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"Chang, Yao‐Yu"
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Study on the Characteristics of Vacuum-Bag-Only Processed Composites by Prepreg/Fiber Interleaved Layup
In this study, the vacuum-bag-only (VBO) process was used to fabricate composite laminates by employing interleaved unidirectional fully impregnated prepreg and dry fiber. The mechanical test results show that the flexure strength, compression after impact (CAI) strength and compression before impact (CBI) strength of the carbon fiber composite laminate produced by this process are about 84%, 72% and 83% of the autoclave composite laminate, respectively. The CAI strength with impact energy of 8.5 J retained about 85.4% and 96.4% of the original strength, respectively, for the components fabricated by the interleaved layup VBO and conventional autoclave processes. Ultrasonic scanning was performed for the 50 × 50 cm
2
unidirectional carbon fiber composite to identify the void distribution. The results show that the composites fabricated by interleaved layup VBO process have good quality and low porosity. In the case of glass fiber composites, the hybrid laminate of this process was used to fabricate composite laminate in which unidirectional glass fiber prepregs and bidirectional dry woven glass fiber fabric are interleaved layup. The ultrasonic test results show that the internal pores of this composite laminate are very few, and the quality is good. The feasibility of applying the process to different materials or woven materials was demonstrated.
Journal Article
Mutation spectra of RAS gene family in colorectal cancer
The clinicopathologic features and frequency of KRAS mutations in colorectal cancer (CRC) patients have been reported; however, the characteristics and impact of NRAS and HRAS mutations on the survival of CRC patients have seldom been addressed.
Under institutional review board approval, 1,519 CRC patients who underwent surgery were enrolled. Mutation status of RAS was determined by polymerase chain reaction and mass spectrophotometry.
The frequency of KRAS, NRAS, and HRAS mutations was 39.6%, 4.3%, and 1.7%, respectively. The KRAS mutation was associated with fewer left-sided tumors, fewer poor differentiated tumors, more mucin component, and less lymphovascular invasion. The NRAS or HRAS mutations were not associated with any of the clinicopathologic features examined. After univariate analysis, only NRAS mutation was associated with patients' overall and disease-free survival. However, the association of NRAS with patients' overall and disease-free survival disappeared after stepwise elimination.
This study demonstrates the clinicopathologic characteristics of CRC patients with RAS mutations. Patients with NRAS mutation tended to have worse outcomes.
•Of the 1,519 colorectal cancer patients, 602 (39.6%), 66 (4.3%), and 26 (1.7%) were found to have KRAS, NRAS, and HRAS mutations, respectively.•The KRAS mutation was associated with fewer left-sided tumors, fewer poor differentiated tumors, more mucin component, and less lymphovascular invasion.•Patients with the NRAS mutation, but not the KRAS or HRAS mutation, had an insignificantly worse outcome.
Journal Article
Clinical Outcomes after Intracorporeal versus Extracorporeal Anastomosis in Patients Undergoing Laparoscopic Right Hemicolectomy for Colon Cancer
Background and Objectives: Laparoscopic right hemicolectomy (LRHC) is commonly performed for patients with colon cancer, selecting between intracorporeal anastomosis (ICA) or extracorporeal anastomosis (ECA). However, the impact of ICA versus ECA on patient outcomes remains debatable. The varying levels of experience among surgeons may influence the outcomes. Therefore, this study sought to compare the short- and long-term outcomes of LRHC using ICA versus ECA. Materials and Methods: This retrospective study extracted patient data from the medical records database of Changhua Christian Hospital, Taiwan, from 2017 to 2020. Patients with colon cancer who underwent LRHC with either ICA or ECA were included. Primary outcomes were post-surgical outcomes and secondary outcomes were recurrence rate, overall survival (OS), and cancer-specific survival (CSS). Between-group differences were compared using chi-square, t-tests, and Fisher’s exact tests and Mann–Whitney U tests. Associations between study variables, OS, and CSS were determined using Cox analyses. Results: Data of 240 patients (61 of ICA and 179 of ECA) with a mean age of 65.0 years and median follow-up of 49.3 months were collected. No recognized difference was found in patient characteristics between these two groups. The ICA group had a significantly shorter operation duration (median (IQR): 120 (110–155) vs. 150 (130–180) min) and less blood loss (median (IQR): 30 (10–30) vs. 30 (30–50) mL) than the ECA group (p < 0.001). No significant differences were found in 30-day readmission (ICA vs. ECA: 1.6% vs. 2.2%, p > 0.999) or recurrence (18.0% vs. 13.4%, p = 0.377) between the two groups. Multivariable analyses revealed no significant differences in OS (adjusted hazard ratio (aHR): 0.65; 95% confidence interval (CI): 0.25–1.44) or CSS (adjusted sub-hazard ratio (aSHR): 0.41, 95% CI: 0.10–1.66) between groups. Conclusions: Both ICA and ECA in LRHC for colon cancer had similar outcomes without statistically significant differences in post-surgical complications, 30-day readmission rates, recurrence rate, and long-term survival outcomes. However, ICA may offer two advantages in terms of a shorter operative duration and reduced blood loss.
Journal Article
Efficacy and Safety of a Parenteral Nutrition Program for Patients with RAS Wild-Type Metastatic Colorectal Cancer Administered First-Line Cetuximab Plus Chemotherapy: A Propensity Score Matching Study
Malnutrition is a common problem in patients with metastatic colorectal cancer (mCRC) receiving targeted therapy plus chemotherapy, resulting in severe toxicity and decreased survival rates. This retrospective study employing propensity score matching (PSM) examined the efficacy and safety of a supplemental home parenteral nutrition (HPN) program for patients with RAS wild-type mCRC receiving cetuximab plus chemotherapy. This retrospective nationwide registry study included data from 14 medical centers/hospitals across Taiwan, and the data period ranged from November 2016 to December 2020. Patients with RAS wild-type mCRC receiving cetuximab plus chemotherapy as their first-line therapy were included and divided into HPN and non-HPN program groups. HPN was initiated based on patient-specific factors, such as baseline nutritional status, treatment-related toxicities, and comorbidities. Clinical outcomes were evaluated using response to therapy, duration of response (DoR), progression-free survival (PFS), and overall survival (OS). This study recruited 758 patients, of whom 110 and 648 were included in the HPN and non-HPN program groups, respectively. After 1:3 PSM, the data of 109 and 327 patients from the HPN and non-HPN program groups were analyzed, respectively. The HPN program group had a higher metastasectomy rate (33.9% vs. 20.2%, p = 0.005), and longer duration of treatment and DoR than the non-HPN program group (13.6 vs. 10.3 and 13.6 vs. 9.9 months, p = 0.001 and < 0.001, respectively). The HPN program group tended to have a longer median PFS (18.2 vs. 13.9 months, p = 0.102). Moreover, we noted a significant improvement in the median OS in the same group (53.4 vs. 34.6 months, p = 0.002). Supplemental HPN programs may be recommended for select patients with mCRC receiving targeted therapy plus chemotherapy to improve oncological outcomes.
Journal Article
Optimizing third-line and beyond therapies for metastatic colorectal cancer in Taiwan: an evidence-based consensus
A treatment consensus for advanced colorectal cancer in the later-line setting in Taiwan Metastatic colorectal cancer (mCRC) remains a leading cause of cancer-related mortality in Taiwan. Although multiple therapies are available after first- and second-line treatment, clinical outcomes in later lines remain limited. International guidelines provide general recommendations, but their direct application in Taiwan is constrained by differences in drug reimbursement, access to newer therapies, and availability of molecular testing. To address these gaps, a multidisciplinary panel of colorectal cancer experts in Taiwan developed a consensus framework for the management of mCRC beyond second-line therapy. Using a structured, evidence-informed process, the panel integrated international clinical trial data with Taiwanese real-world experience and healthcare system considerations. Twelve consensus recommendations were established, covering disease monitoring, systemic and local treatment strategies, and therapeutic options in third-line and subsequent settings. This consensus provides a practical framework that aligns global evidence with Taiwan’s healthcare environment, supporting more consistent treatment decision-making and highlighting areas where policy and resource development may further improve care for patients with advanced colorectal cancer.
Journal Article
Preoperative Prognostic Nutritional Index Predicts Postoperative Outcomes in Colorectal Cancer: A Propensity Score-Matched Cohort Study
The Prognostic Nutritional Index (PNI) is a numerical score used to assess the nutritional and immunological status, derived from serum albumin concentration and lymphocyte count. While malnutrition and systemic inflammation are known to influence surgical outcomes and cancer prognosis, the predictive value of PNI in colorectal cancer (CRC) is underexplored. This study aimed to evaluate whether preoperative PNI predicts postoperative complications and long-term survival in patients with CRC undergoing curative-intent surgery.
The records of 2,026 patients who underwent curative-intent surgery for CRC between 2011 and 2023 at a tertiary center in Taiwan were retrospectively reviewed. Propensity score matching (PSM) was used and patients were stratified into high and low PNI groups based on the median value. Outcomes included in-hospital complications, 5-year overall survival (OS), and disease-free survival (DFS) in the subgroup of patients with stage I-III disease. Multivariable logistic regression and Cox proportional hazards models were used as well as restricted cubic spline (RCS) analysis.
High PNI was independently associated with lower rates of overall complications (adjusted odds ratio [aOR] = 0.22, 95% confidence interval [CI]: 0.17-0.28), ileus (aOR = 0.23), anastomotic leakage (aOR = 0.16), and lung-related complications (aOR = 0.38). High PNI was also significantly associated with improved 5-year OS (aHR = 0.45, 95% CI: 0.38-0.55), but not DFS. In additional competing-risk and comorbidity-stratified analyses, high PNI remained protective for both cancer-related (p = 0.0005) and non-cancer-related mortality (p < 0.0001), with consistent effects across CCI strata and attenuation for cancer-related death in CCI ≥ 3 (p = 0.1024). Additionally, PNI demonstrated superior predictive performance over the neutrophil-to-lymphocyte ratio (NLR) for all complication types based on receiver operating characteristic (ROC) analysis.
Preoperative PNI was independently associated with postoperative complications and OS in patients with CRC undergoing curative surgery. Routine assessment of PNI may help refine risk stratification and guide perioperative management to improve surgical outcomes.
Journal Article
Predictive values of stool-based tests for mucosal healing among Taiwanese patients with ulcerative colitis: a retrospective cohort analysis
Over the past two decades, ulcerative colitis (UC) has emerged in the Asia Pacific area, and its treatment goal has shifted from symptom relief to endoscopic remission. Endoscopy is the gold standard for the assessment of mucosal healing; however, it is an invasive method. Fecal calprotectin (FC) is a non-invasive stool-based inflammatory marker which has been used to monitor mucosal healing status, but it is expensive. By contrast, the immune fecal occult blood test (iFOBT) is a widely utilized stool-based screening tool for colorectal cancer. In this study, we compared the predictive values of iFOBT and FC for mucosal healing in Taiwanese patients with UC.
A total of 50 patients with UC identified via the electronic clinical database of Changhua Christian Hospital, Taiwan, were retrospectively enrolled from January 2018 to July 2019. Results of iFOBT, FC level, and blood tests as well as Mayo scores were reviewed and analyzed. Colonic mucosa was evaluated using the endoscopic Mayo subscore.
The average age of the patients was 46 years, and 62% of the patients were men. Disease distribution was as follows: E1 (26%), E2 (40%), and E3 (34%). Complete mucosal healing (Mayo score = 0) was observed in 30% of patients. Endoscopic mucosal healing with a Mayo score of 0 or 1 was observed in 62% of the patients. Results of FC and iFOBT were compared among patients with and without mucosal healing. Predictive cutoff values were analyzed using receiver operating characteristics curves. iFOBT and FC had similar area under the curve for both complete mucosal healing (0.813
0.769, respectively,
= 0.5581) and endoscopic mucosal healing (0.906
0.812, respectively,
= 0.1207).
In daily clinical practice, FC and iFOBT do not differ in terms of predictive values for mucosal healing among Taiwanese patients with UC.
Journal Article
Genomic and tumour microenvironmental biomarkers of immune checkpoint inhibitor response in advanced Taiwanese melanoma
Objective Genomic biomarkers predicting immune checkpoint inhibitor (ICI) treatment outcomes for Asian metastatic melanoma have been rarely reported. This study presents data on next‐generation sequencing (NGS) and tumour microenvironment biomarkers in 33 cases. Methods Thirty‐three patients with advanced melanoma, who underwent ICI treatment at the Chang Gung Memorial Hospital in Taiwan, were recruited. The study evaluated clinical outcomes, including response rate, disease control rate, progression‐free survival (PFS) rate and overall survival (OS) rate. Archived tissue samples from 33 cases were subjected to NGS by ACTOnco, and ACTTME was employed in 25 cases. Results The most prevalent driver mutations were BRAF mutations (24.2%), followed by NRAS (15.2%), KIT (12.1%), KRAS (9.1%) and NF1 (9.1%) mutations. Acral/mucosal melanomas exhibited distinct mutation patterns compared to non‐acral melanomas. Tumour mutational burden estimated using ACTOnco was not associated with ICI efficacy. Notably, genetic alterations in the p53 pathway (CDKNA2 loss, MDM2 gain/amplification and TP53 mutation) accounted for 36.4% and were significantly associated with unfavourable PFS (median PFS 2.7 months vs. 3.9 months, P = 0.0394). Moreover, 26 genes were identified as differentially expressed genes that were upregulated in patients with clinical benefits compared to those without benefits. Four genes, GZMH, GZMK, AIM2 and CTLA4, were found to be associated with both PFS and OS. Conclusion Genetic alterations in the p53 pathway may be critical in Asian patients with melanoma undergoing ICI treatment. Further investigation is required to explore this mechanism and validate these findings. The genetic landscape of melanoma response to immune checkpoint inhibitors (ICIs) has been previously investigated, but without correlation with modulation of the tumour microenvironment in clinical survival and treatment outcomes. We used next‐generation sequencing to define the genetic biomarkers of Asian melanoma associated with ICI response. The p53 pathway (CDKN2A/MDM2/TP53) is a prognostic factor for progression‐free survival after ICI treatment in Taiwanese patients with melanoma.
Journal Article