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08 December 2022, Volume 49 Issue 12 Previous Issue    Next Issue

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Original Articles

Analysis on the incidence and risk factors of pneumonia in patients with lung cancer receiving thoracic radiotherapy and immunotherapy Huang Huayu, Song Qibin, Gong Hongyun, Song Jia 2022, 49 (12):  718-723.  doi: 10.3760/cma.j.cn371439-20220726-00141 Abstract ( 236 )   HTML ( 16 )   PDF (776KB) ( 164 )   Save Objective To analyze the incidence, risk factors and occurrence time of radiation pneumonia （RP） and immune checkpoint inhibitor-related pneumonia （CIP） in patients with lung cancer and lung metastatic cancer who received both thoracic radiotherapy and immunotherapy. Methods The clinicopathological data of 137 patients with lung cancer and lung metastatic cancer receiving thoracic radiotherapy and at least one cycle of immunotherapy from January 2019 to January 2022 in Renmin Hospital of Wuhan University were retrospectively analyzed. The occurrence of RP and CIP was determined according to the clinical symptoms and thin-slice chest CT. The risk factors of symptomatic RP were evaluated by univariate and multivariate analyses of clinical data and treatment plan. The relationship between the occurrence time of symptomatic RP and the sequence of thoracic radiotherapy and immunotherapy was compared. Results In the 137 patients with lung cancer and lung metastatic cancer who received both thoracic radiotherapy and immunotherapy, symptomatic RP was observed in 42 patients （30.7%）, including grade 2 RP in 33 patients （24.1%）, grade 3 RP in 6 patients （4.4%）, grade 4 RP in 1 patient （0.7%）, and grade 5 RP in 2 patients （1.5%）. The incidence of symptomatic RP was 40.0% （28/70） in patients who received thoracic radiation concurrent with immunotherapy and 20.9% （14/67） in non-synchronous patients, and the incidence of severe RP was 10.0% （7/70） and 3.0% （2/67） respectively. CIP was observed in 11 （8.0%） of 137 patients, including grade 2 CIP in 4 patients （2.9%）, grade 3 CIP in 6 patients （4.4%）, grade 5 CIP in 1 patient （0.7%）. There were 54.5% （6/11） of CIP patients with prior or concurrent symptomatic RP. Univariate analysis showed that smoking history （χ2=9.85, P=0.002）, chronic obstructive pulmonary disease （COPD） history （χ2=31.34, P<0.001）, thoracic radiotherapy concurrent with immunotherapy （χ2=5.88, P=0.015）, total radiotherapy dose （χ2=8.57, P=0.003） were associated with symptomatic RP. Multivariate logistic regression analysis showed that COPD history （OR=9.96, 95%CI: 3.40-29.14, P<0.001）, thoracic radiotherapy concurrent with immunotherapy （OR=2.84, 95%CI: 1.15-7.00, P=0.024）, and total radiotherapy dose ≥60 Gy （OR=4.76, 95%CI: 1.68-13.50, P=0.003） were independent risk factors for symptomatic RP. RP occurred earlier in patients who received immunotherapy before thoracic radiotherapy [68.5 d （47.0 d, 101.8 d）] than in patients who received immunotherapy after thoracic radiotherapy [117.5 d （79.0 d, 166.3 d）], with a statistically significant difference （Z=2.54, P=0.010）. Conclusion The incidence of symptomatic RP is high in patients who receive both thoracic radiotherapy and immunotherapy. The history of COPD, thoracic radiotherapy concurrent with immunotherapy, and the total radiotherapy dose ≥60 Gy are independent influencing factors of symptomatic RP in patients with thoracic radiotherapy combined with immunotherapy. Symptomatic RP occurs earlier in patients who receive immunotherapy before thoracic radiotherapy than in patients who receive immunotherapy after thoracic radiotherapy. Figures and Tables | References | Related Articles | Metrics

Level and diagnostic value of serum insulin-like growth factor binding protein 7 in patients with gastric cancer Liu Cantong, Huang Xinyi, Chen Liuyi, Chen Hao, Peng Yuhui, Huang Xuchun 2022, 49 (12):  724-728.  doi: 10.3760/cma.j.cn371439-20220609-00142 Abstract ( 206 )   HTML ( 11 )   PDF (1091KB) ( 124 )   Save Objective To investigate the serum level of insulin-like growth factor binding protein 7 （IGFBP7） in patients with gastric cancer and its diagnostic significance. Methods A total of 100 gastric cancer patients （gastric cancer group） including 49 patients with early gastric cancer （early gastric cancer group）, who were hospitalized in Sun Yat-sen University Cancer Center from May to December 2019 were selected as the research subjects, and 94 physical examination subjects during the same period were selected as the normal control group. The levels of serum IGFBP7 were detected by enzyme-linked immunosorbent assay. At the same time, the laboratory carcinoembryonic antigen （CEA） test results were collected. The relationships between the level of serum IGFBP7 and the clinicopathological features of gastric cancer patients were analyzed. The diagnostic value was evaluated by receiver operating characteristic （ROC） curve. Results The level of serum IGFBP7 in the gastric cancer group was （1.595±0.159） ng/ml, and that in the normal control group was （1.850±0.328） ng/ml, with a statistically significant difference （t=-0.26, P<0.001）, and among them, the level of serum IGFBP7 in the early gastric cancer group was （1.601±0.153） ng/ml, and there was a statistically significant difference compared with the normal control group （t=-0.26, P<0.001）. The level of serum CEA in the gastric cancer group was 2.230 （2.043） ng/ml, and that in the normal control group was 1.805 （1.020） ng/ml, with a statistically significant difference （U=0.45, P=0.004）, and among them, the level of serum CEA in the early gastric cancer group was 2.220 （1.780） ng/ml, and there was a statistically significant difference compared with the normal control group （U=0.53, P=0.002）. There were no significant correlations between IGFBP7 and CEA level （χ2=0.36, P=0.547）, age （χ2=0.16, P=0.688）, gender （χ2=0.97, P=0.326）, depth of invasion （χ2=0.30, P=0.585）, lymph node metastasis （χ2=0.17, P=0.684）, distant metastasis （χ2=0.09, P=0.767） and TNM stage （χ2=0.38, P=0.537）. ROC curve analysis showed that the area under the curve （AUC） of IGFBP7 for gastric cancer diagnosis was 0.84 （95%CI: 0.78-0.89）, the AUC of CEA for gastric cancer diagnosis was 0.62 （95%CI: 0.54-0.70）, and there was a statistically significant difference （Z=4.33, P<0.001）. The AUC of IGFBP7 combined with CEA for gastric cancer diagnosis was 0.85 （95%CI: 0.79-0.90）. Compared with CEA alone, there was a statistically significant difference （Z=4.97, P<0.001）. Compared with IGFBP7 alone, there was no statistically significant difference （Z=1.41, P=0.159）. The AUC of IGFBP7 in the diagnosis of early gastric cancer was 0.84 （95%CI: 0.78-0.91）, the AUC of CEA in the diagnosis of early gastric cancer was 0.66 （95%CI: 0.56-0.75）, and there was a statistically significant difference （Z=3.11, P=0.002）. The AUC of IGFBP7 combined with CEA in the diagnosis of early gastric cancer was 0.85 （95%CI: 0.78-0.91）. Compared with CEA alone, there was a statistically significant difference （Z=3.54, P<0.001）. Compared with IGFBP7 alone, there was no statistically significant difference （Z=1.19, P=0.232）. Conclusion The serum IGFBP7 level of gastric cancer patients is lower than that of normal controls. Compared with CEA, serum IGFBP7 has better diagnostic value for gastric cancer. Figures and Tables | References | Related Articles | Metrics

Exploration of the preponderant population for primary tumor resection of asymptomatic metastatic colorectal cancer Zeng Hai, Zhang Weijia, Wang Qian, Zhang Fan, Li Shuang 2022, 49 (12):  729-734.  doi: 10.3760/cma.j.cn371439-20220726-00143 Abstract ( 176 )   HTML ( 5 )   PDF (968KB) ( 77 )   Save Objective To explore the population who benefit from primary tumor resection （PTR） of asymptomatic metastatic colorectal cancer （mCRC）. Methods The clinicopathological data of 121 patients with asymptomatic mCRC with unresectable liver metastases treated in the First Affiliated Hospital of Yangtze University from January 2014 to January 2019 were retrospectively analyzed. Kaplan-Meier method was used to draw the survival curve accompanied with log-rank test. Cox regression model was used to analyze the prognostic factors. Results The median overall survival （OS） of 121 mCRC patients was 20 months, and the 3- and 5-year survival rates were 34.71% and 10.74%. The median OS of PTR and non-PTR patients were 21 months and 18 months respectively, with no statistically significant difference （χ2=0.79, P=0.375）. In 65 mCRC patients received targeted therapy, the median OS of PTR and non-PTR patients were 25 months and 28 months respectively, with no statistically significant difference （χ2=1.65, P=0.199）. In 84 patients with mCRC of the left colon and rectum, the median OS of PTR and non-PTR patients were 24 months and 18 months respectively, with a statistically significant difference （χ2=4.25, P=0.039）. In 37 patients with mCRC of the right colon, the median OS of PTR and non-PTR patients were 19 months and 17 months respectively, with no statistically significant difference （χ2=0.18, P=0.675）. In 64 mCRC patients who received liver local treatment, the median OS of PTR and non-PTR patients were 36 months and 17 months respectively, with a statistically significant difference （χ2=12.60, P<0.001）. In 57 mCRC patients who did not receive liver local treatment, the median OS of PTR and non-PTR patients were 15 months and 17 months respectively, with no significant difference （χ2=0.58, P=0.445）. Univariate analysis showed that the location of the primary tumor （HR=0.51, 95%CI: 0.25-0.76, P=0.025）, the degree of differentiation （HR=1.46, 95%CI: 1.13-9.45, P=0.004）, the maximum diameter of the liver metastases （HR=1.86, 95%CI: 1.35-4.60, P=0.012）, the level of serum carcinoembryonic antigen （HR=3.55, 95%CI: 2.55-8.45, P<0.001）, local treatment of liver metastases （HR=0.35, 95%CI: 0.19-0.93, P<0.001） were influencing factors for OS of asymptomatic mCRC patients with unresectable liver metastases. Multivariate analysis showed that the primary sites of the left colon and rectum （HR=0.43, 95%CI: 0.25-0.93, P=0.039）, local treatment of liver metastases （HR=0.78, 95%CI: 0.27-0.86, P<0.001） were independent influencing factors for OS of asymptomatic mCRC patients with unresectable liver metastases. Conclusion Asymptomatic mCRC patients with unresectable liver metastases with primary sites of the left colon and rectum and local treatment of liver metastases can benefit from PTR. Figures and Tables | References | Related Articles | Metrics

Reviews

Effects of radiation-associated miRNA in radiotherapy for breast cancer Jin Jiahui, Chen Cunhai, Ma Xuezhen 2022, 49 (12):  735-738.  doi: 10.3760/cma.j.cn371439-20220805-00144 Abstract ( 209 )   HTML ( 17 )   PDF (786KB) ( 150 )   Save Breast cancer is the most common cancer in women, and radiotherapy is an important method of its treatment. The outcome of radiotherapy greatly depends on radiosensitivity of cancer cells. The key pathways of microRNAs （miRNAs） involved in breast cancer radiotherapy response include DNA damage repair, apoptosis, cell cycle arrest, autophagy and related signaling pathways. This article reviews the role of miRNAs in regulating the response of breast cancer to radiotherapy and related signaling pathways. To explore the role of miRNAs in regulating the treatment response of breast cancer to radiotherapy and related signaling pathways, it can provide reference for miRNAs to be used as an indicator to evaluate the diagnosis, prognosis and radiotherapy efficacy of breast cancer. References | Related Articles | Metrics

Predictive value of biomarkers in immunotherapy of advanced non-small cell lung cancer Lei Yan, Zhang Gehong 2022, 49 (12):  739-744.  doi: 10.3760/cma.j.cn371439-20220816-00145 Abstract ( 301 )   HTML ( 33 )   PDF (819KB) ( 217 )   Save Immunotherapy, especially immune checkpoint inhibitor, has revolutionized the treatment mode of advanced non-small cell lung cancer. The predictive effect of programmed death-ligand 1 and tumor mutation burden for treatment response has been fully proved. Neither of which can avoid some problems, including tumor heterogeneity, inconsistent detection methods and identification standards. The studies have found that some novel biomarkers are related to the efficacy of immunotherapy, such as mismatch repair deficiency and microsatellite instability, driver gene mutation, routine peripheral blood biomarkers, circulating tumor cells, circulating tumor DNA and so on. Further research on the predictive value of biomarkers in tumor tissue and peripheral blood in immunotherapy of advanced non-small cell lung cancer can provide a reference for instituting clinical treatment plan. References | Related Articles | Metrics

Application of single-cell RNA-seq technology in the auxiliary diagnosis and treatment of esophageal squamous cell carcinoma Xiang Guangyu, Li Jiahe, Ji Gang, Guo Xin, Lu Qiang 2022, 49 (12):  745-748.  doi: 10.3760/cma.j.cn371439-20220816-00146 Abstract ( 180 )   HTML ( 10 )   PDF (783KB) ( 113 )   Save Single-cell RNA-seq （scRNA-seq） can describe the changes of gene expression in a single tumor cell. And it can reveal the status and function of tumor cells, and capture the extensive transcriptome heterogeneity in the cell population. The application of scRNA-seq can monitor the specific highly expressed genes in esophageal squamous cell carcinoma （ESCC）, and it can also monitor genes related to radio chemotherapy resistance in tumor cells, which is helpful to provide more accurate auxiliary diagnosis for ESCC. Besides, scRNA-seq can evaluate the recurrence risk and survival time of patients. An in-depth study of the relationship between tumor cells and tumor microenvironment in ESCC will provide a theoretical basis for developing a new immunotherapy scheme for ESCC. References | Related Articles | Metrics

Exosomes and liver metastasis of colorectal cancer Li Hongyu, Wu Xinlin 2022, 49 (12):  749-753.  doi: 10.3760/cma.j.cn371439-20220816-00147 Abstract ( 154 )   HTML ( 9 )   PDF (774KB) ( 101 )   Save Colorectal cancer is one of the most common malignant tumors, liver metastasis is the main factor affecting the prognosis of patients with colorectal cancer. Exosomes as lipid bilayer microvesicles widely existing in a variety of biological fluids, can promote the occurrence and development of colorectal cancer liver metastasis by inducing M2 macrophage polarization, regulating the activity of cancer-associated fibroblasts and enhancing drug resistance of tumor cells, plays an important role in the diagnosis, treatment and prognosis of colorectal cancer liver metastasis. To explore the mechanism of exosomes in colorectal cancer liver metastasis and related treatment progress, in order to find new drug targets to improve the prognosis of patients. References | Related Articles | Metrics

Screening and treatment progression of elderly cervical cancer Wang Yue, Wu Qiong, Xu Yuan, Gong Wei, Xu Xiaoting 2022, 49 (12):  754-758.  doi: 10.3760/cma.j.cn371439-20220816-00148 Abstract ( 132 )   HTML ( 17 )   PDF (768KB) ( 115 )   Save The prognosis of elderly patients with cervical cancer is poor. Currently, some studies show that elderly women still need regular screening for cervical cancer, and clinical screening methods with higher sensitivity for elderly women need to be explored. In terms of treatment, fewer elderly patients choose surgery, and radiotherapy is the most commonly used treatment. However, there is still no conclusion on whether chemotherapy, targeted therapy and immunological therapy should be added during radiotherapy. References | Related Articles | Metrics

Research progress of ferroptosis in the treatment of leukemia Zhou Xinyu, Jia Xiuhong 2022, 49 (12):  759-762.  doi: 10.3760/cma.j.cn371439-20220816-00149 Abstract ( 179 )   HTML ( 10 )   PDF (757KB) ( 159 )   Save Leukemia is a group of hematologic malignancie. Ferroptosis is a novel of cell death caused by iron-dependent lipid peroxidation accumulation, which participates in the occurrence and development of leukemia. Activation of different regulatory sites in the ferroptosis pathway can promote the death of leukemia cells. Therefore, it can provide a new direction for the treatment of leukemia by inducing ferroptosis of cells. References | Related Articles | Metrics