Objective:While albumin and the weight-standardized hand grip strength(HGS/W)serve as valuable prognostic indicators for cancer patients,their correlation with the prognosis in frail cancer patients remains inadequate...Objective:While albumin and the weight-standardized hand grip strength(HGS/W)serve as valuable prognostic indicators for cancer patients,their correlation with the prognosis in frail cancer patients remains inadequately explored.This study aimed to investigate the prognostic importance of the albumin level and HGS/W in cancer patients with frailty and to further investigate their combined prognostic value.Moreover,this comprehensive evaluation aimed to facilitate timely intervention and treatment for frail patients.Methods:The research enrolled 5,794 cancer patients identified with frailty from a multicenter research database.The diagnosis of frailty was based on the FRAIL scale.An Albumin-HGS/W score was constructed by combining the albumin and HGS/W values.Cox proportional hazard regression was utilized to examine the association between the albumin level and HGS/W and patient outcomes.Results:Among these patients,2,543 were females and 3,251 were males,with a median age of 60.0 years.Optimal stratification based on patient survival revealed the ideal threshold for HGS/W to be 0.48 for males and 0.39 for females,and for albumin to be 38 for both sexes.The fully adjusted model revealed that higher Albumin-HGS/W scores were correlated with a poorer patient prognosis.Notably,an Albumin-HGS/W score of 2 was associated with a higher risk of mortality compared with a score of 0 in the total population(HR:1.813,95%CI:1.580-2.080,P<0.001).Conclusions:Low albumin or HGS/W values are associated with low survival in cancer patients with frailty.Elevated Albumin-HGS/W scores were linked to decreased survival rates in cancer patients with frailty.展开更多
Pancreatic ductal adenocarcinoma(PDAC)is a common cause of cancer-related death,and most patients are with advanced disease when diagnosed.At present,despite a variety of treatments have been devel-oped for PDAC,few e...Pancreatic ductal adenocarcinoma(PDAC)is a common cause of cancer-related death,and most patients are with advanced disease when diagnosed.At present,despite a variety of treatments have been devel-oped for PDAC,few effective treatment options are available;on the other hand,PDAC shows significant resistance to chemoradiotherapy,targeted therapy,and immunotherapy due to its heterogeneous genetic profile,molecular signaling pathways,and complex tumor immune microenvironment.Nevertheless,over the past decades,there have been many new advances in the key theory and understanding of the in-trinsic mechanisms and complexity of molecular biology and molecular immunology in pancreatic can-cer,based on which more and more diverse new means and reasonable combination strategies for PDAC treatment have been developed and preliminary breakthroughs have been made.With the continuous ex-ploration,from surgical local treatment to comprehensive medical management,the research-diagnosis-management system of pancreatic cancer is improving.This review focused on the variety of treatments for advanced PDAC,including traditional chemotherapy,targeted therapy,immunotherapy,microenviron-ment matrix regulation as well as the treatment targeting epigenetics,metabolism and cancer stem cells.We pointed out the current research bottlenecks and future exploration directions.展开更多
Objective:Serum albumin(ALB)can transport nutrients to circulating and local immune cells by passing through blood vessels and has attracted attention as a prognostic predictor of non-small cell lung cancer(NSCLC)beca...Objective:Serum albumin(ALB)can transport nutrients to circulating and local immune cells by passing through blood vessels and has attracted attention as a prognostic predictor of non-small cell lung cancer(NSCLC)because it reflects the host immunity from peripheral blood(PBL)to the tumor microenvironment. Methods:Clinical data regarding the PBL and tumor tissues were obtained at The First Hospital of Jilin University between February 2009 and March 2017.We detected indices of glucose and lipid metabolism,classified and counted PBL lymphocytes using flow cy-tometry,determined the tumor-infiltrating lymphocytes by quantitative immunofluorescence,and analyzed the T-cell receptor(TCR)rep-ertoire by high-throughput sequencing of the TCR β-chain.The correlations between ALB and metabolic immune indices were analyzed by t tests and Pearson chi-square test. Results:A total of 211 enrolled NSCLC patients were divided into a relatively high-ALB group(>41.75 g/L,n = 56)and a low-ALB group(≤41.75 g/L,n = 155);patients with high ALB had lower Treg cells(P<0.05)and more CD8+ cytotoxic T cells in the PBL(P<0.01)and a higher proportion of stromal CD8+ tumor-infiltrating lymphocytes(P = 0.047)than patients with low ALB.High ALB was also significantly related to more diversity in the TCR repertoire(P = 0.0021,r2 = 0.5481).Moreover,ALB was identified as an in-dependent prognostic factor based on a multivariate Cox regression analysis(P = 0.032;hazard ratio(HR)= 1.804;95%confidence interval(CI)= 1.035-3.146).The median overall survival in patients with low ALB vs high ALB was 28.2 vs 42.2 months(P=0.0142),respectively.Among patients with nonmetastatic NSCLC(stage Ⅰ-Ⅲ),there was a higher incidence of distant metastasis in the low-ALB group than that in the high-ALB group(41.3%and 22.2%,P=0.043).A low ALB also had a strong association with a higher risk for disease progression(P<0.001)and death(P<0.01;HR = 0.555;95%CI= 0.312-0.988). Conclusions:Albumin could affect the host immunity,and high ALB predicted a reduced risk of distant metastasis and improved the prognosis in NSCLC patients.展开更多
The outbreak of coronavirus disease 2019(COVID-19)is a significant challenge for clinicians,especially for immunocompromised cancer patients.By analyzing the impact of COVID-19 on the immune microenvironment of colore...The outbreak of coronavirus disease 2019(COVID-19)is a significant challenge for clinicians,especially for immunocompromised cancer patients.By analyzing the impact of COVID-19 on the immune microenvironment of colorectal cancer(CRC)patients at the tissue level and single-cell level,we found that CRC patients are more easily infected by severe acute respiratory syndrome coronavirus-2(SARSCoV-2),but promotion of infiltration and differentiation of monocytes makes them more likely to develop severe COVID-19.Because of the continuing activation of nuclear factor(NF)-κB and C-C chemokine receptor type 5(CCR5)signaling pathways in monocytes,imbalance of macrophage polarization can aggravate the cytokine release syndrome.Therefore,regulating the infiltration and differentiation of monocytes is helpful for the treatment of COVID-19 in CRC patients.展开更多
Background: The purpose of this study is to evaluate the quality of life(QoL) of hospitalized patients in China suffering from digestive system malignancies and to identify potential risk factors for a decrease in QoL...Background: The purpose of this study is to evaluate the quality of life(QoL) of hospitalized patients in China suffering from digestive system malignancies and to identify potential risk factors for a decrease in QoL.Methods: The European Organization for Research and Treatment Core Quality of Life questionnaire(EORTC QLQ-C30) was applied to evaluate the QoL of 23,519 patients with six digestive malignancies(esophageal cancer, gastric cancer, colorectal cancer, liver cancer, biliary tract cancer, and pancreatic cancer). A t test or analysis of variance was employed to analyze the total EORTC QLQ-C30 scale scores and domain scores of the EORTC QLQ-C30 scale among patients in different subgroups.Results: The average QoL score was 50.4 ± 10.8. The tumor type, age, sex, and TNM stage al had an impact on QoL ratings. Colorectal cancer patients had a better total QoL score(49.3 ± 10.3) and scores in the domains of functioning, with milder symptoms, except for diarrhea. Patients with biliary tract cancer(54.2 ± 12.3) and pancreatic cancer(54.2 ± 12.3) reported a poorer QoL, significant functional impairment, and more pronounced symptoms. Patients with esophageal cancer experienced the most severe financial difficulties(35.2 ± 27.5). Patients aged ≥65 years, women, and those with TNM stage Ⅲ/Ⅳ reported lower QoL. In addition, the disparities in total QoL scores and scores in specific domains were significant among patients with some types of tumors, and based on ethnicity, educational level, occupation, treatment(s) received, and place of residence.Conclusions: There is a need to focus on elderly individuals, those with low educational levels, and patients with progressive malignant tumors and to improve routine disease monitoring and symptom management to enhance the quality of life for patients with malignancies of the digestive system.展开更多
Multiple pulmonary ground-glass nodules(GGNs),a typical clinical manifestation of multiple primary lung cancers(MPLCs),are of great significance for the early screening,diagnosis,and accurate treatment of lung cancer....Multiple pulmonary ground-glass nodules(GGNs),a typical clinical manifestation of multiple primary lung cancers(MPLCs),are of great significance for the early screening,diagnosis,and accurate treatment of lung cancer.Thus,the recent increase in the detection rate of multiple pulmonary GGNs has attracted much attention.However,compared with the more widely studied single GGNs,evaluating GGNs is more challenging because of the uncertainty of the etiology,difficult differential diagnosis,and lack of optimal management standards and guidelines.Most current solutions for multiple GGNs are based on the management experiences and principles of a single GGN.Therefore,it is necessary to obtain better understanding of multiple GGNs and to optimize the diagnostic methods and treatments.Both the existing challenges and potential of new methods for diagnosing and treating multiple pulmonary GGNs are reviewed and discussed in this article,with the aim of providing a reference for the clinical management of this highly prevalent condition.展开更多
Background:IMpower 133 trial first confirmed the efficacy and safety of adding atezolizumab or placebo to first-line treatment with chemotherapy in patients with extensive-stage small-cell lung cancer(SCLC).While,over...Background:IMpower 133 trial first confirmed the efficacy and safety of adding atezolizumab or placebo to first-line treatment with chemotherapy in patients with extensive-stage small-cell lung cancer(SCLC).While,overprice limited its broad use in clinical.The aim of this study was to evaluate the cost-effectiveness of atezolizumab plus chemotherapy in treatment of extensive SCLC as first line in China.Methods:A Markov model was established by extracting data from the IMpower 133 trial with untreated extensive SCLC patients.Utility values were obtained from published studies,and the costs were acquired from real world and literature.Additionally,sensitivity analyses based on a willingness-to-pay(WTP)threshold were performed to identify the uncertain parameters of Markov model.Results:Total costs of atezolizumab group were$48,129,while cost of chemotherapy alone was just$12,920 in placebo group.The quality-adjusted life-years(QALYs)in atezolizumab group was just 0.072 higher than that in placebo group(0.858 QALYs vs.0.786 QALYs).The cost-effectiveness ratio between atezolizumab combination with chemotherapy and chemotherapy alone was$489,013/QALY in China.The net benefit of placebo group was significantly higher than atezolizumab group.One-way sensitivity analyses highlighted that utilities of the progression-free survival(PFS)and progression disease state in placebo group were the most influential parameter.Conclusions:Atezolizumab combination therapy was not more cost-effective than chemotherapy alone at a WTP threshold of$25,929/QALY in China.展开更多
Immunotherapy has opened a new era in cancer treatment.Drugs represented by immune checkpoint inhibitors have led to important breakthroughs in the treatment of various solid tumors,greatly improving the survival rate...Immunotherapy has opened a new era in cancer treatment.Drugs represented by immune checkpoint inhibitors have led to important breakthroughs in the treatment of various solid tumors,greatly improving the survival rate of cancer patients.Many types of immunotherapeutic drugs have become widely available;however,their efficacy is variable,and relatively few patients with advanced cancer experience life-altering durable survival,reflecting the complex and highly regulated nature of the immune system.The research field of cancer immunotherapy(CIT)still faces many challenges in pursuing the broader social goal of“curing cancer.”Increasing attention has been paid to strengthening the understanding of the molecular or cellular drivers of resistance to immunotherapy,actively exploring more effective therapeutic targets,and developing combination therapy strategies.Here,we review the key challenges that have emerged in the era of CIT and the possible solutions or development directions to overcome these difficulties,providing relevant references for basic research and the development of modified clinical treatment regimens.展开更多
Background： Base excision repair （BER） plays an important role in the maintenance of genome integrity and anticancer drug resistance. This study aimed to explore the role of BER gene polymorphisms in response to ch...Background： Base excision repair （BER） plays an important role in the maintenance of genome integrity and anticancer drug resistance. This study aimed to explore the role of BER gene polymorphisms in response to chemotherapy for advanced non-small cell lung cancer （NSCLC） patients treated with platinum-based chemotherapy. Methods： During the period from November 2009 to January 2016, a total of 152 patients diagnosed with NSCLC Stage IIIB and IV in the First Hospital of Jilin University were admitted into this study. The XRCC1 G28152A, MUTYH G972C, HOGG1 C1245G. and PARPI T2444C polymorphisms of all the patients were detected by mass spectrometry. The logistic regression was used for statictical analysis. All tests were bilateral test, and a P 〈 0.05 was considered statistically significant. Results： The logistic regression model showed that the response rate of chemotherapy of the PARP1 T2444C polymorphisms, CC genotype （odds ratio [OR]： 5.216, 95% confidence interval [CI]： 1.568-17.352, P = 0.007）, TC genotype （OR： 2.692, 95% C1：1.007-7.198, P = 0.048）, as well as the genotype of TC together with CC （OR： 3.178, 95% CI： 1.229-8.219, P = 0.017） were significantly higher than those of TT wild type. There was no relationship between the MUTYH G972C, XRCC1 G28152A, and HOGGI C1245G gene polymorphisms and chemosensitivity. Conclusions： The PARPI 2444 mutation allele C might be associated with the decreased sensitivity to platinum-based chemotherapy in advanced NSCLC. These findings may be helpful in designing individualized cancer treatment.展开更多
Background:Circulating tumor DNA(ctDNA)is a promising biomarker for non-invasive epidermal growth factor receptor mutations(EGFRm)detection in lung cancer patients,but existing methods have limitations in sensitivity ...Background:Circulating tumor DNA(ctDNA)is a promising biomarker for non-invasive epidermal growth factor receptor mutations(EGFRm)detection in lung cancer patients,but existing methods have limitations in sensitivity and availability.In this study,we used theΔCt value(mutant cycle threshold[Ct]value-internal control Ct value)generated during the polymerase chain reaction(PCR)assay to convert super-amplification-refractory mutation system(superARMS)from a qualitative method to a semi-quantitative method named reformed-superARMS(R-superARMS),and evaluated its performance in detectingEGFRm in plasma ctDNA in patients with advanced lung adenocarcinoma.Methods:A total of 41 pairs of tissues and plasma samples were obtained from lung adenocarcinoma patients who had knownEGFRm in tumor tissue and were previously untreated.EGFRm in ctDNA was identified by using superARMS.Through making use ofΔCt value generated during the detection process of superARMS,we indirectly transform this qualitative detection method into a semi-quantitative PCR detection method,named R-superARMS.Both qualitative and quantitative analyses of the data were performed.Kaplan-Meier analysis was performed to estimate the progression-free survival(PFS)and overall survival(OS).Fisher exact test was used for categorical variables.Results:The concordance rate ofEGFRm in tumor tissues and matched plasma samples was 68.3%(28/41).At baseline,EGFRm-positive patients were divided into two groups according to the cut-offΔCt value ofEGFRm set at 8.11.A significant difference in the median OS(mOS)between the two groups was observed(EGFRmΔCt≤8.11vs.>8.11:not reachedvs.11.0 months;log-rankP=0.024).Patients were divided into mutation clearance(MC)group and mutation incomplete clearance(MIC)group according to whether theΔCt value ofEGFRm test turned negative after 1 month of treatment.We found that there was also a significant difference in mOS(not reachedvs.10.4 months;log-rankP=0.021)between MC group and MIC group.Although there was no significant difference in PFS between the two groups,the two curves were separated and the PFS of MC group tended to be higher than the MIC group(not reachedvs.27.5 months;log-rankP=0.088).Furthermore,EGFRm-positive patients were divided into two groups according to the cut-off of the changes inΔCt value ofEGFRm after 1 month of treatment,which was set at 4.89.A significant difference in the mOS between the two groups was observed(change value ofΔCt>4.89vs.≤4.89:not reachedvs.11.0 months;log-rankP=0.014).Conclusions:DetectingEGFRm in ctDNA using R-superARMS can identify patients who are more likely sensitive to targeted therapy,reflect the molecular load of patients,and predict the therapeutic efficacy and clinical outcomes of patients.展开更多
To the Editor:Worldwide,lung cancer,particularly non-small cell lung cancer(NSCLC),is the leading cause of tumor-related death.Cost-effectiveness analysis show no economic benefits for advanced NSCLC patients over che...To the Editor:Worldwide,lung cancer,particularly non-small cell lung cancer(NSCLC),is the leading cause of tumor-related death.Cost-effectiveness analysis show no economic benefits for advanced NSCLC patients over chemotherapy.[1]Furthermore,tests such as programmed cell death ligand 1(PD-L1)and tumor mutational burden(TMB)tests,evaluated via immunohistochemical methods and next-generation sequencing,respectively,are widely used for screening potential beneficiaries of immune checkpoint inhibitors(ICIs).However,these two methods have different predictive values,making their comprehensive evaluation the focus of the current controversy.展开更多
基金supported by a Henan Province Science and Technology Research Project(No.252102311033)the National Key Research and Development Program(No.2022YFC2009600 and No.2022YFC2009601).
文摘Objective:While albumin and the weight-standardized hand grip strength(HGS/W)serve as valuable prognostic indicators for cancer patients,their correlation with the prognosis in frail cancer patients remains inadequately explored.This study aimed to investigate the prognostic importance of the albumin level and HGS/W in cancer patients with frailty and to further investigate their combined prognostic value.Moreover,this comprehensive evaluation aimed to facilitate timely intervention and treatment for frail patients.Methods:The research enrolled 5,794 cancer patients identified with frailty from a multicenter research database.The diagnosis of frailty was based on the FRAIL scale.An Albumin-HGS/W score was constructed by combining the albumin and HGS/W values.Cox proportional hazard regression was utilized to examine the association between the albumin level and HGS/W and patient outcomes.Results:Among these patients,2,543 were females and 3,251 were males,with a median age of 60.0 years.Optimal stratification based on patient survival revealed the ideal threshold for HGS/W to be 0.48 for males and 0.39 for females,and for albumin to be 38 for both sexes.The fully adjusted model revealed that higher Albumin-HGS/W scores were correlated with a poorer patient prognosis.Notably,an Albumin-HGS/W score of 2 was associated with a higher risk of mortality compared with a score of 0 in the total population(HR:1.813,95%CI:1.580-2.080,P<0.001).Conclusions:Low albumin or HGS/W values are associated with low survival in cancer patients with frailty.Elevated Albumin-HGS/W scores were linked to decreased survival rates in cancer patients with frailty.
基金supported by grants from the National Key R&D Program of China(2016YFC1303800)Jilin Provincial Key Labora-tory of Biological Therapy(20170622011JC)+1 种基金Jilin Provincial Science and Technology Department(20190303146SF)Jilin Province Finance Department(2018SCZWSZX-010).
文摘Pancreatic ductal adenocarcinoma(PDAC)is a common cause of cancer-related death,and most patients are with advanced disease when diagnosed.At present,despite a variety of treatments have been devel-oped for PDAC,few effective treatment options are available;on the other hand,PDAC shows significant resistance to chemoradiotherapy,targeted therapy,and immunotherapy due to its heterogeneous genetic profile,molecular signaling pathways,and complex tumor immune microenvironment.Nevertheless,over the past decades,there have been many new advances in the key theory and understanding of the in-trinsic mechanisms and complexity of molecular biology and molecular immunology in pancreatic can-cer,based on which more and more diverse new means and reasonable combination strategies for PDAC treatment have been developed and preliminary breakthroughs have been made.With the continuous ex-ploration,from surgical local treatment to comprehensive medical management,the research-diagnosis-management system of pancreatic cancer is improving.This review focused on the variety of treatments for advanced PDAC,including traditional chemotherapy,targeted therapy,immunotherapy,microenviron-ment matrix regulation as well as the treatment targeting epigenetics,metabolism and cancer stem cells.We pointed out the current research bottlenecks and future exploration directions.
基金supported by Research on Chronic Noncommunicable Diseases Prevention and Control of National Ministry of Science and Technology(No.2016YFC1303804)National Natural Science Foundation of China grant(No.81672275,No.81874052,No.3A214DJ63428)to J-WC+1 种基金the Youth Fund of the National Natural Science Foundation of China(No.81802487)the Youth Development Foundation of The First Hospital of jilin University(No.JDYY92018028)to L-YL.
文摘Objective:Serum albumin(ALB)can transport nutrients to circulating and local immune cells by passing through blood vessels and has attracted attention as a prognostic predictor of non-small cell lung cancer(NSCLC)because it reflects the host immunity from peripheral blood(PBL)to the tumor microenvironment. Methods:Clinical data regarding the PBL and tumor tissues were obtained at The First Hospital of Jilin University between February 2009 and March 2017.We detected indices of glucose and lipid metabolism,classified and counted PBL lymphocytes using flow cy-tometry,determined the tumor-infiltrating lymphocytes by quantitative immunofluorescence,and analyzed the T-cell receptor(TCR)rep-ertoire by high-throughput sequencing of the TCR β-chain.The correlations between ALB and metabolic immune indices were analyzed by t tests and Pearson chi-square test. Results:A total of 211 enrolled NSCLC patients were divided into a relatively high-ALB group(>41.75 g/L,n = 56)and a low-ALB group(≤41.75 g/L,n = 155);patients with high ALB had lower Treg cells(P<0.05)and more CD8+ cytotoxic T cells in the PBL(P<0.01)and a higher proportion of stromal CD8+ tumor-infiltrating lymphocytes(P = 0.047)than patients with low ALB.High ALB was also significantly related to more diversity in the TCR repertoire(P = 0.0021,r2 = 0.5481).Moreover,ALB was identified as an in-dependent prognostic factor based on a multivariate Cox regression analysis(P = 0.032;hazard ratio(HR)= 1.804;95%confidence interval(CI)= 1.035-3.146).The median overall survival in patients with low ALB vs high ALB was 28.2 vs 42.2 months(P=0.0142),respectively.Among patients with nonmetastatic NSCLC(stage Ⅰ-Ⅲ),there was a higher incidence of distant metastasis in the low-ALB group than that in the high-ALB group(41.3%and 22.2%,P=0.043).A low ALB also had a strong association with a higher risk for disease progression(P<0.001)and death(P<0.01;HR = 0.555;95%CI= 0.312-0.988). Conclusions:Albumin could affect the host immunity,and high ALB predicted a reduced risk of distant metastasis and improved the prognosis in NSCLC patients.
基金the National Key Research and Development Program of New Coronary Pneumonia and Other Infectious Diseases Prevention Basic Research Orientation Project of China,No.2020YFA0707704(to Qian L)the Ministry of Science and Technology of the People’s Republic of China,No.2016YFC1303800(to Cui JW)+1 种基金the Interdisciplinary Research Funding Program of Jilin University,No.101832020DJX083(to Bai L)and the Outstanding Talent Cultivation Program for Doctoral Students in Norman Bethune Health Science Center of Jilin University(to Bai L).
文摘The outbreak of coronavirus disease 2019(COVID-19)is a significant challenge for clinicians,especially for immunocompromised cancer patients.By analyzing the impact of COVID-19 on the immune microenvironment of colorectal cancer(CRC)patients at the tissue level and single-cell level,we found that CRC patients are more easily infected by severe acute respiratory syndrome coronavirus-2(SARSCoV-2),but promotion of infiltration and differentiation of monocytes makes them more likely to develop severe COVID-19.Because of the continuing activation of nuclear factor(NF)-κB and C-C chemokine receptor type 5(CCR5)signaling pathways in monocytes,imbalance of macrophage polarization can aggravate the cytokine release syndrome.Therefore,regulating the infiltration and differentiation of monocytes is helpful for the treatment of COVID-19 in CRC patients.
基金supported by the National KeyResearch and Development Program(No.2022YFC2009600 andNo.2022YFC2009601).
文摘Background: The purpose of this study is to evaluate the quality of life(QoL) of hospitalized patients in China suffering from digestive system malignancies and to identify potential risk factors for a decrease in QoL.Methods: The European Organization for Research and Treatment Core Quality of Life questionnaire(EORTC QLQ-C30) was applied to evaluate the QoL of 23,519 patients with six digestive malignancies(esophageal cancer, gastric cancer, colorectal cancer, liver cancer, biliary tract cancer, and pancreatic cancer). A t test or analysis of variance was employed to analyze the total EORTC QLQ-C30 scale scores and domain scores of the EORTC QLQ-C30 scale among patients in different subgroups.Results: The average QoL score was 50.4 ± 10.8. The tumor type, age, sex, and TNM stage al had an impact on QoL ratings. Colorectal cancer patients had a better total QoL score(49.3 ± 10.3) and scores in the domains of functioning, with milder symptoms, except for diarrhea. Patients with biliary tract cancer(54.2 ± 12.3) and pancreatic cancer(54.2 ± 12.3) reported a poorer QoL, significant functional impairment, and more pronounced symptoms. Patients with esophageal cancer experienced the most severe financial difficulties(35.2 ± 27.5). Patients aged ≥65 years, women, and those with TNM stage Ⅲ/Ⅳ reported lower QoL. In addition, the disparities in total QoL scores and scores in specific domains were significant among patients with some types of tumors, and based on ethnicity, educational level, occupation, treatment(s) received, and place of residence.Conclusions: There is a need to focus on elderly individuals, those with low educational levels, and patients with progressive malignant tumors and to improve routine disease monitoring and symptom management to enhance the quality of life for patients with malignancies of the digestive system.
文摘Multiple pulmonary ground-glass nodules(GGNs),a typical clinical manifestation of multiple primary lung cancers(MPLCs),are of great significance for the early screening,diagnosis,and accurate treatment of lung cancer.Thus,the recent increase in the detection rate of multiple pulmonary GGNs has attracted much attention.However,compared with the more widely studied single GGNs,evaluating GGNs is more challenging because of the uncertainty of the etiology,difficult differential diagnosis,and lack of optimal management standards and guidelines.Most current solutions for multiple GGNs are based on the management experiences and principles of a single GGN.Therefore,it is necessary to obtain better understanding of multiple GGNs and to optimize the diagnostic methods and treatments.Both the existing challenges and potential of new methods for diagnosing and treating multiple pulmonary GGNs are reviewed and discussed in this article,with the aim of providing a reference for the clinical management of this highly prevalent condition.
基金This work was supported by Research on Chronic Noncommunicable Diseases Prevention and Control of National Ministry of Science and Technology(2016YFC1303804)the National Natural Science Foundation of China(81802487)+2 种基金China Postdoctoral Foundation Project(2019M651217)Youth Development Foundation of the First Hospital of Jilin University(JDYY92018028)the National Natural Science Foundation of China(81500116).
文摘Background:IMpower 133 trial first confirmed the efficacy and safety of adding atezolizumab or placebo to first-line treatment with chemotherapy in patients with extensive-stage small-cell lung cancer(SCLC).While,overprice limited its broad use in clinical.The aim of this study was to evaluate the cost-effectiveness of atezolizumab plus chemotherapy in treatment of extensive SCLC as first line in China.Methods:A Markov model was established by extracting data from the IMpower 133 trial with untreated extensive SCLC patients.Utility values were obtained from published studies,and the costs were acquired from real world and literature.Additionally,sensitivity analyses based on a willingness-to-pay(WTP)threshold were performed to identify the uncertain parameters of Markov model.Results:Total costs of atezolizumab group were$48,129,while cost of chemotherapy alone was just$12,920 in placebo group.The quality-adjusted life-years(QALYs)in atezolizumab group was just 0.072 higher than that in placebo group(0.858 QALYs vs.0.786 QALYs).The cost-effectiveness ratio between atezolizumab combination with chemotherapy and chemotherapy alone was$489,013/QALY in China.The net benefit of placebo group was significantly higher than atezolizumab group.One-way sensitivity analyses highlighted that utilities of the progression-free survival(PFS)and progression disease state in placebo group were the most influential parameter.Conclusions:Atezolizumab combination therapy was not more cost-effective than chemotherapy alone at a WTP threshold of$25,929/QALY in China.
基金the National Key R&D Program of China(No.2016YFC1303800)the Innovation Project of Health and Technology in Jilin Province(No.2017J064)+2 种基金the 13th Five-Year Science and Technology Project of Jilin Provincial Education Department(No.JJKH20190020KJ)Jilin Province Science and Technology Development Plan Projectand Jilin Provincial Key Laboratory Project(No.20180101009JC).
文摘Immunotherapy has opened a new era in cancer treatment.Drugs represented by immune checkpoint inhibitors have led to important breakthroughs in the treatment of various solid tumors,greatly improving the survival rate of cancer patients.Many types of immunotherapeutic drugs have become widely available;however,their efficacy is variable,and relatively few patients with advanced cancer experience life-altering durable survival,reflecting the complex and highly regulated nature of the immune system.The research field of cancer immunotherapy(CIT)still faces many challenges in pursuing the broader social goal of“curing cancer.”Increasing attention has been paid to strengthening the understanding of the molecular or cellular drivers of resistance to immunotherapy,actively exploring more effective therapeutic targets,and developing combination therapy strategies.Here,we review the key challenges that have emerged in the era of CIT and the possible solutions or development directions to overcome these difficulties,providing relevant references for basic research and the development of modified clinical treatment regimens.
基金This study was supported by grants from the National Key Research and Development Program of China （No. 2016YFC1303804）, the National Natural Science Foundation of China （No. 81672275 and No. 81501962）, the Key Laboratory Construction Project of Science and Technology Department （No. 20170622011JC）, the Industrial Research and Development Project of Development and Reform Commission of Jilin Province （No. 2017C022）, the State Key Program of National Natural Science of China （No. 31430021）, and the Youth Fund of the First Hospital of Jilin university （No. JDYY52015003）.
文摘Background： Base excision repair （BER） plays an important role in the maintenance of genome integrity and anticancer drug resistance. This study aimed to explore the role of BER gene polymorphisms in response to chemotherapy for advanced non-small cell lung cancer （NSCLC） patients treated with platinum-based chemotherapy. Methods： During the period from November 2009 to January 2016, a total of 152 patients diagnosed with NSCLC Stage IIIB and IV in the First Hospital of Jilin University were admitted into this study. The XRCC1 G28152A, MUTYH G972C, HOGG1 C1245G. and PARPI T2444C polymorphisms of all the patients were detected by mass spectrometry. The logistic regression was used for statictical analysis. All tests were bilateral test, and a P 〈 0.05 was considered statistically significant. Results： The logistic regression model showed that the response rate of chemotherapy of the PARP1 T2444C polymorphisms, CC genotype （odds ratio [OR]： 5.216, 95% confidence interval [CI]： 1.568-17.352, P = 0.007）, TC genotype （OR： 2.692, 95% C1：1.007-7.198, P = 0.048）, as well as the genotype of TC together with CC （OR： 3.178, 95% CI： 1.229-8.219, P = 0.017） were significantly higher than those of TT wild type. There was no relationship between the MUTYH G972C, XRCC1 G28152A, and HOGGI C1245G gene polymorphisms and chemosensitivity. Conclusions： The PARPI 2444 mutation allele C might be associated with the decreased sensitivity to platinum-based chemotherapy in advanced NSCLC. These findings may be helpful in designing individualized cancer treatment.
基金supported by the National Key Research&Development Program of China(No.2016YFC1303800)Innovation Project of Health and Technology in Jilin Province(No.2017J064)+1 种基金Special Project of Development and Reform Commission in Jilin Province(No.2017C022)Key Laboratory Construction Project of Department of Science and Technology of Jilin Province(No.20170622011JC)。
文摘Background:Circulating tumor DNA(ctDNA)is a promising biomarker for non-invasive epidermal growth factor receptor mutations(EGFRm)detection in lung cancer patients,but existing methods have limitations in sensitivity and availability.In this study,we used theΔCt value(mutant cycle threshold[Ct]value-internal control Ct value)generated during the polymerase chain reaction(PCR)assay to convert super-amplification-refractory mutation system(superARMS)from a qualitative method to a semi-quantitative method named reformed-superARMS(R-superARMS),and evaluated its performance in detectingEGFRm in plasma ctDNA in patients with advanced lung adenocarcinoma.Methods:A total of 41 pairs of tissues and plasma samples were obtained from lung adenocarcinoma patients who had knownEGFRm in tumor tissue and were previously untreated.EGFRm in ctDNA was identified by using superARMS.Through making use ofΔCt value generated during the detection process of superARMS,we indirectly transform this qualitative detection method into a semi-quantitative PCR detection method,named R-superARMS.Both qualitative and quantitative analyses of the data were performed.Kaplan-Meier analysis was performed to estimate the progression-free survival(PFS)and overall survival(OS).Fisher exact test was used for categorical variables.Results:The concordance rate ofEGFRm in tumor tissues and matched plasma samples was 68.3%(28/41).At baseline,EGFRm-positive patients were divided into two groups according to the cut-offΔCt value ofEGFRm set at 8.11.A significant difference in the median OS(mOS)between the two groups was observed(EGFRmΔCt≤8.11vs.>8.11:not reachedvs.11.0 months;log-rankP=0.024).Patients were divided into mutation clearance(MC)group and mutation incomplete clearance(MIC)group according to whether theΔCt value ofEGFRm test turned negative after 1 month of treatment.We found that there was also a significant difference in mOS(not reachedvs.10.4 months;log-rankP=0.021)between MC group and MIC group.Although there was no significant difference in PFS between the two groups,the two curves were separated and the PFS of MC group tended to be higher than the MIC group(not reachedvs.27.5 months;log-rankP=0.088).Furthermore,EGFRm-positive patients were divided into two groups according to the cut-off of the changes inΔCt value ofEGFRm after 1 month of treatment,which was set at 4.89.A significant difference in the mOS between the two groups was observed(change value ofΔCt>4.89vs.≤4.89:not reachedvs.11.0 months;log-rankP=0.014).Conclusions:DetectingEGFRm in ctDNA using R-superARMS can identify patients who are more likely sensitive to targeted therapy,reflect the molecular load of patients,and predict the therapeutic efficacy and clinical outcomes of patients.
基金the grants from the Nation Key Research and Development Program of China(No.2016YFC1303800)the National Natural Science Foundation of China(No.81802487)+2 种基金the China postdoctoral foundation project(No.2019M651217)the Research on the method of medical data correlation analysis and platform construction(No.45119031C003)the Youth Development Foundation of the First Hospital of Jilin university(No.JDYY92018028)。
文摘To the Editor:Worldwide,lung cancer,particularly non-small cell lung cancer(NSCLC),is the leading cause of tumor-related death.Cost-effectiveness analysis show no economic benefits for advanced NSCLC patients over chemotherapy.[1]Furthermore,tests such as programmed cell death ligand 1(PD-L1)and tumor mutational burden(TMB)tests,evaluated via immunohistochemical methods and next-generation sequencing,respectively,are widely used for screening potential beneficiaries of immune checkpoint inhibitors(ICIs).However,these two methods have different predictive values,making their comprehensive evaluation the focus of the current controversy.
