[The clinical features, survival analysis, and geriatric assessment of 85 patients with follicular lymphoma: a single-center study].

Objective: To retrospectively analyze the clinical characteristics and prognosis of 85 newly diagnosed patients with follicular lymphoma (FL), as well as the prognostic value of comprehensive geriatric assessment (CGA) in patients with FL aged ≥ 60 years old. Methods: The clinical data and prognosis of 85 newly diagnosed FL patients admitted from August 2011 to June 2022 were collected. The clinical features, laboratory indicators, therapeutic efficacy, survival and prognostic factors of patients were statistically analyzed, and the prognosis of patients was stratified using various geriatric assessment tools. Results: ① The patients with FL were mostly middle-aged and older, with a median age of 59 (20-87) years, including 41 patients (48.2%) aged ≥60 years. The ratio of male to female was 1∶1.36. Overall, 77.6% of the patients were diagnosed with Ann Arbor stage Ⅲ-Ⅳ, and 17 cases (20.0%) were accompanied by B symptoms. Bone marrow involvement was the most common (34.1%). ②Overall, 71 patients received immunochemotherapy. The overall response rate was 86.6%, and the complete recovery rate was 47.1% of 68 evaluated patients. Disease progression or relapse in the first 2 years was observed in 23.9% of the patient. Overall, 14.1% of the patients died during follow-up. ③Of the 56 patients receiving R-CHOP-like therapies, the 3-year and 5-year progression-free survival (PFS) rates were 85.2% and 72.8%, respectively, and the 3-year and 5-year overall survival (OS) rates were 95.9% and 88.8%, respectively. The univariate analysis showed that age ≥60 years old (HR=3.430, 95% CI 1.256-9.371, P=0.016), B symptoms (HR=5.030, 95% CI 1.903-13.294, P=0.016), Prognostic Nutritional Index (PNI) <45.25 (HR=3.478, 95% CI 1.299-9.310, P=0.013), Follicular Lymphoma International Prognostic Index (FLIPI) high-risk (HR=2.918, 95% CI 1.074-7.928, P=0.036), and PRIMA-prognostic index (PRIMA-PI) high-risk (HR=2.745, 95% CI 1.057-7.129, P=0.038) significantly predicted PFS. Moreover, age ≥60 years old and B symptoms were independent risk factors for PFS. Progression of disease within 24 months (POD24) significantly predicted OS in the univariate analysis. Conclusions: FL is more common among middle-aged and older women. Age, B symptoms, PNI score, FLIPI high-risk, PRIMA-PI high-risk, and POD24 influenced PFS and OS. The CGA can be used for treatment selection and risk prognostication in older patients with FL.

[Surgical treatment and prognosis analysis of hilar cholangiocarcinoma].

Objective: To investigate the surgical treatment effect and prognostic factors of hilar cholangiocarcinoma. Methods: This is an ambispective cohort study. From August 2005 to December 2022,data of 510 patients who diagnosed with hilar cholangiocarcinoma and underwent surgical resection at the Hepatobiliary Center of the First Affiliated Hospital of Nanjing Medical University were retrospectively collected. In the cohort,there were 324 males and 186 females,with an age of (M (IQR)) 63(13)years (range:25 to 85 years). The liver function at admission was Child-Pugh A (343 cases,67.3%) and Child-Pugh B (167 cases,32.7%). Three hundred and seventy-two(72.9%) patients had jaundice symptoms and the median total bilirubin was 126.3(197.6) µmol/L(range: 5.4 to 722.8 µmol/L) at admission. Two hundred and fourty-seven cases (48.4%) were treated with percutaneous transhepatic cholangial drainage or endoscopic nasobiliary drainage before operation. The median bilirubin level in the drainage group decreased from 186.4 µmol/L to 85.5 µmol/L before operation. Multivariate Logistic regression was used to identify the influencing factors for R0 resection,and Cox regression was used to construct multivariate prediction models for overall survival(OS) and disease-free survival(DFS). Results: Among 510 patients who underwent surgical resection,Bismuth-Corlett type Ⅲ-Ⅳ patients accounted for 71.8%,among which 86.1% (315/366) underwent hemi-hepatectomy,while 81.9% (118/144) underwent extrahepatic biliary duct resection alone in Bismuch-Corlett type Ⅰ-Ⅱ patients. The median OS time was 22.8 months, and the OS rates at 1-,3-,5-and 10-year were 72.2%,35.6%,24.8% and 11.0%,respectively. The median DFS time was 15.2 months,and the DFS rates was 66.0%,32.4%,20.9% and 11.0%,respectively. The R0 resection rate was 64.5% (329/510), and the OS rates of patients with R0 resection at 1-,3-,5-and 10-year were 82.5%, 48.6%, 34.4%, 15.2%,respectively. The morbidity of Clavien-Dindo grade Ⅲ-Ⅴ complications was 26.1%(133/510) and the 30-day mortality was 4.3% (22/510). Multivariate Logistic regression indicated that Bismuth-Corlett type Ⅰ-Ⅲ (P=0.009), hemi-hepatectomy and extended resection (P=0.001),T1 and T2 patients without vascular invasion (T2 vs. T1:OR=1.43 (0.61-3.35),P=0.413;T3 vs. T1:OR=2.57 (1.03-6.41), P=0.010;T4 vs. T1, OR=3.77 (1.37-10.38), P<0.01) were more likely to obtain R0 resection. Preoperative bilirubin,Child-Pugh grade,tumor size,surgical margin,T stage,N stage,nerve infiltration and Edmondson grade were independent prognostic factors for OS and DFS of hilar cholangiocarcinoma patients without distant metastasis. Conclusions: Radical surgical resection is necessary to prolong the long-term survival of hilar cholangiocarcinoma patients. Hemi-hepatectomy and extended resection,regional lymph node dissection and combined vascular resection if necessary,can improve R0 resection rate.

[The prognostic effects of two comprehensive geriatric assessment methods in elderly patients with acute myeloid leukemia].

Objective: To evaluate the prognostic effects of two comprehensive geriatric assessment (CGA) methods in elderly patients with acute myeloid leukemia (AML). Methods: Ninety-seven patients with newly diagnosed AML at Beijing Hospital from August 2008 to December 2019 were included (≥60 years old). All patients were evaluated by two methods of CGA. One was IACA index proposed by Beijing Hospital, including instrumental activities of daily living (IADL), age, Charlson comorbidity index (CCI), albumin; the other was proposed by Italian FIL study group (FIL-CGA), including activities of daily living (ADL), IADL, age, and modified cumulative illness rating score for geriatrics (MCIRS-G). Results: Among 97 patients, 54 patients received standard chemotherapy, 16 with decitabine, 2 with targeted therapy and 25 with the best supportive therapy. The overall response rate (ORR) in 72 treated patients were 67.7%, 33.3% and 0 respectively in fit, unfit and frail groups according to IACA index (P=0.001). Based on FIL-CGA, the ORRs of fit, unfit and frail groups were 52.5%, 41.7% and 35.0% respectively (P=0.418). The 1-year OS rates of fit, unfit and frail groups regarding IACA method were 78.7%, 27.7% and 0 respectively (P<0.01). The 1-year OS rates of fit, unfit and frail groups regarding FIL-CGA method were 67.8%, 28.2% and 13.9% respectively (P<0.01), while no significant difference was seen between unfit group and frail group (P=0.111). The early death rates of fit, unfit and frail groups by IACA were 0, 6.0% and 28.6% respectively (P=0.006), while those by FIL-CGA were 2.3%, 5.9%, 13.9% respectively (P=0.123). Conclusion: Compared with FIL-CGA method, IACA predicts more effectively the treatment response, survival and early mortality in elderly patients with AML.

[The prognosis value of comprehensive geriatric assessment in elder patients with acute myeloid leukemia in a single center].

Objective: To evaluate the prognostic significance of comprehensive geriatric assessment (CGA) in Chinese elderly acute myeloid leukemia (AML) patients. Methods: 73 AML patients over the age of 60 were enrolled. CGA stratification included the following 3 instrument assessment: activity of daily living (ADL) ; instrumental activity of daily living (IADL) ; comorbidity score according to the Modified cumulative illness rating score for geriatrics (MCIRS-G) . According to CGA and age, the enrolled patients were grouped into 'fit', 'unfit' and 'frail' categories. Results: The median age of 73 elderly AML patients were 75 years old. According to CGA, 37 (50.1%) patients were classified as 'fit', 14 (19.2%) as 'unfit', and 22 (30.7%) as 'frail'. 33 (89.2%) patients in fit group received induction chemotherapy, or demethylation treatment, as 8 (57.9%) in unfit, 10 (45.5%) in frail. The overall response rate was 68.7%、62.5%, 75.0% in fit, unfit, and frail group, respectively (χ(2)=0.615, P=0.769) .The early mortality (8 weeks) in three groups were different: 5.4%, 7.1%, 27.3%, respectively (P<0.05) . The 1-year overall survival in the 'fit', 'unfit' and 'frail' groups was 64.9%, 28.6% and 22.7%, respectively (P<0.05) . The CGA score, age, ECOG score, WHO classification (2016) were the prognostic factors of AML patients. Conclusion: CGA can be used to determine the prognosis of elderly AML patients.

[A comparative study of comprehensive geriatric assessment in elder patients with non-Hodgkin's lymphoma].

Objective: To measure the comprehensive geriatric assessment (CGA) in elder non-Hodgkin's Lymphoma (NHL) patients in a cross-sectional study; to compare the differences between Eastern Cooperative Oncology Group (ECOG)-performance status (PS) and CGA. Methods: CGA stratification included the following 3 instrument assessments: activity of daily living (ADL);instrumental activity of daily living (IADL);comorbidity score according to the modified cumulative illness rating score for geriatrics (MCIRS-G). According to CGA and age, NHL patients, aged ≥60 years, were classified as"fit","unfit"and"frail"groups. ECOG-PS was evaluated and compared with CGA. Results: According to CGA, 51.6% senior NHL patients (33 cases) were classified as"fit", 12.5%(8 cases) as"unfit"and 35.9%(23 cases) as"frail". Several comorbidities were observed in majority patients, such as cardiovascular disease, diabetes mellitus and hypertension. In the"younger aged"patients between 60 to 64ys, 25%(3/12) was considered as"frail". However, this proportion increased to 42.9%(6/14) in patients older than 80ys. Moreover, impaired CGA was observed in 38.9%(21/54) of ECOG-PS ≤1 patient. Conclusions: Impaired CGA is as common as approximately half in elderly NHL patients and more than one third even in ECOG-PS ≤1 patients. ECOG-PS may underestimate the impaired fitness function in elder NHL patients.

Recent advances in thermal treatment techniques and thermally induced immune responses against cancer.

In the past decades, techniques for tumor diagnosis and treatment have been significantly advanced. However, the five-year survival rate of cancer patients remains low. New modalities are highly desirable based on technology innovation and translational medicine. In this paper, recent outcomes of thermal ablation techniques are reviewed, including thermal energy delivery methods, thermally induced immune responses in depth. It is suggested that the synergy of local thermal ablation and thermally induced whole body immune response could be a promising direction for effective cancer therapy in the near future, especially for highly metastatic tumor.

A convenient route to synthesize the fully conjugated bimetallic complex (Bu4N)2[tto[Ni(dmit)2]] (tto = tetrathiooxalate, C2S4(2-), and dmit = 1,3-dithiole-2-thione-4,5-dithiolate, C3S5(2-) and the crystal structure of a new crystal form.

A novel route for the conversion of (Bu4N)2[Ni(dmit)2] to (Bu4N)2[tto[Ni(dmit)2]] is reported here. This provides a much more efficient way of synthesizing (Bu4N)2[tto[Ni(dmit)2]] than the literature method. During the process, the conversion of dmit2- to tto2- was realized for the first time. This new synthesis should facilitate further research on the conducting bimetallic complexes [C]x[tto[Ni(dmit)2]]. In addition, a new crystal form of (Bu4N)2[tto[Ni(dmit)2]]. In addition, a new crystal form of (Bu4N)2[tto[Ni(dmit)2]] was determined by X-ray crystallographic analysis.

Molecular cytogenetic alterations in the early stage at human bronchial epithelial cell carcinogenesis.

Lung carcinogenesis is a multi-step process involving activation of oncogenes and inactivation of tumor suppress genes. Many molecular and cytogenetic alterations occur in the early stages of carcinogenesis. We have developed an effective culture system for human bronchial epithelial cells and lung cancer cells. Four immortalized human bronchial epithelial cell lines were established by transfecting the epithelial cells with plasmid DNA containing the early region of SV40. Some molecular and cytogenetic alterations, such as 3p-, 2q-, 9p-, c-myc translocation t(8;14) (q23; q32), were found in one immortalized bronchial epithelial cell line M when approaching malignant transformation. An increase in cell proliferation and decrease of apoptosis were noted in the late passages of the immortalized cell line M. Some molecular cytogenetic alterations were also observed in human primary non-small cell lung cancers. Molecular cytogenetic alterations during the early stage of carcinogenesis of human bronchial epithelial cells may be useful as biomarkers for both diagnosis and intermediate endpoint of chemoprevention of lung cancer.