surgery as standard care, approximately 30% of patients achieve pathological complete response (pCR), prompting exploration of active surveillance (AS). The landmark SANO phase Ⅲ trial (2025) demonstrated non-inferior 2-year overall survival (74% AS vs. 71% surgery), with 31% of patients avoiding surgery. Multimodal assessment (endoscopic deep biopsy+EUS+PET-CT) reduced residual disease misdiagnosis to 10%. The Asian-led NEEDS trial is evaluating definitive chemoradiotherapy with salvage surgery. Although immunotherapy boosts pCR rates to 40%-55%, challenges persist, including 8%-12% false-negative cCR assessments, limited long-term data, and East-West histological disparities. The 2024 NCCN guidelines conditionally recommend AS (Category 2B, prioritized for squamous cell carcinoma), emphasizing centralized implementation. Future directions involve ctDNA and radiomics for risk stratification to advance precision organ-preserving strategies.
Objective To study the role of ultracision harmonic scalpel and skin flap in axillary fossa external fixation in operation of breast cancer. Methods One hundred and sixty-six patients with breast cancer were included in this study between May 2009 and November 2009. Combined group (n=51) applied ultracision harmonic scalpel combined with skin flap external fixation. External fixation group （n=52） used the skill of skin flap external fixation. Routine group included 63 patients. Operative time, accidental injury during operation， volume of bleed and drainage, time of drainage, detection amount of lymph node, and complications such like subcutaneous fluidity were observed and recorded. Results The operative time and detection amount of lymph node were not different among three groups （Pgt;0.05）. The volume of bleed in combined group was less than that in other groups （Plt;0.05）. The volume of drainage and the time of drainage were decreased or shorten by turns from routine group, external fixation group to combined group （Plt;0.05）. The incidence rate of subcutaneous fluidity in combined group was lower than that in routine group （Plt;0.05）. Conclusions Using ultracision harmonic scalpel in operation of breast cancer can remarkably reduce the volume of bleed and drain postoperatively. Ultracision harmonic scalpel combined with skin flap external fixation is safety and can reduce the incidence rate of subcutaneous fluidity, thus can be applied widely in breast cancer operation.
Objective To study the long-term effect of neoadjuvant chemotherapy on advanced breast cancer. Methods The CAF neoadjuvant chemotherapy 〔CTX 500 mg/m2（1st day, 8th day), 5-FU 500 mg/m2（1st day, 8th day), and ADM 30 mg/m2 (1st day) every 3 weeks〕 was carried out in 31 breast cancer patients (stageⅢ,Ⅳ) for 2 cycles before operation, compared with 30 patients (stage Ⅲa) whose therapies were never done and operations could be feasible. Results The overall response rate was 87.1%(27/31). The stages of 19 patients among 31 (61.3%) declined (6 patients to stage Ⅲa, 8 to stageⅡb, 4 to stageⅡa, 1 to stage 0, 1 to complete response and none to pathological complete response). The diseasefree survival time of the patients was 56.3 months which was obviously longer than that of the patients without neoadjuvant chemotherapy (43.5 months, P＜0.05). The 5-year diseasefree survival rate of the patients with neoadjuvant chemotherapy was 38.7% which was a little higher than that (33.3%) of the patients without the chemotherapy, and the two groups had no significant difference. Conclusion The neoadjuvant chemotherapy can reduce the stages of patients with advanced breast cancer, obviously prolong the diseasefree survival time of patients, and reduce or delay recurrence or metastasis.
There is still a lack of experience in the perioperative strategy for esophageal cancer patients in China during the epidemic of COVID-19. In December 2022, a 59-year-old male patient with esophageal cancer was admitted to our department. He received 2 cycles of neoadjuvant therapy before surgery, and developed COVID-19 perioperatively. After treatment, the infection symptoms of the patient were improved, and the postoperative recovery was satisfactory.
目的 研究质子泵抑制剂在反流性食管炎维持治疗的临床疗效。 方法 将2009年3月-月门诊及住院的121例反流性食管炎并胃镜证实病灶已愈合，且停药1周内症状又复发者，随机分为A、B、C 3组，3组均选用兰索拉唑。A组为兰索拉唑15 mg，1次/d，早餐前服；B组为兰索拉唑15 mg，1次/d，晚餐前服；C组兰索拉唑15 mg，2次/d，餐前服。3组疗程均为4周。疗程结束后进行临床症状疗效评定，并予复查胃镜，评价3组胃镜下总有效率，并观察3组不良反应。 结果 三种方案有效率分别为77.5%、95.0%、92.7%。 结论 晚餐前15 mg 1次/d的兰索拉唑为反流性食管炎较佳维持治疗方案。
Objective To compare the combination of Xiao Chai Hu Tang and interferon versus the simple interferon for the management of chronic hepatitis B (CHB) in terms of clinical therapeutic effect and safety. Methods Such databases as PubMed, CBM disc, CNKI, VIP, Japana Centra Revuo Medicina were searched to include the randomized control trials (RCTs) of treating chronic hepatitis B by using Xiao Chai Hu Tang plus interferon as the treatment group and the interferon as the control group. The quality of the inclusive methodology was evaluated by two reviewers independently. RevMan5.0.24 software was employed for meta-analyses. Results Seven RCTs involving 668 patients were included and all of them were classified as Grade C methodologically. The results of meta-analyses demonstrated: compared with the simple interferon treatment, adding Xiao Chai Hu Tang to interferon was able to significantly increase the HBV-DNA negative conversion ratio (RR=1.44, 95%CI 1.18 to 1.76, P=0.000 4) and the HBeAg negative conversion ratio (RR=1.54, 95%CI 1.21 to 1.94, P=0.000 4); when the intervention duration was more than 12 weeks, the ALT normalization rate was improved significantly (24 weeks: RR=1.39, 95%CI 1.17 to 1.66, P=0.000 2; 12 weeks: RR=1.79, 95%CI 1.23 to 2.61, P=0.002) and the incidence of flu-like symptoms induced by interferon was significantly reduced (liver-protection treatment: RR=0.54, 95%CI 0.40 to 0.73, Plt;0.000 1; Non-liver-protection treatment: RR=0.75, 95%CI 0.59 to 0.95, P=0.02). The funnel plot was asymmetric, indicating publication bias. Conclusion Although Xiao Chai Hu Tang maybe has certain potential supplementary benefits to interferon for the management of CHB. The results of the above meta-analyses should be interpreted prudently because there exit disparities in domestic and international trails with the shortage of double blind or multi-centered clinical trials with high quality. The current evidence provides no way to compare the combination of Xiao Chai Hu Tang plus interferon with the simple interferon for the treatment of CHB and no accurate conclusion in terms of clinical therapeutic effects and safety.
目的 评价国内干扰素（INF）治疗多发性骨髓瘤（MM）的疗效与安全性。 方法 计算机检索中国期刊全文数据库（1989年－2011年）、中国生物医学文献数据库（1989年-2011年）和中文科技期刊全文数据库（1989年－2011年），并手工检索所有纳入文献的参考文献，纳入INF治疗MM的随机对照试验（RCT）。评价纳入研究的方法学质量并进行资料提取后，采用RevMan 5.0软件进行Meta分析。 结果 共纳入10个RCT，包括366例患者。Meta分析显示，INF联合美法仑+泼尼松（MP） 方案与单用MP方案比较，其总有效率差异有统计学意义[OR=4.52，95% CI（1.84，11.10），P=0.001]；INF联合长春新碱+多柔比星+地塞米松/泼尼松[VAD（P）]与单用VAD（P）方案比较，其总有效率[OR=4.13，95% CI（1.53，11.14），P=0.005]和完全缓解率[OR=3.88，95% CI （1.49，10.16），P=0.006]差异也均有统计学意义；INF+其他化疗方案与单用化疗方案比较，其总有效率[OR=2.57，95%CI（1.11，5.96），P=0.03]和完全缓解率[OR=3.17，95% CI（1.21，8.27），P=0.02]，差异均有统计学意义。 结论 目前国内研究结果表明，INF与化疗联合运用能增加MM治疗的总有效率和缓解率，但由于纳入研究样本量小且质量较低，上述结论尚需要高质量、大样本的随机与双盲对照试验加以分析。
Objective To evaluate the effectiveness and safety of chemotherapy regimens represented by pirarubicin (THP) vs. adriamycin hydrochloride (ADM) for non-Hodgkin lymphoma (NHL) in mainland China. Methods The randomized controlled trials (RCTs) about THP vs. ADM for treating NHL were collected in the databases such as CNKI, CBM, VIP and WanFang Data, and the references of the included studies were also retrieved manually, with the retrieval time from January 1989 to September 2012. According to the inclusion and exclusion criteria, two reviewers independently screened articles, extracted data, and assessed the methodological quality of the included studies. Then meta-analysis was performed using RevMan 5.0 software. Results A total of 15 RCTs involving 1 659 patients were included. The results of meta-analysis showed that: a) As for the total effective rate, the CTOP (C: cyclophosphamide, T: pirarubicin, O: vincristine, P: prednison) regimen was superior to the CHOP (C: cyclophosphamide H: adriamycin hydrochloride, O: vincristine, P: prednison) regimen with a significant difference (OR=1.07, 95%CI 1.02 to 1.12, P=0.006); and b) As for the safety, there were significant differences between the two groups in the incidence of cardiac toxicity (OR=0.42, 95%CI 0.30 to 0.57, Plt;0.000 01), gastrointestinal tract response (OR=0.69, 95%CI 0.56 to 0.85, P=0.000 5) and liver damage (OR=0.69, 95%CI 0.48 to 1.00, P=0.05). But no significant differences were found between the two groups in the incidence of mye1osuppression: the decreased hemoglobin (OR=0.83, 95%CI 0.61 to 1.14, P=0.25), leucopenia (OR=0.85, 95%CI 0.68 to 1.07, P=0.17), and thrombocytopenia (OR=0.99, 95%CI 0.70 to 1.39, P=0.95). Conclusion Based on the domestic evidences at current and compared with CHOP regimen represented by ADM, CTOP regimen represented by THP for treating NHL shows a higher total effective rate and less side effects. However, more high quality, large sample and double blind RCTs are required to prove this conclusion for the quality and quantity limitation of the included studies.