Purpose We aim to develop an updated, parsimonious pathological TNM staging system with ideal hierarchical outcomes for non-metastatic colorectal cancer (CRC). Methods Available individual patient data from 161208 patients with non-metastatic CRC were collected from the SEER database (2010-2020, training dataset) and the Zhejiang Cancer Hospital (ZJCH) (2010-2024, validation dataset). The TNtdM framework was proposed by integrating the tumor deposit (TD) counts into N staging and reweighting T staging. Results TD was significantly associated with poor prognosis in patients with non-metastatic CRC (HR =1.39; P <0.001), and its count was found to negatively linearly correlated with cancer-specific survival (CSS) (TD1: 1-3, HR =1.31; TD2: ≥ 4, HR =1.77; P <0.001). The novel NTD staging system (NTD0-4), integrating N and TD categories, robustly stratified patients into five groups with monotonically declining 5-year CSS rates from 87.2% (NTD0) to 38.9% (NTD4) (P <0.001). By incorporating this NTD system and increasing the weighting of T staging, the TNtdM staging system, comprising 7 substages (stages IA, IB, IIA, IIB, IIIA, IIIB, and IIIC), was established and successfully resolved the survival paradox (e.g. the 5-years CSS rates: 79.6% in stage IIA, 70.5% in stage IIB, 57.6% in stage IIIA). The survival curves stratified by the TNtdM classification demonstrated excellent separation and stepwise deterioration of CSS with increased substages. Compared with the 8th edition AJCC TNM staging system, the TNtdM exhibited higher discrimination power and better goodness-of-fit. The above results were further external validated in the ZJCH cohort. Conclusions The TNtdM staging system provided superior risk stratification and more accurate prognostic information than the current AJCC staging, thereby supporting its implementation in guiding precise clinical decision-making for non-metastatic CRC.

Colorectal cancer (CRC) exhibits significant molecular and immunological heterogeneity. Neutrophil infiltration patterns play a crucial yet poorly understood role in tumor progression and patient outcomes. This study presents a comprehensive single-cell atlas of the CRC tumor microenvironment (TME), integrating transcriptomic data from 388,511 cells across 98 samples from 63 patients. Employing advanced computational methods, we stratified patients based on their immune cell infiltration profiles, revealing distinct immunophenotypes with potential therapeutic implications. Our analysis focused on tissue-resident neutrophils (TRNs) and uncovered previously uncharacterized subpopulations with diverse functional states. Trajectory inference analysis revealed a dynamic differentiation path from normal-associated neutrophils to tumor-associated neutrophils, highlighting the remarkable plasticity of these cells within the tumor environment. By integrating single-cell data with bulk transcriptomic and clinical information, we identified specific neutrophil-derived gene signatures associated with poor prognosis in CRC, suggesting their potential as novel prognostic biomarkers. This study not only provides unprecedented insights into neutrophil heterogeneity in CRC but also identifies potential targets for immunomodulatory therapies. Our findings lay the groundwork for developing more nuanced, personalized immunotherapeutic strategies for CRC, potentially improving treatment efficacy for patients who currently show a limited response to existing immunotherapies.

Lung metastasectomy has been considered the cornerstone of treatment of resectable colorectal cancer pulmonary oligometastases (CRCPOM). However, the role of chemotherapy in the neoadjuvant setting remains unclear. This study aimed to determine whether neoadjuvant therapy (NAT) could further improve survival outcomes of patients with resectable CRCPOM. We included all 253 consecutive patients at our center between 2010 and 2022. Propensity score matching (PSM) was performed to balance the baseline characteristics. The efficacy of NAT was evaluated using the Response Evaluation Criteria in Solid Tumors, version 1.1 (RECIST v1.1). Disease-free survival (DFS) was the primary endpoint, which was estimated by the Kaplan–Meier method. Multivariate analyses were conducted using Cox proportional hazards regression to identify independent predictors. The cumulative 5- and 10-year DFS rates following lung metastasectomy were 48.3

138 Background: Anlotinib is an oral multi-target tyrosine kinase inhibitor, mainly targeting VEGFR1-3, FGFR 1-4, PDGFR a/b and c-kit. Previous trial had demonstrated that anlotinib monotherapy was effective and safe in advanced colorectal cancer. ALTER-C002 trial is an open-label, single-arm, phase II study, aimed to evaluate the efficacy and safety of anlotinib plus CAPEOX as first-line therapy in patients with RAS/ BRAF wild-type unresectable metastatic colorectal cancer (mCRC). Preliminary results demonstrated significant antitumor activity and manageable toxicity. Here we reported the updated results at the data cutoff of August 19, 2022. Methods: RAS/BRAF wild-type unresectable mCRC patients with no prior systemic treatment received anlotinib (12 mg p.o. qd, d1-d14, q3w), capecitabine (850 mg/m2 p.o., bid, d1-d14, q3w) and oxaliplatin (130 mg/m2 i.v., d1, q3w) for 6 cycles followed by anlotinib and capecitabine as maintenance therapy until disease progression. Tumor response was assessed every 6 weeks according to RECIST v1.1 by investigator. The primary endpoint was ORR, and secondary endpoints included safety, DCR, DOR and PFS. Results: From Nov 2019 to February 2021, 30 eligible patients were enrolled, of whom, median age was 60y (range, 32-72y), 26 (86.7%) had left colon or rectal cancer, and 25 (83.3%) had liver metastases. The ORR was 76.7% (95% CI, 57.7-90.1%) with 2 patient achieved a complete response (CR); DCR was 93.3% (95% CI, 77.9-99.2%). At the data cutoff date, the median DOR was 7.9 months (95% CI, 4.3–11.4) and the median DOT was 8.38 months (95%CI, 5.9-10.9). The median OS has not reached yet, the 24-month OS rate was 72.8% (95%CI, 50.7-86.3%) and the 30-month OS rate was 58.3% (95%CI:25.5-80.8%). Grade 3-4 treatment-emergent adverse events (TEAEs) occurred in 25 (83.3%) patients; the most common grade 3 or 4 TEAEs ( > 10%) were hypertension (50%, 15/30 pts), neutropenia (26.7%, 8/30 pts) and diarrhea (13.3%, 4/30 pts). No grade 5 treatment-related events occurred. Conclusions: Anlotinib combined with CAPEOX exhibited promising ORR in the first-line treatment of mCRC compared to those of previous treatment. A longer follow-up is needed for a more complete assessment, and we launched a phase III, multicenter, open-label trial to assess the efficacy of this regimen comprehensively. Clinical trial information: NCT04080843 .

The optimal treatment of ypT1 rectal cancer after neoadjuvant chemoradiotherapy (nCRT) remains controversial. This study aimed to determine whether local excision is non-inferior to radical surgery and whether adjuvant chemotherapy (ACT) would improve survival in patients with ypT1 rectal cancer after nCRT. We enrolled 1212 and 91 patients with ypT1 rectal cancer underwent nCRT followed by radical surgery from the SEER database (2004–2018) and the Zhejiang Cancer Hospital (ZJCH) (2010–2022), respectively. Another 62 patients underwent LE were also identified from SEER registries. Propensity score matching was performed to balance baseline characteristics between patients in different treatment groups. Regional nodal metastasis was histopathologically detected in 257 patients (20.7

OBJECTIVE:The extent of tumor regression varies widely among patients who receive neoadjuvant chemoradiotherapy (NACRT) followed by total mesorectal excision (TME) surgery. We evaluated the tumor regression grade (TRG) classification of patients and analyzed factors related to TRG and its value in predicting prognosis in locally advanced rectal cancer (LARC).METHODS:This study retrospectively analyzed the clinicopathologic data of 269 consecutive patients with LARC treated from February 2002 to October 2014. The grade of TRG was based on the extent of primary tumor replaced by fibrosis. Clinical characteristics and relative survival were retrospectively analyzed.RESULTS:There were 269 patients, among whom 67 patients (24.9%) achieved TRG0, whereas 46 patients (17.1%) showed TRG3. TRG1 and TRG2 were both found in 78 patients (29.0%). Clinicopathologic factors that were related to TRG included post-NACRT carcinoembryonic antigen (CEA) level (P=0.002), clinical T stage (P=0.022), pathologic T stage (P<0.001) and pathologic lymph node status (P=0.003). The 5-year overall survival (OS) was 74.6%, 55.1%, 47.4%, 28.3% for TRG0, TRG1, TRG2, TRG3, respectively (P<0.001). The 5-year disease-free survival (DFS) was 64.2%, 47.4%, 37.2%, 23.9% for TRG0, TRG1, TRG2, TRG3, respectively (P<0.001). Based on multivariate analysis, TRG was a significant predictor for both OS (P=0.039) and DFS (P=0.043).CONCLUSION:Clinicopathologic factors such as post-NACRT CEA level, clinical T stage, pathological T stage and pathological lymph node status are significantly associated with TRG. TRG is an independent predictor of survival. Therefore, it is reasonable to include the TRG for clinicopathologic assessment.

CA1RO5是一项开放标签、多中心、随机、对照Ⅲ期研究,旨在比较对于初始不可切除的结直肠癌肝转移(colorectal cancer liver metastases,CRLM)患者,目前临床常用的一线全身治疗策略的疗效及安全性.该研究在2014年11月13日 至2022年1月31日期间在荷兰46个和比利时1个二/三级医疗中心进行.根据原发部位及基因状态进行分层随机分组,右侧原发性肿瘤部位或RAS或者BRAFV600E突变肿瘤患者随机分配(1:1)接受FOLFOX或FOLFIRI联合贝伐单抗(A组)或者FOLFOXIRI联合贝伐单抗(B组).左侧肿瘤且RAS和BRAFV600E野生型肿瘤患者随机分配(1∶1)接受FOLFOX或FOLFIRI联合贝伐单抗(C组)或者FOLFOX或FOLFIRI联合帕尼单抗(D组).主要研究终点是ITT人群的无进展生存期.本研究共纳入530例初始不可切除的CRLM患者,其中A组148例(28％),B组146例(28％),C组118例(22％),D组118例(22％).C组和D组因研究失败而提前关闭.右侧原发性肿瘤部位或者RAS或BRAFV600E突变肿瘤患者中,与FOLFOX或FOLFIRI加贝伐单抗治疗组相比较,FOLFOXIRI联合贝伐单抗治疗组可以延长中位无进展生存期(10.6个月vs9.0个月,P=0.032),降低CRLM患者的疾病进展或死亡风险23％.而在左侧肿瘤且RAS和BRAFV600E野生型肿瘤患者中,FOLFOX或FOLFIRI联合贝伐单抗治疗组和FOLFOX或FOLFIRI联合帕尼单抗治疗组之间中位无进展生存期无统计学差异(10.8个月vs 10.4个月,P=0.46).在安全性方面,FOLFOXIRI联合贝伐单抗治疗组严重不良事件(≥3级)明显高于FOLFOX或FOLFIRI加贝伐单抗治疗组(52％vs 31％),其中最常见的是中性粒细胞减少症,同时FOL-FOXIRI联合贝伐单抗治疗组报告了 7例与治疗相关死亡病例,显著高于其他治疗组.在左侧肿瘤且RAS和BRAFV600E野生型肿瘤患者中,FOLFOX或FOLFIRI中加入帕尼单抗,相比较于贝伐单抗,并未显示临床获益,但与更高的严重不良事件(≥3级)发生率相关.CAIRO5研究结果提示,对于右半结肠或者RAS或BRAV600E突变型初始不可切除CRLM患者,FOLFOXIRI联合贝伐单抗是首选治疗方案;而对于左半结肠RAS和BRAFV600E野生型患者,在FOLFOX或FOLFIRI的基础上联合帕尼单抗对比贝伐单抗并未能获得更好的临床疗效,且将增加治疗相关毒性.

目的 探讨以行为转变理论为指导的示范性教育在前列腺癌患者盆底肌功能锻炼的应用效果.方法 选取 2020年 4 月至 12 月浙江省肿瘤医院收治的 84 例前列腺癌根治术患者,按随机数字表法将其分为对照组和试验组,每组各 42例.对照组患者给予常规宣教,试验组患者进行以行为转变理论为指导的示范性教育干预,比较两组患者的盆底肌功能锻炼依从性、并发症发生率及生活质量.结果 干预 3个月、6 个月,试验组患者的盆底肌功能锻炼依从性及自我效能均优于对照组(P<0.05);干预 12 个月后,试验组患者的并发症总发生率显著低于对照组(16.67%vs.38.10%,χ2=4.850,P=0.028);干预 12 个月,试验组患者的躯体功能、角色功能、认知功能、情绪功能、社会功能、疲乏、食欲丧失、失眠、经济困难及总体健康状况评分均显著高于对照组(P<0.05).结论 以行为转变理论为指导的示范性教育可提高前列腺癌根治术患者术后盆底肌锻炼的依从性,加快盆底肌功能恢复,减少并发症发生,改善生活质量.

Objective:To investigate the effect of life review therapy on spiritual comfort and dignity among patients with advanced bladder cancer, to provide reference for the improvement of quality of death outcomes.Methods:A total of 60 patients with advanced bladder cancer who were admitted to the Cancer Hospital of the University of Chinese Academy of Sciences from March 2018 to January 2020 were selected as the research objects. Randomly divided all the patients into the control group and the experimental group, 30 cases in each group. The control group was given routine end-of-life care, and the experimental group was given 5 times of life review therapy on the basis of the control group. The effect of the intervention was evaluated by the Functional Assessment of Chronic Illness Therapy-Spiritual Well-being Scale(FACIT-Sp-12) and the Patient Dignity Inventory (PDI).Results:Finally, there were 28 cases in the experimental group and 29 cases in the control group. After the intervention, the scores of peace, meaning and belief demensions and total scores in FACIT-Sp-12 in the experimental group were (10.61 ± 2.23), (11.14 ± 1.90), (10.67 ± 1.79) and (32.36 ± 3.28), respectively, which was significantly higher than those in the control group (8.34 ± 2.24), (10.03 ± 1.49), (8.66 ± 1.89) and (27.03 ± 3.61), the differences were statistically significant ( t values were 2.45-5.82, all P<0.05). The psychological state, dependence, mental peace, social support demension scores and total scores of PDI in the experimental group were (8.64 ± 2.06), (3.14 ± 0.89), (4.21 ± 0.79), (2.43 ± 0.69) and (28.46 ± 4.98), which were significantly lower than those in the control group (10.34 ± 2.93), (4.17 ± 1.17), (4.93 ± 1.33), (3.17 ± 1.07) and (34.01 ± 4.79), the differences were statistically significant ( t values were 2.48-4.28, all P<0.05). Conclusions:Life review therapy can promote spiritual comfort and alleviate dignity destroyed in patients with advanced bladder cancer.

目的 探讨预见性护理干预对前列腺癌根治术患者术后尿失禁的影响.方法 选取2020年1月至2021年10月于中国科学院大学附属肿瘤医院确诊的前列腺癌并接受前列腺根治术的80例患者纳入本研究.根据纳入时间先后将其分为对照组(2020年1～12月,40例)和研究组(2021年1～10月,40例).对照组患者给予前列腺癌根治术后常规护理,研究组患者应用基于循证护理的前列腺癌根治术后尿失禁的预见性护理.比较两组患者的国际尿失禁咨询委员会尿失禁问卷(international consultation on incontinence questionnaires,ICIQ)评分、尿垫使用情况及对护理的满意度.结果 术后6个月,两组患者的ICIQ评分均显著低于本组术后3个月(P<0.05);术后3个月、6个月,研究组患者的ICIQ评分均显著低于同期对照组(P<0.05).两组患者的尿垫使用情况比较差异无统计学意义(P>0.05).研究组患者的总满意度显著高于对照组(χ2=11.259,P=0.010).结论 基于循证护理的预见性护理干预能更有效地预防前列腺癌根治术后尿失禁的发生,改善患者的生活质量,提高患者的满意度.

目的 观察前列腺癌根治术后应用延续性健康教育对患者自我管理能力的影响.方法 选择2019年1月至2020年3月该院行前列腺癌根治术患者80例,随机分为观察组与对照组各40例.对照组采取常规健康教育,观察组在对照组基础上结合延续性健康教育.观察两组干预前与干预6个月后心理状况、自我管理能力和生活质量变化.结果 两组干预6个月后,观察组焦虑自评量表和抑郁自评量表评分低于对照组,自我概念、自我护理技能、自护责任感和健康知识评分以及WHOQOL-BREF评分高于对照组;差异均有统计学意义(P<0.01).结论 前列腺癌根治术后患者应用延续性健康教育可改善生活质量及提高自我管理能力.

Abstract Background Anlotinib, an oral small molecule tyrosine kinase inhibitor targeting VEGFR 1/2/3, FGFR 1-4, PDGFR a/β, and c-kit, had demonstrated prolonged progression-free survival (PFS) in refractory metastatic colorectal cancer (mCRC). This multicenter, single-arm, phase II, exploratory study was conducted to evaluate the efficacy and safety of anlotinib combined with capecitabine and oxaliplatin as first-line treatment for unresectable RAS/BRAF wild-type mCRC. Methods Patients aged 18–75 with RAS/BRAF wild-type unresectable mCRC, without prior systemic treatment, and ECOG performance status ≤1 were enrolled. Eligible patients received capecitabine (850 mg/m2, p.o., bid, on day 1–14 every 21 days), oxaliplatin (130 mg/m2, i.v., on day 1 every 21 days), and anlotinib (12 mg, p.o., qd, on days 1–14 every 21 days) as induction therapy. Following 6 cycles of therapy, patients who achieved response or stable disease received capecitabine and anlotinib as maintenance therapy until tumor progression. The primary endpoint was objective response rate (ORR) according to RECIST (version: 1.1), and the secondary endpoints were PFS, disease control rate (DCR), duration of response (DOR), and safety. Results Between November 2019 and February 2021, 31 patients were enrolled. One patient was excluded for refusing treatment. The primary endpoint of ORR was 76.7% (95% CI, 57.7–90.1) with 1 patient achieving a complete response and 22 patients partial response. DCR was 93.3% (95% CI, 77.9–99.2). At a median follow-up of 14.1 months (95% CI, 9.9–18.3), median PFS was 11.3 months (95% CI, 7.1–14.1), and DOR was 7.9 months (95% CI, 5.5–12.7). Twenty-five (83.3%) patients experienced grade 3 or 4 treatment-emergent adverse events (TEAEs). No grade 5 TEAE was reported. The most common grade 3 or 4 TEAEs (>10%) were hypertension (15/30; 50%), neutrophil count decreased (8/30; 26.7%), and diarrhea (4/30; 13.3%). A total of 18 (60%) patients had TEAEs that resulted in dose reduction, interruptions, or delays. Conclusions Anlotinib combined with capecitabine and oxaliplatin showed considerable ORR, DCR, PFS, and DOR in the first-line therapy of mCRC with manageable toxicity profiles. Trial registration ClinicalTrials.gov : NCT04080843

Abstract Background Immunotherapy‐antiangiogenesis combination therapy has achieved excellent survival outcomes in hepatocellular carcinoma (HCC) in clinical trials. However, the combination therapy for HCC outside clinical trials is not well studied, and predictive factors are lacking. Here, we retrospectively analyzed the efficacy and safety of immunotherapy‐antiangiogenesis combination therapy in unresectable HCC patients in a real‐world setting. Methods We conducted a four‐center, retrospective study of unresectable HCC patients who received the combination of programmed death 1 (PD‐1) inhibitor and antiangiogenic agent between April 2018 and July 2021 in China. Results In total, 136 patients were enrolled in the cohort. The objective response rate (ORR) and disease control rate (DCR) were 38.0% and 81.8%, respectively. The median time to progression (TTP), progression‐free survival (PFS), and overall survival (OS) were 7.2, 7.3, and 19.6 months, respectively. The multivariate analysis indicated that ECOG performance status score (PS) 2 was a significantly independent negative factor of ORR. Moreover, ECOG PS 2, peritoneum metastasis and previous immunotherapy were found to be independent negative predictors of PFS. A shorter OS was associated with ECOG PS 2, peritoneum metastasis, the presence of previous immunotherapy, Child‐Pugh stage B, and high alpha‐fetoprotein (AFP) concentration. One hundred and twenty‐five patients (91.9%) reported adverse events (AEs) with any grade. Conclusion We elucidated the efficacy and safety of immunotherapy‐antiangiogenesis combination therapy and identified potential predictors for response and survival in a real‐world cohort of patients with unresectable HCC.

Background Regional lymph node metastasis (LNM) is crucial for planning additional lymphadenectomy, and is directly correlated with poor prognosis in gastroenteropancreatic neuroendocrine tumors (GEP-NETs). However, the patterns of LNM for small (≤20 mm) GEP-NETs remain unclear. This population-based study aimed at evaluating LNM patterns and identifying optimal surgical strategies from the standpoint of lymph node dissemination. Methods This retrospective cohort study retrieved data from the Surveillance, Epidemiology, and End Results (SEER) 18 registries database for 17,308 patients diagnosed as having localized well-differentiated GEP-NETs ≤ 20 mm between January 1, 2004, and December 31, 2017. The patterns of LNM were characterized in 6,622 patients who underwent extended resection for adequate lymph node harvest. Results Of 6,622 patients with localized small GEP-NETs in the current study, 2,380 (36%) presented with LNM after regional lymphadenectomy. Nodal involvement was observed in approximately 7.4%, 49.1%, 13.6%, 53.7%, 13.8%, 7.8%, and 15.4% of gastric (g-), small intestinal (si-), appendiceal (a-), colonic (c-), rectal (r-), non-functional pancreatic (nfp-), and functional pancreatic (fp-) NETs ≤ 20 mm. Patients with younger age, larger tumor size, and muscularis invasion were more likely to present with LNM. Additional lymphadenectomy conferred a significant survival advantage in NETs (≤10 mm: HR, 0.47; 95% CI, 0.33–0.66; p < 0.001; 11–20 mm: HR, 0.54; 95% CI, 0.34–0.85; p = 0.008) and fp-NETs ≤ 20 mm (HR, 0.08; 95% CI, 0.02–0.36; p = 0.001), as well as g-NETs (HR, 0.39; 95% CI, 0.16–0.96; p = 0.041) and c-NETs of 11–20 mm (HR, 0.07; 95% CI, 0.01–0.48; p = 0.007). Survival benefits of additional lymphadenectomy were not found in a-NETs, r-NETs, and nfp-NETs with a small size. Conclusions Given the increased risk for nodal metastasis, primary tumor resection with regional lymphadenectomy is a potential optimal surgical strategy for si-NETs and fp-NETs ≤ 20 mm, as well as g-NETs and c-NETs of 11–20 mm. Local resection is an appropriate and reliable surgical approach for a-NETs, r-NETs, and nfp-NETs ≤ 20 mm.

目的 探讨结直肠神经内分泌癌(NEC)患者临床病理特征与预后的关系.方法 选取2012年1月1日至2020年7月31日在浙江省肿瘤医院接受手术治疗且术后病理证实为结直肠NEC的28例患者为研究对象,分析其临床病理特征与预后的关系.结果 就诊时是否发生转移以及不同肿瘤类型、Ki-67增殖指数的患者术后3年累计生存率比较,差异均有统计学意义(均P<0.05);不同性别、年龄、肿瘤直径以及突触素、嗜铬粒素A、神经元特异性烯醇化酶表达是否阳性患者术后3年累计生存率比较,差异均无统计学意义(均P>0.05).28例患者术后3年累计生存率为50.0％,就诊时发生转移患者的预后明显差于未转移患者(P<0.05),混合性腺神经内分泌癌(MANEC)患者的预后明显差于单纯NEC患者(P<0.05),Ki-67增殖指数>55％的患者预后明显差于≤55％的患者(P<0.05).结论 就诊时发生转移、MANEC、Ki-67增殖指数增高的结直肠NEC患者预后较差.

e15564 Background: Antiangiogenic therapy plus chemotherapy is one of the standard treatments in mCRC. Anlotinib, an oral small multi-targeted tyrosine kinase inhibitor targeting VEGFR 1/2/3, FGFR 1-4, PDGFR α/β and c-kit, has demonstrated prolonged PFS in refractory mCRC. This trial was conducted to evaluate the efficacy and safety of anlotinib combined with CAPEOX as first-line treatment for unresectable RAS/BRAF wild-type mCRC. Methods: Patients aged 18-75, with RAS/BRAF wild-type unresectable mCRC, without prior systemic treatment and ECOG status ≤ 1were enrolled in 3 hospitals in Zhejiang, China. Enrolled patients received capecitabine (850 mg/m2 p.o., bid, on day 1-14 every 3 weeks), oxaliplatin (130 mg/m2 i.v., on day 1 every 3 weeks) and anlotinib (12 mg p.o. qd, on day1-14 every 3 weeks) as inducing therapy. After 6 cycles of combined therapy, patients who achieve complete response (CR)/ partial response (PR)/ stable disease (SD) would receive capecitabine and anlotinib as maintenance therapy until tumor progression. The primary endpoint is objective response rate (ORR); secondary endpoints included safety, disease control rate (DCR) and progression-free survival (PFS). Results: From November, 2019 to February, 2021, 31 patients had been enrolled. 1 patient was excluded for refused treatment. By now, 27 patients received at least 2 cycles of treatment and were available for efficacy evaluation: 22 patients had partial response (PR), 5 patients had stable disease (SD). The ORR was 81.5% (95% CI: 61.9–93.7%), and DCR was 100% (95% CI: 87.2–100%).1 patient received radical surgery after 6 cycles of treatment. The median PFS has not been reached yet. The most common grade≥3 AEs included hypertension (45.2%), neutropenia (25.8%) and diarrhea (12.9%). No treatment-related deaths occurred. Conclusions: The combination of anlotinib and CAPEOX showed promising antitumor activity and manageable toxicity in unresectable RAS/BRAF wild-type mCRC. Furthermore, we are launching a phase 3, multicenter, double-blind trial to further assess the efficacy of this regimen. Clinical trial information: NCT04080843. [Table: see text]

侧方淋巴结转移是目前直肠癌诊治中的难点之一.对于侧方淋巴结清扫(LPLND),在东西方国家的临床实践中存在争议,主要与中低位直肠癌解剖划分、清扫范围与指征、术前新辅助放化疗、是否行整块清扫等因素有关.目前国内共识不推荐常规行LPLND,而是建议对侧方淋巴结疑似转移的进展期直肠癌患者采取新辅助放化疗联合选择性LPLND的治疗策略.随着淋巴结示踪剂的使用和影像学技术的发展,可以进一步提高直肠癌侧方淋巴结转移预测的特异度和准确度,从而开展更精准的选择性LPLND,实现直肠癌个体化治疗.

Adequate lymphadenectomy is critical for accurate nodal staging and planning adjuvant therapy in colon cancer. However, the optimal lymph node (LN) yield for stage II right-sided colon cancer (RSCC) is still unclear. This population-based study aimed to determine the optimal LN yield associated with survival and LN positivity in patients with stage II RSCC. All patients with stage II–III RSCC were identified from the Surveillance, Epidemiology, and End Results database over a 10-year interval (2006–2015). The optimal threshold for LN yield was explored using an outcome-oriented approach based on survival and LN positivity. The median number of LNs examined for all 17,385 patients with stage II RSCC was 17 (IQR 12–23). Nineteen LNs were determined as the optimal cut-off point to maximize survival benefit from lymphadenectomy. Increased LN yield was associated with a gradual increase in the risk of node positivity, with no change after 19 nodes. Compared with patients with 19 or more LNs examined, the group with fewer LNs had a significantly poor cancer-specific survival (< 12 nodes: hazard ratio (HR) 2.26, P < 0.001; 12–18 nodes: HR 1.58, P < 0.001) and overall survival (< 12 nodes: HR 1.80, P < 0.001; 12–18 nodes: HR 1.31, P < 0.001). Similar survival results were found in the validation cohort. Patients with older age, small tumor size, and appendix and transverse colon cancer were more likely to receive inadequate LN harvest. A minimum of 19 LNs is needed to be examined for optimal survival and adequate node staging in lymph node-negative RSCC.

总结1例结节性硬化症伴双肾错构瘤一侧破裂出血患者的护理.护理要点是在肾动脉栓塞治疗前后做好出血的观察与护理,加强高热护理及靶向药物的用药及副反应管理,予以良好的心理支持和出院康复指导.经过治疗及护理,患者病情控制良好,住院19 d出院.

Background: The objective of this study was to evaluate the prognostic value of the variation in tumor regression grade (TRG) and peritumoral lymphocytic infiltration of colorectal liver metastases (CRLMs) after neoadjuvant chemotherapy (NACT). Methods: A retrospective review was performed in 98 patients with CRLMs who underwent NACT between 2010 and 2016. The TRG scores and counts of TILs at the tumor-normal interface were assessed in all 176 resected liver metastases to determine their association with prognosis. According to the variation in TRG scores, 40 patients with more than one liver metastasis were divided into a decreased TRG group and a stable TRG group. An additional independent cohort of 64 patients with 106 resected liver specimens was established to validate our main findings. Results: In the derivation cohort of 98 patients, 41.8% patients had a favourable pathological response to NACT (TRG 1-3), which were significantly associated with improved prognosis. Seventeen patients (42.5%) showed decreased TRG scores, and the remaining patients had stable scores. The multivariate analysis indicated that patients with decreased TRG scores had a better recurrence-free survival (RFS) compared with those with stable TRG scores (HR=0.42, P=0.034), and a similar trend was observed in the validation cohort (P=0.068). Dense TILs surrounding the metastases were present in 55.1% of the derivation cohort and associated with pathological response (P=0.008). Among patients with a pathological response to NACT, those with dense TILs had a superior RFS compared to those with weak TILs in both cohorts (derivation: HR=0.36, P=0.035; validation: HR=0.34, P=0.016). Conclusions: Variation in TRG scores and peritumoral lymphocytic infiltration may be proposed as secondary pathological parameters to evaluate the pathological response to NACT and predict the risk of recurrence after liver surgery.