ABSTRACT
Objective:To analyze the clinical efficacy and prognostic factors of intracranial primary diffuse large B-cell lymphoma (DLBCL).Methods:Clinical data of 205 patients pathologically diagnosed with intracranial primary DLBCL at Sun Yat-sen University Cancer center from March 2001 to September 2020 were retrospectively analyzed. Among them, 101 patients were male and 104 female, the median age was 54 years old. Non-germinal center B cell (GCB) subtype accounted for 74.1%(126/170). A total of 177 patients received high-dose methotrexate (HD-MTX) and 91 patients received rituximab. After induction chemotherapy, 59 patients (30.4%) achieved complete response (CR), 112 patients (57.7%) achieved partial response (PR) or stable disease (SD). A total of 83 patients received consolidation or salvage radiotherapy, and only 14 patients received autologous stem cell transplantation (ASCT). The influence of pathological type, chemotherapy, rituximab treatment, radiotherapy and radiotherapy mode, ASCT and other factors on the overall survival (OS) and progression free survival (PFS) was evaluated. The survival rate was calculated by Kaplan-Meier method. Univariate prognostic analysis was performed by log-rank test. Multivariate prognostic analysis was conducted by COX model.Results:The median follow-up time was 34 months. The 5-year OS and PFS rates were 55.6% and 44.2%, respectively. GCB subtype, chemotherapy with HD-MTX, rituximab treatment, remission status after induction chemotherapy, and radiotherapy were favorable prognostic factors for OS or PFS, in which the last three were the independent prognostic factors. Consolidation radiotherapy in patients who obtained CR after induction chemotherapy did not significantly improve survival, while salvage radiotherapy in patients who achieved PR/SD after induction chemotherapy significantly improved both OS and PFS(both P<0.01). Consolidation radiotherapy showed no significant survival difference compared with consolidation ASCT. Conclusions:The non-GCB subtype of intracranial primary DLBCL is related to poor prognosis. The addition of rituximab to HD-MTX based induction chemotherapy can improve survival. Radiotherapy is still an important treatment for intracranial primary DLBCL, and there are limitations of ASCT in practical clinical application.
ABSTRACT
Anxiety disorders are one of the most common mental health problems, with a high burden of disease, high morbidity and poor adherence to medication. Cognitive-behavioral therapy (CBT) is an evidence-based type of psychotherapy that works well for anxiety disorders, but it differs greatly across individuals. Studies have shown that the efficacy of CBT for anxiety disorders is related to a variety of genes, and these genes play different roles in the efficacy of CBT. There are few relatively studies in China. By exploring the possible mechanism of these genes in the effect of CBT in patients with anxiety disorders, biological markers of anxiety disorders can be further explored, which can provide reference for domestic research in this field and be applied to the diagnosis and treatment of anxiety disorders. This paper summarized the efficacy of CBT in the treatment of anxiety disorders through HPA axis related genes, 5-hydroxytryptamine system related genes, monoamine oxidase system related genes, and neurodevelopmental related genes, and found that these genes were related to the efficacy of CBT in the treatment of anxiety disorders. It mainly included methylation of FK506 binding protein 5 promoter, methylation and polymorphism of 5-HT transporter gene, gene polymorphism of tryptophan hydroxylase 2, gene polymorphism of catechol oxymethyltransferase, and gene polymorphism of monoamine oxidase A, and so on. By studying the relationship between genetics and CBT efficacy in anxiety disorders, we can explore the related loop of how pathogenic genes of anxiety disorders affect CBT efficacy, further clarify the mechanism of genetic factors in the occurrence and development of anxiety disorders, and explore the genetic predictors of CBT efficacy.