Objective To investigate the expression of phosphatidylinositol 3 kinase (PI3K), phosphatase deleted on chromosome 10 (PTEN) and glycogen synthase kinase (GSK)-3β in astrocytoma and its relationship with clinicopathological features and prognosis. Methods Eighty astrocytoma tissue samples and 20 normal brain tissue samples were collected from January 2014 to December 2018,PI3K, PTEN and GSK-3βexpression in the above tissues were detected by immunohistochemistry and real-time fluorescence quantitative PCR (qPCR). The relationship between their expression and clinicopathological features and overall survival(OS) was analyzed. Spearman method was used for correlation analysis, and Cox proportional hazards regression model was used for multivariate analysis. Results Immunohistochemical staining showed that the expression of PI3K increased with the increase of astrocytoma WHO grade (P=0.109), the expression of GSK-3βand PTEN decreased with the increase of WHO grade (P=0.029, P=0.033). qPCR showed that the relative expression of PI3K mRNA increased with the increase of astrocytoma WHO grade (P=0.158), and the relative expression of PTEN mRNA and GSK-3β mRNA decreased with the increase of astrocytoma WHO grade（P=0.038,P=0.029）. PI3K was negatively correlated with PTEN and GSK-3β(r=-0.263, P=0.018; r=-0.285, P=0.010); GSK-3β was not related to the expression of PTEN (r=0.056, P=0.620). The expression of PI3K was not related to clinicopathological parameters (P>0.05); The expression of PTEN and GSK-3β was related to WHO grade and IDH-1 expression (P<0.05), but not to age, sex and the expression of GFAP and Vimentin (P>0.05). The 1-year and 2-year survival rates of PI3K positive expression group were 57.1% and 31.0%, respectively, lower than 79.0% and 71.1% of negative expression group (P=0.001); The 1-year and 2-year survival rates in GSK-3β positive expression group were 74.4% and 61.5% respectively, which were higher than 61.0% and 39.0% in negative expression group (P=0.049); The 1-year and 2-year survival rates of PTEN positive expression group were 74.9% and 62.9% respectively, which were higher than 53.3% and 23.3% of negative expression group (P=0.270). Univariate analysis showed that WHO grade, and the expression of PI3K and GSK-3β were related to OS in patients with astrocytoma (P<0.05). Cox multivariate analysis showed that PI3K expression was the independent factor affecting OS in patients with astrocytoma (P=0.001). Conclusion  The level of PI3K increases with the increase of astrocytoma WHO grade, and the level of PTEN and GSK-3β decreases with the increase of WHO grade. The prognosis of patients with PI3K positive expression, and negative expression of PTEN and GSK-3β is poor. They may be involved in the occurrence and development of astrocytoma and have a certain value in predicting the prognosis.

Objective To explore the expression of tumor necrosis factor receptor superfamily 21 (TNFRSF21) in hepatocellular carcinoma (HCC), related biological function and its relationships with prognosis and immune system. Methods The data sets of HCC cell lines were obtained from Gene Expression Omnibus (GEO) database to screen the common differentially expressed genes. The data of HCC patients were obtained from The Cancer Genome Atlas (TCGA) database, the expression of TNFRSF21 of HCC and paracancerous tissues was compared, and the relationship between TNFRSF21 and overall survival (OS), as well as clinicopathological characteristics was analyed. Moreover, expression level of TNFRSF21 in 67 patients with HCC from July 2009 to October 2010 were detected by real-time quantitative PCR (qPCR).The relationship of expression level of TNFRSF21 with OS of HCC patients was analyzed. The TNFRSF21 proteinprotein interaction network was constructed by STRING, and the biological functions and tumor-related pathways of TNFRSF21 were enriched by Gene Ontology(GO) and Kyoto Encyclopedia of Genes and Genomes(KEGG). TIMER and TISIDB were used to analyze the correlation between TNFRSF21 and immune infiltrating cells in HCC. ResultsCommon differentially expressed genes TNFRSF21, CROT, APPBP2 and CPD in HepG2 and Huh7 cell lines with CSN5 knockdown, as well as HepG2 and Huh7 cell lines with COP1 knockdown were screened based on GEO database. Based on TCGA database, the median mRNA of TNFRSF21 was 3.125 in paracancerous tissues and 3.953 in 374 HCC tissues (P<0.001). TNFRSF21 mRNA in HCC tissues was 1.77±1.60, which was higher than 1.07±0.83 in paracancerous tissues (P=0.002). Survival analysis showed that only TNFRSF21 gene expression level was correlated with OS (P=0.030). In 67 HCC patients, the median OS in the high-expression group was unreached, superior to 35.0 months in the low-expression group (P=0.039). According to TCGA database, 374 HCC patients were divided into high and low expression groups based on the median TNFRSF21 expression of 2.678.It was found that TNFRSF21 expression level was significantly correlated with serum AFP level (P<0.001) and vascular invasion (P=0.029) of HCC patients. According to STRING and GO&KEGG enrichment analysis, TNFRSF21 may be involved in NF-κB and JNK signaling pathways through APP and TARDD, thus regulating the occurrence and development of tumors. TIMER analysis showed that the high expression of TNFRSF21 was associated with B cells (r=0.299,P<0.001), CD8+T cells (r=0.242, P<0.001), CD4+T cells (r=0.417, P<0.001), macrophages (r=0.527, P<0.001), neutrophils (r=0.389, P<0.001) and dendritic cells(r=0.363, P<0.001). TISIDB analysis showed that the expression of TNFRSF21 was positively correlated with the abundance of activated dendritic cells (r=0.271, P<0.001), follicular helper T cells (r=0.333, P<0.001), mast cells (r=0.270, P<0.001) and CD4+ central memory T cells (r=0.393, P<0.001). Conclusion TNFRSF21 gene is up-regulated in HCC, and related to poor prognosis. TNFRSF21 may promote the occurrence and development of HCC by inducing endothelial cell necrosis and tumor microenvironment through tumor immune infiltrating cells. TNFRSF21 can be used as a molecular marker for prognosis in HCC.

Objective To explore the expression and clinical value of microRNA (micro RNA, miR)-183 and cell cycle G1 to S phase transition 1 (GSPT1) in cervical cancer. Methods From January 2014 to December 2016，91 patients with cervical cancer who were surgically treated were enrolled. Fluorescence quantitative PCR was used to detect the expression of miR183 and GSPT1 in 91 cases of cervical cancer and adjacent tissues. The correlation between the expression of miR-183 and GSPT1 in cancer tissues were analyzed by linear correlation analysis. Bioinformatics was used to predict the site of interaction between the two. The relationship of miR-183, GSPT1 expression with clinicopathological parameters as well as prognosis were statistically analyzed. Results The expression of miR183 in cancer tissues (0.521±0.065) was lower than that in adjacent tissues (1.241±0.286), and the difference was statistically significant (P=0.000); the expression of GSPT1 in cancer tissues (2.034±0.374) was significantly higher than that in adjacent tissues (0.708±0.157) , and the difference was statistically significant (P=0.000). There was a significant negative correlation between the expression of miR-183 and GSPT1 in cancer tissues (r=-0.621, P=0.001). Bioinformatics predicted that GSPT1 mRNA between base 981 to 987 had an interaction site with miR-183.The expression of miR-183 and GSPT1 was related to FIGO stages, tumor differentiation, depth of muscle invasion and lymph node metastasis (P<0.05), but not with pathological types and age (P>0.05). The 1-, 3-, and 5-year disease-free survival rates of 91 cervical cancer patients were 86.8%, 73.6% and 61.5%, respectively. The 1-, 3- and 5-year disease-free survival rates in the high miR-183 expression group were 91.1%, 86.6% and 80.0% respectively, which were better than 82.6%, 60.9% and 43.5% in the low miR-183 expression group (P=0.012). The 1-, 3- and 5-year diseasefree survival rates in the high GSPT1 expression group were 86.0%, 60.4% and 39.5%, respectively, lower than 87.5%, 85.4% and 81.2% in the low GSPT1 expression group (P=0.007). Conclusion The expression of miR-183 in cervical cancer is decreased, and the expression of GSPT1 is increased. The two promotes the tumor progression of cervical cancer, which are expected to be prognostic markers for cervical cancer.

Objective To investigate the application of ExacTrac X-ray image guidance system in position correction in craniospinal intensity modulated radiation therapy(IMRT). MethodsFrom December 2017 to March 2021, 34 patients underwent craniospinal irradiation were enrolled in this study. Each patient was treated with three target regions, including whole brain section (UP), cervical thoracic section (MID) and lumbosacral section (DOWN). The position of each section of target area was corrected by ExacTrac X'ray image guidance system before treatment, the three translation directions of left and right (Lat), head foot (Long) and ventral dorsal (Vert) axis of each target area and the three rotation directions of Pitch (rotation around Lat), Roll (rotation around Long) and Yaw (rotation around Vert) were obtained, and the positioning error before and after correction was obtained. The nonparametric Wilcoxon signed rank test was used to compare the positioning error before and after correction. ResultsTwenty treatment data were obtained from each patient, and the ExacTrac X'ray system was applied for each treatment. Among the 34 patients, each patient got 680 groups of data before and after correction. The positioning errors of UP target after correction were less than those before correction. Except for the differences in Lat, Long and Pitch directions, the differences in other directions were statistically significant (P<0.05). The positioning errors of MID target after correction were less than those before correction. Except for the differences in Lat and Yaw directions, the differences in other directions were statistically significant (P<0.05). In the DOWN target area, the positioning error after correction was less than that before correction. Except for the difference in Yaw direction, the difference in other directions was statistically significant (P<0.05). The error values before the correction of the translation direction of the target area in UP section were all distributed in (-8-8) mm, and the translation direction after the correction was all distributed in (-1-1) mm; Before the correction of rotation direction, the error value was evenly distributed in (-4-4)°, and after rotation, it was evenly distributed in (-1-1)°. The translation directions of MID section and DOWN section were distributed in (-1010) mm before correction and (-1-1) mm after correction; Before the correction of rotation direction, the error value was evenly distributed in (-4-4)°, and after rotation, it was evenly distributed in (-1-1)°. Conclusion ExacTrac X'ray image guidance system can reduce the positioning error in craniospinal IMRT, which is worthy of clinical application.

Objective To evaluate the efficacy of osimertinib as the second'line treatment for patients with epidermal growth factor receptor (EGFR)'mutant advanced non'small cell lung cancer (NSCLC), and to explore the relationship of location of metastasis before treatment and progression after drug resistance with the efficacy. Methods  From January 1, 2017 to January 1, 2019, 67 patients with advanced NSCLC who were treated with 1-2 generation EGFR'tyrosine kinase inhibitor (TKI) and 50 patients who developed drug resistance after first'line chemotherapy were included. EGFR exon T790M was mutant in all 117 patients. Osimertinib 80 mg was orally administrated once a day until the disease progressed or intolerable adverse reactions were observed. Curative effects of the whole group and different subgroups were analyzed. Results  As of October 31, 2020, 28 of 117 patients still took osimertinib, with the longest duration of 43.2 months. Eighty'nine cases progressed after treatment, and 45 cases of them died. The median progression'free survival (PFS) of the whole group was 15.2 (95% CI: 12.352'18.114) months and the median overall survival (OS) was not reached. Subgroup analysis showed that gender, the first'line treatment, and the location of the metastatic lesions before treatment had impacts on PFS (P<0.05). The first'line treatment, EGFR mutation type and primary extrafocal metastasis type before treatment were related to OS (P<0.05). The presence of intrapulmonary metastasis, pleural metastasis, pleural effusion tumor exfoliated cells, liver metastasis, lymph node metastasis and bone metastasis shortened median PFS (P<0.05), and the presence of intrapulmonary metastasis, lymph node metastasis, liver metastasis and bone metastasis shortened median OS (P<0.05). There were also differences in median PFS and death rate among patients with different location of progressive lesions, but there was no significant difference (P>0.05). The death rate of patients with bone metastasis was the highest (75.0%), while the median PFS of patients bearing adrenal metastasis was the shortest (7.1 months). Conclusion  Osimertinib showed good efficacy as the second'line treatment for advanced NSCLC bearing EGFR positive mutation. The PFS of first'line treatment with EGFR'TKI sequenced by osimertinib is longer than that of first'line chemotherapy sequenced by osimertinib. The prognosis of patients with intra'and extra'pulmonary metastasis before treatment is poor, and the influence of the location of progression on the effect is limited.

 

Objective To analyze the factors influencing the optimal number of lymph node detection in laparoscopic radical gastrectomy for advanced gastric cancer. Methods The data of 536 patients with advanced gastric cancer who underwent laparoscopic radical gastrectomy from January 2018 to July 2020 were reviewed, and the clinicopathological data was analyzed. The number of lymph nodes was submitted for detection after surgery, and the factors influencing the number of lymph nodes for detection were analyzed. Results Among the 536 patients, 147 had no lymph node metastasis and 389 had lymph node metastasis. In patients without lymph node metastasis, there was a statistically significant difference in tumor diameter between the group with lymph node number ≥16 and the group with lymph node number <16 (P=0.027). Receiver operator characteristic (ROC) curve analysis showed that the area under curve of the tumor diameter predicting the number of lymph nodes ≥16 for detection was 0.719 (95% CI:0.627-0.810, P<0.001), and the optimal cut'off value was 2.8 cm. In patients with lymph node metastasis, there were statistically significant differences in age and lymph node metastasis between the group with lymph node number ≥30 and the group with lymph node number<30 (P<0.05). The results of multivariate Logistic regression analysis showed that age and lymph node metastasis (N3a and N3b)were independent factors affecting lymph nodes number <30 for detection(P< 0.05). ROC curve analysis showed that the area under curve of age and lymph node metastasis predicting number of lymph node metastasis≥30 for detection were 0.575 (95% CI:0.519-0.632, P=0.008) and 0.615 (95% CI:0.559-0.672,P<0.001), respectively. The optimal cut'off values were 54 years old and 6. Conclusion Patients with tumor diameter ≤2.8 cm without lymph node metastasis were more likely to have <16 lymph nodes for detection. Patients aged >54 years and with no more than 6 metastatic lymph nodes were more likely to have <30 lymph nodes for detection. In clinical work, various influencing factors should be comprehensively considered to ensure sufficient lymph node detection, so as to formulate individualized treatment plan and improve the quality of treatment.

 

Objective  To investigate the value of PET/CT biphasic imaging in predicting lymph node metastasis of cervical carcinoma. Methods  We retrospectively analyzed 202 lymph nodes from January 2019 to July 2021 in 97 patients with cervical carcinoma who underwent surgery and had preoperative PET/CT for early and delayed imaging (duplex). The metabolic parameters of lymph nodes in early imaging, such as SUVmaxL1, SUVmean, SUVpeak, MTV, TLG, length-short diameter ratio (L/D), SUVmaxT of lesions, SUVmaxA of abdominal aorta, SUVmaxH of liver, and SUVmaxL2 of lymph nodes in delayed imaging were measured. The corresponding ratios, △SUVmax (SUVmaxL2-SUVmaxL1) and retention index (RI) were calculated. The differences of each parameter between lymph node metastasis group(n=42) and non-metastasis group(n=160) were compared. Multivariate regression analysis was performed in combination with traditional diagnostic criteria to establish a combined predictive diagnostic model. Receiver operating characteristic (ROC) curve was used to compare the diagnostic efficacy. Results  SUVmaxL1, SUVmean, SUVpeak, MTV, TLG, L/D, SUVmaxL2, △SUVmax, RI, SUVmaxL1/T, SUVmaxL1/A and SUVmaxL1/H were significantly different between metastasis and non-metastasis groups, and Logistic multi-factor regression analysis showed that SUVpeak, L/D, conventional PET/CT diagnostic criteria and SUVmaxL2 were independent risk factors for lymph node metastasis of cervical cancer; the area under curve (AUC) of conventional PET/CT diagnostic criteria was 0.839, with a sensitivity of 67.7 % and specificity of 87.5%; the AUC of single-temporal combined predictive diagnostic model was 0.915, with a sensitivity and specificity of 83.3% and 85.6%, respectively; the AUC of dual'temporal combined predictive diagnostic model was 0.995, with a sensitivity and specificity of 97.6% and 98.7%, respectively. The AUC of the single-temporal combined predictive diagnostic model was higher than that of the conventional PET/CT diagnostic criteria, the AUC of the dual-temporal combined predictive diagnostic model was higher than that of the conventional PET/CT diagnostic criteria, and the AUC of the dual-temporal combined predictive diagnostic model was higher than that of the single-temporal image.The difference was statistically significant (P<0.05). Conclusion The diagnostic efficacy of single-temporal and dual'temporal combined predictive diagnostic models for lymph node metastasis is higher than that of conventional diagnostic criteria, and the diagnostic efficacy of dual-temporal combined predictive diagnostic model is significantly higher than that of single-temporal combined predictive diagnostic model.

Objective To investigate the relevant prognostic factors of malignant peripheral nerve sheath tumors (MPNST). MethodsThe data of 33 patients with MPNST from September 2010 to December 2019 were reviewed. The 33 patients included 15 males and 18 females, and the median age was 42 years (ranged from 3 to 69 years). Eleven cases were neurofibromatosis type 1(NF-1)-associated MPNST, and 22 were sporadic MPNST. The distribution of lesion location included 20 cases of extremities and 13 cases of trunk. There were 28 cases with negative surgical margin and 5 cases with positive surgical margin. All patients underwent surgery. Five patients were treated with adjuvant radiotherapy and 9 patients with adjuvant chemotherapy. One patient with ROS1 mutation received crizotinib. Progression-free survival (PFS) and overall survival (OS) were analyzed as clinical outcomes. Prognostic factors were analyzed by Cox multivariate analysis. Results The follow-up time was 6-96 months. Eight patients had local recurrence (4 of extremities, 4 of trunk),and 14 patients were companied by  metastasis (6 of extremities, 8 of trunk). The 5-year progression'free survival rate was 38.3% and 5-year overall survival rate was 53.3%. Univariate analysis showed that the tumor size, the expression of S-100 and H3K27me3, and margin status were related with PFS (P<0.05), while the expression of S-100 and H3K27me3, margin status and radiotherapy were related with OS (P<0.05). Multivariate Cox regression analysis showed that S-100 and margin status were the independent factors affecting PFS (P<0.05), while margin status was the independent prognostic factor affecting OS (P<0.05). Conclusion S-100 and surgical margin are important factors affecting the prognosis of patients with MPNST. Individualized treatment should be made according to the clinicopathological features and gene detection results of patients.

 Objective  To investigate the efficacy of simultaneous sucralfate retention enema during radiotherapy on preventing the occurrence of acute and chronic radiation proctitis in patients with cervical cancer, and to evaluate the impact on the clinical symptoms and quality of life. Methods  From January 2017 to June 2019, 208 cases of cervical cancer patients underwent radiation were enrolled in this study, and they were divided into experimental group (n=104) and control group (n=104) according to the random number table method. Patients in experimental group received simultaneous sucralfate retention enema during radiotherapy once daily. RTOG/EORTC table, simple clinical colitis activity index (SCCAI) questionnaire and inflammatory bowel diseases questionnaire (IBDQ) were used to evaluate all patients. Results  The incidences of acute radiation proctitis in experimental group and control group were 35.6% and 58.5%, respectively (P=0.000), and the occurrence of acute radiation proctitis was 21.3 days and 17.4 days (P=0.000). Grade 1, grade 2 and grade 3 acute radiation proctitis were found 19,15 and 3 cases in experimental group, and 22, 31 and 8 cases in control group. The incidences of chronic radiation proctitis in experimental group and control group were 9.6% and 22.1%, respectively (P=0.012), and and the occurrence of chronic radiation proctitis was 10.1 months and 9.2 months, respectively (P=0.235). Grade 1, grade 2, grade 3 and grade 4 chronic radiation proctitis were found 3, 4, 2, and 1 cases in experimental group and 4, 9, 8 and 2 cases in control group. Patients in experimental group had lower SCCAI scores than the control group at the end of radiotherapy, 3 months and 12 months after radiotherapy (P<0.05), while the IBDQ score was higher than that in the control group (P<0.05). Conclusion  Sucralfate retention enema during radiotherapy can effectively reduce the risk of acute and chronic radiation proctitis in patients with cervical cancer and improve the patients' clinical symptoms and quality of life.

 Objective  To explore the value of ultrasonic strain elastography (SE) combined with supermicro blood flow imaging (SMI) in the identification of thyroid nodules. Methods  The imaging and clinical data of 80 patients with thyroid nodules who were examined from May 2019 to August 2020 were selected, and pathological examination results were used as the gold standard, and patients were divided into benign group (n=34) and malignant group (n=46), SE and SMI were performed in both groups. The ultrasound elasticity scoring standard was used to evaluate the results of SE detection of thyroid nodules, the results of SMI detection of thyroid nodules were evaluated according to Alder blood flow classification, and receiver operating characteristic curve (ROC)was used to analyze the diagnostic efficiency of SE and SMI alone and in combination in the diagnosis of thyroid nodules. ResultsThe ultrasonic elastic score of malignant thyroid nodules detected by SE was significantly higher than that of benign nodules (P=0.000). A total of 38 cases of malignant nodules were detected, including 5 cases in benign group and 33 cases in malignant group. Taking 4 points as the cut-off value, the malignant rate of 1-3 points was 31.0% (13/42), and the malignant rate of 4-5 points was 86.8% (33/38). The Alder blood flow grade of malignant thyroid nodules detected by SMI was significantly higher than that of benign nodules (P = 0.000). A total of 39 cases of malignant nodules were detected, including 7 cases in benign group and 32 cases in malignant group. Taking grade 2 as the cut-off value, the malignant rate of grade 0-1 was 34.1% (14/41), and the malignant rate of grade 2-3 was 82.1% (32/39). In the diagnosis of benign and malignant thyroid nodules, the sensitivity of SE, SMI and their combination were 0.690, 0.659 and 0.871 respectively, the specificity were 0.868, 0.821 and 0.857 respectively, the accuracy were 0.775, 0.738 and 0.863 respectively, and the areas under the ROC curve were 0.785, 0.745 and 0.854 respectively. Conclusion  Compared with separate diagnosis, the combined diagnosis of SE and SMI can effectively improve the diagnostic efficiency of benign and malignant thyroid nodules, and has a higher reference value.

 

Breast cancer is the most common female malignant tumor and has become the most common cancer in the world.With the advent of targeted drugs and the improvement of systemic treatment for breast cancer, the prognosis of patients with early breast cancer has been greatly improved. However, for patients with refractory breast cancer after multi'line therapy and newly diagnosed distant metastasis, the antibodies or cytotoxic drugs alone cannot meet the therapeutic needs. Antibody-drug conjugates (ADCs) are immunoconjugates that connect cytotoxic drugs and monoclonal antibodies via the molecular linker, which can selectively deliver cytotoxic drugs to cancer cells through monoclonal antibodies targeting tumor antigens, and so they have the advantages of strong selectivity, high efficiency and low toxicity. In recent years, ADCs have played an increasingly important role in the treatment of breast cancer. This review summarizes the main mechanism of ADCs,the current status and progress of ADCs for breast cancer.

In the progression of breast cancer, brain metastasis will occur in 15% to 30% patients. Due to the prolonged survival of breast cancer patients, the incidence of brain metastasis is gradually increasing. The incidence and characteristics of brain metastasis from breast cancer of different molecular subtypes are different. Current treatment for breast cancer brain metastasis includes local treatment and systemic treatment. In recent years, with the development of comprehensive treatment of breast cancer, the application of chemotherapy, endocrine therapy and molecular targeted therapy in breast cancer brain metastasis has received more and more attention. Many new treatment methods such as conjugated drugs, immunotherapy and other methods have also shown certain effects on breast cancer brain metastasis. This article reviews the clinical characteristics and treatment progress of different molecular subtypes of breast cancer brain metastasis, and aims to provide certain ideas and basis for the clinical diagnosis, treatment and management of breast cancer brain metastasis.

Rad51 is the central molecule of homologous recombination (HR), which assembles on ssDNA as an oligomeric nucleoprotein filament and then invades the homologous double'stranded DNA during chromosome pairing to complete the repairing of DNA damage through different downstream pathways. The role of Rad51 in malignant tumors is mainly to promote tumor development, metastasis and anticancer drug resistance, including: (1) The interactions between Rad51 and cycle checkpoint molecules play a regulatory role in related pathways to affect tumor development and metastasis. (2) The reduced expression of Rad51 leads to partial reversal of epithelial mesenchymal transformation(EMT) process to regulate EMT'related metastasis and drug resistance of tumor cells. (3)The relationship between Rad51 and drug resistance of tumor can be revealed through gene polymorphism studies. (4) A number of microRNAs and long non'coding RNAs targeting the coding region of Rad51 can regulate gene expression and ultimately regulate HR efficiency and the development of drug resistance of tumor cells. Recently, the mechanisms above have been identified by the reports of Rad51 overexpression in ovarian, breast and lung cancer, which indicates that the over'expression of Rad51 is related to metastasis and drug resistance of malignant tumor. The regulation of Rad51 expression can reverse the process of tumor drug resistance, and it is expected to become a novel target for the treatment and drug resistance of cancer.

 

The use of immunecheckpoint inhibitors (ICIs) has completely changed the treatment mode of advanced cancer. At present, U.S. Food and Drug Administration (FDA) has approved various ICIs for clinical application, including cytotoxic T'lymphocyte associated antigen-4 (CTLA-4), programmed death-1 (PD-1) and its ligand (PD-L1), etc. Different from the responses of traditional chemotherapy and targeted therapy, immunotherapy is often accompanied by atypical responses, such as pseudoprogression, hyperprogression disease (HPD), dissociated responses, durable response and etc. These atypical reactions bring challenges to the evaluation of the efficacy of immunotherapy in the clinical practice. Clinicians need to regularly monitor and evaluate the treatment effect of patients, and optimize the treatment plan according to the changes of the disease. In this paper, we reviewed the atypical responses of immunotherapy at present, which provided reference for clinicians to distinguish the anti'tumor immune responses.