OBJECTIVETo observe the proportion change of immune cells in the peripheral blood of patients with rectal cancer after neoadjuvant therapy and to explore the relationship between tumor regression and CD4⁺CD25(High)CD127(low) regularly T cells(Treg cells).

METHODSPatients with rectal cancer who underwent the neoadjuvant therapy before surgery at the Shanxi Cancer Hospital Colorectal Surgery Department from January to December 2013 were prospectively enrolled. These patients were divided into down-staging group and non-down-staging group according to the change of staging in accordance with TNM classification for rectal cancer after neoadjuvant therapy. Flow cytometry was used to analyze the proportions of Treg cells, CD4+T cells, CD8+T cells, NK cells, B cells, and CD4+/CD8+ ratio in the peripheral blood from these patients before and after neoadjuvant therapy.

RESULTSA total of 108 patients were enrolled, including 76 cases in the down staging group and 32 cases in the non-down-staging group. Differences of immune cells proportions between two groups before neoadjuvant therapy were not statistically significant(all P>0.05). In the down-staging group, the proportions of Treg cells, B cells and CD4+/CD8+ ratio were decreased while the proportion of NK cells did not change obviously after the neoadjuvant therapy. Interestingly, in the non-down-staging group, the proportions of B cells and CD4+/CD8+ ratio were decreased while the proportions of Treg cells and NK cells did not change obviously after the neoadjuvant therapy. In addition, after neoadjunvat therapy, the proportion of Treg cells in down-staging group was significantly lower than that in non-down-staging group [(4.4 ± 1.7)% vs. (6.2 ± 1.9)%, P=0.001].

CONCLUSIONFor patients in the down-staging group after neoadjuvant therapy, the proportion of Treg cells in peripheral blood decreases, suggesting that Treg cells may be a valuable biomarker for assessing tumor regression.

CD4-CD8 Ratio ; Flow Cytometry ; Humans ; Interleukin-2 Receptor alpha Subunit ; Interleukin-7 Receptor alpha Subunit ; Killer Cells, Natural ; Neoadjuvant Therapy ; Rectal Neoplasms ; T-Lymphocytes, Regulatory ; Treatment Outcome

The incidence of adenocarcinoma of esophagogastric junction (AEG) is increasing,but its treatment strategy is still controversial.Surgery is the main strategy of multidisciplinary treatment.Siewert classification and TNM staging play a decisive role in the choice of operative approach,clinical decision and prognosis.Perioperative chemoradiotherapy plays an important role in the multidisciplinary treatment of AEG,and more researches support neoadjuvant therapy in patients with AEG.What's more,targeted therapy has become an integral part of multidisciplinary treatment of AEG with the constantly emergence of targeted drugs.In addition,the particularity of AEG determines that its treatment requires multidisciplinary cooperation,and the multidisciplinary team is expected to improve the prognosis of AEG patients.

Objective: To explore the clinical efficacy of ladder neoadjuvant therapy in treatment of advanced mid-low rectal cancer. Methods: We performed a retrospective study of one hundred and eighty mid and low rectal cancer patients who underwent ladder neoadjuvant therapy(neoadjuvant chemotherapy followed by surgery if neoadjuvant chemotherapy was effective; neoadjuvant chemotherapy followed by neoadjuvant chemoradiotherapy if neoadjuvant chemotherapy was ineffective)(n=90) or neoadjuvant chemoradiotherapy (n=90). Results: In the ladder neoadjuvant therapy group, the descent stage rate was 85.6% (77/90), the anastomosis rate was 50.0% (45/90), the pre-sacral infection rate was 4.4% (4/90), the pathological complete remission (pCR) was 13.3%(12/90), R0 resection rate was 85.6% (77/90), the 2-year disease control rate was 76.7% (69/90), and the 2-year survival rate was 90.0% (81/90). In the control group, the descent stage rate was 88.9% (80/90), The anastomosis rate was 45.6% (41/90), the rate of pre-sacral infection was 11.1% (10/90), pCR was 16.7% 15/90), R0 resection rate was 88.9% (80/90), the 2-year disease control rate was 78.9% (71/90), and the 2-year survival rate was 87.8% (79/90). The difference was not statistically significant (P>0.05). The ladder neoadjuvant therapy group had lower prophylactic transverse colostomyrate(10.0% vs 34.4%), lower radiation injury rate (6.7% vs 27.8%), and lower sexual dysfunction rate (38.9% vs 87.8)compared to the control group. Conclusions The ladder neoadjuvant therapy might reduce side injury caused by radiotherapy, improve compliance of patients, and reduce treatment costs. Moreover, the RO resection rate, 2-year local control rate and 2-year survival rate of ladder neoadjuvant therapy group was comparable with neoadjuvant chemoradiotherapy.

The incidence of adenocarcinoma of esophagogastric junction (AEG) has been increasing. The surgical strategy for AEG remains controversial. The Siewert definition of AEG facilitates decision of surgical approach, while TNM stage for AEG contributes to prognosis evaluation and clinical decision making. Generally, transthoracic procedure is suitable for Siewert I and transhiatal is suitable for Siewert III. The lymph node drainage of AEG is characterized by simultaneous drainage to the mediastinal and abdominal lymphatic pathways. The optimal lymphadenectomy depends on the distribution of lymph node metastasis. Reconstruction of the digestive tract requires safety as a precondition, taking into account of postoperative complications and quality of life. For AEG patients undergoing total gastrectomy, Roux-en-Y anastomosis is more common. For those undergoing proximal gastrectomy, esophageal residual stomach (tubular stomach) anastomosis is more common, but the proportion of postoperative reflux esophagitis is higher. Some documents have revealed advantages of minimally invasive laparoscopic operation for AEG, but higher level evidences is needed.
Adenocarcinoma ; pathology ; surgery ; Esophageal Neoplasms ; pathology ; surgery ; Esophagogastric Junction ; pathology ; surgery ; Gastrectomy ; Humans ; Lymph Node Excision ; Lymphatic Metastasis ; Quality of Life ; Retrospective Studies ; Stomach Neoplasms ; pathology ; surgery

OBJECTIVE: To compare the prognostic value of TNM staging systems in the 7th edition and the 8th edition AJCC in Siewert III adenocarcinoma of esophagogastric junction (AEG). METHODS: Data of 160 patients with Siewert III AEG who underwent radical surgery (R0) from January 2009 to January 2013 in PLA General Hospital were collected retrospectively. Exclusion standards:(1)preoperative neoadjuvant chemoradiotherapy;(2)with distant metastasis before or during operation;(3)palliative operation or R1/R2 resection;(4)pathological type as non-adenocarcinoma;(5)number of retrieved lymph nodes less than 16;(6)diagnosed with other malignant tumors concurrently or within 5 years after operation;(7)incomplete clinical or follow-up data. According to the above criteria, 160 patients were included in this study finally. All the patients underwent radical total or proximal gastrectomy by abdominal approach. D1 or D1+ lymph node dissection was performed in early patients and D2 in advanced patients. All the patients were re-staged by the gastric cancer TNM7 (G7), the gastric cancer TNM8 (G8) and the esophageal cancer TNM7(E7). Univariate analysis and Cox regression analysis were performed. Kappa value and Akaike's information criterion (AIC, the less AIC, the better prognosis) value were compared between different staging systems in agreement and predicting prognosis. RESULTS: There were 128 males and 32 females(sex ratio 4:1), and the average age was (60.2±11.6) years and 17 patients with basic disease. Of all the patients, 133 cases (83.1%) underwent radical total gastrectomy and 27 cases (16.9%) underwent proximal gastrectomy. The median number of dissected lymph nodes were 31 and the median number of positive lymph nodes were 4. Multivariate analysis showed that the G7, G8, E7 staging systems were independent prognostic factors (HR=1.374, 1.407 and 1.305 respectively,all P<0.001). Stage migration between G7 and G8 were only observed in IIIA, IIIB and IIIC, and stage migration rate was 8.1% (13/160), and the agreement was very good (weighted Kappa 0.904, P<0.001). However, the difference between G8 and E7 was quite obvious, stage migration rate was 40.6%(65/160), and the agreement between G8 and E7 was not satisfied (weighted Kappa 0.536, P<0.001). AIC value was 811.4 in G8, 812.8 in G7 and 815.9 in E7, respectively. CONCLUSION Compared with G7 and E7 staging systems, the G8 staging system is superior in predicting the prognosis of patients with Siewert III AEG.
Adenocarcinoma ; classification ; pathology ; surgery ; Aged ; Esophageal Neoplasms ; classification ; pathology ; surgery ; Esophagogastric Junction ; pathology ; surgery ; Female ; Gastrectomy ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; methods ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; classification ; pathology ; surgery