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08 August 2020, Volume 47 Issue 8 Previous Issue    Next Issue

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Healthy People, Healthy Society

Diagnosis and surgical treatment of differentiated thyroid carcinoma in 40 years Hou Xiaofeng, Xue Jincai, Tian Youxin, Liu Qinjiang 2020, 47 (8):  449-456.  doi: 10.3760/cma.j.cn371439-20200623-00056 Abstract ( 516 )   HTML ( 29 )   PDF (719KB) ( 230 )   Save Differentiated thyroid cancer (DTC) is the most common type of thyroid cancer. Most of patients with DTC are characterized by low invasiveness and good prognosis. With the development of medical imaging, fine needle biopsy and molecular biology technology, especially the progress of surgical technology, the early diagnosis rate of DTC and the survival rate after operation are significantly increased. However, the cognition understanding of DTC and some views of surgical treatment are still controversial. A systematic review and summary of the diagnosis and surgical treatment of DTC are made based on the changes in the past 40 years, especially the treatment strategy, surgical resection scope and indications of DTC primary focus and cervical lymph node metastasis, in order to propose a more reasonable and accurate individual diagnosis and treatment plan for patients with DTC. References | Related Articles | Metrics

Original Articles

A dosimetric comparison of volumetric modulated arc therapy with intensity modulated radiation therapy for head and neck cancer Qian Wenchuan, Wang Fan 2020, 47 (8):  457-461.  doi: 10.3760/cma.j.cn371439-20200224-00057 Abstract ( 805 )   HTML ( 17 )   PDF (599KB) ( 258 )   Save Objective To compare the dosimetric differences between volumetric modulated arc therapy (VMAT) and intensity modulated radiation therapy (IMRT) for head and neck cancer. Methods From January 2019 to December 2019, 46 cases of patients with head and neck cancer confirmed by pathology in the First Affiliated Hospital of Anhui Medical University were selected. All patients underwent CT-simulation in supine position. Planning target volumes (PTVs) were delineated for two dose levels of PTV70 and PTV54 in 35 equal fraction. Simultaneous integrated boost plan was generated for all patients and optimized with both techniques, VMAT and IMRT with similar planning objectives. The dosimetry differences between the two plans were compared. Results The conformity index (CI)95% of PTV70 in VMAT plan was higher than that in IMRT plan (0.91±0.02 vs. 0.86±0.06), and the difference was statistically significant (t=4.933, P=0.004). The homogeneity index (HI)95% of PTV54 in VMAT plan was superior to that in IMRT (0.09±0.04 vs. 0.26±0.02), and the difference was statistically significant (t=4.548, P=0.038). The spinal cord D1% of VMAT was lower than that in IMRT (37.62±4.34 vs. 40.93±7.45), and the difference was statistically significant (t=2.615, P=0.045). The dose of left parotid gland in VMAT was (21.28±8.13) Gy and the dose of right parotid gland was (22.39±7.42) Gy, which were slightly lower than those in IMRT [(22.73±11.42) Gy and (24.25±7.91) Gy], but the differences were not statistically significant (t=0.703, P=0.322; t=1.134, P=0.315). Compared with IMRT, VMAT could significantly reduce the number of monitor units (521±112 vs. 2 129±564), and could significantly shorten the treatment time of patients [(2.12±0.39) min vs. (9.18±2.62) min], and the differences were statistically significant (t=18.957, P<0.001; t=18.213, P<0.001). Conclusion The dose distribution of VMAT technology is better than IMRT, the dose of organ at risk is reduced, the monitor unit is lesser, and the treatment time is shorter. Figures and Tables | References | Related Articles | Metrics

Predictive value of TRAF6 expression in the efficacy of radiotherapy for esophageal cancer Zhu Guomin, Pan Wei, Zhang Yufeng, Chen Hui 2020, 47 (8):  462-466.  doi: 10.3760/cma.j.cn371439-20200227-00058 Abstract ( 367 )   HTML ( 17 )   PDF (681KB) ( 205 )   Save Objective To investigate the predictive value of tumor necrosis factor receptor-associated factor 6 (TRAF6) expression in the efficacy of radiotherapy for patients with esophageal squamous cell carcinoma (ESCC). Methods A total of 278 patients with ESCC received radical radiotherapy in Yixing Cancer Hospital of Jiangsu Province from February 2012 to March 2015 were included. The expression of TRAF6 in esophageal cancer tissue was detected by immunohistochemistry. The correlations between the expression of TRAF6 and clinicopathological features, short-term efficacy of radiotherapy and survival of ESCC patients were investigated. Results All the patients were divided into positive expression group (n=194) and negative expression group (n=84). TRAF6 expression was significantly associated with TNM stage and lymph node metastasis in ESCC patients (χ2=13.670, P<0.001; χ2=45.497, P<0.001). The total effective rate of radiotherapy in the TRAF6 positive expression group was 62.9% (122/194), which was significantly lower than that of TRAF6 negative expression group (92.9%, 78/84), and the difference was statistically significant (χ2=26.085, P<0.001). The median survival time of TRAF positive expression group was 51 months, while that of TRAF negative expression group was not reached, and the difference of survival curve between the two groups was statistically significant (χ2=7.952, P=0.005). Further analysis showed that higher TNM stage, lymph node metastasis and positive expression of TRAF6 increased the risk of death in ESCC patients (HR=1.96, 95%CI: 1.39-2.76; HR=1.72, 95%CI: 1.29-2.29; HR=2.31, 95%CI: 1.57-3.39). Conclusion Patients with TRAF6 positive expression of ESCC have low radiotherapy sensitivity. TRAF6 may be a new target for diagnosis and treatment of ESCC patients, which provides a new idea for the diagnosis, treatment and prognosis of ESCC. Figures and Tables | References | Related Articles | Metrics

Predictive values of preoperative LMR and PLR in early postoperative recurrence of patients with esophageal squamous cell carcinoma Wang Tingting, Liu Lianke 2020, 47 (8):  467-471.  doi: 10.3760/cma.j.cn371439-20190712-00059 Abstract ( 598 )   HTML ( 19 )   PDF (795KB) ( 278 )   Save Objective To explore the predictive values of preoperative peripheral blood lymphocyte-to-monocyte ratio (LMR) and platelet-to-lymphocyte ratio (PLR) in early postoperative recurrence of patients with esophageal squamous cell carcinoma. Methods A total of 83 patients with esophageal squamous cell carcinoma who underwent radical surgery in the First Affiliated Hospital of Nanjing Medical University from November 2015 to December 2018 were collected. Patients were divided into recurrent group (n=41) and control group (n=42) according to the recurrence within 1 year. The levels of LMR and PLR before operation were detected by automatic blood analyzer, and the differences of LMR and PLR between the two groups were compared. The values of LMR, PLR and the combination of LMR and PLR in predicting early postoperative recurrence of esophageal squamous cell carcinoma were analyzed by receiver operating characteristic (ROC) curve. Results Compared with the control group, the recurrence group had smaller LMR (3.91±1.73 vs. 5.08±2.15; t=2.710, P=0.008), larger PLR (142.81±67.80 vs. 114.03±42.47; t=2.324, P=0.023), larger tumor diameter [(4.28±1.61) cm vs.(3.19±1.30) cm; t=3.420, P=0.001], deeper infiltration (Z=2.633, P=0.008) and later clinical stage (Z=2.616, P=0.009), with statistically significant differences. The sensitivity and specificity of LMR in predicting recurrence of esophageal cancer after surgery were 69.0% and 58.5% respectively, with the area under the curve of 0.666 (95%CI: 0.551-0.782, P=0.009) and a critical value of 4.12. The sensitivity and specificity of PLR in predicting recurrence of esophageal cancer after surgery were 51.2% and 78.6% respectively, with the area under the curve of 0.642 (95%CI: 0.522-0.761, P=0.026) and a critical value of 130.85. The sensitivity and specificity of LMR combined with PLR were 68.3% and 61.9% respectively, and area under the curve of ROC was 0.675 (95%CI: 0.560-0.791, P=0.006). Patients with low LMR and high PLR had higher risk of recurrence rate [81.0%(17/21)] than those with high LMR and low PLR [35.1%(13/37)], and the difference was statistically significant (P=0.001). Conclusion Preoperative LMR and PLR are effective indicators for early postoperative recurrence in patients with esophageal squamous cell carcinoma, and the combination of LMR and PLR has a higher predictive value. Figures and Tables | References | Related Articles | Metrics

A prognostic risk assessment model for pancreatic cancer established based on immune-related lncRNAs Chen Xiaoxu, Yu Yang, Zhang Tianxue 2020, 47 (8):  472-479.  doi: 10.3760/cma.j.cn371439-20200113-00060 Abstract ( 617 )   HTML ( 29 )   PDF (6259KB) ( 325 )   Save Objective To identify and screen out immune-related long non-coding RNAs (lncRNAs) in pancreatic cancer, and construct a prognostic risk assessment model to predict the prognostic factors of patients with pancreatic cancer. Methods RNA-Seq data and corresponding clinicopathological and follow-up information of 177 pancreatic cancer patients were downloaded from The Cancer Genome Atlas (TCGA) database. The 177 pancreatic cancer samples were randomly divided into discovery cohort (n=89) and validation cohort (n=88) using random number table method. Immune-related lncRNAs were identified by Pearson correlation coefficient analysis. Univariate and multivariate Cox analysis were used to select prognosis-related lncRNAs and construct the risk score formula based on the data of discovery cohort. The conclusion generated from discovery cohort would be verified in the validation cohort. Results A total of 788 immune-related lncRNAs were screened out using Pearson correlation coefficient calculation formula, and 5 lncRNAs (AC006237.1, AC025154.2, RASSF8-AS1, AL122010.1 and AC073896.3) were selected by univariate and multivariate Cox analysis to build the risk score formula based on the discovery cohort. Based on the above risk score formula, pancreatic cancer patients from the discovery cohort were divided into high-risk group (n=44) and low-risk group (n=45). Survival analysis indicated that the median survival time of high-risk group (1.09 years) was significantly shorter than that of low-risk group (4.11 years; χ2=26.016, P<0.001). The validation cohort was also divided into high-risk group (n=44) and low-risk group (n=44) based on the above risk score formula. Survival analysis showed that the median survival time of high-risk group (1.28 years) was also significantly shorter than that of low-risk group (1.90 years; χ2=4.422, P=0.035). Besides, univariate and multivariate analyses suggested that the prognostic risk assessment model could effectively predict the prognosis of patients with pancreatic cancer, and could be used as an independent prognostic prediction model (HR=2.618, 95%CI: 1.285-5.332, P=0.008). The predictive efficiency of this model was better than that of common clinicopathological information such as age, gender and tumor histopathological grade [1-year area under curve (AUC)=0.687, 3-year AUC=0.725 and 5-year AUC=0.782]. The expression levels of AC025154.2, AC073896.3, AL122010.1 and RASSF8-AS1 were significantly different in various clinical characteristics of pancreatic cancer (all P<0.05), and might serve as potential new targets for diagnosis and treatment in pancreatic cancer. Interferon α, mammalian target of rapamycin complex 1 (mTORC1), MYC regulatory genes and transforming growth factor-β (TGF-β) signaling pathways were significantly activated, and myogenesis and pancreas β cells signaling pathways were significantly suppressed in the high-risk group, which may explain the underlying molecular mechanisms of the prognostic risk assessment model. Conclusion The prognostic risk assessment model based on 5 immune-related lncRNAs can effectively predict the prognosis of pancreatic cancer patients. Besides, the above immune-related lncRNAs may serve as new biomarkers in the diagnosis and therapy in pancreatic cancer. Figures and Tables | References | Related Articles | Metrics

Construction of a nomogram of overall survival of patients with clear cell renal cell carcinoma based on preoperative CT findings Wang Jiali, Han Dong, Chen Ying, Zhang Yamin, Ai Meimei 2020, 47 (8):  480-486.  doi: 10.3760/cma.j.cn371439-20190923-00061 Abstract ( 543 )   HTML ( 20 )   PDF (1760KB) ( 206 )   Save Objective To explore the independent risk factors of preoperative CT findings affecting the overall survival of patients with clear cell renal cell carcinoma (ccRCC) and to draw a nomogram. Methods The retrospective study was performed on 238 patients with ccRCC who underwent preoperative CT scan and were pathologically confirmed in First Affiliated Hospital of Air Force Medical University from October 2011 to December 2015. CT findings of each patient were evaluated by two radiologists, and general information, renal function examination, and World Health Organization/International Society for Urology and Pathology (WHO/ISUP) grading were collected. The Kaplan-Meier survival curve was plotted, and survival rates were compared using log-rank test. Cox proportional hazard regression was used for univariate and multivariate analysis, and the nomogram was drawn according to the results of multivariate analysis, and the C-index was calculated after internal validation by Bootstrap 1000. Results After 3-74 months of follow-up for 238 patients, 32 cases were in the death group and 206 cases were in the censored group. The tumor diameter of the death group [(65.70±27.29) mm] was larger than that of the censored group [(46.25±26.16) mm], with a statistically significant difference (t=-3.889, P<0.001). The incidence rate of tumor necrosis (χ2=45.716, P<0.001), regional lymph node enlargement (χ2=43.342, P<0.001) and perirenal fat invasion (χ2=19.324, P<0.001) in the death group were higher than those in the censored group. Survival rates were different in patients with different tumor diameter of ccRCC, with a statistically significant difference (χ2=17.108, P<0.001). The survival rate of patients with tumor necrosis was lower than those without necrosis (χ2=48.195, P<0.001). The survival rate of patients with regional lymph node enlargement was lower than those without regional lymph node enlargement (χ2=47.232, P<0.001). The survival rate of patients with perirenal fat invasion was lower than those without perirenal fat invasion (χ2=19.964, P<0.001). Survival rates were also different in ccRCC patients with different WHO/ISUP grades, with a statistically significant difference (χ2=27.765, P<0.001). In Cox multivariate analysis, tumor diameter (HR=2.90, 95%CI: 1.37-6.14, P=0.006), necrosis (HR=8.88, 95%CI: 3.33-23.69, P<0.001) and regional lymph node enlargement (HR=4.48, 95%CI: 2.04-9.86, P<0.001) in CT findings were independent risk factors for death in patients with ccRCC. The C-index of nomogram was 0.870. Conclusion Preoperative CT findings are correlated with survival rate of patients with ccRCC, in which tumor diameter, tumor necrosis and regional lymph node enlargement are independent risk factors for death, and the nomograms has high accuracy. Figures and Tables | References | Related Articles | Metrics

Reviews

Research progress in predictive biomarkers related to tumor immunotherapy Zhang Min, Zhou Lina, Xu Shanshan, Chen Jun 2020, 47 (8):  487-491.  doi: 10.3760/cma.j.cn371439-20191105-00062 Abstract ( 493 )   HTML ( 27 )   PDF (602KB) ( 586 )   Save Tumor immunotherapy is a treatment method mainly for programmed cell death-1 (PD-1) and its ligand PD-L1. PD-1/PD-L1 inhibitors have obvious clinical benefits and long-lasting responses in a variety of tumors. But overall response rates are still low. Studies show that PD-L1 and tumor mutation burden can predict the effect of immunotherapy. MSI-H/dMMR, TP53 and KRAS mutations are positively correlated with the effect of immunotherapy. While MDM2/4, EGFR, ALK and other genes are negatively correlated with the effect of immunotherapy. References | Related Articles | Metrics

Clinical application progress of variations in the technique of liver partition from ALPPS Liu Junguo, Zhang Jinjuan, Wang Yijun 2020, 47 (8):  492-495.  doi: 10.3760/cma.j.cn371439-20191112-00063 Abstract ( 351 )   HTML ( 12 )   PDF (593KB) ( 212 )   Save There are many technical variations and improvements in associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). Its main purpose is to reduce the incidence of complications and mortality, and at the same time, the future liver remnant compensation can be increased more faster and its function becomes more robust. In clinical practice, different researchers have studied the variation and related clinical results of liver disconnection technique in ALPPS, such as partial hepatectomy, portal vein ligation assisted radio frequency hepatectomy, laparoscopic microwave ablation and portal vein ligation staged hepatectomy, combined liver tourniquet and portal vein ligation staged hepatectomy, continuous combined liver tourniquet and portal vein ligation staged hepatectomy, in situ hepatectomy combined with portal vein embolization via anterior approach and portal vein embolization instead of hepatectomy separation of visceral substance, and so on. References | Related Articles | Metrics

Research progress of radiosensitivity in cervical cancer Shu Hang, Xu Zhonghua, Zhu Haochen, Yang Yahui, Lyu Yin 2020, 47 (8):  496-500.  doi: 10.3760/cma.j.cn371439-20191120-00064 Abstract ( 594 )   HTML ( 21 )   PDF (603KB) ( 319 )   Save Radiotherapy plays an important role in the treatment of cervical cancer. The radiosensitivity of cervical cancer is closely related to genes, RNA regulation, tumor microenvironment, drugs and other factors. Recently, many studies have been conducted to continuously explore the mechanisms of these factors in radiotherapy sensitization, and progress has been made in radiotherapy sensitization of cervical cancer at basic or clinical level. References | Related Articles | Metrics