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Objective:To investigate the prognostic value of Onodera's prognostic nutrition index (PNI) before treatment in patients with cervical and upper thoracic esophageal squamous cell carcinoma (CUTESCC) undergoing definitive chemoradiotherapy (dCRT) and its predictive value in the occurrence of ≥ grade 2 radiation esophagitis (RE).Methods:The data of 163 CUTESCC patients eligible for inclusion criteria admitted to the Fourth Hospital of Hebei Medical University from January 2012 to December 2017 were retrospectively analyzed. The receiver operating characteristic (ROC) curve was used to calculate the best cut-off value of PNI for predicting the prognosis of patients. The prognosis of patients was analyzed by univariate and Cox multivariate analyses. Logistics binary regression model was adopted to analyze the risk factors of ≥ grade 2 RE in univariate and multivariate analyses. The significant factors in logistic multivariate analysis were used to construct nomogram for predicting ≥ grade 2 RE.Results:The optimal cut-off value of PNI was 48.57 [area under the curve (AUC): 0.653, P<0.001]. The median overall survival (OS) and progression-free survival (PFS) were 26.1 and 19.4 months, respectively. The OS ( χ2=6.900, P=0.009) and PFS ( χ2=9.902, P=0.003) of patients in the PNI ≥ 48.57 group ( n=47) were significantly better than those in the PNI < 48.57 group ( n=116). Cox multivariate analysis showed that cTNM stage and PNI were the independent predictors of OS ( HR=1.513, 95% CI: 1.193-1.920, P=0.001; HR=1.807, 95% CI: 1.164-2.807, P=0.008) and PFS ( HR=1.595, 95% CI: 1.247-2.039, P<0.001; HR=2.260, 95% CI: 1.439-3.550, P<0.001). Short-term efficacy was another independent index affecting PFS ( HR=2.072, 95% CI: 1.072-4.003, P=0.030). Logistic multivariate analysis showed that the maximum transverse diameter of the lesion ( OR=3.026, 95% CI: 1.266-7.229, P=0.013), gross tumor volume (GTV) ( OR=3.456, 95% CI: 1.373-8.699, P=0.008), prescription dose ( OR=3.124, 95% CI: 1.346-7.246, P=0.009) and PNI ( OR=2.072, 95% CI: 1.072-4.003, P=0.030) were the independent factors affecting the occurrence of ≥ grade 2 RE. These four indicators were included in the nomogram model, and ROC curve analysis showed that the model could properly predict the occurrence of ≥ grade 2 RE (AUC=0.686, 95% CI: 0.585-0.787). The calibration curve indicated that the actually observed values were in good agreement with the predicted RE. Decision curve analysis (DCA) demonstrated satisfactory nomogram positive net returns in most threshold probabilities. Conclusions:PNI before treatment is an independent prognostic factor for patients with CUTESCC who received definitive chemoradiotherapy. The maximum transverse diameter of the lesion, GTV, prescription dose and PNI are the risk factors for ≥ grade 2 RE in this cohort. Establishing a prediction model including these factors has greater predictive value.
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Objective To analyze the failure patterns and prognostic factors of radical surgery in patients with T1-4N0-1M0 thoracic esophageal squamous cell carcinoma (TESCC),and the implications for the target area design of postoperative therapy.Methods We retrospectively analyzed 1 191 patients with TESCC who underwent radical surgery at our institution.The failure patterns,the prognostic factors,as well as the effects of lesion locations and N stage on the failure patterns were analyzed.Results The thoracic-region recurrence rate and the distant metastasis rate was 31.7％ and 16.4％ in all patients.The multivariate analysis showed that the lesion locations,the degree of inflammatory adhesion,T staging,N staging and the rate of lymph nodes metastasis were independent factors affecting the regional recurrence (P ＜ 0.05).Gender,tumor differentiation and the rate of lymph nodes metastasis were independent factors affecting distant metastasis (P ＜ 0.05).The intrathoracic lymph nodes recurrence rate of upper/middle TESCC was significantly higher than that of the lower TESCC (x2 =6.179,P =0.046),while the abdomen lymph nodes recurrence rate of the lower was significantly higher than that of upper/middle TESCC (x2 =15.853,P ＜ 0.05).The recurrence rate and distant metastasis rate of stage N1 patients were significantly higher than that of N0 patients (x2 =7.764-56.495,P ＜ 0.05).The abdomen lymph nodes recurrence rate of stage N1 patients was significantly higher than that of N0 in upper TESCC (x2 =7.905,P ＜0.05).The supraclavicular and intrathoracic lymph nodes recurrence rates of stage N1 patients were significantly higher than that of N0 patients in middle TESCC (x2 =12.506,18.436,P ＜ 0.05).The supraclavicular lymph nodes,anastomosis and abdomen lymph node recurrence rates of stage N1 were significantly higher than that of N0 patients in lower TESCC (x5 =5.272,4.878,18.006,P ＜ 0.05).The anastomotic recurrence rate of stage T3+4 was higher than that of T1+2 in middle/lower TESCC (x2 =4.341,7.154,P ＜ 0.05),and the abdominal lymph nodes recurrence rate of stage T3 +4 was higher than that of T1 +2 in lower TESCC (x2 =5.366,P ＜ 0.05).Conclusions The lymphatic drainage regions for postoperative radiotherapy (PORT) are selective.We suggest that abdominal lymph nodes drainage area should be noted for the stage N1 patients with upper TESCC,and the supraclavicular lymph nodes drainage area should be noted for the N1 patients with lower TESCC.In addition,the anastomosis is suggested to be included in PORT target area for stage T3/T4 middle/lower TESCC patients.
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Objective: To investigate the effect of zinc supplementation on expression of MT-1 and MT-2 mRNA in placenta and small intestine of pregnant rats. Method: Eighteen healthy pregnant SD rats were randomly divided into two groups,normal control (ZC) and zinc supplement group (ZS). Rats in both groups were fed the same normal diet. Rats in ZC group drank deionized water and those in ZS group drank the water supplemented with 1.26 mmol/L Zn. At gestational 9.5d and 17.5d, serum zinc was determined by atomic absorption spectrophotometer and the expression of MT-1 and MT-2 mRNA of placenta and small intestine was examined by RT-PCR. Results: Serum zinc levels at gestational 9.5d and 17.5d were higher in ZS group. Relative expression of both MT-1 and MT-2 mRNA in placenta, MT-1 mRNA at gestational 17.5d and MT-2 mRNA at each time point were higher in ZS group. At gestational 9.5d, there was no difference between two groups in expression of MT-1 mRNA. Conclusion: The expression of MT-1 and MT-2 mRNA in placenta and small intestine was up-regulated by dietary zinc supplementation during pregnancy.
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Objective:To investigate the effect of zinc supplementation on the expression profile of zinc transporters mRNA in placenta and small intestine of pregnant rats.Method:Eighteen pregnant SD rats were randomly divided into normal control(ZC)and zinc supplement group(ZS).Rats in ZC group drank deionized distilled water while those in ZS group drank water supplemented with zinc of 1.26 mmol/L.Placenta and small intestine were taken at gestational day 9.5 and 17.5,respectively.The expression of ZnT1,2,5 and 6 mRNA was examined by RT-PCR.Results:At gestational D9.5,the expression of placental ZnT1,2 and small intestinal ZnT1,2,6 mRNA was up-regulated,and placental ZnT5 mRNA down-regulated by dietary zinc supplementation.Dietary zinc intake had no effect on the expression of placental ZnT6 and small intestinal ZT5 mRNA.At gestational D17.5,the expression of placental ZnT5 and 6 mRNA was up-regulated by dietary zinc supplementation,and dietary zinc had no effect on the expression of placental and small intestinal ZnT1,2 mRNA.The expression of ZnT5 mRNA at gestational D17.5 in both groups was not detectable.Conclusion:Dietary zinc supplementation during pregnancy has significant effect on the expression profile of ZnT 1,2,5 and 6mRNA in placenta and small intestine of pregnant rats.