Screening for nasopharyngeal carcinoma in high-incidence regions——Next steps

Epstein-Barr virus(EBV)infection is a well-established risk factor in the development of nonkeratinizing and undifferentiated forms of nasopharyngeal carcinoma(NPC)common in parts of China and Southeast Asia.Early detection of NPC can significantly improve survival rates,as the 5-year survival rate for patients diagnosed at an early stage can exceed 90%after treatment.Studies have demonstrated that screening for NPC using EBV markers is an effective tool for identifying individuals with the disease.Future efforts should focus on implementing screening programs in high-incidence populations,assessing and refining screening algorithms,and exploring new,potentially more cost-effective screening methods.It is crucial to ensure that any new approaches are validated as superior or non-inferior to existing protocol before being adopted on a wider scale.The success of these screening tools in reducing NPC-related morbidity and mortality will depend on their effective implementation and ensuring access for the populations most in need of preventive interventions.This opinion piece briefly summarizes the current evidence supporting EBV-based screening for NPC detection and discusses future steps,including:1)the implementation of effective NPC screening programs,2)the evaluation of improvements in screening methodologies,and 3)the consideration of novel approaches to screening.

Sister Mary Joseph's nodule as the first sign of pregnancy-associated gastric cancer:A case report

Sister Mary Joseph's nodule is an inconspicuous and uncommon clinical sign of advanced malignant disease, especially gastric cancer. Pregnancy-associated gastric cancer is an extremely rare condition and can be difficult to diagnose, due to the absence or misinterpretation of symptoms as pregnancy-related. Diagnostic aids, such as a basic chemistry panel and imaging techniques, may not show any abnormalities. We present a case of a 37-year-old pregnant patient whose umbilical nodule was the first presenting physical sign of gastric cancer, which had metastasized throughout the abdominal and pelvic regions.

Nasopharyngeal carcinoma with synchronous breast metastasis:A case report

BACKGROUND Recent reports have described cases of metachronous breast metastasis in patients with nasopharyngeal carcinoma.However,no similar cases of synchronous breast metastasis have been reported,and evidence that can be used to support the clinical diagnosis of stage IV nasopharyngeal carcinoma in patients with concurrent breast metastasis remains lacking.Therefore,additional evidence is required to elucidate the clinical characteristics of this condition and aid in the development of optimal management strategies.CASE SUMMARY We report the case of a 46-year-old woman who visited our hospital with a right breast mass as the first symptom.The first pathological biopsy report suggested triple-negative breast invasive carcinoma.Subsequent imaging revealed a nasopharyngeal mass.Further puncture biopsy of the nasopharyngeal mass,molecular pathological Epstein–Barr virus in situ hybridization,and immunohistochemistry confirmed the diagnosis of nasopharyngeal carcinoma with breast metastasis.The patient did not undergo a mastectomy and achieved complete remission after chemotherapy and radiotherapy.She continued to receive oral chemotherapy as maintenance therapy and experienced no recurrence or metastasis during the 6-month follow-up period.CONCLUSION This case report suggests that breast specialists should carefully rule out secondary breast cancers when diagnosing and treating breast masses.Furthermore,clinicians should aim to identify the pathological type of the tumor to obtain the most accurate diagnosis and prevent excessive diagnosis and treatment.

Endovascular treatment of a ruptured pseudoaneurysm of the internal carotid artery in a patient with nasopharyngeal cancer:A case report

BACKGROUND Radiation therapy(RT)for nasopharyngeal cancer can cause several complications.In rare cases,an internal carotid artery pseudoaneurysm can occur,which can be fatal.We report the experience of a nasopharyngeal cancer patient who underwent radiation therapy and subsequently developed a fatal pseudoaneurysm of the petrous internal carotid artery.CASE SUMMARY A 39-year-old man was diagnosed with nasopharyngeal cancer 2 years ago(American Joint Committee on Cancer Stage T3N2M0)and received concurrent chemoradiation therapy.He subsequently relapsed and received chemotherapy.One week after the 4th cycle of chemotherapy,he was admitted to the emergency room of our hospital because of massive epistaxis accompanied by a headache.A pseudoaneurysm of the petrous internal carotid artery was confirmed by digital subtraction angiography(DSA).Stent-assisted endovascular coil embolization was performed and complete occlusion was achieved.No pseudoaneurysm was observed on DSA after coil embolization;however,intermittent epistaxis was maintained even after coil embolization.After seven days,a diagnostic laryngoscopy was performed.Massive bleeding occurred after aspiration of the blood clot during the laryngoscopy and the patient died of hypovolemic shock.In this case,epistaxis may have been a sign of pseudoaneurysm;therefore,treatment such as embolization should be performed promptly,and careful management should be undertaken after treatment.CONCLUSION This case highlights a rare,serious complication of RT in nasopharyngeal cancer and how it should be recognized and treated.

Cancer stem-like cells in Epstein-Barr virus-associated nasopharyngeal carcinoma

Although the Epstein-Barr virus(EBV) has spread to all populations in the world, EBV-associated nasopharyngeal carcinoma(NPC) is prevalent only in South China and Southeast Asia. The role of EBV in the malignant transformation of nasopharyngeal epithelium is the main focus of current researches. Radiotherapy and chemoradiotherapy have been successful in treating early stage NPC, but the recurrence rates remain high. Unfortunately, local relapse and metastasis are commonly unresponsive to conventional treatments. These recurrent and metastatic lesions are believed to arise from residual or surviving cells that have the properties of cancer stem cells. These cancer stem-like cells(CSCs) have the ability to selfrenew, differentiate, and sustain propagation. They are also chemo-resistant and can form spheres in anchorage-independent environments. This review summarizes recent researches on the CSCs in EBVassociated NPC, including the findings regarding cell surface markers, stem cell-related transcription factors, and various signaling pathways. In particular, the review focuses on the roles of EBV latent genes [latent membrane protein 1(LMP1) and latent membrane protein 2A(LMP2A)], cellular microRNAs, and adenosine triphosphate(ATP)-binding cassette chemodrug transporters in contributing to the properties of CSCs, including the epithelial-mesenchymal transition, stem-like transition, and chemo-resistance. Novel therapeutics that enhance the efficacy of radiotherapy and chemoradiotherapy and inhibitors that suppress the properties of CSCs are also discussed.

A Retrospective Study of Clinicoepidemiological Aspects of Nasopharyngeal Cancer at NCI-Cairo (2000-2010)

Aim of Work: The aim of this work was to study the clinico-epidemiological characteristics of the patients with nasopharyngeal carcinoma (NPC), analyse the prognostic factors of the disease and to analyse the results of different treatment modalities and their effect on loco-regional, distal metastatic disease control and both overall survival (OS) and disease free survival (DFS) rates. Patients and Methods: This is a retrospective study reviewing all adult nasopharyngeal carcinoma (NPC) patients who presented to the radiotherapy department—National Cancer Institute Cairo University in the period from (2000-2010). Results: In this study, it was found that the mean age was 45 years;most of the patients were of locally advanced stages. Multivariate cox proportional hazards regression identified T-stage, radiotherapy course completion & addition of chemotherapy as independent prognostic factors for local control (LC), DFS, & OS. The 5-year LC, DFS and OS rates for all studied patients were 38.2%, 33.5% & 37.2% respectively. The median DFS was 26 months and median OS was 36.5 months. Conclusion: This study matches the published data that support that radical concurrent chemoradiation is the mainstay of treatment of locally advanced NPC, & that T-stage, M-stage, prescribed dose completion, response to initial treatment are independent prognostic factors for survival. All measures should be taken to improve the local response during primary treatment as this will improve survival rates of patients with NPC.

The Current Status of the Delineation and Determination of the Targets and the Radiation Protocols for Nasopharyngeal Cancer with Intensity-Modulated Radiotherapy

IMRT has increased the local-regional control and decreased the complications from treating nasopharyngeal cancer （NPC）. Therefore studying IMRT is important. CT and MRI are complementary, and their joint use is currently considered to be the optimal modality to delineate the extent of the primary spread of NPC. The key problem in delineation of the neck nodes is how to translate anatomic node regions into the CT boundaries. The consensus guideline which narrowed the gap among different cancer centers is recommended in delineating the boundary of the cervical lymph node regions. The definition of the NPC GTV is clear and almost the same among the main cancer centers in their IMRT planning protocols. The suggested biological dose to the GTV is close to or more than 80 Gy; the main differences are the definitions of the CTVs and their schemes for the prescribed dose, and also the dosage to the high cervical region is different among those centers. According to their long-term follow-up results, it is suggested that, besides adding 5-10 mm margins to the primary lesions, the immediate high-risk structures （including the entire nasopharyngeal cavity, retropharyngeal space, clivus, base of the skull, pterygoid plates and muscles, parapharyngeal space, the sphenoid and partial ethmoid sinuses, the posterior third of the maxillary sinuses and the nasal cavity） should also be included with a prescription of more than 60 Gy, and the bilateral Ib, II and Va node levels should be ranked as high-risk regions and differentially prescribed for treatment with no less than 60 Gy.

Prognosis and Survival of Nasopharyngeal Cancer in Cameroon

Background: Nasopharyngeal carcinoma (NPC) is an entity belonging to up-per aerodigestive tract Cancers. NPC is more widespread in Southern China and South East Asia. In our country, it is the leading cause of head and neck cancers. Its prognosis remains bleak because of the late stage at diagnostic. Objectives: The objectives of this study were to determine the prognostic fac-tors and survival rate of patients with nasopharyngeal cancer in six reference hospitals in Cameroon. Material and Methods: It was a retrospective analytic study, conducted from January 2009 to December 2018. It was conducted in oncology, surgery and Ear Nose and Throat (ENT) units of six reference hos-pitals. Data from 114 files meeting the inclusion were collected. We have drawn survival curves and determined the different survival probabilities with the help of Kaplan-Meier Method. The different survival curves were compared using the Log-Rank Test (P < 0.05), variables that were statistically associated with the 5% cut off were introduced into the Cox regression model for multivariate analysis, thus allowing us to bring out the prognostic factors significantly associated with survival. Results: The mean age at the time of diagnosis of the 114 patients recruited was 45.30 ± 17.14 years. The predominant histological type was the UCNT (Undifferentiated Carcinoma of the NasoPharynx) representing 84.2%. According to the WHO classification, 2 patients were classified as stage I (1.8%), 33 as stage II (28.9%), 42 as stage III (36.8%), 25 as stage IV A (21.9%) and 12 as stage IV B (10.5%). At the end of the survival assessment period, 34 patients were dead and 73 patients (64%) were still alive. The median overall survival was 44 months. The overall survival rates at one, two, three, and four years were 80%;74%;68%;44%, respectively. The prognostic factors associated with poor survival were: late consultation time of more than 12 months, N3 lymph node involvement, 3 and 4 advanced clinical stages. Conclusion: The study showed a low survival, with a median overall survival of 44 months. The overall survival rates at one, two, three, and four years were 80%;74%;68%;44% respectively. The prognostic factors associated with poor survival were late consultation time of more than 12 months, N3 lymph Node involvement, 3 and 4 advanced clinical stages. In order to improve this survival, it is recommended that special emphasis be placed on early detection.

High incidence of nasopharyngeal cancer: similarity for 60% of mitochondrial DNA signatures between the Bidayuhs of Borneo and the Bai-yue of Southern China

Populations in Southern China (Bai-yue) and Borneo (Bidayuh) with high incidence of nasopharyngeal cancer (NPC) share similar mitochondrial DNA signatures, supporting the hypothesis that these two populations may share the same genetic predisposition for NPC, which may have first appeared in a common ancestral reference population before the sea levels rose after the last ice age.

PhaseⅠ/Ⅱtrial evaluating concurrent carbon-ion radiotherapy plus chemotherapy for salvage treatment of locally recurrent nasopharyngeal carcinoma

Background: After deinitive chemoradiotherapy for non-metastatic nasopharyngeal carcinoma(NPC), more than 10% of patients will experience a local recurrence. Salvage treatments present signiicant challenges for locally recurrent NPC. Surgery, stereotactic ablative body radiotherapy, and brachytherapy have been used to treat locally recurrent NPC. However, only patients with small-volume tumors can beneit from these treatments. Re-irradiation with X-ray—based intensity-modulated radiotherapy(IMXT) has been more widely used for salvage treatment of locally recurrent NPC with a large tumor burden, but over-irradiation to the surrounding normal tissues has been shown to cause frequent and severe toxicities. Furthermore, locally recurrent NPC represents a clinical entity that is more radioresistant than its primary counterpart. Due to the inherent physical advantages of heavy-particle therapy, precise dose delivery to the target volume(s), without exposing the surrounding organs at risk to extra doses, is highly feasible with carbon-ion radiotherapy(CIRT). In addition, CIRT is a high linear energy transfer(LET) radiation and provides an increased relative biological efectiveness compared with photon and proton radiotherapy. Our prior work showed that CIRT alone to 57.5 Gy E(gray equivalent), at 2.5 Gy E per daily fraction, was well tolerated in patients who were previously treated for NPC with a deinitive dose of IMXT. The short-term response rates at 3–6 months were also acceptable. However, no patients were treated with concurrent chemotherapy. Whether the addition of concurrent chemotherapy to CIRT can beneit locally recurrent NPC patients over CIRT alone has never been addressed. It is possible that the beneits of high-LET CIRT may make radiosensitizing chemotherapy unnecessary. We therefore implemented a phase I/II clinical trial to address these questions and present our methodology and results.Methods and design: The maximal tolerated dose(MTD) of re-treatment using raster-scanning CIRT plus concurrent cisplatin will be determined in the phase I, dose-escalating stage of this study. CIRT dose escalation from 52.5 to 65 Gy E(2.5 Gy E × 21–26 fractions) will be delivered, with the primary endpoints being acute and subacute toxicities. Eicacy in terms of overall survival(OS) and local progression-free survival of patients after concurrent chemotherapy plus CIRT at the determined MTD will then be studied in the phase II stage of the trial. We hypothesize that CIRT plus chemotherapy can improve the 2-year OS rate from the historical 50% to at least 70%.Conclusions: Re-treatment of locally recurrent NPC using photon radiation techniques, including IMXT, provides moderate eicacy but causes potentially severe toxicities. Improved outcomes in terms of eicacy and toxicity proile are expected with CIRT plus chemotherapy. However, the MTD of CIRT used concurrently with cisplatin-based chemotherapy for locally recurrent NPC remains to be determined. In addition, whether the addition of chemotherapy to CIRT is needed remains unknown. These questions will be evaluated in the dose-escalating phase I and randomized phase II trials.

Clinical characteristics and changes in living quality of patients with radiation encephalopathy induced by radiation therapy for treating nasopharyngeal carcinoma

BACKGROUND： Radiation encephalopathy （RE） caused by radiation therapy of nasopharyngeal carcinoma severely influences patients＇ quality of life （QOL）. The factors, which influence such patients＇ QOL, have not been confirmed. OBJECTIVE： To observe the clinical and imageological characteristics of patients with radiation therapy of nasopharyngeal carcinoma-induced RE and the changes in QOL, and analyze QOL influencing factors. DESIGN： Retrospective case analysis. SETTING： Department of Neurology, the Second Affiliated Hospital of Sun Yat-sen University. PARTICIPANTS： Eighty-nine inpatients or outpatients with RE induced by radiation therapy of nasopharyngeal carcinoma admitted to Sun Yat-sen University Cancer Center and Department of Neurology, the Second Affiliated Hospital of Sun Yat-sen University from March 1994 to August 2004 were involved in this experiment. They all met the diagnosis criteria of RE from MERRITT＇S neurology （10th edition）. Thirty-three involved patients were randomly chosen as RE group. Another 34 concurrent inpatients or outpatients with nasopharyngeal carcinoma who received radiation therapy but without RE were chosen as control group. Informed consents of detected items were obtained from all the involved subjects. METHODS： （1） Patients were evaluated when they were followed up. The World Health Organization Quality of Life Questionnaire abbreviated version （WHOQOL-BREF） was used for on-the-spot evaluation. High points of WHOQOL-BREF indicated better QOL. The Late Effects on Normal Tissues - Subjective, Objective, Management and Analytic （LENT-SOMA） scale for evaluating radiation injury was used to evaluate headache and neurologic disorder of patients with RE induced by radiation therapy of nasopharyngeal carcinoma. The evaluation was graded into 5 degrees. High degrees indicted severer clinical symptoms. （2） Disease latency （i.e. time interval from symptoms and body signs appearing or radiation therapy ending to onset）, initial symptoms, common symptoms, imageological characteristics, QOL and other related factors of patients were recorded. （3） Statistical management was carried out with SPSS 10.0 software. MAIN OUTCOME MEASURES： QOL and clinical characteristics of patients with RE induced by radiation therapy of nasopharyngeal carcinoma as well as QOL influencing factors. RESULTS： All the involved subjects participated in the final analysis. （1） Disease latency of patients with RE ranged from 0 to 24 years, and 95% confidence interval was 0 to 15 years. There were significant differences in amount of invaded cases between 6 months after one radiation therapy and 6 months after two or more radiation therapies （ x^2=36.76, P 〈 0.01）. （2） The common initial symptom of patients with RE was glossopharyngeal paralysis （33 cases, 37%）. （3） The first 3 common symptoms of patients with RE were glossopharyngeal paralysis （52 cases, 58%）, limb inertia and sensory disorder （25 cases, 28%） and headache （25 cases, 28%）.（4）Imageology of patients with RE was characterized by long TI and T2 signal shadow on magnetic resonance. （5）Total scores of health, of daily life and of social relationship, measured with WHOQOL-BREF, of patients in RE group were significantly lower than those in the control group, respectively [ （2.06 ± 0.86） points vs. （2.59 ± 0.66） points; （2.45 ± 0.75 ） points vs. （2.91 ± 0.75 ） points; （51.67±15.24） points vs. （59.22±13.03） points, P 〈 0.05]. Patients undergoing two or more radiation therapies were inferior to those undergoing one radiation therapy in total scores of health, and of daily life, scores of physiology, and of psychology （P 〈 0.05）. （6）Glossopharyngeal paralysis was negatively correlated with scores of psychology, total scores of daily life and of health in WHOQOL-BREF （P 〈 0.05）; Head was negatively correlated with scores of psychology in WHOQOL-BREF （P 〈 0.05）; Neurologic deficit was negatively correlated with scores of psychology, and total scores of health in WHOQOL-BREF （P 〈 0.05）. CONCLUSION： （1）The latency of RE of patients undergoing two or more radiation therapies is remarkably shortened, and QOL is decreased, but there is no difference in QOL between two genders. （2） Brain edema is common in imageology of RE after radiation therapy. The first 3 ones of initial symptoms and common symptoms both are glossopharyngeal paralysis, neurologic deficit and headache, which greatly negatively influence QOL of patients.

Nasopharyngeal carcinoma incidence and mortality in China in 2009

Nasopharyngeal carcinoma (NPC) is rare globally but common in China and exhibits a distinct ethnic and geographic distribution. In 2009, the National Central Cancer Registry in China provided real-time surveillance information on NPC. Individual NPC cases were retrieved from the national database based on the ICD-10 topography code C11. The crude incidence and mortality of NPC were calculated by sex and location (urban/rural). China's population in 1982 and Segi's world population structures were used to determine age-standardized rates. In regions covered by the cancer registries in 2009, the crude incidence of NPC was 3.61/100,000 (5.08/100,000 in males and 2.10/100,000 in females; 4.19/100,000 in urban areas and 2.42/100,000 in rural areas). Age-standardized incidences by Chinese population (ASIC) and Segi's world population (ASIW) were 2.05/100,000 and 2.54/100,000, respectively. The crude mortality of NPC was 1.99/100,000 (2.82/100,000 in males and 1.14/100,000 in females; 2.30/100,000 in urban areas and 1.37/100,000 in rural areas). The age-standardized mortalities by Chinese population (ASMC) and world population (ASMW) were 1.04/100,000 and 1.35/100,000, respectively. The incidence and mortality of NPC were higher in males than in females and higher in urban areas than in rural areas. Both agespecific incidence and mortality were relatively low in persons younger than 30 years old, but these rates dramatically increased. Incidence peaked in the 60-64 age group and mortality peaked in the over 85 age group. Primary and secondary prevention, such as lifestyle changes and early detection, should be carried out in males and females older than 30 years of age.

Potential factors associated with clinical stage of nasopharyngeal carcinoma at diagnosis: a case–control study

Background: In China, most patients with nasopharyngeal carcinoma(NPC) are diagnosed at a late stage and con?sequently have a poor prognosis. This study aimed to investigate potential factors associated with the clinical stage of NPC at diagnosis.Methods: Data were obtained from 118 patients with early?stage NPC and 274 with late?stage NPC who were treated at Sun Yat?sen University Cancer Center between August 2014 and July 2015. Patients were individually matched by age, sex, and residence, and a conditional logistic regression model was applied to assess the associa?tions of clinical stage at diagnosis with socioeconomic status indicators, knowledge of NPC, physical examinations, patient interval, and risk factors for NPC.Results: Although knowledge of early NPC symptoms, smoking cessation, and patient interval were important fac?tors, the number of cigarettes smoked per day, motorbike ownership, and physical examination exhibited the strong?est associations with the clinical stage of NPC at diagnosis. Compared with smoking fewer than ten cigarettes a day, smoking 10–30 cigarettes [odds ratio(OR) 4.03; 95% confidence interval(CI) 1.11–14.68] or more than 30 cigarettes(OR 11.46; 95% CI 1.26–103.91) was associated with an increased risk of late diagnosis. Compared with not owning a motorbike, owning a motorbike(OR 0.38; 95% CI 0.23–0.64) was associated with early diagnosis. Subjects who under?went physical examinations were less likely to receive a late diagnosis than those who did not undergo examinations(OR 0.50; 95% CI 0.28–0.89). However, indicators of wealth were not significant factors.Conclusions: Initiatives to improve NPC patient prognosis should aim to promote knowledge about early symptoms and detection, health awareness, and accessibility to health facilities among all patients, regardless of socioeconomic status.

Plasma Epstein-Barr virus DNA as a biomarker for nasopharyngeal carcinoma

Nasopharyngeal carcinoma(NPC)is common in southern China and Southeast Asia.Epstein-Barr virus(EBV)infection is an important etiology for NPC,and EBV genome can be detected in almost all tumor tissues of NPC in this region.Plasma EBV DNA,when quantitatively analyzed using real-time polymerase chain reaction(PCR),has been developed as a biomarker for NPC.In this review,the different clinical applications of plasma EBV DNA in the management of NPC,including screening,monitoring,and prognostication,are discussed.In addition,the biological issues of circulating EBV DNA,including the molecular nature and clearance kinetics,are also explored.

Effect of WNT5A on epithelial-mesenchymal transition and its correlation with tumor invasion and metastasis in nasopharyngeal carcinoma

Objective:To investigate the correlation between nasopharyngeal carcinoma cell WNT5A and epithelial-mesenchytnal transition(emt)/metastasis,and investigate its possible mechanisms.Methods:RT-PCR and gene transfection were used to detect the expression of nasopharyngeal carcinoma cell strains WNT5A and EMT related factor 5-8F.Transient transfcction of NPC cell line 5-8F was determined by liposome of plasmid with WNT5A gene.The differential expressions of WNTSA and EMT-related factors in cells before and after transfection were detected by RTPCR.Cell scratch assay and Transwell assay were used to detect the motility abilities of cells before and after 5-8F transfection.Results:The expressions of WNT5A and EMT related factors matrix metalloproleinasc-2 of the WNTSA transferred group in the nasopharyngeal carcinoma cell line 5-8F were higher than the blank control group and the empty vector transferred group,and the transfer ability of the WNTSA transferred group was higher than that in the blank control group and the empty vector transferred group,while the expressions of EMT related factors E-cadherin were lower than that in the blank control group and the empty vector transferred group,and the transfer ability of the WNT5A transferred group was higher than that in the blank control group and the empty vector transferred group.Conclusions:In nasopharyngeal carcinoma cells,WNT5A can regulate the epithelial-mesenchymal transition and affect the ability of tumor invasion and metastasis of nasopharyngeal carcinoma.

Yi Qi Jie Du Decoction Inhibits Proliferation and Induces Apoptosis of Nasopharyngeal Carcinoma Stem Cells Through Mitochondrial Apoptosis Pathway

Objective To assess the effects of Yi Qi Jie Du Decoction(YQJDD)on nasopharyngeal carcinoma stem cells(NPC-SCs)and investigate the underlying mechanism.Methods NPC-SCs were collected in serum-free culture system and identified by the sphere formation assay.The effect of YQJDD on the proliferation of NPC-SCs was detected using the Cell Counting Kit-8 assay.The change of mitochondrial membrane potential(ΔΨm)in NPC-SCs following treatment with YQJDD was investigated by JC-1 staining.The levels of apoptosisassociated proteins were examined using western blot analysis.Results YQJDD significantly inhibited the proliferation of NPCSCs in dose-and time-dependent manners.JC-1 staining revealed that YQJDD lowered theΔΨm of NPC-SCs in a timedependent manner.After treatment with YQJDD,the expression of cleaved caspase-3,-7 and-9,cleaved poly-ADP ribose polymerase,P21 and P53 were increased,while the expression of Survivin in NPC-SCs was decreased.However,the expression of cleaved caspase-8 remained nearly unchanged.Conclusions YQJDD inhibits the growth and induces apoptosis of NPC-SCs via an intrinsic apoptosis pathway.

Expressions of genes related to genome stability and DNA repair in nasopharyngeal carcinoma clustering families

Objective： The aim of the study was to observe the expressions of genes related to genome stability and DNA repair in the members of nasopharyngeal carcinoma （NPC） clustedng families. Methods： In the Zhongshan City where there is highly incidence rate of NPC, we chose the members of the NPC clustering families as objects, and the patients of nasopharyngitis and NPC as the control group. We isolated the RNA from the nasopharyngeal tissue, and synthesized its cRNA, the genome stability and DNA repair genes chip technique, chemiluminescent detection and real-time fluorescence quantita- tive technique were used to examine the genome stability and DNA repair genes in the nasopharyngeal tissue. Results： More genome stability and DNA repair genes were up-regulated in the members of the NPC clustering families than the NPC patients, and the range of up-regulated was high, with the over up-regulated 100 times genes including TEP1, MSH4, PMS2LI. Fewer genome stability and DNA repair genes were down-regulated in the members of the NPC clustering families than the NPC patients, the ubiquitin genes almost were down-regulated, the results also could be confirmed by real-time fluorescence quantitative PCR. Conclusion： There are specially expression character of genome stability and DNA repair genes in the members of NPC clustering families.

Correlation of Skp2 overexpression to prognosis of patients with nasopharyngeal carcinoma from South China

S-phase kinase-associated protein 2 (Skp2), which plays a role in cell cycle regulation, is commonly overexpressed in a variety of human cancers and associated with poor prognosis. However, its role in nasopharyngeal carcinoma (NPC) is not well understood. In this study, we examined the clinical significance of Skp2, with a particular emphasis on overall survival (OS) and disease-free survival (DFS), in NPC cases in South China, where NPC is an epidemic. Additionally, we explored the function of Skp2 in maintaining a cancer stem cell -like phenotype in NPC cell lines. Skp2 expression was assessed for 127 NPC patients using tissue microarrays and immunohistochemistry and analyzed together with clinicopathologic features, OS, and DFS. Skp2 expression was detectable, or positive, in 75.6% of patients. Although there was no correlation between Skp2 and any clinicopathologic factor, Skp2 expression significantly portended inferior OS (P = 0.013) and DFS (P = 0.012). In the multivariate model, Skp2 expression remained significantly predictive of poor OS [P = 0.009, risk ratio (RR) = 4.06] and DFS (P = 0.008, RR = 3.56), and this was also true for clinical stage (P = 0.012 and RR=3.201 for OS; P = 0.002 and RR=1.94 for DFS) and sex (P = 0.016 and RR=0.31 for OS; P = 0.006 and RR = 0.27 for DFS). After Skp2 knockdown, a colony formation assay was used to evaluate the self-renewal property of stem-like cells in the NPC cell lines CNE-1 and CNE-2. The colony formation efficiency in CNE-1 and CNE-2 cells was decreased. In Skp2-transfected CNE-1 and CNE-2 cells, side population (SP) proportion was increased as detected by flow cytometry. Skp2 is an independent prognostic marker for OS and DFS in NPC. Skp2 may play a role in maintaining the cancer stem cell-like phenotype of NPC cell lines.

MRI与CT模拟定位技术在局部晚期鼻咽癌放射治疗中剂量学对比研究

目的通过MRI模拟定位技术与CT模拟定位技术在局部晚期鼻咽癌肿瘤靶区和危及器官(OAR)勾画方面的应用对比,探讨两种定位技术在鼻咽癌放射治疗中的剂量学差异。方法选择蚌埠医学院第一附属医院2022年4月至2023年9月接受鼻咽癌放射治疗的37例患者,其中男性29例,女性8例;年龄29~75岁,平均年龄53.14岁;美国癌症联合委员会(AJCC)分期Ⅱ期24例,Ⅲ期13例。患者在相同体位下行CT模拟定位及MRI模拟定位,在CT定位上通过患者现有影像学资料勾画靶区及OAR,并完成三维适形调强治疗计划;然后进行CT模拟定位及MRI模拟定位融合,再进行靶区勾画及OAR勾画;比较两种计划靶区体积、剂量[近似最大剂量(D_(2%))、近似最小剂量(D_(98%))、中位剂量(D_(50%))和OAR接受的最大点剂量(D_(max))]及适形性指数(CI)和均匀性指数(HI)差异。并比较二者OAR的剂量学差异。结果MRI模拟定位图像上所勾画放疗计划靶区体积小于CT模拟定位(30.54 mm^(3)±18.98 mm^(3)vs 39.56 mm^(3)±19.22 mm^(3)),差异有统计学意义(t=2.004,P=0.049)。CT模拟定位原发病灶放射剂量D_(2%)大于MRI模拟定位[(73.00±1.08)Gy vs(72.23±0.76)Gy],差异有显著统计学意义(t=3.536,P=0.001)。MRI模拟定位在靶区的HI和CI均明显优于CT模拟定位(0.037±0.009 vs 0.049±0.021、0.88±0.02 vs 0.84±0.01。t=3.119、9.951,P<0.01)。OAR,MRI模拟定位的脑干、颞叶、内耳D_(max)明显优于CT定位[脑干:(46.79±5.78)Gy vs(50.87±3.66)Gy;颞叶:(46.39±5.21)Gy vs(49.68±4.72)Gy;内耳:(34.28±5.29)Gy vs(38.71±4.33)Gy。P<0.01]。结论MRI模拟定位下所勾画的鼻咽癌肿瘤靶区体积小于CT定位下的勾画,且MRI定位在剂量的均质性和适形性更好,OAR最高剂量更低。因此在局部晚期鼻咽癌放疗中,MRI模拟定位技术值得更多的关注和应用。

鼻咽癌放疗后患者吞咽困难发生的相关影响因素及其干预措施分析

目的:探讨鼻咽癌放疗后患者吞咽困难发生的相关影响因素及其干预措施。方法:采用便利抽样方法选择2020年3月~2023年3月在本院行放射治疗的400例鼻咽癌患者为研究对象,调查其吞咽困难发生情况及其相关影响因素。结果:鼻咽癌放疗后患者吞咽困难发生率为65.00%(260/400);单因素分析显示,年龄、肿瘤临床TNM分期、放射剂量、放射性口腔炎、放射性皮炎与鼻咽癌放疗后吞咽困难有关(P<0.05);受教育程度、婚姻状况、放疗前BMI、放疗时间、性别、吸烟、合并基础疾病、同期化疗、饮酒与鼻咽癌放疗后吞咽困难无关(P>0.05)。经Logistic回归分析显示:年龄≥60岁(B=0.934,OR=2.545,95%CI=1.652-3.922)、肿瘤临床TNM分期Ⅲ~Ⅳ期(B=1.142,OR=3.132,95%CI=2.006-4.888)、放射剂量>72Gy(B=0.703,OR=2.020,95%CI=1.312-3.111)、放射性口腔炎(B=1.593,OR=4.920,95%CI=3.049-7.939)、放射性皮炎(B=1.529,OR=4.612,95%CI=2.956-7.197)是鼻咽癌放疗后吞咽困难的高危因素(P<0.05)。结论:鼻咽癌放疗后患者吞咽困难发生率较高,其受年龄、肿瘤临床TNM分期、放射剂量、放射性口腔炎、放射性皮炎等多种因素影响,针对上述因素制定干预措施,可能减少或避免患者发生吞咽困难。