Trend of tuberculosis prevalence during 2010 to 2018 among students in Bengbu city / 中国学校卫生

Objective@#To understand the incidence and trend of pulmonary tuberculosis among students in Bengbu city during 2010 to 2018.@*Methods@#Descriptive epidemiological method was adopted to analyze data from "Bengbu tuberculosis management information system" during 2010-2018. Trend of student tuberculosis prevalence, epidemiological characteristics and management of medical registration card were analyzed.@*Results@#During 2010-2018, there were 681 cases of tuberculosis among students registered in Bengbu city, with an average annual incidence of 12.98/100 000. Majority of the cases aged 15-19 years, and were reported in the first quarter. Four clusters of outbreaks were reported. Most of the patients were found through symptomatic treatment. The average rate of delay a patient visited medical center was 48.60%, and the average rate of diagnosis delay was 23.79% . The delay rate of the patients showed a downward trend ( χ 2=31.64, P <0.01). The rate of delayed diagnosis was increasing ( χ 2=15.76, P <0.01). Among the 681 report cards, 248 were incomplete, with an incomplete rate of 36.42%. The completeness of the infectious disease report card showed an increasing trend year by year ( χ 2=383.81, P <0.01).@*Conclusion@#Tuberculosis epidemic among students in Bengbu warrants further attention. Collaboration should be strengthened between health and education departments. Implementation and dissemination of prevention programs, school health education, and regular physical examination and routine epidemic monitoring should be encouraged.

Correlation of Skp2 overexpression to prognosis of patients with nasopharyngeal carcinoma from South China / 癌症

S-phase kinase-associated protein 2 (Skp2), which plays a role in cell cycle regulation, is commonly overexpressed in a variety of human cancers and associated with poor prognosis. However, its role in nasopharyngeal carcinoma (NPC) is not well understood. In this study, we examined the clinical significance of Skp2, with a particular emphasis on overall survival (OS) and disease-free survival (DFS), in NPC cases in South China, where NPC is an epidemic. Additionally, we explored the function of Skp2 in maintaining a cancer stem cell-like phenotype in NPC cell lines. Skp2 expression was assessed for 127 NPC patients using tissue microarrays and immunohistochemistry and analyzed together with clinicopathologic features, OS, and DFS. Skp2 expression was detectable, or positive, in 75.6% of patients. Although there was no correlation between Skp2 and any clinicopathologic factor, Skp2 expression significantly portended inferior OS (P = 0.013) and DFS (P = 0.012). In the multivariate model, Skp2 expression remained significantly predictive of poor OS [P = 0.009, risk ratio (RR) = 4.06] and DFS (P = 0.008, RR = 3.56), and this was also true for clinical stage (P = 0.012 and RR=3.201 for OS; P = 0.002 and RR=1.94 for DFS) and sex (P = 0.016 and RR=0.31 for OS; P = 0.006 and RR = 0.27 for DFS). After Skp2 knockdown, a colony formation assay was used to evaluate the self-renewal property of stem-like cells in the NPC cell lines CNE-1 and CNE-2. The colony formation efficiency in CNE-1 and CNE-2 cells was decreased. In Skp2-transfected CNE-1 and CNE-2 cells, side population (SP) proportion was increased as detected by flow cytometry. Skp2 is an independent prognostic marker for OS and DFS in NPC. Skp2 may play a role in maintaining the cancer stem cell-like phenotype of NPC cell lines.

Prophylactic irradiation of cervical lymph nodes for Stage-N0 nasopharyngeal carcinoma / 癌症

<p><b>BACKGROUND AND OBJECTIVE</b>It is controversial for the irradiation level and dose of the regional prevention for naspharyngeal cancer (NPC) with one or both cervical lymph node-negative neck. The study was to analyze the proophylactic irradiation of cervical lymph nodes for Stage -N0 NPC patients.</p><p><b>METHODS</b>From January 2002 and December 2004, 205 NPC patients with negative lymphadenopathy diagnosed by imaging, were retrospectively analyzed. Before treatment, each patient underwent CT or MRI. Facial-cervical portals and 6-8 MV photons were used in radiotherapy. Doses applied were 60-80 Gy to the nasopharynx and 46-64 Gy to the neck without lymphadenopathy. Consecutive radiotherapy was performed employing conventional fractionation of 2 Gy/fraction, once a day, for a total of five fractions per week. Chemotherapy was administered to 60 patients. Median follow-up was 44 months. The survival function was calculated according to the Kaplan-Meier method. A log-rank test was used to compare the differences in survival. The Cox proportional hazards model was used for multivariate analysis. A total of 205 patients with stage-N0 NPC were divided into an upper-neck irradiation group and an entire-neck group.</p><p><b>RESULTS</b>The 3-year overall survival rate (OS) was 92.9% and the 3-year disease-free survival rate (DFS) was 91.9%. A total of 88 patients received irradiation to the upper neck and 117 to the entire neck. The rate of regional failure for the upper-neck group and the entire-neck group were 2.27% and 0%, respectively (P>0.05). The rates of regional failure in patients with T1-, T2-, T3- and T4-stage disease were 0, 3.08%, 0, and 0, respectively (P>0.05). The rates of regional failure in the patients both without and with local failure were 1.03% and 0, respectively (P>0.05). The 1-and 3-year OS for the upper-neck group were 97.7% and 94.2%, and the 1- and 3-year OS for the entire-neck group were 97.4% and 91.9% (P=0.950). The 1- and 3-year DFS for the upper-neck group were 96.6% and 92.9%, and the 1- and 3-year DFS for the entire-neck group were 95.6% and 90.9% (P= 0.730). In multivariate analysis, sex (P=0.039) and T stage (P=0.004) were independent prognosis factors for patients with stage-N0 NPC.</p><p><b>CONCLUSIONS</b>Prophylactic irradiation to the upper neck does not influence regional failure or long-term survival in the patients with stage-N0 NPC. Radiotherapy to the upper neck (levels II, III, VA) is recommended for the patients with stage-N0 NPC. Involvement of the parapharyngeal space, T stage, and the rates of local failure do not influence regional failure in these patients. Sex and T stage were independent prognosis factors of stage-N0 NPC patients.</p>

The results and prognosis of different treatment modalities for solitary metastatic lung tumor from nasopharyngeal carcinoma: a retrospective study of 105 cases / 癌症

<p><b>BACKGROUND AND OBJECTIVE</b>Nasopharyngeal carcinoma (NPC) is known for its propensity for distant metastases. Lung metastasis is one of the most important causes of death for patients with NPC. Solitary metastatic lung tumor from NPC is a distinctive group associated with a better survival. This study was to find a more effective treatment modality and prognostic factors for the group.</p><p><b>METHODS</b>Clinical data of 105 cases of solitary metastatic lung tumor from NPC were retrospectively analyzed. Survival rate was calculated by the Kaplan-Meier method. The difference of survival between the patients treated by different modalities was evaluated by the log-rank test. The Cox univariate and multivariate analyses of gender, age, pathologic type, stage, adjuvant chemotherapy, evaluation of treatment for NPC, disease-free interval, size of metastatic tumor, pulmonary hilar and/or mediastinal lymph node metastasis, treatment modalities, recurrent distant metastases and/or relapse of NPC were conducted.</p><p><b>RESULTS</b>The local control rate was 53.8% in chemotherapy group, 88.0% in radiotherapy ± chemotherapy group, and 96.4% in operation ± chemotherapy group (P < 0.01). The most promising progression-free survival (PFS) and overall survival (OS) were obtained with operation ± chemotherapy and followed by radiotherapy ± chemotherapy. Both of them showed much better efficacy than chemotherapy (P < 0.001). The Cox multivariate analysis showed that recurrent distant metastases and/or relapse of NPC affected the survival (OR = 2.087, 95% CI = 1.277-3.410, P = 0.003). The T stage of NPC, size of metastatic tumor, hilar and/or mediastinal lymph node metastasis, and the treatment modality were independent prognostic factors.</p><p><b>CONCLUSIONS</b>Operation ± chemotherapy and radiotherapy ± chemotherapy are better treatment of solitary metastatic lung tumor from NPC, which could improve the local control and prolong the PFS and OS. Chemotherapy is recommended for patients with higher T stage of NPC, size of metastatic tumor ≥ 3 cm, pulmonary hilar and/or mediastinal lymph node metastasis.</p>

Clinical analysis of 20 adults esthesioneuroblastoma with combined therapy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To retrospectively compare the survival difference of 20 patients with esthesioneuroblastoma (EN) who received combined therapy, and try to analyze the most optimized modalities.</p><p><b>METHODS</b>Twenty patients of adult ( > or = 14 years) EN received combined therapy in Cancer Center of Sun Yat-sen University from Jan 1998 to Jan 2005. Six patients were staged Kadish B and fourteen patients Kadish C. Twelve of them received induction chemotherapy followed by radiotherapy while the other 8 received surgery followed by adjuvant radiotherapy. The disease free survival and overall survival rate were calculated by Kaplan-Meier method and compared by Log-rank method. And the baseline characteristics was examined by Fisher's exact test.</p><p><b>RESULTS</b>Follow up from beginning of treatment to 31th March, 2008, the 3-year overall survival rate was 50.0%, the 3-year disease free survival and overall survival rates were 16.7%, 25.0% for chemoradiation group and 75.0%, 87.5% for surgery plus radiotherapy group, respectively. The disease free survival and overall survival rate of the latter group were better than the former (chi2 values were 6.81 and 7.33, P values were 0.0091 and 0.0068, respectively).</p><p><b>CONCLUSIONS</b>Surgery combined with adjuvant radiotherapy may increase the survival rate compared with induction chemotherapy followed by radiotherapy for local advanced esthesioneuroblastoma. Active surgery combined with radiotherapy and chemotherapy may further improve the survival of EN.</p>

Tonsillar carcinoma: analyses of the therapy and prognostic factors / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To retrospectively analyze the therapeutic effect on patients with tonsillar carcinoma and factors affecting their prognosis.</p><p><b>METHODS</b>Clinical data of 61 patients pathologically confirmed with tonsillar carcinoma without distant metastasis were analyzed. All the patients were treated in Cancer Center of Sun Yat-sen University from April 1997 to April 2008. There were 2 patients with undifferentiated carcinoma, 26 with poorly differentiated squamous cell carcinoma and 33 with median-well differentiated squamous cell carcinoma. According to the AJCC 2002 staging criteria for head-neck cancers, there were 9 staged I cases, 7 staged II cases, 23 staged III cases and 22 staged IV cases. The treatment was radiotherapy alone in 27 cases, radiotherapy combined with chemotherapy in 23 cases, surgery combined with postoperative radiotherapy in 6 cases, neoadjuvant chemotherapy plus surgery combined with postoperative radiotherapy in 3 cases, radiotherapy with salvage surgery in 2 cases.</p><p><b>RESULTS</b>The overall 5-year survival rate was 50.2%. For 16 cases with staged I-II staged, there were 8 cases with radiotherapy alone, 5 years survival was 50.0%, 6 cases with surgery combined with postoperative radiotherapy, 5 years survival was 83.3%. The difference between the two treatments was not significant in statistics (P = 0.318). For III-IV staged 45 cases, there were 19 cases with simple radiotherapy, 5 years survival was 51.5%, 21 cases with radiotherapy combined with chemotherapy, 5 years survival was 36.4%, 5 cases with surgery combined with postoperative radiotherapy, 5 years survival was 75.0%. The difference among the three treatments was not significant in statistics (P = 0.239). According to T stages, the 5-year survival rates of stage T1-T4 cases were 91.8%, 46.8%, 29.1%, 0% respectively (chi(2) = 30.168, P < 0.001). Multivariate analysis demonstrated that T stage, therapeutic effect of primary site and cervical metastatic lymph node were the independent prognostic factors (P < 0.05).</p><p><b>CONCLUSIONS</b>T stage, the therapeutic effect of primary site and cervical metastatic lymph node were the independent prognostic factors. For I-II staged tonsillar tumor cases, based on organ preservation, were tendency to choice simple radiotherapy. For III-IV staged cases, yet the relationships between therapeutic mode and therapeutic effect still need further researches.</p>

Retrospective analysis of 934 nasopharyngeal carcinoma patients treated with conventional external beam radiotherapy alone / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the clinical outcome of 934 primary nasopharyngeal carcinoma treated with conventional external beam radiotherapy alone.</p><p><b>METHODS</b>34 patients were treated from Jan. 1, 1999 to Dec. 31, 1999. The radiation fields were delineated according to the CT/MRI imaging findings on disease extent. Two lateral opposing isocentric portals with customized blockings were used for the nasopharynx and upper neck. The dose delivered to tumor in the nasopharynx was 68-70 Gy/2 Gy fraction/7 weeks. The doses delivered to the neck was 60-70 Gy/6-7 weeks for patients with positive lymph nodes and 50 Gy/5 weeks for the patients with negative lymph node.</p><p><b>RESULTS</b>The 1-, 2-, 3- and 4-year overall survival rate (OS) was 89.5%, 81.9%, 78.1% and 75.7%, and metastasis-free survival rate (MFS) was 84.0%, 77.2%, 74.4% and 72.0%, respectively. The 1-, 2-, 3- and 4-year disease-free survival rate (DFS) was 80.8%, 73.1%, 68.5% and 65.1%, and the relapse-free survival rate (RFS) was 95.5%, 92.7%, 90.3% and 87.3%, respectively. The overall failure rate was 30.9% (289/934). At the end of the radiotherapeutic course, the percentage of residual disease was 14.6%. The 4-year loco-regional recurrence and distant metastasis rates after radiotherapy were 7.2% and 9.2% with a median time of 19.3 months and 12.8 months.</p><p><b>CONCLUSION</b>It may be helpful to improve radiotherapy curative effect when the target is individually designed through improving irradiation technique according to CT/MRI findings and by shortening the overall course time, enhancing irradiation dose and strictly implementing QA/QC measures.</p>

Cancer of the nasal cavity / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the factors affecting prognosis of patients with nasal carcinoma.</p><p><b>METHODS</b>163 patients treated from 1985 to 1998 were analyzed. The survival analysis was performed by Kaplan-Meier estimate and the comparison between groups by Log-rank test. Multivariate analysis was carried out by Cox proportional hazard model.</p><p><b>RESULTS</b>The overall 5-year survival rate was 58.2%. The 5-year survival rate was 55.8% in squamous-cell carcinoma, 44.0% in adenocarcinoma, 59.7% in undifferentiated carcinoma, 76.3% in adenoid cystic carcinoma, 71.4% in mucoepidermoid carcinoma, 25.0% in rhabdomyosarcoma, 26.7% in malignant melanoma, 50.0% in neuroblastoma (P > 0.05). Patients with cervical metastasis gave a 5-year survival of 53.5% while those without gave 58.9% (P > 0.05). Patients with involvement of sphenoidal sinus or maxillary sinus gave the worse survival. The 5-year survival rate was 73.8% in patients whose cancer completely disappeared after treatment. It was 41.6% in patients whose cancer incompletely disappeared, and 34.3% in patients whose cancer remained refractory (P < 0.01). The 5-year survival was 78.3% in stage I disease, 56.4% in stage II disease, 54.2% in stage III and 35.9% in stage IV (P < 0.05). The 5-year survival rate of patients who were treated with radiotherapy only was 56.9%. That of patients who were treated with surgery only was 56.6%. That with chemotherapy only was 25.0% whereas that of patients treated with combination treatment was 61.8% (P > 0.05). So far, 85 patients have died up to writing this report, 57.6% (49 patients) of recurrence or uncontrolled.</p><p><b>CONCLUSION</b>Clinical stage, immediate therapeutic response and involvement of sphenoidal or maxillary sinus; but not the pathologic type, the presence of cervical metastasis nor the method of treatment, are the factors affecting the prognosis of patients with nasal carcinoma. Recurrence and uncontrolled disease are the cause of death.</p>