Efficacy and safety of ultrasound-guided totally implantable venous access ports via the right innominate vein in adult patients with cancer: Single-centre experience and protocol

BackgroundTotally implantable venous access ports (TIVAPs) are widely used and are an essential tool in the efficient delivery of chemotherapy. This study aimed to evaluate the feasibility and safety of implantation of ultrasound (US)-guided TIVAPs via the right innominate vein (INV) for adult patients with cancer.MethodsThis study retrospectively reviewed the medical records of 283 adult patients with cancer who underwent US-guided INV puncture for TIVAPs between September 2015 and September 2017. It also analysed the technical success rate, operation time, and short-term and long-term surgical complications.ResultsTechnical success was achieved in all patients (100%). The mean operation time was 28.31 ± 7.31 min (range: 23–39 min), and the puncture success rate for the first attempt was 99.30% (281/283). Minor complications included artery puncture during the operation in one patient, but no pneumothorax was encountered. The mean TIVAP time was 304.16 ± 42.54 days (range: 38–502 days). The rate of postoperative complications was 2.83% (8/283), including poor healing of the incision in one patient, catheter-related infections in three patients, port thrombosis in one patient, and fibrin sheath formation in three patients; no catheter malposition, pinch-off syndrome, catheter fracture, or other serious complications were observed.ConclusionsTIVAPs are widely employed for chemotherapy. The present study found that the novel approach of using US-guided INV puncture to implant TIVAPs in adult patients with cancer is both short-termly feasible and safe for long-term central venous access.     

Safety,efficacy and tumor mutational burden as a biomarker of overall survival benefit in chemo-refractory gastric cancer treated with toripalimab,a PD-1 antibody in phase Ib/II clinical trial NCT02915432

BackgroundHigh tumor mutational burden (TMB-H) is correlated with enhanced objective response rate (ORR) and progression-free survival (PFS) for certain cancers receiving immunotherapy. This study aimed to investigate the safety and efficacy of toripalimab, a humanized programmed death-1 (PD-1) antibody, in advanced gastric cancer (AGC), and the predictive survival benefit of TMB and PD-L1.Patients and methodsWe reported on the AGC cohort of phase Ib/II trial evaluating the safety and activity of toripalimab in patients with AGC, oesophageal squamous cell carcinoma, nasopharyngeal carcinoma and head and neck squamous cell carcinoma. In cohort 1, 58 chemo-refractory AGC patients received toripalimab (3 mg/kg d1, Q2W) as a monotherapy. In cohort 2, 18 chemotherapy-naive AGC patients received toripalimab (360 mg d1, Q3W) with oxaliplatin 130 mg/m² qd, d1, capecitabine 1000 mg/m² b.i.d., d1–d14, Q3W as first-line treatment. Primary end point was ORR. Biomarkers such as PD-L1 and TMB were evaluated for correlation with clinical efficacy.ResultsIn cohort 1, the ORR was 12.1% and the disease control rate (DCR) was 39.7%. Median PFS was 1.9 months and median OS was 4.8 months. The TMB-H group showed significant superior OS than the TMB-L group [14.6 versus 4.0 months, HR = 0.48 (96% CI 0.24–0.96), P = 0.038], while PD-L1 overexpression did not correlate with significant survival benefit. A 77.6% of patients experienced at least one treatment-related adverse event (TRAE), and 22.4% of patients experienced a grade 3 or higher TRAE. In cohort 2, the ORR was 66.7% and the DCR was 88.9%. A 94.4% of patients experienced at least one TRAE and 38.9% of patients experienced grade 3 or higher TRAEs.ConclusionsToripalimab has demonstrated a manageable safety profile and promising antitumor activity in AGC patients, especially in combination with XELOX. High TMB may be a predictive marker for OS of AGC patients receiving toripalimab as a single agent.Trial registrationClinicalTrials.gov NCT02915432.     

乳腺癌患者血清中 tRF-32-Q99P9P9NH57SJ的表达及临床意义

目的　检测tRNA 及其来源片段（tRNA-derived fragments）- tRF-32-Q99P9P9NH57SJ（tRF-32）在乳腺癌患者 血清中的表达及意义。方法　选取2017 年11 月~ 2019 年2 月在江苏省肿瘤医院乳腺外科确诊的51 例乳腺癌患者及同 期25 例健康对照者的血清,记录患者临床资料。运用RT-PCR 检测血清tRF-32 的表达水平,分析其表达水平与临床病 理资料的关系。结果　51 例乳腺癌患者血清中tRF-32 的表达量（13.84 ± 2.62）与25 例健康对照组血清中的tRF-32 表 达量（39.47 ± 7.21）比较,差异有统计学意义（t = 4.091, P < 0.000 1）。临床TNM 分期I-II 期的tRF-32 表达量（16.97 ± 3.315）明显高于 III-IV 期tRF-32 表达量（7.07 ± 2.83）,差异有统计学意义（t = 2.241, P = 0.029）。无淋巴结转移 患者血清中的tRF-32 表达量 (18.75 ± 3.91) 明显高于有淋巴结转移患者血清中tRF-32 表达量（7.80 ± 2.51),差异有统 计学意义（t = 2.47, P = 0.017）。乳腺癌患者tRF-32 表达量与年龄无关（χ2=0.621,P >0.05）,与TNM 临床分期（χ2=8.463, P = 0.004）以及淋巴结是否转移相关（χ2 =5.856, P = 0.016）。受试者工作曲线（receiver operating characteristic curve, ROC）显示血清tRF-32 诊断乳腺癌的曲线下面积（area under curve, AUC）是0.776（95% CI: 0.673 ~ 0.880）,敏感度 和特异度分别为84.0 % 和68.8%。结论　tRF-32 在乳腺癌患者血清中低表达,tRF-32 的表达水平与乳腺癌的临床分期 和淋巴结转移有关。     

宫颈癌细胞DNA含量的流式细胞分析初步小结

用流式细胞计,对36例宫颈癌病人活检标本进行癌细胞DNA 含量分析。结果发现宫颈鳞癌细胞DNA 指数为1.(?)2±0.48,而宫颈腺癌为1.88±0.47。宫颈癌细胞DNA 含量与患者的临床分期,肿瘤生长类型无明显差异(P>0.05)。结果提示DNA 含量的测定对肿瘤恶性度、预后判断及指导治疗方面有较大的参考价值。     

鬼臼类中药及其木脂素类成分的药效学研究

目的：研究小叶莲、桃儿七、秕鳞八角莲提取物及鬼臼类中药主要成分鬼臼毒素、去氧鬼臼毒素的抗肿瘤作用。方法：以移植性肝癌及艾氏腹水癌小鼠为实验动物,ig给予上述样品,分别观察各样品的抗肿瘤作用。结果桃儿七、秕鳞八角莲提取物具有较强的抗肿瘤活性。结论：5种样品均有抗肿瘤活性。     

DNA repair gene XRCC1 and XPD polymorphisms and risk of lung cancer in a Chinese population

X-ray repair cross-complementing group 1 (XRCC1) and xeroderma pigmentosum group D (XPD) are mainly involved in base excision repair (BER) and nucleotide excision repair (NER) of DNA repair pathways, respectively. Polymorphisms of DNA repair gene XRCC1 and XPD has recently been identified, and there is a growing body of evidence that these polymorphisms may have some phenotypic significance. To investigate the role of XRCC1 polymorphisms (codon 194 and codon 399) and XPD polymorphism (codon 751) in lung cancer, a population-based case-control study of 109 lung cancer patients and 109 healthy control subjects (individually matched on age and gender) in a Chinese population was conducted. XRCC1 and XPD genotypes were identified using PCR-restriction fragments length polymorphism technique. Conditional logistic regression analysis revealed that XRCC1 codon 194Trp/Trp genotype was associated with a borderline increased risk of lung cancer [adjusted odd ratio (OR) = 3.06; confidence interval (CI) 0.94-9.92]. The XPD 751 Lys allele (combined Lys/Lys and Lys/Gln genotypes) was associated with a significantly increased risk of lung cancer (OR = 3.19; CI 1.01-10.07). The risk of lung cancer increased more than additive interaction (adjusted OR = 8.77; CI 1.47-52.31) for the individuals with both putative high-risk genotypes of XRCC1 194 Trp/Trp and XPD 751 Lys allele. Our results suggested that the genotypes of XRCC1 194Trp/Trp and XPD 751 Lys allele might be the risk genotypes for lung cancer in Chinese population.     

错配修复基因hMLH1错义突变Val384Asp与四种肿瘤遗传易感性的研究

目的 了解中国人hMLH1基因Va1384Asp错义突变在四种肿瘤中的存在状况。方法在中国汉族人群中分别提取233例大肠癌患者、273例胃癌患者、111例乳腺癌患者、90例食管癌患者和268名健康人外周血细胞的基因组DNA;采用聚合酶链反应扩增hMLH1基因第12外显子的部分DNA片段(217bp),变性高效相色谱检测,DNA测序验证,比较分析Val384Asp基因型在四种肿瘤中的分布。结果 6.34％正常人群携带Val384Asp,在大肠癌患者和胃癌患者中Val384Asp的检出率与正常人群相比差异有统计学意义(P<0.05),尤其在<45岁的大肠癌患者和<50岁的胃癌患者中,Val384Asp的检出率与正常人群相比差异有统计学意义(P<0.01),而在乳腺癌患者和食管癌患者中Val384Asp的检出率与正常人的相同或相近。结论 Val384Asp错义突变作为中国人hMLH1基因上的一个多态位点,是大肠癌和胃癌遗传易感因素,可作为中国人胃肠道肿瘤,尤其是低龄胃肠道肿瘤高危人群筛选的候选指标。     

乙醇脱氢酶2基因多态和饮酒习惯与肝癌易感性

目的:研究乙醇脱氢酶2(ADH2)基因多 态性和饮酒习惯与肝癌的易感性关系。方法:在 肝癌高发区江苏省泰兴市采用病例对照研究方 法,病例为确诊的原发性肝癌(207例)新发病例, 对照(207例)按1∶1配对,选取与病例同性别、年 龄相差不超过2岁,与病例居住同村或同一街道 的非肿瘤居民,调查研究对象的饮酒习惯等因素, 并采用聚合酶链反应 限制性片段长度多态性 (PCR PFLP)方法检测了他们的ADH2基因型。 结果:1)病例组及对照组中ADH2 1/ 1、 ADH2 1/ 2、ADH2 2/ 2的基因型分布频 度分别为10.14%、63.77%、26.09%及12.56%、 46.86%、40.58%。与携带ADH2 1/ 1基因型 者相比,无论是携带ADH2 2/ 2(OR=0.8, 95%CI=0.39～1.64)或ADH2 1/ 2(OR= 1.68,95%CI=0.86～3.32)基因型者,患肝癌的危 险性均无明显增加。2)携带ADH2 1/ 2或 ADH2 2/ 2基因型饮酒者与携带ADH2 1/ 1基因型的不饮者相比,患肝癌的风险差异 无统计学意义(OR=0.997,95%CI=0.296～ 3.354)。3)在调整了年龄、性别、HBsAg、肝硬化和 血吸虫病因素后,结合饮酒习惯将前者与后者相 比,若开始饮酒年龄<25岁、饮酒量>3kg/月、饮 酒年数>23年和饮酒总量(千克年)>3时,前者 患肝癌的危险性分别是后者的1.88(95%CI=0.53 ～6.70)、1.35(95%CI