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08 February 2025, Volume 52 Issue 2 Previous Issue    Next Issue

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Chinese expert consensus on the diagnosis and treatment of cancer-related anorexia Chinese Society of Clinical Oncology-Supportive Care and Rehabilitation Committee, Chinese Expert Consensus Working Group on Cancer-related Anorexia 2025, 52 (2):  67-78.  doi: 10.3760/cma.j.cn371439-20241223-00011 Abstract ( 60 )   HTML ( 9 )   PDF (1970KB) ( 55 )   Save Cancer-related anorexia refers to the loss or reduction of appetite caused by cancer itself and/or anticancer treatments. This condition encompasses a spectrum of symptoms， including anorexia， nausea， gustatory alteration， early satiety or dysphagia， etc. Cancer-related anorexia not only affects the nutritional status of patients， but is also closely associated with severe adverse outcomes， such as reduced survival， decreased compliance with anti-tumor treatment， increased treatment-related side effects， and diminished quality of life. Despite its widespread prevalence among patients and the urgency of its prevention and treatment， the understanding and management of both doctors and patients need to be further deepened and improved. Recognizing these challenges， Chinese Society of Clinical Oncology-Supportive Care and Rehabilitation Committee convened a panel of experts across relevant fields in China to summarize the screening and diagnosis criteria of cancer-related anorexia based on the current status of clinical practice and the existing research evidence， and to systematically propose a comprehensive management strategy. This consensus will become an important reference for clinicians in the diagnosis and treatment of cancer-related anorexia， which can better standardize the diagnosis and treatment measures for cancer-related anorexia， achieve active screening， early intervention and standardized treatment， so as to benefit more patients. Figures and Tables | References | Related Articles | Metrics

Original Article

Effects of ALKBH5 on the malignant biological behavior of esophageal squamous cell carcinoma and the related mechanism Ma Peihan, Zhang Lingmin, Li Qian, Lu Ning, Wen Hua, Zhang Mingxin 2025, 52 (2):  79-88.  doi: 10.3760/cma.j.cn371439-20240607-00012 Abstract ( 24 )   HTML ( 6 )   PDF (3611KB) ( 12 )   Save Objective To investigate the role and potential mechanism of m6A demethylase ALKBH5 in esophageal squamous cell carcinoma （ESCC）. Methods Real time fluorogenic quantitative PCR and Western blotting were used to detect ALKBH5 expression in normal esophageal epithelial cells （Het-1A） and ESCC cell lines （Eca109， KYSE30， KYSE150， KYSE410）. Transient cell lines with overexpression/knockdown of ALKBH5 （siRNA transfection was divided into si-ALKBH5-1 group and si-ALKBH5-2 group） and control cell lines were constructed. The effects of ALKBH5 on ESCC cell proliferation， migration and apoptosis were studied by MTT assay， cell scratch assay and cell apoptosis assay respectively. The differentially expressed gene was screened by the intersection of RNA sequencing （RNA-seq） and methylated RNA immunoprecipitation sequencing （MeRIP-seq） techniques， and the effect of ALKBH5 on the gene expression was detected by RT-qPCR. Results Real time fluorogenic quantitative PCR results showed that， the relative expression levels of ALKBH5 RNA in Het-1A， Eca109， KYSE30， KYSE150 and KYSE410 were 1.03±0.28， 0.46±0.02， 0.23±0.10， 0.04±0.02， 0.05±0.00， respectively， with a statistically significant difference （F=444.60， P<0.001）. Western blotting showed that， the relative expression levels of ALKBH5 protein in Het-1A， Eca109， KYSE30， KYSE150 and KYSE410 were 1.14±0.03， 0.88±0.04， 0.66±0.01， 0.69±0.01， 0.95±0.01， respectively， with a statistically significant difference （F=139.90， P<0.001）. MTT test showed that the absorbance （A） values of KYSE30 control group and ALKBH5 overexpression group were 0.86±0.01 and 1.25±0.01 after 72 hours， respectively， with a statistically significant difference （t=46.93， P<0.001）. The A values of KYSE150 control group and ALKBH5 overexpression group were 1.00±0.03 and 1.43±0.02 after 72 hours， respectively， with a statistically significant difference （t=16.80， P<0.001）. The A values of KYSE30 control group， si-ALKBH5-1 group and si-ALKBH5-2 group were 0.98±0.01， 0.85±0.02 and 0.80±0.09 after 96 hours， respectively， with a statistically significant difference （F=72.97， P<0.001）. The A values of KYSE30 control group were higher than those of si-ALKBH5-1 and si-ALKBH5-2 groups （both P<0.001）. The A values of KYSE410 control group， si-ALKBH5-1 group and si-ALKBH5-2 group were 1.28±0.02， 1.15±0.02 and 1.08±0.05 after 72 hours， respectively， with a statistically significant difference （F=16.97， P=0.003）. The A values in KYSE410 control group were higher than those in si-ALKBH5-1 group and si-ALKBH5-2 group （P=0.020； P=0.003）. The cell scratch test showed that 48 hours after scratch， the migration rates of KYSE30 cells in control group and ALKBH5 overexpression group were （27.39±0.54）% and （48.89±5.12）%， respectively， with a statistically significant difference （t=5.90， P=0.004）. The migration rates of KYSE150 cells in control group and ALKBH5 overexpression group were （39.67±0.43）% and （62.20±0.60）%， respectively， with a statistically significant difference （t=43.15， P<0.001）. The migration rates of KYSE30 cells in control group， si-ALKBH5-1 group and si-ALKBH5-2 group were （25.08±1.86）%， （18.75±1.59）% and （7.67±0.52）%， respectively， with a statistically significant difference （F=74.28， P<0.001）. The migration rates of KYSE30 cells in control group were higher than those of si-ALKBH5-1 group and si-ALKBH5-2 group （P=0.010； P<0.001）. The migration rates of KYSE410 cells in control group and si-ALKBH5-1 group， si-ALKBH5-2 group were （38.70±0.41）%， （28.27±1.01）% and （19.40±0.47）%， respectively， with a statistically significant difference （F=400.20， P<0.001）. The migration rates of KYSE410 cells in control group were higher than those of si-ALKBH5-1 group and si-ALKBH5-2 group （both P<0.001）. Apoptosis test showed that the apoptosis rates of KYSE30 cells in control group and ALKBH5 overexpression group were （9.59±0.88）% and （4.81±0.89）%， respectively， with a statistically significant difference （t=6.23， P=0.006）. The apoptosis rates of KYSE150 cells in control group and ALKBH5 overexpression group were （8.36±0.09）% and （6.42±0.19）%， respectively， with a statistically significant difference （t=12.90， P<0.001）. The apoptosis rates of KYSE30 cells in control group， si-ALKBH5-1 group and si-ALKBH5-2 group were （4.31±0.19）%， （5.72±0.30）% and （8.94±0.71）%， respectively， with a statistically significant difference （F=53.46， P<0.001）. The apoptosis rates in KYSE30 cells in control group were lower than those in si-ALKBH5-1 group and si-ALKBH5-2 group （P=0.049； P<0.001）. The apoptosis rates of KYSE410 control group， si-ALKBH5-1 group and si-ALKBH5-2 group were （4.45±0.36）%， （5.40±0.11）% and （6.64±0.15）%， respectively， with a statistically significant difference （F=43.36， P<0.001）. The apoptosis rates in KYSE410 cells in control group were lower than those in si-ALKBH5-1 group and si-ALKBH5-2 group （P=0.016； P<0.001）. The differentially expressed gene IGF2BP3 was screened by the intersection of RNA-seq and MeRIP-seq techniques， and the RT-qPCR results showed that， the relative expression levels of IGF2BP3 in KYSE30 were 1.01±0.10 and 1.41±0.10 in control group and ALKBH5 overexpression group， respectively， with a statistically significant difference （t=4.06， P=0.015）. The relative expression levels of IGF2BP3 in KYSE150 were 1.00±0.10 and 1.94±0.24 in control group and ALKBH5 overexpression group， respectively， with a statistically significant difference （t=5.08， P=0.007）. The relative expression levels of IGF2BP3 in KYSE410 were 1.01±0.14， 0.67±0.04 and 0.41±0.04 in control group， si-ALKBH5-1 group and si-ALKBH5-2 group， respectively， with a statistically significant difference （F=24.36， P=0.001）. The relative expression levels of IGF2BP3 in KYSE410 control group were higher than those in si-ALKBH5-1 group and si-ALKBH5-2 group （P=0.017； P=0.001）. Conclusions ALKBH5 is underexpressed in ESCC cell lines， but the overexpression of ALKBH5 can promote the proliferation and migration of ESCC cells and inhibit cell apoptosis， which may be related to some negative feedback regulation mechanism. IGF2BP3 may be the downstream target of ALKBH5. Figures and Tables | References | Related Articles | Metrics

Predictive value of MRI combined with serum lncRNA KCNQ1OT1， miR-204-5p for axillary lymph node metastasis of breast cancer Wang Zhibao, Li Guangxian, Zhang Xinxin, Cui Wei, Zhang Wei 2025, 52 (2):  89-93.  doi: 10.3760/cma.j.cn371439-20240727-00013 Abstract ( 16 )   HTML ( 1 )   PDF (1024KB) ( 7 )   Save Objective To investigate the value of MRI combined with serum long non-coding RNA （lncRNA） KCNQ1OT1 and microRNA-204-5p （miR-204-5p） in predicting axillary lymph node metastasis in breast cancer patients. Methods A total of 70 patients with breast cancer who were surgically diagnosed in the No.2 Hospital of Baoding， Hebei Province from January 2020 to December 2022 were selected as the study objects. Patients were divided into metastatic group （n=31） and non-metastatic group （n=39） according to the status of lymph node metastasis. The MRI features and the levels of serum lncRNA KCNQ1OT1 and miR-204-5p were compared between the two groups. Receiver operator characteristic （ROC） curve was used to evaluate the predictive efficacy of the three detections alone and in combination for axillary lymph node metastasis in breast cancer. Results There were statistically significant differences in tumor maximum diameter （χ2=4.28， P=0.039） and Ki-67 expression （χ2=10.88， P=0.001） between the metastatic and non-metastatic groups. There were statistically significant differences between the breast cancer axillary lymph node metastatic group and the non-metastatic group in the mode of internal reinforcement type （χ2=6.60，P=0.037）， peripheral vessel diameter（t=4.33，P<0.001）， number of peripheral vessel roots（t=4.38，P<0.001）， apparent diffusion coefficient（t=3.59，P=0.001）， and MRI lymph node status（χ2=29.70，P<0.001）. The level of serum lncRNA KCNQ1OT1 in metastatic group was higher than that in non-metastatic group （1.41±0.32 vs. 0.99±0.18， t=6.94， P<0.001）， and the level of miR-204-5p was lower than that in non-metastatic group （0.72±0.17 vs. 1.03±0.21， t=6.66， P<0.001）. Bioinformatics analysis showed that miR-204-5p may have a targeting relationship with lncRNA KCNQ1OT1. ROC curve analysis showed the area under the curve of MRI features， serum levels of lncRNA KCNQ1OT1， miR-204-5p and their combined detection to predict lymph node metastasis of breast cancer patients were 0.823， 0.858， 0.843， 0.946， respectively. The predictive efficacy of the combined detection was better than that of MRI features and serum lncRNA KCNQ1OT1 and miR-204-5p levels alone （Z=3.29， P=0.001； Z=2.07， P=0.038； Z=2.23， P=0.026）. Conclusions Serum lncRNA KCNQ1OT1 level is up-regulated and the level of miR-204-5p is down-regulated in patients with axillary lymph node metastasis of breast cancer. And the combination of MRI features with serum lncRNA KCNQ1OT1 and miR-204-5p has high predictive efficacy in predicting lymph node metastasis in breast cancer patients. Figures and Tables | References | Related Articles | Metrics

Expression and clinical significance of DHCR7 in gastric cancer based on bioinformatics analysis Ji Haitao, Wang Yanfeng, Liu Yongcheng, Hao Nan 2025, 52 (2):  94-100.  doi: 10.3760/cma.j.cn371439-20240727-00014 Abstract ( 21 )   HTML ( 3 )   PDF (1798KB) ( 9 )   Save Objective To explore the expression of 7-dehydrocholesterol reductase （DHCR7） in gastric cancer using bioinformatics methods and its relationship with clinical pathological characteristics and prognosis of gastric cancer patients. Methods DHCR7 expression in gastric cancer was analyzed using the UALCAN database； DHCR7 mRNA expression and its relationship with the prognosis of gastric cancer patients were analyzed using the Kaplan-Meier plotter database； The expression of DHCR7 and its correlation with tumor immune infiltration level were analyzed using Sangerbox 3.0 and TIMER database； Real-time fluorescence quantitative PCR was used to detect the expression of DHCR7 mRNA in gastric cancer tissues and adjacent tissues； immunohistochemical staining was conducted to detect the DHCR7 expression in gastric cancer tissues and adjacent tissues and its correlation with clinical pathological parameters； Receiver operator characteristic （ROC） curve was used to evaluate the efficacy of DHCR7 expression in the diagnosis of gastric cancer. Results The analysis results of the UALCAN database showed that there were statistically significant differences in DHCR7 mRNA expression among gastric cancer patients of different genders （χ2=18.15， P<0.001）， grades （χ2=16.32， P<0.001）， and TP53 mutation status （χ2=20.12， P<0.001）. Survival analysis showed that the 10-year overall survival （OS） rate （HR=1.55， 95%CI： 1.31-1.84， P<0.001）， 10-year progression free survival （PFS） rate （HR=1.67， 95%CI： 1.36-2.05， P<0.001）， and 10-year post progression survival （PPS） rate （HR=1.81， 95%CI： 1.43-2.28， P<0.001） of gastric cancer patients with high DHCR7 expression were significantly lower than those with low DHCR7 expression. Immune infiltration analysis showed the expression of DHCR7 was negatively correlated with the comprehensive score （r=-0.51， P<0.001）， stromal cell score （r=-0.48， P<0.001）， immune cell score （r=-0.45， P<0.001）， CD4+ T cells （r=-3.01， P<0.001）， macrophages （r=-0.40， P<0.001）， neutrophils （r=-0.32， P<0.001）， and dendritic cells （r=-0.37， P<0.001） infiltration levels in gastric cancer， and positively correlated with the purity of gastric cancer cells （r=0.15， P<0.001）. The qRT-PCR results showed that compared with adjacent tissues （1.86±0.51）， the expression of DHCR7 in gastric cancer tissues （3.43±0.13） was significantly upregulated， with a statistically significant difference （t=42.89， P<0.001）. The relative expression level of DHCR7 in normal gastric mucosal cells GES-1 was 1.06±0.19， and the relative expression levels in four types of gastric cancer cells （HGC-27， AGS， SNU-1， and SGC-7901） were 2.40±0.26， 1.88±0.11， 1.51±0.04， and 2.63±0.20， respectively，there were statistically significant differences in the expression of DHCR7 among the five types of cells （F=38.34， P<0.001）， and the relative expression level of DHCR7 in normal gastric mucosal cells was statistically significant different compared to the four types of gastric cancer cells mentioned above （P=0.002； P=0.003； P=0.017； P<0.001）；The immunohistochemical results showed that the high expression rate of DHCR7 in gastric cancer tissues was 80.0% （96/120）， which was significantly higher than that in adjacent tissues （68.3%） （82/120） （χ2=56.84， P<0.001）. There were statistically significant differences in tumor maximum diameter （χ2=40.17， P<0.001）， histological grade （χ2=16.20， P<0.001） and pTNM stage （χ2=16.99， P<0.001） between patients with high and low DHCR7 expression. The ROC curve results showed that the area under the curve （AUC） of DHCR7 expression level for diagnosing gastric cancer were 0.76 （based on TCGA database， 95%CI： 0.68-0.83， P<0.001） and 0.97 （120 clinical samples of gastric cancer， 95%CI： 0.95-0.99， P<0.001）， respectively. Conclusions DHCR7 is highly expressed in gastric cancer and closely associated with poor prognosis in patients， which may be a novel biomarker for the diagnosis and prognosis of gastric cancer. Figures and Tables | References | Related Articles | Metrics

Predictive analysis of NLR and TNF-α level for the efficacy of TACE combined with microwave ablation therapy in patients with massive liver cancer Xing Hui, Tan Ying, Wang Xiuzhen, Li Rui, Liu Xia 2025, 52 (2):  101-106.  doi: 10.3760/cma.j.cn371439-20240522-00015 Abstract ( 17 )   HTML ( 0 )   PDF (995KB) ( 10 )   Save Objective To explore the predictive value of neutrophil-to-lymphocyte ratio （NLR） and tumor necrosis factor -α （TNF-α） level on the therapeutic effect of transcatheter arterial chemoembolization （TACE） combined with microwave ablation in patients with massive liver cancer. Methods The medical records of 106 patients with massive liver cancer who underwent TACE combined with microwave ablation treatment in the Affiliated Hospital of Weifang Medical University from February 2020 to February 2023 were retrospectively analyzed. The efficacy was evaluated 6 weeks after surgery， and the patients were divided into remission group and non-remission group according to the therapeutic effect. The levels of NLR and TNF-α in the two groups were detected before surgery， 3 days after surgery and 7 days after surgery. Point two column correlation was used to analyze the relationship between the levels of NLR and TNF-α in different time periods and the therapeutic effect of TACE combined with microwave ablation in patients with massive liver cancer. The receiver operator characteristic （ROC） curve was drawn to analyze the predictive value of NLR and TNF-α levels in different time periods for the therapeutic effect of TACE combined with microwave ablation in patients with massive liver cancer. Results Six weeks after surgery， out of 106 patients with massive liver cancer， 13 achieved complete remission， 48 achieved partial remission， 20 experienced disease progression， and 25 remained stable. The overall remission rate was 57.55% （61/106）. Before surgery， the levels of NLR [（2.26±0.13） vs. （2.43±0.12）， t=6.87， P<0.001] and TNF-α [（36.20±4.38） pg/ml vs. （42.74±5.74） pg/ml， t=6.66， P<0.001] in the remission group （n=61） were lower than those in the non-remission group （n=45）， with statistically significant differences. At 3 days after surgery， there were no statistically significant difference in the levels of NLR [（6.16±3.22） vs. （6.22±3.30）， t=0.09， P=0.925] or TNF-α [（48.84±7.22） pg/ml vs. （49.13±7.34） pg/ml， t=0.20， P=0.840] between the remission group and the non-remission group. At 7 days after surgery， the levels of NLR [（2.60±0.18） vs. （2.82±0.26）， t=5.15， P<0.001] and TNF-α [（38.20±6.30） pg/ml vs. （45.57±5.79） pg/ml， t=6.16， P<0.001] in the remission group were lower than those in the non-remission group， with statistically significant differences. There were statistically significant differences in NLR and TNF-α levels before surgery， 3 days and 7 days after surgery between the remission group and the non-remission group （F=82.43，P<0.001； F=54.45，P<0.001； F=76.23，P<0.001； F=15.61，P<0.001）. Further pair-to-pair comparison showed that the levels of NLR and TNF-α were higher in both groups 3 and 7 days after surgery than before surgery， but the levels of NLR and TNF-α were lower in both groups 7 days after surgery than 3 days after surgery， with statistically significant differences （all P<0.005）. Point two column correlation analysis showed that NLR level， TNF-α level and the efficacy of TACE combined with microwave ablation in patients with massive liver cancer were significantly positively correlated before and 7 days after surgery （r=0.42， P<0.001； r=0.49， P<0.001； r=0.43， P<0.001； r=0.46， P<0.001）. ROC curve showed that the area under the curve （AUC） of NLR and TNF-α alone in predicting the efficacy of TACE combined with microwave ablation in patients with massive liver cancer before and 7 days after surgery was 0.750 （95%CI： 0.656-0.844）， 0.788 （95%CI： 0.699-0.877）， 0.751 （95%CI： 0.652-0.850）， 0.788 （95%CI： 0.700-0.876）， respectively. The AUC of combined prediction of NLR and TNF-α before and 7 days after surgery were 0.818 （95%CI： 0.736-0.900） and 0.813 （95%CI： 0.730-0.897）， respectively. There were no statistically significant differences in the AUC values of NLR and TNF-α alone or in combination for predicting the therapeutic effect of TACE combined with microwave ablation in patients with massive liver cancer before and 7 days after surgery （all P>0.05）. Conclusions The levels of NLR and TNF-α before and 7 days after surgery are related to the effect of TACE combined with microwave ablation in patients with massive liver cancer， and the combination of NLR and TNF-α levels before and 7 days after surgery has certain value in predicting the effect of TACE combined with microwave ablation in patients with massive liver cancer. Figures and Tables | References | Related Articles | Metrics

Review

Mechanism of Breg cell in tumor immune escape and related therapeutic targets Wang Xibo, Tian Baowen, Chen Shiqiao 2025, 52 (2):  107-112.  doi: 10.3760/cma.j.cn371439-20240522-00016 Abstract ( 46 )   HTML ( 5 )   PDF (838KB) ( 22 )   Save Tumor cells can escape the surveillance and attack of the immune system， namely immune escape. In recent years， regulatory B （Breg） cell have attracted much attention in researches about tumor immunity. Breg cell plays an important role in tumor immune escape by secreted various cytokines. Mechanistic progress has been made in this field， which provides more targets and ideas for tumor clinical treatment. However， the phenotypic classification of Breg cells and its complex mechanism in tumor immunity still need to be systematically analyzed. References | Related Articles | Metrics

Research progress of clock gene Period family in head and neck squamous cell carcinoma Ye Yongying, Zou Yan, Chen Tianming, Wu Weili 2025, 52 (2):  113-118.  doi: 10.3760/cma.j.cn371439-20240927-00017 Abstract ( 17 )   HTML ( 2 )   PDF (828KB) ( 5 )   Save Head and neck squamous cell carcinoma （HNSCC） is the most common type of heterogeneous malignant tumor. Over 60% of HNSCC patients are at locally advanced stage at the time of diagnosis. Despite the emergence of advanced diagnosis and treatment measures， the prognosis of patients with recurrent or metastatic HNSCC remains poor. The Period （PER） gene family is an important member of the circadian clock genes， with family members PER1， PER2， and PER3 showing differential expression in HNSCC， participating in biological processes such as proliferation， apoptosis， invasion， or metastasis of tumor cells. In most studies， they exhibit anti-cancer effects and are closely related to the tumor microenvironment， immunotherapy， chronotherapy， etc.， making them potential biomarkers. A comprehensive analysis of the expression of PER gene family in HNSCC， its biological role in the occurrence and development of tumor and the corresponding molecular biological mechanism is helpful to explore its potential application value in the diagnosis and treatment of HNSCC. References | Related Articles | Metrics

Progress of clinical application of circulating tumor cells in lung cancer Chen Danlei, Deng Junjun, Li Miao 2025, 52 (2):  119-123.  doi: 10.3760/cma.j.cn371439-20240607-00018 Abstract ( 16 )   HTML ( 4 )   PDF (820KB) ( 5 )   Save Lung cancer is the cancer with the highest incidence of morbidity and mortality in the world， and the number of lung cancer cases in China is also increasing year by year， which seriously threatens the life and health of human beings. Circulating tumor cells （CTCs） refer to the tumor cell that falls off from primary tumor tissue or metastatic focus into the peripheral blood， which is the key to tumor metastasis. Currently， there are various methods for CTCs testing， each with its own advantages and disadvantages. In recent years， there have been numerous studies on the application of CTCs in lung cancer around the world. Further exploration of the progress of clinical application of CTCs in lung cancer can provide a new basis for the role of CTCs in early diagnosis， efficacy assessment and prognostic monitoring of lung cancer. References | Related Articles | Metrics

Current status and advances in immunotherapy for advanced renal cell carcinoma Chen Ruyan, Fu Zhenming 2025, 52 (2):  124-128.  doi: 10.3760/cma.j.cn371439-20240820-00019 Abstract ( 24 )   HTML ( 4 )   PDF (815KB) ( 6 )   Save Approximately 25% of renal cell carcinoma （RCC） patients are already at an advanced stage at the time of initial diagnosis. Additionally， nearly 30% of patients with localized RCC eventually develop distant metastases even after undergoing radical surgery. Traditional chemotherapy and radiotherapy have shown limited effect on advanced RCC treatment， resulting in poor prognosis， with a 5-year survival rate of only about 8%. In recent years， immunotherapy for RCC has become a significant focus of research. With further research， the treatment options for advanced RCC have become increasingly diverse. The exploration of the current clinical applications and research advancements in immunotherapy for advanced RCC could offer medical evidence for optimizing treatment strategies for advanced RCC patients. References | Related Articles | Metrics