Ye Zhou

Chinese consensus guidelines for diagnosis and management of gastrointestinal stromal tumor

In order to further promote the standardization of diagnosis and treatment of gastrointestinal stromal tumor (GIST) in China, the members of Chinese Society of Clinical Oncology (CSCO) Expert Committee on GIST thoroughly discussed the key contents of the consensus guidelines, and voted on the controversial issue. In final, the Chinese consensus guidelines for the diagnosis and management of GIST (2017 edition) was formed on the basis of 2013 edition consensus guidelines, which is hereby announced. The consensus included the pathological diagnosis, recurrence risk classification evaluation, targeted agent therapy, surgery and principles of surveillance of GIST.

Better predictive value of axillary lymph node (ALN) status after systemic therapy for operable HER2-overexpressing breast cancer: A single-institution retrospective study.

BACKGROUNDnThresholds for using Preoperative Systemic Therapy (PreST) have decreased to include early breast cancer. This study investigates the predictive value of axillary lymph node (ALN) status before and after systemic therapy and discusses whether it is better to receive PreST first in operable HER2-overexpressing breast cancer patients.nnnMETHODSnFrom January 2008 to June 2013xa0at Fudan University Shanghai Cancer Center, we identified 406 eligible female patients with stage II-IIIa, operable and pathologically confirmed HER2-overexpressing invasive ductal carcinoma. Of these patients, 269 underwent surgery first followed by chemotherapy plus trastuzumab (chemo-trastuzumab) (SurgFirst group), whereas 137 received systemic chemo-trastuzumab therapy first followed by surgery (STFirst group). Disease-free survival (DFS) and overall survival (OS) were evaluated according to different ALN statuses using the Kaplan-Meier method. Multivariate COX model analyses were also conducted.nnnRESULTSnThe median follow-up time was 47 months (IQR: 37-60). Both ALN status and overall pathological complete remission (pCR) status were shown to be significant for the prediction of DFS (pxa0=xa00.001 and pxa0=xa00.005, respectively) and OS (pxa0=xa00.009 and pxa0=xa00.027, respectively) in the STFirst group. However, patients with positive ALN(s) did not experience significantly poorer survival compared with those with negative ALN in the SurgFirst group. The adjusted hazard ratios (HRs) for positive ALN status in the STFirst and SurgFirst groups were 6.66 (pxa0=xa00.001, 95%CI: 2.18-20.38) and 2.40 (pxa0=xa00.126, 95%CI: 0.78-7.34), respectively.nnnCONCLUSIONnThe ALN status after systemic chemo-trastuzumab therapy better predicts the survival outcome. We recommend the application of PreST followed by surgery in patients with operable HER2-overexpressing breast cancer.

Comparative effectiveness of preoperative, postoperative and perioperative treatments for resectable gastric cancer: A network meta-analysis of the literature from the past 20 years

BACKGROUNDnDifferent preoperative, postoperative or perioperative treatment strategies, including chemotherapy or chemoradiotherapy, are available for patients with gastric cancer, but conventional meta-analyses that assess two alternative treatments are unable to compare differences in overall survival. Thus, we performed a network meta-analysis to identify the best treatment strategy.nnnMETHODSnWe systematically searched and assessed studies for eligibility and extracted data. We then pooled the data and conducted a Bayesian network meta-analysis to combine direct comparisons with indirect evidence. The node-splitting method was used to assess the inconsistency. Rank probabilities were assessed by the probability of treatment rankings.nnnRESULTSnThirty-three eligible randomized controlled trials were included in the network meta-analysis. Four treatments that had significantly improved prognoses when compared with surgery only were postoperative chemotherapy [HRu202f=u202f0.80 with 95% CrI: (0.73, 0.88)], postoperative chemoradiotherapy [HRu202f=u202f0.73 with 95% CrI: (0.61, 0.87)], preoperative chemoradiotherapy [HRu202f=u202f0.77 with 95% CrI: (0.62, 0.98)] and perioperative chemotherapy [HRu202f=u202f0.69 with 95% CrI: (0.55, 0.84)]. Preoperative chemotherapy, however, did not significantly improve survival when compared with surgery alone [HRu202f=u202f0.94 with 95% CrI: (0.71, 1.2)]. There was no statistically significant difference between postoperative chemotherapy, postoperative chemoradiotherapy, preoperative chemoradiotherapy and perioperative chemotherapy in terms of overall survival. Chemoradiotherapy after D2 lymphadenectomy did not significantly improve OS when compared with postoperative chemotherapy [HRu202f=u202f0.95 with 95% CrI: (0.73, 1.3)].nnnCONCLUSIONnAmong patients with operable gastric cancer, perioperative chemotherapy had the highest probability of being the best treatment. Further clinical resources may be required to assess the efficacy and safety of perioperative chemotherapy for patients with gastric cancer.

Comparative effectiveness of neoadjuvant treatments for resectable gastroesophageal cancer: a network meta-analysis

Background: Several neoadjuvant treatments are available for patients with resectable gastroesophageal cancer. We did a Bayesian network meta-analysis (NMA) to compare available treatments, summarizing the direct and indirect evidence. Method: We searched relevant databases for randomized controlled trials of neoadjuvant treatments for resectable gastroesophageal cancer which compared two or more of the following treatments: surgery alone, perioperative docetaxel, oxaliplatin, leucovorin, and fluorouracil (FLOT), and neoadjuvant treatments listed in National Comprehensive Cancer Network guideline. Then we performed a NMA to summarize the direct and indirect evidence to estimate the relative efficacy for outcomes including overall survival (OS), progression-free survival and R0 resection rate. We calculated odds ratio (OR) and hazard ratio (HR) with 95% credible intervals (CrI) for dichotomous data and time-to-event data, respectively. We also calculated the surface under the cumulative ranking curve (SUCRA) value of each intervention to obtain a hierarchy of treatments. Result: Eight eligible trials (2434 patients) were included in our NMA. The treatment with the highest probability of benefit on OS as compared with surgery alone was perioperative FLOT [HR = 0.58 with 95% CrI: (0.43, 0.78), SUCRA = 93%], followed by preoperative radiotherapy, paclitaxel, and carboplatin (RT/PC) [HR = 0.68 with 95% CrI: (0.53, 0.87), SUCRA = 72%], perioperative cisplatin with fluorouracil (CF) [HR = 0.70 with 95% CrI: (0.51, 0.95), SUCRA = 68%], and perioperative epirubicin, cisplatin, and fluorouracil or capecitabine (ECF/ECX) [HR = 0.75 with 95% CrI: (0.60, 0.94), SUCRA = 56%]. Conclusion: Compared with surgery alone, perioperative CF, perioperative ECF/ECX, perioperative FLOT, and preoperative RT/PC significantly improved survival. Perioperative FLOT is likely to be the most effective neoadjuvant treatment for the disease. Further clinical studies are needed and justified.

Cytoreductive surgery for metastatic gastrointestinal stromal tumors followed by sunitinib compared to followed by imatinib-a multi-center cohort study

BACKGROUNDnThe progression-free survival (PFS) is not optimal when imatinib was recommended for treatment of gastrointestinal stromal tumor (GIST) undergoing surgery after tumor local or multifocal progression.nnnMETHODSnWe evaluate PFS of patients undergoing R0 resection or optimal cytoreductive surgery followed by sunitinib therapy compared with imatinib after tumor unifocal or multifocal progression.nnnRESULTSnFrom January 2006 to June 2017, ninety-seven patients from thirteen medical centers were enrolled. Fifty-six patients continued imatinib therapy and 41 patients switched sunitinib treatment directly after R0 resection or optimal cytoreductive surgery. The PFS of sunitinib group was longer than that of imatinib group (30.0 months vs 12.0 months, pxa0=xa00.009). In subgroup analysis, the PFS of the sunitinib and imatinib groups were 25.5 months and 12.0 months in patients with tumor multifocal progression (pxa0=xa00.008), and 39.0 months and 13.0 months in patients with unifocal progression (pxa0=xa00.156), respectively. PFS of postoperative sunitinib group was also superior to the total PFS of postoperative imatinib group (PFS of postoperative imatinib plus PFS of subsequent sunitinib therapy (30.0 months vs 21.0 months, pxa0=xa00.012). The overall survival in the sunitinib and imatinib groups were 37.0 months and 33.0 months, respectively (pxa0=xa00.794).nnnCONCLUSIONSnSurgery followed by sunitinib in GIST patients with unifocal or multifocal progression on imatinib may improve PFS, compared with surgery followed by imatinib.

Hydrothemal synthesis of zeolite-like zirconogermanates by the use of organic amines

Abstract A new class of microporous zirconogermanates, including FDZG-1 ((C 4 N 2 H 12 )[ZrGe 4 O 10 F 2 ]), FDZG-2 ((NH 4 ) 2 ZrGe 3 O 9 ), FDZG-3 ((C 2 H 10 N 2 )·H 2 O·[ZrGe 3 O 9 ) and a known one, ASU-15 ((C 4 N 2 H 14 )[ZrGe 2 O 6 F 2 ]) have been synthesized by using cheap inorganic salt ZrO(NO 3 ) 2 ·2H 2 O as a zircoium source and organic amines as the structure direct agents in hydrothermal condition. Their structures are all based on the principle whereby germanate units such as cyclic trigermanate, germanate chain and germanate layer, are bridged by ZrO 6 (or ZrO 4 F 2 ) octahedrons to form frameworks. Non-framework species such as protonated organic amine cations, ammonium or water molecules fill the intra-crystalline pore space. FDZG-1 has a new three-dimensional (3D) open framework built up 1D 10-member ring (MR) channels. FDZG-2 has a new hexagonal structure (space group P63/m ) with 3D framework composed of (4,6)-connected cage-like net. FDZG-3 is also a novel zirconogermanate with a framework composed by odd rings, 3- and 7-MR. FDZG-1 and FDZG-3 have a relatively low framework density (FD) with a value of 13.5 and 13.4 T/1000 3 respectively.