Low-dose, short-interval target vessel regional chemotherapy through the hepatic artery combined with transarterial embolization in gastric cancer patients with liver metastases after failure of first-line or second-line chemotherapy: a preliminary analysis

Comparative Study on Diagnosis Value of Contrast-Enhanced Ultrasound and Contrast-Enhanced Computed Tomography after Treating Advanced Renal Cancer Patients with Yiqi Jiedu Decoction

OBJECTIVE

To compare and analyze the diagnosis value of contrast-enhanced ultrasound (CEUS) and contrast-enhanced computed tomography (CECT) after treating advanced renal cancer patients with Yiqi Jiedu decoction.

METHODS

The case data of 60 patients diagnosed with advanced renal cancer from January 2013 to January 2021 at the Affiliated People's Hospital of Ningbo University were retrospectively analyzed, 30 patients who accepted the conventional treatment were included in the control group, and the rest treated with Yiqi Jiedu decoction on the basis of conventional treatment were included in the study group. After treatment, patients in both groups received the CEUS and CECT examinations, the diagnosis efficacy of both examinations was evaluated with the ROC curve, and the overall survival (OS) of patients was analyzed.

RESULTS

No significant between-group differences in the general information were observed (P > 0.05); the clinical remission rate and disease control rate were not significantly different between the two groups (P > 0.05); the enhancement and attenuation, degree of enhancement, uniformity of enhancement, and pseudocapsule sign of the CEUS and CECT examinations were not remarkably different (P > 0.05); according to the results of CEUS and CECT examinations, the maximum diameters of tumor after treatment were smaller in the study group than in the control group, but with no significant between-group difference (P > 0.05); in addition, there were no obvious differences in determining the maximum diameter of tumor by CEUS and CECT (P > 0.05), and the results of the maximum diameter of tumor determined by CEUS, CECT, and pathological specimen were not statistically different (P > 0.05); as for the diagnosis efficacy, the result was CEUS + CECT > CEUS > CECT; and the OS of patients in the study group was longer than those in the control group.

CONCLUSION

The patients treated with Yiqi Jiedu decoction obtain longer OS, and the application value of CEUS combined with CECT in the treatment effect and prognosis of patients with advanced renal cancer is higher.

Lycorine inhibits cell proliferation and induced oxidative stress-mediated apoptosis via regulation of the JAK/STAT3 signaling pathway in HT-3 cells

Human cervical cancer is the fourth most common carcinoma in women in the world. The JAK/STAT3 signaling pathways crucially regulate cell growth and apoptosis. It is a significant target signaling pathway for the development of novel antitumor medicine. This study intended to explore whether lycorine could prevent HT-3 proliferation and induce apoptosis by targeting the JAK/STAT3 signaling cascade. The HT-3 cells were treated with various lycorine dosages and we analyzed cell growth, lipid peroxidation, antioxidants, mitochondrial membrane potential (ΔΨm), DNA damage, apoptosis markers by different in vitro methodologies. Our results revealed that lycorine substantially reserved cell growth via decreased antioxidants, augmented reactive oxygen species (ROS) generation which leads to loss of ΔΨm, increased nuclear crumbling and chromatin condensation, thus resulting in representative increased apoptotic cell death. Furthermore, we analyzed that the molecular mechanical action of lycorine considerably repressed JAK1/STAT3 transactional activation and decrease its downstream molecules Bcl-2, and enhances the expressional activity of Bax, cytochrome c, caspase 3 and 9 in HT-3 cells. Finally, the fact that N-acetylcysteine inhibits lycorine-induced ROS-mediated apoptosis was confirmed in HT-3 cells. Thus, the results indicate that lycorine efficiently enhances apoptosis and inhibits HT-3 cell proliferation. These outcomes collectively proposed that lycorine could be a beneficial chemotherapeutic agent for treating and managing human cervical carcinoma.

Combination Therapy of Chemoembolization and Hepatic Arterial Infusion Chemotherapy in Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis Compared with Chemoembolization Alone: A Propensity Score-Matched Analysis

Background

Survival of patients with portal vein tumor thrombosis (PVTT) is extremely poor; transarterial chemoembolization (TACE) is a treatment for patients with HCC and PVTT. Some studies showed that hepatic arterial infusion chemotherapy (HAIC) might improve the survival of HCC with PVTT. There were few researches of combining TACE with HAIC for patients with HCC and PVTT.

Aim

This study was aimed at comparing overall survival (OS) and progression-free survival (PFS) following treatment with conventional transarterial chemoembolization plus hepatic arterial infusion chemotherapy (cTACE-HAIC) or conventional transarterial chemoembolization (cTACE) alone in patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombosis (PVTT).

Methods

From January 2011 to December 2016, 155 patients with HCC and PVTT who received cTACE-HAIC (cTACE-HAIC group) (n = 86) or cTACE alone (cTACE group) (n = 69) were retrospectively evaluated. Propensity score matching (PSM) reduced the confounding bias and yielded 60 matched patient pairs. The tumors' responses were evaluated using the modified response evaluation criteria in solid tumors (mRECIST). OS and PFS of groups were compared using the Kaplan-Meier method, log-rank test, and Cox proportional hazard regression models.

Results

The median follow-up duration was 93 months (range: 1-93 months). The cTACE-HAIC group's OS (9.0 months) and PFS (6.0 months) were significantly longer than the cTACE group's OS (5.0 months) and PFS (2.0 months) (p = 0.018 and p = 0.045, respectively) in the matched cohort. Multivariate analyses showed that cTACE-HAIC was independently associated with OS (hazard ratio (HR) 0.602, p = 0.010) and PFS (HR 0.66, p = 0.038). The matched groups did not differ regarding grade 3 or 4 adverse events.

Conclusion

cTACE-HAIC was superior to cTACE alone regarding OS and PFS in patients with HCC and PVTT. Treatment-associated toxicities were generally well tolerated.

Chinese consensus on the diagnosis and treatment of gastric cancer with liver metastases

Background

The incidence of gastric cancer with liver metastases (GCLM) is 9.9-18.7%, with a median survival time of 11 months and a 5-year survival rate <20%. Multidisciplinary treatment (MDT) is gradually gaining recognition as the most important method. However, specific treatment plans remain unclear. The aim of study was to provide a consensus to improve the diagnosis and treatment of GCLM.

Methods

We brought together experts from relevant medical fields across China, including the Chinese Research Hospital Association Digestive Tumor Committee, Chinese Association of Upper Gastrointestinal Surgeons, Chinese Gastric Cancer Association, and the Gastrointestinal Surgical Group of Chinese Surgical Society Affiliated to Chinese Medical Association, to discuss and formulate this consensus.

Results

A consensus was reached on the diagnosis and treatment of GCLM. Moreover, we have developed a new clinical classification system, the Chinese Type for Gastric Cancer Liver Metastases, based on the likelihood of a surgical treatment being successful.

Conclusions

The MDT mode should be implemented throughout all treatment of GCLM.A Chinese version of this expert consensus has been published in the Chinese Journal of Practical Surgery (Volume 39, Issue 10, p. 405-411). Written permission was obtained from the Chinese Journal of Practical Surgery to disseminate the expert consensus in English.

Target hepatic artery regional chemotherapy and bevacizumab perfusion in liver metastatic colorectal cancer after failure of first-line or second-line systemic chemotherapy

Colorectal cancer liver metastasis (CRLM) is a refractory disease after failure of first-line or second-line chemotherapy. Bevacizumab is recommended as first-line therapy for advanced colorectal cancer, but is unproven in CRLM through the hepatic artery. We report favorable outcomes with targeted vessel regional chemotherapy (TVRC) for liver metastatic gastric cancer. TVRC with FOLFOX and bevacizumab perfusion through the hepatic artery was attempted for CRLM for efficacy and safety evaluation. In a single-institution retrospective observational study, 246 patients with CRLM after at least first-line or second-line failure of systemic chemotherapy received TVRC with FOLFOX (i.e. oxaliplatin, leucovorin, and 5-fluorouracil). Of 246 patients, 63 were enrolled into two groups: group 1 (n=30) received bevacizumab and TVRC following tumor progression during previous TVRC treatments; group 2 (n=33) received TVRC plus bevacizumab for CRLM on initiating TVRC. There were no significant differences in the median survival time (14.7 vs. 13.2 months, P=0.367), although the median time to progression was significant (3.3 vs. 5.5 months, P=0.026) between groups. No severe adverse events related to TVRC plus bevacizumab perfusion occurred. Target vessel regional chemotherapy with FOLFOX plus bevacizumab perfusion through the hepatic artery was effective and safe in CRLM. The optimal combination of TVRC and bevacizumab needs further confirmation in future phase II-III clinical trials.

Comparison of Safety and Efficacy of Different Models of Target Vessel Regional Chemotherapy for Gastric Cancer with Liver Metastases

BACKGROUND/AIMS

We previously demonstrated the safety and efficacy of low-dose, short-interval target vessel regional chemotherapy (TVRC(LDSI)) delivered through the hepatic artery with transarterial embolization (TAE) in patients with advanced gastric cancer (AGC). The present study aimed to compare the efficacy of TAE + TVRC(LDSI) with that of standard TAE + TVRC in AGC patients with liver metastases who failed to respond to first- or second-line systemic chemotherapy.

METHODS

This study recruited a total of 58 GC patients with liver metastases after failure of first- or second-line systemic chemotherapy. Twenty-eight patients were assigned to the TAE + TVRC(LDSI) group and 30 patients to the TAE + TVRC group. The primary end point was overall survival (OS(TVRC)), which was defined as the time from the initiation of TVRC until the last follow-up or death.

RESULTS

OS(TVRC), time to progression (TTP) until appearance of intra- and extrahepatic metastases, and overall TTP and treatment periods in the TAE + TVRC(LDSI) group were all significantly longer than in the TAE + TVRC group (all p < 0.001).

CONCLUSION

TAE + TVRC(LDSI) had a higher efficacy and safety, which was reflected by OS rates, progression-free survival rates, longer duration of treatment and milder side effects compared to standard TAE + TVRC.

Multidisciplinary treatment of liver metastases of gastric cancer

The liver is the main target organ of the metastasis for gastric cancer. In cases of liver metastases of gastric cancer, the clinical effects of many treatments are not ideal. The morbidity of liver metastases of gastric cancer is high, which is one of the leading causes of death in gastric cancer patients. Currently, there have been no standardized treatment strategies. In recent years, the use of multidisciplinary treatment can prolong the survival of gastric cancer patients with liver metastases. Multidisciplinary treatment, which is based on individual patient's condition and combines surgery, chemotherapy, radiofrequency ablation, transarterial chemoembolization and targeted therapy, may improve the outcomes radically.

Treatment and survival of gastric cancer patients with metachronous liver metastases

AIM: To investigate the treatment and survival of gastric cancer patients with metachronous liver metastases.

METHODS: Clinical data for 92 gastric cancer patients pathologically diagnosed with metachronous liver metastases treated from January 2004 to December 2009 were included. The patients received treatments including chemotherapy (n = 44), chemotherapy + hepatic artery chemoembolization (TACE) (n = 28), and chemotherapy + liver cancer resection (n = 20). The patients were followed for 6 mo to 70 mo, and the 5-year survival rate was calculated. Prognostic factors were assessed using univariate and Cox regression analysis.

RESULTS: The total effective rate was 50.00% and the 1-, 3- and 5-year survival rates were 72.73%, 22.73% and 2.27% in the patients receiving chemotherapy alone; the corresponding percentages were 57.14%, 71.43%, 28.57% and 10.71% in the chemotherapy + TACE group, and 60.00%, 75.00%, 60.00% and 40.00% in the chemotherapy + liver cancer resection group. Although the total effective rate and 1-year survival rate showed no significant difference among the three group (P > 0.05), the differences in the 3- and 5-year survival rates were statistically significant (P < 0.05). Univariate analysis showed that the diameter of primary tumor, differentiation, hepatic metastasis, liver cancer type, the number of cancer metastases, and treatment efficacy were associated with the prognosis in gastric cancer patients with metachronous liver metastases (all P < 0.05). Cox regression analysis showed that the diameter of primary tumor, the number of liver metastases and liver cancer type were independent risk factors.

CONCLUSION: Chemotherapy + liver cancer resection can effectively improve survival in gastric cancer patients with metachronous liver metastases. When selecting appropriate treatment, the type of liver cancer, tumor size and the number of liver metastases should be taken into account.