Apatinib has been demonstrated to be effective and safe among patients with gastric cancer failing after at least two lines chemotherapy. This study aimed to evaluate its effectiveness and safety of low‐dose apatinib for the treatment of gastric cancer in real‐world practice. We performed a prospective, multicenter observation study in a real‐world setting. Patients with advanced gastric cancer more than 18 years old were eligible and received low‐dose apatinib (500 mg or 250mg per day) therapy. The median progression‐free survival (PFS), median overall survival (OS), objective response rate (ORR), disease control rate (DCR), and safety were assessed. Between September 2017 and April 2019, a total of 747 patients were enrolled. The mPFS was 5.56 months (95% CI 4.47‐6.28), and mOS was 7.5 months (95% CI 6.74‐8.88). Four patients achieved complete response, 47 achieved partial response, and 374 patients achieved stable disease. The ORR was 6.83% and DCR was 56.89%. In addition, multivariate Cox regression analysis indicated that hand‐foot syndrome was one independent predictor for PFS and OS. The most common adverse events (AEs) at any grade were hypertension (36.55%), proteinuria (10.26%), hand‐foot syndrome (33.53%), fatigue (24.9%), anemia (57.35%), leukopenia (44.49%), thrombocytopenia (34.21%), and neutropenia (53.33%). Grade 3‐4 AEs with incidences of 5% or greater were anemia (13.97%), thrombocytopenia (7.14%), and neutropenia (6.67%). No treatment‐related death was observed during the treatment of apatinib. The prospective study suggested that low‐dose apatinib was an effective regimen for the treatment of advanced gastric cancer with tolerable or controlled toxicity in real world. Trial registration: NCT03333967.
Background: Activated circulating endothelial cells (aCECs) have been indicated as a potential biomarker for cancerous angiogenesis in varieties of malignancies. Furthermore, several studies have exhibited aCECs were related with progression-free survival (PFS) and overall survival (OS) in anti-angiogenesis therapy. Anlotinib is a TKI of VEGFR1/2/3, FGFR1-4, PDGFR a/b, and c-Kit. As a third-line and above treatment on advanced NSCLC, Anlotinib has shown an affirmatory efficacy in ALTER0303 controlled trial. Herein we investigated the connection between aCECs and PFS, OS and metastases burden in the trial. Method: Blood samples were collected at baseline (pre-therapeutically), the 7th, 15th, 21th, 42nd, 63rd day of Anlotinib or placebo. aCECs was measured by Flow Cytometry. Receiver-operating characteristics (ROC) analysis was used to determine a cutoff value of baseline aCECs counts to divide them into high and low groups. The predicting value of aCECs for PFS was investigated by univariate survival analysis. Chi-square test for baseline aCECs counts and patients' clinical characteristics before Anlotinib or placebo treatment was performed. Result: aCECs were obtained in 78 patients (Anlotinib n¼49). No significant difference in baseline characteristics was found between two arms (P>0.05). High baseline aCECs count was statistically in connection with more metastatic lesions (>3) (c 2 ¼ 4.905,P¼0.027). 49 Anlotinib treated patients were divided into 35 and 14 according to the ratio of minimal aCECs counts at every time point and baseline (aCECs min/baseline), as <1 and 1. Median follow-up was 8.6 months. Patients with min/baseline<1 had longer median PFS than ones with min/baseline>1 (193 vs.124 days, HR¼0.439, 95%CI 0.211-0.912, P¼0.023. shown in Table1). However, no significant relation between PFS and aCECs min/baseline was found in control arm. Conclusion: Decreased aCECs during an initial period of Anlotinib therapy may predict longer PFS and baseline aCECs count may be related with the number of metastatic lesions.
Surgical resection remains the gold standard treatment for gastric cancer; however, the rate of post-operative complications remains unsatisfactory. Although the majority of complications are treatable, it remains unknown whether the long-term survival of patients is affected and what type of complications affect prognosis. In the present study, the modified Clavien-Dindo classification system was used to examine the incidence of early complications along with the related risk factors following radical gastrectomy (RG) and to determine the effects of such complications on long-term prognosis. For this purpose, 525 gastric cancer patients with RG were analyzed retrospectively. The results revealed that age [odds ratio (OR), 1.781; P=0.013], pre-operative comorbidity (OR, 1.765; P=0.020), blood loss (OR, 2.153; P=0.001) and the type of surgery (OR, 3.137; P<0.001) were identified as independent risk factors associated with post-surgery complications. Blood loss (OR, 13.053; P=0.013) and the resection type (OR, 7.936; P= 0.047) were identified as independent risk factors for severe complications. The 5-year overall survival (OS) rate of patients in the severe complication group was 35%, which was significantly worse than that of patients in the non-severe complication group (61.8%). Severe complications (hazard ratio, 1.595; P=0.107) were not found to be independent risk factors associated with the 5-year OS. On the whole, the present study demonstrates that complications following RG were significantly related to age, pre-operative comorbidity, blood loss and the type of surgery. Severe complications were distinctly affected by blood loss and the resection type. The 5-year OS of patients in the severe complication group was significantly worse than that of patients in the non-severe complication group; however, severe complications were not found to be independent risk factors associated with long-term survival.
BACKGROUND Retroperitoneal cysts are rare and usually asymptomatic abdominal lesions. Epidermoid cysts are frequent benign cutaneous tumors, but retroperitoneal localization of these cysts does not occur very often. CASE SUMMARY We report a case report of a 25-year-old woman with a giant mass in the abdominal cavity. Because imaging examination indicated that the mass probably originated from the pancreas, the mass was considered a solid pseudopapillary tumor of the pancreas (SPTP). However, surgery revealed a retroperitoneal epidermoid cyst located behind the pancreas neck and the root of the superior mesenteric artery (SMA). We performed complete resection of the tumor. Postoperative pathology showed an epidermoid cyst. The patient fared well after two months of follow-up. CONCLUSION Surgery is the gold standard for the diagnosis and treatment of retroperitoneal epidermoid cysts. Retroperitoneal epidermoid cysts around the pancreas are easily misdiagnosed as cystic SPTPs. Surgeons should pay particular attention to preoperative diagnosis to reduce severe surgical complications and improve the quality of life of patients.
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