A Radiosensitivity Prediction Model Developed Based on Weighted Correlation Network Analysis of Hypoxia Genes for Lower-Grade Glioma.

Background and Purpose: Hypoxia is one of the basic characteristics of the physical microenvironment of solid tumors. The relationship between radiotherapy and hypoxia is complex. However, there is no radiosensitivity prediction model based on hypoxia genes. We attempted to construct a radiosensitivity prediction model developed based on hypoxia genes for lower-grade glioma (LGG) by using weighted correlation network analysis (WGCNA) and least absolute shrinkage and selection operator (Lasso). Methods: In this research, radiotherapy-related module genes were selected after WGCNA. Then, Lasso was performed to select genes in patients who received radiotherapy. Finally, 12 genes (AGK, ETV4, PARD6A, PTP4A2, RIOK3, SIGMAR1, SLC34A2, SMURF1, STK33, TCEAL1, TFPI, and UROS) were included in the model. A radiosensitivity-related risk score model was established based on the overall rate of The Cancer Genome Atlas (TCGA) dataset in patients who received radiotherapy. The model was validated in TCGA dataset and two Chinese Glioma Genome Atlas (CGGA) datasets. A novel nomogram was developed to predict the overall survival of LGG patients. Results: We developed and verified a radiosensitivity-related risk score model based on hypoxia genes. The radiosensitivity-related risk score served as an independent prognostic indicator. This radiosensitivity-related risk score model has prognostic prediction ability. Moreover, a nomogram integrating risk score with age and tumor grade was established to perform better for predicting 1-, 3-, and 5-year survival rates. Conclusions: We developed and validated a radiosensitivity prediction model that can be used by clinicians and researchers to predict patient survival rates and achieve personalized treatment of LGG.

Outcomes of Lymphoma Among American Adolescent and Young Adult Patients Varied by Health Insurance-A SEER-based Study.

INTRODUCTION: Impacts of health insurance status on survival outcomes among adolescent and young adult (AYA, 15 to 39 years of age) patients with lymphoma in the United States are insufficiently known. This study aimed to clarify associations between health insurance status and overall survival (OS) estimates in this population. MATERIALS AND METHODS: We examined 18 Surveillance, Epidemiology, and End Results registries in the United States and analyzed American AYA patients with lymphoma diagnosed during January 2007 and December 2016. Health insurance status was categorized, and Kaplan-Meier and multifactor Cox regressions were adopted using hazard ratio and 95% confidence interval. Probable baseline confounding was modulated by multiple propensity score. RESULTS: A total of 21,149 patients were considered; ~28% were 18 to 25 years old, and 63.5% and 7.5% had private and no insurance, respectively. Private insurance rates increased in the 18 to 25 age group (60.1% to 6.1%, P<0.001) following the 2010 Patient Protection and Affordable Care Act (ACA), and lymphoma survival rates improved slightly 1 to 5 years postdiagnosis. Five-year OS rates decreased with age (93.9%, 90.4%, and 87.0% at 15 to 17, 18 to 25, and 26 to 39, respectively) and differed among insurance conditions (81.7%, 79.2%, 89.2%, and 92.0% for uninsured, Medicaid, insured, and insured/no specifics, respectively). Risk of death was significantly higher for those with Medicaid or no insurance than for those with private insurance in multiple propensity score-adjusted models (hazard ratio [95% confidence interval]=1.07 [1.03-1.12]), independent of stage at diagnosis. CONCLUSIONS: No or insufficient insurance was linked to poor OS in our sample in exposure-outcome association analysis. Insurance coverage and health care availability may enhance disparate outcomes of AYAs with cancer. The ACA has improved insurance coverage and survival rates for out sample. Nevertheless, strategies are needed to identify causality and eliminate disparities.

Health insurance status and outcomes in children, adolescents, and young adults: a systematic review and meta-analysis.

BACKGROUND: The impacts of health insurance status on survival outcomes in children, adolescents, and young adults (aged 0-39 years) with malignant tumors have not been addressed in depth. The present study aimed to identify significant relationships of health insurance condition with overall survival or all-cause mortality among children (age 0-14 years) and adolescents and young adults (AYAs, age 15-39 years) with malignant tumors. METHODS: PubMed, Wiley Cochrane Central Register of Controlled Trials, Econlit, CINAHL, Web of Knowledge, PsychInfo, Business Source Premier, ProQuest Dissertation & Theses Database, and SCOPUS were systematically searched from inception to February 29, 2020 with no language restriction. All related articles comparing the effect of health insurance status on the risk of overall survival and the risk of all-cause mortality in malignant conditions affecting children and AYAs were identified. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were computed using a random- or fixed-effect model as per the heterogeneity evaluated using Cochran`s Q and I < sup > 2 < /sup > statistics. RESULTS: Fourteen studies including 149,680 individuals were selected for this meta-analysis. The pooled RR for all-cause mortality with insurance versus without insurance was 0.78 (95%CI, 0.71-0.86; I2=33.7%). Among the insurance types, patients with private insurance presented with a lower all-cause mortality (RR 0.70, 95% CI 0.60-0.82), with considerable heterogeneity (I2=83.3%). CONCLUSIONS: The findings of this review suggest that a lack of or insufficient insurance is related to all-cause mortality of AYAs with malignant cancers. Strategies aimed at identifying causality and reducing disparities are warranted.

Comparison of Clinical Efficacy of Neoadjuvant Chemoradiation Therapy Between Lower and Higher Radiation Doses for Carcinoma of the Esophagus and Gastroesophageal Junction: A Systematic Review.

PURPOSE: Neoadjuvant concurrent chemoradiation therapy (nCRT) plus surgery has been a standard treatment for locoregionally advanced esophageal cancer and carcinoma of the gastroesophageal junction (EC/GEJ), but the optimal preoperative radiation dose is still unclear. We performed this systematic review to explore the treatment efficacy and toxicity of different radiation dose levels and find an optimal dose-fractionation strategy in EC/GEJ patients receiving nCRT. METHODS AND MATERIALS: Embase and Ovid Medline were searched for articles involving cases of operable squamous and adenocarcinoma of the esophagus and GEJ in which patients received nCRT up to a dose of 50.4 Gy in 28 fractions that were published until July 2019, when the search was performed. Physical dose distributions were converted to biologically equivalent doses (BEDs), which were described in units of gray (alpha/beta). Pooled rates of overall survival (OS), progression-free survival (PFS), failure patterns, and toxicities were compared between lower-dose radiation therapy (LDRT; BED ≤48.85 Gy10) and higher-dose radiation therapy (HDRT; BED >48.85 Gy10) for patients treated with nCRT. RESULTS: A total of 110 studies with 7577 EC/GEJ patients receiving nCRT were included in this pooled analysis. Both the PFS and OS rates of patients receiving LDRT were significantly higher than those of patients receiving HDRT. Patients receiving LDRT had improved safety regarding treatment-related adverse events and lower distant failure rates than patients receiving HDRT. Utilization of modern radiation therapy (RT) techniques, including 3-dimensional conformal RT and intensity modulated RT, was associated with improved oncologic outcomes compared with 2-dimensional methods. Subgroup analysis showed that EC/GEJ patients receiving conventionally fractionated radiation to a dose of 40.0 to 41.4 Gy in 20-23 fractions showed improved OS compared with those receiving radiation above this dose. CONCLUSIONS: Based on the limited data, nCRT using BED ≤48.85 Gy10 was suitable for locoregionally advanced, resectable EC/GEJ. A total dose of 40.0 to 41.4 Gy in 20 to 23 fractions using modern RT techniques might provide the optimal therapeutic ratio.

Survival Disparities in Multiple Myeloma by Health Insurance Status among US Non-Elderly Adults: A SEER-Based Comparative Analysis.

BACKGROUND/AIM: The impacts of health insurance status on survival outcomes in multiple myeloma (MM) have not been addressed in depth. The present study was conducted to identify definite relationships of cancer-specific survival (CSS) and overall survival (OS) with health insurance status in MM patients. METHODS: MM patients aged 18-64 years and with complete insurance records between January 1, 2007, and December 31, 2016, were identified from 18 Surveillance, Epidemiology, and End Results (SEER) Database registries. Health insurance condition was categorized as uninsured, any Medicaid, insured, and insured (no specifics). Relationships of health insurance condition with OS/CSS were identified through Kaplan-Meier, and uni-/multivariate Cox regressions using the hazard ratio and 95% confidence interval. Potential baseline confounding was adjusted using multiple propensity score (mPS). RESULTS: Totally 17,981 patients were included, including 68.3% with private insurance and only 4.9% with uninsurance. Log-rank test uncovered significant difference between health insurance status and OS/CSS among MM patients. Patients with non-insurance or Medicaid coverage in comparison with private insurance tended to present poorer OS/CSS both in multivariate Cox regression and in mPS-adjusted model (non-insurance vs. private insurance [OS/CSS]: 1.33 [1.20-1.48]/1.13 [1.00-1.28] and 1.45 [1.25-1.69]/1.18 [1.04-1.33], respectively; Medicaid coverage vs. private insurance [OS/CSS]: 1.67 [1.56-1.78]/1.25 [1.16-1.36] and 1.76 [1.62-1.90]/1.23 [1.13-1.35], respectively). CONCLUSIONS: Our observational study of exposure-outcome associations suggests that insufficient or no insurance is moderately linked with OS among MM patients aged 18-64 years. Wide insurance coverage and health-care availability may strengthen some disparate outcomes. In the future, prospective cohort research is needed to further clarify concrete risks with insurance type, owing to the lack of definite division of insurance data in SEER.

[Clinical observation on therapeutic effect of suspended moxibustion on temperature-sensitive acupoints plus medication for chronic prostatitis].

OBJECTIVE: Observe therapeutic effect of suspended moxibustion on temperature-sensitive acupoints for chronic prostatitis, to explore a new therapy. METHODS: Sixty cases were randomly divided into an observation group and a control group (n = 30 in each group). The suspended moxibustion on temperature-sensitive acupoints plus herbalenema were practiced in the observation group. The moxibustion at Guanyuan (CV 4), Zhongji (CV 3), Shenshu (BL 23) combined with herbalenema were practiced in the control group. The score of syndromes, the score of symptom indexes (NIH-CPSI), and WBC in prostatic secretion (EPS-WBC) were used as observation index for chronic prostatitis. The therapeutic effect was compared between the two groups. RESULTS: The markedly cured rate was 50.0% in the observation group, better than that of 26.7% in the control group (P < 0.05). The score of syndromes, NIH-CPSI and EPS-WBC in the observation group were lower than the control group (P < 0.05, P < 0.01). CONCLUSION: The therapeutic effect of suspended moxibustion on temperature-sensitive acupoints plus medication is better than moxibustion plus medication for chronic prostatitis in improvement of symptoms and EPS-WBC.

[Clinical study on acupuncture combined with moxibustion on temperature-sensitive points for treatment of Bell palsy in the acute stage].

OBJECTIVE: To probe into a new therapy with less pain, good therapeutic effect and convenience for facial palsy in acute stage. METHODS: Sixty cases were randomly divided into 2 groups, an observation group and a control group, 30 cases in each group. The observation group was treated with routine acupuncture plus moxibustion on temperature-sensitive points, and the control group with the routine acupuncture. Their therapeutic effects were assessed by the criteria for assessment of facial nerve function stipulated by Japanese Institute for Researching the Facial Nerve in 1997. RESULTS: There were significant differences in cumulative scores of symptoms before and after treatment in the two groups (both P < 0.01) and there was a significant difference in the cumulative score of symptoms after treatment between the two groups (P < 0.01). The cured rate was 76.67% in the observation group and 50.00% in the control group with a significant difference between the two groups (P < 0.05). The total effective rates were respectively 93.33% and 76.67% in the two groups with no significant difference between the two groups (P > 0.05). CONCLUSION: Both acupuncture combined with moxibustion on temperature-sensitive points and simple acupuncture have good therapeutic effects on idiopathic facial palsy, but the observation group is better than the control group.