Treatment Free Intervals after Subsequent Chemotherapy Lines in Recurrent Ovarian Cancer

Aim: Despite recent advances in the treatment of ovarian cancer, recurrence of the disease is still frequent. This study evaluated whether multiple lines of chemotherapy have impact on overall survival (OS), progression free survival (PFS) or on treatment free intervals (TFIs) after serial chemotherapy lines in recurrent settings. Methods: A total of 189 patients with ovarian cancer (including fallopian tube and primary peritoneal cancer), who were treated in Kuopio University Hospital in Finland during 2009-2014, were enrolled. The medical files of these patients were retrospectively reviewed. Results: Median OS and PFS were significantly higher at the time of the first relapse compared to subsequent relapses (p < 0.001). TFIs shortened significantly after the first relapse (p < 0.001). The differences in TFIs were also seen when comparing platinum sensitive, semi-sensitive and platinum resistant patients. The total amount of TFI times during the whole follow-up time was significantly reduced in those patients that received at least one form of aggressive care at the end of life (p = 0.004). Conclusions: Ovarian cancer patients received often multiple lines of chemotherapy. TFIs after subsequent chemotherapy lines decreased during the disease course. More efforts should be taken to avoid unnecessary and ineffective treatments especially in recurrent phase of the disease.

A Metabolic-associated Nomogram Predicts Recurrence Survival of Thyroid Cancer

Objective:Various studies have suggested that metabolic genes play a significant role in papillary thyroid cancer(PTC).The current study aimed to identify a metabolic signature related biomarker to predict the prognosis of patients with PTC.Methods:We conducted a comprehensive analysis on the data obtained from the Cancer Genome Atlas(TCGA)database.The correlation between survival result and metabolic genes was evaluated based on the univariate Cox analyses,least absolute shrinkage and selection operator(LASSO)and multivariate Cox analyses.The performance of a 7-gene signature was assessed according to Kaplan-Meier and receiver operating characteristic(ROC)analysis.Multivariate Cox regression analysis was adopted to unearth clinical factors related to the recurrence free survival(RFS)of patients with PTC.Finally,a prognostic nomogram was developed based on risk score,cancer status and cancer width to improve the prediction for RFS of PTC patients.Results:Seven metabolic genes were used to establish the prognostic model.The ROC curve and C-index exhibited high value in training,testing and the whole TCGA datasets.The established nomogram,incorporating the 7-metabolic gene signature and clinical factors,was able to predict the RFS with high effectiveness.The 7-metabolic gene signature-based nomogram had a good performance to predict the RFS of patients with PTC.Conclusion:Our study identified a 7-metabolic gene signature and established a prognostic nomogram,which were useful in predicting the RPS of PTC.

Long-term survival and risk factors in esophageal squamous cell carcinoma:A Kaplan-Meier and cox regression study

BACKGROUND The global incidence of esophageal cancer(EC)remains high.Despite advan-cements in medical technology and deeper research into the causes and treatment methods of EC,the effectiveness of treatment for EC is still unsatisfactory.Therefore,it is crucial to address the urgent problem of improving the long-term survival rate of EC patients and providing personalized treatment.AIM To analyze the survival prognosis and influencing factors of esophageal squamous cell carcinoma(ESCC).METHODS A retrospective analysis was conducted on the clinical data of 115 patients with pT3N0M0 ESCC who underwent radical surgery alone from January 1,2013,to December 31,2019.The Kaplan–Meier method was used to evaluate the 1-year,3-year,and 5-year survival rates and median survival time of the patients.The Cox proportional hazards regression model was used to assess the hazard ratios(HRs)and 95%confidence intervals(95%CIs)of risk factors.RESULTS The 1-year,3-year,and 5-year overall survival(OS)rates for the 115 EC patients analyzed were 85.22%,50.43%,and 37.48%,respectively.The median OS was 37.00(95%CI:24.93-49.07)months,and the median disease-free survival was 21.00(95%CI:14.71-27.29)months.Both univariate and multivariate Cox regression analyses revealed that high body mass index(BMI;HR=1.137,95%CI:1.054-1.226),positive perineural invasion(PNI;HR=13.381,95%CI:4.899-36.547),and smoking(HR=2.415,95%CI:1.388-4.203)were independent risk factors for a poor prognosis.In contrast,compared to the upper thoracic location of the tumor,middle thoracic(HR=0.441,95%CI:0.240-0.810)and lower thoracic(HR=0.328,95%CI:0.144-0.750)locations were protective factors.CONCLUSION BMI,tumor location,PNI,and smoking are associated with the prognosis of ESCC patients.This study highlights the prognostic risk factors for T3N0M0 ESCC patients and offers personalized insights for clinical treatment.

Predicting prognosis of rectal cancer patients with total mesorectal excision using molecular markers

AIM:To explore the prognostic variables in rectal cancer patients undergoing curative total mesorectal excision and the effect of postoperative chemotherapy in advanced rectal cancer. METHODS:A total of 259 consecutive rectal cancer patients treated with curative total mesorectal excision between 1999 and 2004 were collected. p53,p21,PCNA,and CD44v6 were examined using immunohistochemistry (IHC). The correlation between clinicopathological or molecular variables and clinical outcomes,including local recurrence,metastasis,disease-free survival and overall survival,was analyzed. RESULTS:The median follow-up was 44 mo. Five-year survival rates and 5-year disease free survival rates were 75.43% and 70.32%,respectively. Multi-analysis revealed TNM staging,preoperative CEA,and CD44v6 level were independent risk factors predicting overall survival or disease free survival. The hazard ratio of peroperative CEA was 2.65 (95% CI 1.4-5) and 3.10 (95% CI 1.37-6.54) for disease free survival and overall survival,respectively. The hazard ratio of CD44v6 was 1.93 (95% CI 1.04-3.61) and 2.21 (95% CI 1.01-4.88) for disease free survival and overall survival,respectively. TNM staging was the only risk factor predicting local recurrence. Postoperative chemotherapy without radiotherapy did not improve patients' outcome. CONCLUSION:TNM staging,preoperative CEA and CD44v6 were independent prognostic factors for rectal cancer patients with total mesorectal excision. Postoperative chemotherapy may be only used together with radiotherapy for rectal cancer patients.

Gemcitabine plus concurrent irreversible electroporation vs gemcitabine alone for locally advanced pancreatic cancer

BACKGROUND Locally advanced pancreatic cancer(LAPC)is a common malignant digestive system tumor that ranks as the fourth leading cause of cancer-related death in the world.The prognosis of LAPC is poor even after standard treatment.Irreversible electroporation(IRE)is a novel ablative strategy for LAPC.Several studies have confirmed the safety of IRE.To date,no prospective studies have been performed to investigate the therapeutic efficacy of conventional gemcitabine(GEM)plus concurrent IRE.AIM To compare the therapeutic efficacy between conventional GEM plus concurrent IRE and GEM alone for LAPC.METHODS From February 2016 to September 2017,a total of 68 LAPC patients were treated with GEM plus concurrent IRE(n=33)or GEM alone(n=35).Overall survival(OS),progression free survival(PFS),and procedure-related complications were compared between the two groups.Multivariate analyses were performed to identify any prognostic factors.RESULTS There were no treatment-related deaths.The technical success rate of IRE ablation was 100%.The GEM+IRE group had a significantly longer OS from the time of diagnosis of LAPC(19.8 mo vs 9.3 mo,P<0.0001)than the GEM alone group.The GEM+IRE group had a significantly longer PFS(8.3 mo vs 4.7 mo,P<0.0001)than the GEM alone group.Tumor volume less than 37 cm3 and GEM plus concurrent IRE were identified as significant favorable factors for both the OS and PFS.CONCLUSION Gemcitabine plus concurrent IRE is an effective treatment for patients with LAPC.

Clinical Observation of Patients with Hematologic Malignancies Treated with Hematopoietic Stem Cell Transplantation

To evaluate the therapeutic effect of hematopoietic stem cell transplantation (HSCT), we performed HSCT in 30 patients with hematologic maligancies. Of the 30 patients, 10 underwent autologous peripheral blood stem cell transplantation (auto-PBSCT), 13 underwent myeloablative allogeneic HSCT while 7 underwent nonmyeloablative allogeneic HSCT, which were designated as autologous group, myeloablative group and nonmyeloablative group, respectively. All patients except the one who underwent cord blood transplantation, were successfully engrafted. Median time for the granulocytes≥0.5×10\+9/L and platelets≥20×10\+9/L were 12 days and 13 days respectively in autologous group, 16 days and 19 days in myeloablative group, 15 days and 12 days in nonmyeloablative group. In myeloablative group, acute graft-versus-host diseases (aGVHD) was observed in 3 patients, all of which were I—Ⅱgrade. Oral mucous cGVHD was observed in 1 patient. In nonmyeloablative group, 1 patient developed intestinal aGVHD grade Ⅳ and cutaneous cGVHD was induced by donor lymphocyte infusions (DLI) in 3 patients. 1 patient had hematological relapse in autologous group. 1 patient had cytogenetic relapse in myeloablative group. In nonmyeloablative group 3 patients had cytogenetic relapse and were cured by DLI, 1 patient had hematological relapse. 4 of the 30 patients died of infection (2 patients), grade Ⅳ aGVHD (1) and relapse (1) respectively. 26 patients are still alive. 3 years overall survival (OS) and 3 years disease free survival (DFS) were 100 % and 64.81 % respectively in autologous group, 78.75 % and 63 % respectively in myeloablative group while both 66.67 % in nonmyeloablative group. In conclusion, autologous group had less transplant-related complications and mortality. Active prophylaxis of relapse could significantly promote DFS. The transplant-related mortality limited DFS in myeloablative group. More relapses occurred in nonmyeloablative group, but could be cured by DLI.

Helicobacter pylori in gastric cancer: Features of infection and their correlations with long-term results of treatment

BACKGROUND Helicobacter pylori(H.pylori)is a spiral-shaped bacterium responsible for the development of chronic gastritis,gastric ulcer,gastric cancer(GC),and MALTlymphoma of the stomach.H.pylori can be present in the gastric mucosa(GM)in both spiral and coccoid forms.However,it is not known whether the severity of GM contamination by various vegetative forms of H.pylori is associated with clinical and morphological characteristics and long-term results of GC treatment.AIM To establish the features of H.pylori infection in patients with GC and their correlations with clinical and morphological characteristics of diseases and long-term results of treatment.METHODS Of 109 patients with GC were included in a prospective cohort study.H.pylori in the GM and tumor was determined by rapid urease test and by immunohistochemically using the antibody to H.pylori.The results obtained were compared with the clinical and morphological characteristics and prognosis of GC.Statistical analysis was performed using the Statistica 10.0 software.RESULTS H.pylori was detected in the adjacent to the tumor GM in 84.5%of cases,of which a high degree of contamination was noted in 50.4%of the samples.Coccoid forms of H.pylori were detected in 93.4%of infected patients,and only coccoid-in 68.9%.It was found that a high degree of GM contamination by the coccoid forms of H.pylori was observed significantly more often in diffuse type of GC(P=0.024),in poorly differentiated GC(P=0.011),in stage T3-4(P=0.04)and in N1(P=0.011).In cases of moderate and marked concentrations of H.pylori in GM,a decrease in 10-year relapse free and overall survival from 55.6%to 26.3%was observed(P=0.02 and P=0.07,respectively).The relationship between the severity of the GM contamination by the spiral-shaped forms of H.pylori and the clinical and morphological characteristics and prognosis of GC was not revealed.CONCLUSION The data obtained indicates that H.pylori may be associated not only with induction but also with the progression of GC.

Efficacy of percutaneous ethanol injection in the adjuvant treatment of hepatocellular carcinoma after TACE

Objective： To evaluate the efficacy of percutaneous ethanol injection （PEI） in the adjuvant treatment of hepatocellular carcinoma （HCC） after transcatheter arterial chemoembolization （TACE） by primary end points of time to progress （TTP）. Methods： The study population consisted of 73 consecutive patients with inoperable HCC （China Classification System IIN liB）. Among them, 22 patients were treated with TACE and PEI （experimental group）, and the rest 51 were treated only with TACE （control group）, and then the time to progress （TTP） and overall survival （OS） of these two groups were analyzed. Results： The median TTP was 10 months [95% confidence interval （CI）, 7.9-12.1 months] in experimental group and 6 months （95% CI, 4.7-7.3 months） in control group. The 3-month,6-month, and 1-year Progression Free Survival （PFS） rates were respectively 77.3%, 63.6%, and 48.1% in experimental group, and 76.5%, 42.15%, and 24.8% in control group. The TTP of experimental group was significantly longer than that of control group （P 〈 0.05）. The median survival period was 17 months [95% confidence interval （CI）, 11-23 months] of experimental group and 12 months （95% CI, 10-14 months） of control group （P 〉 0.05）. Conclusion： Compared with single TACE, the combination of TACE and PEI can obviously postpone disease progress and prolong survival of HCC patients.

Clinical benefit of COX-2 inhibitors in the adjuvant chemotherapy of advanced non-small cell lung cancer: A systematic review and metaanalysis

BACKGROUND Lung cancer is a major cause of death among patients,and non-small cell lung cancer(NSCLC)accounts for more than 80%of all lung cancers in many countries.AIM To evaluate the clinical benefit(CB)of COX-2 inhibitors in patients with advanced NSCLC using systematic review.METHODS We searched the six electronic databases up until December 9,2019 for studies that examined the efficacy and safety of the addition of COX-2 inhibitors to chemotherapy for NSCLC.Overall survival(OS),progression free survival(PFS),1-year survival rate(SR),overall response rate(ORR),CB,complete response(CR),partial response(PR),stable disease(SD),and toxicities were measured with more than one outcome as their endpoints.Fixed and random effects models were used to calculate risk estimates in a meta-analysis.Potential publication bias was calculated using Egger’s linear regression test.Data analysis was performed using R software.RESULTS The COX-2 inhibitors combined with chemotherapy were not found to be more effective than chemotherapy alone in OS,progression free survival,1-year SR,CB,CR,and SD.However,there was a difference in overall response rate for patients with advanced NSCLC.In a subgroup analysis,significantly increased ORR results were found for celecoxib,rofecoxib,first-line treatment,and PR.For adverse events,the increase in COX-2 inhibitor was positively correlated with the increase in grade 3 and 4 toxicity of leukopenia,thrombocytopenia,and cardiovascular events.CONCLUSION COX-2 inhibitor combined with chemotherapy increased the total effective rate of advanced NSCLC with the possible increased risk of blood toxicity and cardiovascular events and had no effect on survival index.

Analysis of tumor recurrence factors in patients of primary hepatocellular carcinoma with postoperative transcatheter arterial chemoembolization (TACE)

Objective： The aim of the study was to analyze the tumor recurrence factors in patients of primary hepatocellular carcinoma （PHC） with postoperative transcatheter arterial chemoembolization （TACE）. Methods： A total of 121 cases of PHC by TACE after 1-2 months of surgery was retrospectively analyzed, followed up and analyzed the free survival time and the factors related to tumor-free survival. Results： In all 121 cases, 1-, 2-, and 3-year tumor-free survival rates were 72.73%, 46.21% and 26.93%, respectively. Gender, age, HBV infection, tumor size, capsule is complete, degree of differentiation and the presence of vascular thrombosis were put into the COX proportional hazards model of survival time to select the influential variables. In the clinical data of all variables entering COX proportional hazards model, tumor size, tumor differentiation and the presence of vascular thrombosis were statistically significant contributions to the model. In the tumor diameter less than or equal 10 cm [P = 0.040, Exp （B） = 2.210], vascular thrombosis [P = 0.039, Exp （B） = 2.922] and the lower degree of tumor differentiation [P = 0.035, Exp （B） = 3.038], the risk of tumor recent recurrence increased. Conclusion： Tumor size, differentiation, and the presence of vascular thrombosis are the independent risk factors affecting the prognosis of PHC after TACE.

Clinical outcomes of gastrointestinal stromal tumor in southern Thailand

AIM: To review a single institutional experience in clinical management of gastrointestinal stromal tumors (GIST) and analyze for factors determining treatment outcome. METHODS: Clinicopathological data of patients with a diagnosis of GIST who were treated at our institute during November 2004 to September 2009 were retrospectively reviewed. RESULTS: Ninety-nine cases were included in the analysis. Primary tumor sites were at the stomach in and small bowel in 44% and 33%, respectively. Thirty-one cases already had metastasis at presentation and the most common metastatic site was the liver. Sixty-four cases (65%) were in the high-risk category. Surgical treatment was performed in 77 cases (78%), 3 of whom received upfront targeted therapy. Complete resection was achieved in 56 cases (73% of operative cases) and of whom 27 developed local recurrence or distant metastasis at a median duration of 2 years. Imatinib was given as a primary therapy in unresectable cases (25 cases) and as an adjuvant in cases with residual tumor (21 cases). Targeted therapy gave partial response in 7 cases (15%), stable disease in 27 cases (57%) and progressive disease in 13 cases (28%). Four-year overall survival was 74% (95% CI: 61%-83%). Univariate survival analysis found that low-risk tumor, gastric site, complete resection and response to imatinib were associated with better survival. CONCLUSION: The overall outcomes of GIST can be predicted by risk-categorization. Surgery alone may not be a curative treatment for GIST. Response to targeted therapy is a crucial survival determinant in these patients.

Prognostic significance of primary tumor localization in stage Ⅱ and Ⅲ colon cancer

AIM To investigate the effects of tumor localization on disease free survival(DFS) and overall survival(OS) in patients with stage Ⅱ-Ⅲ colon cancer.METHODS This retrospective study included 942 patients with stage Ⅱ and Ⅲ colon cancer, which were followed up in our clinics between 1995 and 2017. The tumors from the caecum to splenic flexure were defined as right colon cancer(RCC) and those from splenic flexure to the sigmoid colon as left colon cancer(LCC).RESULTS The median age of the patients was 58 years(range: 19-94 years). Male patients constituted 54.2%. The rates of RCC and LCC were 48.4%(n = 456) and 51.6%(n = 486), respectively. During the median follow-up of 90 mo(range: 6-252 mo), 14.6% of patients developed recurrence and 9.1% of patients died. In patients with stage Ⅱ and Ⅲ disease with or without adjuvant therapy, DFS was similar in terms of primary tumor localization(stage Ⅱ; P = 0.547 and P = 0.481, respectively; stage Ⅲ; P = 0.976 and P = 0.978, respectively). In patients with stage Ⅱ and Ⅲ disease with or without adjuvant therapy, OS was not statistically significant with respect to primary tumor localization(stage Ⅱ; P = 0.381 and P = 0.947, respectively; stage Ⅲ; P = 0.378 and P = 0.904, respectively). The difference between median OS of recurrent RCC(26 ± 6.2 mo) and LCC(34 ± 4.9 mo) cases was eight months(P = 0.092).CONCLUSION Our study showed no association of tumor localization with either DFS or OS in patients with stage Ⅱ or Ⅲ colon cancer managed with or without adjuvant therapy. However, post-recurrence OS appeared to be worse in RCC patients.

Predictors for Metachronous Metastases in Early Breast Cancer: A Single Institution Study

Background: Breast cancer (BC) is considered the most common women cancer worldwide. The main clinicopathological prognostic factors are tumor size, lymph node status and estrogen/progesterone (ER/PR) receptor status. In addition, some factors are both prognostic and predictive as ER/PR receptors and HER2/neu overexpression. Axillary lymph node status is the most important prognostic factor for breast cancer. Node negative breast cancer patients had the best 5-year overall survival (OS) of 82.8% compared to 73%, 45.7%, and 28.4% for patients with 1 - 3, 4 - 12, and ≥13 positive nodes, respectively. The aim of this study was to determine the association between different clinicopathological features and development of metastasis in a group of Egyptian women with early breast cancer, also, to assess patients’ Relapse-free survival (DFS) and OS and their correlation with different clinicopathological features. Patients and Methods: We retrospectively reviewed the files of breast cancer patients who were treated and followed-up at the clinical oncology department and surgical oncology unit, Alexandria Main University Hospital during the period from January 2014 to December 2017. A total of 1848 breast cancer cases were presented during this period of time. 141 out of the 1848 patients developed metastasis from breast cancer during follow-up. Among the 141 patients, only 102 had adequate clinical, pathological, treatment and follow-up data enough for analysis and were included in our study. Results: The number of patients who developed distant metastasis from breast cancer during the study period (metachronous metastasis) ranges from 17 - 31 cases/year. All the study patients had documented metastatic disease constituting 102 out of 1848 collected patients representing about 5.5%. The median time for development of metastasis from the initial diagnosis among the 102 studied patients was 17.88 months. Seventy-two out of 102 cases had distant recurrence. There was a significant correlation between DFS and tumor size, grade, number of lymph nodes involved and hormone receptor (ER and PR) status. Age, tumor grade, tumor size and Her2 status had a significant impact on the OS. Conclusion: The clinicopathological characteristics of the primary tumor are important for predicting the risk of metastasis among early breast cancer patients and determining their prognosis.

Assessing radiation dose for postoperative radiotherapy in prostate cancer: Real world data

BACKGROUND Approximately 30%of patients with localized prostate cancer(PCa)who undergo radical prostatectomy will develop biochemical recurrence.In these patients,the only potentially curative treatment is postoperative radiotherapy(PORT)with or without hormone therapy.However,the optimal radiotherapy dose is unknown due to the limited data available.AIM To determine whether the postoperative radiotherapy dose influences biochemical failure-free survival(BFFS)in patients with PCa.METHODS Retrospective analysis of patients who underwent radical prostatectomy for PCa followed by PORT-either adjuvant radiotherapy(ART)or salvage radiotherapy(SRT)-between April 2002 and July 2015.From 2002 to 2010,the prescribed radiation dose to the surgical bed was 66-70 Gy in fractions of 2 Gy;from 2010 until July 2015,the prescribed dose was 70-72 Gy.Patients were grouped into three categories according to the total dose administered:66-68 Gy,70 Gy,and 72 Gy.The primary endpoint was BFFS,defined as the post-radiotherapy prostatespecific antigen(PSA)nadir+0.2 ng/mL.Secondary endpoints were overall survival(OS),cancer-specific survival(CSS),and metastasis-free survival(MFS;based on conventional imaging tests).Treatment-related genitourinary(GU)and gastrointestinal(GI)toxicity was evaluated according to Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria.Finally,we aimed to identify potential prognostic factors.BFFS,OS,CSS,and MFS were calculated with the Kaplan-Meier method and the log-rank test.Univariate and multivariate Cox regression models were performed to explore between-group differences in survival outcome measures.RESULTS A total of 301 consecutive patients were included.Of these,93(33.6%)received ART and 186(66.4%)SRT;22 patients were excluded due to residual macroscopic disease or local recurrence in the surgical bed.In this subgroup(n=93),43 patients(46.2%)were Gleason score(GS)≤6,44(47.3%)GS 7,and 6(6.5%)GS≥8;clinical stage was cT1 in 51(54.8%),cT2 in 35(39.3%),and cT3 in one patient(1.1%);PSA was<10 ng/mL in 58(63%)patients,10-20 ng/mL in 28(30.6%),and≥20 ng/mL in 6(6.4%)patients.No differences were found in BFFS in this patient subset versus the entire cohort of patients(P=0.66).At a median follow-up of 113 months(range,4-233),5-and 10-year BFFS rates were 78.8%and 73.7%,respectively,with OS rates of 93.3%and 81.4%.The 5-year BFFS rates in three groups were as follows:69.6%(66-68 Gy),80.5%(70 Gy)and 82.6%(72 Gy)(P=0.12):the corresponding 10-year rates were 63.9%,72.9%,and 82.6%(P=0.12),respectively.No significant between-group differences were observed in MFS,CSS,or OS.On the univariate analysis,the following variables were significantly associated with BFFS:PSA at diagnosis;clinical stage(cT1 vs cT2);GS at diagnosis;treatment indication(ART vs SRT);pre-RT PSA levels;and RT dose 66-68 Gy vs.72 Gy(HR:2.05;95%CI:1.02-4.02,P=0.04).On the multivariate analysis,the following variables remained significant:biopsy GS(HR:2.85;95%CI:1.83-4.43,P<0.001);clinical stage(HR:2.31;95%CI:1.47-4.43,P=0.01);and treatment indication(HR:4.11;95%CI:2.06-8.17,P<0.001).Acute grade(G)1 GU toxicity was observed in 11(20.4%),17(19.8%),and 3(8.3%)patients in each group(66-68 Gy,70 Gy and 72 Gy),respectively(P=0.295).Acute G2 toxicity was observed in 2(3.7%),4(4.7%)and 2(5.6%)patients,respectively(P=0.949).Acute G1 GI toxicity was observed in 16(29.6%),23(26.7%)and 2(5.6%)patients in each group,respectively(P=0.011).Acute G2 GI toxicity was observed in 2(3.7%),6(6.9%)and 1(2.8%)patients,respectively(P=0.278).No cases of acute G3 GI toxicity were observed.CONCLUSION The findings of this retrospective study suggest that postoperative radiotherapy dose intensification in PCa is not superior to conventional radiotherapy treatment.

Autologous peripheral blood stem cell transplantation in the patients with hematologic malignancies and solid tumors

Objective To evaluate the long-term therapeutic effects of autologous peripheral blood stem cell transplantation (auto-PBSCT) on the treatment of hematological and solid tumors.Methods Fifty-one patients were recruited in this auto-PBSCT study, in which several potentially important parameters were studied including the optimal time for stem cell collection, the dose of stem cell reinfusion, the time of hematopoietic reconstitution, the disease free survival (DFS) and overall survival (OS), complications related to transplantation, and maintenance chemotherapy after auto-PBSCT.Results After APBSCT, 3-year and 5-year survival rates of NHL were 83.3%; those of AML were 74.7%; those of MM were 37.9% and 19%; those of ALL were 40% and 0% respectively. Hematopoietic reconstitution was greatly promoted by granulocyte colony stimulating factor (G-CSF). The mean time for patients' neutrophil to recover up to >0.5×109/L after APBSCT was 11.14 days in the group of the patients receiving G-CSF in contrast to 17.6 days in the group receiving no G-CSF. The most common complications of transplantation were fever, liver dysfunction and hypokalaemia, which were curable. No death was due to transplantation related complications.Conclusion Comparing with conventional chemotherapy, our study suggests that auto-PBSCT is a very important therapeutic option that can significantly improve the prognosis in the patients with hematological and solid tumors, especially in the patients with AML and NHL.

Clinical significance of chromosomal abnormalities detected by interphase fluorescence in situ hybridization in newly diagnosed multiple myeloma patients

Background Chromosome 13q14 deletion （del13q14）, chromosome 1q21 gain （amp1q21） and chromosome 17p13 deletion （del17p13） are the most frequent chromosomal aberrations in multiple myeloma （MM）. They play an important role in prognosis. The aim of this study was to investigate the clinical significance of the chromosomal changes in Chinese MM patients.Methods Interphase fluorescence in situ hybridization （FISH） on bone marrow （BM） cells was performed in 72 enrolled MM patients. Relationships between chromosomal abnormalities and clinical features, response to therapies and prognosis were analyzed.Results As a result of interphase FISH, 77.8% （56/72） patients had chromosome changes. The incidences of each probe were RB1 51.4% （37/72）, D13S319 47.2% （34/72）, 1q21 45.8% （33/72） and p53 22.2% （12/72）. Osteolytic lesion,BM plasma cells index, serum calcium and serum M component were significantly correlated to del13q14. BM plasma cells and hemoglobin were correlated to amp1q21. Serum lactate dehydrogenase （LDH） was correlated with del17p13.Patients with del13q14 treated with bortezomib had a notably higher overall response rate than the patients treated with traditional chemotherapies （93% vs. 65%, P=0.048）. Patients carrying amp1q21 or/and del17p13 did not achieve satisfactory response to bortezomib. The median progression-free survival （PFS） for patients with amp1q21 was 5 months and patients without amp1q21 got 9-month PFS （P=0.001）. The median PFS for patients with del13q14 was 5 months （vs. 8 months, P=0.026）. The median PFS for patients with del17p13 was 3 months （vs. 8 months, P=0.002）.Patients with β2-microglobulin 〉5.5 mg/L also had a worse outcome, whose median PFS was 5 months （vs. 8 months,P=0.016）.Conclusions The prevalence of chromosomal abnormalities of MM patients was similar in Chinese and Caucasian people. Genetic changes were associated with patients＇ responses to therapies and prognosis.

Clinical outcomes of people living with human immunodeficiency virus(HIV)with diffuse large B-cell lymphoma(DLBCL)in Shanghai,China

Background:Numerous studies have focused on lymphoma among patients infected with human immunodeficiency virus(HIV).However,little is known about the treatment options and survival rate of lymphoma in the Chinese people living with HIV(PLHIV).Our study aimed to investigate the prognosis and compare outcome of dose-adjusted etoposide,prednisone,vincristine,cyclophosphamide,doxorubicin,and rituximab(DA-EPOCH-R)with standard cyclophosphamide,doxorubicin,vincristine,prednisone and rituximab(R-CHOP)as front line therapy for PLHIV with diffuse large B-cell lymphoma(DLBCL)receiving modern combined antiretroviral therapy(cART).Methods:A retrospective analysis evaluating PLHIV with DLBCL was performed in Shanghai Public Health Clinical Center from July 2012 to September 2019.The demographic and clinical data were collected,and overall survival(OS)and progression-free survival(PFS)analyses of patients receiving R-CHOP or DA-EPOCH-R therapy were performed by Kaplan-Meier analysis.Additionally,a Cox multiple regression model was constructed to identify related factors for OS.Results:A total of 54 eligible patients were included in the final analysis with a median follow-up of 14 months(interquartile range[IQR]:8-29 months).The proportion of high international prognostic index(IPI)patients was much larger in the DA-EPOCH-R group(n=29)than that in the R-CHOP group(n=25).The CD4 cell counts and HIV RNA levels were not significantly different between the two groups.The 2-year OS for all patients was 73%.However,OS was not significantly different between the two groups,with a 2-year OS rate of 78%for the DA-EPOCH-R group and 66%for the R-CHOP group.Only an IPI greater than 3 was associated with a decrease in OS,with a hazard ratio of 5.0.The occurrence of grade 3 and 4 adverse events of chemotherapy was not significantly different between the two groups.Conclusions:Outcomes of R-CHOP therapy do not differ from those of DA-EPOCH-R therapy.No HIV-related factors were found to be associated with the OS of PLHIV in the modern cART era.

Outcome of childhood acute lymphoblastic leukemia： a report of 121 patients treated at Wuhan Union Hospital of China

Prognostic factors are biological or physical characteristics of a patient or the patient＇s cancer that can be used to predict the outcome of the individual. The prognosis of childhood acute lymphoblastic leukemia （ALL） has been improved greatly in the past 40 years, reaching a long-term event free survival （EFS） of about 75% and overall survival of about 80% in developed countries.3-6 The same result has also been achieved in China. The ALL-XH-99 Protocol at Shanghai Children＇s Medical Center adopted early intensification treatment and triple intrathecal chemotherapy with high-dose methotrexate treatment for all patients and intensive chemotherapy in median risk （MR） and high risk （HR） patients. More intensive chemotherapy might cause more complications. In order to reevaluate the outcome of childhood ALL treated with the ALL-XH-99 Protocol and to fully elucidate the prognostic factors and the sequelae, a retrospective analysis was carried out to evaluate patients diagnosed with childhood ALL who were treated with the ALL-XH-99 Protocol in the past decade.

Association of an anaplastic lymphoma kinase pathway signature with cell de-differentiation, neoadjuvant chemotherapy response, and recurrence risk in breast cancer

Background:Aberrant activation of anaplastic lymphoma kinase(ALK)signaling has been found to be involved in the tumorigenesis of multiple types of cancer.The aim of this study was to determine the role of this pathway in the pathogenesis of breast cancer.Methods:An ALK pathway signature that we generated previously was used to compute the ALK pathway activity in 6381 breast cancer samples from 42 microarray datasets,and the associations between ALK pathway signature score and clinical variables were examined using logistic regression and survival analyses.Results:Our results indicated that high ALK pathway activity was a significant risk factor for hormone receptor-negative,high-grade breast cancer in the 42 datasets.ALK pathway activity was positively associated with pathological complete response(pCR)in 15 datasets annotated with patient’s neoadjuvant chemotherapy response information(overall odds ratio=1.67,P<0.01),and this association was more significant in HER2-negative and grade 1&2 tumors than in HER2-positive and grade 3 tumors.ALK pathway activity was also positively associated with recurrence risk in breast cancer patients from 30 datasets annotated with survival information(overall hazard ratio=1.21,P<0.01),particularly in patients with age>50 years old,with positive lymph nodes,or with residual disease after neoadjuvant chemotherapy.Conclusions:ALK may be involved in breast cancer tumorigenesis,and ALK pathway signature score may serve as a prognostic biomarker for breast cancer.