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08 October 2021, Volume 48 Issue 10 Previous Issue    Next Issue

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One Hundred Years of the Party′s Striving for the People′s Health

Establishing minimal clinically important differences of Quality of Life Instruments for Cancer Patients-Leukemia based on the distribution-based approach Li Weiqiang, Wu Yang, Wan Chonghua, Tan Jianfeng, He Zhengchun, Meng Qiong 2021, 48 (10):  577-582.  doi: 10.3760/cma.j.cn371439-20210420-00114 Abstract ( 231 )   HTML ( 20 )   PDF (3907KB) ( 50 )   Save Objective To develop the minimal clinically important difference (MCID) of Quality of Life Instruments for Cancer Patients-Leukemia (QLICP-LE) (V2.0). Methods The quality of life of 101 patients with leukemia in First Affiliated Hospital of Kunming Medical University and First People's Hospital of Yunnan Province from October 2011 to May 2012 were measured. The QLICP-LE (V2.0) was used for data collection, and the MCID for the overall score and scores of various domains of QLICP-LE (V2.0) were established by using the distribution-based approach including indexes of effect size, standard error of measurement (SEM), reliable change index, standardized response mean and responsiveness statistic, and the recommended values of MCID were determined through the consensus method. Results The MCID formulated by the above five indexes were as follows: the total scale 1.4-9.3, physical functional domain 1.6-15.6, psychological functional domain 2.9-15.6, social functional domain 2.2-18.0, common symptoms and side-effects domain 1.7-17.1, common module 1.8-10.0, and the specific module 1.1-12.1. Through the expert consensus method, it was recommended to use the MCID results calculated by 1.96SEM: the total scale was 4, physical domain was 8, psychological domain was 8, social domain was 9, common symptoms and side-effects domain was 9, common module was 4, and the specific module was 6. Conclusion Each index of distribution-based approach has its own advantages and disadvantages, which can be selected based on actual conditions. There is clinical significance when the score change of QLICP-LE (V2.0) of leukemia patients after treatment exceeds its MCID. Figures and Tables | References | Related Articles | Metrics

Original Articles

Effects of Ophiopogon D combined with cyclooxygenase-2 silencing on proliferation, migration and invasion of human pancreatic cancer BxPC-3 cells Zhong Yang, He Miao, Liu Zhi, Chen Jianyu, Zhang Guangnian, Qin Long, Li Ting, Li Jianshui 2021, 48 (10):  583-590.  doi: 10.3760/cma.j.cn371439-20201208-00115 Abstract ( 210 )   HTML ( 21 )   PDF (41417KB) ( 62 )   Save Objective To explore the effects of Ophiopogon D combined with cyclooxygenase-2 (COX-2) gene silencing on the proliferation, migration and invasion of human pancreatic cancer BxPC-3 cells. Methods BxPC-3 cells were divided into blank control group, Ophiopogonin D high-dose group (40 μmol/L), medium-dose group (20 μmol/L) and low-dose group (10 μmol/L). The COX-2-slienced cells were divided into control group, COX-2 inhibited group (50 pmol/ml siRNA-COX-2), Ophiopogonin D group (20 μmol/L) and combination treatment group (Ophiopogonin D 20 μmol/L+50 pmol/ml siRNA-COX-2). The proliferation activity of BxPC-3 cells was detected by CCK-8, and the migration distance of BxPC-3 cells was detected by scratched assay. The invasion degree of BxPC-3 cells was detected by Transwell, the relative expression level of COX-2 gene in BxPC-3 cells was detected by real-time quantitative PCR (RT-qPCR), and the relative expressions of COX-2,hypoxia inducible factor-1α (HIF-1α) and vascular endothelial growth factor (VEGF) proteins in BxPC-3 cells were detected by Western blotting. Results The cell proliferation rates of blank control group, Ophiopogonin D high-dose, medium-dose and low-dose groups were (100.0±4.9)%, (71.8±5.4)%, (80.5±5.8)% and (89.7±5.7)%, respectively. The migration distances were (279.8±24.0) μm, (141.9±21.2) μm, (168.8±37.1) μm and (224.6±19.9) μm, respectively. The absorbance (A) values of invasion number were 1.107±0.095, 0.390±0.030, 0.596±0.017 and 0.826±0.034, respectively.There were statistically significant differences (F=19.770, P<0.001; F=48.270, P<0.001; F=198.400, P<0.001).The above indexes of the Ophiopogonin D high-, medium- and low-dose groups were significantly lower than those in the blank control group (all P<0.05).The relative expression levels of COX-2 gene were 1.007±0.178, 0.387±0.169, 0.567±0.142 and 0.740±0.030, respectively,and the relative protein expression levels were 1.000±0.033, 0.654±0.085, 0.762±0.110 and 0.881±0.049, respectively, with statistically significant differences (F=10.280, P=0.004;F=11.780, P=0.003). The above indexes of the Ophiopogonin D high- and medium-dose groups were significantly lower than those in the blank control group (all P<0.05), and there was no statistically significant difference between the Ophiopogonin D low-dose group and blank control group (both P>0.05). The medium-dose of Ophiopogonin D (20 μmol/L) was selected as the subsequent concentration.After COX-2 silencing,the proliferation rates of the control group, COX-2 inhibited group, Ophiopogonin D group and combination treatment group were (100.0±2.8)%, (68.4±6.7)%, (67.7±5.9)% and (57.0±8.5)%, respectively,the migration distances were (274.4±23.8) μm, (217.0±18.8) μm, (186.2±18.6) μm and (115.7±15.8) μm, respectively,and the A values of invasion number were 1.143±0.092, 0.791±0.058, 0.715±0.026 and 0.424±0.058, respectively, with statistically significant differences (F=34.430, P<0.001; F=103.400, P<0.001; F=131.100, P<0.001). The proliferation rates, migration distances and invasion numbers in each treatment group were significantly lower than those in the control group (all P<0.001). Compared with the COX-2 inhibited group and Ophiopogonin D group, the cell proliferation, migration and invasion were significantly inhibited in the combination treatment group (all P<0.05). Compared with the Ophiopogonin D group, only the migration distance of the COX-2 inhibited group was significantly different (P<0.05).The relative expression levels of COX-2 protein in the above groups were 0.995±0.037, 0.779±0.060, 0.806±0.076 and 0.645±0.079, respectively,the relative expression levels of HIF-1α were 1.083±0.104, 0.749±0.070, 0.736±0.070 and 0.394±0.016, respectively,and the relative expression levels of VEGF protein were 1.016±0.103, 0.757±0.090, 0.745±0.021 and 0.603±0.023, respectively,with statistically significant differences (F=14.650, P=0.001; F=45.220, P<0.001; F=18.180, P<0.001).The expression levels of the three proteins in each treatment group were significantly lower than those in the control group (all P<0.05). Compared with the COX-2 inhibited group and Ophiopogonin D group, the relative protein expression levels of COX-2, HIF-1α and VEGF in the combination treatment group were significantly decreased (all P<0.05). Compared with the Ophiopogonin D group, there were no significant differences in the expression of the three proteins in the COX-2 inhibited group (all P>0.05). Conclusion Ophiopogon D combined with COX-2 gene silencing can inhibit the proliferation, migration and invasion of pancreatic cancer cells, and the mechanism may be related to the inhibition of COX-2 pathway and the decrease of HIF-1α and VEGF protein expression levels. Figures and Tables | References | Related Articles | Metrics

Atypical MSCT pleomorphic signs in metastatic adenocarcinoma and squamous cell carcinoma of the lung Zhang Bei, Wang Ye, Hu Jun, Li Mei, Wang Jun, Mu Yunfeng, Yang Bo 2021, 48 (10):  591-595.  doi: 10.3760/cma.j.cn371439-20200707-00116 Abstract ( 231 )   HTML ( 20 )   PDF (4929KB) ( 54 )   Save Objective To investigate the correlations between multi-slice spiral CT (MSCT) atypical pleomorphic signs and pathological findings of lung metastases. Methods From January 2012 to July 2019, the MSCT chest imaging data of 168 metastatic tumor of lung from the General Hospital of Central Theater Command of the Chinese People's Liberation Army and Shaanxi Provincial Tumor Hospital were collected. According to the pathological type, they were divided into metastatic adenocarcinoma group (n=88) and metastatic squamous cell carcinoma group (n=80). The atypical imaging signs of MSCT of the two groups were observed and recorded, and classified after labeling one by one. The difference of atypical MSCT imaging features between the two groups was compared, and the correlations between lesion size and atypical imaging features of MSCT in the metastatic adenocarcinoma group and metastatic squamous cell carcinoma group were analyzed. Results The spicule sign in metastatic adenocarcinoma and metastatic squamous cell carcinoma were 61 (69.32%) and 28 (35.00%), with a statistically significant difference (χ2=19.811, P<0.001). The pleural depression sign in the two groups were 48 (54.55%) and 16 (20.00%), and there was a statistically significant difference (χ 2=21.206, P<0.001). The vacuole/cavity sign in the two groups were 10 (11.36%) and 61 (76.25%), and there was a statistically significant difference (χ 2=72.303, P<0.001). The air bronchial sign in the two groups were 43 (48.86%) and 13 (16.25%), with a statistically significant difference (χ 2=20.057, P<0.001). The halo sign/ground glass shadow in the two groups were 58 (65.91%) and 37 (46.25%), with a statistically significant difference (χ2=6.591, P=0.010). The results of the Spearman rank correlation analysis indicated a positive correlation between the size of metastatic adenocarcinoma and spicule sign, pleural depression sign (r=0.270, P=0.011; r=0.226, P=0.035). There was no correlation between the nodule size and atypical MSCT imaging features in metastatic squamous cell carcinoma (all P>0.05). Conclusion The atypical MSCT of metastatic lung adenocarcinoma are mostly spicule sign, pleural depression sign, air bronchial sign and halo sign/ground glass shadow. The characteristic atypical imaging of metastatic squamous cell carcinoma is vacuole/cavity sign. The spicule sign and pleural depression sign are related to the size of metastatic lung adenocarcinoma nodules. Figures and Tables | References | Related Articles | Metrics

Clinical observation of albumin-bound paclitaxel or pemetrexed combined with cisplatin in the treatment of advanced mutation negative lung adenocarcinoma Zhou Liya, Li Xiaoli, Cao Zixiao, Xiang Junxin, Liu Jiahui, Xia Xuemei, Li Dianming 2021, 48 (10):  596-601.  doi: 10.3760/cma.j.cn371439-20210210-00117 Abstract ( 480 )   HTML ( 23 )   PDF (4008KB) ( 110 )   Save Objective To compare the short-term clinical efficacy, adverse reactions and pharmacoeconomics of advanced mutation negative lung adenocarcinoma treated by albumin-bound paclitaxel or pemetrexed combined with cisplatin. Methods From September 2019 to October 2020, 80 patients with advanced lung adenocarcinoma diagnosed in the First Affiliated Hospital of Bengbu Medical College were divided into observation group and the control group according to the randomized digital table, with 40 cases in each group. The observation group received albumin-bound paclitaxel combined with cisplatin, and the control group received pemetrexed combined with cisplatin. After 2 cycles of treatment, the short-term efficacy and the adverse reactions of the two groups were evaluated. The cost of chemotherapy drugs and the average length of hospital stay were compared between the two groups. Results The objective response rates of the observation group and the control group were 30.0% (12/40) and 32.5% (13/40), the disease control rates were 77.5% (31/40) and 82.5% (33/40) respectively, and there were no significant differences (χ2=0.058, P=0.809; χ 2=0.313, P=0.576). The adverse reactions of the two groups were mainly grade Ⅰ-Ⅱ. The incidences of leucopenia, neutropenia, thrombocytopenia, hemoglobin decreased, gastrointestinal reaction, liver function damage and renal function damage in the observation group were 20.0% (8/40), 20.0% (8/40), 20.0% (8/40), 17.5% (7/40), 37.5% (15/40), 12.5% (5/40) and 7.5% (3/40) respectively, those in the control group were 25.0% (10/40), 20.0% (8/40), 17.5% (7/40), 15.0% (6/40), 32.5% (13/40), 17.5% (7/40) and 5.0% (2/40) respectively, and there were no statistically significant differences between the two groups (χ 2=0.287, P=0.592; χ 2<0.001, P>0.999; χ2=0.082, P=0.775; χ 2=0.092, P=0.762; χ 2=0.220, P=0.639; χ 2=0.392, P=0.531; χ 2<0.001, P>0.999). The median cost of chemotherapy drugs and the median length of hospital stay in the observation group were 7 453 yuan and 6 days respectively, which were less than 8 956 yuan and 7 days in the control group, with statistically significant differences (Z=-3.057, P=0.002; Z=-2.733, P=0.006). Conclusion The short-term efficacy of albumin-bound paclitaxel combined with cisplatin is equal to pemetrexed combined with cisplatin in treatment of advanced mutation negative lung adenocarcinoma, and the adverse reactions are similar. However, the average cost of chemotherapy drugs of albumin-bound paclitaxel combined with cisplatin is less than pemetrexed combined with cisplatin, and the average length of hospital stay is shorter. Figures and Tables | References | Related Articles | Metrics

Effects of apatinib combined with chemoradiotherapy on the efficacy and tumor markers of advanced gastric cancer Wang Xuan, Cui Lichun, Dang Shengqiang 2021, 48 (10):  602-607.  doi: 10.3760/cma.j.cn371439-20210610-00118 Abstract ( 200 )   HTML ( 15 )   PDF (3950KB) ( 79 )   Save Objective To observe the short- and long-term efficacy of apatinib combined with chemoradiotherapy in the treatment of advanced gastric cancer and its effect on tumor markers. Methods From January 2013 to January 2017, 84 patients with advanced gastric cancer admitted to the Department of Oncology of Chang'an Hospital of Xi'an City were selected as the subjects. The patients were divided into synchronous chemoradiotherapy group and targeted chemoradiotherapy group by prospective nested control method, with 42 cases in each group. The synchronous chemoradiotherapy group was treated with synchronous chemoradiotherapy, and the targeted chemoradiotherapy group was treated with apatinib combined with chemoradiotherapy, 2 weeks was a cycle, a total of 12 cycles. The short- and long-term efficacy, median overall survival, changes of gastric cancer-related markers and adverse reactions of the two groups were compared. Results After 3 months of treatment, there was no significant difference in the efficacy distribution between the synchronous chemoradiotherapy group and the targeted chemoradiotherapy group (Z=0.240, P=0.887). The disease control rates of the two groups were 69.05% (29/42) and 73.81% (31/42) respectively, with no statistically significant difference (χ2=0.233, P=0.629). After 6 months of treatment, the difference of the efficacy distribution between the synchronous chemoradiotherapy group and the targeted chemoradiotherapy group was statistically significant (Z=6.288, P=0.043), and the disease control rates of the two groups were 42.86% (18/42) and 69.05% (29/42) respectively, with a statistically significant difference (χ 2=5.845, P=0.016). The median overall survival in the targeted chemoradiotherapy group and synchronous chemoradiotherapy groups were 18.7 months (95%CI: 8.4-24.8) and 13.8 months (95%CI: 7.2-18.7), with a statistically significant difference (χ 2=7.542, P<0.001). After 3 months of treatment, the levels of carbohydrate antigen (CA) 19-9, CA125, carcino-embryonic antigen (CEA) were (16.27±2.13) U/ml, (13.25±2.26) U/ml, (2.97±0.85) ng/ml in the targeted chemoradiotherapy group and (29.34±3.69) U/ml, (21.63±2.69) U/ml, (6.19±1.23) ng/ml in the synchronous chemoradiotherapy group respectively, all of them were lower than those before treatment, and the CA19-9, CA125, CEA in the targeted chemoradiotherapy group were lower than those in the synchronous chemoradiotherapy group, and there were statistically significant differences (t=19.880, P<0.001; t=15.458, P<0.001; t=13.957, P<0.001). The total incidence of grade 3-4 adverse reactions in the targeted chemoradiotherapy group was 23.81% (10/42) and 28.64% (12/42) in the synchronous chemoradiotherapy group, and there was no statistically significant difference (χ 2=0.186, P=0.667). Conclusion The long-term efficacy of apatinib combined with chemoradiotherapy in the treatment of advanced gastric cancer is better than that of synchronous chemoradiotherapy, and it is safe and reliable. At the same time, it can prolong the overall survival and reduce the levels of serum tumor markers. Figures and Tables | References | Related Articles | Metrics

Expression of lymphoid enhancer factor-1 in pancreatic ductal adenocarcinoma and its effect on prognosis Li Keke, Kong Panpan, Yi Chao, Wang Xiyan, Yan Dong 2021, 48 (10):  608-613.  doi: 10.3760/cma.j.cn371439-20201111-00119 Abstract ( 287 )   HTML ( 20 )   PDF (5843KB) ( 55 )   Save Objective To investigate the expression of lymphoid enhancement factor-1 (LEF-1) in Wnt signaling pathway in pancreatic ductal adenocarcinoma (PDAC) and its significance. Methods The relative expressions of LEF-1 mRNA in human PDAC cell line PANC-1 and normal pancreatic ductal epithelial cell line HPDE6 were detected by fluorescence quantitative PCR. A total of 45 pancreatic cancer tissue specimens and their corresponding paracancerous tissue specimens were collected from the Department of Hepatobiliary and Pancreatic Surgery, Affiliated Tumor Hospital of Xinjiang Medical University from June 2012 to December 2013. The expressions of LEF-1 in the cancer tissues and paracancerous tissues were detected by immunohistochemistry, and the relationships between LEF-1 expression and clinicopathological characteristics and prognosis of patients were analyzed. Results Fluorescence quantitative PCR showed that the relative expression level of LEF-1 mRNA in PANC-1 cell line was significantly higher than that in HPDE-6 cell line (2.895±0.485 vs. 1.006±0.126, t=3.056, P<0.001). Immunohistochemical results showed that LEF-1 was highly expressed in 33 cases (73.3%) of cancer tissues, which was higher than that in 12 cases (26.7%) of adjacent tissues, and there was a statistically significant difference (χ2=14.815, P<0.001). LEF-1 expression was correlated with preoperative carbohydrate antigen (CA) 19-9 level (P<0.001) and local lymph node metastasis (P=0.041). Survival analysis showed that the median overall survival (OS) was 22.0 months in patients with PDAC, 19.0 months in patients with high LEF-1 expression (n=33), 31.0 months in patients with low LEF-1 expression (n=12), and there was a statistically significant difference (χ 2=5.554, P=0.018). Univariate Cox regression analysis showed that age (HR=1.962, 95%CI: 1.043-3.692, P=0.037), LEF-1 (HR=2.253, 95%CI: 1.097-4.630, P=0.027), and CA19-9 (HR=2.667, 95%CI: 1.258-5.656, P=0.011) were associated with OS. Multivariate Cox regression analysis showed that CA19-9 (HR=6.431, 95%CI: 1.078-38.382, P=0.041), CA125 (HR=0.151, 95%CI: 0.027-0.839, P=0.031), primary tumor size (HR=8.364, 95%CI: 1.925-36.335, P=0.005), LEF-1 (HR=2.281, 95%CI: 1.025-5.075, P=0.043) were independent risk factors affecting the prognosis of PDAC patients. Conclusion LEF-1 expression is up-regulated in PDAC tissues, which is positively correlated with preoperative CA19-9 level and local lymph node metastasis, and is an independent prognostic factor in patients with PDAC. Figures and Tables | References | Related Articles | Metrics

Reviews

Role of cancer-associated fibroblasts in breast cancer Wang Ailing, Niu Ximei, Huang Guofu, Leng Xiaoling 2021, 48 (10):  614-617.  doi: 10.3760/cma.j.cn371439-20201208-00120 Abstract ( 172 )   HTML ( 15 )   PDF (2908KB) ( 259 )   Save The interaction between breast cancer cells and the tumor microenvironment plays a vital role in the occurrence and development of breast cancer. Cancer-associated fibroblasts are heterogeneous stromal cells that are abundant in the tumor microenvironment. They participate in tumor angiogenesis, treatment resistance and distant metastasis by secreting a variety of cytokines, growth factors and chemokines. It has great potential as a biomarker for targeted therapy and clinical prognosis of breast cancer, and it can also provide new ideas for adjuvant treatment of breast cancer. References | Related Articles | Metrics

Research progress of radiotherapy and CDK4/6 inhibitors in metastatic breast cancer Yang Yiting, Xu Xiaoting 2021, 48 (10):  618-621.  doi: 10.3760/cma.j.cn371439-20201222-00121 Abstract ( 286 )   HTML ( 7 )   PDF (3172KB) ( 158 )   Save Cyclin-dependent kinase (CDK) 4/6 inhibitors are a new class of molecular targeted drugs, which can enhance radiotherapy sensitivity by anti angiogenesis, inhibiting DNA damage repair and inhibiting mammalian target of rapamycin signal transduction. Existing clinical trials have confirmed that radiotherapy combined with CDK4/6 inhibitors can effectively control the local symptoms of breast cancer metastases and prolong progression-free survival. Compared with CDK4/6 inhibitors alone, the combination with radiotherapy does not significantly increase the incidence and severity of adverse reactions. However, there are also reports about severe adverse reactions of normal tissue happened in the radiation field in individual cases of combined treatment, and its efficacy and safety need to be clarified by more basic and clinical observational researches. References | Related Articles | Metrics

Epigenetics and drug resistance in lung cancer He Miao, Fan Kui, Cao Fang 2021, 48 (10):  622-626.  doi: 10.3760/cma.j.cn371439-20210429-00122 Abstract ( 180 )   HTML ( 12 )   PDF (3815KB) ( 62 )   Save Lung cancer has the highest mortality rate among malignant tumors, and drug resistance in lung cancer treatment is currently a major challenge for clinical practitioners. Recent studies have found that epigenetics is closely linked to drug resistance in lung cancer, especially in DNA methylation, histone modifications and non-coding RNA regulation. By exploring the mechanisms affecting drug resistance in lung cancer through the above three features and exploring drugs that can effectively improve drug resistance in lung cancer in response to the mechanisms, it can provide ideas for solving the problems related to drug resistance in lung cancer in clinical work and provide a reference basis for prognostic assessment of lung cancer patients. References | Related Articles | Metrics

Consideration on the new stage of cervical cancer revised by the International Federation of Obstetrics and Gynecology in 2018 Niu Wenjuan, Duan Wenjie, Su Yating, Wei Fang 2021, 48 (10):  627-630.  doi: 10.3760/cma.j.cn371439-20201230-00123 Abstract ( 151 )   HTML ( 11 )   PDF (3157KB) ( 47 )   Save An effective, reliable and practical staging is of great help to the diagnosis and treatment of malignant tumors. Cervical cancer is a malignant tumor using clinical stage in gynecological tumors, but staging lacks objectivity in judging the tumor size, para-uterine invasion, vaginal margin, vascular invasion and so on. By October 2018, the International Federation of Obstetrics and Gynecology (FIGO) had revised the 2009 FIGO cervical cancer staging that had been used before.However, the changed points of the 2018 FIGO cervical cancer staging are controversial. References | Related Articles | Metrics