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Objective: To evaluate the efficacy and safety of dose-modified FOLFOXIRI as first-line chemotherapy in advanced gastric cancer patients. Methods: Twenty patients without prior chemotherapy were enrolled between July 2016 and March 2019 at the Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. Treatment consisted of oxaliplatin 85 mg/m2 on day 1, irinotecan 120 mg/m2 on day 1, leucovorin 200 mg/m2 on day 1, and 5-fluorouracil 2400 mg/m2 as a 44-h continuous infusion starting on day 1; treatment was repeated every two weeks. The primary endpoint was objective response rate (ORR). The secondary endpoints were progression-free survival (PFS), overall survival (OS), disease control rate (DCR), duration of response (DOR), and safety. Results: The median number of treatment cycles was eight. ORR and DCR were 50% and 95%, respectively. The median time to response was 1.6 months, and the median DOR reached 8.7 months. The median follow-up was 19.5 months, the median PFS was 9.5 months (95% CI: 7.309-11.691), and the median OS was 19.9 months (95% CI: 9.754-30.046). The most common adverse enents (AEs) were leukopenia, elevation of ALT and AST, and diarrhea. Grade 3 neutropenia, diarrhea, and elevation of ALT occurred in 50%, 10%, and 5% patients, respectively. No Grade 4/5 AEs were observed. Conclusion: The dose-modified FOLFOXIRI showed promising antitumor activity and was well tolerated by advanced gastric cancer patients without previous treatment.
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Objective@#To assess the clinicopathological feature and prognosis of gastric cancer associated with pregnancy in Chinese population.@*Methods@#We collected the clinical features, pathological findings, treatment modalities, the health status of infants and the information of prognosis for ten patients developed gastric cancer associated with pregnancy between 2001 and 2016 in our hospital and the counterpart 12 patients reported in China National Knowledge Internet (CNKI), Wanfang database and China Science and Technology Journal Database.@*Results@#The most common symptoms were nausea and vomiting (n=14). Melena (n=8), abdominal distension (n=7) and abdominal pain (n=6) were also frequent. When considering the complications, gastrointestinal bleeding (n=9), intestinal obstruction (n=3) and gastric perforation (n=2) were common. The vast majority of pathology showed poorly differentiated tumors, poorly differentiated adenocarcinoma (n=14) and signet ring cell carcinoma (n=7). Only one patient was diagnosed at stage Ⅰ. And 17 patients developed metastatic disease of stage Ⅳ. Peritoneum (n=7) and ovary (n=5) were the most common metastasis sites. Three patients received abortion immediately after diagnosis in the first trimester of pregnancy. For the five patients in the second trimester of pregnancy, pregnancy termination was given to three patients. Caesarean section followed by gastrectomy was performed on three patients who were after the third trimester of gestation. Curative resection and palliative operation were carried out on six and five patients respectively. Combined chemotherapy based on oxaliplatin and fluorouracil was the common treatment for the peri-operative patients. For the metastatic gastric caner, platinum in combination with fluorouracil was recommended in the first line condition, irinotecan or raltitrexed were used in the second line treatment. One-year survival rate was 23.1%, and two-years survival was 15.4%. Three patients after R0 resection were alive without relapse over 18 months.@*Conclusions@#The poor prognosis of gastric cancer associated with pregnancy may due to the late stage and the poor pathological type. There still lacks data of the appropriate treatment in these patients. It was demonstrated most patients have no chance of tumor resection due to the late stage. For the metastatic patients, platinum in combination with fluorouracil was recommended in the first line treatment. Irinotecan or raltitrexed were considered the choice for the second line treatment.
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Objective To investigate the effects of Qi-Boosting Toxin-Resolving Formula (QBTRF) on CD4+CD25+ regulatory T cells and Th17 cells of patients with middle to late staged nasopharyngeal carcinoma (NPC). Methods Flow cytometry was performed to detect the ratio of CD4+CD25+ regulatory T cells and Th17 cells in the peripheral blood mononuclear cells (PMBC) among 18 patients with middle to late stage of NPC treated by QBTRF added to conventional therapy (treatment group), Foxp3 mRNA and ROR-γt mRNA in PMBC was determined by RT-PCR technique. Furthermore, serum levels of IL-6 and TGF-β were assayed by ELISA. Meanwhile, 15 patients with NPC treated by conventional therapy were taken as the control group. Results The ratio of CD4+CD25+ regulatory T cells to the total CD4+ T cells and the transcriptional level of Foxp3 mRNA in PMBC were significantly lower in treatment group than that of control group (P<0.05), the ratio of Th17 cells to the total CD4+T cells and the transcriptional level of ROR-γt mRNA in PMBC were significantly higher in treatment group than that of control group (P<0.05). However, the serum level of IL-6 was obviously higher in treatment group than that of control group (P<0.05), and the serum leve of TGF-βwas obviously lower in treatment group than that of control group (P<0.05). Conclusion QBTRF can significantly affect the number ratio and functional activity of CD4+CD25+ regulatory T cells and enforce the differentiation of Th17 cells among patients with middle to late staged NPC, which it may be reversed the immune tolerance of NPC through regulating the level of IL-6 and TGF-β.
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Objective To investigate the implications of ratio of the CD4+ and CD25+ positive regulatory T cells (CD4+CD25+Tregs) in peripheral blood mononuclear cells (PBMC) and its associated regulatory factors such as forkhead transcription factor 3 (Foxp3) mRNA transcriptional activity in PBMC,serum levels of transforming growth factor beta-1 (TGF-β1),and interleukin 10 (IL-10) in the immunopathology of patients with middle to late staged nasopharyngeal carcinoma (NPC) based on a clinical trial.Methods In this study,18 NPC cases at middle to late stage as observing group and 10 healthy persons as control group were included to detect their ratio of the CD4+CD25+Tregs in the PBMC with flow cytometry (FCM) technique,transcriptional activity of Foxp3 with RT-PCR procedure,and serum levels of TGF-β1 and IL-10 with enzyme-linked immunosorbent assay (ELISA) method.A comparative analysis was used to explore their implications in the immunopathological correlation of NPC cases with their lesion.Results The ratio of the CD4+CD25+Tregs to total CD4+T cells in PBMC was significantly increased [(4.23 ±0.53)％ vs (2.65 ±0.31)％,t =8.60,P ＜0.01],accompanied with significantly elevated levels of Foxp3 transcription in PBMC (3.699 ± 0.309 vs 1.109 ± 0.146,t' =31.08,P ＜ 0.05],and serum contents of TGF-β1 [(645.56 ± 39.61) pg/ml vs (488.82 ± 36.91) pg/ml,t =10.27,P ＜ 0.01] and IL-10 [(1.27 ± 0.21) pg/ml vs (0.68 ± 0.08) pg/ml,t' =10.61,P ＜ 0.05] in these patients,when compared with that of healthy controls.Conclusions It may be true that CD4 + CD25 + Tregs,transcriptional regulatory factor Foxp3,and cytokines TGF-β1 as well as IL-10 altogether were composed of a regulating system in a positive feedback way to promote the developing process of immunotolerance phenomena in the tumor microenvironment and the initiation of immunoescape among patients with middle to late staged nasopharyngeal carcinoma.
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Objective To investigate the clinicopathological characteristics and prognostic factors of hepatolithiasis associated with intrahepatic cholangiocarcinoma (HLAIHCC).Method A ret rospective study was conducted on 36 patients who suffered from histopathologically confirmed HLAIHCC.These patients received surgical resection of the tumor from June 2006 to September 2009.Results The overall 1,3,5 year survival rates for patients with HLAIHCC were not significantly better than those patients with ICC (63.6％,36.4％,and 30.3i％ vs.65.4％,34.3％,and 28.6％,P=0.57).For the patients who received curative resection,the 1-,3-,and 5-year survival rates (81.4 ％,61.7 ％,and 58.6 ％) were significantly better than those who received palliative resections (x2 =20.426,P＜0.001).The white blood cell count was significantly higher in the HLAIHCC group than in the ICC group (x2 =19.70,P＜0.001) and tumor size was significantly smaller in the ICC group than in the HLAIHCC group (P=0.04).Serum CA19-9 level (P=0.049) and resection margin (P=0.019) were independent risk factors of prognosis.Conclusions This study showed HLAIHCC to have different clinicopathological characteristics from ICC.Curative resection was the optimal surgical treatment for HLAIHCC.Serum CA19-9 level and resection margin were independent risk factors of prognosis.