头颈部肿瘤调强放射治疗后甲状腺功能减退的临床参数和剂量影响因素

目的 探讨头颈部肿瘤患者接受调强放射治疗（IMRT）后出现甲状腺功能减退（HT）与患者临床特征参数、剂量体积直方图（DVH）参数的相关性。方法 收集28例接受头颈部IMRT（颈部照射剂量 ≥ 40 Gy）联合化疗的肿瘤患者资料。治疗前后及随访观察中监测血清促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（FT3）和游离甲状腺素（FT4）。原发性HT定义为血清TSH高于正常值的上限伴或不伴有FT3/FT4的降低。基于放疗计划系统DVH,记录每一位患者甲状腺体积（TV）、甲状腺平均照射剂量（MTD）、最大点剂量（D_max）、甲状腺接受≥5~50 Gy的相对体积（表示为V_x,x=5~50,5 Gy为间隔）。回顾性分析患者年龄、性别、化疗、TV、MTD、D_max及各DVH参数与HT的相关性。 结果 全组患者治疗前血清TSH、FT3和FT4中位数分别为1.51 μU/ml、5.38和18.57 pmol/L。中位随访15个月（3~57月）,14例（50.0%）患者出现HT,出现HT的中位时间为放疗后8个月（2~23月）。患者首次监测发现HT时间点的TSH、FT3和FT4中位数分别为7.48 μU/ml（4.67~60.11 μU/ml）、4.05 pmol/L（0.40~5.77 pmol/L）和12.32 pmol/L（4.12~21.25 pmol/L）,HT患者的TSH较治疗前明显升高（P<0.01）。HT患者的TV中位数为17.76 cm³,显著低于未出现HT患者的20.21 cm³（Z=-2.154,P<0.05）。单因素分析显示患者年龄和V₄₀与HT的发生风险相关（χ²=11.340、4.102,OR=30.0、9.17,P<0.05）。多因素分析证实患者年龄、V₄₀均是HT的独立影响因素（OR=34.7、6.13,P<0.05）。结论 头颈部肿瘤患者IMRT后出现HT伴随TSH的显著增高。低龄、甲状腺体积较小的患者,甲状腺V₄₀大于80%是发生HT的高风险因素。     

食管癌放疗后达完全缓解患者的失败模式分析

目的 分析食管癌放疗患者近期疗效为完全缓解（CR）患者的治疗失败模式,并分析影响近期疗效的因素。方法 选取260例行根治性放疗的食管癌患者进行研究,分析治疗后的失败模式及影响患者近期疗效和预后的影响因素。结果 全组患者治疗后完全缓解（CR）91例（35.0%）,部分缓解（PR）158例（60.8%）,无缓解（NR）11例（4.2%）。患者性别（χ²=7.647,P<0.05）、T分期（χ²=33.548,P<0.05）、N分期（χ²=13.365,P<0.05）、TNM分期（χ²=27.792,P<0.05）、病变X射线长度（χ²=20.851,P<0.05）和大体肿瘤体积（GTV）（χ²=41.772,P<0.05）为近期疗效的影响因素。全组患者局部复发75例（28.8%）,远处转移66例（25.4%）,复发伴远处转移16例（6.2%）。复发患者1、3、5年生存率分别为71.4%、15.4%、7.7%,显著低于无复发患者的78.1%、43.2%、33.1%（χ²=23.330,P<0.05）;转移患者1、3、5年生存率分别为68.3%、12.2%、4.9%,显著低于无转移患者的79.2%、43.3%、33.1%（χ²=29.350,P<0.05）。治疗后达CR者出现复发/转移的比率显著低于PR者和NR者（χ²=11.248、20.301,P<0.05）,CR总生存率、局部控制率、无远处转移生存率及无瘤生存率高于PR者和NR者（χ²=83.080、41.340、72.640、40.010,P<0.05）。T分期、N分期及近期疗效为独立性预后影响因素（HR=1.197、2.309、2.149,P<0.05）。结论 近期疗效为食管癌患者长期生存预后的影响因素,且与治疗后复发/转移密切相关,治疗后达CR者预后明显优于PR者及NR者。     

X射线照射后小鼠血清、小肠和心脏组织中游离泛素水平的变化

目的 研究X射线照射对C57 BL/6N小鼠血清、小肠和心脏组织中游离泛素（free UB）水平的影响。方法 应用ELISA法定量检测受照小鼠血清、小肠、心脏组织匀浆中free UB的含量;Western blot法检测小鼠组织中free UB蛋白的表达;RT-PCR法检测小鼠组织中free UB编码基因UBB的mRNA水平。结果 与未照射组相比,照射后24和48 h,小鼠血清中free UB水平随照射剂量的增加而增加（F=183.1、435.3,P<0.01）;5和10 Gy照射后,血清中free UB随照射后时间的延长而增加（F=131.4、442.9,P<0.01）。与未照射组相比,10 Gy X射线照射后24 h,小肠中free UB蛋白表达水平和free UB编码基因UBB的mRNA表达水平均明显增加（t=-18.7、-10.1,P<0.01）;而心脏组织中free UB蛋白表达水平和UBB的mRNA表达水平均无明显改变（t=-2.0、3.1,P > 0.05）。结论 通过诱导辐射敏感组织小肠中free UB蛋白表达水平增加,电离辐射能够增加小鼠血清中free UB的表达量;free UB水平可能与组织的辐射敏感性和组织受损程度有关。     

miR-424*在X射线照射后的A549细胞体内、外及非小细胞肺癌组织和血清中的表达

目的 研究2、4 Gy X射线照射后人肺腺癌细胞miR-424^*体内、外表达以及非小细胞肺癌患者肺组织及血清中miR-424^*的表达变化及其意义。方法 2、4 Gy X射线分别照射体外培养的A549细胞,以实时定量PCR（RT-qPCR）法检测A549细胞中miR-424^*表达水平;用照射后的A549细胞制备裸鼠肺转移动物模型,检测裸鼠肺组织及血清中miR-424^*的表达水平;收集肺癌患者肺组织及血清样本,检测miR-424^*表达水平。结果 2、4 Gy X射线照射后1、2、12、24及48 h,miR-424^*表达均显著升高（2 Gy：t=-45.886~-6.709,P<0.05;4 Gy：t=-29.087~-7.833,P<0.05）;0、2、4 Gy照射后,miR-424^*在裸鼠肺及血清中表达水平分别为空白对照组的9.72、8.58及4.7与11.93、9.22及8.99倍（t=-13.243~-3.052,P<0.05）。6/11例（54.5%）患者肺癌组织中高表达miR-424^*,腺癌、鳞癌病理类型间检出率差异无统计学意义（P>0.05）;43/84例（51.20%）肺癌患者与健康志愿者相比,血清miR-424^*表达升高 1.97~17.71倍,其中腺癌患者血清检出率为39.1%（18/46）,鳞癌患者血清检出率为65.8%（25/38）,两种病理类型检出率差异有统计学意义（t=5.919,P<0.05）;此外,84例肺癌患者中,miR-424^*[JP3]在未接受放疗的肺癌患者血清中的阳性检出率为41.5%（22/53）,显著低于接受放疗的肺癌患者血清的阳性检出率67.7%（21/31）[JP]（t=5.387,P<0.05）。结论 2、4 Gy X射线照射可增加A549细胞miRNA-424^*的体内、外表达水平,可能与增强A549细胞体内、外侵袭转移能力有关。肺癌患者中50%以上的肺癌组织及肺癌患者血清中miR-424^*表达水平显著升高,可能与肺癌的病理类型及放疗相关。     

电离辐射对肺癌A549细胞miR-21体内外表达的影响及意义

目的 研究miR-21在肺癌组织及血清中的表达与肺癌预后及放疗因素的关系,进而探讨电离辐射对人肺癌A549细胞体内外表达miR-21的影响。方法 收集肺癌患者病理组织及血清样本,检测不同病理类型肺癌组织及血清中的miR-21的表达水平,同时检测是否接受放疗的非小细胞肺癌患者血清中miR-21的表达水平,并进行生存分析;以2、4 Gy X射线照射体外培养的A549细胞,并以A549细胞制备裸鼠肺转移癌模型,分别检测A549细胞与裸鼠血清及肺中miR-21的表达水平。结果 肺癌组织中miR-21高表达占60.0%;肺癌血清中miR-21高表达占50.5%,腺癌与鳞癌检出率差异有统计学意义（χ²=5.766,P<0.05）;87例非小细胞肺癌中放疗患者miR-21检出率66.7%显著高于非放疗患者39.6%（χ²=6.321,P<0.05）;Kaplan-Meier法生存分析显示,miR-21高表达患者预后明显低于低表达患者,差异有统计学意义（P<0.05）;Cox回归模型分析显示,miR-21高表达、区域淋巴结转移及放疗均为影响患者预后的独立危险因素。2、4 Gy X射线照射A549细胞后不同时间点miR-21表达显著升高（t=-7.552~-1.206,P<0.05）,miR-21在裸鼠血清及肺组织中的表达水平显著升高（t=-47.845~-2.356,P<0.05）。结论 电离辐射可上调A549细胞体内外miR-21的表达水平,可能与增强A549细胞侵袭转移能力相关。     

食管癌患者放疗前后血清血管内皮生长因子变化的临床意义

目的 检测食管癌患者放疗前、中、后血清血管内皮生长因子(VEGF)的水平,探讨其变化及临床意义。方法 采集67例食管癌患者和30例健康体检者(健康对照组)血清,应用酶联免疫吸附法(ELISA)测定VEGF水平,并对其变化与临床分期和患者放疗疗效的关系进行分析。结果 食管癌患者放疗前、中、后血清VEGF水平均较健康对照组升高,差异有统计学意义(F=11.65,P＜0.01);放疗后较放疗前VEGF水平明显降低,差异有统计学意义(F=10.72,P＜0.01)。T₃、T₄患者的平均VEGF水平与健康对照组比较显著升高,差异有统计学意义(F=14.10,P＜0.01)。N₁、N₂组患者的平均VEGF水平显著高于健康对照组,差异具有统计学意义(F=8.64,P＜0.01)。可评价疗效的62例患者中,有21例放疗后血清VEGF水平较放疗前升高,有41例较放疗前降低,升高组的放疗有效率为61.90%,降低组的放疗有效率为90.24%,两组比较差异有统计学意义(χ²=6.08,P＜0.05)。50例CR+PR患者放疗后及放疗中的血清VEGF水平均比放疗前显著降低,差异有统计学意义(F=7.98,P＜0.01)。结论 监测食管癌患者血清VEGF水平变化可判断患者放射治疗的敏感性,对临床预测放射治疗的预后有重要的意义。     

抗放利对电离辐射诱导人外周血淋巴细胞遗传损伤的保护作用

目的 探讨2,2-二甲基四氢噻唑盐酸盐（抗放利）对辐射诱导人外周血淋巴细胞遗传损伤的防护作用。方法 采集健康人外周血,分为健康对照组、单纯照射组和抗放利防护组。照射剂量为2 Gy。抗放利防护组分0.2、0.5、1、2 mmol/L 4个浓度组,于照前30 min给药。通过染色体畸变分析、微核及单细胞凝胶电泳检测,观察抗放利对辐射致人外周血淋巴细胞遗传损伤的防护作用。结果 各浓度抗放利防护组与单纯照射组比较,染色体畸变率（t=5.34~25.48,P<0.05）、微核细胞率（t=5.18~29.44,P<0.05）与微核率（t=4.67~12.04,P<0.05）、彗星细胞尾长（t=16.18~19.64,P<0.05）、 尾矩（t=11.79~13.01,P<0.05）和Olive尾矩（t=12.44~14.88,P<0.05）、 尾部DNA含量（t=12.05~17.30,P<0.05）均明显降低。两个高浓度防护组（1、2 mmol/L）分别与两个低浓度防护组（0.2、0.5 mmol/L）比较,Olive尾矩明显降低（t=5.67~16.56,P<0.05）。2 mmol/L防护组与其余各防护组相比,微核率和微核细胞率明显降低（t=4.23~5.57,P<0.05）。结论 抗放利对辐射诱导人外周血淋巴细胞遗传损伤具有防护作用。     

辐射诱导双基因质粒pEgr-1-endostatin-TNF-α的抗肿瘤作用研究

目的 探讨放射线诱导重组质粒pEgr-1-endostatin-TNF-α在小鼠体内的表达及其与射线协同抗肿瘤效应。方法 Lewis肺癌荷瘤鼠240只,随机分为4组:对照组、照射组、质粒组、质粒+照射组。将重组质粒pEgr-1-endostatin-TNF-α注射到荷瘤鼠肿瘤内,24 h后对质粒+照射组采用γ射线肿瘤局部照射10 Gy,诱导目的基因表达,ELISA法测定小鼠不同时间血清中的内皮抑素及TNF-α浓度,免疫组织化学染色检测肿瘤组织中血管内皮细胞CD31的表达,与HE染色分别计算肿瘤血管密度,测量肿瘤大小,观察肿瘤生长情况。结果 质粒+照射组内皮抑素及TNF-α表达量明显增加,第2周表达量达到高峰,分别为(52.64±4.19)和(12.01±0.87)ng/ml,持续到第4周仍有较高浓度表达,与其他3组比较差异有统计学意义(F=29.726,P<0.05)。质粒+对照组HE染色肿瘤组织血管密度较对照组明显减少[(4.7±0.8)与(10.0±1.2)个/视野, t=14.063, P<0.05],肿瘤生长较对照组和照射组受到明显抑制[(5907.2±78.6)、(4653.4±32.8)和(763.5±12.3) mm³, F=16.415,P <0.05)]。结论 重组质粒pEgr-1-endostatin-TNF-α可以通过射线的诱导在小鼠体内表达,与单纯放疗相比较表现出明显的抑制肿瘤血管形成和控制肿瘤生长的作用。     

131I对Graves病外周血粒细胞集落刺激因子和白细胞的影响

目的 探讨¹³¹I治疗Graves病(GD)对患者外周血粒细胞集落刺激因子(G-CSF)和白细胞的影响。方法 采用酶联免疫吸附试验(ELISA)、Coulter 3分类血细胞分析和放射免疫分析法(RIA),分别检测初发43例白细胞正常和22例白细胞减少的GD患者于¹³¹I治疗前及治疗后30、90和180 ｄ血清G-CSF水平、白细胞总数和甲状腺激素水平,并进行相关性分析。30例年龄与性别相匹配的健康者作为健康对照。结果 GD患者中白细胞正常组血清G-CSF水平(28.4±11.7)μg/L显著高于健康对照组(18.3±6.98)μg/L (t=2.376,P<0.05);白细胞减少组血清G-CSF水平(40.1±13.8)μg/L升高(t=3.672,P<0.01);¹³¹I治疗180 ｄ后,甲状腺功能恢复正常,症状缓解,血清G-CSF水平逐渐下降,但白细胞减少组(25.7±11.5) μg/L仍高于健康对照组(t=2.103,P<0.05);GD患者G-CSF与白细胞呈负相关(r=-0.38,P<0.05),与FT₃、FT₄、TSH没有相关性。 结论 GD患者体内存在G-CSF异常表达,可能与白细胞减少有关;¹³¹I治疗能有效抑制GD患者自身免疫,可能是治疗伴白细胞减少GD患者一种安全可靠、疗效显著的方法,宜尽早选用。     

凋亡刺激蛋白抑制因子表达对鼻咽癌预后预测的研究

目的 探讨凋亡刺激蛋白抑制因子（iASPP）的表达水平与鼻咽癌预后的关系。方法 随访2012年1月至12月广西医科大学第一附属医院放疗科治疗的初诊鼻咽癌患者130例。临床分期依据2009 AJCC/UICC分期标准。所有患者均接受调强放射治疗,Ⅲ~Ⅳ_B期患者行铂类为基础的同步放化疗。采用免疫组织化学法检测iASPP在130例鼻咽癌组织中的表达情况,比较iASPP表达与临床病理因素的关系,并分析其表达对鼻咽癌患者疗效和生存的影响。结果 130例患者中iASPP阳性表达者86例（66.2%）,阴性表达者44例（33.8%）。不同N分期和临床分期患者的iASPP阳性表达率比较,差异有统计学意义（χ²=7.565、4.947,P<0.05）。治疗后3个月,iASPP阳性表达者与阴性表达者的近期疗效差异无统计学意义（P>0.05）。单因素分析显示,iASPP阳性表达者3年无远处转移生存（DMFS）和无进展生存（PFS）均低于iASPP阴性表达者（82.6% vs. 95.4%,χ²=4.335,P=0.037和74.4% vs. 93.1%,χ²=6.640,P=0.01）。N_2~3患者3年DMFS、PFS和总生存（OS）均低于N_0~1患者（χ²=8.058、9.554、6.987,P<0.01）。多因素分析显示,iASPP表达水平及N分期是影响PFS的独立预后因素（χ²=4.336、5.228,P<0.05）。结论 鼻咽癌患者iASPP阳性表达水平升高是影响预后的不利因素。     

同步放化疗对非小细胞肺癌患者Fas水平的影响

目的 用酶联免疫吸附试验研究非小细胞肺癌患者同步放化疗对血清可溶性Fas的影响及其与预后的关系。方法 对60例患者比较治疗前、治疗后1个月血清Fas水平变化,并设正常对照组。比较治疗有效组(完全缓解+部分缓解,50例)与无效组(无变化+进展,10例) 治疗前Fas水平变化。以2年生存为观察指标,观察血清Fas水平对生存时间的影响。结果 非小细胞肺癌患者治疗前血清Fas水平明显高于正常对照组(8.55±0.63) ng/L和(6.03±0.55) ng/L(t=18.63,P<0.01),治疗后1个月明显低于治疗前(7.24±0.52) ng/L和(8.55±0.63) ng/L(t=12.44,P<0.01)。治疗有效组疗前血清Fas水平明显低于无效组的(8.02±0.43)ng/L和(8.97±0.42)ng/L(t=8.67,P<0.01)。生存满2年者(26例)治疗前Fas水平明显低于生存不足2年者(34例)(t=645.88,P<0.05)。结论 同步放化疗可降低非小细胞肺癌患者血清可溶性Fas水平,治疗前后Fas水平变化有可能成为判断非小细胞肺癌患者预后的观察指标。     

G蛋白信号通路调节蛋白5抑制肺癌细胞生长和增强X射线照射作用及其分子机制

目的 观察G蛋白信号通路调节蛋白5(RGS5)对人肺癌细胞的作用并探索其可能的分子机制.方法 采用MTT法检测过表达RGS5对人肺癌细胞系A549及Calu-3生长的影响;采用克隆形成法检测过表达RGS5及联合X射线照射对人肺癌细胞系A549及Calu-3的存活的影响;采用Western blot法检测凋亡相关蛋白的表达.结果 过表达RGS5可显著地降低人肺癌细胞系A549及Calu-3的生长,pTriEX-RGS5组在受照后48和72 h时A549、Calu-3细胞的生长抑制率分别为44.4%(F=29.18, P<0.05)和39.27%(F=23.04, P<0.05)、54.3%(F=103.45, P<0.05)和44.7%(F=108.02, P<0.05).RGS5可诱导肺癌细胞的凋亡,对照组、pTRiEX组及pTRiEX-RGS5组处理36 h后,A549、Calu-3细胞的凋亡率分别为(1.3±0.2)%、(3.4±0.6)%、(19.6±2.3)%(F=86.62,P<0.05)和(3.2±0.8)%、(3.0±0.9)%、(12.8±1.8)%(F=28.80,P<0.05).此外,过表达RGS5与X射线照射联合,可以显著地增强抑制肺癌细胞的存活能力.结论 RGS5可显著地抑制人肺癌细胞的生长,并且过表达RGS5可增强X射线照射对肺癌细胞的杀伤作用.     

γ-Glutamyltranspeptidase as a Prognostic Biomarker in Advanced Hepatocellular Carcinoma Treated with Transarterial Chemoembolization

PurposeTo evaluate the prognostic value of pretreatment serum γ-glutamyltransferase (GGT) level in patients with advanced hepatocellular carcinoma (HCC) receiving transarterial chemoembolization.Materials and MethodsThis retrospective study included 140 patients (123 male, 17 female; mean age, 56.9 y ± 12.0; range, 22.0–82.0 y) with Barcelona Clinic Liver Cancer class C HCC who received first-line conventional chemoembolization between December 2013 and March 2018. Patients were divided into low and high GGT groups based on a cutoff value calculated with a receiver operating characteristic curve. Overall survival (OS) was compared between groups by log-rank test. Univariate and multivariate survival analyses were performed.ResultsThe optimal cutoff values of GGT were 119.5 U/L in men and 175.0 U/L in women. The 6-, 9-, and 12-mo OS rates were 81.7%, 72.4%, and 62.9%, respectively, for patients in the low GGT group (n = 44) and 58.8%, 35.7%, and 28.8%, respectively, for patients in the high GGT group (n = 96; P < .001). Multivariable Cox regression analysis identified high pretreatment serum GGT level (hazard ratio [HR], 2.71; 95% confidence interval [CI], 1.67–4.40; P < .001), multiple tumors (HR, 3.05; 95% CI, 1.23–7.53; P = .02), and performance of target treatment (ie, sorafenib; HR, 0.41; 95% CI, 0.24–0.72; P = .002) or ablation (HR, 0.35; 95% CI, 0.18–0.66; P = .001) as independent prognostic factors for OS.ConclusionsPretreatment serum GGT level was an independent prognostic factor for OS in patients with advanced HCC treated with chemoembolization, suggesting that GGT is a useful prognostic biomarker for advanced HCC.     

Diagnostic and prognostic values of FDG-PET in patients with non-small cell lung cancer

PurposeThe aim of this study was to address the efficacy of 2-[F-18]-Fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) in the staging of non-small cell lung cancer (NSCLC) and in prognostic prediction in patients with NSCLC.MethodsForty-four patients (26 males, 18 females) were analyzed.ResultsAccurate staging was obtained by addition of FDG-PET. Multivariate analysis indicated that the standardized uptake value of the primary tumor was the most significant prognostic factor for disease-free survival (P=.0073).ConclusionFDG-PET is useful for the diagnosis of NSCLC and for prognostic prediction in patients with NSCLC.     

放疗对血清miR-150-5p和miR-23a-3p表达水平的影响

目的 通过采集肿瘤患者放疗前后外周血,探讨照射对人外周血血清miR-150-5p、miR-23a-3p表达的影响,以期为寻找辐射生物标志物提供科学依据。方法 以2021年10月至2022年3月63例行放疗的肿瘤患者为研究对象,采用实时荧光定量PCR(qPCR)方法,检测患者放疗前后外周血血清miR-150-5p与miR-23a-3p的相对表达水平。比较两种miRNAs放疗前后在患者外周血血清中的差异表达变化,分析其与肿瘤类型等因素的关系。结果 放疗后,患者外周血血清miR-150-5p与miR-23a-3p的相对表达量明显低于放疗前(t=4.97,Z=-2.77,P<0.05)。不同的肿瘤类型中,乳腺癌、食管癌和其他消化道肿瘤患者放疗后miR-150-5p的相对表达量降低(t=3.47、2.47、2.87,P<0.05),消化道肿瘤患者放疗后miR-23a-3p相对表达量下降(Z=-1.99,P<0.05)。在放疗前、后miR-150-5p的表达改变均不受性别、年龄、化疗和肿瘤类型等因素影响(P>0.05),而miR-23a-3p的表达改变在放疗后受性别、年龄和化疗等因素影响(t=2.04、 -3.34、-2.29,P<0.05)。结论 放疗可影响肿瘤患者血清中miR-150-5p的表达,其有作为辐射生物学标志物的潜力。     

Serum MicroRNA-210 as a Predictive Biomarker for Treatment Response and Prognosis in Patients with Hepatocellular Carcinoma undergoing Transarterial Chemoembolization

PurposeTo investigate whether serum microRNA-210 (miR-210) level can serve as an indicator of prognosis and a predictor of efficacy of transarterial chemoembolization in patients with hepatocellular carcinoma (HCC).Materials and MethodsSerum miR-210 level was measured in 113 patients with HCC before transarterial chemoembolization (t1), 3 days after transarterial chemoembolization (t2), and 4 weeks after transarterial chemoembolization (t3) and compared with 39 healthy control subjects. The correlations between miR-210 levels and clinicopathologic factors, tumor responsiveness, and prognosis were analyzed. The modified Response Evaluation Criteria in Solid Tumors assessment was conducted at t3.ResultsA higher mean baseline miR-210 level was observed in patients with HCC compared with control subjects (3.69 ± 2.04 vs 1.08 ± 0.45, P < .001). A positive correlation between baseline miR-210 level and tumor size (P < .001), vascular invasion (P = .005), tumor differentiation (P = .037), and Barcelona Clinic Liver Cancer stage (P < .001) was observed. Elevated baseline miR-210 level also served as an independent prognostic factor predicting poor overall survival (risk ratio, 2.082; P = .003). Patients who did not respond to transarterial chemoembolization had higher baseline miR-210 levels than patients who did respond to treatment (4.34 ± 1.67 vs 3.28 ± 2.15, P < .001). In addition, miR-210 levels increased significantly 4 weeks after transarterial chemoembolization in nonresponders (5.79 ± 2.06 at t3 vs 4.34 ± 1.67 at t1, P < .001), whereas no significant change was observed in responders (3.53 ± 2.20 at t3 vs 3.28 ± 2.15 at t1, P = .116). Lastly, an inverse correlation was identified between miR-210 change t1–t3 with the time to radiologic progression (P < .001).ConclusionsSerum miR-210 may represent a novel biomarker for predicting efficacy of transarterial chemoembolization and overall survival for patients with HCC.     

Percutaneous Radiofrequency Ablation for Pulmonary Metastases from Esophageal Cancer: Retrospective Evaluation of 21 Patients

PurposeTo evaluate retrospectively outcomes after radiofrequency (RF) ablation for pulmonary metastases from esophageal cancer.Materials and MethodsThis study included 21 consecutive patients who met inclusion criteria (all men; mean age, 66.0 y) and had pulmonary metastases from esophageal cancer. There were 31 tumors (mean size, 1.7 cm) that were treated with 27 planned ablation sessions. At the initial RF ablation sessions, 3 patients had viable extrapulmonary recurrences, and 18 patients had viable recurrences confined to the lung. Primary study endpoints included patient survival and the determination of prognostic factors. Secondary endpoints included local efficacy and safety of the treatment. The log-rank test was used to identify prognostic factors. Adverse events were evaluated according to the National Cancer Institute Common Terminology Criteria for Adverse Events Version 4.0.ResultsMedian follow-up duration after the initial RF ablation was 22.4 months (range, 6.2–76.1 mo). Estimated overall survival rates were 85.7% at 1 year, 54.8% at 2 years, and 38.4% at 3 years after the initial RF ablation session. The presence of viable extrapulmonary recurrences at the initial RF ablation session was an unfavorable prognostic factor (P < .001). Local tumor progression was observed in 25.8% (8 of 31) of tumors and occurred 2.6–10.0 months (median, 4.8 mo) after RF ablation. Grade 3 adverse events occurred in 7.4% (2 of 27) of sessions, including pleural effusion requiring chest tube placement and pneumoderma requiring surgical intervention. No grade 4 or greater adverse events occurred.ConclusionsRF ablation is a promising treatment option for patients with pulmonary metastases from esophageal cancer.     

Prognosis for Pneumonic-Type Invasive Mucinous Adenocarcinoma in a Single Lobe on CT: Is It Reasonable to Designate It as Clinical T3?

ObjectiveTo compare pneumonic-type invasive mucinous adenocarcinoma (pIMA) confined to a single lobe with clinical T2, T3, and T4 stage lung cancer without pathological node metastasis regarding survival after curative surgery and to identify prognostic factors for pIMA.Materials and MethodsFrom January 2010 to December 2017, 41 patients (15 male; mean age ± standard deviation, 66.0 ± 9.9 years) who had pIMA confined to a single lobe on computed tomography (CT) and underwent curative surgery were identified in two tertiary hospitals. Three hundred and thirteen patients (222 male; 66.3 ± 9.4 years) who had non-small cell lung cancer (NSCLC) without pathological node metastasis and underwent curative surgery in one participating institution formed a reference group. Relapse-free survival (RFS) and overall survival (OS) were calculated using the Kaplan–Meier method. Cox proportional hazard regression analysis was performed to identify factors associated with the survival of patients with pIMA.ResultsThe 5-year RFS and OS rates in patients with pIMA were 33.1% and 56.0%, respectively, compared with 74.3% and 91%, 64.3% and 71.8%, and 46.9% and 49.5% for patients with clinical stage T2, T3, and T4 NSCLC in the reference group, respectively. The RFS of patients with pIMA was comparable to that of patients with clinical stage T4 NSCLC and significantly worse than that of patients with clinical stage T3 NSCLC (p = 0.012). The differences in OS between patients with pIMA and those with clinical stage T3 or T4 NSCLC were not significant (p = 0.11 and p = 0.37, respectively). In patients with pIMA, the presence of separate nodules was a significant factor associated with poor RFS and OS {unadjusted hazard ratio (HR), 4.66 (95% confidence interval [CI], 1.95–11.11), p < 0.001 for RFS; adjusted HR, 4.53 (95% CI, 1.59–12.89), p = 0.005 for OS}.ConclusionThe RFS of patients with pIMA was comparable to that of patients with clinical stage T4 lung cancer. Separate nodules on CT were associated with poor RFS and OS in patients with pIMA.     

Clinical Outcomes and Patency after Transjugular Intrahepatic Portosystemic Shunt Reduction for Overshunting Adverse Events

PurposeTo assess clinical outcomes and patency after transjugular intrahepatic portosystemic shunt (TIPS) reduction for overshunting adverse events.Materials and MethodsThis multicenter, retrospective observational study included 33 patients (male-to-female ratio, 20:13; mean age, 59 years; mean Model for End-Stage Liver Disease [MELD] score, 15) who underwent TIPS reduction between 2007 and 2020. Procedure indications included medically refractory hepatic encephalopathy (HE) (85%), post-TIPS hepatic insufficiency (HI) (12%), and heart failure (3%). The measured outcomes included improvement in HE (classified using the West Haven system) and HI, patency of reduced TIPS, and transplant-free survival (TFS).ResultsTIPS reductions were successfully performed using parallel stent (94%) or other (6%) techniques at a median of 120 days after TIPS creation (HE, median, 164 days; HI, median, 5 days). The portosystemic pressure gradient increased from a mean of 10 to 17 mm Hg (P < .001). The overall HE rate after TIPS reduction was 54%; HE was persistent, improved, and resolved in 21%, 32%, and 46% cases, respectively. In patients with HI, the MELD score increased from a mean of 22 before TIPS to 34 after TIPS (P = .061), but without improvement (0%) in HI after TIPS reduction (mean MELD score, 30; P = .266). Recurrent ascites occurred in 14% of the patients. The median shunt patency was 961 days (95% confidence interval, 476–1,447). The 30-day, 6-month, 1-year, and 3-year shunt patency rates were 92%, 81%, 74%, and 37%, respectively. The median TFS was not reached. The 30-day, 6-month, 1-year, and 3-year survival rates were 97%, 90%, 81%, and 60%, respectively.ConclusionsAlthough TIPS reduction may be an effective and durable approach to treat post-TIPS medically refractory HE, shunt reduction may not achieve meaningful benefit for HI.     

低剂量半身照射对恶性肿瘤患者免疫功能的影响

目的 评价低剂量辐射对恶性肿瘤患者免疫功能的影响。方法 将20例患者(其中非何杰金氏淋巴瘤13例、小细胞肺癌7例)随机分为两组:HBR组和RR组。其中HBR组10例患者采用常规放疗(RR)加低剂量半身照射,低剂量半身照射方法为10 cGy/次,2次/周,总剂量为100 cGy,每次均间隔6～8 h再行常规放疗;RR组10例患者只予以常规放疗。采用流式细胞术(FCM)双标法检测HBR与RR组在放疗前、中、后外周血淋巴细胞CD₄、CD₈、CD₂₅和CD₅₆等指标的变化。结果 照射后RR组患者的CD₄⁺ CD₈⁺降低(P<0.05),HBR组患者的CD₄⁺升高(P<0.05),CD₂₅⁺和CD₅₆⁺分子表达均明显地增加(P<0.05),放疗前和放疗后CD₈⁺均低(P<0.05),放疗中(P<0.05)和放疗后(P<0.01)CD₄⁺ CD₈⁺均高。结论 低剂量半身照射可增强机体的免疫功能。