Effect of neoadjuvant chemoradiotherapy on perioperative immune function of patients with locally advanced esophageal cancer.

This study aims to evaluate the effect of neoadjuvant chemoradiotherapy (NCRT) on perioperative immune function during surgery to treat resectable locally advanced esophageal cancer. Records were retrospectively analyzed for 220 patients with locally advanced esophageal cancer, of whom 112 received surgery alone and 98 received neoadjuvant NCRT plus surgery. The two groups were compared in terms of proportions of CD3+, CD4+, CD8+, and natural kill (NK) cells, as well as the ratio of CD4+ to CD8+ cells. These measurements were made using flow cytometry on preoperative day 1 and on postoperative days 1 and 7. Subgroup analysis were performed in terms of degrees of pathological response of NCRT. When the entire NCRT and no-NCRT (surgery alone) cohorts were compared, no significant differences in propocrtions of CD3+, CD4+, CD8+, or NK cells or in the CD4+/CD8+ ratio occurred at any of the three time points. Similar results were obtained using the subgroup of NCRT patients who were NCRT-sensitive, but the subgroup of NCRT-insensitive patients showed significantly lower CD4+ and NK proportions and lower CD4+/CD8+ ratio than the no-NCRT group. Our findings suggest that NCRT does not affect perioperative immune function in patients who are NCRT-sensitive, but it does significantly reduce such function in patients who are NCRT-insensitive.

Preoperative Prediction Power of Radiomics for Breast Cancer: A Systemic Review and Meta-Analysis.

Background: To evaluate the preoperative predictive value of radiomics in the diagnosis of breast cancer (BC). Methods: By searching PubMed and Embase libraries, our study identified 19 eligible studies. We conducted a meta-analysis to assess the differential value in the preoperative assessment of BC using radiomics methods. Results: Nineteen radiomics studies focusing on the diagnostic efficacy of BC and involving 5865 patients were enrolled. The integrated sensitivity and specificity were 0.84 (95% CI: 0.80-0.87, I 2 = 76.44%) and 0.83 (95% CI: 0.78-0.87, I 2 = 81.79%), respectively. The AUC based on the SROC curve was 0.91, indicating a high diagnostic value. Conclusion: Radiomics has shown excellent diagnostic performance in the preoperative prediction of BC and is expected to be a promising method in clinical practice.

CDFRegNet: A cross-domain fusion registration network for CT-to-CBCT image registration.

BACKGROUND AND OBJECTIVE: Computer tomography (CT) to cone-beam computed tomography (CBCT) image registration plays an important role in radiotherapy treatment placement, dose verification, and anatomic changes monitoring during radiotherapy. However, fast and accurate CT-to-CBCT image registration is still very challenging due to the intensity differences, the poor image quality of CBCT images, and inconsistent structure information. METHODS: To address these problems, a novel unsupervised network named cross-domain fusion registration network (CDFRegNet) is proposed. First, a novel edge-guided attention module (EGAM) is designed, aiming at capturing edge information based on the gradient prior images and guiding the network to model the spatial correspondence between two image domains. Moreover, a novel cross-domain attention module (CDAM) is proposed to improve the network's ability to guide the network to effectively map and fuse the domain-specific features. RESULTS: Extensive experiments on a real clinical dataset were carried out, and the experimental results verify that the proposed CDFRegNet can register CT to CBCT images effectively and obtain the best performance, while compared with other representative methods, with a mean DSC of 80.01±7.16%, a mean TRE of 2.27±0.62 mm, and a mean MHD of 1.50±0.32 mm. The ablation experiments also proved that our EGAM and CDAM can further improve the accuracy of the registration network and they can generalize well to other registration networks. CONCLUSION: This paper proposed a novel CT-to-CBCT registration method based on EGAM and CDAM, which has the potential to improve the accuracy of multi-domain image registration.

Prognostic Index for Nonsmall Cell Lung Cancer Based on Immune-Related Genes Expression.

Immune system dysregulation is associated with tumor incidence and growth. Here, we established an RNA-based individualized immune signature associated with prognosis for nonsmall cell lung cancer (NSCLC) to guide adjuvant therapy. We downloaded publicly accessible data on RNA expression and clinical characteristics of NSCLC from the Cancer Genome Atlas (TCGA). From immune-related genes (IRGs) retrieved from the immunology database and analysis portal (ImmPort) database, we then screened differentially expressed immune-related genes (DEIRGs). Using overall survival (OS) as a clinical endpoint, we identified 26 prognostic DEIRGs via univariate and multivariate Cox regression analysis, and then developed a risk model based on these 26 IRGs with an area under the curve (AUC) of 0.701, and its predictive ability independent from other clinical factors. We also downloaded tumor immune infiltrate data and analyzed the correlations between lymphocytic infiltration with our risk scores, but found no significant association. Furthermore, we retrieved 86 differentially expressed transcription factors (TFs) to assess their regulatory relationships with the 26 prognostic DEIRGs. In summary, we developed a robust risk model to predict survival in patients with NSCLC, based on the expression of 26 IRGs. It provides novel predictive and therapeutic molecular targets.

Value of circulating tumor cells in the diagnosis and treatment of solitary pulmonary nodules.

BACKGROUND: Lung cancer has become the most common malignant tumor worldwide, with the highest rates of morbidity and mortality. The detection of circulating tumor cells (CTCs) can be simple, rapid, and minimally invasive, thus endowing them with a high value in the diagnosis of malignant tumors. We aimed to explore the correlation between CTCs in peripheral blood and benign or malignant solitary pulmonary nodules (SPNs). METHODS: A total of 223 patients with SPNs from January 2018 to May 2020 were recruited. During the same period, 20 healthy volunteers were recruited as controls. Venous blood samples were collected from participants for detecting CTCs using a folate receptor (FR)-positive cell detection kit, as well as tumor biomarkers. RESULTS: A significant difference in the level of CTCs were observed between the malignant SPNs group, the benign SPNs group, and the control group, which was markedly higher in the malignant SPNs group (10.48±3.49 FU/3 mL) than both the benign SPNs and control groups (6.38±0.53 and 4.45±1.21 FU/3 mL, respectively) (P<0.001). In addition, the level of CTCs was significantly higher in the benign SPNs group than in the control group (P=0.023). In particular, in the malignant SPNs group, patients older than 60 years (11.45±3.92 FU/3 mL) presented a notably higher level of CTCs than other patients (9.55±2.74 FU/3 mL). The patients were then classified according to the pathological subtypes of lung cancer. There was a significant difference in level of CTCs among patients with squamous cell carcinoma (9.10±1.94 FU/3 mL), adenocarcinoma (10.77±3.71 FU/3 mL), and adenosquamous cell carcinoma (11.78±2.61 FU/3 mL). Binary logistic regression analysis suggested that CTCs were an independent risk factor of malignant SPN (OR =3.698, 95% CI: 1.136-11.035, P=0.030). The sensitivity and specificity of CTCs in diagnosing malignant SPNs was significantly higher than tumor biomarkers (single or combined) [sensitivity =89.1%; specificity =92.3%; area under curve (AUC) (95% CI) =0.907 (0.861-0.942)]. CONCLUSIONS: Peripheral blood CTCs can be used in the diagnosis of malignant SPNs and are recommended for clinical application.

The Role of Leukocyte-Platelet-Rich Fibrin in Promoting Wound Healing in Diabetic Foot Ulcers.

To explore the effect of leukocyte-platelet-rich fibrin (L-PRF) on promoting wound healing in diabetic foot ulcers. A total of 42 patients with diabetic foot ulcers at our hospital from January 2017 to July 2020 were retrospectively analyzed. A control group and a PRF group were established. The two groups of patients underwent debridement. In the platelet-rich fibrin (PRF) group, autologous L-PRF was used to cover ulcer wounds. One time each week, Vaseline gauze was used to cover the ulcer wounds. In contrast, the control group was treated with the external application of mupirocin ointment and recombinant human epidermal growth factor gel (yeast). Two times each week, the sterile Vaseline gauze was covered with a bandage. Both groups were treated for 5 weeks. The wound recovery of the two groups was observed. During the early stage of treatment (first and second weeks) for diabetic foot ulcers, the wound healing rate was significantly better with L-PRF treatment than traditional treatment. For later-stage treatment (third to fifth weeks), the overall cure rate was higher with L-PRF than the traditional treatment method. L-PRF can effectively promote wound healing in diabetic foot ulcers.

Does the lymph node yield affect survival in patients with esophageal cancer receiving neoadjuvant therapy plus esophagectomy? A systematic review and updated meta-analysis.

BACKGROUND: Conflicting data have been reported on the prognostic impact of the extent of lymphadenectomy during esophagectomy for esophageal cancer (EC) after neoadjuvant therapy, especially after neoadjuvant chemoradiotherapy (nCRT). METHODS: A comprehensive online search was performed to explore the association between increased lymph node yield (LNY) and survival of patients with EC, in which the overall survival (OS) was set as the primary outcome. In addition to analysis of the entire cohort, subgroup analyses of different induction therapy and different populations were also performed. FINDINGS: A total of 19528 patients from twelve studies were included in our study. The pooled data revealed that more lymph node harvested was associated with better OS (HR = 0·87; 95% CI: 0·79-0·95, p < 0·001). Notably, a higher LNY was associated with better OS if the threshold was less than 18. However, more thorough lymphadenectomy might not bring additional survival benefits when it came to a cutoff value more than 18. The subgroup analysis further revealed that a higher LNY after nCRT was associated favorable survival. In terms of subset analysis of different populations, increased LNY was associated with longer OS in Western populations but not in Eastern. INTERPRETATION: Increased LNY during esophagectomy after neoadjuvant therapy, especially after nCRT, might be associated with improved OS. More studies are warranted to assess the survival benefits of a higher LNY receiving neoadjuvant therapy plus esophagectomy, especially in Eastern populations. FUNDING: Supported by the projects from Suzhou Key Laboratory of Thoracic Oncology (SZS201907), Suzhou Key Discipline for Medicine (SZXK201803), the Science and Technology Research Foundation of Suzhou Municipality (SYS2018063, SYS2018064), Municipal Program of People's Livelihood Science and Technology in Suzhou (SS2019061) and Major Project for Social Development, Jiangsu Provincial Department of Science and Technology (SBE2020750085).

Expression patterns and clinical significances of ENO2 in lung cancer: an analysis based on Oncomine database.

BACKGROUND: Lung cancer is a heterogeneous malignant tumor involving more than 50 histological subtypes. Currently, molecularly targeted drugs have been shown to have promising applications in the clinical treatment of lung cancer. This study aims to explore the expression patterns and prognostic potential of enolase 2 (ENO2) in lung cancer. METHODS: Differential expressions of ENO2 in lung cancer cases were analyzed using the Oncomine database. Meanwhile, the prognostic potentials of ENO2 in lung cancer were assessed by deploying the Kaplan-Meier plotter database. RESULTS: Forty-one studies reported a significant difference in ENO2 expression between tumors and the normal healthy control tissues. Among all the studies, there was an upregulation of ENO2 in 29 studies, and downregulation in 12 studies. 9/41 studies revealed upregulated ENO2 in distinct types of tumor tissues, including cervical cancer, esophageal cancer, kidney cancer, leukemia, melanoma, pancreatic cancer, sarcoma, and lung cancer. Furthermore, upregulated ENO2 was identified in 365 cases of lung cancer (P<0.05). By analyzing the Kaplan-Meier Plotter database, the ENO2 level was negatively correlated to the overall survival of lung cancer patients (P<0.05). Subsequently, subgroup analysis revealed that the prognostic potential of ENO2 was much more pronounced in lung adenocarcinoma patients (P<0.05). CONCLUSIONS: ENO2 is upregulated in lung cancer tissues and linked to the prognosis. It can be used as a therapeutic target for developing lung cancer drugs.

[Trachea-bronchoplasty in the treatment of centrally located lung cancer].

BACKGROUND: To maximize the preservation of functional pulmonary parenchyma and improve the quality of life of patients with centrally located lung cancer, trachea-bronchoplasty has been used in clinical application with good efficacy. The aim of this study is to explore the appropriate admission and management of trachea-bronchoplasty and prevent complications of trachea-bronchial sleeve resection in the treatment of centrally located lung cancer. METHODS: Seventy-six patients with central lung cancer, who were treated with trachea-bronchoplasty from June, 1988 to October, 2004, were analyzed. There were 49 cases of squamous cell carcinoma, 16 adenocarcinoma, 7 adenosquamous carcinoma, 3 small cell lung cancer and 1 adenoid cystic adenocarcinoma. Seventeen patients were in stage I, 39 in stage II, 17 in stage IIIA and 3 in stage IIIB. There were 55 cases of sleeve lobectomy, 12 lobectomy with wedge resection of the main bronchus, 8 big arc resection of superior lobar bronchus-main trachea-lateral wall of trachea, 1 resection of right upper lobe-right main bronchus-carina-lateral trachea and carinal reconstruction. RESULTS: Postoperative complications happened in 7 patients. Pneumonia and atelectasis occurred in 6 cases, in which 1 died of heart and respiratory failure. Another one died of haemorrhage of upside alimentary canal. Seventy-one patients were followed up (93.4%). The 1-, 3-, 5-year survival rate was 82.4% (56/68), 57.8% (26/45) and 41.7% (15/36) respectively. CONCLUSIONS: The trachea-bronchoplasty can not only preserve functional pulmonary parenchyma as much as possible and improve the quality of life of patients, but also provide an operative opportunity to those patients with poor pulmonary function in the treatment of centrally located lung cancer.

Excision repair cross complementation group 1 is a chemotherapy-tolerating gene in cisplatin-based treatment for non-small cell lung cancer.

This study aimed to evaluate the biological functions of excision repair cross complementation goup 1 (ERCC1) in cell proliferation, cell cycle, invasion and cisplatin response of non-small cell lung cancer (NSCLC) cells. Firstly, ERCC1 gene was successfully transfected into H1299 cells by gene cloning and transfection techniques. Then, cell proliferation was determined with the cell growth curve and colony-forming assays. Flow cytometry (FCM) was employed to investigate the cell cycle distribution. The ability of cell invasion was estimated by means of Matrigel invasion assays. Response of NSCLC cells to cisplatin was detected utilizing MTT assays, and the intracellular drug concentrations were determined by the high performance liquid chromatography (HPLC) analysis. Expression of the two cell membrane proteins, P-glycoprotein (P-gp) and multidrug resistance-associated protein (MRP), was also evaluated utilizing FCM technique. By contrast, ERCC1 expression in the NSCLC A549 cells was silenced by small interfering RNA (siRNA) through RNAi technique. In addition, the cytotoxic effect of cisplatin on A549 cells was detected by MTT assays. In the present study, the results demonstrated that ERCC1 had no effect on cell proliferation, cell cycle and the ability of invasion, but showed significant impact on cisplatin response of the NSCLC H1299 cells. Furthermore, siRNA-induced suppression of ERCC1 evidently enhanced sensitivity to cisplatin of NSCLC A549 cells. Therefore, it is confirmed that ERCC1 is a chemotherapy-tolerating gene and a promising predictor in tailoring chemotherapy of NSCLC.