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BACKGROUND: Concurrent chemoradiotherapy (CCRT) is the standard treatment for locally advanced esophageal squamous cell carcinoma (ESCC). However, the optimal radiotherapy regimen, particularly in terms of total dose and planned range of irradiation field, remains unclear. This phase III clinical trial aimed to compare the survival benefits between different radiation doses and different target fields. METHODS: This trial compared two aspects of radiation treatment, total dose and field, using a two-by-two factorial design. The high-dose (HD) group received 59.4 Gy radiation, and the standard-dose (SD) group received 50.4 Gy. The involved field irradiation (IFI) group and elective nodal irradiation (ENI) group adopted different irradiation ranges. The participants were assigned to one of the four groups (HD+ENI, HD+IFI, SD+ENI and SD+IFI). The primary endpoint was overall survival (OS), and the secondary endpoints included progression-free survival (PFS). The synergy indexwas used to measure the interaction effect between dose and field. RESULTS: The interaction analysis did not reveal significant synergistic effects between the dose and irradiation field. In comparison to the target field, patients in IFI or ENI showed similar OS (hazard ratio [HR] = 0.99, 95% CI: 0.80-1.23, p = 0.930) and PFS (HR = 1.02, 95% CI: 0.82-1.25). The HD treatment did not show significantly prolonged OS compared with SD (HR = 0.90, 95% CI: 0.72-1.11, p = 0.318), but it suggested improved PFS (25.2 months to 18.0 months). Among the four groups, the HD+IFI group presented the best survival, while the SD+IFI group had the worst prognosis. No significant difference in the occurrence of severe adverse events was found in dose or field comparisons. CONCLUSIONS: IFI demonstrated similar treatment efficacy to ENI in CCRT of ESCC. The HD demonstrated improved PFS, but did not significantly improve OS. The dose escalation based on IFI (HD+IFI) showed better therapeutic efficacy than the current recommendation (SD+ENI) and is worth further validation.
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BACKGROUND: Peritoneal dialysis (PD) is a widely-used renal replacement therapy while low ultrafiltration volume usually results in technique failure. Retroperitoneal leakage has been reported to be one of the causes of acquired decline in ultrafiltration. The present study investigated retroperitoneal leakage in PD patients and explored related risk factors. METHODS: This study was designed as a prospective, observational study. A total of 420 PD patients regularly followed up at our center were enrolled from May 2011 to July 2021 and followed until December 2021. Retroperitoneal leakage was determined by magnetic resonance peritoneography and was used as the endpoint. Patients with retroperitoneal leakage were given intermittent PD or temporary hemodialysis (HD) as therapy. Cox regression models were used to identify risk factors for retroperitoneal leakage. RESULTS: The cohort was followed up for up to 125.0 months (median: 46.4 months; interquartile range: 16.6 months). During the follow-up, 68 patients developed retroperitoneal leakage, with 31 (45.6%) cases occurring within the first year after PD initiation. A total of 62 (91.2%) patients recovered from retroperitoneal leakage and resumed their original PD regimen. Multivariate Cox regression analysis revealed that age and gender were independent predictors for retroperitoneal leakage. Younger males were more likely to develop retroperitoneal leakage. In females, waistline and body mass index (BMI) were found to be risk factors for retroperitoneal leakage. CONCLUSIONS: Retroperitoneal leakage was common in PD patients with ultrafiltration insufficiency and was usually reversible after appropriate treatment. Age and gender were independent risk factors for retroperitoneal leakage.
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As a central component for anion exchange membrane fuel cells (AEMFCs), the anion exchange membrane is now facing the challenge of further improving its conductivity and alkali stability. Herein, a twisted all-carbon backbone is designed by introducing stereo-contorted units with piperidinium groups dangled at the twisted sites. The rigid and twisted backbone improves the conduction of hydroxide and brings down the squeezing effect of the backbone on piperidine rings. Accordingly, an anion exchange membrane prepared through this method exhibits adapted OH- conductivity, low swelling ratio and excellent alkali stability, even in high alkali concentrations. Further, a fuel cell assembled with a such-prepared membrane can reach a power density of 904.2 mW/cm2 and be capable of continuous operation for over 50 h. These results demonstrate that the designed membrane has good potential for applications in AEMFCs.
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While Ru owns superior catalytic activity toward hydrogen oxidation reaction and cost advantages, the catalyst deactivation under high anodic potential range severely limits its potential to replace the Pt benchmark catalyst. Unveiling the deactivation mechanism of Ru and correspondingly developing protection strategies remain a great challenge. Herein, we develop atomic Pt-functioned Ru nanoparticles with excellent anti-deactivation feature and meanwhile employ advanced operando characterization tools to probe the underlying roles of Pt in the anti-deactivation. Our studies reveal the introduced Pt single atoms effectively prevent Ru from oxidative passivation and consequently preserve the interfacial water network for the critical H* oxidative release during catalysis. Clearly understanding the deactivation nature of Ru and Pt-induced anti-deactivation under atomic levels could provide valuable insights for rationally designing stable Ru-based catalysts for hydrogen oxidation reaction and beyond.
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This study systematically explores the impact of the anodic flow field design on the transport of O2 bubble and subsequent energy efficiency in electrolysis devices. Two distinct configurations, namely a conventional serpentine flow panel and an interdigitated flow panel, are integrated at the anode side of the electrolyzer. The interdigitated flow field exhibits superior performance in both alkaline water splitting and CO2 reduction despite the experience of an increased pressure drop. Numerical simulations reveal that the enhanced convective flow of the O2 bubbles induced by a forced anolyte flow through the porous electrode within the interdigitated panel design resulted in a 3 orders of magnitude increase in the level of the O2 bubble transport compared to the serpentine configuration. These findings not only underscore the significance of flow field design on bubble management but also provide a basis for advancing the electrolysis efficiency at industrial-level current densities.
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Anion-exchange membranes (AEMs) that can selectively transport OH-, namely, alkaline membranes, are becoming increasingly crucial in a variety of electrochemical energy devices. Understanding the membrane design approaches can help to break through the constraints of undesired performance and lab-scale production. In this Outlook, the research progress of alkaline membranes in terms of backbone structures, synthesis methods, and related applications is organized and discussed. The evaluation of synthesis methods and description of membrane stability enhancement strategies provide valuable insights for structural design. Finally, to accelerate the deployment of relevant technologies in alkaline media, the future priority of alkaline membranes that needs to be addressed is presented from the perspective of science and engineering.
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The hemoglobin, albumin, lymphocyte and platelet (HALP) score and the Gustave Roussy immune score (GRImâScore) are prognostic markers in several types of malignant tumors. The prognostic values of HALP score and GRImâScore in concurrent chemoradiotherapy for unresectable esophageal cancer remain unknown. METHODS: We enrolled 150 esophageal squamous cell carcinoma (ESCC) patients who underwent concurrent chemoradiotherapy in our institution between 2013 and 2018. The cutoff values for HALP, and GRImâScore were defined by using receiver's operating characteristic curves. Survival was analyzed with the Kaplan- Meier method, with differences analyzed with the log-rank test. Multivariate Cox proportional-hazards models were used to evaluate the prognostic significance of HALP and GRIm for ESCC. RESULTS: HALP was significantly associated with the Zubrod ECOG WHO performance status, tumor location, and the clinical tumor, node, metastasis stage. Modified GRIm (mGRIm) was only significantly associated with metastasis / recurrence before radiotherapy (χ2 = 6.25). Univariate Cox regression analysis showed that higher mGRIm (HR 1.9 95%CI 1.3-2.9) and lower HALP (HR 2.4 95%CI 1.6-3.7) were all associated with worse OS. Multivariate COX analysis found that higher mGRIm score (HR 1.7 95%CI 1.1-2.6), and lower HALP score (HR 2 95%CI 1.3-3.2) were both independent risk factors of overall survival. The nomogram c-index in inside validation was 0.66. CONCLUSION: Both HALP and mGRIm are independent prognostic factors for patients with unresectable ESCC.
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Neoplasias Esofágicas , Carcinoma de Células Escamosas do Esôfago , Humanos , Carcinoma de Células Escamosas do Esôfago/terapia , Albuminas/metabolismo , Linfócitos/patologia , Prognóstico , Quimiorradioterapia , Hemoglobinas/metabolismo , Estudos RetrospectivosRESUMO
Importance: Double-agent intravenous chemotherapy concurrent with radiotherapy is the standard of care for patients with inoperable esophageal cancer. However, patients tend to tolerate intravenous chemotherapy less well with age and comorbidities. It is essential to find a better treatment modality that improves survival outcomes without reducing the quality of life. Objective: To evaluate the effectiveness of simultaneous integrated boost radiotherapy (SIB-RT) with concurrent and consolidated oral S-1 chemotherapy for patients aged 70 years and older with inoperable esophageal squamous cell carcinoma (ESCC). Design, Setting, and Participants: This multicenter, phase III randomized clinical trial was conducted between March 2017 and April 2020 in 10 centers in China. Patients with inoperable, locally advanced, clinical stage II to IV ESCC were enrolled and randomized to receive SIB-RT concurrent with and followed by oral S-1 chemotherapy (CRTCT group) or SIB-RT alone (RT group). Data analysis was completed on March 22, 2022. Interventions: In both groups, the planning gross tumor volume was administered with radiation dose of 59.92 Gy and the planning target volume was administered with radiation dose of 50.4 Gy, in 28 fractions each. In the CRTCT group, concurrent S-1 was administered on radiotherapy days, and consolidated S-1 was administered at 4 to 8 weeks after SIB-RT. Main Outcomes and Measures: The primary end point was overall survival (OS) of the intent-to-treat population. Secondary end points were progression-free survival (PFS) and toxicity profile. Results: A total of 330 patients (median [IQR] age, 75.5 [72-79] years; 220 [66.7%] male patients) were included, with 146 patients randomized to the RT group and 184 randomized to the CRTCT group. A total of 107 patients (73.3%) in the RT group and 121 patients (67.9%) in the CRTCT group were clinically diagnosed with stage III to IV disease. At the time of analysis of the 330 patients in the intent-to treat-population (March 22, 2022), OS was improved in the CRTCT group compared with the RT group at 1 year (72.2% vs 62.3%) and 3 years (46.2% vs 33.9%; log-rank P = .02). PFS was similarly improved in the CRTCT group compared with the RT group at 1 year (60.8% vs 49.3%) and 3 years (37.3% vs 27.9%; log-rank P = .04). There was no significant difference in the incidence of treatment-related toxic effects higher than grade 3 between the 2 groups. Grade 5 toxic effects occurred in each group, including 1 patient who experienced myelosuppression and 4 patients with pneumonitis in the RT group and 3 patients with pneumonitis and 2 patients with fever in the CRTCT group. Conclusions and Relevance: These findings suggest that oral S-1 chemotherapy administered with SIB-RT should be considered as an alternative treatment option for patients aged 70 years and older with inoperable ESCC, since it improved survival outcomes without additional treatment-related toxic effects compared with SIB-RT alone. Trial Registration: ClinicalTrials.gov Identifier: NCT02979691.
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Neoplasias Esofágicas , Carcinoma de Células Escamosas do Esôfago , Pneumonia , Humanos , Masculino , Idoso , Idoso de 80 Anos ou mais , Feminino , Carcinoma de Células Escamosas do Esôfago/tratamento farmacológico , Neoplasias Esofágicas/tratamento farmacológico , Qualidade de Vida , Quimiorradioterapia/efeitos adversos , Pneumonia/etiologiaRESUMO
Background: Esophageal cancer (EC) is one of the most common cancers worldwide. The prognoses for patients with the same stage of EC can vary substantially. The progress of single-cell analysis technology has furthered the understanding of tumor heterogeneity. This paper aimed to apply single-cell analysis to explore the characteristics of the tumor environment of EC and provide a basis for personalized treatment. Methods: The latest gene expression data and clinical follow-up information of single-cell sequencing results of EC samples were downloaded from The Cancer Genome Atlas (TCGA) Genomic Data Commons (GDC) Application Programming Interface (API). A differential gene function analysis of the immune infiltration signature agents in the tumor microenvironment (TME) was performed using bioinformatics analytical methods, and potential molecular targets were sought. Results: We identified specific cell subsets in the EC and paracancerous samples, including panel cells, natural killer (NK) cells, exhausted cluster of differentiation (CD)8+ T cells, CD8+ memory T (Tcm) cells, and effector memory T (Tem) cells, including B cell enrichment in the cancer samples. Differences were detected between B cells and monocytes in stage II and III tumors, which may be related to RNA transcription and degradation. The CXCL8 protein was identified as a valid potential prognostic marker. Conclusions: Cell groups with homogenous cell surface markers exhibit intercellular variations that exert a considerable effect on cell function. Our study will contribute to the understanding of the TME and cellular heterogeneity in EC patients and serve as a valuable resource for in-depth exploration of the pathogenesis of EC and the identification of potential therapeutic targets in the future.
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The lack of high-performance and substantial supply of anion-exchange membranes is a major obstacle to future deployment of relevant electrochemical energy devices. Here, we select two isomers (m-terphenyl and p-terphenyl) and balance their ratio to prepare anion-exchange membranes with well-connected and uniformly-distributed ultramicropores based on robust chemical structures. The anion-exchange membranes display high ion-conducting, excellent barrier properties, and stability exceeding 8000 h at 80 °C in alkali. The assembled anion-exchange membranes present a desirable combination of performance and durability in several electrochemical energy storage devices: neutral aqueous organic redox flow batteries (energy efficiency of 77.2% at 100 mA cm-2, with negligible permeation of redox-active molecules over 1100 h), water electrolysis (current density of 5.4 A cm-2 at 1.8 V, 90 °C, with durability over 3000 h), and fuel cells (power density of 1.61 W cm-2 under a catalyst loading of 0.2 mg cm-2, with open-circuit voltage durability test over 1000 h). As a demonstration of upscaled production, the anion-exchange membranes achieve roll-to-roll manufacturing with a width greater than 1000 mm.
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Biomimetic ion permselective membranes with ultrahigh ion permeability and selectivity represent a research frontier in ion separation, yet the successful fabrication of such membranes remains a formidable challenge. Here, we demonstrate a 4-sulfocalix[4]arene (4-SCA)-modified graphene oxide (GO) membrane that shows extraordinary performance in separating mono-from multivalent cations, as well as having reversible pH-responsiveness. The resulting 4-SCA-modified GO (SCA-GO) membrane preferentially transports potassium ions (K+) over radionuclide cations (Co2+, UO22+, La3+, Eu3+, and Th4+). The ion selectivities are an order of magnitude higher than that of the unmodified GO membrane. Theoretical calculations and experimental investigations demonstrate that the much-improved ion selectivity arises from the specific recognition between 4-SCA and radionuclide cations. The transport of multivalent radionuclides is impeded by a binding-obstructing mechanism from the host-guest interactions. Interestingly, the host-guest interactions are responsive to the protonation/deprotonation transformation of the 4-SCA. Therefore, the SCA-GO membrane mimics pH-regulated ion selective behavior found in biological ion channels. Our strategy of designing a biomimetic permselective GO membrane may allow efficient nuclear wastewater treatment and, more importantly, deepen our understanding of biomimetic ion transport mechanisms.
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Biomimética , CátionsRESUMO
Career crafting is a new concept in the field of career research in recent years. However, the research on career crafting is still in its infancy, and there are few systematic and integrated studies. In this study, we have collected the existing research and extracted the 12 most related articles from 10 databases (Web of Science, Google Scholar, ProQuest, and EBSCO Host, etc.) by the end of 2022 to discuss the concepts of discrimination, theoretical basis, research methods, and measurement tools and variables of career crafting. As a reference for the follow-up in-depth study, future research should progress forward, such as by deepening and expanding the theoretical basis, testing and developing mature scales, building multilevel influencing factors and testing their interaction, and furthering the research on the mechanism of multi-field effects.
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The McMurry coupling is a facile, gentle and low-cost chemical reaction for synthesizing. Here, for the first time, we employed the McMurry coupling reaction to prepare π-conjugated anion exchange membranes (AEMs). The inter-chain π-π stacking between adjacent benzene rings induces directional self-assembly aggregation and enables highly ordered ion-conductive channels. The resulting structure was characterized through UV/VIS spectrum, X-ray diffraction (XRD) pattern, small-angle X-ray scattering (SAXS), transmission electron microscopy (TEM) and density functional theory (DFT) calculations, leading to high OH- conductivity of 135.5â mS cm-1 at 80 °C. Furthermore, the double bonds in the π-conjugated system also trigger in situ self-crosslinking of the AEMs to enhance dimensional and alkaline stability. Benefiting from this advantage, the as-obtained Cr-QPPV-2.51 AEM exhibits superior alkaline stability (95 % conductivity retention after 3000â hrs in 1â M KOH at 80 °C) and high mechanical strength of 34.8â MPa. Moreover, the fuel cell using Cr-QPPV-2.51 shows a maximum peak power density of 1.27â W cm-2 at 80 °C.
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AIM: Coronary artery calcification (CAC) is a common and severe complication in peritoneal dialysis (PD) patients, and it progresses in a majority of patients. Fetuin-A, encoded by the alpha 2-Heremans-Schmid glycoprotein (AHSG) gene, is a serum calcification inhibitor. The study aimed to examine the role of AHSG gene polymorphism rs4918 in CAC and CAC progression of PD patients. METHODS: Incident PD patients at Huashan Hospital Fudan University in China from August 2007 to July 2018 were recruited in this prospective study and followed up for 2 years. Patients underwent CAC measurements at recruitment and 2 years later. AHSG gene polymorphism rs4918 and serum fetuin-A were determined at baseline. The demographic characteristics, clinical data, and laboratory data were collected during the follow-up period. Binary logistic regression was performed to explore the association between rs4918 with CAC and CAC progression. RESULTS: A total of 202 PD patients (112 men, 55.4%) were recruited, with a mean age of 54 ± 16 years. The multivariate logistic regression identified genotype GG as an independent risk factor that correlates to CAC (odds ratio [OR] = 2.153; 95% CI: 1.182-3.925; p = .012) and CAC progression (OR = 2.482; 95% CI: 1.422-4.330; p = .001). The serum fetuin-A level was influenced by the rs4918 variants of AHSG, with a dose-dependent effect depending on the number of the G allele. CONCLUSION: AHSG gene polymorphism rs4918 affects serum fetuin-A levels and is significantly associated with both CAC and CAC progression in a cohort of patients receiving PD.
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Doença da Artéria Coronariana , Diálise Peritoneal , alfa-2-Glicoproteína-HS , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , alfa-2-Glicoproteína-HS/genética , Doença da Artéria Coronariana/genética , Diálise Peritoneal/efeitos adversos , Polimorfismo de Nucleotídeo Único , Estudos Prospectivos , FemininoRESUMO
Objectives: To investigate the health-related quality of life (HRQL) of long-term survivors of inoperable esophageal squamous cell carcinoma (ESCC) treated with definitive radiation therapy, the real-world trends in the use of advanced radiation techniques, and their impact on the survival outcomes of ESCC patients. Methods: In this multicenter retrospective observational study, the medical records related to demographics and treatment of ESCC patients who were treated with definitive radiation therapy at 14 provincial hospitals in China from 1 January 2015 to 31 December 2016 were analyzed. A HRQL questionnaire was completed by survivors and collected by doctors at the final follow-up. The difference in quality of life between patients with or without recurrence was compared using the Wilcoxon-Mann-Whitney test. Overall survival (OS) was estimated using the Kaplan-Meier method and the group differences were assessed by unstratified log-rank test. The Cox proportional hazards model with Efron's method of tie handling was used to calculate the risk factors for OS. Results: The data of a total of 3,308 patients were collected for this study, 248 were excluded because of missing data, and a final of 3,060 patients were included in the analysis. Most patients (2,901; 94.8%) received intensity-modulated radiotherapy (IMRT)/volumetric-modulated arc therapy (VMAT)/tomotherapy (TOMO). The 5-year OS rate was 30%. Patients who received either two-dimensional radiotherapy (2DRT; HR, 2.43 [95% CI, 1.70-3.47]; P < 0.001) or three-dimensional radiotherapy (3DRT; HR, 1.45 [95% CI, 1.14-1.84]; P = 0.003) had a significantly increased risk of death compared to those who received IMRT/VMAT/TOMO. Of the 716 (23.4%) long-term survivors who completed the HRQL questionnaire, nearly 70% patients were still able to swallow normally or almost normally, and >80% patients did not experience weight loss. Nearly 80% patients found life very enjoyable or were fairly enjoying life. Conclusions: This large, multicenter retrospective study on ESCC patients who received definitive radiation therapy found that most ESCC survivors are satisfied with their quality of life. Most patients received advanced radiation technology. Patients who received either 2DRT or 3DRT had a significantly increased risk of death compared to those who received advanced radiation technology.
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BACKGROUND AND AIM: Plasma fibrinogen has been proven to be significantly associated with cardiovascular mortality in patients undergoing peritoneal dialysis (PD). The study aimed to investigate the role of fibrinogen in left ventricular (LV) remodeling and functions in patients on PD, and explore risk factors related to high fibrinogen level. METHODS: From February 2008 to July 2018, adult patients on regular PD for at least 1 month were recruited and followed up for two years. Correlation analysis was performed to explore the fibrinogen level and echocardiography measurements. Pathogenic factors correlated to the left ventricular hypertrophy (LVH) progression were explored by logistic regression models and the role of fibrinogen in it was verified by receiver operating characteristic (ROC) curves. Linear regression models were conducted to identify factors associated with fibrinogen level. RESULTS: A total of 278 patients undergoing PD (168 males, 60.4%) were recruited. Patients were trisected according to fibrinogen levels at baseline. Mean wall thickness (MWT), relative wall thickness (RWT), and left ventricular mass index (LVMI) were positively associated with fibrinogen level while E/A ratio was negatively associated with it. Multivariate logistic regression and ROC curve showed that fibrinogen was an independent risk factor for LVH progression. Multivariate linear regression analysis identified age, total cholesterol (CHO), fasting blood glucose (FBG), and high-sensitivity C-reactive protein (hsCRP) were significantly related to plasma fibrinogen level. CONCLUSIONS: An elevated fibrinogen level was independently associated with LVH progression in patients undergoing PD. Older age, higher level of FBG, CHO, and hsCRP were risk factors for elevated plasma fibrinogen level.
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Fibrinogênio , Diálise Peritoneal , Masculino , Adulto , Humanos , Proteína C-Reativa , Remodelação Ventricular , Diálise Peritoneal/efeitos adversos , Fatores de Risco , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/etiologiaRESUMO
Anion exchange membranes (AEMs) with desirable properties are the crucial components for numerous energy devices such as AEM fuel cells (AEMFCs), AEM water electrolyzers (AEMWEs), etc. However, the lack of suitable AEMs severely limits the performance of devices. Here, a series of physically and chemically stable AEMs have been prepared by the reaction between the alkyl bromine terminal ether-bond-free aryl backbone and the urea group-containing crosslinker. Morphology analyses confirm that the hydrogen bonding interaction between urea groups is capable of driving the ammonium cations to aggregate and further form continuous ion-conducting channels. Therefore, the resultant AEM demonstrates remarkable OH− conductivity (59.1 mS cm−1 at 30 °C and 122.9 mS cm−1 at 90 °C) despite a moderate IEC (1.77 mmol g−1). Simultaneously, due to the adoption of ether-bond-free aryl backbone and alkylene chain-modified trimethylammonium cation, the AEM possesses excellent alkaline stability (87.3% IEC retention after soaking in 1 M NaOH for 1080 h). Moreover, the prepared AEM shows desirable mechanical properties (tensile stress > 25 MPa) and dimensional stability (SR = 20.3% at 90 °C) contributed by the covalent-bond and hydrogen-bond crosslinking network structures. Moreover, the resulting AEM reaches a peak power density of 555 mW cm−2 in an alkaline H2/O2 single fuel cell at 70 °C without back pressure. This rational structural design presented here provides inspiration for the development of high-performance AEMs, which are crucial for membrane technologies.
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Concurrent chemoradiotherapy (CRT) is regarded as the standard treatment for inoperable esophageal cancers (EC). It is still controversial whether consolidation chemotherapy (CCT) or induction chemotherapy (IC) is beneficial for the patients who received CRT. Therefore, we carried out a retrospective analysis at our institution. A total of 186 inoperable EC patients from 20 October 2017 to 7 June 2021 who have previously received CRT were included in our study. The patients were divided into IC + CRT (n = 52), CCRT (n = 64), and CRT + CCT (n = 70) groups according to whether they received induction chemotherapy, consolidation chemotherapy, or not. We used Kaplan−Meier statistics to analyze their 1-, 2-, and 3-year OS. The median follow-up time for the whole group was 14.15 months. The 1-, 2-, 3- year overall survival (OS) for the CCRT group were 72.2%, 52.5%, and 29.5%, and 50.9%, 37.5%, and 25% for the IC + CRT group (p > 0.05). For the CRT + CCT group,1-, 2-, and 3-year OS were 89.8%, 59.0%, and 42.5% (p < 0.05). Adverse reactions in the three groups were mainly graded 0−3. The difference between the three groups was not statistically significant (p > 0.05). For non-surgical EC patients who received CRT, CCT after CRT but not IC before CRT can improve 1-, 2-, and 3-year OS with a low incidence of associated severe adverse effects. As a result, the addition of consolidation chemotherapy to chemoradiotherapy has significant prognostic advantages for inoperable EC patients.
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Quimioterapia de Consolidação , Neoplasias Esofágicas , Quimiorradioterapia , Neoplasias Esofágicas/tratamento farmacológico , Humanos , Quimioterapia de Indução , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
BACKGROUND: Radiation-induced bystander effect (RIBE) can promote tumor metastasis contributing to the failure of radiotherapy for esophageal squamous cell carcinoma (ESCC). Aberrant expression of DJ-1 has been identified in ESCC; however, the relationship between DJ-1 and RIBE in ESCC remains unknown. METHODS: We detected DJ-1 in the serum and cell supernatants by enzyme-linked immunosorbent assay (ELISA) and evaluated tumor metastasis by phenotypic experiments in vivo and in vitro. RNA-seq, mass spectrometry, western blot (WB), immunoprecipitation (IP), and dual-luciferase reporter assays were performed to explore the underlying mechanisms. RESULTS: DJ-1 was highly expressed in the serum of patients with ESCC receiving radiotherapy and was significantly overexpressed in the medium of ESCC cells receiving irradiation. DJ-1 promoted tumor metastasis via the TGF-ß1 pathway. Mechanistic studies revealed that DJ-1 bound to HSC70 to promote Smad3 phosphorylation and nuclear aggregation in a protein-interaction manner, which activated the transcription of Thrombospondin-1 (TSP1). Subsequently, the activation of TGF-ß1 by TSP1 re-promoted Smad3 phosphorylation and nuclear aggregation, constituting a positive feedback loop to strengthen the metastasis of ESCC cells, which was effectively blocked by LY2109761 and LSKL. Moreover, higher levels of serum DJ-1 in patients with ESCC were related to a poorer prognosis of radiotherapy. CONCLUSIONS: Irradiation can induce ESCC cells secreting DJ-1. Secreted DJ-1 enters bystander cells to initiate activation of the TGF-ß1 pathway via the DJ-1/HSC70/Smad3 signaling axis. The TSP1/TGF-ß1/Smad3 positive feedback pathway constitutes the core pathway that promotes ESCC metastasis. DJ-1 is a useful biomarker for predicting the efficacy of radiotherapy and a potential therapeutic target for reversing RIBE in ESCC. Schematic diagram showing the underlying mechanism that irradiation-induced secretion of DJ-1 accelerates the metastasis of bystander ESCC cells.