Human papillomavirus infection and HRAS, PIK3CA mutations analysis in patients with early laryngeal carcinoma / 肿瘤研究与临床

Objective To detect human papillomavirus (HPV) infection and HRAS,PIK3CA mutations in early laungeal squamous cell carcinoma (LSCC),and prognostic analysis regarding the clinicopathological teatures,including HPV status,was conducted.Methods A total of 186 patients with T2N0-1M0 LSCC were included in this study.HPV infection,p16INK4A expression,and PIK3CA,HRAS hot spot mutations were detected.Results 9.8 ％ (16/163) cases of high-risk HPV infection and 3.8 ％ (7/186) cases of p16INK4A overexpression were found in the cohort.Three cases of PIK3CA mutation and no HRAS mutation were found.HPV-positive cases had a significantly longer overall survival (OS) (P =0.019).N1 stage had a significantly reduced RFS (P =0.021).In multivariate analysis,HPV status was the only significantly prognostic factor for OS (RR =0.30,95 ％ CI 0.09-0.96,P =0.043).Conclusions p16 cannot be used as a surrogate biomarker of HPV status in early LSCC patients.HRAS or PIK3CA mutation is not a common event in early LSCC,and no mutation is found in HPV-positive cases.HPV status is an independent prognostic factor for survival.

The prognostic value of HIF-1α and VEGF expression in hypopharyngeal squamous cell carcinoma / 中华放射肿瘤学杂志

ObjectiveTo examine the relationship between HIF-1αt and VEGF expression and the clinicopathological characteristics in hypopharyngeal squamous cell carcinoma. Methods The expression status of HIF-1α and VEGF were examined by immunohistochemistric method (IHC) in 62 tumor tissue and 19 paracancerous normal tissue.The relationships between the expression of HIF-1α and VEGF and clinicopathological characteristic were analyzed. Results HIF-1αt and VEGF expression were higher in hypopharyngeal carcinoma tissues than those in paracancerous normal tissues (66. 1％:26. 3％ ;x2 =18. 02,P ＜0. 05 ;67. 7％ : 31.6％ ; x2 =19.22, P ＜ 0. 05 ). The expression intensity of HIF-1 α was related to T stage, N stage and TNM stage ( x2 =4. 23,5.83,9.94,all P ＜0. 05). The expression intensity of VEGF was related to metastasis, T stage, N stage and TNM stage (x2 =5.62,7. 38,15.75,4. 29 ,all P ＜0. 05 ). There was minus relationship between overall survival and expression level of HIF-1 α and/or VEGF (x2 =29. 25, P＜0.01; x2 =24.88, P＜ 0.01 ).On multivariate analysis,HIF-1α expression and T stage were independent prognostic factors for overall survival (x2 =4.80,5.74, all P＜0. 05).ConclusionsHIF-1α and VEGF may be considered as a parameter in evaluation of progression, metastasis and prognosis of hypopharyngeal carcinoma and also may be a direction of molecular target therapy.

The role of PET-CT in diagnosing distant metastasis of nasopharyngeal carcinoma / 肿瘤研究与临床

Objective To explore the clinical significance of PET-CT in evaluating distant metastasis and M staging of nasopharyngeal carcinoma(NPC). Methods 257 NPC patients with no prior treatment were investigated with PET-CT and conventional imaging (chest X-ray, abdominal ultrasound, and bone scan). The findings of PET-CT in diagnosing distant metastasis and M staging were compared with those of conventional imaging according to the results of biopsy and follow-up. Results PET-CT disclosed 34 of 39 patients with distant malignancy compared with 22 patients disclosed by conventional imaging. The false positive rate of PET-CT was 12.8 %. On region-based analyses, PET-CT was more effective than bone scan and chest X-ray for detecting mediastinum metastasis (x2=4.063, P =0.041) and bone metastasis (x2=5.939, P=0.015), respectively. Compared with conventional imaging, PET-CT had an impact on the M staging of 19 patients (7.4 %), of which 15 patients were truly staged and 4 patients incorrectly staged. Conclusion PET-CT is superior to MRI in evaluating distant metastasis and M staging of NPC.

Spread patterns of retropharyngeal lymph nodal metastasis of nasopharyngeal carcinoma / 肿瘤研究与临床

Objective To explore the spread patterns of retropharyngeal lymph node (RLN) metastasis of nasopharyngeal carcinoma. Methods From July 2003 to March 2005, three hundred and three patients with nasopharyngeal carcinoma in initial treatment were enrolled in this study. All patients underwent magnetic resonance imaging (MRI) before treatment, meanwhile measured the minimal and maximal axial diameters, the longitudinal diameter and the central and craniocaudad locations of each positive RLN. Results A total number of 264 positive RLN were found in 177 patients. The minimal and maximal axial diameters and longitudinal diameter of positive RLN were 9.9, 12.9 and 22.4 mm, respectively. Ipsilateral metastatic RLN were noted as follows: two nodes in 21 patients, three nodes in 3 patients and four nodes in 1 patient. According to the longitudinal central location of 263 positive lateral RLN, the numbers of nodes at occipital bone, C1, C1/C2, C2, C2/C3 and C3 were 27, 166, 40, 23, 5 and 2, respectively; the mean minimal axial diameters of nodes were 6.8, 9.9, 12.5, 10.4, 9.3 and 8.0 mm, respectively. Conclusion Multiple metastatic ipsilateral RLN are not common in NPC. The rate of RLN metastasis shows the trend of decreasing from vertebral C1 to C3.The maximal diameters of RLN are in the C1/C2 intervertebral space, and reveal a decreasing frequency along the craniocaudal directions of occipital and vertebral C1.

Effects of quality of life on the prognosis of long-term survivors with nasopharyngeal carcinoma / 肿瘤研究与临床

Objective To analyze the effect of quality of life (QOL) on the prognosis of long-term survivors with nasopharyngeal carcinoma (NPC). Methods A total of 192 NPC patients treated between 1999 and 2000 and with tumor-free survival before July 2003 were enrolled in this study. All patients received QOL measurement between July and August in 2003. Measurement scales included Chinese SF-36 questionnaire and a checklist consisting of fourteen items about self-rating symptoms. The median follow-up time was 7.9S years (range 2.67-9.55 years). The effects of QOL, social demographic and clinical factors on prognosis were analyzed. Results Univariate analysis showed that QOL affected the tumor-free survival and overall survival. Multivariate analysis showed that hypomnesia was an independent prognostic factor of tumor-free survival, while trismus, headache and age were independent prognostic factors of overall survival. The younger and the better QOL had better prognosis. The other sociodemographic and clinical factors had no prognostic value. Conclusion QOL is an important factor affecting the prognosis of long-term survivors with NPC, and it should be routinely evaluated during the follow-up.

Prognosis analysis of 117 nasopharyngeal carcinoma patients treated by intensity modulated radiotherapy / 肿瘤研究与临床

Objective To analyse the prognosis of 117 newly diagnosed nasopharyngeal carcinoma (NPC) patients underwent intensity modulated radiotherapy (IMRT). Methods From Jan to Nov 2005, 117 NPC patients who were treated by IMRT were enrolled. There were 81 males and 36 females with a median age of 42 years (range 18-76 years). According to Chinese Fuzhou Staging system(1992), 11 cases were Stage I , 15 Stage Ⅱ, 54 Stage Ⅲ and 37 Stage ⅣA. IMRT was carried out with Peacock plan. The prescription dose to the gross target volume(GTVnx) of nasopharyngeal tumor was 68 Gy, that of positive neck lymph nodes (GTVnd) was 60-66 Gy, clinical target volume 1 (CTV1) was 60 Gy, and CTV2 was 54 Gy. Results After a median follow-up time of 48 months (range 10.5-59.5 months), the 3-and 5-year overall survival (OS) rates were 95.7 % and 89.7 %, the disease-free survival (DFS) rates were 91.5 % and 87.2%, and the local-regional control rates were 94.0 % and 91.5 %. Univariate analysis showed the KPS, stage, Fuzhou clinical stage, status of blood platelet before treatment and uric acid after treatment were correlated with OS rate. T stage was the only independent factor of prognosis in the COX stepwise regression model. Conclusion Radical IMRT significantly prolongs the survival of NPC patients. T stage is the only independent prognostic factor for NPC patients.

Clinical analysis of 35 cases second primary tongue squamous cell carcinoma after nasopharyngeal carcinoma radiotherapy / 肿瘤研究与临床

Objective To investigate the clinical features, effective treatment, survival and prognostic factors of second primary tongue squamous cell carcinoma (SPTSCC) after nasopharyngeal carcinoma (NPC) radiotherapy. Methods The clinical data of 35 cases with SPTSCC after NPC radiotherapy were analyzed retrospectively. Kaplan-Meier method, Log-Rank test and COX proportional hazard mode was performed for statistical analysis. Results 3-year and 5-year overall survival rates were 55 % and 47 %, respectively, lymph node metastasis rate was 5.71 %. Univariate analysis indicated that gender (χ2 = 8.89, P = 0.00), T classification (χ2= 5.58, P= 0.02), clinical stage (χ2 = 8.51, P= 0.04) and treatment methods (χ2 = 29.37, P = 0.00) were important factors of prognosis. Multivariate analysis showed that treatment methods (P = 0.00) and T classification (P = 0.03) were independent prognostic factors. Operative treatment group had better prognosis than the non-operative treatment group, the difference was statistically significant (P <0.05), male patients in the risk of SPTSCC was higher than the female patients, and the incidence of SPTSCC was increased along with extension of the time after NPC radiotherapy. Conclusion The rate of the lymph node metastasis is lower for SPTSCC after NPC radiotherapy and treatment patterns and T stage are independent prognostic factors. Long-term follow-up after NPC radiotherapy is necessary to the early diagnosis of SPTSCC, so that to give surgery or combined therapy with surgery in order to achieve a good effect.

Feasibility of the Chinese version of SF-36 health survey questionaire in long-term survivors of nasopharyngeal carcinoma / 中华放射肿瘤学杂志

Objective To evaluate the reliability, validity and feasibility of the Chinese version of SF-36 health survey questionaire in long-term survivors of nasopharyngeal carcinoma (NPC). Methods A total of 85 long-term NPC survivors completed the Chinese version of SF-36 by either telephone or mail survey. Correlation analysis, reliability analysis and factor analysis were performed to evaluate the reliability and validity of the scale. Results The Chinese version of SF-36 was easy to complete. The split-half reliability was 0. 92 and the Cronbach's α coefficient among domains were all above 0. 70, which showed good reliability and discrimination capacity among domains. All the correlation coefficients between each item and its domain achieved or approached 0. 5, which were greater than those between the item and other domains. These results demonstrated that the Chinese version of SF-36 had good content validity and discriminatory validity. Six principal components were extracted from the scale, which could basically represent eight domains. The cumulative variance was 71.4%. Two common factors were extracted from the eight domains, which accounted for 73.3% of the variance. The Chinese version of SF-36 was able to detect differences in the quality of life between NPC patients and healthy populations. Conclusions The Chinese version of SF-36 has good feasibility, reliability and validity in evaluating the quality of life in long-term NPC survivors.

Clinical features and treatment of primary non-Hodgkin lymphoma of bone / 白血病·淋巴瘤

Objective To analyze clinical features and treatment results of primary non-Hodgkin lymphoma of bone (PLB) and further to investigate the rational treatment. Methods Clinical data of 26 patients with PLB were analyzed. Twenty-three (88.5 %) patients received radiotherapy in combination with chemotherapy, three received chemotherapy alone, and three patients also received surgical resection. Results The pathological types of lymphoma in the patients were diffused large B-cell iymphoma (DLBCL) in 15 patients (57.7 %), small B-cell lymphoma in 1 patient(3.8 %), B-cell lymphoma with unclassified subtypes in 4 patients (15.5 %), T-cell lymphoma in 5 patients (19.3 %,among which anaplastic large cell lymphoma in 3 patients), and unclassified lymphoma in one patient (3.8 %). Of the 26 cases of PLB, 15 were at stage Ⅰ, 3 at stage Ⅱ, 3 at stage Ⅲ and 5 at stage Ⅵ. The 3- and 5-year overall survival rates were 59.16 % and 31.37 %respectively. In the eleven patients who died of lymphoma, three had Iocol-regional relapse, and nine had systemically involved lymphoma. The radiation-induced bone fracture had not been observed after local radiotherapy with median dose of 50 Gy. Conclusion Pelvis maybe a common primary site of PLB, and DLBCL type are the most observed histological subtype. The optimal treatment for PLB is radiotherapy combined with chemotherapy. Local regional radiotherapy with median dose of 50 Gy can be safe and feasible.

Change in visual evoked potential by radiotherapy of nasopharyngeal carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the effect of radiotherapy of nasopharyngeal carcinoma on visual evoked potential (VEP).</p><p><b>METHODS</b>VEP of 63 patients with nasopharyngeal carcinoma were tested before, at the end of, half a year, one year, 2 years and 3 years after their radiotherapy.</p><p><b>RESULTS</b>Within the male group, one year after radiotherapy, the latency of VEP was significantly delayed than that before and at the end of radiotherapy, while the amplitude was decreased significantly. Two years after radiotherapy, the latency of VEP was significantly delayed more than that before radiotherapy. However there was no significant difference among VEP at the end of, half a year and 3 years after radiotherapy. Within the female group, 2 years after radiotherapy, the latency of VEP was significantly delayed than that before radiotherapy. Three years after radiotherapy, the latency of VEP was significantly delayed than that before, at the end of, half a year and one year after radiotherapy. There was no significant difference in VEP amplitudes before and after radiotherapy.</p><p><b>CONCLUSION</b>Within the male group, the abnormal delay of VEP latency mostly happens one or two years after radiotherapy. Within the female group, the significant delay of VEP latency happens at the end of radiotherapy and lasts for 3 years, while the VEP amplitude does not change significantly during the 3 years after radiotherapy. The result indicates that the sustained radiation damage within the female visual nerve system starts at the end of radiotherapy, but to a lesser degree. It was shown that radiotherapy of nasopharyngeal carcinoma certainly damages the visual nerve system, though there is sex difference in the impairment.</p>

Prognostic factors of 60 nasal cavity carcinoma patients / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the treatment modalities and the prognostic factors of nasal cavity carcinoma.</p><p><b>METHODS</b>A retrospective study was done on 60 nasal cavity carcinoma patients treated from 1985 to 1992. Thirty-four patients received radiotherapy alone and 26 patients received surgery plus radiotherapy. Kaplan-Meier method was used to evaluate the survival, Log-rank test to assess the difference between these two groups and Cox proportional hazard model by multivariate analysis.</p><p><b>RESULTS</b>The overall 5- and 10-year survival rates were 55.9% and 36.9% respectively. The 5- and 10-year survival rates were 79.0% and 57.9% in patients with early lesions (stage I, II) and 44.1% and 26.0% in patients with advanced lesions (stage III, IV) (P = 0.005). There was no significant difference in the survival rate between radiotherapy alone and radiotherapy plus surgery (P = 0.33). Patients with squamous cell carcinoma had obviously poorer survival rate than patients with adenocarcinoma (P = 0.04). Patients with positive nodes had a lower survival rate compared with negative node patients (P = 0.09).</p><p><b>CONCLUSION</b>Histological type and clinical stage, but not method of treatment or neck node metastasis, are the important prognostic factors.</p>