RESUMEN
This study analyzed breast cancer patients treated with trastuzumab in Brazil's unified health system (SUS) from 2008 to 2015. A non-concurrent cohort study using SUS data applied propensity score matching to reduce bias between trastuzumab and non-trastuzumab groups. Survival probabilities were estimated via Kaplan-Meier, with subgroup analysis using the log-rank test. Hazard ratios (HR) were calculated using Cox proportional hazards models. Among 20,852 patients, the overall survival rate was 92%, with 94% in the trastuzumab group and 90% in the non-trastuzumab group. Younger, black patients and those in the North region had poorer survival. Advanced disease stages and palliative treatments were linked to higher mortality, while adjuvant therapy and radiotherapy were protective. During follow-up, 8.1% of patients died, with better outcomes observed in the trastuzumab group (p < 0.0001). Late initiation of trastuzumab (after 16 months) improved survival, especially in early stages (I and II). Invasive tumors and stage IV disease were associated with worse prognoses. The study demonstrates trastuzumab's effectiveness in SUS, underscores survival disparities related to sociodemographic factors, and emphasizes the need for early detection, equitable access, and optimized treatment timelines to improve outcomes in public healthcare.
Asunto(s)
Antineoplásicos Inmunológicos , Neoplasias de la Mama , Trastuzumab , Estimación de Kaplan-Meier , Estudios de Cohortes , Brasil/epidemiología , Trastuzumab/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/radioterapia , Factores Sociodemográficos , Humanos , Femenino , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Programas Nacionales de Salud/estadística & datos numéricos , Factores de Tiempo , Antineoplásicos Inmunológicos/uso terapéutico , Quimioterapia Adyuvante/estadística & datos numéricosRESUMEN
BACKGROUND: Neoadjuvant chemotherapy (NACT) is the standard-of-care treatment for patients with locally advanced breast cancer (LABC), providing crucial benefits in tumor downstaging. Clinical parameters, such as molecular subtypes, influence the therapeutic impact of NACT. Moreover, severe adverse events delay the treatment process and reduce the effectiveness of therapy. Although metabolic changes during cancer treatment are crucial determinant factors in therapeutic responses and toxicities, related clinical research remains limited. METHODS: One hundred paired blood samples were collected from 50 patients with LABC before and after a complete NACT treatment cycle. Untargeted metabolomics was used by liquid chromatography-mass spectrometry (LC-MS) to investigate the relationship between dynamically changing metabolites in serum and the responses and toxicities of NACT. RESULTS: Firstly, we observed significant alterations in serum metabolite levels pre- and post-NACT, with a predominant enrichment in the sphingolipid and amino acid metabolism pathways. Second, pre-treatment serum metabolites successfully predicted the therapeutic response and hematotoxicities during NACT. In particular, molecular subtype variations in favorable treatment responses are linked to acyl carnitine levels. Finally, we discovered that the therapeutic effects of NACT could be attributed to essential amino acid metabolism. CONCLUSION: This study elucidated the dynamic changes in metabolism during NACT treatment, providing a possibility for developing responsive metabolic signatures for personalized NACT treatment.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias de la Mama , Metaboloma , Metabolómica , Terapia Neoadyuvante , Humanos , Femenino , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/sangre , Neoplasias de la Mama/metabolismo , Neoplasias de la Mama/patología , Terapia Neoadyuvante/métodos , Metabolómica/métodos , Persona de Mediana Edad , Estudios Retrospectivos , Adulto , Estudios Longitudinales , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Anciano , Biomarcadores de Tumor/sangre , Resultado del Tratamiento , Carnitina/sangre , Carnitina/análogos & derivados , Pronóstico , Cromatografía Liquida , Quimioterapia Adyuvante/métodosRESUMEN
Adjuvant endocrine therapy (AET) is essential for improving survival and reducing mortality and recurrence rates in breast cancer (BrCa) patients. However, the adherence to AET among BrCa patients is poor, and there is no scale to measure adherence to AET or the reasons for non-adherence among BrCa patients in mainland China. The aim of this study was to assess the psychometric properties of the simple Chinese version of the Medication Adherence Reasons (MAR) scale in BrCa patients undergoing AET. This study utilized a cross-sectional research design with two phases: (1) translation and cross-cultural adaptation of the original English version of the MAR scale into simple Chinese and (2) validation of the simple Chinese version of the MAR scale (s-ChMAR scale) in BrCa patients. Instrument assessments included content validity, face validity, item analysis, construct validity, criterion-related validity and reliability testing. This study recruited participants using convenience sampling to investigate adherence to AET among BrCa patients. Inclusion criteria were: (a) female, (b) aged 18 years or older, (c) diagnosed with Stage I to III BrCa, (d) completed primary treatment for hormone receptor-positive BrCa and had been on AET for more than six months but less than five years, (e) proficient in Mandarin, and (f) provided informed consent. Exclusion criteria included psychiatric illness, cognitive impairment, or a diagnosis of another cancer type. The sample size for exploratory factor analysis (EFA) was determined based on a ratio of five to ten participants per scale item to ensure sufficient statistical power. Data were collected from a sample of 325 participants who received AET for over six months. All the items had a content validity index (CVI) of more than 0.80. Regarding construct validity, the s-ChMAR scale fit a four-dimensional model, the same as the original MAR scale tested in asthma patients. The s-ChMAR scale had good internal reliability (Cronbach's α = 0.896) and good stability (ICC = 0.837). In terms of quantifying non-adherence, the s-ChMAR scale identified a non-adherent participant rate of over 50%. The study findings support the reliability and validity of the s-ChMAR scale in measuring the non-adherence of Chinese BrCa patients to AET.
Asunto(s)
Antineoplásicos Hormonales , Neoplasias de la Mama , Cumplimiento de la Medicación , Psicometría , Humanos , Femenino , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/psicología , Persona de Mediana Edad , Cumplimiento de la Medicación/estadística & datos numéricos , Cumplimiento de la Medicación/psicología , Psicometría/métodos , Adulto , Quimioterapia Adyuvante , China , Antineoplásicos Hormonales/uso terapéutico , Estudios Transversales , Encuestas y Cuestionarios , Anciano , Reproducibilidad de los Resultados , Comparación TransculturalRESUMEN
INTRODUCTION: The standard of care for stage III colon cancer is 3 or 6 months of double-drug regimen chemotherapy following radical surgery. However, patients with positive circulating tumour DNA (ctDNA) exhibit a high risk of recurrence risk even if they receive standard adjuvant chemotherapy. The potential benefit of intensified adjuvant chemotherapy, oxaliplatin, irinotecan, leucovorin and fluoropyrimidine (FOLFOXIRI), for ctDNA-positive patients remains to be elucidated. METHODS AND ANALYSIS: This multicentre phase II randomised controlled trial aims to investigate the utility of ctDNA in monitoring chemosensitivity and to preliminarily assess whether intensified chemotherapy with FOLFOXIRI can increase ctDNA clearance and improve survival outcomes. A total of 60 eligible patients with stage III colon cancer exhibiting postoperatively positive ctDNA before and after two cycles of oxaliplatin and capecitabine (XELOX) will be randomly assigned to continue five additional cycles of XELOX (control arm) or switch to eight cycles of FOLFOXIRI (experimental arm). This sequential approach is designed to escalate treatment for patients with persistent ctDNA positivity while avoiding overtreatment in those who may respond well to standard chemotherapy. The primary endpoint is the change in ctDNA concentration, defined as the difference between the ctDNA concentration measured after two cycles of XELOX and after the completion or termination of chemotherapy. Secondary endpoints include the ctDNA clearance rate, 2-year disease-free survival, distant metastasis-free survival, chemotherapy-related side effects and quality of life. ETHICS AND DISSEMINATION: This trial has been approved by the Ethics Committee of the West China Hospital, Sichuan University (approval number: 20231998). The findings will be disseminated through peer-reviewed publications and presentations at scientific conferences. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov (NCT06242418, registered on 27 January 2024).
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica , Capecitabina , ADN Tumoral Circulante , Neoplasias del Colon , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Capecitabina/administración & dosificación , Capecitabina/uso terapéutico , Quimioterapia Adyuvante , ADN Tumoral Circulante/sangre , ADN Tumoral Circulante/genética , Ensayos Clínicos Fase II como Asunto , Neoplasias del Colon/tratamiento farmacológico , Neoplasias del Colon/genética , Neoplasias del Colon/patología , Fluorouracilo/uso terapéutico , Fluorouracilo/administración & dosificación , Leucovorina/uso terapéutico , Leucovorina/administración & dosificación , Estudios Multicéntricos como Asunto , Estadificación de Neoplasias , Oxaliplatino/uso terapéutico , Oxaliplatino/administración & dosificación , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
BACKGROUND: Hepatic artery infusion (HAI) chemotherapy, particularly with floxuridine (FUDR), has previously shown effectiveness in improving recurrence-free survival (RFS) in colorectal cancer (CRC) patients with colorectal liver metastases (CRLM). Nonetheless, its adjuvant use alongside modern systemic chemotherapy remains unevaluated. PATIENTS AND METHODS: The HARVEST trial is an open-label, randomized, controlled study conducted from May 2018 to August 2021. CRC patients with resectable primary tumors and CRLM were recruited and randomized to receive standard systemic chemotherapy only (non-HAI group) or in combination with HAI-FUDR (HAI group). However, due to a FUDR manufacturing shortage, the study was terminated early after enrolling 92 patients. The primary endpoint was the 3-year RFS rate, with secondary endpoints including overall survival (OS), liver-specific RFS, and adverse events. RESULTS: Of the 92 randomized patients, 77 were included in the modified intention-to-treat analysis. Three-year RFS rates were comparable between the HAI (N = 38) and non-HAI (N = 39) groups (31.4 % vs. 34.4 %; P = 0.28). However, improved 1-year RFS and a longer expected five-year OS were observed in the HAI group. While exploratory subgroup analysis suggested potential RFS benefits for patients with multiple liver metastases, RAS/BRAF mutations, and positive postoperative ctDNA methylation, multivariable analysis did not identify these as independent factors. Safety analysis showed comparable chemotherapy-related adverse events, except for a higher occurrence of ALT elevation in the HAI group. CONCLUSIONS: While our study showed no significant difference in three-year RFS, adjuvant chemotherapy intensification with HAI-FUDR is feasible and may offer early benefits in RFS and long-term OS. Nonetheless, a larger sample size is needed for validation and identifying which patient subgroup might benefit from this regimen. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03500874.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias Colorrectales , Floxuridina , Fluorouracilo , Arteria Hepática , Infusiones Intraarteriales , Leucovorina , Neoplasias Hepáticas , Metastasectomía , Humanos , Masculino , Femenino , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Floxuridina/administración & dosificación , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/tratamiento farmacológico , Fluorouracilo/administración & dosificación , Leucovorina/administración & dosificación , Leucovorina/uso terapéutico , Persona de Mediana Edad , Anciano , Quimioterapia Adyuvante , Metastasectomía/métodos , Camptotecina/análogos & derivados , Camptotecina/administración & dosificación , Camptotecina/uso terapéutico , Compuestos Organoplatinos/administración & dosificación , Compuestos Organoplatinos/uso terapéutico , AdultoRESUMEN
Recently, neoadjuvant chemotherapy comprising docetaxel, cisplatin, and 5-fluorouracil showed promising efficacy for esophageal squamous cell carcinoma. However, some patients do not achieve curative resection despite neoadjuvant chemotherapy using these drugs. This study aimed to clarify the pretherapeutic characteristics of these patients. We included 113 patients who underwent neoadjuvant chemotherapy with docetaxel, cisplatin, and 5-fluorouracil for potentially resectable esophageal squamous cell carcinoma and compared the clinical characteristics between patients who achieved curative resection (curative group) and those who failed to achieve curative resection after planned neoadjuvant chemotherapy (noncurative group). Moreover, we determined the factors predicting noncurative outcomes. Ninety-one (81%) and 22 patients (19%) were in the curative and noncurative groups, respectively. The noncurative group had significantly more tumors located in the upper third of the esophagus, larger-sized tumors, and borderline resectable tumors than the curative group (P = 0.003, 0.049, and <0.001, respectively). Moreover, the noncurative group had significantly higher serum squamous cell carcinoma antigen concentrations than the curative group (P = 0.008). Multivariable analysis identified tumor location in the upper third of the esophagus (odds ratio 7.31, P = 0.002), tumor size ≥50 mm (odds ratio 4.71, P = 0.037), and borderline resectable tumors (odds ratio 6.65, P = 0.003) as independent predictors for noncurative outcomes. Tumor location in the upper third of the esophagus, larger-sized tumors, and borderline resectable tumors might be significant predictors for noncurative outcomes in patients who received neoadjuvant chemotherapy with docetaxel, cisplatin, and 5-fluorouracil.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica , Carcinoma de Células Escamosas , Cisplatino , Docetaxel , Neoplasias Esofágicas , Carcinoma de Células Escamosas de Esófago , Fluorouracilo , Terapia Neoadyuvante , Taxoides , Humanos , Fluorouracilo/administración & dosificación , Fluorouracilo/uso terapéutico , Cisplatino/administración & dosificación , Cisplatino/uso terapéutico , Docetaxel/administración & dosificación , Docetaxel/uso terapéutico , Terapia Neoadyuvante/métodos , Neoplasias Esofágicas/tratamiento farmacológico , Neoplasias Esofágicas/patología , Masculino , Femenino , Persona de Mediana Edad , Carcinoma de Células Escamosas de Esófago/tratamiento farmacológico , Carcinoma de Células Escamosas de Esófago/patología , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Anciano , Taxoides/administración & dosificación , Taxoides/uso terapéutico , Carcinoma de Células Escamosas/tratamiento farmacológico , Carcinoma de Células Escamosas/patología , Estudios Retrospectivos , Insuficiencia del Tratamiento , Esofagectomía , Quimioterapia Adyuvante , Adulto , Carga Tumoral , Antígenos de Neoplasias , SerpinasRESUMEN
BACKGROUND/AIM: Squamous cell carcinoma antigen (SCC) is widely used as a tumor marker for esophageal cancer. In this study, we investigated the relationship between SCC and long-term outcomes in patients with esophageal squamous cell carcinoma after neoadjuvant chemotherapy (NAC) followed by minimally invasive esophagectomy (MIE). PATIENTS AND METHODS: Between 2010 and 2018, 124 patients with ESCC who underwent MIE after NAC (cisplatin plus 5-fluorouracil) were included. Patients were divided into low and high groups based on their pre-NAC SCC level, according to the cut-off value determined using a receiver operating characteristic curve. These two patient groups were further divided into subgroups by receiver operating characteristics according to whether SCC was low or high after NAC. RESULTS: For overall survival (OS), the cut-off value for SCC pre-NAC was 0.9 ng/ml. Ninety-six patients were in the high SCC group (≥0.9 ng/ml) and 28 patients were in the low SCC group (<0.9 ng/ml) prior to NAC. The patients were then divided into pre-NAC/post-NAC SCC subgroups accordingly: low/low SCC (n=7), low/high SCC (n=21), high/low SCC (n=53), and high/high SCC (n=43). The 5-year OS rates were 100%, 66.7%, 50.9%, and 32.6%, respectively. In the multivariate analysis for OS, a high/high pre-NAC/post-NAC SCC status was an independent prognostic factor for poorer OS, along with pathological N stage. CONCLUSION: For patients with esophageal squamous cell carcinoma treated with NAC followed by MIE, a high SCC level prior to NAC which was also high after NAC was an independent prognostic factor and might contribute to deciding the need for adjuvant therapy.
Asunto(s)
Antígenos de Neoplasias , Neoplasias Esofágicas , Carcinoma de Células Escamosas de Esófago , Esofagectomía , Terapia Neoadyuvante , Serpinas , Humanos , Masculino , Femenino , Serpinas/sangre , Persona de Mediana Edad , Carcinoma de Células Escamosas de Esófago/cirugía , Carcinoma de Células Escamosas de Esófago/tratamiento farmacológico , Carcinoma de Células Escamosas de Esófago/patología , Carcinoma de Células Escamosas de Esófago/mortalidad , Terapia Neoadyuvante/métodos , Anciano , Pronóstico , Neoplasias Esofágicas/patología , Neoplasias Esofágicas/tratamiento farmacológico , Neoplasias Esofágicas/cirugía , Neoplasias Esofágicas/mortalidad , Fluorouracilo/administración & dosificación , Fluorouracilo/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biomarcadores de Tumor , Adulto , Cisplatino/administración & dosificación , Cisplatino/uso terapéutico , Quimioterapia Adyuvante , Procedimientos Quirúrgicos Mínimamente Invasivos , Estudios RetrospectivosRESUMEN
BACKGROUND: Adjuvant chemotherapy can promote the 5-year overall survival rate of pancreatic cancer (PC) patients to 16%-21%. However, the negative emotions of patients, such as anxiety, are usually omitted. Moreover, their disease burden concentrates on pain symptoms, seriously affecting the quality of life of patients. How to improve the negative emotions of PC patients, alleviate their pain, and ameliorate their quality of life has become an urgent issue. OBJECTIVE: To explore the effect of mindfulness meditation (MM) combined with the BrainLink intelligent biofeedback instrument on the anxiety, pain, brain fatigue, and quality of life of PC patients under chemotherapy. METHOD: A total of 145 PC patients under chemotherapy were admitted to the Department of Hepatobiliary Surgery of the Second Affiliated Hospital of Army Military Medical University from January 2022 to March 2024 and were incorporated as study objects. They were divided into a control group (n = 72) and a test group (n = 73) according to the random number table. The control group received routine nursing treatment; the experimental group was treated with MM combined with an intelligent biofeedback instrument. The general information, anxiety (SAS), pain (VAS), EEG signal data (degrees of fatigue, concentration, and relaxation and EEG waves), and quality of life (EORTC QLQ-C30) of the two groups before intervention and 4th, 8th, and 12th weeks after intervention were compared. RESULT: There is no significant difference in baseline data and pathological features between the two groups. After the 4th, 8th, and 12th weeks of intervention, the SAS values of the experimental group are remarkably lower than those of the control group (p < 0.05). In the 4th, 8th, and 12th weeks of intervention, the VAS scores of the experimental group are apparently lower than those of the control group (p < 0.05). In the 4th, 8th, and 12th weeks of intervention, the score of the quality of life (EORTC QLQ-C30) in the experimental group is significantly higher than that in the control group (p < 0.05). In the 4th, 8th, and 12th weeks, compared with the control group, the experimental group patients showed significant improvement in brain fatigue relief, concentration, and relaxation levels (p < 0.05), while the experimental group's brain α and θ. The wave showed an upward trend (p < 0.05). CONCLUSION: MM combined with the BrainLink intelligent biofeedback instrument can significantly mitigate the anxiety, pain severity, and brain fatigue relief degree of PC patients under chemotherapy, thereby promoting their quality of life. It provides a novel intervention for the psychosomatic health of PC patients under chemotherapy.
Asunto(s)
Ansiedad , Biorretroalimentación Psicológica , Meditación , Atención Plena , Neoplasias Pancreáticas , Calidad de Vida , Humanos , Neoplasias Pancreáticas/terapia , Neoplasias Pancreáticas/tratamiento farmacológico , Masculino , Atención Plena/métodos , Femenino , Persona de Mediana Edad , Ansiedad/terapia , Ansiedad/etiología , Meditación/métodos , Biorretroalimentación Psicológica/métodos , Fatiga/terapia , Fatiga/etiología , Adulto , Anciano , Quimioterapia AdyuvanteRESUMEN
BACKGROUND: We aim to explore the impact of excessive glutathione (GSH) intake on chemotherapy sensitivity in breast cancer. METHODS: Clinicopathological data were collected from 460 breast cancer patients who underwent adjuvant chemotherapy from January 2016 to December 2019 from Zhengzhou University People's Hospital. The clinicopathological characteristics following GSH treatment were collected and compared with those in Non-GSH group after 1:2 propensity score matching (PSM). Intracellular GSH levels and the expression of antioxidant enzymes (NRF2, GPX4 and SOD1) were evaluated in tumor tissues in 51 patients receiving neoadjuvant chemotherapy. RESULTS: The recurrence rate after adjuvant chemotherapy was significantly higher in the GSH group (n = 28, 31.8%) than that in the Non-GSH group (n = 39, 22.2%; P = 0.010). Additionally, patients in the HGSH group (high GSH intake, ≥ 16 days) exhibited an elevated recurrence rate compared to that in the LGSH group (low GSH intake, < 16 days) (n = 15 (46.8%) vs. n = 52 (22.4%); P = 0.003). Cox regression revealed that High GSH intake, Ki67 ≥ 30%, Triple negative and Lymphovascular invasion were independent risk factors of progression after adjuvant chemotherapy. Among patients receiving neoadjuvant chemotherapy, intracellular GSH levels and the expression levels of antioxidant enzymes (NRF2, GPX4 and SOD1) in the resistant patients were substantially higher (P < 0.001). CONCLUSIONS: Excessive GSH intake may contribute to chemotherapy resistance in breast cancer, and the levels of intracellular GSH and antioxidant enzymes are elevated in resistant patients after neoadjuvant chemotherapy, indicating that the standardization of GSH intake may assist in reducing chemotherapy resistance.
Asunto(s)
Neoplasias de la Mama , Resistencia a Antineoplásicos , Glutatión , Terapia Neoadyuvante , Recurrencia Local de Neoplasia , Puntaje de Propensión , Humanos , Femenino , Resistencia a Antineoplásicos/efectos de los fármacos , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/patología , Neoplasias de la Mama/metabolismo , Persona de Mediana Edad , Glutatión/metabolismo , Pronóstico , Quimioterapia Adyuvante/métodos , Terapia Neoadyuvante/métodos , Estudios de Seguimiento , Recurrencia Local de Neoplasia/metabolismo , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/tratamiento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Fosfolípido Hidroperóxido Glutatión Peroxidasa/metabolismo , Adulto , Superóxido Dismutasa-1/metabolismo , Factor 2 Relacionado con NF-E2/metabolismo , Biomarcadores de Tumor/metabolismo , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
Objectives: To analyze the long-term prognosis of patients with locally advanced gastric cancer in the stage of ypT0~2N0M0 after neoadjuvant chemotherapy. Methods: The clinical data of 78 patients with locally advanced gastric cancer who underwent neoadjuvant chemotherapy and radical resection at ypT0~2N0M0 stage from January 2012 to December 2019 in the Department of Abdominal Surgery/Pancreatic and Gastric Surgery of the Cancer Hospital of Chinese Academy of Medical Sciences were retrospectively analyzed. Kaplan-Meier method was used to calculate the overall survival and disease-free survival, and the survival difference between patients with postoperative ypT0N0M0 and ypT1~2N0M0 was compared. Multivariate Cox proportional hazards regression analysis was performed on clinical, pathologic and treatment measures that may affect survival. Results: Among the 78 patients, there were 18 cases (23.1%) with ypT0N0M0, 14 cases (17.9%) with ypT1aN0M0, 17 cases (21.8%) with ypT1bN0M0, and 29 cases (37.2%) with ypT2N0M0. Median follow-up time was 74.1 (19.8~132.5) months. Fourteen patients (17.9%) had tumor recurrence and metastasis, and 9 patients died from tumor recurrence and metastasis. The 5-year disease-free survival and overall survival rates were 84.4% and 87.8%, respectively. There was no statistically significant difference in 5-year overall survival (86.9% vs 87.8%) or 5-year disease-free survival (88.9% vs 83.2%) between patients with ypT0N0M0 and ypT1~2N0M0. Analysis of factors that may affect prognosis revealed that signet ring cell carcinoma, nerve invasion, and lymph node dissection of fewer than 16 were significantly associated with prognosis (Pï¼0.05). Multivariate Cox analysis including these three factors showed that only lymph node dissection of fewer than 16 was an independent risk factor affecting prognosis (OS: HR=10.44 ,95% CI: 2.15-50.72, P=0.004; DFS: HR=11.47, 95% CI: 2.85-46.20, P=0.001). Conclusions: The long-term prognosis of patients with locally advanced gastric cancer at ypT0~2N0M0 stage after neoadjuvant chemotherapy is relatively good, and the long-term survival time of patients with ypT1~2N0M0 and ypT0N0M0 is similar. Lymph node dissection of less than 16 nodes may be an independent risk factor affecting prognosis. During surgery, efforts should be made to increase the number of lymph node dissections. For patients with less than 16 nodes dissected, postoperative treatment and follow-up should be strengthened.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica , Gastrectomía , Terapia Neoadyuvante , Estadificación de Neoplasias , Neoplasias Gástricas , Humanos , Neoplasias Gástricas/patología , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/cirugía , Estudios Retrospectivos , Pronóstico , Factores de Riesgo , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Gastrectomía/métodos , Tasa de Supervivencia , Femenino , Masculino , Supervivencia sin Enfermedad , Modelos de Riesgos Proporcionales , Persona de Mediana Edad , Quimioterapia Adyuvante , Estimación de Kaplan-Meier , Fluorouracilo/administración & dosificaciónRESUMEN
One of the most used chemotherapy agents in clinical practice is 5-Fluorouracil (5-FU), a fluorinated pyrimidine in the category of antimetabolite agents. 5-FU is used to treat a variety of cancers, including colon, breast, pancreatic, and stomach cancers, and its efficacy lies in its direct impact on the patient's DNA and RNA. Specifically, its mechanism blocks the enzymes thymidylate synthetase and uracil phosphatase, inhibiting the synthesis of uracil, which cannot be incorporated into nuclear and cytoplasmic RNA. Despite being one of the most used drugs in oncology, it is associated with several significant side effects, including inflammation of the mouth, loss of appetite, and reduction in blood cells. In our study, we examined the reduction of side effects in a 5-FU regimen administered at doses of 15 mg/kg and 6 mg/kg for 14 days in 6-week-old male Sprague-Dawley rats. On the 14th day, the rats were treated orally for 2 weeks with 100 mg/kg of Ulva pertusa, a well-known seaweed from the Ulvaceae family, which has demonstrated powerful biological properties. The administration of this green alga alleviated the side effects of 5-FU, improving several parameters including body weight, food intake, and diarrhea index. It also helped reduce side effects in the blood, kidneys, and liver. Histological and molecular analyses were conducted on serum and colon tissues from the rats, examining changes in colon structure and the release of oxidative stress markers such as iNOS, COX-2, and nitrotyrosine. Several biochemical indicators, including SOD, CAT, GSH, MDA, and ascorbic acid, were also evaluated. Overall, our data indicated Ulva pertusa to be a promising therapeutic against 5-FU's adverse effects, therefore, it could be worthwhile to investigate the possibility of using this alga in safer cancer treatment formulations. Certainly, future preclinical and clinical studies could assess the alga's efficacy in diverse cancer treatment regimens, exploring its role as an adjuvant therapy that may reduce chemotherapy-related toxicity without compromising therapeutic outcomes.
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Colon , Fluorouracilo , Estrés Oxidativo , Ulva , Animales , Estrés Oxidativo/efectos de los fármacos , Fluorouracilo/efectos adversos , Fluorouracilo/farmacología , Ratas , Masculino , Colon/efectos de los fármacos , Colon/metabolismo , Colon/patología , Ulva/química , Ratas Sprague-Dawley , Extractos Vegetales/farmacología , Extractos Vegetales/uso terapéutico , Biomarcadores , Antimetabolitos Antineoplásicos/efectos adversos , Quimioterapia Adyuvante/métodosRESUMEN
PURPOSE: Many cancer patients express interest in using herbal medicine during chemotherapy, but little is known about its benefits and risks. This study aimed to evaluate the effects of the Chinese herbal medicine JianPi-BuShen formula (JPBS) on adjuvant chemotherapy completion in colon cancer patients. PATIENTS AND METHODS: This multi-center, phase III, randomized, placebo-controlled trial included patients with stage II (high risk for recurrence) and stage III colon cancer following surgery, planning to receive CAPOX (capecitabine and oxaliplatin) chemotherapy. Patients were randomized 1:1 to receive either JPBS or a placebo. The primary outcome was the completion rate of planned chemotherapy cycles. Secondary outcomes included relative dose intensity (RDI), chemotherapy-induced toxicities, quality of life (measured by the Edmonton Symptom Assessment System - ESAS), adverse events (AEs), and serious AEs (SAEs). Predefined subgroup analyses were performed by age (>65/≤65) and TNM stage (II/III). RESULTS: A total of 376 participants were analyzed, with a median age of 60.3 years; 56.9 % were male, and 67.6 % had stage III disease. Chemotherapy completion was significantly higher in the JPBS group than in the placebo group (63.0 % vs. 47.6 %, P = 0.003). Oxaliplatin RDI was also higher in the JPBS group (P = 0.049). Subgroup analyses showed JPBS significantly improved completion rates for stage II patients (73.0 % vs. 42.4 %, P = 0.001) and younger patients (66.9 % vs. 48.8 %, P = 0.004). JPBS reduced grade ≥ 2 vomiting (3.8 % vs. 6.4 %, P = 0.007) but increased grade ≥ 2 thrombocytopenia (16.2 % vs. 12.4 %, P = 0.012). Quality of life improved in stage II and younger patients. CONCLUSION: JPBS improved chemotherapy completion rates in stage II and younger colon cancer patients without compromising tolerability. Further research is needed to explore its mechanisms and long-term effects.
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Protocolos de Quimioterapia Combinada Antineoplásica , Capecitabina , Neoplasias del Colon , Medicamentos Herbarios Chinos , Estadificación de Neoplasias , Humanos , Masculino , Femenino , Persona de Mediana Edad , Medicamentos Herbarios Chinos/uso terapéutico , Medicamentos Herbarios Chinos/efectos adversos , Neoplasias del Colon/tratamiento farmacológico , Neoplasias del Colon/patología , Quimioterapia Adyuvante , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Capecitabina/uso terapéutico , Capecitabina/administración & dosificación , Capecitabina/efectos adversos , Oxaliplatino/administración & dosificación , Oxaliplatino/uso terapéutico , Oxaliplatino/efectos adversos , Calidad de Vida , AdultoRESUMEN
BACKGROUND: Ampullary cancer is a relatively rare malignant tumor in the digestive system. Its incidence has increased in recent years. As for now, its biological characteristics have not been fully clarified. Recent studies have primarily focused on the histological classification and genetic changes, but there are fewer investigations into the differences among site-specific subgroups. The clinicopathological characteristics of ampullary cancer occurring in different positions have not been elucidated. Furthermore, the role of adjuvant therapy in the treatment of patients with ampullary cancer remains controversial. AIM: To study the clinicopathological features of the two site-specific subgroups of ampullary cancer and explore the factors affecting prognosis. METHODS: A total of 356 patients who met the inclusion and exclusion criteria were enrolled. Patients were divided into ampulla of Vater cancer (AVC) and duodenal papilla cancer (DPC) based on the gross and microscopic findings. Baseline data, admission examination results, and perioperative outcomes were collected and analyzed. The Kaplan-Meier curve was used for survival analysis. Univariate and multivariate analysis was performed to explore the independent risk factors affecting the overall survival (OS) of both groups. RESULTS: The preoperative total bilirubin level in patients with AVC was significantly higher than those with DPC (P = 0.04). The OS for patients with DPC was 58.90 ± 38.74 months, significantly longer than 44.31 ± 35.90 months for patients with AVC (P < 0.01). The independent risk factors affecting the OS of AVC included: Preoperative albumin level (P = 0.009), total bilirubin level (P = 0.017), and number of positive lymph nodes (P = 0.005). For DPC, risk factors included: Age (P = 0.004), tumor size (P = 0.023), number of positive lymph nodes (P = 0.010) and adjuvant treatment (P = 0.020). Adjuvant therapy significantly improved the OS rate of patients with DPC, but not for those with AVC. CONCLUSION: Patients with AVC had a shorter OS compared to those with DPC. The prognosis factors and the role of adjuvant therapy of two groups were different.
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Ampolla Hepatopancreática , Neoplasias del Conducto Colédoco , Estimación de Kaplan-Meier , Humanos , Ampolla Hepatopancreática/patología , Masculino , Femenino , Neoplasias del Conducto Colédoco/patología , Neoplasias del Conducto Colédoco/mortalidad , Neoplasias del Conducto Colédoco/terapia , Neoplasias del Conducto Colédoco/cirugía , Persona de Mediana Edad , Anciano , Factores de Riesgo , Pronóstico , Estudios Retrospectivos , Metástasis Linfática , Adulto , Resultado del Tratamiento , Quimioterapia Adyuvante , Bilirrubina/sangre , Anciano de 80 o más Años , Análisis MultivarianteRESUMEN
Adjuvant oxaliplatin plus capecitabine (XELOX) therapy is recommended for patients with curatively resected colon cancer. However, prospective data on its practical application in Japanese patients are limited. Therefore, we aimed to conduct a long-term clinical evaluation of the efficacy and safety of adjuvant XELOX in patients with curatively resected stage III colon cancer (MCSCO-1024). This prospective, multi-center, open-label, single-arm, phase II study enrolled patients with curatively resected stage III colon cancer. The treatment protocol consisted of a 120-minute intravenous infusion of oxaliplatin (130 mg/m2) on day 1 and two divided doses oral capecitabine (2000 mg/m2/day) for 14 days in a 3-week cycle, totaling eight cycles (24 weeks). The primary endpoint was 3-year disease-free survival (DFS), and the secondary endpoints were 5-year overall survival and long-term prognosis of peripheral sensory neuropathy. A total of 196 patients were enrolled between November 2011 and August 2014 (34 months). The 3-year DFS rate was 73%, and the 5-year overall survival rate was 87%. The overall incidence of peripheral sensory neuropathy was 17%, with a 1% rate of grade 3 neuropathy after 5 years. Adjuvant XELOX demonstrated utility and safety in the clinical management of Japanese patients with stage III colon cancer.
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Protocolos de Quimioterapia Combinada Antineoplásica , Capecitabina , Neoplasias del Colon , Estadificación de Neoplasias , Humanos , Capecitabina/administración & dosificación , Capecitabina/efectos adversos , Capecitabina/uso terapéutico , Neoplasias del Colon/tratamiento farmacológico , Neoplasias del Colon/patología , Masculino , Femenino , Anciano , Persona de Mediana Edad , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Adulto , Quimioterapia Adyuvante/efectos adversos , Enfermedades del Sistema Nervioso Periférico/inducido químicamente , Enfermedades del Sistema Nervioso Periférico/etiología , Estudios Prospectivos , Oxaliplatino/administración & dosificación , Oxaliplatino/efectos adversos , Oxaliplatino/uso terapéutico , Fluorouracilo/análogos & derivados , Fluorouracilo/efectos adversos , Fluorouracilo/administración & dosificación , Fluorouracilo/uso terapéutico , Desoxicitidina/análogos & derivados , Desoxicitidina/administración & dosificación , Desoxicitidina/efectos adversos , Desoxicitidina/uso terapéutico , Japón , Resultado del Tratamiento , Oxaloacetatos , Supervivencia sin Enfermedad , Anciano de 80 o más Años , Pueblos del Este de AsiaRESUMEN
Objective To investigate the efficacy and safety of Xihuang capsules as an adjuvant treatment for metastatic colorectal cancer and their impact on immune function. Methods A retrospective analysis was conducted on clinical data from 112 patients diagnosed with metastatic colorectal cancer. The patients were categorized into two groups: a control group (n=56) that did not take Xihuang capsules and an observation group (n=56) that did. The efficacy, improvement of quality of life, toxic and side effects and immune function of the two groups were analyzed and compared. Results After treatment, the disease control rate (DCR) and the rate of improvement in quality of life were significantly higher in the observation group compared to the control group. Additionally, levels of carcinoembryonic antigen (CEA) and the incidence of adverse reactions, including bone marrow suppression and liver and kidney function damage, were significantly lower in the observation group. Furthermore, the percentages of CD4+ and CD8+ T cells, the CD8+/CD4+ T cells ratio, as well as serum levels of high mobility group box-1 (HMGB1) and interleukin 2 (IL-2) in observation group were significantly elevated compared to pre-treatment levels. Subgroup analysis revealed that patients with a Karnofsky Performance Status (KPS) score ≤80, a high CD8+/CD4+ T cells ratio, and elevated HMGB1 levels experienced a significantly higher objective response rate (ORR) in the observation group. Conversely, patients with stage IVB disease, who had KPS score ≤80, a low CD8+/CD4+ T cells ratio and high CEA and IL-2 levels demonstrated a more pronounced DCR in the observation group. Conclusion Xihuang capsules exhibit promising clinical efficacy as an adjuvant treatment for advanced colorectal cancer. They not only enhance patients' quality of life and reduce the toxic and adverse effects of chemotherapy, but also improve immune function. These benefits are particularly significant in patients with a high tumor burden, indicating that Xihuang capsules are worthy of clinical application.
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Cápsulas , Antígeno Carcinoembrionario , Neoplasias Colorrectales , Medicamentos Herbarios Chinos , Calidad de Vida , Humanos , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Colorrectales/inmunología , Masculino , Femenino , Persona de Mediana Edad , Medicamentos Herbarios Chinos/uso terapéutico , Medicamentos Herbarios Chinos/administración & dosificación , Medicamentos Herbarios Chinos/efectos adversos , Anciano , Antígeno Carcinoembrionario/sangre , Estudios Retrospectivos , Adulto , Metástasis de la Neoplasia , Interleucina-2/sangre , Proteína HMGB1/sangre , Quimioterapia AdyuvanteRESUMEN
BACKGROUND: Esophageal cancer is the 6th most common cancer in terms of incidence and the 4th most common cause of mortality in China. Given the limited survival outcomes observed in patients with locally advanced disease managed exclusively with surgical intervention, postoperative treatment is critically important. This study sought to assess the prognostic value of total cholesterol (TC) levels and the prognostic nutritional index (PNI) in patients undergoing postoperative chemotherapy for esophageal cancer. METHODS: A total of 101 patients who underwent postoesophagectomy chemotherapy were included in this retrospective analysis. PNI values for prechemotherapy were calculated for each patient [PNI = albumin + 5 × lymphocyte count] and TC. The optimal cutoff values for these indices were calculated from the receiver operating characteristic (ROC) curve. Patients were stratified into three groups on the basis of their PNI and TC levels. A novel nutritional prognostic index, termed the cholesterol-dependent nutritional prognostic index (CPNI), was developed on the basis of the PNI and TC. Univariate and multivariate Cox analyses were employed to determine the associations between each indicator and clinical outcomes. RESULTS: The prechemotherapy PNI, TC level, and TNM stage became independent risk factors for OS (p < 0.05). Patients in the high PNI-high TC group had significantly improved DFS and OS compared with those in the low PNI-low TC group (p < 0.001) and had a lower early recurrence rate (P = 0.008). In contrast, patients with a high CPNI had a higher mortality rate. CONCLUSION: The prechemotherapy PNI combined with TC is an accurate and useful predictor of patient prognosis.
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Colesterol , Neoplasias Esofágicas , Humanos , Neoplasias Esofágicas/tratamiento farmacológico , Neoplasias Esofágicas/cirugía , Neoplasias Esofágicas/mortalidad , Neoplasias Esofágicas/patología , Femenino , Masculino , Persona de Mediana Edad , Colesterol/sangre , Pronóstico , Quimioterapia Adyuvante/métodos , Anciano , Estudios Retrospectivos , Evaluación Nutricional , Adulto , Estado Nutricional , EsofagectomíaRESUMEN
INTRODUCTION: Colorectal cancer is the third most common cancer with the second highest mortality worldwide in 2020. Adjuvant chemotherapy is given for stage II-III colorectal cancer. However, there are side effects that decrease the patient's quality of life. Several studies have found that vitamin D could reduce the side effects of chemotherapy, but studies at Hasan Sadikin Hospital have not been done. METHODS: A study regarding the effect of vitamin D supplementation on the quality of life of stage II-III colorectal cancer patients undergoing adjuvant chemotherapy from May 2022 to April 2023 at Hasan Sadikin Hospital was conducted. A single-blinded, randomized controlled trial (RCT) with consecutive sampling was done at the digestive surgery outpatients. Data was taken from the medical record, history taking, and personal interviews. Quality of life was measured at the first, third, and sixth months after chemotherapy using the validated Indonesian version of the EORTC QLQ-C30 questionnaire. RESULTS: A total of 34 patients received vitamin D and 34 others received placebo. Serum vitamin D levels significantly increased (p < 0.001) in the intervention arm, from a median of 21.34 (5.26-29.95) to 27.92 (13.58-40.49). Meanwhile, it decreased in the placebo arm, from a median of 22.78 (8.3-29.93) to 21.37 (7.45-31.26). The patient's quality of life improved significantly after receiving vitamin D, compared with the placebo group on the third (median of 75.0 vs 45.83) and sixth (median of 83.33 vs 33.33) months after chemotherapy. CONCLUSION: Vitamin D consumption (10,000 IU/day) could improve the quality of life of colorectal cancer patients undergoing adjuvant chemotherapy.
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Neoplasias Colorrectales , Suplementos Dietéticos , Estadificación de Neoplasias , Calidad de Vida , Vitamina D , Humanos , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Colorrectales/psicología , Neoplasias Colorrectales/patología , Masculino , Vitamina D/administración & dosificación , Vitamina D/uso terapéutico , Femenino , Quimioterapia Adyuvante/métodos , Persona de Mediana Edad , Método Simple Ciego , Anciano , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversosRESUMEN
OBJECTIVE: We evaluated associations between social support and delays to surgery and adjuvant chemotherapy in a cohort of women with breast cancer (BC) from a large integrated healthcare system in Northern California. METHODS: This study included 3983 women from the Pathways Study diagnosed from 2005 to 2013 with stages I-IV BC, who had surgery as their first line of treatment and who responded to the Medical Outcomes Study Social Support survey â¼2 months following diagnosis. A second set of analyses included those receiving adjuvant chemotherapy (N = 1761). We used log binomial regression to evaluate associations of social support, and types of support, with relative prevalence of delays from diagnosis to definitive surgery > 30 days, delays to chemotherapy from diagnosis > 90 days, and delays to chemotherapy from definitive surgery > 60 days. We further examined analyses stratified by sociodemographic factors and disease severity. RESULTS: Twenty-one percent had surgery delays and 18.3% had chemotherapy delays from diagnosis (24.7% from surgery). Adjusted for covariates, women in the lowest tertile of social support were more likely to have delays to surgery (prevalence ratio (PR) = 1.27, 95% confidence interval (CI):1.08-1.48, p-continuous = 0.01) and chemotherapy (PR = 1.48, 95% CI: 1.08-2.02, p = 0.05) from diagnosis, due to associations of low tangible and emotional support with delays. We noted no effect modification in these analyses. By contrast, low social support was related to chemotherapy delays from diagnosis in women < 54 (PR = 1.96, 95% CI: 1.33-2.88) but not ≥ 54 (PR = 1.09, 95% CI: 0.79-1.49) years of age, p-interaction = 0.05. Other tests of effect modification were nonsignificant. CONCLUSIONS: Low social support was associated with delays to BC surgery and chemotherapy.
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Neoplasias de la Mama , Prestación Integrada de Atención de Salud , Apoyo Social , Tiempo de Tratamiento , Humanos , Femenino , Neoplasias de la Mama/psicología , Neoplasias de la Mama/terapia , Persona de Mediana Edad , Tiempo de Tratamiento/estadística & datos numéricos , Anciano , California/epidemiología , Adulto , Quimioterapia Adyuvante/estadística & datos numéricos , Mastectomía/psicología , Mastectomía/estadística & datos numéricos , Estadificación de Neoplasias , Retraso del TratamientoRESUMEN
BACKGROUND: This systematic review aims to explore the effect of traditional Chinese medicine combined with chemotherapy on the clinical efficacy of breast cancer postoperative patients, providing theoretical basis for the treatment of breast cancer postoperative patients with traditional Chinese medicine. METHODS: A comprehensive search was conducted on databases such as China National Knowledge Infrastructure, Wanfang Database, VIP Database, Chinese Biomedical Literature Database, PubMed, and the Cochrane Library from their inception to August 2023 to screen RCTs comparing the effect of traditional Chinese medicine combined with chemotherapy with that of chemotherapy alone on the clinical efficacy of breast cancer postoperative patients. The included literature was systematically reviewed. RESULTS: A total of 22 RCTs involving 1834 breast cancer postoperative patients were finally included, with 918 patients in the traditional Chinese medicine combined with chemotherapy group (treatment group) and 916 patients in the chemotherapy alone group (control group). Meta-analysis showed that compared with the control group, therapeutical effective rate, CD3, CD4, CD4/CD8, and adverse reactions in the treatment group were all improved, and the incidence of leukopenia and thrombocytopenia after chemotherapy were all reduced, with statistically significant differences. CONCLUSION: Traditional Chinese medicine combined with chemotherapy is superior to chemotherapy alone in improving the therapeutical effective rate after breast cancer surgery, reducing chemotherapy adverse reactions, and enhancing immune function.
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Neoplasias de la Mama , Medicina Tradicional China , Humanos , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/cirugía , Femenino , Medicina Tradicional China/métodos , Medicamentos Herbarios Chinos/uso terapéutico , Medicamentos Herbarios Chinos/administración & dosificación , Antineoplásicos/uso terapéutico , Antineoplásicos/efectos adversos , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento , Quimioterapia Adyuvante/métodosRESUMEN
Background: Ginsenosides (GS), including total GS, Rh2, Rg3 and compound K (CK), have been utilized as adjuvants in transarterial chemoembolization (TACE), surgery, and chemotherapy for hepatocellular carcinoma (HCC) therapy. However, the safety and efficacy of such combination treatments have been contradictory across different studies. This study aims to systematically evaluate the efficacy and safety of GS as adjuvant therapy for HCC. Methods: A literature search of PubMed, CNKI, Wanfang Data, Cochrane Library, Embase, and Web of Science was conducted up to May 2024 for clinical randomized controlled trials (RCTs) on GS-based adjuvant treatments for HCC. Two researchers independently screened the literature, extracted relevant data, and assessed study quality. Meta-analysis was conducted using RevMan 5.4. Results: Nineteen articles involving 1448 patients were included. Meta-analysis showed that GS as an adjuvant therapy for HCC improved disease control rate (risk ratio (RR) = 1.42, 95% CI [1.26, 1.60]), objective response rate (RR = 1.20, 95% CI [1.09, 1.32]), life quality (RR = 1.49, 95% CI [1.23, 1.79]), 1-year overall survival rate (RR = 1.27, 95% CI [1.06, 1.52]), 2-year overall survival rate (RR = 1.43, 95% CI [1.06, 1.95]), ehanced Child-Pugh in A level (RR = 1.59, 95% CI [1.08, 2.34]), Child-Pugh in B level (RR = 1.28, 95% CI [1.08, 1.52]); increased CD3+ (MD = 8.81, 95% CI [3.91, 13.71]), NKC (MD = 8.00, 95% CI [6.76, 9.24]) and CD4+ (MD = 9.38, 95% CI [8.04, 10.72]), and reduced incidence of adverse reactions including nausea and vomiting (RR = 0.66, 95% CI [0.57, 0.77]), anorexia (RR = 0.33, 95% CI [0.21, 0.50]), leukopenia (RR = 0.55, 95% CI [0.46, 0.67]) and myelosuppression (RR = 0.54, 95% CI [0.40, 0.74]); decreased Child-Pugh in C level (RR = 0.43, 95% CI [0.27, 0.68]) and CD4+/CD8+ ratio (MD = 0.50, 95% CI [0.47, 0.57]). Conclusions: In summary, GS combined with Western medical approaches (TACE, surgery, chemotherapy) for the treatment of HCC can improve clinical efficacy, increase overall survival rates, enhance patient life quality, and reduce the occurrence of adverse reactions. However, due to the generally low quality of the included studies, more large-sample, multi-center, high-quality, RCTs are warranted to further consolidate these findings.