Chinese Clinical Oncology

Inactivation of protein kinase Cδ on proliferation， apoptosis and related signaling pathways of human osteosarcoma stem cells

LV Huicheng， JIA Haisheng， MA Min， WANG Mingbo， WU Yimin.

Chinese Clinical Oncology. 2015, 20 (12): 1057.

Abstract ( 700 )

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Objective To investigate the effect of short hairpin RNA （shRNA） targeting protein kinase Cδ（PKCδ） on the proliferation， apoptosis and related signaling pathways of human osteosarcoma stem cells. Methods According to the PKCδ sequence in Genbank database， the specified shRNA series for PKCδ （PKCδ-shRNA-1 and PKCδ-shRNA-2） were designed， synthesized， and then cloned into pRNA6-1-Neo plasmid vector. The Western blotting was used to detect the level of PKCδ at 24， 48， 72， and 96 h after transfectioin. The shRNA with the best inhibition effect was chosen to transfect osteosarcoma stem cells （Transfection group）， and the stem cells transfected with the negative control sequence （Negative control group） and without any transfection （Blank control group） were prepared. The proliferation inhibition rates were measured by Thiazolyl blue （MTT） at 24， 48， 72， and 96 h after transfectioin. The flow cytometry was used to measure the apoptosis and cell cycle. Fluorescent quantitative PCR was used to detect the expression of related apoptotic genes. Western blotting was used to detect the levels of related protein in PI3K／Akt and Wnt／β-catenin pathways at 96 h after transfection. Results The level of PKCδ decreased after the transfection of PKCδshRNA1 and PKCδshRNA2. Given the better inhibition effect of PKCδ-shRNA-1， PKC-shRNA-1 was used in the subsequent experiment. Compared with other two groups， the proliferation inhibition rate， apoptosis rate and mRNA levels of Bax and Bad were increased， while the Bcl-2 level was decreased in Transfection group （P＜0.05）. The proportion of G0／G1 phase was increased， but the S phase and G2／M phase cells were decreased in Transfection group versus other groups （P＜0.05）. In PI3K／Akt pathway， the level of PTEN was increased， but the level of Akt was decreased. In Wnt／β-catenin pathway， the levels of β-catenin， C-myc and Cyclin D1 were decreased in the transfected group（P＜0.05）. Conclusion ShRNA inhibits the proliferation and induces apoptosis and cell cycle arrest of osteosarcoma stem cells by inhibiting the expression of PKCδ gene.

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Reversal effect of miR-155 on the resistance of leukemia cells to adriamycin by regulating Ets-1 expression

SHA Min， YE Jun， GUO Ting， ZHANG Lixin， LUAN Zhengyun

Chinese Clinical Oncology. 2015, 20 (12): 1063.

Abstract ( 682 )

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Objective To detect the expression of miR-155 and Ets-1 in leukemia cell line K562 and adriamycin resistance K562／A02 cell line， and explore the relationship between miR155， Ets-1 and drug resistance in leukemia treatment. Methods miR-155 simulation oligonucleotide probes and miR-155 inhibitor oligonucleotide probes， Ets-1 expression plasmid and Ets-1 interference expression plasmid were transfected in K562 and K562／A02 cells by Lipofectamine 2000. Real-time quantitative PCR was used to determine the expression of miR-155, Ets-1 and multidrug resistance（MDR1）. The protein levels of Ets-1 and MDR1 were analyzed by Western blotting. The viability of K562 and K562／A02 cells was evaluated by MTT assay. Results The expression levels of miR-155， Ets-1 and MDR1 were significantly increased in K562／A02 cells than those in K562 cells. Down-regulation of miR-155 could obviously increase the inhibition rate of adriamycin on K562／A02 cells and inhibit the expression of Ets-1 and MDR1， which could be reversed by overexpression of Ets-1. While， up-regulation of miR-155 could significantly increase the inhibition rate of adriamycin on K562 cells and stimulate the expression of Ets-1 and MDR1， which could be reversed by Ets-1 siRNA. Conclusion miR-155 is involved in the mechanism of drug resistance in leukemia by regulating Ets-1 expression， which may provide a potential novel target for overcoming drug-resistance.

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Function study of miR-26b targeting GSK-3β on the anti-stemness of breast cancer cells

MA Deliang， QIN Jing， ZHANG Dianfu.

Chinese Clinical Oncology. 2015, 20 (12): 1068.

Abstract ( 676 )

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Objective To investigate the effect of miR-26b on the proliferation， apoptosis and stemness of the breast cancer cells as well as the related mechanism. Methods The MCF-7 cell was cultured with serum free suspension culture in order to obtain the MCF-7 stem cells. Real time fluorescence quantitative PCR （qRT-PCR） was used to detect the miR-26b levels of MCF-7 and its stem cells. According to the experiment protocol， the MCF-7 stem cells were divided into 3 groups： control group， empty transfection group（cells transfected with con-mimics） and overexpression group（cells transfected with miR-26b mimics）. MTT assay was used to measure the proliferation ability at different times （24， 48， 72 and 96 h） after transfection. Flow cytometry was used to detect the level of apoptosis and the number of side population （SP） cells after transfection. The sphere rate after transfection was assessed by stem cells culture in vitro. The mRNA levels of Lin-28B， ALDH-1， BMI-1， OCT-4 and CD44 were detected by qRT-PCR after transfection. The verification of miR26b target genes of glycogen synthase kinase 3β （GSK-3β） were evaluated by biological information science and Western blotting analysis. Results The miR-26b level of MCF-7 stem cells was lower than that of MCF-7 cells （P＜0.05）. The transfection of miR-26b mimics could increase the miR26b level of MCF-7 stem cells. Compared with the control group， the proliferation inhibition rate and apoptosis rate were increased， but the number of SP cells and sphere rate were decreased in overexpression group （P＜0.05）. Transfection of miR-26b mimics could lead to lower levels of Lin-28B， BMI-1， ALDH-1， OCT-4 mRNA （P＜0.05）. Bioinformatics software predicted GSK-3β as the potential target gene of miR-26b. Transfection of miR-26b mimics could significantly reduce the expression of GSK-3β， and double luciferase reporter gene assay proved that miR-26b could predict the target position in the 3’UTR mRNA region of GSK-3β gene. Conclusion MiR-26b was lowlyexpressed in MCF-7 stem cells. MiR-26b can inhibit cell proliferation， induce apoptosis and negatively regulate the stemness of breast cancer cells， which may be related to the down-regulation of GSK-3β expression.

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Anti-proliferation effect of polyenephosphatidylcholine combined with oxaliplatin on gastric cancer cells

GAO Lei， ZHANG Hongjun， JIANG Tao， SONG Hao， ZHAO Yuanyuan， LIU Xiguang.

Chinese Clinical Oncology. 2015, 20 (12): 1074.

Abstract ( 708 )

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Objective To investigate the effect of polyenephosphatidylcholine（PPC） combined with oxaliplatin（L-OHP） on proliferation of gastric cancer cell lines. Methods After different concentrations of PPC and L-OHP treated on SGC7901 gastric cancer cells for 24，48，72 hours， MTT assay was used to examine the proliferation ability of each group. The MTT assay was used to calculate the proliferation ability of L-OHP at the concentration lower than the halfinhibitory concentration （IC₅₀） combined with different concentrations of PPC acting on SGC7901 gastric cancer cells for 48 hours. Flow cytometry was used to evaluate the apoptosis rate and analyze cell cycle of combined group. Western blotting was used to measure the expression levels of cytochrome c， Bcl-2， Bax， caspase-9， caspase-3, Cyclin D1 and Cyclin E.
Results L-OHP could significantly inhibit the proliferation of SGC-7901 cells in a dose and time-dependent manner（P＜0.05）. The effect of PPC on the proliferation of SGC7901 cells was dose-related（P＜0.05）， but not time-related（P＞0.05）. The antiproliferation effect of PPC combined with L-OHP on SGC-7901 cells was synergistic， which had statistical significance compared with L-OHP alone（P＜0.05）. PPC greatly promoted cell apoptosis and G0／G1 phase arrest induced by L-OHP. But the promotive effect was not related with the dose of PPC（P＞0.05）. PPC and L-OHP could upregulate the expression of cytochrome c and activate the following downstream protein including Bcl-2, Bax, caspase-9 and caspase-3， downregulate Cyclin D1 and Cyclin E expression. Conclusion PPC combined with L-OHP can inhibit the proliferation， induce the apoptosis of SGC-7901 cell lines， and block the cells at G0／G1 phase， which shows a synergistic anti-tumor effect on gastric cancer cells.

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RAS， CD68 and CD34 expression in breast cancer tissue and their clinical significance

SHI Yue， YUAN Gaofeng， SHI Fengling， FENG Chengting， WU Baoan， LI Wei， TAO Min， LIANG Rongrui.

Chinese Clinical Oncology. 2015, 20 (12): 1080.

Abstract ( 714 )

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Objective To investigate the expression of active RAS，CD68 and CD34 in breast cancer and their clinical significance. Methods Immunohistochemistry was used to detect the expression of RAS， CD68， CD34 in breast cancer tissues. The correlation of the level of RAS with TNM staging， lymph node metastasis， HER-2， ER and PR， tumor size and so on was analyzed. The correlation between RAS and CD68， CD34 expression in breast cancer tissues were investigated. Results Of the 65 cases of breast cancer tissues, 43 cases were positive for RAS and 63 cases were positive for CD68, the median values of CD68 positive cells were 12, and the median value of microvessle density（MVD） was 49. RAS expression level was significantly positively related with length to diameter of tumor and HER2（r=0.342，P=0.005；r=0.334，P=0.006）.CD68 positive cells level was significantly positively related with length to diameter of tumor, TNM staging and HER2（r=0.303，P=0.014； r=0.358，P=0.003；r=0.325，P=0.008）.RAS level was significantly positively related with CD68 positive cells level（r=0.277，P=0.026）. MVD level was positively related with CD68 positive cells level（r=0.330, P=0.007）. Conclusion The horizontal of RAS and the CD68 positive cells in breast cancer are significantly related with HER-2，tumor size，TNM stage. RAS may affect the process of MVD generation promoted by macrophages， and its mechanism still needs to be further studied.

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Expression of SATB1 in Xinjiang Uygur patients with breast cancer and its relationship with clinicopathological features

JIANG Weihua，SUN Xiaohong，LI Yongtao，ZHANG Mingshuai，WANG Xiaowen， OU Jianghua.

Chinese Clinical Oncology. 2015, 20 (12): 1084.

Abstract ( 620 )

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Objective To detect the special AT rich sequence binding protein（SATB1） expression in Uygur patients with breast cancer，and explore its relationship with clinicopathologic characteristics. Methods One hundred and fiftyeight Uygur patients with breast cancer from Jan. 2014 to Jan. 2015 in Xinjiang Tumor Hospital were enrolled， including 26 cases of carcinoma in situ and 132 cases of invasive carcinoma. SATB1 expression in cancer tissues were detected by immunohistochemistry method, and the relationship between SATB1 expression and clinicopathologic characteristics was analyzed.
Results The positive expression rate of SATB1 in paracarcinoma tissues was 8.0％（4／50）， in carcinoma in situ tissues was 42.3％（11／26）， and in invasive carcinoma tissues was 70.5％（93／132）. The difference was statistically significant （P＜0.05）. In breast invasive carcinoma patients， SATB1 expression was related with primary tumor size， lymph node metastasis, TNM staging and histological grade（P＜0.05）， but not related with the age， menopausal status， pathological types， hormone receptors and HER2 expression （P＞0.05）. Conclusion SATB1 expression in breast cancer tissue of Uygur patients can be influential in the occurence and development of breast cancer.

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Relationship between the levels of VEGF， MMP-9 and chemotherapy effect in patients with advanced breast cancer

LI Li， LIU Delin， WU Yuan， WANG Youqun， SUN Weili.

Chinese Clinical Oncology. 2015, 20 (12): 1088.

Abstract ( 663 )

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Objective To study the relationship between the change of expression levels of vascular endothelial growth factors（VEGF）and matrix metalloproteinase-9（MMP-9）of advanced breast cancer patients before and after chemotherapy and the chemotherapy response. Methods Sixty-five advanced breast cancer patients in Jiangsu Cancer Hospital from December 1 2009 to December 1 2014 were enrolled in this study. All the patients were infused with two agents chemotherapy， in which 39 were with platinumbased regimen and 26 received nonplatinumbased regimen. Serum samples were collected from the 65 patients respectively before chemotherapy and after 2 cycles chemotherapy to determine the expression levels of VEGF and MMP-9. The expression levels of VEGF and MMP-9 were compared before and after chemotherapy， between platinum-based regimen and non-platinum-based regimen as well as between different efficacies. Meanwhile the median time to progress（TTP） of different expression of VEGF and MMP-9 were evaluated after chemotherapy.
Results The mean value of serum VEGF and MMP-9 were 596.5 pg／ml and 686.5 ng／ml before chemotherapy， higher than 215.0 pg／ml and 500.4 ng／ml after chemotherapy（P＜0.05）. The expression level of VEGF of 56 patients with clinical benefit before and after chemotherapy was 678.1 pg／ml and 232.0 pg／ml（P.0.05）， while the expression level of MMP-9 was 679.3 ng／ml and 450.6 ng／ml（P＜0.05）. Those indexes in 9 patients with disease progression had no differences before and after chemotherapy （P＞0.05）. In 39 patients with platinum-based chemotherapy， the mean value of MMP-9 after chemotherapy were 451.7 ng／ml， lower than 742.6 ng／ml before chemotherapy（P＜0.05）. The median TTP of 30 patients with decreased level of MMP-9（5.0 months）was superior to the 25 patients with increased level of MMP-9（3.0 months） with significant difference （P＜0.05）； whereas there was no significant difference between patients with the decreased and increased level of VEGF（P＞0.05）. Conclusion The decline of serum VEGF and MMP-9 expression levels may be a index of effective chemotherapy in advanced breast cancer.

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Expression and clinical significance of nr5A2 and GPC3 in human gastric cancer tissues

the First Department of Oncology， Qinhuangdao First Hospital Affiliated to Hebei Medical University

Chinese Clinical Oncology. 2015, 20 (12): 1093.

Abstract ( 563 )

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Objective To investigate the expression levels of nuclear receptor 5A2（nr5A2）and Glypican-3（GPC3）in gastric cancer tissues and the relationship between them and the clinical pathological characteristics and prognosis of gastric cancer. Methods The expression of GPC3 and nr5A2 in paraffin sections of 68 cases of gastric cancer tissues and 59 cases of para carcinoma tissues were detected by immunohistochemical SP method. According to product value of the percentage of positive cells and intensity of staining， the expression levels were divided into negative expression（＜3） and positive expression（≥3）. We analyzed the relationship between the different expression and clinical pathological parameters（gender， age， clinical stage， tumor size， Lauren type， differentiation degree， invasion depth and lymph node metastasis）and prognosis of gastric cancer. Spearman correlation analysis was used to analyze the expression of GPC3 and nr5A2 in gastric cancer tissues， and the prognosis of patients with different expression of the both proteins was analyzed by KaplanMeier method. Results The positive expression rates of nr5A2 and GPC3 in gastric cancer tissues were 64.7％（44／68）and 57.4％（39／68）， higher than 32.2％（19／59）and 22.0％（13／59）of the adjacent tissues with statistical significance（P＜0.05）. The expression of nr5A2 was positively correlated with GPC3 in gastric cancer tissues（r=0.421， P=0.001）. The expression of the both proteins was related to clinical stage and Lauren typing. In addition， the expression of nr5A2 was related to the depth of invasion， and the expression of GPC3 was related to the degree of differentiation and lymph node metastasis（P＜0.05）. The median survival time（OS）of nr5A2 positive expression patients was 22.5 months， lower than 32.0 months of nr5A2 negative expression patients（P＜0.05）. The difference was not statistically significant between different expression levels of GPC3. Conclusion Both nr5A2 and GPC3 are positive expression in gastric cancer tissues， which is related to clinical stage and Lauren typing. nr5A2 expression is related to prognosis. Both proteins may play an important role in the development of gastric cancer， which can be used in the diagnosis and evaluation of gastric cancer.

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Expression and clinical significance of BLZF1 in human gastric cancer tissues

FENG Changyi， WU Haiyan， XU Zizhi， LIU Kaiyuan.

Chinese Clinical Oncology. 2015, 20 (12): 1099.

Abstract ( 656 )

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Objective To determine the expression of basic leucine zipper nuclear factor 1（BLZF1）in gastric cancer and analyze the relationship of its expression with clinical features and prognosis. Methods The expression level of BLZF1 was detected by tissue microarray technology and immunohistochemistry in 156 cases of gastric cancer and paired adjacent normal tissues. The relationship between the expression of BLZF1 and clinical parameters were analyzed as well as overall survival（OS）. Results The positive rate of BLZF1 in gastric cancer tissues was 52.56％（82／156）， lower than 95.51％（149／156）of paracarcinoma tissues（P＜0.05）. The expression of BLZF1 was related with T stage， TNM stage and differentiation degree（P＜0.05）， but unrelated with age， sex， tumor size and N stage（P＞0.05）. The median OS for the patients with negative expression of BLZF1 was 29.0 months， shorter than 42.5 months of patients with positive expression of BLZF1（P＜0.05）. Multivariate analysis revealed that T stage， tumor size， TNM stage and BLZF1 expression were independent prognostic factors for gastric cancer patients. Conclusion BLZF1 is down-regulated in gastric cancer and may be related to tumor genesis and development. Loss of BLZF1 expression is associated with the poor prognosis of gastric cancer.

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A single center， single arm and phase Ⅱ clinical trail： efficacy and safety of pulsatile administration of high-dose gefitinib or erlotinib for advanced NSCLC patients with secondary drug resistance

ZHU Yanzhe，PAN Yueyin，DU Yingying，LIU Hu，MA Tai，SHEN Yuanyuan.

Chinese Clinical Oncology. 2015, 20 (12): 1103.

Abstract ( 685 )

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Objective To observe the efficacy and safety of pulsatile administration of highdose gefitinib or erlotinib for advanced nonsmall cell lung cancer（NSCLC） patients with secondary drug resistance to standard dose of epidermal growth factor receptor tyrosine kinase inhibitor（EGFR-TKI） treatment. Methods Forty-two cases of NSCLC patients with drug resistance after 1year conventional treatment of gefitinib or erlotinib were recruited in this study from August 2013 to December 2014. The gefitinib group， including 29 cases， received one dose of 1000 mg gefitinib every four days. The erlotinib group， including 13 cases， received one dose of 450 mg erlotinib every three days. Treatments continued till disease progression or development of intolerable toxicity. The shortterm efficacy and progressionfree survival（PFS） were compared between the two groups. Results The median PFS of the total 42 cases was 30 months， with 31 months in gefitinib group and 24 months in erlotinib group， respectively. No significant difference was observed in the two groups in PFS（P＞0.05）. After the highdose pulsatile administration， the total group had 8 cases of PR， 11 cases of SD and 23 case of PD. Meanwhile， the response rate（RR） was 19.0％， the disease control rate（DCR） was 45.2％，the median PFS was 6 months. Gefitinib group had 6 cases of PR， 9 cases of SD and 14 cases of PD. The erlotinib group had 2 cases of PR， 2 cases of SD and 9 cases of PD. The median PFS of gefitinib and erlotinib group was 8 months and 6 months， respectively， with no significant difference（P＞0.05）. All cases were divided to 2 groups based on the mutation of EGFR exon. Exon 19 mutation group had 4 cases of PR， 6 cases of SD and 17 cases of PD. Exon 21 mutation group had 4 cases of PR， 5 cases of SD and 6 cases of PD. The median PFS of two groups were 6 months and 7 months， respectively， with no significant difference（P＞0.05）. Adverse reactions were all in grade 12， such as rash， fatigue， anorexia and dry skin were observed. The incidence had no difference between the two groups（P＞0.05）. Conclusion For advanced NSCLC patients who have previously undergone a standard dose treatment of gefitinib or erlotinib， highdose EGFR-TKI pulsatile treatment is a safe and efficient choice， which can improve prognosis of a portion of the patients.

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Association of clinical pathological characteristics and prognosis with lymph node metastasis of non-small cell lung cancer

LIN Xiao， CHEN Yusheng， LI Hongru， ZENG Dunhuang， WU Yanling.

Chinese Clinical Oncology. 2015, 20 (12): 1110.

Abstract ( 729 )

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Objective To investigate the association of clinical pathological characteristics and prognosis with lymph node metastasis of non-small cell lung cancer（NSCLC）.
MethodsData from 154 NSCLC patients receiving lobectomy or pneumonectomy with systematic lymph node dissection in Fujian Provincial Hospital from January 2010 to August 2013 were retrospectively reviewed. The frequency of intrathoracic lymph node metastasis in each group， and the relationship of tumor type， primary site， clinical pathological characteristics and prognosis with lymph node metastasis were analyzed.
ResultsA total of 748 groups of intrathoracic lymph node were removed in 154 cases of lung cancer patients. Metastasis occurred in 133 groups of lymph node. Intrathoracic lymph node metastasis occurred in 74 patients， the transfer rate was 48.1％. The 4，5，6，10，11 groups had a higher frequency of lymph node metastasis than 1，2，3，7，8，9 groups. The metastasis rate of hilar lymph node in central lung cancer patients was significantly higher than that of peripheral lung cancer（51.2% vs. 28.4%，P＜0.05）. Subcarinal lymph node metastasis rate of lower lobe cancer patients was higher than that of upper and middle lobe patients. The frequency of lymph node metastasis and skip N2 metastasis in patients with stage Ⅲ lung cancer were higher than those of lung cancer patients with stageⅠ and Ⅱ. The total rate of lymph node metastasis in central lung cancer patients was significantly higher than those of peripheral lung cancer. The metastasized lymph nodes were divided into 3 groups： one group without lymph node metastasis（Ng0）， 1 to 3 groups with lymph node metastasis（Ng1）， 4 to 6 groups with lymph node metastasis（Ng2）. Survival analysis suggested that Ng， lymph node stage， T stage and lung cancer types were associatied with prognosis. Cox regression analysis showed that Ng, lymph node stage and T stage were independent factors of the prognosis of lung cancer patients. Conclusion The lymph node metastasis of lung cancer occurred more likely in interlobar， hilar and pulmonary root lymph node. The lymph node metastasis frequency of lung cancer was associatied with TNM stage and lung cancer types. Ng, lymph node stage and T stage were significantly related with prognosis of lung cancer patients.

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Recombinant human endostatin combined with cisplatin perfusion chemotherapy for malignant pleural effusions：a Meta-analysis

YANG Minjie，HE Wei，WANG Feng，WU Mengjiao，FAN Qingxia.

Chinese Clinical Oncology. 2015, 20 (12): 1117.

Abstract ( 670 )

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Objective To evaluate the efficacy and safety of recombinant human endostatin（Endostar）plus cisplatin perfusion chemotherapy versus cisplatin alone in the treatment of malignant pleural effusions. Methods Databases of PubMed， The Cochrane Library， Web of Science， Wanfang， CNKI， VIP were searched and randomized controlled trials（RCTs） on endostar plus cisplatin versus cisplatin alone for malignant pleural effusions from 2005 to 2015 were collected. The quality of RCTs was assessed by Cochrane handbook 50 and Metaanalysis was carried out by RevMan 5.2 software. Results A total of 15 RCTs involving 936 patients were included. Compared with the cisplatin alone group， the endostar plus cisplatin group had a higher effective rate of controlling malignant effusions（RR=1.54，95％CI：1.38-1.71，P＜0.000 01）， better improvement in quality of life（RR=1.61，95％CI：1.41-1.84，P＜0.000 01）. As for side effects， there were no significant differences between the two groups in the incidences of gastrointestinal reaction， chest pain， fever， myelosuppression， dysfunction of liver and kidney， fatigue， electrocardiographic abnormality. Conclusion Compared with cisplatin alone， endostar plus cisplatin can improve the efficacy and quality of life of patients with malignant pleural effusions without increasement of adverse reactions.

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Clinical significance of serum lactate dehydrogenase and β2-microglobulinin in patients with diffuse large Bcell lymphoma

ZHAO Shuqing， LI Junmin，CHEN Li，YANG Chenmin.

Chinese Clinical Oncology. 2015, 20 (12): 1124.

Abstract ( 745 )

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Objective To investigate the clinical significance of serum levels of lactate dehydrogenase（LDH） and β2-microglobulin（β2-MG） in diffuse large Bcell lymphoma（DLBCL）. Methods The serum levels of LDH and β2-MG of 58 patients with DLBCL were measured by rate method and radioimmunoassay. Besides， the clinicopathological characteristics of the patients such as gender， age， B symptoms， clinical stages， ECOG score of performance status（ECOG-PS） and bone marrow invasion were summarized and anylyzed. Meanwhile， the association between the level change of LDH and β2-MG after chemotherapy and therapeutic effectiveness was also evaluated. Results The levels of LDH and β2MG in the advanced stage group，ECOG≥2 group， bone marrow invasion group were significantly higher than those of their counterpart （P＜0.05）.The level of β2MG in aged over 60 patients was higher than that of younger ones （P＜0.05），but there was no statistical significance in the LDH level（P＞0.05）. The level of LDH in B symptoms group was higher than that of without B symptoms（P＜0.05），but there was no statistical significance in the β2MG level（P＞0.05）. There was no statistical significance about LDH and β2MG levels in gender（P＞0.05）. The levels of LDH and β2-MG in positive response group significantly decreased after chemotherapy （P＜0.05）. Conclusion LDH and β2-MG can be taken as indicators in classifying the clinical phase and judging whether there is bone marrow infiltration or not， and evaluating the chemotherapeutic effectiveness of DLBCL patients.

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Comparison of the transperitoneal and retroperitoneal approach in robotic-assisted laparoscopic partial nephrectomy in treatment of renal carcinoma

TANG Hao， ZHANG Zhengyu， ZHOU Wenquan，WEI Wu， XUE Song， DONG Jie， ZHOU Zhongkui， GE Jingping.

Chinese Clinical Oncology. 2015, 20 (12): 1128.

Abstract ( 648 )

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Objective To compare the transperitoneal and retroperitoneal approach in roboticassisted （daVinci surgical system） laparoscopic partial nephrectomy（RALPN） in treating the renal carcinoma and assess its clinical efficacy.
Methods Clinical data of 82 renal carcinoma patients from December 2011 to February 2015 was retrospectively reviewed. Forty-nine patients were performed RALPN by transperitoneal approach， and 33 patients by retroperitoneal approach. The operation time， renal artery clamping time， operative blood loss， postoperative intestinal discharge time， surgical margin status and postoperative complications were observed and compared. Results Both groups were performed successfully. The operation time， renal artery clamping time， operative blood loss， surgical margin status and postoperative complications did not show any significant difference between the two approaches （P＞0.05）. In retroperitoneal approach group， the postoperative intestinal discharge time was （2.1±0.7）d， shorter than （5.7±1.4）d of transperitoneal approach group （P＜0.05）. Conclusion Retroperitoneal approach appears to be a safe， technically feasible and minimally invasive option in RALPN in treatment of renal carcinoma, which shows equivalent outcomes to those of the transperitoneal approach and advantages in recovery of intestinal function.

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Comparison on efficacy of two kinds of lead brick treatment modalities in the fourfield whole pelvic irradiation for cervical cancer with uterus excursion

LIN Gaojuan， LIU Taowen， XU Lirong， YE Shiqi， FENG Kaiyong， ZHAO Huiling.

Chinese Clinical Oncology. 2015, 20 (12): 1132.

Abstract ( 636 )

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Objective To investigate the efficacy and safety of the whole pelvic fourfield irradiation therapy for middle and advancedstage cervical cancer with uterus excursion. Methods From Jan. 2009 to Mar. 2013，108 patients pathologically diagnosed as ⅡBⅣA cervical cancer received concurrent chemoradiotherapy. When patients received the whole pelvic irradiation to 34-40 Gy／17-20 f， they were measured distance interrelations between uterine axis（in the A point section of uterus） under the simulator. Seventy cervical cancer patients with uterus excursion were divided randomly into observation group （35 patients） and control group （35 patients）. Patients in the observation group used with lead brick along with the uterine central axis in the fourfield whole pelvic irradiation in conventional fractionation. Patients in the control group used with lead brick along with the pelvic central in the fourfield whole pelvic irradiation in conventional fractionation. They all received 15-20 Gy／8-10 f， respectively. The shortterm efficacy， survival rate， local recurrence rate and toxicity were observed in two groups. Results The complete remission rate and recurrence rate in observation group and control group were 94.29％ vs.74.29％， 5.71％ vs.22.86％， respectively， with significant statistically differences （P＜0.05）. The 1-， 2-year survival rate of patients in observation group and control group were 94.29％, 82.86％ and 85.71%, 71.43％， respectively. There were no significant statistically differences in two groups （P＞0.05）. The major toxicity was myelosuppression， gastrointestinal tract， radiation cystitis and radiation proctitis. There were no significant statistical differences for the incidence of toxicity in two groups （P＞0.05）. Conclusion It is suggested that fourfield whole pelvic irradiation which used lead brick along with the uterine central axis for cervical cancer with uterus excursion can decrease the dosage “cold point” and improve the complete remission rate, as well as reduce the local recurrence rate.

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CT-guided coil localization and VATS resection under radioscopy for subcentimeter pulmonary nodules

SUN Yijun，XU Jian，YI Jun，LI Demin

Chinese Clinical Oncology. 2015, 20 (12): 1136.

Abstract ( 602 )

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Objective To investigate the accuracy and safety of preoperative CTguided coil localization of subcentimeter solitary small pulmonary nodule（SPN）and followed by videoassisted thoracic surgery（VATS）resection under radioscopy. Methods From March 2014 to April 2015， 53 patients with subcentimeter SPN underwent CT-guided coil localization of SPN and VATS resection under radioscopy were retrospectively reviewed. Results The SPNs were localized and resected with success rate of 100％. The complications associated with procedure included 4 pneumothorax， 2 local parenchymal hemorrhage and 1 hemopneumothorax. Twentyone nodules were confirmed as malignancies， including 16 well differentiated adenocarcinoma， 3 minimally invasiveadenocarcinoma and 2 metastatic lesions. Thirtytwo nodules were confirmed as benign lesions， including 12 chronic granulomatous inflammation， 10 inflammatory fibrosis， 5 atypical adenomatous hyperplasia， 3 sclerosing hemangioma， and 2 harmatoma. Two patients suffered from pulmonary infection， and recovered by conservative treatment. The postoperative hospital stay was 3-7 d，with average length of stay （4.11±1.03）d. Conclusion CT-guided coil localization followed by VATS resection under radioscopy can be an effective and safe procedure for accurate resection and diagnosis of subcentimeter pulmonary nodules.

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The expression of PD-L1 in tumor and its related mechanism research

LEI Zemin， MO Xiangyang，YU Zongyang

Chinese Clinical Oncology. 2015, 20 (12): 1140.

Abstract ( 727 )

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Immune evasion is an important hallmark of cancer， and a better understanding of this mechanism is essential for the development of effective strategies against cancer. The programmed cell death lagand 1（PD-L1， also know as B7-H1）／programmed cell death 1（PD-1， CD279） pathway has been demonstrated as a major mechanism of immune evasion in tumor site. In recent years， anti PD-L1／PD1 immunotherapy has achieved encouraging success. Inducible B7-H1 expression in tumor microenvironment is complex. Understanding these interactions and how tumors take advantage of this pathway can help us design future strategies for better therapeutic efficacy and to overcome drug resistance. In this paper， the expression of PD-L1 and the relevant mechanisms are summarized.

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Significance of hypoxia tumor microenvironment and hypoxia inducible factors to CSCs，EMT and CTCs

SUN Wenwen，XU Zhihong，GAO Beili，HU Jiaan.

Chinese Clinical Oncology. 2015, 20 (12): 1145.

Abstract ( 649 )

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Hypoxia has been a common peculiarity of solid tumor and played a crucial role in tumor microenvironment. More and more evidences have shown that the tumors biological behavior，to large extent，is influenced by microenvironment.The cancer cells adapt to the micro environment by regulating the hypoxia inducible factors（HIFs）. Microenvironment hypoxia accelerates the formation of cancer stem cells（CSCs），circulating tumor cells（CTCs）， and induces epithelialmesenchymal transition（EMT）. Besides it increases the possibility of invasion， metastasis and drug resistance of the tumor. Improving the hypoxia tumor microenvironment can impede the occurrance and development of the tumor.

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标准刊号：	ISSN 1009-0460
	CN 32-1577/R