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08 January 2023, Volume 50 Issue 1 Previous Issue    Next Issue

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Original Articles

Clinical prognosis and influencing factors of patients with hypopharyngeal squamous cell carcinoma treated by salvage surgery Che Yanmin, Zhang Wanhong, Lyu Gaofeng 2023, 50 (1):  12-16.  doi: 10.3760/cma.j.cn371439-20220805-00002 Abstract ( 151 )   HTML ( 19 )   PDF (897KB) ( 51 )   Save Objective To investigate the clinical prognosis and influencing factors of patients with hypopharyngeal squamous cell carcinoma treated by salvage surgery. Methods A total of 78 patients with hypopharyngeal squamous cell carcinoma underwent salvage surgery in Jincheng Second People's Hospital of Shanxi Province from January 2017 to January 2022 were included retrospectively. Postoperative complications were recorded. Logstic regression analysis was used to evaluate the influencing factors of survival after 5 years of salvage surgery， and receiver operating characteristic （ROC） curve was drawn to analyze the predictive value of various influencing factors on the survival of patients with hypopharyngeal squamous cell carcinoma after 5 years of salvage surgery. Results The incidence of complications after salvage surgery in 78 patients was 21.79% （17/78）. The median total survival time was 20.5 months. There were 21 deaths 5 years after operation. Univariate analysis showed that the age of salvage surgery （χ2=30.25， P<0.001）， location of recurrent tumor （χ2=8.72， P=0.013）， surgical margin status （χ2=6.93， P=0.008）， depth of tumor invasion （χ2=8.31， P=0.004） and whether to accept radiotherapy （chemotherapy） after salvage operation （χ2=4.24， P=0.040） were all related to the survival of patients with hypopharyngeal squamous cell carcinoma after 5 years of salvage surgery. Multivariate analysis showed that the status of the surgical margin （OR=26.26， 95%CI： 4.58-150.62， P<0.001）， the depth of tumor invasion （OR=14.03， 95%CI： 3.04-64.70， P<0.001） and whether to accept radiotherapy （chemotherapy） after the salvage surgery （OR=7.73， 95%CI： 1.68-35.54， P=0.008） were independent factors affecting the survival of patients with hypopharyngeal squamous cell carcinoma after 5 years of salvage surgery. The ROC curve analysis showed that the sensitivity of surgical margin status， tumor invasion depth and whether to accept radiotherapy （chemotherapy） after salvage surgery to predict the survival of patients with hypopharyngeal squamous cell carcinoma after 5 years of salvage surgery were 84.15%， 79.60% and 76.43% respectively， and the specificity were 76.03%， 83.51% and 69.46% respectively. The sensitivity and specificity of combined prediction of the three indicators were 92.74% and 77.98% respectively. Conclusion The overall prognosis of hypopharyngeal squanous cell carcinoma patients after salvage surgery is satisfactory. Positive surgical margin， tumor invasion of muscle， bone tissue or lymph node capsule， and no radiotherapy or chemical therapy after salvage surgery are closely related to poor prognosis. Meanwhile， the combination of surgical margin status， tumor invasion and adjuvant treatment after salvage surgery has good efficacy in predicting postoperative survival benefit of patients. Figures and Tables | References | Related Articles | Metrics

Cardiac dosimetry analysis and quality of life evaluation of internal breast lymph node irradiation in postoperative left breast cancer Zhu Qiwei, Cui Juanjuan, Zhang Zihan, Yang Yanguang, Ge Binbin, Liu Yu, Chu Kaiyue 2023, 50 (1):  17-21.  doi: 10.3760/cma.j.cn371439-20221123-00003 Abstract ( 103 )   HTML ( 8 )   PDF (781KB) ( 53 )   Save Objective To analyze the cardiac dosimetry of lymph node irradiation in the internal breast region after left-sided breast cancer surgery and to assess its impact on patients' quality of life. Methods The clinical data of 108 patients who underwent inverse intensity modulated radiotherapy （IMRT） after left-sided breast cancer surgery in Cancer Hospital of Nantong University from May 2019 to May 2021 were collected and retrospectively analyzed， and divided into a study group （with internal breast， 55 cases） and a control group （without internal breast， 53 cases） according to whether the postoperative radiotherapy included lymph node irradiation in the internal breast region. The dosimetric indexes of planned target area （PTV）， cardiac tolerance， serum myocardial injury markers and quality of life before and after radiotherapy were compared between the two groups. Results In terms of PTV dosimetry， the conformality index （CI） of the study group and the control group were 0.73±0.07 and 0.75±0.08， the homogeneity index （HI） were 0.17±0.03 and 0.17±0.02， the Dmax were （55.69±1.02） Gy and （55.46±1.13） Gy， the Dmean were （50.54±0.23） Gy and （50.48±0.21） Gy respectively， there were no statistically significant differences （t=1.38， P=0.169； t<0.01， P>0.999； t=1.11， P=0.269； t=1.41， P=0.160）. In terms of cardiac receptivity， the Dmean of the two groups were （5.93 ± 0.32） Gy， （5.64 ± 0.30） Gy， V40 were （0.47 ± 0.10） %， （0.41 ± 0.11） %， and V30 were （2.48 ± 0.51） %， （2.06 ± 0.49） % respectively， and there were statistically significant differences （t=4.86， P<0.001； t=2.97， P=0.004； t=4.36， P<0.001）. The levels of serum troponin Ⅰ （cTnⅠ） before radiotherapy in the study group and the control group were （0.09±0.02） ng/ml and （0.09±0.01） ng/ml， creatine kinase isoenzyme MB （CK-MB） were （0.27±0.08） U/L and （0.25±0.08） U/L， myoglobin （MYo） were （3.84±1.02） μg/L and （3.69±0.97） μg/L， and brain natriuretic peptide （BNP） were （172.35±16.24） pg/ml and （169.81±15.93） pg/ml respectively， there were no statistically significant differences （t<0.01， P>0.999； t=1.30， P=0.197； t=0.78， P=0.436； t=0.82， P=0.414）. One month after radiotherapy， the levels of serum cTnⅠ in the two groups were （0.09±0.03） ng/ml and （0.09±0.02） ng/ml， CK-MB were （0.29±0.09） U/L and （0.28±0.08） U/L， MYo were （4.06±1.08） μg/L and （4.01±1.03） μg/L， and BNP were （175.13±17.09） pg/ml， （172.47±16.28） pg/ml respectively， there were no statistically significant differences （t<0.01， P>0.999； t=0.61， P=0.544； t=0.25， P=0.806； t=0.83， P=0.410）. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 （EORTC QLQ-C30） scores before radiotherapy in the study and the control groups were （60.24±5.13） points and （61.19±5.46） points， （74.12±7.20） points and （75.35±7.88） points at 1 month after radiotherapy， （77.53±7.14） points and （78.95±7.08） points at 6 months after radiotherapy， and （75.02±6.93） points and （76.68±6.74） points at 1 year after radiotherapy respectively， there were no statistically significant differences （t=0.93， P=0.353； t=0.85， P=0.399； t=1.04， P=0.302； t=1.26， P=0.210）. The EORTC QLQ-C30 scores at 1 month， 6 months， and 1 year after radiotherapy were higher than those before radiotherapy in the two groups， and there were statistically significant differences （all P<0.001）. Conclusion IMRT containing lymph node irradiation in the internal breast region after left breast cancer surgery brings a certain degree of increased cardiac dose， but it is feasible to control it within a certain range and does not affect the patients' cardiac function or quality of life in the short term. Figures and Tables | References | Related Articles | Metrics

Reviews

Application progress of domestic carbon nanoparticles suspension in sentinel lymph node biopsy for malignant tumors Wang Yixin, Cao Meng, Wang Yan 2023, 50 (1):  22-27.  doi: 10.3760/cma.j.cn371439-20220816-00004 Abstract ( 135 )   HTML ( 5 )   PDF (776KB) ( 44 )   Save Sentinel lymph nodes （SLNs） are the first lymph nodes to undergo lymph node metastasis from primary tumors， and various tracers are currently being researched in the field of SLNs. Domestic carbon nanoparticles suspension （CNP） has a good lymphatic system tropism， can indeed stain lymph nodes in a short time without entering the blood circulation， and has been widely used in various malignant tumors as a third generation specific lymphatic tracer. Although there are still many factors that affect the effectiveness of CNP tracer， CNP has the advantages of safety， high efficiency， non-radioactivity and easy operation compared with other kinds of tracers， and is expected to be a powerful means to identify SLNs metastasis of malignant tumors. Figures and Tables | References | Related Articles | Metrics

Advances in clinical diagnosis and treatment of radiation enteritis Ma Chenying, Zhao Jing, Xu Xiaoting, Qin Songbing, Zhou Juying 2023, 50 (1):  28-32.  doi: 10.3760/cma.j.cn371439-20220930-00005 Abstract ( 116 )   HTML ( 10 )   PDF (767KB) ( 81 )   Save Small bowel capsule endoscopy and double-balloon enteroscopy have become new methods for clinical diagnosis of radiation enteritis （RE）， especially for abnormal intestinal tissue. Targeted biopsy or interventional therapy is expected to achieve precision treatment of RE. The screening of molecular markers in biological samples has also become a new direction for RE diagnosis. Fecal microbiota transplantation has become one of the promising treatments for RE. In addition， mechanism studies based on traditional Chinese medicine， targeted cell death， and omics analysis provide rich strategies for the diagnosis and treatment of RE. References | Related Articles | Metrics

Research progress on the mechanism of bone marrow suppression after chemotherapy Sun Qi, Li Wenqian, Xie Youbang, Zhou Houfa 2023, 50 (1):  33-36.  doi: 10.3760/cma.j.cn371439-20221005-00006 Abstract ( 310 )   HTML ( 13 )   PDF (785KB) ( 148 )   Save As an effective treatment for cancer， chemotherapy not only removes tumor cells， but also produces obvious killing effects on proliferating cells， especially hematopoietic cells， resulting in bone marrow suppression after chemotherapy， and affecting the effects of chemotherapy drug treatment and treatment cycle. Therefore， starting from the aspects of hematopoietic microenvironment damage and hematopoietic stem cell aging， to explore the mechanism of myelosuppression after chemotherapy， which provides new ideas and theoretical support for the intervention and management of bone marrow suppression after cancer chemotherapy. References | Related Articles | Metrics

Treatment status of non-small cell lung cancer with METexon14 skipping mutation Zhang Jingxian, Su Jianfei, Wei Xueqin, Yi Dan, Li Xiaojiang 2023, 50 (1):  37-41.  doi: 10.3760/cma.j.cn371439-20220930-00007 Abstract ( 128 )   HTML ( 9 )   PDF (802KB) ( 65 )   Save MET exon14 （METex14） skipping mutation is an independent driver gene in non-small cell lung cancer （NSCLC）. About 3%-4% of NSCLC patients carry METex14 skipping mutation. These patients have poor prognoses and poor responses to traditional chemotherapy and immunotherapy. Highly selective MET inhibitors such as capmatinib， tepotinib， savolitinib have shown good efficacy and safety data in clinical trials， which bring new treatment options for patients with METex14 skipping mutations. References | Related Articles | Metrics

Research progress in reversing multidrug resistance in colorectal cancer Wang Xi, Wu Chuanqing 2023, 50 (1):  42-46.  doi: 10.3760/cma.j.cn371439-20220614-00008 Abstract ( 96 )   HTML ( 4 )   PDF (767KB) ( 56 )   Save Multidrug resistance impacts negatively upon the curative effect of chemotherapy and prognosis in colorectal cancer. There is a growing body of studies trying to develop drugs to overcome multidrug resistance against its common targets， including ATP-binding cassette proteins， metabolic enzymes， apoptotic genes， signaling pathways and genetic material， among which P-glycoprotein inhibitors and drugs disrupting DNA are deeply developed. Developing new inhibitors or combining existing inhibitors with conventional treatment are hopeful ways to overcome multidrug resistance in colorectal cancer. References | Related Articles | Metrics

Advances in the immune microenvironment in cervical cancer Ma Xueyan, Lu Lili, Sun Pengfei 2023, 50 (1):  47-50.  doi: 10.3760/cma.j.cn371439-20220715-00009 Abstract ( 154 )   HTML ( 8 )   PDF (756KB) ( 95 )   Save Lymphocyte subsets and tumor-associated macrophages， which are the primary immune cells in the tumor microenvironment， interacts with its released cytokines to form the immunological microenvironment. It has grown to be a significant factor in the recurrence and metastasis of cervical cancer and influences the effectiveness of concurrent radiotherapy and chemotherapy for the disease， which in turn influences the prognosis and outcome of patients. Immunotherapy and targeted therapy for cervical cancer based on the immune microenvironment have grown in popularity as research topics in recent years. References | Related Articles | Metrics

Study progression on mechanism of long non-coding RNAs regulating drug resistance in osteosarcoma Ma Xiaoping, Chang Junli, Sun Xingyuan, Yang Yanping 2023, 50 (1):  51-54.  doi: 10.3760/cma.j.cn371439-20221005-00010 Abstract ( 119 )   HTML ( 5 )   PDF (780KB) ( 61 )   Save Osteosarcoma is the most common primary solid bone malignancy. The main factor leading to recurrence and metastasis of osteosarcoma is resistance to chemotherapy drugs. Long non-coding RNAs can affect drug resistance in osteosarcoma by regulating epithelial-mesenchymal transition， cell autophagy， apoptosis， drug efflux， and cell cycle， suggesting that long non-coding RNAs may become new targets for drug resistance in osteosarcoma treatment. References | Related Articles | Metrics

Research progress in the pathogenesis of extramedullary disease in multiple myeloma Zhao Jianhao, Duan Yanchao 2023, 50 (1):  55-59.  doi: 10.3760/cma.j.cn371439-20220520-00011 Abstract ( 136 )   HTML ( 11 )   PDF (769KB) ( 73 )   Save Multiple myeloma（MM） lesions are mostly localized in the marrow. Extramedullary disease in multiple myeloma （MM-EMD） is defined as malignant plasma cell infiltration away from the bone marrow or adjacent soft tissue， may occur at the initial diagnosis or during the consultation. MM-EMD may be found at initial diagnosis or during the treatment. MM-EMD has high invasiveness and poor prognosis， with clinical behavior distinct from marrow-restricted myeloma. However， its pathogenesis has not been elucidated. In general， the obstructed homing of myeloma cells， enhanced invasiveness， the degradation of extracellular matrix， and increased angiogenesis capacity may be involved in the occurrence of MM-EMD. Tumor genetic abnormalities and changes in the bone marrow microenvironment play important roles in the above pathogenesis. References | Related Articles | Metrics