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08 January 2022, Volume 49 Issue 1 Previous Issue    Next Issue

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Effects of proton pump inhibitors on outcomes for advanced solid tumor patients treated with immune checkpoint inhibitors Liu Chaoxing, Yan Xuebing, Yang Mengxue, Tong Jiandong, Mao Haiyan 2022, 49 (1):  26-32.  doi: 10.3760/cma.j.cn371439-20210315-00003 Abstract ( 336 )   HTML ( 531 )   PDF (4399KB) ( 322 )   Save Objective To evaluate the effects of proton pump inhibitors (PPIs) on the clinical outcomes for advanced solid tumor patients treated with immune checkpoint inhibitors (ICIs). Methods A total of 204 patients with advanced solid tumors who received ICIs in the Affiliated Hospital of Yangzhou University from November 2016 to December 2020 were retrospectively analyzed. The patients were divided into PPIs group (n=73) and Non-PPIs group (n=131) according to whether they received PPIs within 1 month before or after the initiation of ICIs treatment. The correlations between the uses of PPIs and the clinical characteristics of patients were explored, and the clinical efficacy of the two groups was evaluated. Kaplan-Meier survival curve was applied to analyze the effects of PPIs uses on overall survival (OS) and progression-free survival (PFS) of patients. The Cox proportional hazards model was used to clarify whether PPIs was an independent indicator of patients' prognosis. Results During ICIs treatment of advanced solid tumors, the use of PPIs was not correlated with the patients' gender, age, tumor type, the score of the United States Eastern Collaborative Group, types of immunotherapy drugs and treatment strategy (all P>0.05). The objective response rate of the Non-PPIs group was better than that of the PPIs group (45.0% vs. 24.7%, χ2=8.286, P=0.004). The disease control rate of the Non-PPIs group was better than that of the PPIs group (75.6% vs. 52.0%, χ 2=11.755, P=0.001). In patients with advanced solid tumors, the median OS (3.4 months vs. 6.1 months) and median PFS (2.8 months vs. 4.0 months) in the PPIs group were shorter than those in the Non-PPIs group (χ 2=9.563, P=0.002; χ 2=5.761, P=0.016). Univariate analysis showed that among patients with advanced solid tumors treated with ICIs, PPIs uses was significantly correlated with OS (HR=1.85, 95%CI: 1.24-2.76, P=0.003); PPIs uses(HR=1.65, 95%CI: 1.09-2.51, P=0.019) and age (HR=1.56, 95%CI: 1.05-2.32, P=0.029) were significantly correlated with PFS. Multivariate analysis showed that PPIs uses was an independent prognostic factor affecting OS (HR=1.90, 95%CI: 1.27-2.85, P=0.002) and PFS (HR=1.73, 95%CI: 1.12-2.65, P=0.013). Meanwhile, subgroup analysis discovered that in the course of ICIs treatment of lung cancer patients, the median OS (3.2 months vs. 6.2 months) and median PFS (2.2 months vs. 3.8 months) in the PPIs group (n=64) were shorter than those in the Non-PPIs group (n=34) (χ 2=16.187, P<0.001; χ 2=5.106, P=0.020). Univariate analysis showed that PPIs uses was associated with OS (HR=2.97, 95%CI: 1.70-5.22, P<0.001) and PFS (HR=1.97, 95%CI: 1.09-3.55, P=0.025) in lung cancer patients treated with ICIs. Multivariate analysis showed that PPIs uses was an independent prognostic factor for OS (HR=3.38, 95%CI: 1.87-6.11, P<0.001) and PFS (HR=2.31, 95%CI: 1.22-4.38, P=0.010) in lung cancer patients treated with ICIs. Conclusion The use of PPIs reduces the effect of ICIs in the treatment of advanced solid tumor, especially in lung cancer. PPIs should be used cautiously in patients with advanced solid tumors treated with ICIs. Figures and Tables | References | Related Articles | Metrics

Effects of different treatments on prognosis of triple-negative breast cancer Liu Xiaojing, Zhu Minghua, Zuo Si, Meng Di, Bi Yan, Wang Wei, Jin Shujuan 2022, 49 (1):  33-38.  doi: 10.3760/cma.j.cn371439-20210409-00004 Abstract ( 351 )   HTML ( 58 )   PDF (3484KB) ( 189 )   Save Objective To analyze the clinical features and the effects of different treatments on 5-year overall survival (OS) rate and 5-year disease free survival (DFS) rate of stage 0-Ⅲ triple-negative breast cancer (TNBC). Methods The data of 209 patients diagnosed as stage 0-Ⅲ TNBC in Ward 2 of Department of General Surgery of the Fifth Medical Center of PLA General Hospital from January 2004 to December 2013 were selected. The relationships between the clinical features, treatments and 5-year OS rate, 5-year DFS rate were retrospectively analyzed. Kaplan-Meier method was used to draw survival curves, and Cox proportional risk model was used for multivariate analysis. Results Univariate analysis found that clinical stage and methods of surgery were associated with 5-year OS rate (χ2=52.615, P<0.001; χ2=17.329, P=0.001) and 5-year DFS rate (χ2=55.112, P<0.001; χ2=18.816, P<0.001). Multivariate analysis showed that clinical stage was an independent prognostic factor of DFS (HR=3.637, 95%CI: 2.146-6.164, P<0.001) and OS (HR=3.545, 95%CI: 2.091-6.009, P<0.001). For the TNBC patients without axillary lymph node metastasis (n=118), the 5-year OS rates of patients with breast conservation surgery + sentinel lymph node biopsy, total breast resection + sentinel lymph node biopsy, modified radical mastectomy and breast conserving surgery + axillary lymph node dissection were 97.6%, 97.7%, 91.4%, 100% respectively, the 5-year DFS rates were 97.3%, 94.3%, 85.8%, 100% respectively, and there were no significant differences among the four groups (χ2=3.369, P=0.338; χ2=3.868, P=0.276). The 5-year OS rate (74.5% vs. 91.1%) and 5-year DFS rate (73.6% vs. 86.8%) were significantly different in patients receiving neoadjuvant chemotherapy (n=106) compared with those receiving adjuvant chemotherapy (n=80) (χ2=4.504, P=0.034; χ2=4.683, P=0.030). The patients receiving neoadjuvant chemotherapy had later clinical stages than those receiving adjuvant chemotherapy (χ2=35.314, P<0.001). There were no significant differences in 5-year OS rate and 5-year DFS rate between the patients receiving neoadjuvant chemotherapy and adjuvant chemotherapy with the same clinical stage (all P>0.05). The 5-year OS rates of patients with pathologic complete response (pCR), partial response (PR) and stable disease (SD) obtained by neoadjuvant chemotherapy were 100%, 75.8% and 57.1% respectively, and the 5-year DFS rates were 100%, 74.5% and 55.7% respectively, with statistically significant differences (χ2=10.086, P=0.006; χ2=10.399, P=0.006). Between the pCR group and the PR group, the 5-year OS rate (χ2=4.238, P=0.040) and 5-year DFS rate (χ2=4.525, P=0.033) were significantly different. Between the pCR group and the SD group, the 5-year OS rate (χ2=8.163, P=0.004) and 5-year DFS rate (χ2=8.509, P=0.004) were significantly different. Between the PR group and the SD group, the 5-year OS rate (χ2=3.931, P=0.047) and 5-year DFS rate (χ2=3.896, P=0.048) were significantly different. Conclusion For the patients with stage 0-Ⅲ TNBC, clinical stage is an independent prognostic factor. For the TNBC patients without axillary lymph node metastasis, breast conservation surgery + sentinel lymph node biopsy, total breast resection + sentinel lymph node biopsy, modified radical mastectomy and breast conserving surgery + axillary lymph node dissection have similar outcomes. There is no significant difference between neoadjuvant chemotherapy and adjuvant chemotherapy in the prognosis of patients with the same clinical stage, but patients with pCR or PR obtained by neoadjuvant chemotherapy can achieve better survival. Figures and Tables | References | Related Articles | Metrics

Efficacy and influencing factors of anlotinib in treatment of elderly patients with small cell lung cancer after second-line treatment failure Tao Jie, Wu Mei, Zhang Yan 2022, 49 (1):  39-44.  doi: 10.3760/cma.j.cn371439-20210520-00005 Abstract ( 640 )   HTML ( 73 )   PDF (3767KB) ( 164 )   Save Objective To investigate the efficacy and influencing factors of anlotinib in treatment of elderly patients with small cell lung cancer after second-line treatment failure. Methods A total of 56 elderly patients with small cell lung cancer who were diagnosed and treated in the Tumor Hospital Affiliated to Xinjiang Medical University from September 2018 to February 2020 were collected. All patients were treated with anlotinib capsule after failure of second-line chemotherapy, objective response rate (ORR), disease control rate (DCR) and progression-free survival (PFS) were calculated, and ORR, DCR and PFS of patients with different clinical characteristics were compared. Cox proportional hazards model was used to analyze the factors influencing PFS in elderly patients with small cell lung cancer, and adverse drug reactions were observed. Results After 2 cycles of treatment, the ORR and DCR of 56 elderly patients with small cell lung cancer were 10.7% (6/56) and 53.6% (30/56) respectively. Among them, the ORR and DCR of patients without brain metastasis were 20.8% (5/24) and 75.0% (18/24), which were higher than 3.1% (1/32) and 37.5% (12/32) in patients with brain metastasis, with statistically significant differences (χ2=4.496, P=0.034; χ2=7.754, P=0.005). The ORR and DCR of patients with Eastern Cooperative Oncology Group (ECOG) score of 0-1 were 21.7% (5/23) and 69.6% (16/23), which were higher than those of patients with ECOG score of 2-3 [3.0% (1/33), 42.4% (14/33)], with statistically significant differences (χ2=4.959, P=0.026; χ2=4.014, P=0.045). ORR and DCR were not related to gender, age, clinical stage or smoking status (all P>0.05). The median PFS of 56 patients was 3.8 months. The median PFS of patients aged ≤70 years was 5.0 months, and that of patients aged >70 years was 3.4 months, with a statistically significant difference (χ2=5.452, P=0.020). The median PFS of patients without brain metastasis was 5.1 months, and that of patients with brain metastasis was 3.2 months, with a statistically significant difference (χ2=8.895, P=0.003). The median PFS of patients with ECOG score of 0-1 was 5.0 months, and that of patients with ECOG score of 2-3 was 2.9 months, with a statistically significant difference (χ2=5.923, P=0.015). The median PFS of patients with limited stage was 5.0 months, and that of patients with extensive stage was 3.1 months, with a statistically significant difference (χ2=5.141, P=0.023). Cox multivariate analysis showed that ECOG score (HR=2.522, 95%CI: 1.378-4.615, P=0.003) and brain metastasis or not (HR=0.323, 95%CI: 0.168-0.622, P=0.001) were independent prognostic factors of PFS. During the treatment of anlotinib, the main adverse reactions were grade Ⅰ-Ⅱ, grade Ⅲ-Ⅳ adverse reactions were mainly hypertension and hand-foot syndrome, which improved after drug reduction and symptomatic treatment, and could be tolerated later. The incidence of drug reduction was 3.6% (2/56), and there were no patients with drug interruption or termination of treatment. Conclusion Anlotinib has good short-term efficacy and survival benefits in the treatment of elderly patients with small cell lung cancer after second-line treatment failure. It has good therapeutic effect for patients with low ECOG score and without brain metastasis, and has tolerable adverse reactions and high safety. Figures and Tables | References | Related Articles | Metrics

Correlation between the expressions of miR-524-5p and SOX9 in advanced gastric cancer and their influences on chemotherapy efficacy and prognosis Luo Liyun, Lai Canhui, Liang Renpei, Yang Aiwu, Lin Zhimin 2022, 49 (1):  45-50.  doi: 10.3760/cma.j.cn371439-20210106-00006 Abstract ( 224 )   HTML ( 48 )   PDF (3941KB) ( 157 )   Save Objective To investigate the correlation between the expressions of miR-524-5p and sex determining region Y box protein 9 (SOX9) in advanced gastric cancer and their influences on the efficacy and prognosis of chemotherapy. Methods A total of 82 patients diagnosed as advanced gastric cancer who received DCF (docetaxel + cisplatin + fluorouracil) chemotherapy in 910th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army from January 2015 to December 2017 were selected as the research objects. The expression levels of miR-524-5p and SOX9 in gastric cancer tissues were detected by fluorescence quantitative PCR. The correlation between the expressions of miR-524-5p and SOX9 was analyzed, the total effective rates of chemotherapy in patients with different miR-524-5p and SOX9 expression levels were compared, and the predictive value of miR-524-5p combined with SOX9 on the efficacy of chemotherapy was analyzed. Overall survival (OS) and progression-free survival (PFS) were analyzed. Results The expressions of miR-524-5p and SOX9 were not related to gender or age of patients with advanced gastric cancer (all P>0.05), but were related to the degree of differentiation (χ2=3.577, P=0.001; χ2=5.654, P<0.001) and distant metastasis (χ2=2.466, P=0.016; χ2=5.218, P<0.001) of patients with advanced gastric cancer. There was a negative correlation between the expressions of miR-524-5p and SOX9 in advanced gastric cancer (r=-0.348, P=0.001). According to the median expressions of miR-524-5p and SOX9 in gastric cancer tissues, patients were divided into high expression and low expression groups, miR-524-5p≥0.64 was high expression (n=41), <0.64 was low expression (n=41), SOX9≥1.84 was high expression (n=41), and <1.84 was low expression (n=41). The total effective rate of advanced gastric cancer patients with high expression of miR-524-5p was 58.54% (24/41), which was higher than that of patients with low expression of miR-524-5p (24.39%, 10/41), and there was a statistically significant difference (χ2=9.484, P=0.002). The total effective rate of advanced gastric cancer patients with high expression of SOX9 was 21.95% (9/41), which was lower than 60.97% (25/41) of patients with low expression of SOX9, and there was a statistically significant difference (χ2=12.863, P<0.001). Receiver operating characteristic curve analysis showed that the expressions of miR-524-5p and SOX9 had predictive value for the efficacy of chemotherapy, and the area under the curve was 0.753 (95%CI: 0.644-0.861, P<0.001) and 0.660 (95%CI: 0.540-0.780, P=0.014) respectively. The combination of miR-524-5p and SOX9 had predictive value for the efficacy of chemotherapy, and the area under the curve was 0.768 (95%CI: 0.667-0.868, P<0.001). The median PFS and OS of patients with high expression of miR-524-5p were 8 months and 14 months, which were longer than those of patients with low expression of miR-524-5p (6 months, 9 months), and there were statistically significant differences (χ2=21.160, P<0.001; χ2=29.730, P<0.001). The median PFS and OS of patients with high expression of SOX9 were 7 months and 10 months, which were shorter than those of patients with low expression of SOX9 (8 months, 12 months), and there were statistically significant differences (χ2=6.345, P=0.012; χ2=4.107, P=0.043). Conclusion There is a negative correlation between the expressions of miR-524-5p and SOX9 in advanced gastric cancer tissues. The chemotherapy efficacy and prognosis of patients with high expression of miR-524-5p and low expression of SOX9 are better than those of patients with low expression of miR-524-5p and high expression of SOX9. Figures and Tables | References | Related Articles | Metrics

Research progress of functional imaging-assisted radiotherapy target delineation of lung cancer with atelectasis Zhang Hongjiao, Jiang Jie, Huang Wei 2022, 49 (1):  51-55.  doi: 10.3760/cma.j.cn371439-20210408-00007 Abstract ( 260 )   HTML ( 43 )   PDF (3697KB) ( 211 )   Save Radiotherapy is one of the main treatment methods for patients with lung cancer, especially for patients with locally advanced lung cancer. Local advanced lung cancer is often accompanied by atelectasis, so it brings great difficulty and uncertainty to the delineation of radiotherapy target, and then affects the curative effect of patients. The latest research shows that functional imaging has a unique imaging principle, which can truly reflect biological information such as tumor proliferation and metabolism, and has an application prospect in distinguishing the target area of lung cancer from atelectasis. References | Related Articles | Metrics

Clinical research progress of immunotherapy combined with chemoradiotherapy in the treatment of non-small cell lung cancer Lin Xianyong, Hu Xiang, Yin Haitao 2022, 49 (1):  56-60.  doi: 10.3760/cma.j.cn371439-20210407-00008 Abstract ( 583 )   HTML ( 108 )   PDF (3594KB) ( 479 )   Save Radiotherapy, chemotherapy and immunotherapy have a synergistic effect. With the clinical application of immune checkpoint inhibitors, their combination with radiotherapy or chemoradiotherapy of non-small cell lung cancer shows good short-term and long-term efficacy, and is safe and reliable. References | Related Articles | Metrics

Research progress on lncRNAs as members of ceRNA network in melanoma Hong Anlan, Cao Meng, Wang Yan, Fang Fang 2022, 49 (1):  61-64.  doi: 10.3760/cma.j.cn371439-20210520-00009 Abstract ( 372 )   HTML ( 88 )   PDF (3021KB) ( 394 )   Save In recent years, there has been an increasing number of studies on long non-coding RNAs (lncRNAs) as a competing endogenous RNA (ceRNA) in melanoma. Different lncRNAs show high or low expression in melanoma, and competitively combine with miRNAs through ceRNA mechanism, affecting the expression of downstream target mRNAs, thereby playing the role of oncogenes or tumor suppressor genes. Understanding the role of lncRNA as ceRNA in melanoma can provide new ideas for the diagnosis and treatment of melanoma in the future. References | Related Articles | Metrics