Chinese Clinical Oncology

A multicenter， double-blind， randomized control clinical trail of palonosetron hydrochloride capsules for prevention of chemotherapyinduced nausea and vomiting

LUO Linhua， GUAN Xiaoxiang， QIN Shukui， CHEN Yingxia， SHI Jianhua， CHENG Ying， ZHENG Rongsheng， YAO Yang， HAN Baohui， YU Shiying

Chinese Clinical Oncology. 2014, 19 (11): 961.

Abstract ( 987 )

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Objective To observe and evaluate the efficacy and safety of palonosetron hydrochloride capsules made in China for prevention of chemotherapyinduced nausea and vomiting. Methods This study was performed as a multicenter， randomized， doubleblind control clinical trial. The patients were randomized to administer palonosetron hydrochloride capsule（0.5mg） and a simulator of granisetron dispersible tablet（experimental group）， or a granisetron dispersible tablet（1mg） and a simulator of palonosetron（control group）， each administered 1 hour before initiation of moderate emetogenic chemotherapy. After 12h for chemotherapy， experimental group were administered a simulator of granisetron dispersible tablet and control group were administered a granisetron dispersible tablet （1mg）. The acute emetic episodes， delayed emetic episodes， nausea， physical status and VAS scores was recorded， administer rescue medication （granisetron combined with dexamethasone） was taken if patients needed.
Results A total of 240 patients from seven clinical research centers in China were randomized to the clinical trial with 122 patients in experimental group and 118 patients in control group. The proportion of patients with emetic episodes overall periods （0-7days） was lower in experimental group than in control group （21.31％ vs.33.33％， P=0.0422）. The proportion of patients with no emetic episodes during the 24h after chemotherapy administration （acute period） between experimental group and control group was no significant difference through full analysis set （86.89％vs.85.47％， P=0.8338）， and the proportion of patients with no emetic episodes during delay （24h-7days post-chemotherapy） between experimental group and control group was significant difference through perprotocol set analysis（74.38％ vs. 61.54％， P=0.0490）. The average vomiting times of experimental group and control group were 0.15±0.52 and 0.31±0.68 respectively in second day of chemotherapy（P=0.0090）. There were no significant difference for rates of grade 0 nausea and PS scores between two groups in 15 days of chemotherapy（P＞0.05）， except to VAS scores in 2-4 days of chemotherapy（P＜0.05）. The adverse reactions of experimental group and control group included constipation（2 cases）， total bilirubin（2 cases） and constipation（4 cases）， drug dermatitis（1 case），respectively. The adverse reaction rates between two groups were 3.28％ and 4.24％ respectively（P＞0.05）. Conclusion Palonosetron hydrochloride capsule is similar to granisetron for preventing chemotherapyinduced acute nausea and vomiting， and superior to granisetron for delayed nausea and vomiting. Palonosetron hydrochloride capsule is safe and convenient administration.

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The mechanism of rheum emodin reversed resistance of EGFR-TKI in NSCLC

OUYANG Xuenong， FANG Wenzheng， WU Dansen， LIN Shaoqin， Chen Juan， YU Zongyang.

Chinese Clinical Oncology. 2014, 19 (11): 967.

Abstract ( 1160 )

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Objective To investigate the mechanism of rheum emodin reversed resistance of epidermal growth factor receptor tyrosine kinase inhibitors（EGFR-TKI） in nonsmall cell lung cancer（NSCLC）. Methods NSCLC cell lines resistant to EGFR-TKI （HCC827／GR） was built by continuous induction method. MTS method was used to detect the ability of cell proliferation by treating HCC827 and HCC827／GR cells with rheum emodin（30μmol／L）， gefitinib（1μmol／L） and rheum emodin（30μmol／L） combined with gefitinib（1μmol／L）. The expressions of p-EGFR， p-AKT， p-ERK1／2 and p-MET in HCC827 and HCC827／GR cells were detected by Western blotting method. Results The proliferation ability of HCC827／GR cell was not decreased by treating gefitinib or rheum emodin monotherapy， but remarkably decreased by treating the combination of gefitinib and rheum emodin， with statistical difference（P＜0.05）. The expressions of p-EGFR and p-ERK were strong and p-AKT expression was weak in HCC827 and HCC827／GR. pMET expression was significantly increased in HCC827／GR compared with HCC827. After treated with 1μmol／L gefitinib， the expressions of p-EGFR and pERK were downregulated in HCC827， and the expression of p-EGFR was significantly descended in HCC827／GR cell. 30μmol／L rheum emodin could obviously reduce the expression of pMET in HCC827／GR. Otherwise， after treated with rheum emodin and gefitinib， the expressions of p-EGFR， p-ERK1/2 and p-MET were markedly inhibited. Conclusion Rheum emodin may reverse the resistance of EGFR-TKI in NSCLC， probably by inhibiting the activation of c-Met.

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The effect of BTG1 expression on proliferation， apoptosis and invasion of non-small cell lung cancer cells

SUN Guogui， ZHANG Jie， CUI Dawei， LI Chenglin，YANG Congrong， ZHANG Jun， CHENG Yunjie.

Chinese Clinical Oncology. 2014, 19 (11): 972.

Abstract ( 1101 )

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Objective To investigate the expression of Bcell translocation gene 1（BTG1） in nonsmall cell lung cancer（NSCLC） and its biological effect in NSCLC cell line by BTG1 overexpression. Methods Immunohistochemistry and Western blotting were used to detect BTG1 protein expression in 82 cases of NSCLC and 38 cases of adjacent normal lung tissues， and the relationship between BTG1 expression and clinicopathological characteristics was analyzed. BTG1 lentiviral vector and empty vector were respectively transfected into NSCLC H1299 cell line. Quantitative realtime RTPCR（qRT-PCR） and Western blotting were used to detect the mRNA and protein level of BTG1. MTT assay， flow cytometry and Transwell assay were also used to detect the effects of the upregulated expression of BTG1 on H1299 cell proliferation, apoptosis and invasion. Results The positive expression rate of BTG1 protein was 37.8%（31/82） in NSCLC tissues, significantly lower than 84.2%（32/38） in adjacent normal lung tissues（P＜0.05）. The relative amount of BTG1 protein in NSCLC tissues was 0.331±0.035, significantly lower than 0.673±0.072 in adjacent normal lung tissues（P＜0.05）. The level of BTG1 protein expression was correlated with lymph node metastasis， clinical stage and histological grade（P＜0.05）. The result of biological function had shown that H1299 cell transfected BTG1 had a lower survival fraction， higher cell apoptosis， and significant decrease in migration and invasion， and lower Bcl-2， MMP-9 protein expression compared with H1299 cell untransfected BTG1（P＜0.05）. Conclusion BTG1 expression is decreased in NSCLC tissues， suggesting that BTG1 may play an important role as a negative regulator to NSCLC H1299 cell by promoting degradation of Bcl-2 and MMP-9 protein.

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Expressions of 14-3-3ζ and E-cadherin in stage Ⅲ lung adenocarcinoma and their clinical significance

LIU Xiaolian，XING Ying，WANG Xiaoyuan，MENG Qingwei，CAI Li.

Chinese Clinical Oncology. 2014, 19 (11): 977.

Abstract ( 911 )

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Objective To investigate the expressions of 14-3-3ζ and E-cadherin in resected stageⅢ lung adenocarcinoma and their clinical significance.
MethodsThe expressions of 14-3-3ζ and E-cadherin in resected stage Ⅲ lung adenocarcinoma tissues obtained from 59 patients and 43 specimens of corresponding adjacent normal alveolus tissues using immunohistochemistry，and their correlations with clinicopathological characteristics and prognosis of patients were analyzed. The overall survival（OS） of patients was estimated using the KaplanMeier method. The factors affecting the prognosis of stage Ⅲ lung adenocarcinoma patients were analyzed by Cox multivariate survival analysis. ResultsThe high-level expression rate of 14-3-3ζ in lung adenocarcinoma tissue was 57.63％（34／59）， higher than 30.23（13／43） of paired adjacent normal alveolus tissues with statistical difference（P＜0.05）. The high-level expression rate of E-cadherin in lung adenocarcinoma tissue was 67.79％（40／59）， lower than 72.09％（31／43） of paired adjacent normal alveolus tissues without statistical difference（P＞0.05）. Both of 14-3-3ζ and E-cadherin expressions were correlated to differentiation（P＜0.05）.Positive correlation was observed between expressions of 14-3-3ζ and E-cadherin （r=0.351，P=0.015）.The median OS of 59 patients was 29.90 months. The median OS of patients with 14-3-3ζ and E-cadherin high-level expression both were 52.63 months， higher than 16.93 months of patients with lowlevel expression（P＜0.05）. Multivariate survival analysis showed that 14-3-3ζ was independent prognostic indicator for resected stage Ⅲ lung adenocarcinoma patients（P＜0.05）. Conclusion The expressions of 14-3-3ζ and E-cadherin shows a good correlation in lung adenocarcinoma tissues. Detecting the expressions of these two proteins may give a clue on prognosis in patients with stageⅢ lung adenocarcinoma.

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Effects of stellettin B on proliferation and apoptosis of non-small cell lung cancer cells

HE Yuxian， XU Zhifeng， CAI Shaohuan.

Chinese Clinical Oncology. 2014, 19 (11): 982.

Abstract ( 1053 )

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Objective To explore the effects of stellettin B on proliferation， apoptosis of nonsmall cell lung cancer（NSCLC） cells and its possible active mechanism. MethodsThe A549 and NCI-H1299 cells were treated with different concentrations of stellettin B （01， 1， 10， 100μmol／L）. The MTT method was used to measure the proliferation inhibition rate at 24th， 48th， 72nd and 96thh treated with different concentrations of stellettin B. The Hoechst staining was employed to detect the cell apoptosis index at 24th and 48th h after treatment with stellettin B. The Annexin-FITC／PI double staining and PI staining were employed to detect cell apoptosis and cell cycle distribution at 48th h via flow cytometry. The Western blotting was used to measure the protein levels of cell cyclerelated genes （cyclin A， CDK2 and p21CIP1） at 48th h after treatment. Results The stellettin B of different concentrations could increase the proliferation inhibition rates in a dose and timedependent manner. After being treated by stellettin B for 24 and 48h， there were increased apoptosis index， apoptosis rate in a dose dependent manner. With the increase of stellettin B，there were increased G0／G1 phase cell percentage and protein level of p21CIP1 but decreased S and G2／M phase cell percentages and protein level of cyclin A and CDK2 with statistical difference （P＜0.05）. Conclusion Stellettin B can inhibit the proliferation of NSCLC cells as well as inducement of apoptosis and cell cycle arrest， possibly by influencing the expressions of cyclerelated genes.

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Expression of HOXB7 in human lung adenocarcinoma and its clinical significance

UAN Weiwei， TAN Yan， DU Min， LI Hua， XU Chuan， ZHANG Tao， HU Yide.

Chinese Clinical Oncology. 2014, 19 (11): 987.

Abstract ( 1008 )

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Objective To detect the expression of homeobox genes（HOX）B7 in human lung adenocarcinoma， and investigate its clinical significance.
MethodsThe expressions of HOXB7 mRNA and proteins in human lung adenocarcinoma cell lines A549， H1975， H1650， H322 and human bronchial epithelial cell line HBE were detected by reverse transcription PCR（RT-PCR） and Western blotting method, respectively.Immunohistochemistry staining was used to examine the expressions of HOXB7 in 75 samples of lung adenocarcinoma and their corresponding adjacent normal lung tissues.The correlation between HOXB7 expression and clinicopathological features and prognosis of lung adenocarcinoma were analyzed.
Results The expression levels of HOXB7 mRNA and proteins in four lung adenocarcinoma cell lines were significantly higher than those in human bronchial epithelial cell line. The overexpression rate of HOXB7 in lung adenocarcinoma and corresponding paracancerous tissue was 76.0％（57/75） and 9.3％（7/75） with statistical difference（P＜0.05）. Statistical analysis revealed that HOXB7 protein expression was correlated with clinical stage， pathological grade and lymph node metastasis in lung adenocarcinoma（P＜0.05）. The median overall survival time of patients with low HOXB7 expression was 68 months， higher than 51 months of patients with overexpression with statistically significant（P＜0.05）. Conclusion The over-expression of HOXB7 relates to the invasion, metastasis and progression of lung adenocarcinoma. It may play an important role in earlier diagnosis and prognosis evaluation for lung adenocarcinoma.

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Expression of aldehyde dehydrogenase 1A1 in human gastric cancer and its clinical significance

WU Chengli， WANG Yongmei， WANG Gefang， YU Guanzhen， WANG Jiejun.

Chinese Clinical Oncology. 2014, 19 (11): 992.

Abstract ( 992 )

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Objective To detect the expression of aldehyde dehydrogenase 1A1（ALDH1A1） in gastric cancer tissues and clinical significance. Methods ALDH1A1 expression in 1072 gastric cancer tissues and paracacinoma tissues was detected by immunohistochemistry. The associations of ALDH1A1 with clinicopathological characteristics and overall survival（OS） were subsequently assessed. Results The positive expression rates of ALDH1A1 in gastric cancer tissues and para-cacinoma tissues were 49.9％（535／1072）and 43.3％（465／1072），with statistic significance（P＜0.05）.The expression of ALDH1A1 was associated with age， depth of gastic wall invasion， differentiation， lymph node metastasis and TNM stage（P＜0.05）. The median OS of 1072 patients was 32.2 months， and for the patients with positive expression and negative expression of ALDH1A1 were 23.3 and 60.4months（P＜0.001）. Cox multivariate regression model revealed that ALDH1A1 expression， differentiation, TNM stage, age， lymph node metastasis， tumor thrombus, depth of gastic wall invasion and nervous invasion were independent factors influencing OS.Conclusion ALDH1A1 is obviously upregulated in gastric cancer tissues， and correlated with poor prognosis， which may become a new tumor maker for predicting prognosis of gastric cancer.

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Expression of EphA1 protein in ovarian serous adenocarcinoma and its clinical significance

WANG Haiyan，PENG Libo，WANG Jianjun，WEN Juanjuan，SHI Qunli，WANG Xuan， WANG Jiandong.

Chinese Clinical Oncology. 2014, 19 (11): 996.

Abstract ( 1053 )

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Objective To explore the expression level of EphA1 in ovarian serous adenocarcinoma and analyze its correlation with clinicopathological characteristics， as to provide reference for screening a new indicator in ovarian serous adenocarcinoma for diagnosis and prognosis.
Methods The immunocytochemical method was employed to measure the expression of EphA1 in human ovarian cancer cell lines HO8910， SKOV3 and A2780 cells. The protein expression level of EphA1 in 76 ovarian serous adenocarcinoma tissues was detected by immunohistochemical staining. The results were divided into low-level expression（≤5） group and highlevel expression group（＞5） according to the immunohistochemical staining counting method. The relationships between the expression of EphA1 and clinicopathological characteristics were investigated. Results The expression of EphA1 protein was negative in HO8910 and SKOV3 cells but weakly positive in A2780 cell. Out of 76 tissue samples of ovarian serous adenocarcinoma， there were 33 cases（43.4％） with high-level expression and 43 cases（56.6％） with low-level expression， respectively. The expression of EphA1 protein was related with WHO and MDACC grading（P＜0.05）, but unrelated with clinical staging， metastasis， tumor location， tumor diameter and age（P＞0.05）. The median overall survival of highlevel expression group was 71.0 months， higher than 31.0 months of lowlevel expression group with significant difference（P＜0.05）.Conclusion Expression of EphA1 protein in ovarian serous adenocarcinoma is downregulated， and is related with high histological grade and poor prognosis. EphA1 protein may be a new index of diagnosis and clinical prognosis in ovarian serous adenocarcinoma.

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Clinical significance of plasma epstein-barr virus DNA quantitative monitoring in the treatment and followup for locally advanced nasopharyngeal carcinoma

ZHANG Qian， SUN Xiujin， SONG Dan.

Chinese Clinical Oncology. 2014, 19 (11): 1000.

Abstract ( 1107 )

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Objective To explore the clinical significance of plasma epstein-barr virus DNA（EBV-DNA） quantitative monitoring in the treatment and follow-up for locally advanced nasopharyngeal carcinoma. Methods Plasma EBV-DNA levels of 156 locally advanced nasopharyngeal cancer patients were detected during concurrent radiochemotherapy with 0， 2， 4， 6， 8 weeks， and plasma EBV-DNA levels of patients with who plasma EBV-DNApositive before the treatment and followed up were detected after 6， 12， 18， 24 months， using quantitative PCR technique. The efficacy and recurrence and metastasis situation during two years after treatment were evaluated respectively. Results Plasma EBV-DNApositive rate of 156 patients was 91.0％（142／156） before concurrent radiochemotherapy， and positive rate of 9.6％（15／156） after 8 weeks of the treatment. One hundred and twenty-seven out of 142 plasma EBV-DNApositive patients with pretreatment， plasma EBVDNA levels showed a trend of decline from the treatment of 2 weeks. On 6 weeks of the treatment， DNA replication were not detected in 127 patients. The other plasma EBV-DNA level of 15 cases maintained the positive level after 8 weeks of the treatment. One hundred and nineteen cases were complete response and 37 cases were partial response， of which the plasma EBVDNA positive rate of 8 weeks after the treatment was 3.4％（4／119） and 29.7％（11／37）， respectively. 135 out of 142 patients with pre-treatment plasma EBV-DNApositive were followed up for two years， 1， 2year recurrence rate was 14.1％（19／135） and 23.0％（31／135）， respectively. By receiver operating characteristic curve analysis， 1， 2year plasma EBVDNA levels were higher judged on accuracy of 1， 2year recurrence rate （Az1=0.944，Az2=0.925；P＜0.05）. Conclusion Quantification of plasma EBV-DNA level can better reflect the efficacy of locally advanced nasopharyngeal carcinoma after comprehensive treatment. For pretreatment plasma EBV-DNApositive locally advanced nasopharyngeal carcinoma， there is a good clinical value to determine recurrence and metastasis by realtime monitoring of plasma EBVDNA level during two years after concurrent radiochemotherapy.

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Comparative analysis on the modified Ivor-Lewis esophagectomy or Sweet esophagectomy plus postoperative chemoradiotherapy in the treatment of thoracic esophageal squamous cell carcinoma

PAN Xiaojie， GUO Tianxing， YE Mingfan，OU Debin.

Chinese Clinical Oncology. 2014, 19 (11): 1004.

Abstract ( 893 )

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Objective To retrospectively investigate the efficacy of modified IvorLewis esophagectomy or Sweet esophagectomy plus postoperative chemoradiotherapy in the treatment of thoracic esophageal squamous cell carcinoma and analyze the risk factors affecting the prognosis.
Methods Ninety hundred and fourteen patients with thoracic esophageal squamous cell carcinoma were divided into modified Ivor-Lewis esophagectomy group（n=424）or Sweet esophagectomy group（n=490）. For the patients with stage Ⅱ and above, they were divided into single operation group（n=297） and postoperative chemoradiotherapy group（n=446）. The patients were followed up and the survival time was calculated by KaplanMeier method. Difference in survival time was compared by Log-rank test. Cox regression analysis was performed to identify risk prognostic factors. Results The 1， 3， 5year survival rates of modified IvorLewis esophagectomy group and Sweet esophagectomy group were 86.3％， 63.7％， 44.5％ and 90.2％， 64.9％， 45.0％， respectively. In stageⅡ and above patients， the median overall survival（OS） was 36.1 and 46.1 months in patients with single operation and surgery plus postoperative chemoradiotherapy respectively（P=0.04）. The median OS was 346 and 468 months in patients with single operation and surgery plus postoperative chemoradiotherapy on modified Ivor-Lewis esophagectomy respectively， between which there was significant difference（P=0.038）. The median OS was 37.0 and 45.1 months in patients with single operation and surgery plus postoperative chemoradiotherapy on Sweet esophagectomy respectively， between which there was significant difference（P=0.036）. The median OS were no statistical difference among the subgroups in the single operation group or surgery plus postoperative chemoradiotherapy group（P＞0.05）. For the patients of stageⅡ，the median OS of surgery plus postoperative chemoradiotherapy group was not higher than single operation group on modified Ivor-Lewis or Sweet esophagectomy（P＞0.05）. For the patients with stage Ⅲ／Ⅳ， the median OS of surgery plus postoperative chemoradiotherapy group was higher than single operation group（P＜0.05）. Cox proportional hazards model showed that age， histological differentiation， positive margin， depth of invasion， vascular cancer thrombus， positive lymph node， UICC stage and adjuvant radiation and chemotherapy postoperatively were prognostic factors for overall survival （P＜0.05）. Conclusion Both of modified Ivor-Lewis esophagectomy and Sweet esophagectomy are ideal operation method to treat thoracic esophageal squamous cell carcinoma. Postoperative chemoradiotherapy could improve overall survival for patients with stage Ⅲ and above.

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The application of 4D-CBCT on accurate radiotherapy of esophageal cancer

GE Xiaolin， LI Jinkai， WANG Peipei， LI Caihong， CHEN Jiayan， CAO Yuandong，ZHANG Sheng， YANG Yan， LI Danming， MU Qingxia，SUN Xinchen.

Chinese Clinical Oncology. 2014, 19 (11): 1011.

Abstract ( 1054 )

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Objective To investigate the application of four dimension conebeam CT（4D-CBCT） on accurate radiotherapy of esophageal cancer, and provide basis for delineation of planning torget volume（PTV）. Methods Sixteen patients with pathologically confirmed esophageal cancer were included in this study.Each patient received 4D-CBCT based imaging guided analysis once a week.Online CBCT scan，image registration and setup correction were performed before and immediately after radiotherapy. The CBCT images were matched and compared with the images of planning CT automaticly and the setup errors were displayed in the superiorinferior（SI）, leftright（LR） and anteriorpost（AP） directions respectively. The setup errors were corrected with remote control before the treatment. Results A total of 166 CBCT scan from 16 patients were obtained during treatment.Under the condition of non-correction， the error were （5.6±0.4）mm，（3.4±0.5）mm，（2.2±0.2）mm in the SI， LR and AP directions， respectively.When the tumor was corrected in every fraction， the error were （1.6±0.2）mm, （0.2±0.1）mm, （0.3±0.2）mm respectively. The margins of target in the SI, LR and AP directions was 7.3mm, 9.4mm, 7.6mm before correction and 3.0mm, 4.6mm, 2.5mm after correction. Conclusion The use of 4D-CBCT correction markedly reduce the impact of setup error. It is feasible to deliver the online image guided radiation for patients with esophageal cancer.

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CT-guided percutaneous lung biopsy for the elderly solitary pulmonary nodules

YANG Wen， LI Qian， SUN Wenkui，ZENG Junli， LIANG Wenjun， SONG Yong.

Chinese Clinical Oncology. 2014, 19 (11): 1015.

Abstract ( 1104 )

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Objective To evaluate the diagnostic value and complications of CT-guided percutaneous lung biopsy for the elderly solitary pulmonary nodules.
MethodsA total of 113 patients from January 2008 to January 2014 with solitary pulmonary nodules who were performed by percutaneous transthoracic needle biopsy by CT-guided were reviewed. All of the patients were confirmed by pathology or clinical course. The CT scan was used to choose the best targeted level and the puncture point. Results Specimens of 113 patients were obtained successfully. Ninetyfour cases were proved to be malignancies and 19 cases of benign lesions by biopsy. Ninety-six cases （85.0％） of malignancies and 17 cases （15.0％） of benign lesions were proved by pathology and clinical course. The diagnostic accuracy， sensitivity and specificity were 96.5％， 97.1％ and 90.0％， respectively. The diagnostic accuracy of large nodules group （＞15mm and ≤30mm，n=98） was 98.9％， higher than 80.0％ of small nodules group （≤15mm， n=15） with statistical significance （P=0.007）. The main complications were phenmothorax （19.5％） and selflimiting bleeding （13.3％） and both of them were mild. No deathrelated complications happened. The incidence of phenmothorax was related to puncture times （P=0.002） and the length of puncture needle in lung tissues （P=0.06）. Conclusion CT-guided percutaneous lung biopsy for the elderly solitary pulmonary nodules is an efficient and safe diagnostic method with few complications.

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The value of imaging examination in predicting resectability of hilar cholangiocarcinoma

WANG Wei， FEI Yang， WANG Feng， ZONG Guangquan， LIU Renmin， XUAN Ji.

Chinese Clinical Oncology. 2014, 19 (11): 1019.

Abstract ( 982 )

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Objective To investigate the value of imaging examination in assessing the surgical resectability of hilar cholangiocarcinoma. Methods Radiographic data including CT and MRI of fortythree patients pathologically and surgically diagnosed as hilar cholangiocarcinoma were analyzed retrospectively. These data were as follows： the size of tumor， the length of invaded bile duct， the involved extent of portal vein and hepatic artery， the state of lymph node metastasis and distant metastasis and the involved scope of bile duct. Moreover， these cases were classified and staged respectively according to the criteria of improved “proposed Tstaging” system， which were studied statistically concerning the relevance to surgical resectability. Results The resectability in infiltrating tumor cases was 8.3％， and that of massforming cases was 51.6％（P=0.017）. The size of hilar cholangiocarcinoma and the length of involved bile duct measured by CT and MRI respectively had no influence on resectabilities（P＞0.05）. The resectabilities in cases of various Bismuth types were not statistically different（P＞0.05）. On the contrary， the resectabilities with various “proposed Tstaging” types were statistically distinct （P＜0.01）， which declined with higher Tstaging and the differences were significant（P＜0.01）. Conclusion The resectability of infiltrative tumor cases is lower than cases of massforming tumors. Both the size of mass and the length of involved bile duct are not relevant to the resectability of carcinoma. The improved “proposed Tstaging” system is superior to Bismuth classification system in assessing the resectability of hilar cholangiocarcinoma.

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Clinical and pathological features of ocular adnexal lymphoma in 27 patients

ZHU Jing，QIN Shukui，SHI Yi，WANG Lin，CHEN Yingxia，HUA Haiqing，LIU Xiufeng，LI Guimei，ZHANG Zhiqiang.

Chinese Clinical Oncology. 2014, 19 (11): 1024.

Abstract ( 1024 )

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Objective To explore the clinical manifestations and pathological features of ocular adnexal lymphoma. Methods The clinical and pathological information of 27 patients diagnosed as ocular adnexal lymphoma in 81 Hospital of PLA by pathological examination from January 1990 to December 2013 were collected， and the pathological features of the disease were analyzed retrospectively. Results The lesions were limited to the orbital area in 25 cases and the rest 2 cases were secondary to the lymphoma of other organs. The pathological diagnosis in all the cases was non-Hodgkin's lymphoma， of which T cell in 2 cases and B cell lymphoma in 25 cases including mucosaassociated lymphoid tissue（MALT） lymphoma 13 cases， lymphoplasmacytic lymphoma（LPL） 4 cases， mantle cell lymphoma（MCL） 3 cases，small lymphocytic lymphoma（SLL）2 cases，extramedullary plasmacytoma（EMP） 3 cases. There were 13 cases originally diagnozed as small B cell lymphoma. They were clearly diagnozed as 8 MALT lymphoma, 3 MCL and 2 SLL by immunohistochemical staining. Conclusion Clear classification can provide more useful suggestions about the choice of treatment and prognosis for the patients.

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Clinical observation of retention enema with smecta mixture in the treatment of acute radiation-induced enteritis

FENG Jing， FU Zhichao，CHENG Huihua，LIAO Shaoguang.

Chinese Clinical Oncology. 2014, 19 (11): 1030.

Abstract ( 975 )

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Objective To evaluate the efficacy of retention enema with smecta mixture on acute radiationinduced enteritis（RIE） due to radiotherapy for patients postoperation with rectal cancer. Methods A total of 65 patients with rectal cancer after radical surgery were randomized into control group （n=31） and treatment group with smecta mixture（n=34）. All the patients were treated with threedimensional and intensity modulated radiotherapy （50Gy／2Gy／25f） in combination with capecitabine （1600mg／m2 daily， q12h， d1-d14， 3 weeks for a cycle with a total of 2 cycles）. After the onset of grade 1 RIE， control group was carried on symptomatic treatment， while treatment group was applied with symptomatic treatment and smecta mixture retention enema （smecta 3g， compound glutamine granules 670mg and dexamethasone 10mg were resolved in 37℃ 0.9％ NaCl injection 100ml）. RIE during radiation and one month after radiation， as well as life quality pre and postradiation were compared between the two groups.
ResultsThe incidence of RIE at the 1st week of radiation between treatment group and control group had no statistical difference （P＞0.05）， but the incidence of RIE at the 3rd，5th，and 1month after radiation was significantly lower in treatment group compared with the control group （P＜0.05）. Life quality preradiation and at the 1st week of radiation between the two groups had no statistical difference （P＞0.05）， while it was improved in treatment group at the 3rd， 5th and 1month after radiation compared with control group （P＜0.05）. Conclusion Retention emena with smecta mixture is able to relieve acute RIE and improve life quality of patients.

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The clinicopathological and biological characteristics of gastric signet ring cell carcinoma

SHEN Jie， WEI Jia， LIU Baorui.

Chinese Clinical Oncology. 2014, 19 (11): 1033.

Abstract ( 1081 )

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Signet ring cell carcinoma（SCC） is a special form of adenocarcinoma with a large vacuole full of mucin displacing the nucleus to the periphery. The frequency of gastric signet ring cell carcinoma is about 3.4％-39％. With the characteristics of high degree of malignancy， poor differentiation， intramural diffuse infiltrative growth and rapid progression， the prognosis of SCC is quite poor. It is also resistant to chemotherapy and radiotherapy. Recently， it has been found that SCC has certain biological characteristics which differs it from other type adenocarcinoma. Those biological characteristics can be potential biomarkers and targets for therapy. In the current review， we summarize the clinicopathological and biological characteristics of SCC， which may aim at the therapy of it.

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The correlation between sCTLA-4 and CD4+CD25+regulatory T lymphocyte and its relationship with tumor

XIE Quanqin， JIANG Jingting， WU Changping

Chinese Clinical Oncology. 2014, 19 (11): 1038.

Abstract ( 1031 )

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Regulatory T lymphocytes（Treg） play an important role in immune balance and immune regulation. Foxp3 is a symbolic molecule of regulatory T cells. Treg is considered to take part in tumor immune escape in host immune system， and is associated with poor survival outcome in a variety of cancers. Cytotoxic T lymphocyteassociated antigen4（CTLA-4） is expressed on activated T cells， and has negative control response in T cell immune response. CTLA-4 can also exist in organism circulation as a soluble form（sCTLA-4）， and is involved in immunological homeostatic control. CTLA-4 and Treg overlap in functions， and affect the immune regulation process together， but the mechanism of interaction is an area for further study.

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Advances of anti-EGFR family targeted drugs in the treatment of gastric cancer

QIN Junwei，HAN Yu，BAI Yuxian.

Chinese Clinical Oncology. 2014, 19 (11): 1043.

Abstract ( 993 )

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Incidence of gastric cancer accounted for the fourth in global cancer incidence， and the mortality accounted for the second. Most patients bearing gastric cancer are already advanced and unresectable at the time of diagnosis. Chemotherapy and molecular targeted therapy have been more and more emphasised on clinical research and practice as an effective means of treatment of gastric cancer. In recent years， the targeted therapy of epidermal growth factor receptor（EGFR） family has achieved fruitful results in the treatment of gastric cancer. This article summarizes the signal transduction mechanisms of EGFR family and associated targeted drugs in the treatment of gastric cancer.

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Research progress of relationship between circulating cell free mitochondrial DNA and tumor

PENG Xiaohong， YAO Anqi， ZHOU Fuxiang.

Chinese Clinical Oncology. 2014, 19 (11): 1048.

Abstract ( 1040 )

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The distinct characteristics of mitochondrial DNA（mtDNA）， such as short length， simple molecular structure and high copy number， have made mtDNA an unique molecular tool for early tumor detection. Recently， circulating cell free mitochondrial DNA（ccfmtDNA） in blood has emerged as a noninvasive diagnostic and prognostic biomarker for many forms of solid tumors. In this review， we summarize the origin of ccfmtDNA in blood and the possible mechanism of the changes of ccfmtDNA levels. The possible diagnostic value of ccfmtDNA as a tumor marker is evaluated and the role of quantitative ccfmtDNA variations in neoplastic transformation and tumor progression is discussed.

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标准刊号：	ISSN 1009-0460
	CN 32-1577/R