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08 March 2023, Volume 50 Issue 3 Previous Issue    Next Issue

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Efficacy and safety of linear accelerator-based fractionated stereotactic radiotherapy for small volume brain metastases Zhao Yongrui, Gao Ying, Chen Yidong, Xu Jiankun 2023, 50 (3):  138-143.  doi: 10.3760/cma.j.cn371439-20221214-00028 Abstract ( 272 )   HTML ( 18 )   PDF (965KB) ( 121 )   Save Objective To investigate the efficacy and safety of fractionated stereotactic radiotherapy （FSRT） based on linear accelerator for small volume brain metastases. Methods A total of 21 patients with small volume brain metastases who received FSRT from August 2020 to June 2022 were enrolled as subjects， including 45 lesions. Small-volume brain metastases were defined as ≤3 cm in diameter and ≤6 cm3 in volume， and the dose/fractionation scheme was 27-30 Gy/3 F or 30-40 Gy/5 F. Three months after radiotherpy，the efficacy of FSRT in small brain metastases and the incidence of radiation brain injury were evaluated， and the incidence of radiation brain injury in subgroup analysis was performed according to the diameter， volume， dose/fractionation scheme， biological effective dose （BED）10， and location of lesions. Results Twenty-four lesions （53.33%， 24/45） were evaluated as complete response， another 13 lesions （28.89%， 13/45） were evaluated as partial response， and in the remaining 8 lesions （17.78%， 8/45） were evaluated as stable disease. The local control rate was 100% （45/45）， the objective remission rate was 82.22% （37/45）， and the intracranial distant progression rate was 23.81% （5/21）. During the treatment and follow-up， there were 7 lesions （15.56%， 7/45） of radiation-induced brain injury， and the incidence of symptomatic radiation-induced brain injury was 11.11% （5/45）. Subgroup analysis showed that the incidence of radiation brain injury in the group with a lesion diameter of 2-3 cm was higher than that with a lesion diameter of <2 cm group， with a statistically significant difference [80.00% （4/5） vs. 7.50% （3/40）， χ2=12.69， P<0.001]； the incidence rate of radiation brain injury in the group with lesion volume of 4-6 cm3 was higher than that with lesion volume of <4 cm3 group， with a statistically significant difference [57.14% （4/7） vs. 7.89% （3/38）， χ2=7.49， P=0.006]. There was no significant difference in the incidence of radiation brain injury between the dose/fractionation scheme of lesions 27-30 Gy/3 F and 30-40 Gy/5 F [9.52% （2/21） vs. 20.83% （5/24）， χ2=0.40， P=0.527]. There was no significant difference in the incidence of radiation brain injury between the BED10<60 Gy and ≥60 Gy [28.57% （2/7） vs. 13.16% （5/38）， χ2=0.22， P=0.641]. There was no significant difference in the incidence of radiation brain injury between the lesions in the same lobe and the single or multiple lesions in different lobes [28.57% （4/14） vs. 9.68% （3/31）， χ2=1.38， P=0.240）. Conclusion FSRT based on linear accelerator is effective for small volume brain metastases. Brain metastases with the diameter <2 cm or volume <4 cm3 are associated with a lower incidence of radiation brain injury than that of lesions with the diameter of 2-3 cm or volume of 4-6 cm3. Figures and Tables | References | Related Articles | Metrics

Efficacy and safety of bevacizumab combined with capecitabine in the treatment of advanced breast cancer Zhou Ting, Xu Shaohua, Mei Lin 2023, 50 (3):  144-149.  doi: 10.3760/cma.j.cn371439-20230116-00029 Abstract ( 361 )   HTML ( 28 )   PDF (861KB) ( 161 )   Save Objective To investigate the efficacy and safety of bevacizumab combined with capecitabine in the treatment of advanced breast cancer. Methods Seventy-six patients with advanced breast cancer who were diagnosed in the Cancer Center of the People's Liberation Army Navy Anqing Hospital from August 2019 to May 2021 were selected. According to different treatment schemes， the patients were divided into the control group （using single drug capecitabine） and the test group （using bevacizumab combined with capecitabine）， with 38 cases in each group. After 4 cycles of treatment， the clinical efficacy， progression-free survival （PFS）， overall survival （OS） and adverse reactions were compared between the two groups， and the levels of vascular endothelial growth factor （VEGF）-121， VEGF-145， VEGF-165 and quality of life before and after treatment were compared. Results The objective remission rate of the test group [57.89% （22/38）] was higher than that of the control group [42.11% （16/38）]， but there was no statistically significant difference （χ2=1.89， P=0.169）； The disease control rate of the test group [81.58% （31/38）] was better than that of the control group [55.26% （21/38）]， there was a statistically significant difference （χ2=6.09，P=0.014）. The median PFS of patients in the test group （6.3 months） was longer than that in the control group （4.2 months）， there was a statistically significant difference （χ2=0.48， P=0.003）； The median OS of patients in the test group （14.8 months） was not significantly different from that in the control group （13.2 months） （χ2=0.15， P=0.704）. After treatment， the expression level of serum VEGF-121 [（201.25±18.37） ng/L vs. （276.83±20.26） ng/L]， VEGF-145 [（102.24±12.16） ng/L vs. （170.39±15.28） ng/L]， VEGF-165 [（135.08±14.32） ng/L vs. （210.53±16.09） ng/L] in the test group was lower than that in the control group， there were statistically significant differences （t=17.03， P<0.001； t=21.51， P<0.001； t=21.59， P<0.001）. After treatment， patients in the test group were assessed according to 36-item Short-Form （SF-36） physiological function [（80.18±13.96） score vs. （71.72±16.12） score]， physiological function [（67.19±30.62） score vs. （53.12±9.86） score]， physical pain [（70.01±17.97） score vs. （61.06±17.57） score]， overall health [（68.67±18.92） score vs. （57.96±20.97） score]， vitality [（78.39±19.37） score vs. （68.26±18.52） score]， social function [（82.24±19.73） score vs. （70.92±20.31） score]， the scores of emotional function [（73.81±28.86） score vs. （60.23±29.19） score] and mental health [（76.19±12.82） score vs. （70.31±12.54） score] were higher than those of the control group， there were statistically significant differences （t=2.45， P=0.017； t=2.03， P=0.046； t=2.19， P=0.031； t=2.34， P=0.022； t=2.33， P=0.023； t=2.46， P=0.016； t=2.04， P=0.045； t=2.02， P=0.047）. The incidence of adverse reactions in the test group [18.42% （7/38）] was lower than that in the control group [76.32% （29/38）]， there was a statistically significant difference （χ2=25.54， P<0.001）. Conclusion The combination of bevacizumab and capecitabine chemotherapy has a higher clinical effect on advanced breast cancer， which can significantly reduce the level of VEGF in patients， improve the quality of life of patients， with mild adverse reactions and high safety. Figures and Tables | References | Related Articles | Metrics

Analyzing and monitoring real-world clinical safety of ensartinib for the treatment of patients with ALK-positive non-small cell lung cancer Yuan Xiaobin, Wang Yang, Yang Min, Wu Pengxiang, Shen Zhilin, Ma Yongbin, Ding Lieming 2023, 50 (3):  150-156.  doi: 10.3760/cma.j.cn371439-20221230-00030 Abstract ( 238 )   HTML ( 13 )   PDF (763KB) ( 140 )   Save Objective To evaluate the safety of ensartinib in the treatment of anaplastic lymphoma kinase （ALK）-positive non-small cell lung cancer （NSCLC） in the real-world clinical setting. Methods Clinical data of 2 221 patients with ALK-positive locally advanced or metastatic NSCLC who received ensartinib treatment （225 mg/d） from December 16， 2020 to December 16， 2021 were collected and analyzed to assess drug adverse reactions in all population including elderly patients （≥ 65 years old）. Results Among the total 2 221 patients， 511 patients （23.01%） experienced adverse events， including 8 patients （0.36%） who experienced serious adverse events. Adverse events led to dose modification in 67 patients （3.02%） and discontinuation in 18 patients （0.81%）. The common adverse events were rash （407/2 221， 18.33%）， pruritus （41/2 221， 1.85%）， constipation （41/2 221， 1.85%）， and facial edema （31/2 221，1.40%）. Thirty-six patients （1.62%） experienced ≥grade 3 adverse events. After symptomatic treatment of 511 patients with adverse reactions， 50 patients （9.78%） were healed， 271 patients （53.03%） were improved， 120 patients （23.48%） were persisted， and 70 patients （13.71%） were unknown due to loss of follow-up or other reasons. Forty-three patients （1.94%） reported 57 unintended adverse reactions. Among the 599 elderly patients， 116 patients （19.37%） experienced adverse events， including 1 patient （0.17%） who experienced serious adverse events. Adverse events led to dose modification in 25 patients （4.17%） and discontinuation in 5 patients （0.83%）. The common adverse events of elderly patients were rash （88/599， 14.69%）， constipation （14/599， 2.34%）， facial edema （12/599， 2.00%）， and pruritus （10/599， 1.67%）. Twelve patients （2.00%） experienced ≥grade 3 adverse events. Among the 116 elderly patients with adverse reactions following the symptomatic treatment， 11 patients （9.48%） were healed， 58 patients （50.00%） were improved， 28 patients （24.13%） were persisted， and 19 patients （16.39%） were unknown due to loss of follow-up or other reasons. During the treatment， 1 patient （0.05%） experienced grade 2 interstitial lung disease， and no patient died due to adverse events. Conclusion Ensartinib has a favorable safety profile in the real-world populations， with the most frequent adverse events being rash， mostly mild， and low incidence of ≥grade 3 adverse events. Overall， adverse reactions were tolerable and manageable. Figures and Tables | References | Related Articles | Metrics

Construction of postoperative prognosis model for patients with colorectal cancer Huang Zhen, Zhang Caiyutian, Ke Shaobo, Shi Wei, Zhao Wensi, Chen Yongshun 2023, 50 (3):  157-163.  doi: 10.3760/cma.j.cn371439-20221123-00031 Abstract ( 246 )   HTML ( 10 )   PDF (1112KB) ( 108 )   Save Objective To screen the factors influencing overall survival （OS） of patients undergoing radical resection for colorectal cancer （CRC） and to construct a prognostic model for OS of patients after CRC. Methods The clinical data of 350 patients with stage Ⅰ-Ⅳ CRC who underwent radical resection in the People's Hospital of Wuhan University from March 2017 to December 2019 were collected retrospectively. Patients were divided into subgroups 0 （n=70）， 1 （n=172）， and 2 （n=108） according to different preoperative systemic inflammation score （SIS）. The relationship between different SIS， neutrophil to lymphocyte ratio （NLR）， lymphocyte to monocyte ratio （LMR）， systemic immune inflammation index （SII） and prognosis of CRC patients undergoing radical surgical resection were analyzed， and Cox regression models were used to perform univariate and multifactorial analyses of factors affecting patient prognosis， and column line graph models were constructed based on the results of multifactorial analyses. Results By the deadline of follow-up， 80 of 350 CRC patients died， and the 5-year OS rate was 77.14%. The 5-year survival rates of patients in SIS group 0， group 1 and group 2 were 95.71%， 79.65% and 61.11% respectively， with a statistically significant difference （χ2=30.19， P<0.001）. Statistically significant differences in age （χ2=19.40， P<0.001）， tumor site （χ2=8.18， P=0.017）， T stage （χ2=10.01， P=0.007）， TNM stage （χ2=14.80， P=0.001）， tumor diameter （χ2=13.91， P=0.001） and carcino-embryonic antigen （CEA） level （χ2=10.12， P=0.006） among patients in SIS group 0， group 1 and group 2. The 5-year OS rates of patients in the low NLR and high NLR groups were 82.67% and 56.16% respectively， with a statistically significant difference （χ2=24.96， P<0.001）； the 5-year OS rates of patients in the low LMR and high LMR groups were 66.85% and 88.17% respectively， with a statistically significant difference （χ2=22.45， P<0.001）； the 5-year OS rates of patients in the low SII and high SII groups were 86.14% and 69.02% respectively， with a statistically significant difference （χ2=14.76， P<0.001）. Univariate analysis showed that age （HR=2.58， 95%CI： 1.54-4.32， P<0.001）， T stage （HR=2.41， 95%CI： 1.24-4.68， P=0.009）， N stage （HR=3.03， 95%CI： 1.85-4.94， P<0.001）， TNM stage （HR=3.61， 95%CI： 2.15-6.04， P<0.001）， nerve invasion （HR=1.97， 95%CI： 1.27-3.08， P=0.002）， vascular invasion （HR=2.31， 95%CI： 1.49-3.59， P<0.001）， preoperative SIS 1 score（HR=5.09， 95%CI： 1.57-16.56， P=0.007）， SIS 2 score （HR=11.05， 95%CI： 3.42-35.65， P<0.001）， NLR （HR=2.97， 95%CI： 1.90-4.64， P<0.001）， LMR （HR=0.31， 95%CI： 0.19-0.52， P<0.001）， and SII （HR=2.50， 95%CI： 1.54-4.06， P<0.001） were all independent influence factors affecting the postoperative prognosis of CRC patients undergoing radical surgical resection； multivariate analysis showed that age >60 years （HR=2.27， 95%CI： 1.31-3.91， P=0.003）， TNM stage Ⅲ-Ⅳ （HR=7.08， 95%CI： 1.89-26.59， P=0.004）， and preoperative SIS 2 score （HR=4.02， 95%CI： 1.09-14.83， P=0.037） were all independent risk factors affecting the postoperative prognosis of CRC patients undergoing radical surgical resection. The nomogram model built based on the screened variables has high prediction accuracy： the C-index of the nomogram was 0.75. Conclusion Age>60 years old， TNM stage Ⅲ-Ⅳ， SIS 2 score are all independent risk factors for postoperative prognosis of colorectal cancer. The nomograph model constructed by this method has high prediction accuracy. Figures and Tables | References | Related Articles | Metrics

Reviews

Role of E2F1 and lncRNAs in the development of malignant tumors Bai Ying, Li Qi, Li Yaqin, Zhao Weihong 2023, 50 (3):  164-168.  doi: 10.3760/cma.j.cn371439-20221123-00032 Abstract ( 251 )   HTML ( 9 )   PDF (744KB) ( 107 )   Save E2F1， a nucleoprotein gene belongs to transcription factor， is closely associated with the development of malignant tumours. Long non-coding RNAs （lncRNAs） are aberrantly expressed in a variety of tumors. In studies of molecular mechanisms associated with lncRNAs and tumours， E2F1 has been identified as a key factor that can play a critical role as an upstream regulator or downstream target of lncRNAs， and even inter-regulate to form a positive feedback loop. This paper reviews the significance of the interaction between E2F1 and lncRNA in malignant tumors in recent years， and aims to provide ideas for the study of tumor mechanisms. References | Related Articles | Metrics

Role of tertiary lymphoid structures in tumor immune microenvironment regulation and anti-tumor therapy Cao Mengqing, Xu Zhiyong, Shi Yuting, Wang Kai 2023, 50 (3):  169-173.  doi: 10.3760/cma.j.cn371439-20221121-00033 Abstract ( 283 )   HTML ( 10 )   PDF (738KB) ( 145 )   Save Tertiary lymphoid structures （TLSs） is important channel for tumor immune cell infiltration. The existence of tumor TLSs is not only related to the prognosis of patients， but also to the efficacy of a variety of anti-tumor therapies. To explore the function and immunomodulatory mechanism of TLSs and its potential value as a tumor prognostic biomarker in comprehensive anti-tumor therapy will provide new ideas for follow-up research. References | Related Articles | Metrics

Research progress of primary pulmonary lymphoepithelioma-like carcinoma Ma Pengcheng, Chen Yu 2023, 50 (3):  174-178.  doi: 10.3760/cma.j.cn371439-20221121-00034 Abstract ( 263 )   HTML ( 11 )   PDF (741KB) ( 141 )   Save Primary pulmonary lymphoepithelioma-like carcinoma （PPLELC） is a distinct type of lung cancer with histological profiles similar to nasopharyngeal carcinoma. The development is associated with EBV and plasma EBV DNA has predictive value in the progression and prognosis of PPLELC. PPLELC is different from some other types of lung cancer in that it has a low mutation rate of the classical lung cancer driver genes and targeted therapy is ineffective for it. Chemotherapy combined with immunotherapy may be the best first-line treatment option for patients with advanced PPLELC. References | Related Articles | Metrics

Prognostic predictors of immunotherapy in patients with small cell lung cancer Wang Yaqian, Du Yiwei, Wang Xing, Jia Junmei 2023, 50 (3):  179-182.  doi: 10.3760/cma.j.cn371439-20230105-00035 Abstract ( 209 )   HTML ( 9 )   PDF (724KB) ( 125 )   Save The emergence of immune checkpoint inhibitors holds new promise for patients with small cell lung cancer. Studies have found that PD-L1 expression， tumor mutation burden， genomic characteristics， peripheral blood parameters and other indicators can be used as prognostic predictors in patients with small cell lung cancer receiving immunotherapy. Further exploration and evaluation of relevant predictors can provide a reference for screening patients with potential benefits of immunotherapy. References | Related Articles | Metrics

Correlation between blood lipid level and gastric cancer Ji Wei, Guan Quanlin, Chen Yarui, Jiao Fuzhi, Luo Qianwen 2023, 50 (3):  183-185.  doi: 10.3760/cma.j.cn371439-20221103-00036 Abstract ( 230 )   HTML ( 10 )   PDF (678KB) ( 93 )   Save Patients with gastric cancer often have different degrees of dyslipidemia， and the level of lipid changes is closely related to the occurrence， development and prognosis of gastric cancer. The mechanism of lipid metabolism in gastric cancer has also attracted much attention， and it may be related to the reverse cholesterol transport function， antioxidant and anti-inflammatory properties of high-density lipoprotein cholesterol. In addition， statins may reduce the risk of gastric cancer and associated mortality. Further research on the correlation between blood lipid levels and gastric cancer is aimed to provide new ideas for the future prevention and precision diagnosis and treatment of gastric cancer. References | Related Articles | Metrics

Research progress on tumor microenvironment and immune combination therapy of MSS colorectal cancer Xu Liangfu, Li Yuanfei 2023, 50 (3):  186-190.  doi: 10.3760/cma.j.cn371439-20221213-00037 Abstract ( 240 )   HTML ( 5 )   PDF (716KB) ( 140 )   Save In recent years， immunotherapy， especially immune checkpoint inhibitors， has shown obvious advantages in prolonging the survival of patients with advanced tumors， and the tumor microenvironment is one of the important factors affecting the efficacy of immunity. Patients with microsatellite-stable colorectal cancer exhibit immune responses in combination with immune checkpoint inhibitor therapy. In-depth exploration of the tumor microenvironment characteristics of microsatellite-stable colorectal cancer and the application of combined immune checkpoint inhibitor therapy can provide new ideas and directions for colorectal cancer immunotherapy. References | Related Articles | Metrics