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08 September 2022, Volume 49 Issue 9 Previous Issue    Next Issue

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All for People's Health——Our Pursuit in the Past Decade

Research progress of breast cancer with low HER2 expression Xu Hangcheng, Wu Yun, Wang Jiayu 2022, 49 (9):  513-516.  doi: 10.3760/cma.j.cn371439-20220609-00099 Abstract ( 514 )   HTML ( 259 )   PDF (688KB) ( 196 )   Save Breast cancer with low expression of human epidermal growth factor receptor 2 （HER2） has unique biological behaviors. Compared with HER2-zero breast cancer, there are significant differences in molecular subtype and gene expression between the two categories of breast cancer. Novel antibody-drug conjugates represented by T-DXd provide a new treatment option for patients with HER2-low breast cancer, and relevant clinical trials are continuing. At present, the relationship between HER2-low status and prognosis of breast cancer patients remains controversial. In-depth research into HER2-low breast cancer will help further improve clinical outcomes for this population. References | Related Articles | Metrics

Advances in immunotherapy for recurrent and metastatic cervical cancer Zhang Lu, Zhou Juying, Ma Chenying, Lin Zhou 2022, 49 (9):  517-520.  doi: 10.3760/cma.j.cn371439-20220520-00100 Abstract ( 205 )   HTML ( 239 )   PDF (698KB) ( 118 )   Save Immunotherapy mainly includes simple immunotherapy （immune checkpoint inhibitor, therapeutic human papillomavirus vaccine, adoptive T cell therapy, double immunotherapy, etc.）, immuno-therapy combined with other treatments （such as chemotherapy, antiangiogenic therapy, radiotherapy, etc.）. The continuous development of immunotherapy and the improvement of treatment scheme have improved the survival and prognosis of patients, and provided new ideas for the diagnosis and treatment of recurrent and metastatic cervical cancer. References | Related Articles | Metrics

Original Articles

Multivariate analysis of chemotherapy induced oral mucositis in patients with head and neck tumors Chen Yi, Han Liang, Cai Li 2022, 49 (9):  521-525.  doi: 10.3760/cma.j.cn371439-20220707-00101 Abstract ( 221 )   HTML ( 230 )   PDF (700KB) ( 85 )   Save Objective To investigate the influencing factors of chemotherapy induced oral mucositis （CIOM） in patients with head and neck tumors. Methods The clinical data of 98 patients with head and neck tumors treated in Nantong Tumor Hospital of Jiangsu Province from July 2017 to July 2021 were analyzed retrospectively. The patients were divided into CIOM group （n=82） and non-CIOM group （n=16） according to whether CIOM occurred after chemotherapy. The general clinical data of the two groups were compared, and the levels of serum cystatin C （Cys-C）, hypersensitive C-reactive protein （hs-CRP） and homocysteine （Hcy） before chemotherapy of the two groups were detected and compared. Multivariate logistic regression analysis was used to explore the influencing factors of CIOM. Results There were statistically significant differences in body mass index （BMI） （χ2=6.44, P=0.011）, oral care （χ2=4.36, P=0.037）, smoking history （χ2=7.82, P=0.005）, oral pH value （χ2=26.16, P<0.001）, radiotherapy history （χ2=13.31, P<0.001）, chemotherapy regimen （χ2=4.53, P=0.033）, application of antibiotics （χ2=14.53, P<0.001） and application of oral mucosal protec-tive agents （χ2=12.85, P=0.001） between the CIOM group and non-CIOM group. The serum Cys-C [（1.43±0.36） mg/L vs. （1.05±0.28） mg/L], hs-CRP [（19.64±2.05） μmol/L vs. （13.49±1.55） μmol/L] and Hcy [（14.34±1.71） μmol/L vs. （9.63±1.38） μmol/L] before chemotherapy of the CIOM group were significantly higher than those of the non-CIOM group, with statistically significant differences （t=3.88, P<0.001; t=11.38, P<0.001; t=10.36, P<0.001）. Multivariate logistic regression analysis showed that BMI<18.5 kg/m2 （OR=1.66, 95%CI： 1.18-2.14, P=0.005）, poor oral care （OR=2.42, 95%CI： 1.70-4.36, P=0.013）, smoking history （OR=1.53, 95%CI： 1.25-2.28, P=0.003）, oral pH≤7 （OR=2.46, 95%CI： 1.48-4.06, P<0.001）, radiotherapy history （OR=2.04, 95%CI： 1.60-3.44, P<0.001）, chemotherapy regimen containing fluorouracil （5-FU） （OR=1.81, 95%CI： 1.36-2.83, P=0.006）, and increased Cys-C （OR=2.03, 95%CI： 1.40-3.02, P<0.001）, hs-CRP （OR=2.26, 95%CI： 1.64-3.19, P<0.001） and Hcy （OR=1.77, 95%CI： 1.27-2.53, P<0.001） before chemotherapy were independent risk factors for the occurrence of CIOM in patients with head and neck tumors, while the application of antibiotics （OR=0.76, 95%CI： 0.43-0.95, P<0.001） and oral mucosal protective agents （OR=0.58, 95%CI： 0.27-0.88, P<0.001） were independent protective factors for the occurrence of CIOM in patients with head and neck tumors. Conclusion BMI<18.5 kg/m2, poor oral care, smoking history, oral pH≤7, radiotherapy history, chemotherapy regimen containing 5-FU, increased Cys-C, hs-CRP and Hcy before chemotherapy are independent risk factors of head and neck tumors patients complicated with CIOM, while the application of antibiotics and oral mucosal protective agents are independent protective factors. Figures and Tables | References | Related Articles | Metrics

Comparison of the efficacy and safety of percutaneous needle biopsy of pulmonary or pleural lesions guided by CT and ultrasound Song Tongjun, Deng Rui, Fei Lei, Lei Jinhua, Cao Fengjun 2022, 49 (9):  526-531.  doi: 10.3760/cma.j.cn371439-20220221-00102 Abstract ( 183 )   HTML ( 53 )   PDF (822KB) ( 61 )   Save Objective To compare the efficacy and safety of CT and ultrasound-guided percutaneous biopsy of lung or pleural lesions. Methods The clinical data of 193 patients with lung space occupying lesions near the pleura who underwent CT or ultrasound-guided percutaneous puncture in Shiyan People's Hospital Affiliated to Hubei University of Medicine from February 2017 to October 2020 were analyzed retrospectively. According to the puncture mode, the patients were divided into CT-guided group （n=115） and ultrasound-guided group （n=78）. The general clinical data, pathological examination results, puncture success rate and complication rate were compared between the two groups. Logistic regression was used for univariate and multivariate regression analysis. Results The detection rate of malignant tumors in the CT-guided group （60.00%, 69/115） was higher than that in the ultrasound-guided group （50.00%, 39/78）, with no statistically significant difference （χ2=1.89, P=0.170）. The puncture success rate in the CT-guided group （88.70%, 102/115） was slightly lower than that in the ultrasound-guided group （93.59%, 73/78）, with no statistically significant difference （χ2=1.32, P=0.251）. The incidence of postoperative complications in the CT-guided group （18.26%, 21/115） was higher than that in the ultrasound-guided group （6.41%, 5/78）, with a statistically significant difference （χ2=5.60, P=0.018）. The incidence of pneumothorax in the CT-guided group （13.04%, 15/115） was higher than that in the ultrasound-guided group （3.85%, 3/78）, with a statistically significant difference （χ2=4.65, P=0.031）. The incidence rate of bleeding in the CT-guided group （5.22%, 6/115） was higher than that in the ultrasound-guided group （2.56%, 2/78）, with no statistically significant difference （χ2=0.82, P=0.364）. In the CT-guided group, 1 patient （0.87%） had severe bleeding requiring surgical treatment, 5 patients （4.35%） required closed thoracic drainage for treatment. In the ultrasound-guided group, no patients had pneumothorax or bleeding requiring drainage or surgery. Univariate analysis showed that the puncture method was an independent risk factor for the puncture success rate in patients with lesion-pleura contact arc length （LPCAL）≥38 mm （OR=7.82, 95%CI： 1.57-35.50, P=0.039）. Multivariate analysis showed that puncture method is an independent risk factor affecting the puncture success rate in patients with LPCAL≥38 mm （OR=7.75, 95%CI： 1.44-41.36, P=0.042）. Among patients with LPCAL≥38 mm, the puncture success rates of CT- and ultrasound-guided puncture were 84.38% （54/64） and 98.00% （49/50）, respectively, and the puncture success rate of CT-guided puncture was lower than that of ultrasound-guided puncture, with a statistically significant difference （χ2=4.52, P=0.034）. In LPCAL<38 mm patients, the puncture success rates of CT- and ultrasound-guided puncture were 94.12% （48/51） and 85.71% （24/28）, respectively, and the CT-guided puncture success rate was higher than that of the ultrasound-guided puncture, with a statistically significant difference （χ2=0.71, P=0.399）. Conclusion Ultrasound-guided percutaneous puncture biopsy of lung or pleural lesions has the advantages of high diagnostic rate and few complications. Both ultrasound-guided and CT-guided puncture biopsy are feasible methods for puncture of chest wall lesions. When LPCAL≥38 mm, ultrasound-guided puncture biopsy may have more advantages. Figures and Tables | References | Related Articles | Metrics

Analysis of risk factors for deep vein thrombosis of lower extremity after thoracoscopic surgery for elderly lung cancer and establishment and validation of prediction model Yang Sha, Yang Xiaohua, Wang Suhua, Xue Xiaoyan, Xu Jun 2022, 49 (9):  532-536.  doi: 10.3760/cma.j.cn371439-20220621-00103 Abstract ( 198 )   HTML ( 51 )   PDF (825KB) ( 80 )   Save Objective To analyze the risk factors of lower extremities deep vein thrombosis after thoracoscopic surgery in elderly patients with lung cancer, establish a nomogram prediction model and conduct internal verification. Methods A total of 183 elderly patients with lung cancer who underwent thoracoscopic radical resection in Nanchong Central Hospital from February 2018 to February 2022 were selected as the study subjects. According to the presence or absence of deep venous thrombosis of the lower extremities within one month after operation, the patients were divided into lower extremities deep venous thrombosis group （n=61） and non-deep lower extremities venous thrombosis group （n=122）. Univariate and multivariate analyses of deep venous thrombosis of lower extremities after thoracoscopic surgery for lung cancer in the elderly were performed, and a nomogram prediction model was constructed according to the multivariate analysis results, and the model was verified. Results There were statistically significant differences in smoking history （χ2=13.40, P<0.001）, preoperative chemotherapy （χ2=8.79, P=0.003）, surgical method （χ2=7.97, P=0.005）, operation time （t=7.23, P<0.001）, postoperative bed rest time （t=10.40, P<0.001）, combined with diabetes （χ2=6.37, P=0.012）, combined with hyperlipidemia （χ2=9.58, P=0.002）, preoperative D-dimer （t=13.08, P<0.001）, preoperative fibrinogen （t=5.84, P<0.001） and preoperative platelet count （t=7.01, P<0.001） between the lower extremity deep venous thrombosis group and the non-lower extremity deep venous thrombosis group. The results of multivariate logistic regression analysis showed that preoperative chemotherapy （OR=2.45, 95%CI： 1.05-5.71, P=0.038）, surgical method （OR=2.55, 95%CI： 1.14-5.73, P=0.023）, postoperative bed rest time （OR=1.50, 95%CI： 1.24-1.81, P<0.001）, combined with diabetes （OR=3.60, 95%CI： 1.05-12.33, P=0.042）, and preoperative D-dimer （OR=1.01, 95%CI： 1.01-1.01, P<0.001） were all independent risk factors for lower extremity deep vein thrombosis in elderly patients with lung cancer after thoracoscopic surgery. The C-index of nomogram for predicting lower extremity deep vein thrombosis-related factors was 0.86 （95%CI： 0.81-0.93）. The calibration curve showed that the model had a good correlation in predicting lower extremities deep venous thrombosis. Conclusion Preoperative chemotherapy, surgical method, postoperative bed rest time, combined with diabetes, and postoperative D-dimer level are influence factors for lower extremity deep vein thrombosis in elderly patients with lung cancer after thoracoscopic surgery. The nomogram prediction model established in this study has high accuracy and discrimination for the prediction of lower extremity deep vein thrombosis in elderly patients with lung cancer after thoracoscopic surgery. Figures and Tables | References | Related Articles | Metrics

Diagnostic value of serum TIM-3 in patients with liver cancer He Ting, Wang Xi, Zhang Huizhong, Liu Xinyang, Wang Huiping, Dong Ke 2022, 49 (9):  537-542.  doi: 10.3760/cma.j.cn371439-20220506-00104 Abstract ( 174 )   HTML ( 51 )   PDF (1161KB) ( 58 )   Save Objective To analyze the changes of T cell immunoglobulin- and mucin-domain-containing molecule-3 （TIM-3） in serum of patients with liver cancer and its diagnostic value. Methods From March 2021 to May 2021, 37 patients with viral hepatitis type B （hepatitis B group）, 44 patients with liver cirrhosis （liver cirrhosis group） and 27 patients with liver cancer （liver cancer group） were selected in the Second Affiliated Hospital of Air Force Medical University, and 35 healthy subjects who underwent physical examination during the same period were selected as the healthy control group. The serum alpha fetoprotein （AFP）, liver function indexes and TIM-3 levels were detected, and the differences among groups were analyzed. The correlations between TIM-3 and AFP and liver function indexes were analyzed by Spearman correlation. Receiver operating characteristic （ROC） curve was used to analyze the diagnostic value of TIM-3 in liver cancer. Results There was a statistically significant difference in AFP among the hepatitis B group, liver cirrhosis group and liver cancer group （χ2=11.75, P=0.003）. There were statistically significant differences in total bilirubin （χ2=22.85, P<0.001）, direct bilirubin （χ2=25.90, P<0.001）, indirect bilirubin （χ2=19.92, P<0.001）, alanine aminotransferase （χ2=36.64, P<0.001）, aspertate aminotransferase （χ2=26.26, P<0.001）, aspertate aminotransferase/alanine aminotransferase （χ2=34.67, P<0.001） and total bile acid （χ2=13.10, P<0.001） among the hepatitis B group, liver cirrhosis group and liver cancer group. The serum levels of TIM-3 in the healthy control group, hepatitis B group, liver cirrhosis group and liver cancer group were 11.1 （4.2, 14.4） ng/ml, 12.7 （4.3, 23.9） ng/ml, 11.4 （3.4, 17.0） ng/ml and 15.7 （10.5, 21.2） ng/ml, with a statistically significant difference （χ2=11.85, P=0.008）. There were statistically significant differences between the liver cancer group and healthy control group and liver cirrhosis group （both P<0.05）. Spearman correlation analysis showed that TIM-3 had no correlation with AFP in the four groups （r=0.05, P=0.791; r=0.18, P=0.497; r=0.03, P=0.883; r=0.24, P=0.396）. There were correlations between serum TIM-3 and total protein in the healthy control group （r=0.36, P=0.036）, serum TIM-3 and globulin in the hepatitis B group （r=0.35, P=0.034）, and serum TIM-3 and total bile acid in the liver cancer group （r=0.46, P=0.017）. ROC curve analysis showed that the sensitivity of serum TIM-3 for the diagnosis of liver cancer was 48.10%, and the specificity was 91.43%, when taking healthy subjects as the control group. The sensitivity of serum TIM-3 for the diagnosis of liver cancer was 96.30%, and the specificity was 41.77%, when taking healthy subjects and liver cirrhosis patients as the control group. The sensitivity of serum TIM-3 for the diagnosis of liver cancer was 96.30%, and the specificity was 40.52%, when taking healthy subjects, hepatitis B patients and liver cirrhosis patients as the control group. Conclusion The serum level of TIM-3 in patients with liver cancer is significantly increased, which has certain diagnostic value for liver cancer, and can be used as a diagnostic marker and potential therapeutic target for liver cancer patients. Figures and Tables | References | Related Articles | Metrics

Reviews

Role of P4HA2 in promoting cancer progression Song Yuli, Zhang Yi 2022, 49 (9):  543-545.  doi: 10.3760/cma.j.cn371439-20220623-00105 Abstract ( 180 )   HTML ( 52 )   PDF (673KB) ( 90 )   Save P4HA2, one of the important genes encoding the α subunit of collagen prolyl 4-hydroxylase （C-P4H）, is overexpressed in a variety of tumors and promotes tumor progression, and its high expression correlates with the poor prognosis of patients. In different tumors, P4HA2 can promote the proliferation, migration and invasion of tumor cells, increase the proportion of cancer stem cell population, and promote tumor cells to escape from immune system. An in-depth understanding of the role of P4HA2 in tumor progression may provide new ideas and insights for targeting P4HA2 to prevent or reverse tumor progression. References | Related Articles | Metrics

CRISPR/Cas9 genome editing technology and its applications in tumor therapy Zhang Ziyue, Zheng Sihao, Gao Yanjun, Yao Yi, Song Qibin 2022, 49 (9):  546-549.  doi: 10.3760/cma.j.cn371439-20220408-00106 Abstract ( 184 )   HTML ( 47 )   PDF (686KB) ( 117 )   Save Gene editing technology CRISPR/Cas9 and its derivative editing technologies including base editor and prime editor can precisely edit the target genome sequences, having been widely used in tumor therapy and achieved remarkable clinical results in tumor immunotherapy, human papilloma virus infection treatment and oncolytic virotherapy, providing a new means for tumor therapy. References | Related Articles | Metrics

Application of TACE combined with molecular targeted therapy and immunotherapy in BCLC B/C hepatocellular carcinoma Song Jia, Hu Qinyong 2022, 49 (9):  550-554.  doi: 10.3760/cma.j.cn371439-20220520-00107 Abstract ( 173 )   HTML ( 45 )   PDF (701KB) ( 95 )   Save Transcatheter arterial chemoembolization （TACE） is the standard treatment for Barcelona Clinic Liver Cancer （BCLC） stage B hepatocellular carcinoma （HCC）. However, TACE has some limitations, TACE combined with systemic therapy may be more beneficial to patients with BCLC stage B/C HCC. To explore the efficacy and safety of TACE combined with molecular targeted therapy, immunotherapy and molecular targeted therapy + immunotherapy in the treatment of B/C stage HCC of BCLC will provide new ideas for the clinical treatment of HCC. References | Related Articles | Metrics

Application of circulating cell-free nucleic acid in clinical diagnosis and treatment of colorectal cancer Gao Yizhao, Liu Yang, Liu Qiulong, Xing Jinliang 2022, 49 (9):  555-559.  doi: 10.3760/cma.j.cn371439-20220520-00108 Abstract ( 150 )   HTML ( 40 )   PDF (729KB) ( 66 )   Save The incidence of colorectal cancer （CRC） is increasing year by year, and early diagnosis is of great significance to improve the prognosis of patients. Circulating cell-free nucleic acid （cfNA） has the advantages of non-invasive, real-time monitoring, and overcoming tumor heterogeneity. The characteristics of cfNA content, mutation, methylation and fragmentation patterns provid important reference value for early diagnosis, curative effect monitoring, prognosis judgment and medication guidance of CRC. However, the practical application of cfNA in the clinical diagnosis and treatment of CRC still needs to solve the problems of unstandardized detection technology, high detection cost, screening of markers with high diagnostic efficacy, and construction of multi-combination models. These challenges will provide new directions for future cfNA research. References | Related Articles | Metrics

Predictive value of inflammatory markers in colorectal cancer He Zhefeng, Wu Yiyang, Li Zhenjun, Ying Xiaojiang 2022, 49 (9):  560-563.  doi: 10.3760/cma.j.cn371439-20220520-00109 Abstract ( 148 )   HTML ( 46 )   PDF (684KB) ( 91 )   Save The cancer-associated systemic inflammatory response is one of the critical indicators of tumor progression. Serum systemic inflammatory markers, such as neutrophil-lymphocyte ratio, lymphocyte-monocyte ratio, systemic inflammation score, Glasgow prognostic score, prognostic nutritional index, C-reactive protein-albumin ratio, lymphocyte-C-reactive protein ratio, platelet-lymphocyte ratio, are associated with the prognosis of colorectal cancer （CRC）. Further research of the prognostic value of inflammatory marks in CRC can provide help for the prognosis of CRC. References | Related Articles | Metrics

Biological indexes for predicting sensitivity of preoperative concurrent chemoradiotherapy for locally advanced rectal cancer Li Zhilei, Luo Jialin 2022, 49 (9):  564-567.  doi: 10.3760/cma.j.cn371439-20220429-00110 Abstract ( 187 )   HTML ( 51 )   PDF (714KB) ( 95 )   Save After the preoperative concurrent chemoradiotherapy for local advanced rectal cancer, the down-staging of tumor is obvious, the rate of anal preservation and the local control rate are improved, and the side reactions are acceptable, but the individual clinical efficacy varies greatly. Recent studies have found that cyclooxygenase-2, G protein coupled receptor, P53 binding protein 1, fibrinogen-to-albumin ratio, pro-grammed cell death factor 4, tumor infiltrating lymphocytes, microRNA are related to the sensitivity of neoadjuvant therapy for locally advanced rectal cancer, which can predict the sensitivity of preoperative concurrent chemoradiotherapy. References | Related Articles | Metrics

Application of immune checkpoint inhibitors in the treatment of recurrent or metastatic cervical cancer Shi Yingxia, Hu Lijun, Yu Jingping 2022, 49 (9):  568-571.  doi: 10.3760/cma.j.cn371439-20220511-00111 Abstract ( 203 )   HTML ( 51 )   PDF (679KB) ( 110 )   Save Most early-stage cervical cancer patients achieve good recovery through surgical treatment and concurrent chemoradiotherapy. However, for patients with recurrent, metastatic cervical cancer, the available effective treatment is rare and the prognosis is poor. In recent years, with the development of immunotherapy, especially immune checkpoint inhibitors targeting programmed death-1 （PD-1） and its ligand （PD-L1） and cytotoxic T-lymphocyte associated protein-4 （CTLA-4）, such as pembrolizumab, nivolumab, ipilimumab, has made breakthrough progress in the treatment of recurrent or metastatic cervical cancer. References | Related Articles | Metrics