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Objective To explore the correlation of the pan-immune-inflammation value (PIV) and the prognosis of patients with resectable colorectal cancer (CRC) and establish a predictive model. Methods A total of 753 patients who underwent primary lesion resection and were pathologically diagnosed with CRC were enrolled. They were randomly divided into training (n=527) and test (n=226) cohorts. The best cutoff value of PIV was determined by the time-dependent receiver operator characteristics curve, and patients were divided into high- and low-level groups to analyze the relationship between the high- and low-level groups of PIV and the clinicopathological characteristics and survival of patients. Chi-square test, Kaplan-Meier survival analysis, and Cox regression analysis were used to evaluate the prognosis. The accuracy of the model was evaluated by C index and Brier score. Results In the univariate model of overall survival (OS), high (> 231) baseline PIV (HR=1.627; 95%CI: 1.155-2.292, P=0.005) suggested that PIV level might be an independent prognostic factor for OS. The nomogram plotted according to PIV had a C index of 0.823. Its calibration curve showed good agreement between predicted and observed outcomes for one- and three-year OS probabilities, with Brier score of 0.035 and 0.068 for OS, respectively. Conclusion PIV can be used as a prognostic marker in patients with resectable CRC, and a novel prognostic model to guide clinical decision-making in CRC is successfully established.
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Objective To assess the worldwide research status and the development trend of colorectal cancer. Methods Based on the papers of colorectal cancer indexed in SCI-E database from 2000 to 2019, the year of publication, countries, institutes, sources of journals, discipline fields, highly cited papers in ESI and research hotspots were analyzed by the bibliometric method. Results A total of 160183 papers on colorectal cancer were retrieved, and the number of papers increased year by year. The top 10 countries were USA, China, Japan, Germany, the United Kingdom, Italy, South Korea, France, Netherlands and Canada. Harvard University in the USA had a significant advantage on the research of colorectal cancer. The rank of the journals, institutes and highly cited papers were absolutely dominated by USA. Global research activities on the colorectal cancer displayed the characteristics of interdisciplinary development. The research hotspots mainly focus on the gut microbiota, genetic testing, targeted therapy, immunotherapy and so on. Conclusion It is necessary to strengthen the close combination of basic research and clinical application, and carry out colorectal cancer research in interdisciplinary collaboration with clinical problems.
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Objective:To investigate the 2 years’ efficacy of intravesical instillation of domestic BCG versus epirubicin in the prevention of recurrence of intermediate-risk or high-risk non-muscular invasive bladder cancer and predictive factors of BCG instillation.Methods:From July 2015 to June 2020, 18-75 years old patients with moderate to high-risk non muscle invasive bladder cancer (NMIBC) confirmed by pathological examination were involved. The ECOG score was 0-2. Exclusion criteria included ①immune deficiency or impairment (such as AIDS), using immunosuppressive drugs or radiotherapy, suspected allergic to BCG or epirubicin or excipients of the two drugs, fever or acute infectious diseases including active tuberculosis or receiving anti tuberculosis treatment, with severe chronic cardiovascular and cerebrovascular diseases or chronic kidney disease; ②combined with other urogenital system tumors or other organ tumors; ③combined with muscle invasive bladder urothelial carcinoma (≥T 2); ④undergoing chemotherapy, radiotherapy or immunotherapy within 4 weeks (immediate instillation after surgery not included); ⑤ pregnant or lactating women; ⑥ comfirmed or suspected bladder perforation; ⑦gross hematuria; ⑧cystitis with severe bladder irritation that may affect the evaluation; ⑨participat in other clinical trials within 3 months; ⑩alcohol or drug addiction; ?any risk factors that may increasing the risk of patients. Epirubicin 50 mg was irrigated immediately after the operation(TURBT or laser resection). The patients were randomly divided into BCG15 group, BCG19 group and epirubicin group by the ratio of 2∶2∶1, and the patients were maintained intravescical instillation for 1 year. The recurrence and adverse events of the three groups were compared. Univariate and multivariate analysis was performed to predict the risk factors of BCG irrigated therapy failure. Result:By June 15, 2020, the median follow-up duration was 22.1 months(12.1, 32.3), and there was no statistical difference between the groups ( P=0.9024). There were 274 patients enrolled in BCG19 group, 277 patients enrolled in BCG15 group and 130 patients enrolled in the epirubicin group. The drop-off rate was 16.6%(113 cases)and made no difference between groups( P=0.6222). There were no significant difference in age, gender, BMI, or ECOG score( P>0.05). During the follow-up, 116 cases was detected recurrence or progression. The recurrence rate of the three groups was 14.2% and 14.8% in BCG19 group and BCG15 group, and 27.7% in the epirubicin group. There was no difference in recurrence rate between BCG19 and BCG15 group( P=0.9464). The recurrence rate of BCG19 group was lower than that of the epirubicin group ( P=0.0017). The recurrence rate of BCG15 group was lower than that of the epirubicin group ( P=0.0020). There was no difference in the cumulative recurrence free survival rate between BCG19 and BCG15 group (95% CI0.57-1.46, P=0.7173). The cumulative recurrence free survival rate of BCG 19 group was better than that of the epirubicin group( HR=0.439, 95% CI0.26-0.74, P=0.0006), and the cumulative recurrence free survival rate of BCG15 group was better than that of the epirubicin group ( HR=0.448, 95% CI0.29-0.80, P=0.0021). The total incidence of adverse events in 19 BCG19, BCG15 and epirubicin group were 74.5%, 72.6% and 69.8% respectively. There was no difference in the incidence of adverse events between BCG19 and BCG15 group( P=0.6153). The incidence of adverse events in epirubicin group was lower than that of BCG19( P=0.0051) and BCG15( P=0.0167) groups.There was no significant difference in the incidence of serious adverse events (SAE) among the three groups ( P=0.5064). Log rank test univariate analysis and Cox risk regression model multivariate analysis showed that the history of bladder cancer recurrence( HR=6.397, 95% CI1.95-20.94, P=0.0001)was independent risk factor for BCG irrigation failure. Conclusions:The 2 years’ efficacy of intravesical instillation of domestic BCG is better than than of epirubicin with good tolerance and safety. There is no difference between BCG19 and BCG15 group. BCG doesn’t increase SAE compared with epirubicin. Recurrence status was an independent prognostic factor regarding recurrence-free survival.
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Objective To investigate treatment option of inguinal lymph node metastasis after inguinal lymph node dissection in patients with penile cancer.Methods To retrospectively analyze the efficacy and prognostic factors of cisplatin combined with fluorouracil in the concurrent chemoradiotherapy of inguinal lymph node metastasis after penile cancer surgery.Twenty-three patients with inguinal lymph node metastasis after inguinal lymph node dissection for penile squamous cell carcinoma from February 2009 to December 2015 were included.Inguinal lymph node metastasis with squamous cell carcinoma were confirmed by pathology or cytology.Metastatic lymph nodes of each patient were fixed,not less than 2,and greater than 4 cm in diameter.All patients received concurrent chemoradiotherapy with cisplatin and 5-fluorouracil.The response rate was evaluated after radiotherapy.The local control rate,survival time and the prognostic factors were also analyzed.Results The median time of postoperative inguinal lymph node metastasis was 6.1 months,and the recurrence rate of the patients within 16 months after the operation was 95％.The response rate was 65.2％ (15/23).After treatment,the local pain was significantly relieved and 7 cases of local hemorrhage was relieved.The 1-,2-year survival rates were 21.3％ and 5.5％,respectively,with a median survival of 6.3 months (95％ CI:3.4-8.1).And local tumor response rate correlated with radiation dose.Cox multivariate analysis showed that N staging and histological grade were independent prognostic factors for survival after treatment.Conclusions Concurrent chemoradiotherapy is effective for postoperative inguinal lymph node metastasis,especially for the local recurrence with symptoms and for patients who are not suitable for surgical salvage regarding the local tumor control,pain relief and tumor hemorrhage.However,the overall survival rate of the patients who received treatment was still low.Lower extremity edema is the main complication of concurrent chemoradiotherapy.N staging and poor differentiation of the tissue are unfavorable prognostic factors.
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Objective@#To investigate treatment option of inguinal lymph node metastasis after inguinal lymph node dissection in patients with penile cancer.@*Methods@#To retrospectively analyze the efficacy and prognostic factors of cisplatin combined with fluorouracil in the concurrent chemoradiotherapy of inguinal lymph node metastasis after penile cancer surgery. Twenty-three patients with inguinal lymph node metastasis after inguinal lymph node dissection for penile squamous cell carcinoma from February 2009 to December 2015 were included.Inguinal lymph node metastasis with squamous cell carcinoma were confirmed by pathology or cytology. Metastatic lymph nodes of each patient were fixed, not less than 2, and greater than 4 cm in diameter. All patients received concurrent chemoradiotherapy with cisplatin and 5-fluorouracil.The response rate was evaluated after radiotherapy. The local control rate, survival time and the prognostic factors were also analyzed.@*Results@#The median time of postoperative inguinal lymph node metastasis was 6.1 months, and the recurrence rate of the patients within 16 months after the operation was 95%.The response rate was 65.2% (15/23). After treatment, the local pain was significantly relieved and 7 cases of local hemorrhage was relieved. The 1-, 2-year survival rates were 21.3% and 5.5%, respectively, with a median survival of 6.3 months(95% CI: 3.4-8.1). And local tumor response rate correlated with radiation dose. Cox multivariate analysis showed that N staging and histological grade were independent prognostic factors for survival after treatment.@*Conclusions@#Concurrent chemoradiotherapy is effective for postoperative inguinal lymph node metastasis, especially for the local recurrence with symptoms and for patients who are not suitable for surgical salvage regarding the local tumor control, pain relief and tumor hemorrhage. However, the overall survival rate of the patients who received treatment was still low. Lower extremity edema is the main complication of concurrent chemoradiotherapy. N staging and poor differentiation of the tissue are unfavorable prognostic factors.
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Objective To investigate the efficacy and safety of intravesical instillation of BCG vaccine in the prevention of early recurrence of middle and high risk non-muscle invasive bladder cancer.Methods From July 2015,patients with non-muscle invasive bladder cancer aged 18-75 years with informed consent were screened and underwent transurethral resection of bladder tumor (TURBT).Immediately intravesical instillation of epirubicin 50 mg was given postoperatively.After pathology was comfirmed,patients was enrolled in group 1 (BCG15) or group 2 (BCG 19) or the control group (epirubicin 18) randomly with SAS 9.3 software.Data of follow-up and Adverse event was collected and analyzed.Results By May 31,2019,531 patients were enrolled in the study.The drop-off rate was 20.1％.167 patients (143 males and 24 females)in group 1,172 patients (141 males and 31 females)in group2 and 84(75 males and 9 females) in the control group with follow-up data were analyzed.There were no significant differences in age,gender,BMI,ECOG score,risk stratification between the three groups (P =0.8641,P =0.2906,P =0.9384,P =0.6126).The median follow-up time makes no statistical difference between the groups (P =0.9251),12.0 (6.0,22.5) months,13.0 (6.0,22.3) months,and 13.0 (7.0,22.3) months.The median recurrence time of the three groups was 4.0 (3.0,6.0) months,4.5 (3.0,9.8) months,4.5 (3.0,8.8) months.There was no statistical difference between the three groups (P =0.2852).Risk stratification in the patients got no significant difference between the three groups (P ＞ 0.05).The 1-year recurrence-free survival rates were 80.0％ in the group 1 and 88.3％ in the group 2 and 73.7％ in the control group.The group 2 was superior to the group 1 and the control group (P =0.0281,P =0.0031).There was no significant difference between group 1 and control group (P =0.2951).There was no significant difference in the cumulative recurrence-free survival between the experimental group 1 and the experimental group 2,(95％ CI 0.80-2.43,P =0.2433).The cumulative recurrence-free survival in the group 1 and the group 2 was better than the control group (95 ％ CI 0.31-0.92,P =0.0266;95 ％ CI 0.20-0.65,P =0.0008).All the cases underwent instillation were analyzed for adverse events.The incidence of overall AE(adverse events) in group 1 was 68.5％ (152/222),the incidence of grade Ⅰ-Ⅱ AE was 53.2％ (118/222),the incidence of grade Ⅲ-Ⅳ AE was 15.3％ (32/222).The incidence of overall AE in the group 2 was 71.8％ (160/223),the incidence of grade Ⅰ-Ⅱ AE was 60.1％ (134/223),and the incidence of grade Ⅲ-Ⅳ AE was 11.7％ (26/223).The overall AE rate in the control group was 53.2％ (59/111),of which the incidence of grade Ⅰ-Ⅱ AE was 42.4％ (47/111),and the incidence of grade Ⅲ-Ⅳ AE was 10.8％ (12/111).There was no difference in the incidence of overall AE between the group 1 and the group 2 (P =0.4497).The incidence of AE in the two experimental groups was higher than that in the control group (P =0.0062,P =0.0008).There was no difference in the incidence of grade Ⅲ-Ⅳ AE between the three groups (P =0.3902).Conclusions BCG(19 instillation schedule) has a better effect on preventing recurrence after 1 year of bladder surgery,which is superior to epirubicin group.The long-term efficacy of BCG in preventing recurrence and the efficacy of different schedules need to be further followed up.The lower urinary tract symptoms,which are mainly urinary frequency,are one of the causes of case fallout and should be fouced in future.Compared with epirubicin,BCG perfusion does not increase the incidence of grade Ⅲ-Ⅳ adverse reactions,and is safe to use.
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Objective To observe the effect of 5-Aza-CdR on the proliferation and apoptosis of colon cancer cells and the expression of PTEN and to explore its mechanism Methods Different concentrations of 5-Aza-CdR (1, 2, 5,10 μmol/L) were used in vitro on HT-29 cells and the proliferation was detected by MTT assay and the apoptosis was detected by flow cytometry. PTEN mRNA and protein expression changes were observed by real-time PCR and Western blot. Results Different concentrations of 5-Aza-CdR (2, 5,10 μmol/L) could inhibit the proliferation of HT-29 cells with dose and time dependent manner. With the increase of time and dose, the inhibition rate of HT-29 cells increased gradually and the difference was significant. (P < 0.05). After 5-Aza-CdR treated for 48h , the apoptosis rates of HT-29 cells in control and 1 , 2 , 5 , 10 μmol/L group were 2.443 ± 0.210 1, 3.900 ± 0.665 1, 14.07 ± 1.206, 24.70 ± 2.506, and 30.60 ± 2.390 respectively, which were significantly increased and the apoptosis rate increased with the increase of dose , which was statistically significant (P < 0.05). The PTEN mRNA and protein expression of HT-29 cells were gradually increased when treated by different concentrations of 5-Aza-CdR. Conclusion 5-Aza-CdR might induce the expression of PTEN by demethylation and then inhibit the proliferation and induce apoptosis of HT-29 cells.
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Objective:To investigate the effect of enteral nutrition support one week before surgery and postoperative periods on the postoperative immune function and nutritional status in old patients with gastric cancer. Methods:A retrospective analysis was con-ducted on 77 stomach cancer patients who were admitted and received surgical treatment in our hospital. Among the patients, 38 re-ceived enteral nutrition support one week before surgery and early period of postoperation, and were labeled as the experimental group. The remaining 39 patients did not receive enteral nutrition support one week before surgery and early period of postoperation, and were named as the control group. The levels of prealbumin, albumin, transferrin, CD4+T (%), CD8+T (%), and CD4+/CD8+cells were also an-alyzed before surgery and 1 d and 8 d after surgery. Results:No statistical differences in the gender, age, site of tumor, TNM staging, and differentiated degree were found between the two groups. All operations were successful and the patients recovered well after sur-gery. In the nutritional status, the levels of prealbumin, albumin, and transferrin in the patients of the two groups had no significant dif-ference (P>0.05). On the first day after the surgery, the levels of prealbumin, albumin, and transferrin were significantly low in both groups;the control group had lower levels than the experimental group (P0.05). On the first day after surgery, the levels of CD4+T (%), CD8+T (%), and CD4+T/CD8+T cells were significantly low in both groups;the control group had lower levels than the experimental group (P<0.05). Conclusion:Elderly patients with gastric cancer who receive appropriate enteral nutrition support one week before sur-gery would have better immune function and nutritional status after surgery than those who did not, and the recovery of old patients im-proved.
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Objective: To analyze the structure changes of New Rural Cooperative Medical System(NCMS) patients ’ hospitalization costs in a county-level city, and provide references for controlling hospitalization cost. Methods: Collect the cost details of NCMS patients in May from 2012 to 2013, and analyze the structure changes of hospitalization costs though the analysis method of structure variation degree. Results: Specialized hospital has the largest structure change of hospitalization cost, followed by first-level hospitals. Different cost items at hospital of different levels have a different direction of structure changes. Drug and examination are the major factors posing the changes in structure of hospitalization costs. Conclusion: There are significant results on the cost control since the implementation of new NCMS. Although the role of Chinese medicine to be prominent, there is still insufficient. The control of examination cost is a link which could not be ignored in future.
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AIM:To investigate the activation and inactivation of nuclear factor kappa B(NF-κB)when tumor necrosis factor-related apoptosis-inducing ligand(TRAIL)is applied to induce the apoptosis of androgen-independent prostate cancer cell line PC-3M.METHODS:After the treatment of TRAIL or LPS at different doses,we tested the nuclear translocation of NF-κB by cell immunohistochemical staining and electrophoretie mobility shift assay(EMSA),and evaluated the level of IκB by RT-PCR under pyrrolidine dithiocarbamate(PDTC)treatment.RESULTS:EMSA and cell immunohistochemical analysis showed that the translocation of NF-κB was significantly activated when PC-3M cells were treated with TRAIL or LPS(P＜0.05).The pretreatment of PDTC upregulated the expression of IκB and blocked the nuclear translocation of NF-κB.CONCLUSION:TRAIL remarkably stimulates the activation of nuclear NF-κB in androgen-independent prostate cancer cells.On the other hand,the translocation of NF-κB can be significantly and efficiently inhibited in PC-3M cells by pretreatment with PDTC.The increased expression of IκB might be a clue for this inhibition,which means the possible way to enhance the effect of TRAIL in the apoptosis of prostate cancer cells.