Prognostic Significance of Circulating Tumor Cells in Small-Cell Lung Cancer Patients: a Meta-analysis

Circulating tumor cells (CTCs) are believed to be particularly important and a reliable marker of malignancy.However, the prognostic significance of CTCs detected in patients with small cell lung cancer (SCLC) is stillunclear. We therefore aimed to assess the prognostic relevance of CTCs using a meta-analysis. We searchedPubMed for relevant studies and statistical analyses were conducted to calculate the hazard ratio (HR) and95% confidence intervals (CIs) using fixed or random-effect models according to the heterogeneity of includedstudies. A total of 7 papers covering 440 SCLC patients were combined in the final analysis. The meta-analysisrevealed that CTCs were significantly associated with shorter overall survival (HR=1.9; 95%CI: 1.19-3.04;Z=2.67; P<0.0001) and progression-free survival (HR=2.6; 95%CI: 1.9-3.54; Z=6.04; P<0.0001). The resultsthus suggest that the presence of CTCs indicates a poor prognosis in patients with SCLC. Further well-designedprospective studies are required to explore the clinical applications of CTCs in SCLC.     

肺癌神经内分泌分化与术后生存关系探讨

目的探讨非小细胞肺癌神经内分泌(NSCLC-NE)分化与患者手术后生存关系。方法收集1997年4月-1999年4月98例肺癌手术切除病理标本,采用免疫组化标记特异性烯醇化酶(NSE)及突触素(SY),并按强弱区分为“ 、 、 ”。对同一手术病例标本采用电镜观察特异性NE颗粒。术后病例随访36例,最长60月。采用Cox多因素风险模型分析NSCLC-NE分化与患者术后生存的关系。结果91例为非小细胞肺癌。非小细胞肺癌NE阳性表达率为63.7%(58/91),其中NSE阳性表达54例(59.3%),SY阳性表达22例(24.1%),电镜观察NE特异性颗粒30例(33.0%)。结合免疫组化和电镜观察NSCLC-NE分化44例(48.4%)。Cox模型多因素分析结果表明NSCLC-NE分化者术后生存时间明显缩短(P=0.048)。术后生存与肺癌细胞分化程度(P=0.006)、病理分期(P=0.001)、NE表达强弱(P=0.054)有密切关系。结论NSCLC-NE分化与肿瘤细胞分化和患者术后生存有关。采用NE标志特标记肿瘤,并观察其强弱改变,对术后评估具有较重要的参考意义,可作为临床判断患者预后指标之一。     

肺癌神经内分泌分化与术后生存关系探讨(英文)

目的探讨非小细胞肺癌神经内分泌(NSCLC-NE)分化与患者手术后生存关系。方法收集1997年4月～1999年4月98例肺癌手术切除病理标本,采用免疫组化标记特异性烯醇化酶(NSE)及突触素(SY),并按强弱区分为“+、++、+++”。对同一手术病例标本采用电镜观察特异性 NE 颗粒。术后病例随访36例,最长60月。采用Cox 多因素风险模型分析 NSCLC-NE 分化与患者术后生存的关系。结果 91例为非小细胞肺癌。非小细胞肺癌 NE 阳性表达率为63.7%(58/91),其中 NSE 阳性表达54例(59.3%),SY 阳性表达22例(24.1%),电镜观察 NE 特异性颗粒30例(33.0%)。结合免疫组化和电镜观察 NSCLC-NE 分化44例(48.4%)。Cox 模型多因素分析结果表明 NSCLC-NE 分化者术后生存时间明显缩短(P=0.048)。术后生存与肺癌细胞分化程度(P=0.006)、病理分期(P=0.001)、NE 表达强弱(P=0.054)有密切关系。结论 NSCLC-NE 分化与肿瘤细胞分化和患者术后生存有关。采用 NE 标志特标记肿瘤,并观察其强弱改变,对术后评估具有较重要的参考意义,可作为临床判断患者预后指标之一。     

Concurrent Cisplatin-etoposide Chemotherapy plus Thoracic Radiotherapy for Limited-stage Small Cell Lung Cancer

A recent approach in the treatment of limited-stage small celllung cancer (LDSCLC) has involved a combined modality of chemotherapyand chest irradiation. In using the modality, the study of schedulingmethods for combining chemotherapy and radiotherapy should leadto other trials of combined modalities against LDSCLC sinceit is the most basic issue to be evaluated. We have thus conducteda multicenter phase II trial of concurrent cisplatin-etoposide(PVP) chemotherapy and radiotherapy for LDSCLC to determinethe effects of the concurrent administration of a PVP regimenand chest irradiation on response rate, relapse, survival andtreatment toxicity. The chemotherapy regimen consisted of afour-week cycle: cisplatin (80 mg/m², given intravenously onday 1) and etoposide (100 mg/m2, given intravenously on days1–3). This cycle was given four to six times within sixmonths. Chest irradiation to the primary tumors at both thehili and the mediastinum was administered in standard fractionson days 2–12 in the first cycle of chemotherapy and ondays 29–47 in the second cycle, with a total dose of 40–50Gy. Prophylactic cranial irradiation was performed among completeremission (CR) or good partial remission (PR) patients aftercompletion of the concurrent therapy. A total of 66 patientswere entered into the trial and 59 were evaluated. The concurrenttherapy induced an overall response rate of 94.9% in 59 patients:24 patients, 40.7% CR, 32 patients, 54.2% PR. The median responseduration was 8.7 months, and the median survival time for alleligible patients was 14.8 months. The percentage of patientswith two-year survival periods was 20. A local relapse withinthe irradiated area was seen in only 22% of relapsed patients.Brain metastases occurred in 24% of patients. Four of 32 patientstreated with prophylactic cranial irradiation had brain metastases.Toxic effects, chiefly grades 3 and 4 leukopenia, as establishedby the World Health Organization, were detected in all treatedpatients. Other toxicities, including radiation-induced esophagitisand pneumonitis, were deemed almost acceptable. We concludedconcurrent treatment of a PVP regimen with chest irradiationto be a feasible and beneficial therapy with an efficacy compatibleto that of other published reports. The outcome of this protocolwarrants further investigation to determine the optimal typeof schedule for concurrent chemoradiotherapy against LDSCLC.     

Preoperative Neutrophil to Lymphocyte Ratio as a Prognostic Factor in Patients with Non-metastatic Renal Cell Carcinoma

Background: The neutrophil-to-lymphocyte ratio (NLR) is a strong predictor of mortality in patients withcolorectal, lung, gastric cancer, pancreatic and metastatic renal cell carcinoma. We here evaluated whetherpreoperative NLR is an independent prognostic factor for non-metastatic renal cell carcinoma (RCC). Materialsand Methods: Data from 327 patients who underwent curative or palliative nephrectomy were evaluatedretrospectively. In preoperative blood routine examination, neutrophils and lymphocytes were obtained. Thepredictive value of NLR for non-metastatic RCC was analyzed. Results: The NLR of 327 patients was 2.72±2.25.NLR <1.7 and NLR ≥1.7 were classified as low and high NLR groups, respectively. Chi-square test showed thatthe preoperative NLR was significantly correlated with the tumor size (P=0.025), but not with the histologicalsubtype (P=0.095)and the pT stage (P=0.283). Overall survival (OS) and disease-free survival (DFS) wereassessed using the Kaplan-Meier method. Effects of NLR on OS (P=0.007) and DFS (P=0.011) were significant. Toevaluate the independent prognostic significance of NLR, multivariate COX regression models were applied andidentified increased NLR as an independent prognostic factor for OS (P=0.015), and DFS (P=0.019). Conclusions:Regarding patient survival, an increased NLR represented an independent risk factor, which might reflect ahigher risk for severe cardiovascular and other comorbidities. An elevated blood NLR may be a biomarker ofpoor OS and DFS in patients with non-metastatic RCC.     

Prognostic Significance of Absolute Lymphocyte Count,Absolute Monocyte Count,and Absolute Lymphocyte Count to Absolute Monocyte Count Ratio in Follicular Non-Hodgkin Lymphoma

IntroductionRecently, the lymphocyte to monocyte ratio (LMR) has been proposed as an easily determinable prognostic factor in patients with cancer, including lymphomas. The objective of this study was the evaluation of the impact of baseline absolute lymphocyte count (ALC), absolute monocyte count (AMC), and the LMR on the treatment response and prognosis in follicular lymphoma (FL).Patients and MethodsThe data of 100 patients with a FL variant, admitted and treated between January 2009 and June 2018, were analyzed.ResultsThe area under the receiver operator characteristic curve and cutoff values of ALC, AMC, and LMR for discrimination between survival times using receiver operating characteristic curves showed 0.57 × 10⁹/L as the most discriminative ALC cutoff value, 1.235 ×10⁹/L as the most discriminative AMC cutoff value, and 1.63 as the most discriminative LMR cutoff value. Progressive disease and stable disease after first-line therapy and mortality rate were significantly associated with lower ALC, higher AMC, and higher LMR. Shorter overall survival (OS) was significantly associated with patients with lower ALC when compared with those having higher ALC. Shorter OS and progression-free survival (PFS) were significantly associated with higher AMC when compared with those having lower AMC. Shorter OS and PFS were significantly associated with lower LMR when compared with those having higher LMR. High-risk Follicular Lymphoma International Prognostic Index as well as low LMR were considered as risk factors for prediction of OS in all the studied patients with FL in univariate analysis and multivariate analysis.ConclusionALC, AMC, and LMR at diagnosis are simple indices, which reflect the host systemic immunity and can predict the clinical outcomes in FL.     

金属硫蛋白在非小细胞肺癌中的表达及其与预后的关系

目的探讨非小细胞肺癌（NSCLC）组织中金属硫蛋白(metallothionein,MT)的表达及临床意义。方法采用免疫组织化学SP法检测68例NSCLC和25例肺良性疾病中MT的表达,分析其与NSCLC临床病理特征、预后以及耐药蛋白GST-π和TopoⅡ表达的关系。结果MT在NSCLC组织中表达显著高于肺良性病变组织(P<0.05),与年龄、分化程度有关;MT表达患者术后生存期明显短于不表达者。MT表达和GST-π、TopoⅡ表达无相关性(P>0.05)。结论MT在NSCLC组织中存在不同程度的高表达,且与某些生物学行为有关,可以作为评价预后的指标。     

Prognostic Value of CD44 Variant exon 6 Expression in Non-Small Cell Lung Cancer: a Meta-analysis

Background: CD44v6 (CD44 variant exon 6) is the chief CD44 variant isoform regulating tumor invasion, progression, and metastasis. The prognostic value of CD44v6 expression in non small cell lung cancer (NSCLC) has been evaluated in many studies, but the results have remained controversial. Thus, we performed a metaanalysis of currently available studies to investigate the prognostic value of CD44v6 expression in NSCLC patients and the relationship between the expression of CD44v6 and clinicopathological features. Materials and Methods: Two independent reviewers searched the relevant literature in Pubmed, Medline and Embase from 1946 to January 2014. Overall survival (OS) and various clinicopathological features were collected from included studies. This meta-analysis was accomplished using STATA 12.0 and Revman 5.2 software. Pooledhazard ratios (HRs) with 95% confidence intervals (95%CIs) were calculated to estimate the effects. Results: A total of 921 NSCLC patients from ten studies met the inclusion criteria. The results showed that CD44v6 high expression was a prognostic factor for poor survival (HR=1.91, 95%CI=1.12-3.26, p<0.05). With respectto clinicopathological features, CD44v6 high expression was related to histopathologic type (squamous cell carcinoma versus adenocarcinoma: OR=2.72, 95%CI=1.38-5.38, p=0.004), and lymph node metastasis (OR=3.02,95%CI=1.93-4.72, p<0.00001). Conclusions: Our results suggested CD44v6 high expression as a poor prognostic factor for NSCLC, and CD44v6 expression is associated with lymph node metastasis and histopathologic type. Therefore, CD44v6 expression can be used as a novel prognostic marker in NSCLC cases.     

Effect of Prophylactic Cranial Irradiation on Overall Survival in Metastatic Small-Cell Lung Cancer: A Propensity Score-Matched Analysis

Introduction

Patients with small-cell lung cancer (SCLC) have a high incidence of occult brain metastases and are often treated with prophylactic cranial irradiation (PCI). Despite a small survival advantage in some studies, the role of PCI in extensive stage SCLC remains controversial. We used the National Cancer Database to assess survival of patients with metastatic SCLC treated with PCI.

多聚唾液酸在术后肺鳞癌的表达及与预后的关系

目的:探讨多聚唾液酸(Polysialic Acid,PSA)在术后肺鳞癌预后中的应用.方法:选择1995年1月～1997年12月在我院行肺癌切除术的139例肺鳞癌患者进行术后随访,126例患者获随访.将切除标本进行NCAM及PSA免疫组化SABC法染色.结果:126例Ⅰ～Ⅲa期患者,PSA表达与TNM分期无显著性差异(P＞0.05).PSA阳性患者5年生存率(33.3%)与PSA阴性患者5年生存率(53.1%)无显著性差异(P＞0.05),但其中Ⅰ期患者PSA阳性和PSA阴性的5年生存率分别为42.9%和84.6%(P＜0.05),Ⅱ期患者5年生存率分别为20.0%和64.5%,说明Ⅰ期、Ⅱ期PSA阳性患者预后较差.此外,当PSA表达呈阳性时,Ⅰ期、Ⅱ期和Ⅲa期患者术后生存率无差别(P＞0.05).结论:PSA的表达是预测Ⅰ期、Ⅱ期肺鳞癌术后患者预后不良的重要因素.     

小细胞肺癌患者血清NSE、SCC的表达水平变化及其临床意义

目的探讨分析小细胞肺癌患者血清神经元特异性烯醇化酶(NSE)、鳞状上皮细胞癌抗原(SCC)水平的表达及其临床意义。方法随机选取80例小细胞肺癌患者为研究对象,同期选择80例健康体检者作为对照组,分别采用电化学发光法对其血清NSE、SCC表达水平进行检测,再根据检测结果,将80例非小细胞肺癌患者分为单纯血清NSE水平升高者和其他,比较其临床化疗有效率。结果小细胞肺癌组患者血清NSE[(39.22±22.07)ng/mL]和SCC表达水平[(1.74±0.22)ng/mL]明显高于对照组(P<0.05),血清NSE水平异常升高患者的临床化疗有效率(71.88%)明显优于其他组(16.67%),且临床化疗有效者化疗前后的血清NSE水平变化差异较大(P<0.05),但是SCC水平前后变化差异无统计学意义(P>0.05)。结论小细胞肺癌患者的血清NSE表达水平变化较为明显,可将其作为小细胞肺癌临床治疗效果的参考指标,具有积极的临床应用价值。     

Prognostic Value of the Neutrophil to Lymphocyte Ratio (NLR) in Lung Cancer Cases

Haemogram assessment is a cheap and easy method which can be readily performed for almost all patients. Leucocyte, neutrophil and lymphocyte counts and the neutrophil to lymphocyte ratio (NLR) are markers of systemic inflammation. We here aimed to evaluate haemogram parameters of our patients with lung cancer according to the pathologic diagnosis of small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). Materials and Methods: The study included 386 patients diagnosed with lung cancer in our hospital between January 2006 and January 2014. A retrospective examination was made of the data from the patient records and the hospital information. NLR values were categorised into two groups: Results: Median survival time in patients aged aged ≥65 years, it was 18.4 months (p<0.001). The median survival time was 20.2 months in NSCLC and 13.0 months in SCLC patients (p<0.001). In NSCLC cases with NLRthat of patients with NLR≥3 (18 months) (p=0.003). In SCLC patients, no relationship could be found between NLR and median survival time (p=0.408). With every 1 unit increase in lymphocyte count a 5.5% decrease in risk of periodic death ((1/0.947)x100=5.5%) was noted. Conclusion: The results of this study demonstrated that lymphocyte count, neutrophil count, Hb, Htc, and NLR are useful in determining prognosis in lung cancer (LC) patients and NLR could be more significant in determining the prognosis in NSCLC than in SCLC cases.     

Prognostic Significance of Androgen Receptor Expression in Triple Negative Breast Cancer: A Systematic Review and Meta-Analysis

The androgen receptor (AR) is increasingly considered as a potential biomarker for breast cancer. Nevertheless, the prognostic value of AR expression in patients with triple negative breast cancer (TNBC) remains controversial. Therefore, in this meta-analysis, we investigated AR expression and its impact on survival outcome. PubMed, Embase, the Cochrane Library, and references of articles were searched to identify relevant studies that investigated the association between AR expression and prognosis in patients diagnosed with TNBC and were published between 1946 and May 2019. The hazard ratio (HR) and confidence interval (CI) of disease-free survival, overall survival, distant disease-free survival, and recurrence-free survival were weighted and pooled by using the fixed-effect or random-effect model based on the heterogeneity of included studies. A total of 27 studies including 4914 patients with TNBC were included. AR was expressed in 27.96% (1315/4703) of patients with TNBC. In addition, AR expression in TNBC was not associated with disease-free survival (HR, 0.923; 95% CI, 0.671-1.271; P = .634), overall survival (HR, 0.910; 95% CI, 0.678-1.222; P = .531), distant disease-free survival (HR, 1.02; 95% CI, 0.96-1.08; P = .489), or recurrence-free survival (HR, 0.957; 95% CI, 0.462-1.982; P = .906) in TNBC, regardless of confounding factors and heterogeneity that existed among included studies. In patients with TNBC, AR expression is not associated with prognosis.     

局限期小细胞肺癌放疗靶区前瞻性随机对照研究的初步报告

背景与目的 在局限期小细胞肺癌(limited-stage small cell lung cancer,LSCLC)的放化疗综合治疗中,放疗靶区等方面尚存争议.本研究旨在前瞻性比较LSCLC经诱导化疗后按不同靶区范围进行放疗的局部控制率和毒副反应的差异及对生存的影响.方法 LSCLC患者,经EP方案诱导化疗2周期后,随机分为研究组和对照组,分别按照化疗后和化疗前原发灶范围勾画放疗靶区(gross tumor volume-tumor,GTV-T),区域淋巴结靶区(gross tumor volume-nodal,CTV-N)两组均包括达到诊断标准的淋巴结所在的结区.放疗45 Gy/30次/19天,开始于化疗后1周-2周,放疗中按期进行第3周期化疗.放疗后再行3周期化疗.完全缓解者行预防性全脑照射(prophylactic cranial irradiation,PCI).结果 研究组与对照组分别入组37例、40例患者.局部复发率分别为32.4%、28.2%(P=0.80),其中单独照射野外复发率分别为3.096、2.6%(P=0.91),且均位于原发病灶同侧锁骨上区.纵隔型N3是照射野外复发危险因素(P=0.02,OR=14.13,95%CI:1.47-136.13);放疗期间发生I度、Ⅱ度体重减轻分别为29.4%、5.9%和56.4%、7.7%(P=0.04);0度-I度和II度-III度后期放射性肺损伤发生率分别为97.1%、2.96%和84.6%、15.4%(P=0.07).研究组和对照组中位生存时间分别为22.1个月和26.9个月;1、2、3年总生存率分别为77.9%、44.4%、37.3%及75.8%、56.3%、41.7%(P=0.79).结论 本研究结果显示仅照射化疗后原发灶范围及阳性淋巴结区未降低局部控制率和总生存率,而放疗毒性降低.但目前样本量尚未达到设计要求,最终结论需继续扩大样本数后得出.     

大分割放疗联合EP方案化疗治疗局限期小细胞肺癌的临床疗效及安全性

Objective To investigate the efficacy and safety of hypofractionated thoracic radiotherapy combined with EP chemotherapy in the treatment of limited-stage small-cell lung cancer (LS-SCLC). Methods A total of 117 patients with LS-SCLC were enrolled and randomly divided into test group (n=59) and control group (n=58). Patients in the experiment group were given hypofractionated thoracic radiotherapy combined with EP chemotherapy, while patients in the control group were given hyperfractionation radiotherapy combined with EP chemotherapy. Objective response rate (ORR), 2-year overall survival (OS), 2-year progression free survival (PFS), and immune cell level were used to evaluate clinical efficacy. We compared the incidence of side effects between the two groups. Results After the treatment, the ORR of patients in the test group was higher than that in the control group (P>0.05). The mean OS and PFS of patients in the test group were significantly longer than those in the control group (P<0.05). The levels of CD3+, CD4+, CD4+/CD8+, and NK cells in the test group were significantly higher, whereas the levels of CD8+ were significantly lower than those in the control group (P<0.05). The incidence of radiation pneumonitis, radiation esophagitis, and severe dermatitis in the test group was significantly lower than that in the control group (P<0.05). Conclusion Hypofractionated radiotherapy combined with EP chemotherapy for treatment of LS-SCLC can effectively improve the anticancer efficacy and patient survival, reduce the damage to the body’s immune function, and alleviate adverse reaction of radiotherapy. © 2023, CHINA RESEARCH ON PREVENTION AND TREATMENT. All rights reserved.