Gastric cancer is a predominant threat to the health and well-being of China's residents. Data from the World Health Organization(WHO) in 2020 revealed that gastric cancer in China notably accounted for 44.0% of n...Gastric cancer is a predominant threat to the health and well-being of China's residents. Data from the World Health Organization(WHO) in 2020 revealed that gastric cancer in China notably accounted for 44.0% of new cases worldwide and 48.6% of global deaths attributed to this malignancy~1.展开更多
Gastric cancer(GC)ranks fifth in cancer incidence and fourth in cancer-related mortality worldwide.Reactive oxygen species(ROS)are highly oxidative oxygen-derived products that have crucial roles in cell signaling reg...Gastric cancer(GC)ranks fifth in cancer incidence and fourth in cancer-related mortality worldwide.Reactive oxygen species(ROS)are highly oxidative oxygen-derived products that have crucial roles in cell signaling regulation and maintaining internal balance.ROS are closely associated with the occurrence,development,and treatment of GC.This review summarizes recent findings on the sources of ROS and the bidirectional regulatory effects on GC and discusses various treatment modalities for GC that are related to ROS induction.In addition,the regulation of ROS by natural small molecule compounds with the highest potential for development and applications in anti-GC research is summarized.The aim of the review is to accelerate the clinical application of modulating ROS levels as a therapeutic strategy for GC.展开更多
BACKGROUND Gastric cancer(GC)is the fifth most common and the fourth most lethal malignant tumour in the world.Most patients are already in the advanced stage when they are diagnosed,which also leads to poor overall s...BACKGROUND Gastric cancer(GC)is the fifth most common and the fourth most lethal malignant tumour in the world.Most patients are already in the advanced stage when they are diagnosed,which also leads to poor overall survival.The effect of posto-perative adjuvant chemotherapy for advanced GC is unsatisfactory with a high rate of distant metastasis and local recurrence.AIM To investigate the safety and efficacy of a programmed cell death 1(PD-1)inhibitor combined with oxaliplatin and S-1(SOX)in the treatment of Borrmann large type III and IV GCs.METHODS A retrospective analysis(IRB-2022-371)was performed on 89 patients with Borrmann large type III and IV GCs who received neoadjuvant therapy(NAT)from January 2020 to December 2021.According to the different neoadjuvant treatment regimens,the patients were divided into the SOX group(61 patients)and the PD-1+SOX(P-SOX)group(28 patients).RESULTS The pathological response(tumor regression grade 0/1)in the P-SOX group was significantly higher than that in the SOX group(42.86%vs 18.03%,P=0.013).The incidence of ypN0 in the P-SOX group was higher than that in the SOX group(39.29%vs 19.67%,P=0.05).The use of PD-1 inhibitors was an independent factor affecting tumor regression grade.Meanwhile,the use of PD-1 did not increase postoperative complications or the adverse effects of NAT.CONCLUSION A PD-1 inhibitor combined with SOX could significantly improve the rate of tumour regression during NAT for patients with Borrmann large type III and IV GCs.展开更多
BACKGROUND Gastric cancer(GC)is a highly prevalent gastrointestinal tract tumor.Several trials have demonstrated that the location of GC can affect patient prognosis.However,the factors determining tumor location rema...BACKGROUND Gastric cancer(GC)is a highly prevalent gastrointestinal tract tumor.Several trials have demonstrated that the location of GC can affect patient prognosis.However,the factors determining tumor location remain unclear.AIM To investigate the tumor location of patients,we went on to study the influencing factors that lead to changes in the location of GC.METHODS A retrospective evaluation was carried out on 3287 patients who underwent gastrectomy for GC in Zhejiang Cancer Hospital.The patients were followed up post-diagnosis and post-gastrectomy.The clinicopathological variables and overall survival of the patients were recorded.By analyzing the location of GC,the tumor location was divided into four categories:“Upper”,“middle”,“lower”,and“total”.Statistical software was utilized to analyze the relationship of each variable with the location of GC.RESULTS A total of 3287 patients were included in this study.The clinicopathological indices of gender,age,serum levels of carcinoembryonic antigen(CEA),carbohydrate antigen(CA19-9)and CA72-4 levels,were significantly associated with tumor location in patients with GC.In addition,there was a strong correlation between GC location and the prognosis of postoperative patients.Specifically,patients with“lower”and“middle”GC demonstrated a better prognosis than those with tumors in other categories.CONCLUSION The five clinicopathological indices of gender,age,CEA,CA19-9 and CA72-4 levels exhibit varying degrees of influence on the tumor location.The tumor location correlates with patient prognosis following surgery.展开更多
BACKGROUND Tankyrase 2(TNKS2)is a potential candidate molecular target for the prognosis and treatment of non-small cell lung cancer(NSCLC),but its biological functions are unclear.AIM To investigate the biological fu...BACKGROUND Tankyrase 2(TNKS2)is a potential candidate molecular target for the prognosis and treatment of non-small cell lung cancer(NSCLC),but its biological functions are unclear.AIM To investigate the biological functions of TNKS2 in NSCLC.METHODS Using a lentiviral vector,we generated H647 model cells with TNKS2 knockdown by RNA interference and A549 model cells with TNKS2 overexpression by tran-sfection with a TNKS2 overexpressing plasmid.Increased and decreased exp-ression levels of TNKS2 in the two cell lines were verified using real-time reverse transcriptase-polymerase chain reaction and Western blot analyses.Cell apopto-sis,proliferation,and migration were determined using flow cytometry,carbo-xyfluorescein succinimidyl ester staining,and scratch assay,respectively.Im-munofluorescence staining was conducted to examine TNKS2 andβ-catenin ex-pression levels in the two transfected cell lines and the non-transfected cells.RESULTS TNKS2 mRNA and protein expression was significantly higher in the highly malignant NCI-H647 cells,while it remained at a low level in the less malignant A549 cells.Lentivirus-mediated overexpression of TNKS2 in A549 cells resulted in a 3-fold increase in gene expression and a 1.7-fold increase in protein expression(P<0.01).Conversely,shRNA interference targeting TNKS2 Led to an 8-fold decrease in gene expression and a 3-fold decrease in protein expression(P<0.01)in NCI-H647 cells.Furthermore,the cell apoptosis rate was significantly reduced(50%)and cell migration rate was increased(35%)in the TNKS2 overexpression group than in the control group(P<0.05).In contrast,shTNKS2 promoted apoptosis by more than one fold and reduced migration by 60%(P<0.05).Immunofluorescence analysis revealed enhanced nuclear localization ofβ-catenin fluorescence signal associated with high TNKS2 expression levels.Western blot analysis investigating TNKS2/β-catenin-related proteins indicated consistent changes between TNKS2 andβ-catenin expression in lung cancer cells,whereas Axin displayed an opposite trend(P<0.05).CONCLUSION The obtained results revealed that TNKS2 may serve as an adverse prognostic factor and a potential therapeutic target in NSCLC.展开更多
BACKGROUND This study investigated the construction and clinical validation of a predictive model for neuroaggression in patients with gastric cancer.Gastric cancer is one of the most common malignant tumors in the wo...BACKGROUND This study investigated the construction and clinical validation of a predictive model for neuroaggression in patients with gastric cancer.Gastric cancer is one of the most common malignant tumors in the world,and neuroinvasion is the key factor affecting the prognosis of patients.However,there is a lack of systematic analysis on the construction and clinical application of its prediction model.This study adopted a single-center retrospective study method,collected a large amo-unt of clinical data,and applied statistics and machine learning technology to build and verify an effective prediction model for neuroaggression,with a view to providing scientific basis for clinical treatment decisions and improving the tr-eatment effect and survival rate of patients with gastric cancer.AIM To investigate the value of a model based on clinical data,spectral computed to-mography(CT)parameters and image omics characteristics for the preoperative prediction of nerve invasion in patients with gastric cancer.METHODS A retrospective analysis was performed on 80 gastric cancer patients who under-went preoperative energy spectrum CT at our hospital between January 2022 and August 2023,these patients were divided into a positive group and a negative group according to their pathological results.Clinicopathological data were collected,the energy spectrum parameters of primary gastric cancer lesions were measured,and single factor analysis was performed.A total of 214 image omics features were extracted from two-phase mixed energy images,and the features were screened by single factor analysis and a support vector machine.The variables with statist-ically significant differences were included in logistic regression analysis to construct a prediction model,and the performance of the model was evaluated using the subject working characteristic curve.There were statistically significant differences in sex,carbohydrate antigen 199 expression,tumor thickness,Lauren classification and Borrmann classification between the two groups(all P<0.05).Among the energy spectrum parameters,there were statistically significant differences in the single energy values(CT60-CT110 keV)at the arterial stage between the two groups(all P<0.05)and statistically significant differences in CT values,iodide group values,standardized iodide group values and single energy values except CT80 keV at the portal vein stage between the two groups(all P<0.05).The support vector machine model with the largest area under the curve was selected by image omics analysis,and its area under the curve,sensitivity,specificity,accuracy,P value and pa-rameters were 0.843,0.923,0.714,0.925,<0.001,and c:g 2.64:10.56,respectively.Finally,based on the logistic regression algorithm,a clinical model,an energy spectrum CT model,an imaging model,a clinical+energy spe-ctrum model,a clinical+imaging model,an energy spectrum+imaging model,and a clinical+energy spectrum+imaging model were established,among which the clinical+energy spectrum+imaging model had the best efficacy in diagnosing gastric cancer nerve invasion.The area under the curve,optimal threshold,Youden index,sensitivity and specificity were 0.927(95%CI:0.850-1.000),0.879,0.778,0.778,and 1.000,respectively.CONCLUSION The combined model based on clinical features,spectral CT parameters and imaging data has good value for the preoperative prediction of gastric cancer neuroinvasion.展开更多
BACKGROUND Pancreatic cancer is a highly malignant tumor with a rapid progression rate and a high susceptibility to infiltration and metastasis.Astragalus polysaccharide(APS),a pure Chinese medicine preparation primar...BACKGROUND Pancreatic cancer is a highly malignant tumor with a rapid progression rate and a high susceptibility to infiltration and metastasis.Astragalus polysaccharide(APS),a pure Chinese medicine preparation primarily made from the traditional Chinese herb Astragalus,plays a positive role in the treatment of many malignant tumors.AIM To explore the recent efficacy of APS combined with gemcitabine plus tegafur gimeracil oteracil potassium capsule(S-1)(GS)regimen in the treatment of pancreatic cancer and assess its effect on the immune function and long-term survival of patients.METHODS A total of 97 patients who were diagnosed with pancreatic cancer and received GS chemotherapy at The First Affiliated Hospital of Zhejiang Chinese Medical University(Zhejiang Provincial Hospital of Chinese Medicine)from March 2021 to December 2021 were included in the retrospective analysis.Among them,41 patients received APS combined with GS chemotherapy,and 56 patients received GS chemotherapy only.The recent efficacy,immune function,adverse reactions,and long-term survival were compared among these patients.RESULTS After 4 cycles of treatment,the objective response rate of patients receiving the combined therapy of APS and GS was 51.22%,and the disease control rate(DCR)was 56.10%,higher than those of patients receiving the monotherapy with GS alone(30.36%and 35.71%,respectively).Besides,the percentages of CD3+T cells(50.18%±9.57%)and CD4+T cells(31.52%±5.33%)in the peripheral blood of patients receiving the combined therapy of APS and GS were higher compared with those treated with GS regimen alone[(44.06%±8.55%)and(26.01%±7.83%),respectively].Additionally,the incidences of leukopenia,thrombocytopenia,and fatigue in patients receiving the combined therapy of APS and GS were significantly lower than those in patients receiving the monotherapy of GS alone(17.07%,9.76%,31.71%vs 37.50%,28.57%,60.71%).Moreover,the median survival time of patients receiving the combined therapy of APS and GS was 394 days,significantly longer than that of patients receiving the mono-therapy of GS alone(339 days)(hazard ratio:0.66;95%CI:0.45-0.99;P=0.036).All these differences were statistically si-gnificant(P<0.05).CONCLUSION The combined therapy of APS and GS improved the recent efficacy and long-term survival of patients with pancreatic cancer and alleviated chemotherapy-induced immune suppression and adverse reactions.展开更多
Objective: IMpower210(NCT02813785) explored the efficacy and safety of single-agent atezolizumab vs.docetaxel as second-line treatment for advanced non-small cell lung cancer(NSCLC) in East Asian patients.Methods: Key...Objective: IMpower210(NCT02813785) explored the efficacy and safety of single-agent atezolizumab vs.docetaxel as second-line treatment for advanced non-small cell lung cancer(NSCLC) in East Asian patients.Methods: Key eligibility criteria for this phase Ⅲ, open-label, randomized study included age ≥18 years;histologically documented advanced NSCLC per the Union for International Cancer Control/American Joint Committee on Cancer staging system(7th edition);Eastern Cooperative Oncology Group performance status of 0 or 1;and disease progression following platinum-based chemotherapy for advanced or metastatic NSCLC. Patients were randomized 2:1 to receive either atezolizumab(1,200 mg) or docetaxel(75 mg/m^(2)). The primary study endpoint was overall survival(OS) in the intention-to-treat(ITT) population with wild-type epidermal growth factor receptor expression(ITT EGFR-WT) and in the overall ITT population.Results: Median OS in the ITT EGFR-WT population(n=467) was 12.3 [95% confidence interval(95% CI),10.3-13.8] months in the atezolizumab arm(n=312) and 9.9(95% CI, 7.8-13.9) months in the docetaxel arm[n=155;stratified hazard ratio(HR), 0.82;95% CI, 0.66-1.03]. Median OS in the overall ITT population was 12.5(95% CI, 10.8-13.8) months with atezolizumab treatment and 11.1(95% CI, 8.4-14.2) months(n=377) with docetaxel treatment(n=188;stratified HR, 0.87;95% CI, 0.71-1.08). Grade 3/4 treatment-related adverse events(TRAEs) occurred in 18.4% of patients in the atezolizumab arm and 50.0% of patients in the docetaxel arm.Conclusions: IMpower210 did not meet its primary efficacy endpoint of OS in the ITT EGFR-WT or overall ITT populations. Atezolizumab was comparatively more tolerable than docetaxel, with a lower incidence of grade3/4 TRAEs.展开更多
Objective:Several studies have been conducted on the effects and toxicity of adding oxaliplatin to fluorouracilbased or capecitabine-based chemoradiotherapy(CRT)regimens as significantly increasing the toxic response ...Objective:Several studies have been conducted on the effects and toxicity of adding oxaliplatin to fluorouracilbased or capecitabine-based chemoradiotherapy(CRT)regimens as significantly increasing the toxic response without benefit to survival.In this study,we further explored the role of these two postoperative CRT regimens in patients with pathological stage N2 rectal cancer.Methods:This study was a subgroup analysis of a randomized clinical trial.A total of 180 patients with pathological stage N2 rectal cancer were eligible,85 received capecitabine with radiotherapy(RT),and 95 received capecitabine and oxaliplatin with RT.Patients in both groups received adjuvant chemotherapy[capecitabine and oxaliplatin(XELOX);or fluorouracil,leucovorin,and oxaliplatin(FOLFOX)]after CRT.Results:At a median follow-up of 59.2[interquartile range(IQR),34.0−96.8]months,the three-year diseasefree survival(DFS)was 53.3%and 64.9%in the control group and the experimental group,respectively[hazard ratio(HR),0.63;95%confidence interval(95%CI),0.41−0.98;P=0.04].There was no significant difference between the groups in overall survival(OS)(HR,0.62;95%CI,0.37−1.05;P=0.07),the incidence of locoregional recurrence(HR,0.62;95%CI,0.24−1.64;P=0.33),the incidence of distant metastasis(HR,0.67;95%CI,0.42−1.06;P=0.09)and grade 3−4 acute toxicities(P=0.78).For patients with survival longer than 3 years,the conditional overall survival(COS)was significantly better in the experimental group(HR,0.39;95%CI,0.16−0.96;P=0.03).Conclusions:Our results indicated that adding oxaliplatin to capecitabine-based postoperative CRT is safe and effective in patients with pathological stage N2 rectal cancer.展开更多
Background:The purpose of this study is to evaluate the quality of life(QoL)of hospitalized patients in China suffering from digestive system malignancies and to identify potential risk factors for a decrease in QoL.M...Background:The purpose of this study is to evaluate the quality of life(QoL)of hospitalized patients in China suffering from digestive system malignancies and to identify potential risk factors for a decrease in QoL.Methods:The European Organization for Research and Treatment Core Quality of Life questionnaire(EORTC QLQ-C30)was applied to evaluate the QoL of 23,519 patients with six digestive malignancies(esophageal cancer,gastric cancer,colorectal cancer,liver cancer,biliary tract cancer,and pancreatic cancer).A t test or analysis of variance was employed to analyze the total EORTC QLQ-C30 scale scores and domain scores of the EORTC QLQ-C30 scale among patients in different subgroups.Results:The average QoL score was 50.4±10.8.The tumor type,age,sex,and TNM stage all had an impact on QoL ratings.Colorectal cancer patients had a better total QoL score(49.3±10.3)and scores in the domains of functioning,withmilder symptoms,except for diarrhea.Patients with biliary tract cancer(54.2±12.3)and pancreatic cancer(54.2±12.3)reported a poorer QoL,significant functional impairment,and more pronounced symptoms.Patients with esophageal cancer experienced the most severe financial difficulties(35.2±27.5).Patients aged≥65 years,women,and those with TNM stage III/IV reported lower QoL.In addition,the disparities in total QoL scores and scores in specific domains were significant among patients with some types of tumors,and based on ethnicity,educational level,occupation,treatment(s)received,and place of residence.Conclusions:There is a need to focus on elderly individuals,those with low educational levels,and patients with progressivemalignant tumors and to improve routine disease monitoring and symptom management to enhance the quality of life for patients with malignancies of the digestive system.展开更多
Background: The increasing prevalence of colorectal cancer(CRC) in China and the paucity of information about relevant expenditure highlight the necessity of better understanding the financial burden and effect of CRC...Background: The increasing prevalence of colorectal cancer(CRC) in China and the paucity of information about relevant expenditure highlight the necessity of better understanding the financial burden and effect of CRC diagnosis and treatment. We performed a survey to quantify the direct medical and non-medical expenditure as well as the resulting financial burden of CRC patients in China.Methods: We conducted a multicenter, cross-sectional survey in 37 tertiary hospitals in 13 provinces across China between 2012 and 2014. Each enrolled patient was interviewed using a structured questionnaire. All expenditure data were inflated to the 2014 Chinese Yuan(CNY; 1 CNY = 0.163 USD). We quantified the overall expenditure and financial burden and by subgroup(hospital type, age at diagnosis, sex, education, occupation, insurance type, household income, clinical stage, pathologic type, and therapeutic regimen). We then performed generalized linear modeling to determine the factors associated with overall expenditure.Results: A total of 2356 patients with a mean age of 57.4 years were included, 57.1 % of whom were men; 13.9% of patients had stage I cancer; and the average previous-year household income was 54,525 CNY.The overall average direct expenditure per patient was estimated to be 67,408 CNY, and the expenditures for stage Ⅰ, Ⅱ, Ⅲ, and Ⅳ disease were 56,099 CNY, 59,952 CNY, 67,292 CNY, and 82,729 CNY, respectively. Non-medical expenditure accounted for 8.3%of the overall expenditure. The 1-year out-of-pocket expenditure of a newly diagnosed patient was 32,649 CNY, which accounted for 59.9% of their previous-year household income and caused 75.0% of families to suffer an unmanageable financial burden. Univariate analysis showed that financial burden and overall expenditure differed in almost all subgroups(P < 0.05), except for sex. Multivariate analysis showed that patients who were treated in specialized hospitals and those who were diagnosed with adenocarcinoma or diagnosed at a later stage were likely to spend more,whereas those with a lower household income and those who underwent surgery spent less(all P < 0.05).Conclusions: For patients in China, direct expenditure for the diagnosis and treatment of CRC seemed catastrophic,and non-medical expenditure was non-ignorable. The financial burden varied among subgroups, especially among patients with different clinical stages of disease, which suggests that, in China, CRC screening might be cost-effective.展开更多
Aim:Scavenger receptor class B,type I(SR-BI)is an integral plasma membrane protein that has been reported to be overexpressed in various malignancies,such as renal cancer,breast cancer,and prostate cancer,and is an in...Aim:Scavenger receptor class B,type I(SR-BI)is an integral plasma membrane protein that has been reported to be overexpressed in various malignancies,such as renal cancer,breast cancer,and prostate cancer,and is an independent prognostic factor.However,the clinical value and expression of SR-BI in GC are unknown.Our research aimed to explore the role of SR-BI in combination with immune markers as a diagnostic and prognostic marker for gastric cancer(GC).Methods:GC tissues,paracancerous tissues,and clinicopathological data of 149 patients were collected.The expression level of SR-BI,Tumor-infiltrating lymphocytes(TILs),and PD-L1 were evaluated by immunohistochemistry(IHC).The associations of the SR-BI staining intensity with clinicopathological features and immune markers were determined by the chi-square test.Univariate and multivariate COX regression analyses were used to evaluate independent prognostic factors.Kaplan–Meier analyses were performed to plot the survival curve.Results:Our results indicated that SR-BI was expressed at higher levels in tumor tissues than in adjacent paracancerous tissues(p<0.001),and patients with high levels of SR-BI expression had a worse prognosis.Univariate and multivariate analyses revealed that high SR-BI expression was an independent factor for poor prognosis.The chi-square test determined that the expression of SR-BI was negatively correlated with CD4+T cells and CD8+T cells(CD4+T cells,p=0.013;CD8+T cells,p=0.021),and positively correlated with PD-L1(p=0.022).Finally,survival analysis revealed that CD4+T cells were associated with the prognosis of GC patients(p=0.019),and the combined survival analysis of SR-BI and CD4+T cells was also statistically significant(p=0.030).Conclusion:SR-BI is highly expressed in GC tissue and associated with poor prognosis.Moreover,SR-BI can also regulate the GC tumor immune microenvironment.展开更多
Beishashen(BSS)and Maidong(MD)are commonly used Medicine right for the treatment of non-small cell lung cancer(NSCLC),but their specific mechanism of action is not clear.In this study,network pharmacology and molecula...Beishashen(BSS)and Maidong(MD)are commonly used Medicine right for the treatment of non-small cell lung cancer(NSCLC),but their specific mechanism of action is not clear.In this study,network pharmacology and molecular docking techniques were used to investigate the molecular mechanisms of the therapeutic effects of BSS-MD on NSCLC and to experimentally validate some of the targets.The network pharmacology approach,including active ingredient and target screening,drug-compound-target network construction,protein-protein interaction(PPI)network,enrichment analysis,and molecular docking,was used to investigate the mechanism of action of Beisashen and Maitong on NSCLC.First,the active components of BSS-MD and their targets were predicted,of which 423 targets interacted with NSCLC targets.Then,network pharmacology showed that Stigmasterol,Quercetin,Alloisoimperatorin,Isoimperatorin,Beta-sitosterol were the core components of BSS-MD,and PLK1,HSP90AB1,and CDK1 were the key therapeutic targets.KEGG enrichment analysis indicated that the mechanism of action of BSS-MD in NSCLC treatment was related to the cell cycle.Then we further performed experimental validation.CCK-8 assay showed that BSS-MD inhibited LEWIS cell viability and promoted apoptosis in a dose-dependent manner.qPCR assay,immunofluorescence,and protein blotting experiments demonstrated that compared with the control group and the control group,the expression of PLK1,HSP90AB1,and CDK1 mRNAs and proteins were reduced in the treatment group(P<0.01).Therefore,we conclude that BSS-MD can block cell cycle progression by inhibiting the expression of PLK1,CDK1,and HSP90AB1 mRNAs and proteins to inhibit lung cancer cell growth and promote apoptosis,and emphasize that BSS-MD are promising adjuvants for NSCLC treatment.展开更多
Background Since the middle of the 19th century,German pathologist Rudolf Virchow proposed that tumors originate from chronic inflammation[1].At present,the medical community has determined that inflammation is closel...Background Since the middle of the 19th century,German pathologist Rudolf Virchow proposed that tumors originate from chronic inflammation[1].At present,the medical community has determined that inflammation is closely related to the occurrence,development and efficacy of anti-cancer treatment[2].Recently,an“anti-inflammatory diet”that claims to have functions such as cancer prevention has attracted much attention.To unveil the magic of the“anti-inflammatory diet”,let’s start with the concept of inflammation,which is the core of the“anti-inflammatory diet”.展开更多
tract,ranking second among the causes of cancer deaths worldwide,and nearly one million people die of CRC every year,which is a serious threat to human health[1].With the development of the economy and the improvement...tract,ranking second among the causes of cancer deaths worldwide,and nearly one million people die of CRC every year,which is a serious threat to human health[1].With the development of the economy and the improvement of living conditions,people's dietary structure is also quietly changing,and factors such as population aging,obesity,smoking,etc.all increase the risk of CRC[2],CRC morbidity and mortality under the influence of these conditions are showing a rising trend,and gradually younger[3].According to statistics,the incidence of CRC in men is second only to lung cancer and stomach cancer,while in women it is third only to breast cancer and cervical cancer[4–6].At present,there is still no special treatment plan for CRC,and surgery,radiotherapy,chemotherapy,and targeted therapy have long been used as the main treatment modalities.However,patients with malignant tumors often suffer from a variety of underlying diseases,low immunity or even malignant disease,and long-term radiotherapy will kill tumor cells while damaging normal cells,which is therefore difficult for patients to tolerate,and the quality of life of end-stage CRC patients is even more difficult.Therefore,it is often difficult for patients to tolerate it,and the quality of life of end-stage CRC patients is even more difficult to be guaranteed[7].展开更多
Objective:Colorectal cancer(CRC)is one of the most common malignancies in the world,and traditional Chinese medicine(TCM)is widely used in its treatment in China.However,the medication rules of TCM for CRC treatment r...Objective:Colorectal cancer(CRC)is one of the most common malignancies in the world,and traditional Chinese medicine(TCM)is widely used in its treatment in China.However,the medication rules of TCM for CRC treatment remain unclear.Therefore,data mining combined with network pharmacology was utilized to establish treatment principles and rules.Methods:The CRC cases treated at Zhejiang Provincial Hospital of Chinese Medicine from January 1,2016 to October 31,2021 were analyzed using data mining methods.UPLC-Q/TOF-MS analysis was performed to identify the chemical composition of Jiedu Sangen decoction(JSD).Network pharmacology was used to reveal the therapeutic mechanism of JSD.Results:A total of 312 cases 2,998 prescriptions that met the inclusion criteria used 343 kinds of traditional Chinese medicines.The nature of the herbs used in treatment was mainly warm and mild.The taste was mainly sweet,bitter,and pungent.The meridian tropisms were mainly the spleen meridian,followed by lung and stomach meridians.Tonifying and replenishing herbs were the most frequently used in treatment.High-frequency herbs were classified into 11 categories by cluster analysis,and 42 association rules were obtained by association rule analysis.Combined with complex network analysis,3 core prescriptions for clinical CRC treatment were obtained.Jiedu Sangen decoction contains 64 chemical ingredients,out of which 31 active ingredients were identified,including polydatin,caffeic acid,and glutamic acid,along with 130 potential targets such as AKT1,SRC,and MAPK1.Jiedu Sangen decoction may play a role in regulating inflammation,immunity,metabolism,and hormones in the development of CRC via pathways such as the relaxin signaling pathway,IL-17 signaling pathway,prolactin signaling pathway,and T cell receptor signaling pathway.Conclusions:This study summarizes the treatment and medication principles for clinical CRC treatment,promoting the inheritance and development of the traditional Chinese medical experience.展开更多
BACKGROUND The exercise of limb function is the most economical and safe method to promote the maturation of arteriovenous fistula(AVF).However,due to the lack of a uni-fied exercise standard in China,many patients ha...BACKGROUND The exercise of limb function is the most economical and safe method to promote the maturation of arteriovenous fistula(AVF).However,due to the lack of a uni-fied exercise standard in China,many patients have insufficient awareness of the importance of AVF,leading to poor effectiveness of limb function exercise.The self-management education model can effectively promote patients to take pro-active health-related actions.This study focuses on the characteristics of patients during the peri-AVF period and conducts a phased limb function exercise under the guidance of the self-management education model to observe changes in fac-tors such as the maturity of AVF.AIM To assess the impact of stage-specific limb function exercises,directed by a self-management education model,on the maturation status of AVFs.METHODS This study is a randomized controlled trial involving 74 patients with forearm AVFs from the Nephrology Department of a tertiary hospital in Sichuan Province,China.Patients were randomly divided into an observation group and a control group using a random number table method.The observation group underwent tailored stage-specific limb func-tion exercises,informed by a self-management education model which took into account the unique features of AVF at various stages,in conjunction with routine care.Conversely,the control group was given standard limb function exercises along with routine care.The assessment involves the maturity of AVFs post-intervention,post-operative complications,and the self-management level of the fistula in both groups patients.Analyses were conducted using SPSS version 23.0.Count data were represented by frequency and percentage and subjected to chi-square test comparisons.Measurement data adhering to a normal distribution were presented as mean±SD.The independent samples t-test was utilized for inter-group comparisons,while the paired t-test was used for intra-group comparisons.For measurement data not fitting a normal distribution,the median and interquartile range were presented and analyzed using the Wilcoxon rank sum test.RESULTS At the 8-wk postoperative mark,the observation group demonstrated significantly higher scores in AVF symptom recognition,symptom prevention,and self-management compared to the control group(P<0.05).However,the variance in symptom management scores between the observation and control groups lacked statistical signi-ficance(P>0.05).At 4 wk after the operation,the observation group displayed a superior vessel diameter and depth from the skin of the drainage vessels in comparison to the control group(P<0.05).While the observation group did manifest elevated blood flow rates in the drainage vessels relative to the control group,this distinction was not statistically significant(P>0.05).By the 8-wk postoperative interval,the observation group outperformed the control group with notable enhancements in blood flow rates,vessel diameter,and depth from the skin of drainage vessels(P<0.01).Seven days following the procedure,the observation group manifested significantly diminished limb swelling and an overall reduced complication rate in contrast to the control group(P<0.05).The evaluation of infection,thrombosis,embolism,arterial aneurysm stenosis,and incision bleeding showed no notable differences between the two groups(P>0.05).By the 4-wk postoperative juncture,complications between the observation and control groups were statistically indistinguishable(P>0.05).CONCLUSION Stage-specific limb function exercises,under the guidance of a self-management education model,amplify the capacity of AVF patients to discern and prevent symptoms.Additionally,they expedite AVF maturation and miti-gate postoperative limb edema,underscoring their efficacy as a valuable method for the care and upkeep of AVF in hemodialysis patients.展开更多
BACKGROUND Aggressive fibromatosis(AF),also known as desmoid tumor or desmoid-type fibromatosis,is a rare soft tissue neoplasm that can occur in almost any part of the body.Although it is a benign disease,AF is aggres...BACKGROUND Aggressive fibromatosis(AF),also known as desmoid tumor or desmoid-type fibromatosis,is a rare soft tissue neoplasm that can occur in almost any part of the body.Although it is a benign disease,AF is aggressive and infiltrative and has a high recurrence rate after surgery.Common sites for intra-abdominal AF are the small bowel mesentery,retroperitoneum,and pelvis.AF in the colon is extremely rare.CASE SUMMARY Here,we report the first case of sigmoid colon AF,which was accidentally discovered in a 27-year-old woman during laparoscopic myomectomy.Computed tomography confirmed a slightly enhanced mass in the sigmoid colon.Subsequent colonoscopy did not reveal a mass in the colonic lumen,but a suspected external compress was found in the sigmoid colon.Surgical disease involving a gastrointestinal stromal tumor was suspected.The patient underwent laparoscopic exploration,and sigmoidectomy with a negative margin was performed to excise the mass.Postoperative immunohistochemistry revealed that the mass was an AF.The patient recovered well and was recurrence-free at the 30-month follow-up without adjuvant therapy.CONCLUSION AF should be considered in the differential diagnosis of subepithelial colon masses.Radical resection alone can achieve good outcomes.展开更多
Objective:Glioblastomas are highly vascularized malignant tumors.We determined the efficacy and safety of the anti-angiogenic multi-kinase inhibitor,anlotinib,for a newly diagnosed glioblastoma.Methods:This multicente...Objective:Glioblastomas are highly vascularized malignant tumors.We determined the efficacy and safety of the anti-angiogenic multi-kinase inhibitor,anlotinib,for a newly diagnosed glioblastoma.Methods:This multicenter,single-arm trial(NCT04119674)enrolled 33 treatment-naïve patients with histologically proven glioblastomas between March 2019 and November 2020.Patients underwent treatment with the standard STUPP regimen[fractionated focal irradiation in daily fractions of 1.8-2 Gy given 5 d/w×6 w(total=54-60 Gy)]or radiotherapy plus continuous daily temozolomide(TMZ)(75 mg/m^(2)of body surface area/d,7 d/w from the first to the last day of radiotherapy),followed by 6 cycles of adjuvant TMZ(150-200 mg/m^(2)×5 d during each 28-d cycle)plus anlotinib(8 mg/d on d 1-14 of each 3-w cycle for 2 cycles during concomitant chemoradiotherapy,8 maximal cycles as adjuvant therapy,followed by maintenance at 8 mg/d.The primary endpoint was progression-free survival(PFS).Secondary endpoints included overall survival(OS)and adverse events(AEs).Results:Thirty-three patients received the planned treatment.The median PFS was 10.9 months(95%CI,9.9-18.7 months)and the 12-month PFS rate was 48.5%.The median OS was 17.4 months(95%CI,14.5-21.1 months)and the 12-month OS rate was 81.8%.The most common AEs included hypertriglyceridemia[58%(n=19)],hypoalbuminemia[46%(n=15)],and hypercholesterolemia[46%(n=15)]during concurrent chemoradiotherapy and leukopenia[73%(n=24)],hypertriglyceridemia[67%(n=22)],and neutropenia[52%(n=17)]during adjuvant therapy.Five patients discontinued treatment due to AEs.HEG1(HR,5.6;95%CI,1.3-23.7;P=0.021)and RP1L1 alterations(HR,11.1;95%CI,2.2-57.2;P=0.004)were associated with a significantly shorter PFS.Conclusions:Anlotinib plus the STUPP regimen has promising anti-tumor activity against glioblastoma and manageable toxicity.HEG1 and RP1L1 alterations might be novel predictive biomarkers of the response to anlotinib.展开更多
BACKGROUND Prophylactic loop ileostomy is an effective way to reduce the clinical severity of anastomotic leakage following radical resection of rectal cancer.Incisional surgical site infection(SSI)is a common complic...BACKGROUND Prophylactic loop ileostomy is an effective way to reduce the clinical severity of anastomotic leakage following radical resection of rectal cancer.Incisional surgical site infection(SSI)is a common complication after ileostomy closure.AIM To evaluate the efficacy and safety of the micro-power negative pressure wound technique(MPNPWT)in preventing incisional SSI.METHODS This was a prospective,randomized controlled clinical trial conducted at a single center.A total of 101 consecutive patients who underwent ileostomy closure after rectal cancer surgery with a prophylactic ileostomy were enrolled from January 2019 to December 2021.Patients were randomly allocated into an MPNPWT group and a control group.The MPNPWT group underwent intermittent suturing of the surgical incision with 2-0 Prolene and was covered with a micro-power negative pressure dressing.The surgical outcomes were compared between the MPNPWT(n=50)and control(n=51)groups.Risk factors for incisional SSI were identified using logistic regression.RESULTS There were no differences in baseline characteristics between the MPNPWT(n=50)and control groups(n=51).The incisional SSI rate was significantly higher in the control group than in the MPNPWT group(15.7%vs 2.0%,P=0.031).However,MPNPWT did not affect other surgical outcomes,including intra-abdominal complications,operative time,and blood loss.Postoperative hospital stay length and hospitalization costs did not differ significantly between the two groups(P=0.069 and 0.843,respectively).None of the patients experienced adverse effects of MPNPWT,including skin allergy,dermatitis,and pain.MPNPWT also helped heal the infected incision.Our study indicated that MPNPWT was an independent protective factor[odds ratio(OR)=0.005,P=0.025)]and diabetes was a risk factor(OR=26.575,P=0.029)for incisional SSI.CONCLUSION MPNPWT is an effective and safe way to prevent incisional SSI after loop ileostomy closure.展开更多
基金supported by The National Key Research and Development Program of China(2021YFA0910100)Zhejiang Provincial Research Center for Upper Gastrointestinal Tract Cancer(JBZX-202006)+4 种基金Medical Science and Technology Project of Zhejiang Province(WKJ-ZJ-2202 and WKJ-ZJ-2104)the National Natural Science Foundation of China(82074245,81973634, and 81903842)Natural Science Foundation of Zhejiang Province(LR21H280001)Science and Technology Projects of Zhejiang Province(2019C03049)Program of Zhejiang Provincial TCM Sci-tech Plan(2018ZY006 and 2020ZZ005)。
文摘Gastric cancer is a predominant threat to the health and well-being of China's residents. Data from the World Health Organization(WHO) in 2020 revealed that gastric cancer in China notably accounted for 44.0% of new cases worldwide and 48.6% of global deaths attributed to this malignancy~1.
基金supported by The National Key Research and Development Program of China (Grant No. 2021YFA0910100)Healthy Zhejiang One Million People Cohort (Grant No. K-20230085)+7 种基金Post-doctoral Innovative Talent Support Program (Grant No. BX2023375)Zhejiang Provincial Research Center for Upper Gastrointestinal Tract Cancer (Grant No. JBZX-202006)Medical Science and Technology Project of Zhejiang Province (Grant No. WKJ-ZJ-2202 and WKJ-ZJ-2104)National Natural Science Foundation of China (Grant Nos. 82304946, 82074245, 81973634, and 81903842)Natural Science Foundation of Zhejiang Province (Grant No. LR21H280001)Science and Technology Projects of Zhejiang Province (Grant No. 2019C03049)Program of Zhejiang Provincial TCM Scitech Plan (Grant Nos. 2018ZY006, 2020ZZ005)China Postdoctoral Science Foundation (Grant No. 2023M733563)
文摘Gastric cancer(GC)ranks fifth in cancer incidence and fourth in cancer-related mortality worldwide.Reactive oxygen species(ROS)are highly oxidative oxygen-derived products that have crucial roles in cell signaling regulation and maintaining internal balance.ROS are closely associated with the occurrence,development,and treatment of GC.This review summarizes recent findings on the sources of ROS and the bidirectional regulatory effects on GC and discusses various treatment modalities for GC that are related to ROS induction.In addition,the regulation of ROS by natural small molecule compounds with the highest potential for development and applications in anti-GC research is summarized.The aim of the review is to accelerate the clinical application of modulating ROS levels as a therapeutic strategy for GC.
基金Supported by Medical Science and Technology Project of Zhejiang Province(2022KY085).
文摘BACKGROUND Gastric cancer(GC)is the fifth most common and the fourth most lethal malignant tumour in the world.Most patients are already in the advanced stage when they are diagnosed,which also leads to poor overall survival.The effect of posto-perative adjuvant chemotherapy for advanced GC is unsatisfactory with a high rate of distant metastasis and local recurrence.AIM To investigate the safety and efficacy of a programmed cell death 1(PD-1)inhibitor combined with oxaliplatin and S-1(SOX)in the treatment of Borrmann large type III and IV GCs.METHODS A retrospective analysis(IRB-2022-371)was performed on 89 patients with Borrmann large type III and IV GCs who received neoadjuvant therapy(NAT)from January 2020 to December 2021.According to the different neoadjuvant treatment regimens,the patients were divided into the SOX group(61 patients)and the PD-1+SOX(P-SOX)group(28 patients).RESULTS The pathological response(tumor regression grade 0/1)in the P-SOX group was significantly higher than that in the SOX group(42.86%vs 18.03%,P=0.013).The incidence of ypN0 in the P-SOX group was higher than that in the SOX group(39.29%vs 19.67%,P=0.05).The use of PD-1 inhibitors was an independent factor affecting tumor regression grade.Meanwhile,the use of PD-1 did not increase postoperative complications or the adverse effects of NAT.CONCLUSION A PD-1 inhibitor combined with SOX could significantly improve the rate of tumour regression during NAT for patients with Borrmann large type III and IV GCs.
基金Supported by the National Natural Science Foundation of China,No.82473195Natural Science Foundation of Zhejiang Province,No.LTGY23H160018+2 种基金Zhejiang Medical and Health Science and Technology Program,No.2024KY789Beijing Science and Technology Innovation Medical Development Foundation,No.KC2023-JX-0270-07National Natural Science Foundation of China,No.32370797.
文摘BACKGROUND Gastric cancer(GC)is a highly prevalent gastrointestinal tract tumor.Several trials have demonstrated that the location of GC can affect patient prognosis.However,the factors determining tumor location remain unclear.AIM To investigate the tumor location of patients,we went on to study the influencing factors that lead to changes in the location of GC.METHODS A retrospective evaluation was carried out on 3287 patients who underwent gastrectomy for GC in Zhejiang Cancer Hospital.The patients were followed up post-diagnosis and post-gastrectomy.The clinicopathological variables and overall survival of the patients were recorded.By analyzing the location of GC,the tumor location was divided into four categories:“Upper”,“middle”,“lower”,and“total”.Statistical software was utilized to analyze the relationship of each variable with the location of GC.RESULTS A total of 3287 patients were included in this study.The clinicopathological indices of gender,age,serum levels of carcinoembryonic antigen(CEA),carbohydrate antigen(CA19-9)and CA72-4 levels,were significantly associated with tumor location in patients with GC.In addition,there was a strong correlation between GC location and the prognosis of postoperative patients.Specifically,patients with“lower”and“middle”GC demonstrated a better prognosis than those with tumors in other categories.CONCLUSION The five clinicopathological indices of gender,age,CEA,CA19-9 and CA72-4 levels exhibit varying degrees of influence on the tumor location.The tumor location correlates with patient prognosis following surgery.
基金Supported by Traditional Chinese Medicine Foundation of Zhejiang Province,No.2019ZA020。
文摘BACKGROUND Tankyrase 2(TNKS2)is a potential candidate molecular target for the prognosis and treatment of non-small cell lung cancer(NSCLC),but its biological functions are unclear.AIM To investigate the biological functions of TNKS2 in NSCLC.METHODS Using a lentiviral vector,we generated H647 model cells with TNKS2 knockdown by RNA interference and A549 model cells with TNKS2 overexpression by tran-sfection with a TNKS2 overexpressing plasmid.Increased and decreased exp-ression levels of TNKS2 in the two cell lines were verified using real-time reverse transcriptase-polymerase chain reaction and Western blot analyses.Cell apopto-sis,proliferation,and migration were determined using flow cytometry,carbo-xyfluorescein succinimidyl ester staining,and scratch assay,respectively.Im-munofluorescence staining was conducted to examine TNKS2 andβ-catenin ex-pression levels in the two transfected cell lines and the non-transfected cells.RESULTS TNKS2 mRNA and protein expression was significantly higher in the highly malignant NCI-H647 cells,while it remained at a low level in the less malignant A549 cells.Lentivirus-mediated overexpression of TNKS2 in A549 cells resulted in a 3-fold increase in gene expression and a 1.7-fold increase in protein expression(P<0.01).Conversely,shRNA interference targeting TNKS2 Led to an 8-fold decrease in gene expression and a 3-fold decrease in protein expression(P<0.01)in NCI-H647 cells.Furthermore,the cell apoptosis rate was significantly reduced(50%)and cell migration rate was increased(35%)in the TNKS2 overexpression group than in the control group(P<0.05).In contrast,shTNKS2 promoted apoptosis by more than one fold and reduced migration by 60%(P<0.05).Immunofluorescence analysis revealed enhanced nuclear localization ofβ-catenin fluorescence signal associated with high TNKS2 expression levels.Western blot analysis investigating TNKS2/β-catenin-related proteins indicated consistent changes between TNKS2 andβ-catenin expression in lung cancer cells,whereas Axin displayed an opposite trend(P<0.05).CONCLUSION The obtained results revealed that TNKS2 may serve as an adverse prognostic factor and a potential therapeutic target in NSCLC.
文摘BACKGROUND This study investigated the construction and clinical validation of a predictive model for neuroaggression in patients with gastric cancer.Gastric cancer is one of the most common malignant tumors in the world,and neuroinvasion is the key factor affecting the prognosis of patients.However,there is a lack of systematic analysis on the construction and clinical application of its prediction model.This study adopted a single-center retrospective study method,collected a large amo-unt of clinical data,and applied statistics and machine learning technology to build and verify an effective prediction model for neuroaggression,with a view to providing scientific basis for clinical treatment decisions and improving the tr-eatment effect and survival rate of patients with gastric cancer.AIM To investigate the value of a model based on clinical data,spectral computed to-mography(CT)parameters and image omics characteristics for the preoperative prediction of nerve invasion in patients with gastric cancer.METHODS A retrospective analysis was performed on 80 gastric cancer patients who under-went preoperative energy spectrum CT at our hospital between January 2022 and August 2023,these patients were divided into a positive group and a negative group according to their pathological results.Clinicopathological data were collected,the energy spectrum parameters of primary gastric cancer lesions were measured,and single factor analysis was performed.A total of 214 image omics features were extracted from two-phase mixed energy images,and the features were screened by single factor analysis and a support vector machine.The variables with statist-ically significant differences were included in logistic regression analysis to construct a prediction model,and the performance of the model was evaluated using the subject working characteristic curve.There were statistically significant differences in sex,carbohydrate antigen 199 expression,tumor thickness,Lauren classification and Borrmann classification between the two groups(all P<0.05).Among the energy spectrum parameters,there were statistically significant differences in the single energy values(CT60-CT110 keV)at the arterial stage between the two groups(all P<0.05)and statistically significant differences in CT values,iodide group values,standardized iodide group values and single energy values except CT80 keV at the portal vein stage between the two groups(all P<0.05).The support vector machine model with the largest area under the curve was selected by image omics analysis,and its area under the curve,sensitivity,specificity,accuracy,P value and pa-rameters were 0.843,0.923,0.714,0.925,<0.001,and c:g 2.64:10.56,respectively.Finally,based on the logistic regression algorithm,a clinical model,an energy spectrum CT model,an imaging model,a clinical+energy spe-ctrum model,a clinical+imaging model,an energy spectrum+imaging model,and a clinical+energy spectrum+imaging model were established,among which the clinical+energy spectrum+imaging model had the best efficacy in diagnosing gastric cancer nerve invasion.The area under the curve,optimal threshold,Youden index,sensitivity and specificity were 0.927(95%CI:0.850-1.000),0.879,0.778,0.778,and 1.000,respectively.CONCLUSION The combined model based on clinical features,spectral CT parameters and imaging data has good value for the preoperative prediction of gastric cancer neuroinvasion.
文摘BACKGROUND Pancreatic cancer is a highly malignant tumor with a rapid progression rate and a high susceptibility to infiltration and metastasis.Astragalus polysaccharide(APS),a pure Chinese medicine preparation primarily made from the traditional Chinese herb Astragalus,plays a positive role in the treatment of many malignant tumors.AIM To explore the recent efficacy of APS combined with gemcitabine plus tegafur gimeracil oteracil potassium capsule(S-1)(GS)regimen in the treatment of pancreatic cancer and assess its effect on the immune function and long-term survival of patients.METHODS A total of 97 patients who were diagnosed with pancreatic cancer and received GS chemotherapy at The First Affiliated Hospital of Zhejiang Chinese Medical University(Zhejiang Provincial Hospital of Chinese Medicine)from March 2021 to December 2021 were included in the retrospective analysis.Among them,41 patients received APS combined with GS chemotherapy,and 56 patients received GS chemotherapy only.The recent efficacy,immune function,adverse reactions,and long-term survival were compared among these patients.RESULTS After 4 cycles of treatment,the objective response rate of patients receiving the combined therapy of APS and GS was 51.22%,and the disease control rate(DCR)was 56.10%,higher than those of patients receiving the monotherapy with GS alone(30.36%and 35.71%,respectively).Besides,the percentages of CD3+T cells(50.18%±9.57%)and CD4+T cells(31.52%±5.33%)in the peripheral blood of patients receiving the combined therapy of APS and GS were higher compared with those treated with GS regimen alone[(44.06%±8.55%)and(26.01%±7.83%),respectively].Additionally,the incidences of leukopenia,thrombocytopenia,and fatigue in patients receiving the combined therapy of APS and GS were significantly lower than those in patients receiving the monotherapy of GS alone(17.07%,9.76%,31.71%vs 37.50%,28.57%,60.71%).Moreover,the median survival time of patients receiving the combined therapy of APS and GS was 394 days,significantly longer than that of patients receiving the mono-therapy of GS alone(339 days)(hazard ratio:0.66;95%CI:0.45-0.99;P=0.036).All these differences were statistically si-gnificant(P<0.05).CONCLUSION The combined therapy of APS and GS improved the recent efficacy and long-term survival of patients with pancreatic cancer and alleviated chemotherapy-induced immune suppression and adverse reactions.
基金funded by F. Hoffmann-La Roche Ltd. F. Hoffmann-La Roche Ltd sponsored the IMpower210 study。
文摘Objective: IMpower210(NCT02813785) explored the efficacy and safety of single-agent atezolizumab vs.docetaxel as second-line treatment for advanced non-small cell lung cancer(NSCLC) in East Asian patients.Methods: Key eligibility criteria for this phase Ⅲ, open-label, randomized study included age ≥18 years;histologically documented advanced NSCLC per the Union for International Cancer Control/American Joint Committee on Cancer staging system(7th edition);Eastern Cooperative Oncology Group performance status of 0 or 1;and disease progression following platinum-based chemotherapy for advanced or metastatic NSCLC. Patients were randomized 2:1 to receive either atezolizumab(1,200 mg) or docetaxel(75 mg/m^(2)). The primary study endpoint was overall survival(OS) in the intention-to-treat(ITT) population with wild-type epidermal growth factor receptor expression(ITT EGFR-WT) and in the overall ITT population.Results: Median OS in the ITT EGFR-WT population(n=467) was 12.3 [95% confidence interval(95% CI),10.3-13.8] months in the atezolizumab arm(n=312) and 9.9(95% CI, 7.8-13.9) months in the docetaxel arm[n=155;stratified hazard ratio(HR), 0.82;95% CI, 0.66-1.03]. Median OS in the overall ITT population was 12.5(95% CI, 10.8-13.8) months with atezolizumab treatment and 11.1(95% CI, 8.4-14.2) months(n=377) with docetaxel treatment(n=188;stratified HR, 0.87;95% CI, 0.71-1.08). Grade 3/4 treatment-related adverse events(TRAEs) occurred in 18.4% of patients in the atezolizumab arm and 50.0% of patients in the docetaxel arm.Conclusions: IMpower210 did not meet its primary efficacy endpoint of OS in the ITT EGFR-WT or overall ITT populations. Atezolizumab was comparatively more tolerable than docetaxel, with a lower incidence of grade3/4 TRAEs.
基金supported by grants from Sanming Project of Medicine in Shenzhen(No.SZSM202211030)the Science and Technology Department Basic Research Project of Shanxi(No.202203021221284)。
文摘Objective:Several studies have been conducted on the effects and toxicity of adding oxaliplatin to fluorouracilbased or capecitabine-based chemoradiotherapy(CRT)regimens as significantly increasing the toxic response without benefit to survival.In this study,we further explored the role of these two postoperative CRT regimens in patients with pathological stage N2 rectal cancer.Methods:This study was a subgroup analysis of a randomized clinical trial.A total of 180 patients with pathological stage N2 rectal cancer were eligible,85 received capecitabine with radiotherapy(RT),and 95 received capecitabine and oxaliplatin with RT.Patients in both groups received adjuvant chemotherapy[capecitabine and oxaliplatin(XELOX);or fluorouracil,leucovorin,and oxaliplatin(FOLFOX)]after CRT.Results:At a median follow-up of 59.2[interquartile range(IQR),34.0−96.8]months,the three-year diseasefree survival(DFS)was 53.3%and 64.9%in the control group and the experimental group,respectively[hazard ratio(HR),0.63;95%confidence interval(95%CI),0.41−0.98;P=0.04].There was no significant difference between the groups in overall survival(OS)(HR,0.62;95%CI,0.37−1.05;P=0.07),the incidence of locoregional recurrence(HR,0.62;95%CI,0.24−1.64;P=0.33),the incidence of distant metastasis(HR,0.67;95%CI,0.42−1.06;P=0.09)and grade 3−4 acute toxicities(P=0.78).For patients with survival longer than 3 years,the conditional overall survival(COS)was significantly better in the experimental group(HR,0.39;95%CI,0.16−0.96;P=0.03).Conclusions:Our results indicated that adding oxaliplatin to capecitabine-based postoperative CRT is safe and effective in patients with pathological stage N2 rectal cancer.
基金supported by the National KeyResearch and Development Program(No.2022YFC2009600 andNo.2022YFC2009601).
文摘Background:The purpose of this study is to evaluate the quality of life(QoL)of hospitalized patients in China suffering from digestive system malignancies and to identify potential risk factors for a decrease in QoL.Methods:The European Organization for Research and Treatment Core Quality of Life questionnaire(EORTC QLQ-C30)was applied to evaluate the QoL of 23,519 patients with six digestive malignancies(esophageal cancer,gastric cancer,colorectal cancer,liver cancer,biliary tract cancer,and pancreatic cancer).A t test or analysis of variance was employed to analyze the total EORTC QLQ-C30 scale scores and domain scores of the EORTC QLQ-C30 scale among patients in different subgroups.Results:The average QoL score was 50.4±10.8.The tumor type,age,sex,and TNM stage all had an impact on QoL ratings.Colorectal cancer patients had a better total QoL score(49.3±10.3)and scores in the domains of functioning,withmilder symptoms,except for diarrhea.Patients with biliary tract cancer(54.2±12.3)and pancreatic cancer(54.2±12.3)reported a poorer QoL,significant functional impairment,and more pronounced symptoms.Patients with esophageal cancer experienced the most severe financial difficulties(35.2±27.5).Patients aged≥65 years,women,and those with TNM stage III/IV reported lower QoL.In addition,the disparities in total QoL scores and scores in specific domains were significant among patients with some types of tumors,and based on ethnicity,educational level,occupation,treatment(s)received,and place of residence.Conclusions:There is a need to focus on elderly individuals,those with low educational levels,and patients with progressivemalignant tumors and to improve routine disease monitoring and symptom management to enhance the quality of life for patients with malignancies of the digestive system.
基金supported by the grants from the Beijing Hope Run Special Fund(#LC2012YF44)National Natural Science Foundation of China(No.81402740)+1 种基金Specialized Research Fund for the Doctoral Program of Higher Education(No.20131106120014)The National Health and Family Planning Committee of P.R.China
文摘Background: The increasing prevalence of colorectal cancer(CRC) in China and the paucity of information about relevant expenditure highlight the necessity of better understanding the financial burden and effect of CRC diagnosis and treatment. We performed a survey to quantify the direct medical and non-medical expenditure as well as the resulting financial burden of CRC patients in China.Methods: We conducted a multicenter, cross-sectional survey in 37 tertiary hospitals in 13 provinces across China between 2012 and 2014. Each enrolled patient was interviewed using a structured questionnaire. All expenditure data were inflated to the 2014 Chinese Yuan(CNY; 1 CNY = 0.163 USD). We quantified the overall expenditure and financial burden and by subgroup(hospital type, age at diagnosis, sex, education, occupation, insurance type, household income, clinical stage, pathologic type, and therapeutic regimen). We then performed generalized linear modeling to determine the factors associated with overall expenditure.Results: A total of 2356 patients with a mean age of 57.4 years were included, 57.1 % of whom were men; 13.9% of patients had stage I cancer; and the average previous-year household income was 54,525 CNY.The overall average direct expenditure per patient was estimated to be 67,408 CNY, and the expenditures for stage Ⅰ, Ⅱ, Ⅲ, and Ⅳ disease were 56,099 CNY, 59,952 CNY, 67,292 CNY, and 82,729 CNY, respectively. Non-medical expenditure accounted for 8.3%of the overall expenditure. The 1-year out-of-pocket expenditure of a newly diagnosed patient was 32,649 CNY, which accounted for 59.9% of their previous-year household income and caused 75.0% of families to suffer an unmanageable financial burden. Univariate analysis showed that financial burden and overall expenditure differed in almost all subgroups(P < 0.05), except for sex. Multivariate analysis showed that patients who were treated in specialized hospitals and those who were diagnosed with adenocarcinoma or diagnosed at a later stage were likely to spend more,whereas those with a lower household income and those who underwent surgery spent less(all P < 0.05).Conclusions: For patients in China, direct expenditure for the diagnosis and treatment of CRC seemed catastrophic,and non-medical expenditure was non-ignorable. The financial burden varied among subgroups, especially among patients with different clinical stages of disease, which suggests that, in China, CRC screening might be cost-effective.
基金supported by the Natural Science Foundation of Zhejiang Province(HDMY22H160008)the Medical Science and Technology Project of Zhejiang Province(2022KY114)the National Natural Science Foundation of China(82204828).
文摘Aim:Scavenger receptor class B,type I(SR-BI)is an integral plasma membrane protein that has been reported to be overexpressed in various malignancies,such as renal cancer,breast cancer,and prostate cancer,and is an independent prognostic factor.However,the clinical value and expression of SR-BI in GC are unknown.Our research aimed to explore the role of SR-BI in combination with immune markers as a diagnostic and prognostic marker for gastric cancer(GC).Methods:GC tissues,paracancerous tissues,and clinicopathological data of 149 patients were collected.The expression level of SR-BI,Tumor-infiltrating lymphocytes(TILs),and PD-L1 were evaluated by immunohistochemistry(IHC).The associations of the SR-BI staining intensity with clinicopathological features and immune markers were determined by the chi-square test.Univariate and multivariate COX regression analyses were used to evaluate independent prognostic factors.Kaplan–Meier analyses were performed to plot the survival curve.Results:Our results indicated that SR-BI was expressed at higher levels in tumor tissues than in adjacent paracancerous tissues(p<0.001),and patients with high levels of SR-BI expression had a worse prognosis.Univariate and multivariate analyses revealed that high SR-BI expression was an independent factor for poor prognosis.The chi-square test determined that the expression of SR-BI was negatively correlated with CD4+T cells and CD8+T cells(CD4+T cells,p=0.013;CD8+T cells,p=0.021),and positively correlated with PD-L1(p=0.022).Finally,survival analysis revealed that CD4+T cells were associated with the prognosis of GC patients(p=0.019),and the combined survival analysis of SR-BI and CD4+T cells was also statistically significant(p=0.030).Conclusion:SR-BI is highly expressed in GC tissue and associated with poor prognosis.Moreover,SR-BI can also regulate the GC tumor immune microenvironment.
基金This research was supported by“Zhejiang Province Chinese Medicine Science and Technology Program Key Projects”(No.2021ZZ008).
文摘Beishashen(BSS)and Maidong(MD)are commonly used Medicine right for the treatment of non-small cell lung cancer(NSCLC),but their specific mechanism of action is not clear.In this study,network pharmacology and molecular docking techniques were used to investigate the molecular mechanisms of the therapeutic effects of BSS-MD on NSCLC and to experimentally validate some of the targets.The network pharmacology approach,including active ingredient and target screening,drug-compound-target network construction,protein-protein interaction(PPI)network,enrichment analysis,and molecular docking,was used to investigate the mechanism of action of Beisashen and Maitong on NSCLC.First,the active components of BSS-MD and their targets were predicted,of which 423 targets interacted with NSCLC targets.Then,network pharmacology showed that Stigmasterol,Quercetin,Alloisoimperatorin,Isoimperatorin,Beta-sitosterol were the core components of BSS-MD,and PLK1,HSP90AB1,and CDK1 were the key therapeutic targets.KEGG enrichment analysis indicated that the mechanism of action of BSS-MD in NSCLC treatment was related to the cell cycle.Then we further performed experimental validation.CCK-8 assay showed that BSS-MD inhibited LEWIS cell viability and promoted apoptosis in a dose-dependent manner.qPCR assay,immunofluorescence,and protein blotting experiments demonstrated that compared with the control group and the control group,the expression of PLK1,HSP90AB1,and CDK1 mRNAs and proteins were reduced in the treatment group(P<0.01).Therefore,we conclude that BSS-MD can block cell cycle progression by inhibiting the expression of PLK1,CDK1,and HSP90AB1 mRNAs and proteins to inhibit lung cancer cell growth and promote apoptosis,and emphasize that BSS-MD are promising adjuvants for NSCLC treatment.
文摘Background Since the middle of the 19th century,German pathologist Rudolf Virchow proposed that tumors originate from chronic inflammation[1].At present,the medical community has determined that inflammation is closely related to the occurrence,development and efficacy of anti-cancer treatment[2].Recently,an“anti-inflammatory diet”that claims to have functions such as cancer prevention has attracted much attention.To unveil the magic of the“anti-inflammatory diet”,let’s start with the concept of inflammation,which is the core of the“anti-inflammatory diet”.
文摘tract,ranking second among the causes of cancer deaths worldwide,and nearly one million people die of CRC every year,which is a serious threat to human health[1].With the development of the economy and the improvement of living conditions,people's dietary structure is also quietly changing,and factors such as population aging,obesity,smoking,etc.all increase the risk of CRC[2],CRC morbidity and mortality under the influence of these conditions are showing a rising trend,and gradually younger[3].According to statistics,the incidence of CRC in men is second only to lung cancer and stomach cancer,while in women it is third only to breast cancer and cervical cancer[4–6].At present,there is still no special treatment plan for CRC,and surgery,radiotherapy,chemotherapy,and targeted therapy have long been used as the main treatment modalities.However,patients with malignant tumors often suffer from a variety of underlying diseases,low immunity or even malignant disease,and long-term radiotherapy will kill tumor cells while damaging normal cells,which is therefore difficult for patients to tolerate,and the quality of life of end-stage CRC patients is even more difficult.Therefore,it is often difficult for patients to tolerate it,and the quality of life of end-stage CRC patients is even more difficult to be guaranteed[7].
基金supported by Zhejiang Provincial Science and Technology Program of Traditional Chinese Medicine(No.2023ZR095)China Postdoctoral Science Foundation(No.2021M702928)+1 种基金Young Elite Scientists Sponsorship Program by CACM(No.2021-QNRC2-B13)National College Students Innovation and Entrepreneurship Training Program(No.202210344008).
文摘Objective:Colorectal cancer(CRC)is one of the most common malignancies in the world,and traditional Chinese medicine(TCM)is widely used in its treatment in China.However,the medication rules of TCM for CRC treatment remain unclear.Therefore,data mining combined with network pharmacology was utilized to establish treatment principles and rules.Methods:The CRC cases treated at Zhejiang Provincial Hospital of Chinese Medicine from January 1,2016 to October 31,2021 were analyzed using data mining methods.UPLC-Q/TOF-MS analysis was performed to identify the chemical composition of Jiedu Sangen decoction(JSD).Network pharmacology was used to reveal the therapeutic mechanism of JSD.Results:A total of 312 cases 2,998 prescriptions that met the inclusion criteria used 343 kinds of traditional Chinese medicines.The nature of the herbs used in treatment was mainly warm and mild.The taste was mainly sweet,bitter,and pungent.The meridian tropisms were mainly the spleen meridian,followed by lung and stomach meridians.Tonifying and replenishing herbs were the most frequently used in treatment.High-frequency herbs were classified into 11 categories by cluster analysis,and 42 association rules were obtained by association rule analysis.Combined with complex network analysis,3 core prescriptions for clinical CRC treatment were obtained.Jiedu Sangen decoction contains 64 chemical ingredients,out of which 31 active ingredients were identified,including polydatin,caffeic acid,and glutamic acid,along with 130 potential targets such as AKT1,SRC,and MAPK1.Jiedu Sangen decoction may play a role in regulating inflammation,immunity,metabolism,and hormones in the development of CRC via pathways such as the relaxin signaling pathway,IL-17 signaling pathway,prolactin signaling pathway,and T cell receptor signaling pathway.Conclusions:This study summarizes the treatment and medication principles for clinical CRC treatment,promoting the inheritance and development of the traditional Chinese medical experience.
基金Supported by The Research Project 2022 of The People's Hospital of Jianyang City,No.JY202208.
文摘BACKGROUND The exercise of limb function is the most economical and safe method to promote the maturation of arteriovenous fistula(AVF).However,due to the lack of a uni-fied exercise standard in China,many patients have insufficient awareness of the importance of AVF,leading to poor effectiveness of limb function exercise.The self-management education model can effectively promote patients to take pro-active health-related actions.This study focuses on the characteristics of patients during the peri-AVF period and conducts a phased limb function exercise under the guidance of the self-management education model to observe changes in fac-tors such as the maturity of AVF.AIM To assess the impact of stage-specific limb function exercises,directed by a self-management education model,on the maturation status of AVFs.METHODS This study is a randomized controlled trial involving 74 patients with forearm AVFs from the Nephrology Department of a tertiary hospital in Sichuan Province,China.Patients were randomly divided into an observation group and a control group using a random number table method.The observation group underwent tailored stage-specific limb func-tion exercises,informed by a self-management education model which took into account the unique features of AVF at various stages,in conjunction with routine care.Conversely,the control group was given standard limb function exercises along with routine care.The assessment involves the maturity of AVFs post-intervention,post-operative complications,and the self-management level of the fistula in both groups patients.Analyses were conducted using SPSS version 23.0.Count data were represented by frequency and percentage and subjected to chi-square test comparisons.Measurement data adhering to a normal distribution were presented as mean±SD.The independent samples t-test was utilized for inter-group comparisons,while the paired t-test was used for intra-group comparisons.For measurement data not fitting a normal distribution,the median and interquartile range were presented and analyzed using the Wilcoxon rank sum test.RESULTS At the 8-wk postoperative mark,the observation group demonstrated significantly higher scores in AVF symptom recognition,symptom prevention,and self-management compared to the control group(P<0.05).However,the variance in symptom management scores between the observation and control groups lacked statistical signi-ficance(P>0.05).At 4 wk after the operation,the observation group displayed a superior vessel diameter and depth from the skin of the drainage vessels in comparison to the control group(P<0.05).While the observation group did manifest elevated blood flow rates in the drainage vessels relative to the control group,this distinction was not statistically significant(P>0.05).By the 8-wk postoperative interval,the observation group outperformed the control group with notable enhancements in blood flow rates,vessel diameter,and depth from the skin of drainage vessels(P<0.01).Seven days following the procedure,the observation group manifested significantly diminished limb swelling and an overall reduced complication rate in contrast to the control group(P<0.05).The evaluation of infection,thrombosis,embolism,arterial aneurysm stenosis,and incision bleeding showed no notable differences between the two groups(P>0.05).By the 4-wk postoperative juncture,complications between the observation and control groups were statistically indistinguishable(P>0.05).CONCLUSION Stage-specific limb function exercises,under the guidance of a self-management education model,amplify the capacity of AVF patients to discern and prevent symptoms.Additionally,they expedite AVF maturation and miti-gate postoperative limb edema,underscoring their efficacy as a valuable method for the care and upkeep of AVF in hemodialysis patients.
基金Supported by Hangzhou Health Science and Technology Program,No.A20210271.
文摘BACKGROUND Aggressive fibromatosis(AF),also known as desmoid tumor or desmoid-type fibromatosis,is a rare soft tissue neoplasm that can occur in almost any part of the body.Although it is a benign disease,AF is aggressive and infiltrative and has a high recurrence rate after surgery.Common sites for intra-abdominal AF are the small bowel mesentery,retroperitoneum,and pelvis.AF in the colon is extremely rare.CASE SUMMARY Here,we report the first case of sigmoid colon AF,which was accidentally discovered in a 27-year-old woman during laparoscopic myomectomy.Computed tomography confirmed a slightly enhanced mass in the sigmoid colon.Subsequent colonoscopy did not reveal a mass in the colonic lumen,but a suspected external compress was found in the sigmoid colon.Surgical disease involving a gastrointestinal stromal tumor was suspected.The patient underwent laparoscopic exploration,and sigmoidectomy with a negative margin was performed to excise the mass.Postoperative immunohistochemistry revealed that the mass was an AF.The patient recovered well and was recurrence-free at the 30-month follow-up without adjuvant therapy.CONCLUSION AF should be considered in the differential diagnosis of subepithelial colon masses.Radical resection alone can achieve good outcomes.
基金supported by the National Natural Science Foundation of China(Grant No.82272744)Natural Science Foundation of Guangdong Province(Grant No.2022A1515010814)Sun Yat-sen University Clinical Research 5010 Program(Grant No.2022008).
文摘Objective:Glioblastomas are highly vascularized malignant tumors.We determined the efficacy and safety of the anti-angiogenic multi-kinase inhibitor,anlotinib,for a newly diagnosed glioblastoma.Methods:This multicenter,single-arm trial(NCT04119674)enrolled 33 treatment-naïve patients with histologically proven glioblastomas between March 2019 and November 2020.Patients underwent treatment with the standard STUPP regimen[fractionated focal irradiation in daily fractions of 1.8-2 Gy given 5 d/w×6 w(total=54-60 Gy)]or radiotherapy plus continuous daily temozolomide(TMZ)(75 mg/m^(2)of body surface area/d,7 d/w from the first to the last day of radiotherapy),followed by 6 cycles of adjuvant TMZ(150-200 mg/m^(2)×5 d during each 28-d cycle)plus anlotinib(8 mg/d on d 1-14 of each 3-w cycle for 2 cycles during concomitant chemoradiotherapy,8 maximal cycles as adjuvant therapy,followed by maintenance at 8 mg/d.The primary endpoint was progression-free survival(PFS).Secondary endpoints included overall survival(OS)and adverse events(AEs).Results:Thirty-three patients received the planned treatment.The median PFS was 10.9 months(95%CI,9.9-18.7 months)and the 12-month PFS rate was 48.5%.The median OS was 17.4 months(95%CI,14.5-21.1 months)and the 12-month OS rate was 81.8%.The most common AEs included hypertriglyceridemia[58%(n=19)],hypoalbuminemia[46%(n=15)],and hypercholesterolemia[46%(n=15)]during concurrent chemoradiotherapy and leukopenia[73%(n=24)],hypertriglyceridemia[67%(n=22)],and neutropenia[52%(n=17)]during adjuvant therapy.Five patients discontinued treatment due to AEs.HEG1(HR,5.6;95%CI,1.3-23.7;P=0.021)and RP1L1 alterations(HR,11.1;95%CI,2.2-57.2;P=0.004)were associated with a significantly shorter PFS.Conclusions:Anlotinib plus the STUPP regimen has promising anti-tumor activity against glioblastoma and manageable toxicity.HEG1 and RP1L1 alterations might be novel predictive biomarkers of the response to anlotinib.
基金Supported by the Zhejiang Provincial Natural Science Foundation of China,No.LQ20H260002.
文摘BACKGROUND Prophylactic loop ileostomy is an effective way to reduce the clinical severity of anastomotic leakage following radical resection of rectal cancer.Incisional surgical site infection(SSI)is a common complication after ileostomy closure.AIM To evaluate the efficacy and safety of the micro-power negative pressure wound technique(MPNPWT)in preventing incisional SSI.METHODS This was a prospective,randomized controlled clinical trial conducted at a single center.A total of 101 consecutive patients who underwent ileostomy closure after rectal cancer surgery with a prophylactic ileostomy were enrolled from January 2019 to December 2021.Patients were randomly allocated into an MPNPWT group and a control group.The MPNPWT group underwent intermittent suturing of the surgical incision with 2-0 Prolene and was covered with a micro-power negative pressure dressing.The surgical outcomes were compared between the MPNPWT(n=50)and control(n=51)groups.Risk factors for incisional SSI were identified using logistic regression.RESULTS There were no differences in baseline characteristics between the MPNPWT(n=50)and control groups(n=51).The incisional SSI rate was significantly higher in the control group than in the MPNPWT group(15.7%vs 2.0%,P=0.031).However,MPNPWT did not affect other surgical outcomes,including intra-abdominal complications,operative time,and blood loss.Postoperative hospital stay length and hospitalization costs did not differ significantly between the two groups(P=0.069 and 0.843,respectively).None of the patients experienced adverse effects of MPNPWT,including skin allergy,dermatitis,and pain.MPNPWT also helped heal the infected incision.Our study indicated that MPNPWT was an independent protective factor[odds ratio(OR)=0.005,P=0.025)]and diabetes was a risk factor(OR=26.575,P=0.029)for incisional SSI.CONCLUSION MPNPWT is an effective and safe way to prevent incisional SSI after loop ileostomy closure.
