"Nothing is more important than health", but anyone who has been deeply ill or experienced a serious illness of a loved one may have felt this way. For patients, meeting a trusted doctor is like grasping the hand that protects life;For doctors, treating waiting patients is protecting the lives of their hands.
Southern People Weekly has launched a special series of topics on "Hand Care for Life", which dialogues with front-line clinical doctors from the fields of oncology, hematology, and immunology, and walks into the ordinary and bright stories between them and patients.
Wen Yanmu.
Edited by Ling Yang.
In life, Professor Yao Xin has the unique optimistic character of Tianjin people, and is a person who is rarely affected by external objects. In his spare time, he always had a copy of "The Chronicles of the Eastern Zhou Dynasty" at hand, "I read three bad copies, and I felt that I was just a repeater of history, so there was not much to be unhappy about."
But at work, he is the opposite, he will repeatedly ponder the details of every "bad news". One patient suffered from an intestinal fistula after the operation, and he couldn't sleep for five nights in a row, and all he could think about was: "What should this patient do?".”
There is no patient news from any hospital that can be easily turned over to him. He often said to himself, "If you have a way to figure it out, you will have confidence in your patients." ”
Life comes first, and God knows.
When she was in college, Yao Xin used to soak in the library every Tuesday afternoon when there were no classes. There, he met Professor Yu Songting, one of the founders of urology in China. After a period of communication, Mr. Yu sent an invitation to this hard-working young man, "Do you want to come to my graduate school?"At that time, eight-year clinical medicine was a very popular major, and Yao Xin devoted himself to Yu Lao without hesitation.
Now recalling the choice she made when she faced the department after graduation, Yao Xin believes that there is a taste of "peaks and loops" in it. "Urology was still a very small specialty at that time, it was called 'pelvic department' at that time, and the number of patients was not very large, and young doctors generally thought that 'extrathoracic' or 'breast' was more remarkable. However, after rotating around the departments in the hospital, he found that "in fact, there are many types of diseases that the pelvic department should pay attention to, but there was no subdivision in the past, so everyone thinks that 'urology' is only a small field, but in fact, it has a very broad space for development." In order to be able to apply the majors learned in graduate school to the real world, and in order to live up to the expectations of her teacher, Yao Xin finally returned to the pelvic department and chose the "road that few people walked" at that time.
In 2006, Hao Xishan, an academician of the Chinese Academy of Engineering, approached Yao Xin, who was studying in the United States as a postdoctoral fellow, and sent him an invitation: "Why don't you come back, let's build our own urology department in the hospital." Yao Xin remembers very well that that year, the urology department of Tianjin Cancer Hospital was established and 200 surgeries were completed, and 17 years later, that number has increased tenfold. "So in retrospect, there was nothing wrong with that. ”
Looking back on his career of more than 20 years, Yao Xin said that when he first entered the industry, his medical creed was only four words - "life first", and now he has added "God knows" at the end. He reminded himself with these eight words: "No matter what the situation is, don't forget your original intention, stick to your own principles, and really think of ways and work hard to improve the survival time and quality of life of patients." ”
Because of her busy schedule, Yao Xin was often stopped by patients who had not yet been able to register on her way to and from the outpatient clinic and the operating room to inquire about her condition. For patients who don't speak much Mandarin and can't articulate their symptoms, the silver-haired, non-smiling dignified professor will patiently stand there and guide the patient step by step until he finds the key question and gives an answer. "Sometimes the patient's expression is not so good, and it needs to be judged quickly through the doctor's logic and clinical experience. Yao Xin explained.
Unlike being patient with patients at all times, Yao Xin is almost a race against time in disease research - he is eager to learn about the newly released research results, new methods and drugs in the field of urological oncology, because in the cancer ward, snatching time is to save lives.
In her decades in the Department of Urologic Oncology, Yao Xin has witnessed the establishment of the Department of Urology of Tianjin Cancer Hospital from "zero to one", and also experienced the development of "one to infinite" in the field of urological oncology in China. Along the way, he is pushing himself to learn and dig out innovative knowledge and help patients achieve a better survival. "You have to be very aware of their disease progression and their physical condition, and when you have a full body of knowledge, confidence and confidence, your patients will have confidence," he said. ”
Lonely standard-bearer.
In the Department of Urology-Oncology, patients often encounter the entanglement of "whether to keep their organs", and this decision is not only related to the choice of medicine, but also to the patient's "survival values".
Take muscle-invasive bladder cancer as an example, which is a type of cancer that progresses rapidly, is easy to metastasize, is prone to distant metastasis, and has a high degree of malignancy and high mortality rate. "Clinically, the standard way for muscle-invasive bladder cancer is to cut off the bladder entirely, which means that the patient does not have a normal urinary storage organ after surgery, which will have a great impact on his daily life, and many people are reluctant to accept this method. "Even if it is invasive bladder cancer that has not metastasized at the time of diagnosis, 50% of patients will still metastasize after surgery, and the 5-year survival rate is only 60%1.
Around 2000, "whether it can be directly surgically removed" is the most direct signal for a bladder cancer patient to judge their own condition, which can almost be equated with "whether they can still be saved". While most patients follow the doctor's advice to prolong their survival, Yao Xin has also met patients who are reluctant to have a cystectomy regardless of whether it is life-threatening. At this time, it is necessary to provide him with other methods through personal knowledge and experience, so that his life can be extended as much as possible. Instead of rudely saying to the patient, 'If you don't have surgery, you will find someone else to do it'. In Yao Xin's view, doctors need to be responsible for every word they say and every ** choice. "If there's a limit to what you can do right now, then you're going to have to find a different way to find it. ”
In 2003, while reading foreign literature, Yao Xin came across the results of a phase III clinical study that he thought was of great significance at the time, which pointed out that "for all patients with muscle-invasive bladder cancer who undergo total cystectomy, preoperative neoadjuvant chemotherapy can prolong the survival time of the patients". The idea of neoadjuvant** inspired him to envision this approach in China's patient population. "But I was not particularly confident at that time, because the Western method was not necessarily suitable for Eastern patients, and the neoadjuvant chemotherapy in China was basically in the blank stage at that time. ”
In fact, the process of rolling out this approach is far more difficult than it seems. Yao Xin once met a patient who was suitable for preoperative neoadjuvance**, "At that time, it took a lot of effort to convince him, but he didn't come after only one cycle of neoadjuvant, and the second cycle did not appear." It wasn't until two weeks after missing the chemotherapy that Yao Xin saw the patient again. During the two weeks of his disappearance, he went to other hospitals "and wanted to have surgery directly", until one of the doctors told him that "neoadjuvant chemotherapy can indeed improve survival time, and Dr. Yao, who had treated you before, was not incapable of surgery, but wanted to give you a better choice", and the patient finally returned to Yao Xin's office.
The myth of "direct surgery" is not limited to patients. Since 2011, Yao Xin has been implementing neoadjuvant chemotherapy in the department, and he has found that many doctors are the same—they may already know about neoadjuvant**, but they don't have much motivation to change the existing and habitual** regimen. "But this is about prolonging the survival time of patients, as a front-line clinical doctor, I feel that I have the obligation to persuade the patient, explain to him the benefits and disadvantages, but also guide the doctors in my own department, and have the courage to embrace the correct and innovative solutions. ”
Today, more than ten years later, neoadjuvant chemotherapy (cisplatin-based) combined with cystectomy has become the standard protocol for patients with muscle-invasive urothelial carcinoma, but in the years when it was still in the experimental exploration stage in China, Yao Xin was like this, popularizing it one by one, accumulating it one by one, and firmly but not alone on the road of exploration of neoadjuvant chemotherapy for bladder cancer in China. In 2018, at the annual meeting of the Urothelial Carcinoma Committee of the Chinese Society of Clinical Oncology, Professor He Zhisong, director of the Department of Urology at Peking University First Hospital, introduced Yao Xin and called him the "lonely standard-bearer" of neoadjuvant chemotherapy for bladder cancer in China – he said that this was the happiest moment of his career so far, "finally someone understands me". At the mention of this title, Yao Xin's eyes lit up.
"Work hard" for the patient
In 2011, if you asked a urologist how much blood would be bleeding in a total cystectomy, the answer would be two or three hundred milliliters, and this is something that only experienced doctors can do. Yao Xin remembers, "In the past, if there was a shortage of (spare) blood, no doctor would dare to prescribe it. ”
It is not easy for surgeons to be able to perform a certain operation skillfully. But Yao Xin is not satisfied with this, and the next stop he wants to arrive at has always been written "innovation and breakthrough".
At the end of 2015, under the overall arrangement of the National Health Commission, Tianjin Cancer Hospital introduced the first and only local robot that can be used for surgery. In the face of new technologies, everything starts from scratch. "When you've mastered one method, it's a bit of a human nature to give it up and learn another. ”
However, Yao Xin clearly sees that compared with traditional surgical forms, robotic surgery has very obvious advantages. "Robotic surgery can push the camera very close to the suture position, so that the surgical site can be seen more clearly, so that every stitch is accurately placed. The delicate operation makes the wound smaller, and the amount of bleeding is only a few tens of milliliters, which also means that the patient can recover faster. Yao Xin feels that this is a gradual process, and only by recognizing the advantages of the new technology for patients can we push ourselves to master it.
At that time, this only robot had to be assigned to several departments in the hospital to arrange the operation date in turn, and everyone rushed to use it. Yao Xin recalled the schedule at that time, "Basically, when I used a robot, I would schedule four or five surgeries a day, and I would do it until one or two o'clock in the morning, so I gritted my teeth and did it." Yao Xin said, "There is a curve in learning, and after passing through that stage, you will have a breakthrough, and you will slowly fall in love with such things." ”
Today, 8 years later, Yao Xin has become the first surgeon in the field of urology in Tianjin to exceed 1,000 robotic surgeries. And the problem he is still thinking about every day is still the "new" related to patients - how to expand its use in some new fields, or use its advantages to make new improvements to traditional methods to improve the best results of patients?”
The progress of medicine is often based on the bold attempts and hard work of doctors. When a new way of data continues to accumulate and iterate, perhaps, it can become a routine in the future, so that more patients can benefit.
But in the field of urologic oncology, a successful operation does not mean a final victory. "Even if chemotherapy and surgery remove the tumor, there will still be residual tumor cells in the body, and these cells will not be visible through imaging because they do not form too large a mass. "This poses a potential risk to the patient.
In fact, the effectiveness of postoperative maintenance of patients has always been a matter of concern in the field of urological oncology. Yao Xin further explained, "For example, not all patients with urothelial carcinoma can achieve the desired downstaging outcome after neoadjuvant**;The biggest challenge brought by cisplatin-based chemotherapy is that heavy metals may increase the damage to the patient's kidneys, causing damage to kidney function, and some patients with poor underlying kidney function can not even receive platinum-based chemotherapy”
Fortunately, in the past decade, drug innovation in the field of urothelial carcinoma has made great progressYao Xin's expression when she mentioned postoperative adjuvant aid** was obviously more relieved than when she was exploring neoadjuvance**. "In particular, immunoadjuvance** can play a very important role in the maintenance of patients in the future. ”
In January 2023, China's first and currently the only PD-1 inhibitor for adjuvant urothelial carcinoma** was approved in China, opening a new situation for adjuvant urothelial carcinoma**. The three-year follow-up results of the Phase III clinical study also showed that in all populations, the median DFS (disease-free survival) with PD-1 inhibitors was more than twice that of the control group,** or the risk of death was reduced by 29%2.
New types of immunity**, such as PD-1, stand up at this time, can break the body's immune escape mechanism, let the immune cells function normally, and kill the residual tumor cells. Yao Xin added, "If you are worried about the unsatisfactory prognosis of the patient after surgery, immunity needs to play a role at this time, which can keep the patient in a stable state during chemotherapy or surgery." ”
This year's latest study data also demonstrated for the first time that immunodrug-based combinations** bring more significant survival benefits than platinum-based chemotherapy in the first line of patients with unresectable or metastatic urothelial cancer**. More hope is bursting out in innovation, so that guardians like Yao Xin who are exploring and moving forward in the field of urological oncology have more hands.
In his vision, there are many emerging areas of urologic oncology waiting for him to explore, such as using holograms for intraoperative navigation and 3D reconstruction to present complex disease ......From the "responsibility" of "knowing from God" to the "hard work" in the face of innovative technologies, innovative ** and innovative drugs, this professor who always speaks eloquently seems to outline for us the rapid development of urological tumors in the past few decades and the expected breakthroughs in the next decade.
The innovation of theory, technology and drugs has given doctors the method and confidence to guard, making it possible to be precise, precise and keep improving. Yao Xin knows that the road to innovation in the fight against cancer is endless, and every lone standard-bearer will have the next journey after overcoming a difficulty.
He is not afraid to start from scratch, nor does he resist being alone. "Life first, God knows" is like a lighthouse in front of him, guiding his footsteps - from a lonely standard-bearer to gathering more and more comrades-in-arms, he knows that on this road of protecting life, he will hold the hands of more colleagues, hold the hands of more patients, and use medical innovation to make each other's clasped hands more powerful.
References: 1witjes ja et al.muscle-invasive and metastatic bladder cancer guidelines. european association of urology.2016. june 21, 2016.
2.adjuvant opdivo (nivolumab) continues to provide significant, durable clinical benefits for patients with radically resected, high-risk muscle-invasive urothelial carcinoma after three years in checkmate -274 trial. retrieved february 20, 2023