1
|
Dang LH, Hung SH, Le NTN, Chuang WK, Wu JY, Huang TC, Le NQK. Enhancing Nasopharyngeal Carcinoma Survival Prediction: Integrating Pre- and Post-Treatment MRI Radiomics with Clinical Data. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024:10.1007/s10278-024-01109-7. [PMID: 38689151 DOI: 10.1007/s10278-024-01109-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/26/2024] [Accepted: 04/02/2024] [Indexed: 05/02/2024]
Abstract
Recurrences are frequent in nasopharyngeal carcinoma (NPC) despite high remission rates with treatment, leading to considerable morbidity. This study aimed to develop a prediction model for NPC survival by harnessing both pre- and post-treatment magnetic resonance imaging (MRI) radiomics in conjunction with clinical data, focusing on 3-year progression-free survival (PFS) as the primary outcome. Our comprehensive approach involved retrospective clinical and MRI data collection of 276 eligible NPC patients from three independent hospitals (180 in the training cohort, 46 in the validation cohort, and 50 in the external cohort) who underwent MRI scans twice, once within 2 months prior to treatment and once within 10 months after treatment. From the contrast-enhanced T1-weighted images before and after treatment, 3404 radiomics features were extracted. These features were not only derived from the primary lesion but also from the adjacent lymph nodes surrounding the tumor. We conducted appropriate feature selection pipelines, followed by Cox proportional hazards models for survival analysis. Model evaluation was performed using receiver operating characteristic (ROC) analysis, the Kaplan-Meier method, and nomogram construction. Our study unveiled several crucial predictors of NPC survival, notably highlighting the synergistic combination of pre- and post-treatment data in both clinical and radiomics assessments. Our prediction model demonstrated robust performance, with an accuracy of AUCs of 0.66 (95% CI: 0.536-0.779) in the training cohort, 0.717 (95% CI: 0.536-0.883) in the testing cohort, and 0.827 (95% CI: 0.684-0.948) in validation cohort in prognosticating patient outcomes. Our study presented a novel and effective prediction model for NPC survival, leveraging both pre- and post-treatment clinical data in conjunction with MRI features. Its constructed nomogram provides potentially significant implications for NPC research, offering clinicians a valuable tool for individualized treatment planning and patient counseling.
Collapse
Affiliation(s)
- Luong Huu Dang
- Department of Otolaryngology, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Shih-Han Hung
- Department of Otolaryngology, School of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Otolaryngology, Wan Fang Hospital, Taipei, Taiwan
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Nhi Thao Ngoc Le
- International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei, Taiwan
| | - Wei-Kai Chuang
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jeng-You Wu
- Department of Radiation Oncology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Ting-Chieh Huang
- Department of Otolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Nguyen Quoc Khanh Le
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
- AIBioMed Research Group, Taipei Medical University, Taipei, Taiwan.
- Translational Imaging Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
| |
Collapse
|
2
|
Yang Z, Zuo Q, Liu R, Wu H, Xiong L, Jia J, Xiang Z. Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy with or without nimotuzumab in the treatment of locally advanced nasopharyngeal carcinoma: a retrospective study. BMC Cancer 2023; 23:1140. [PMID: 37996813 PMCID: PMC10668510 DOI: 10.1186/s12885-023-11608-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/03/2023] [Indexed: 11/25/2023] Open
Abstract
PURPOSE We aimed to investigate the efficacy and side effects of concurrent chemoradiotherapy, with or without nimotuzumab, for the treatment of locally advanced nasopharyngeal carcinoma after neoadjuvant chemotherapy. METHODS This study retrospectively enrolled 109 patients with NPC from our hospital from July 2019 to May 2021.All patients were treated with docetaxel, cisplatin, and fluorouracil(TPF) neoadjuvant chemotherapy for 2 cycles, and concurrent chemoradiotherapy was performed 2 weeks after chemotherapy. According to whether nimotuzumab was added in concurrent chemoradiotherapy, they were divided into the nimotuzumab group and the control group, with 52 cases in the nimotuzumab group and 57 cases in the control group.The efficacy and adverse reactions of the two groups were retrospectively analyzed. RESULTS The objective remission and complete remission rates in the nimotuzumab and control groups were 100% vs 98.2% (p = 1.000), and 92.3% vs 78.9% (p = 0.049), respectively. The 3-year distant metastasis-free survival of the nimotuzumab and control groups was 91.6% and 77.3% (p = 0.047), respectively.The 3-year progression-free survival, locoregional relapse-free survival, and overall survival of the nimotuzumab and control groups were 87.6% vs 75.5% (p = 0.110), 90.5% vs 86.9% (p = 0.566), and 94.5% vs 87.1% (p = 0.295), respectively. In the nimotuzumab group, subgroup analysis showed that patients aged < 60 years (hazard ratio [HR] = 0.350, 95% confidence interval [CI]: 0.131-0.934, p = 0.036) and those with a neutrophil-to-lymphocyte ratio (neutrophil/lymphocyte ratio) ≤ 4 (HR = 0.365, 95% CI: 0.144-0.923, p = 0.033) achieved a better result. Additionally, multivariate analysis demonstrated that neutrophil/lymphocyte ratio was an independent risk factor for disease progression (HR = 7.485, p = 0.012) and distant metastasis (HR = 17.540, p = 0.009).No grade 4 adverse reactions were observed in either group. Grade 3 oral mucosal reactions, as well as pharyngeal and esophageal reactions were slightly higher in the nimotuzumab group than in the control group, but the difference was not statistically significant. No significant differences were observed in the incidence of adverse reactions such as leukopenia, HB reduction, thrombocytopenia between the two groups (P > 0.05). CONCLUSION The concurrent chemoradiotherapy plus nimotuzumab after neoadjuvant chemotherapy for locally advanced nasopharyngeal carcinoma achieved a higher complete remission rate and significantly improved distant metastasis-free survival compared with concurrent chemoradiotherapy alone. Additionally, an increasing trend was observed in progression-free survival, and the incidence of side effects was similar in both groups.
Collapse
Affiliation(s)
- Zhi Yang
- Department of Oncology, People's Hospital of Xiangxi Tujia and Miao Autonomous Prefecture, First Affiliated Hospital of Jishou University, Jishou, 416000, Hunan, China
| | - Quan Zuo
- Department of Oncology, People's Hospital of Xiangxi Tujia and Miao Autonomous Prefecture, First Affiliated Hospital of Jishou University, Jishou, 416000, Hunan, China
| | - Rong Liu
- Department of Oncology, People's Hospital of Xiangxi Tujia and Miao Autonomous Prefecture, First Affiliated Hospital of Jishou University, Jishou, 416000, Hunan, China
| | - Hui Wu
- Department of Oncology, People's Hospital of Xiangxi Tujia and Miao Autonomous Prefecture, First Affiliated Hospital of Jishou University, Jishou, 416000, Hunan, China
| | - Li Xiong
- Department of Oncology, People's Hospital of Xiangxi Tujia and Miao Autonomous Prefecture, First Affiliated Hospital of Jishou University, Jishou, 416000, Hunan, China
| | - Jieqi Jia
- Department of Otolaryngology, People's Hospital of Xiangxi Tujia and Miao Autonomous Prefecture, First Affiliated Hospital of Jishou University, Jishou, 416000, Hunan, China.
| | - Zhibi Xiang
- Department of Oncology, People's Hospital of Xiangxi Tujia and Miao Autonomous Prefecture, First Affiliated Hospital of Jishou University, Jishou, 416000, Hunan, China.
| |
Collapse
|
3
|
Yan C, Zhao R, Chen KH, Chen BY, Zhang CJ, Chen X, Meng WW, Lai L, Qu S, Zhu XD. Development of A Nomogram for Progression-free Survival in Patients with Stage II/T3N0 Nasopharyngeal Carcinoma to Explore Different Treatment Modalities. J Cancer 2023; 14:3368-3377. [PMID: 37928433 PMCID: PMC10622997 DOI: 10.7150/jca.87901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/27/2023] [Indexed: 11/07/2023] Open
Abstract
Purpose To explore the prognostic value of clinical and serological risk factors for progression-free survival (PFS) in stage II and T3N0 nasopharyngeal carcinoma (NPC) and construct a nomogram based on these factors. Additionally, to investigate the long-term survival and short-term toxic reactions of patients in different risk stratification under different treatment modalities. Methods The patients were randomly divided into training and validation cohorts in a 7:3 ratio. Independent prognostic factors were identified using Cox regression analysis, and a nomogram was constructed by combining these predictive factors with the TNM staging system. The nomogram was then validated in the validation cohort, and patients were classified into different risk groups based on the nomogram. The PFS, overall survival (OS), and acute toxicities were compared among different treatment modalities after balancing baseline characteristics. Results Multivariate Cox regression analysis indicated that pathological type, alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) were independent prognostic factors(p<0.05) in this study. The nomogram showed good prognostic accuracy in both the training and validation cohorts (C-index of 0.73 and 0.70, respectively). In the different risk subgroups, there were no statistically significant differences in PFS and OS between radiotherapy and chemoradiotherapy groups(p>0.05). The treatment modality of combined chemotherapy was associated with more acute toxic reactions. Conclusion We established and validated a nomogram for predicting PFS in patients with stage II/T3N0 NPC. Intensity-modulated radiation therapy (IMRT) combined with chemotherapy did not provide additional survival benefits for these patients and was associated with more chemotherapy-related side effects.
Collapse
Affiliation(s)
- Chang Yan
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530021, People's Republic of China
| | - Rong Zhao
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530021, People's Republic of China
| | - Kai-Hua Chen
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530021, People's Republic of China
| | - Biao-You Chen
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530021, People's Republic of China
| | - Chao-Jun Zhang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530021, People's Republic of China
| | - Xi Chen
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530021, People's Republic of China
| | - Wan-Wan Meng
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530021, People's Republic of China
| | - Lin Lai
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530021, People's Republic of China
| | - Song Qu
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530021, People's Republic of China
| | - Xiao-Dong Zhu
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530021, People's Republic of China
- Department of Oncology, Wuming Hospital of Guangxi Medical University, Nanning, Guangxi, 530199, People's Republic of China
| |
Collapse
|
4
|
Wang L, Zhuang H, Xu X, Zhou J, Jiao Y. Efficacy and survival analysis of nimotuzumab combined with concurrent chemoradiotherapy in the treatment of locally advanced nasopharyngeal carcinoma. Front Oncol 2023; 13:1129649. [PMID: 36814816 PMCID: PMC9939457 DOI: 10.3389/fonc.2023.1129649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/25/2023] [Indexed: 02/09/2023] Open
Abstract
Objective This study investigated the curative effect of adding nimotuzumab (NTZ) in patients with locally advanced nasopharyngeal carcinoma (NPC) who were treated with concurrent chemoradiotherapy (CCRT) and explored significant prognostic factors of NPC. Materials and methods The clinical data of 307 patients with NPC treated in the First Affiliated Hospital of Soochow University from January 2013 to December 2018 were retrospectively analyzed. The patients were divided into the NTZ-CCRT group and the CCRT group according to whether they were associated with NTZ. We applied propensity score matching to reduce the interference of biases and compared the short-term efficacy and long-term survival rate of the two groups. Moreover, univariate and multivariate analyses were performed for all patients, and subgroup analysis was used to compare the efficacy of therapy combined with NTZ in different subgroups. Results In primary nasopharyngeal tumors, the objective response rates in the NTZ-CCRT group and CCRT group were 95.8% and 85.7%, respectively (P =0.007). In cervical positive lymph nodes, the objective response rates in the NTZ-CCRT group and CCRT group were 98.3% and 87.4%, respectively (P =0.001). Compared with CCRT alone, the addition of NTZ significantly improved the 5-year OS (94.1% vs. 81.8%, P=0.014) and the 5-year DFS (84.2% vs. 75.5%, P=0.031) of NPC patients; however, the addition of NTZ was accompanied by more severe hematologic toxicity and acute oral mucositis. Multivariate analysis demonstrated that the addition of NTZ was an important prognostic factor for OS and DFS (HR 0.367, 95% CI 0.167-0.808, P=0.013 for OS and HR 0.536, 95% CI 0.312-0.919, P=0.023 for DFS) and the level of pretreatment LDH (HR 5.170, 95% CI 2.125-12.580, P<0.001 for OS and HR 2.421, 95% CI 1.027-5.707, P=0.043 for DFS). Moreover, patients with high levels of hsCRP before treatment (HR 0.389, 95% CI 0.177-0.853, P=0.018) may gain more benefits from combined treatment with NTZ. Conclusions For locally advanced NPC patients treated with concurrent chemoradiotherapy, the addition of NTZ can significantly improve their survival outcome. However, it is necessary to guard against the associated increase in hematological toxicity and acute oral mucositis.
Collapse
Affiliation(s)
- Lili Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hengzhao Zhuang
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaoyan Xu
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Juying Zhou
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China,*Correspondence: Juying Zhou, ; Yang Jiao,
| | - Yang Jiao
- School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou, China,*Correspondence: Juying Zhou, ; Yang Jiao,
| |
Collapse
|
5
|
Chen Q, Shen L, Li S. Tumor volume reduction after induction chemotherapy with gemcitabine plus cisplatin in nasopharyngeal carcinoma. Eur Arch Otorhinolaryngol 2022; 280:2497-2509. [PMID: 36572820 DOI: 10.1007/s00405-022-07809-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 12/18/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To evaluate the tumor volume reduction after induction chemotherapy (IC) with gemcitabine plus cisplatin (GP) and to build prediction models for tumor volume reduction in nasopharyngeal carcinoma (NPC). METHODS NPC patients who received GP IC were retrospectively enrolled. The gross tumor volume of the nasopharynx and lymph nodes (GTVnx and GTVnd) were contoured before and after IC. Univariate and multivariate analyses were performed to identify associated factors. Nomogram models were constructed to predict the possibility of tumor volume reduction. RESULTS A total of 192 patients were enrolled. The mean relative volume reduction for GTVnx and GTVnd was 29.66% and 31.75%, respectively. The volume reduction of GTVnx and GTVnd had a weak association (r = 0.229, p < 0.001). For GTVnx volume reduction, pre-treatment neutrophil count (p = 0.043), lymphocyte count (p = 0.026), LDH level (p = 0.005), and BMI (p = 0.020) were independently associated factors. For GTVnd volume reduction, pre-treatment EBV-DNA (p = 0.029), GTVnd volume (p < 0.001), eosinophil count (p = 0.043), NLR (p = 0.039), LDH level (p = 0.026), and serum potassium level (p = 0.027) were independently associated factors. For the GTVnx nomogram model, areas under the receiver-operating characteristic curve (AUC) were 0.702 and 0.698 for the training and validation cohorts, respectively. For the GTVnd nomogram model, the AUC was 0.872 and 0.758 for the training and validation cohorts, respectively. CONCLUSIONS Tumor volumes reduce significantly after GP induction chemotherapy. Nomogram models for predicting the possibility of tumor volume reduction are built.
Collapse
Affiliation(s)
- Qian Chen
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Liangfang Shen
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Shan Li
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China.
- National Clinical Research Center for Geriatric Disorders, Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, China.
| |
Collapse
|
6
|
Papadopoulos E, Santa Mina D, Abu Helal A, Alibhai SMH. The relationship between objective measures of physical function and serum lactate dehydrogenase in older adults with cancer prior to treatment. PLoS One 2022; 17:e0275782. [PMID: 36201554 PMCID: PMC9536539 DOI: 10.1371/journal.pone.0275782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 09/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lactate dehydrogenase (LDH) reflects tumor burden and is a prognosticator of all-cause mortality in patients with cancer. Objective measures of physical function are associated with clinically relevant outcomes in older adults with cancer. However, whether physical function is associated with LDH in geriatric oncology is unknown. The objective of this study was to assess the relationship between objective measures of physical function and serum LDH in older adults with cancer prior to treatment. METHODS Data from older adults with cancer prior to treatment were retrieved from an institutional database and medical records within a tertiary cancer centre. Physical function measures involved muscle strength and physical performance. Muscle strength and physical performance were assessed through grip strength and the Short Physical Performance Battery (SPPB), respectively. LDH was log transformed using the natural logarithm. Multivariable logistic regression was used to examine the relationship between objective measures of physical function and LDH prior to treatment in all participants. Stratified analyses were performed for participants with solid and hematological cancers. RESULTS A total of 257 participants (mean age: 80.2y) were included in the analysis. Most participants were females (50.6%) and were diagnosed with locally advanced (26.8%), gastrointestinal disease (35.0%). The multivariable analysis indicated that SPPB was inversely associated with LDH in all participants (B = -0.019, 95%CI = -0.036 to -0.002, p = 0.028). Notably, the inverse relationship between SPPB and LDH persisted only in patients with hematological malignancies in the multivariable model of the stratified analysis (B = -0.049, 95%CI = -0.087 to -0.011, p = 0.013). Neither grip strength alone nor the combination of low grip strength and/or SPPB were associated with LDH. Compared to participants with metastatic disease, those with localized or locally advanced disease had lower serum LDH. CONCLUSION Physical performance is inversely associated with serum LDH in older adults with hematological cancers prior to treatment.
Collapse
Affiliation(s)
| | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Ali Abu Helal
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Shabbir M. H. Alibhai
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
- * E-mail:
| |
Collapse
|
7
|
Huang ML, Luo WL. Engrailed homeobox 1 transcriptional regulation of COL22A1 inhibits nasopharyngeal carcinoma cell senescence through the G1/S phase arrest. J Cell Mol Med 2022; 26:5473-5485. [PMID: 36196630 PMCID: PMC9639036 DOI: 10.1111/jcmm.17575] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 11/30/2022] Open
Abstract
EN1 is well known as a transcription factor in other tumours, but its role in NPC is unclear. In this study, we first used bioinformatics to analyse GEO data to obtain the differentially expressed gene EN1, and subsequently verified that EN1 was highly expressed in nasopharyngeal carcinoma cells by tissue microarrays as well as cell lines. Further, we down‐regulated the expression of EN1 in cells for RNA sequencing. The analysis of sequencing results using KEGG and GO revealed significant changes in cell proliferation and cycle function after downregulation of EN1. Meanwhile, we found that cells underwent senescence after inhibition of EN1 under electron microscopy and the SA‐β‐gal assays. Based on the sequencing results, we verified that EN1 can promote the proliferation and cycle of NPC cells in cell function experiments and animal experiments. To investigate how EN1 affects cell senescence, we found that EN1 transcriptional regulation of COL22A1 regulated cell proliferation and cycle via CDK4/6‐cyclin D1‐Rb signalling pathway by dual luciferase reporter, Immunoblotting and rescue experiment. Accordingly, we uncovered that EN1 could serve as a target for the regulation of senescence in NPC.
Collapse
Affiliation(s)
- Mao-Ling Huang
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wen-Long Luo
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
8
|
Yan T, Liu L, Yan Z, Peng M, Wang Q, Zhang S, Wang L, Zhuang X, Liu H, Ma Y, Wang B, Cui Y. A Radiomics Nomogram for Non-Invasive Prediction of Progression-Free Survival in Esophageal Squamous Cell Carcinoma. Front Comput Neurosci 2022; 16:885091. [PMID: 35651590 PMCID: PMC9149002 DOI: 10.3389/fncom.2022.885091] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/11/2022] [Indexed: 01/02/2023] Open
Abstract
To construct a prognostic model for preoperative prediction on computed tomography (CT) images of esophageal squamous cell carcinoma (ESCC), we created radiomics signature with high throughput radiomics features extracted from CT images of 272 patients (204 in training and 68 in validation cohort). Multivariable logistic regression was applied to build the radiomics signature and the predictive nomogram model, which was composed of radiomics signature, traditional TNM stage, and clinical features. A total of 21 radiomics features were selected from 954 to build a radiomics signature which was significantly associated with progression-free survival (p < 0.001). The area under the curve of performance was 0.878 (95% CI: 0.831–0.924) for the training cohort and 0.857 (95% CI: 0.767–0.947) for the validation cohort. The radscore of signatures' combination showed significant discrimination for survival status. Radiomics nomogram combined radscore with TNM staging and showed considerable improvement over TNM staging alone in the training cohort (C-index, 0.770 vs. 0.603; p < 0.05), and it is the same with clinical data (C-index, 0.792 vs. 0.680; p < 0.05), which were confirmed in the validation cohort. Decision curve analysis showed that the model would receive a benefit when the threshold probability was between 0 and 0.9. Collectively, multiparametric CT-based radiomics nomograms provided improved prognostic ability in ESCC.
Collapse
Affiliation(s)
- Ting Yan
- Key Laboratory of Cellular Physiology of the Ministry of Education, Department of Pathology, Shanxi Medical University, Taiyuan, China
| | - Lili Liu
- Key Laboratory of Cellular Physiology of the Ministry of Education, Department of Pathology, Shanxi Medical University, Taiyuan, China
| | - Zhenpeng Yan
- Key Laboratory of Cellular Physiology of the Ministry of Education, Department of Pathology, Shanxi Medical University, Taiyuan, China
| | - Meilan Peng
- Key Laboratory of Cellular Physiology of the Ministry of Education, Department of Pathology, Shanxi Medical University, Taiyuan, China
| | - Qingyu Wang
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, China
| | - Shan Zhang
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, China
| | - Lu Wang
- Key Laboratory of Cellular Physiology of the Ministry of Education, Department of Pathology, Shanxi Medical University, Taiyuan, China
| | - Xiaofei Zhuang
- Department of Thoracic Surgery, Shanxi Cancer Hospital, Taiyuan, China
| | - Huijuan Liu
- Key Laboratory of Cellular Physiology of the Ministry of Education, Department of Pathology, Shanxi Medical University, Taiyuan, China
| | - Yanchun Ma
- Key Laboratory of Cellular Physiology of the Ministry of Education, Department of Pathology, Shanxi Medical University, Taiyuan, China
| | - Bin Wang
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, China
- Bin Wang
| | - Yongping Cui
- Key Laboratory of Cellular Physiology of the Ministry of Education, Department of Pathology, Shanxi Medical University, Taiyuan, China
- *Correspondence: Yongping Cui
| |
Collapse
|
9
|
Shen DS, Yan C, Chen KH, Li L, Qu S, Zhu XD. A Nomogram Based on Circulating CD4 + T Lymphocytes and Lactate Dehydrogenase to Predict Distant Metastasis in Patients with Nasopharyngeal Carcinoma. J Inflamm Res 2021; 14:6707-6718. [PMID: 34916820 PMCID: PMC8668247 DOI: 10.2147/jir.s341897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/24/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose Distant metastasis is the main pattern of treatment failure in nasopharyngeal carcinoma (NPC) in the era of intensity-modulated radiotherapy (IMRT). We aimed to establish and validate a prognostic nomogram to identify patients with a high risk of distant metastasis. Patients and Methods A total of 503 patients with nonmetastatic NPC were included in this retrospective study. We established a prognostic nomogram for distant metastasis-free survival (DMFS) based on the Cox proportional hazards model. The predictive discriminative ability and accuracy of the nomogram were assessed with the concordance index (C-index), receiver operating characteristic (ROC) curve, and calibration curve. The nomogram’s clinical utility was also evaluated using decision curve analysis (DCA) and Kaplan–Meier method. The predictive ability of the nomogram was validated in an independent cohort. Results The multivariate analysis showed that circulating CD4+ T lymphocytes, lactate dehydrogenase (LDH), serum ferritin (SF), and N stage were independent prognostic factors for DMFS. Then, we constructed the nomogram based on these factors. The C-indexes of the nomogram for distant metastasis were 0.763 (95% CI: 0.685–0.841) and 0.760 (95% CI: 0.643–0.877) in the training cohort and validation cohort, respectively, which was higher than the 8th TNM staging system (0.672 and 0.677). The calibration curve showed that the prediction results of the nomogram were in high agreement with the actual observation. The ROC curve indicated that the nomogram had a better predictive ability than TNM staging. The DCA also demonstrated that the nomogram was clinically beneficial. In addition, the patients were classified into two different risk groups (high-risk, low-risk) by the nomogram. Conclusion As a supplement to TNM staging, our nomogram could provide a more effective and accurate prognostic prediction of distant metastasis in NPC patients. It has the potential to guide the individualized treatment of patients to improve their survival.
Collapse
Affiliation(s)
- De-Song Shen
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530021, People's Republic of China
| | - Chang Yan
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530021, People's Republic of China
| | - Kai-Hua Chen
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530021, People's Republic of China
| | - Ling Li
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530021, People's Republic of China
| | - Song Qu
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530021, People's Republic of China
| | - Xiao-Dong Zhu
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530021, People's Republic of China.,Department of Oncology, Wuming Hospital of Guangxi Medical University, Nanning, Guangxi, 530199, People's Republic of China
| |
Collapse
|
10
|
Gao Y, Mao Y, Lu S, Tan L, Li G, Chen J, Huang D, Zhang X, Qiu Y, Liu Y. Magnetic resonance imaging-based radiogenomics analysis for predicting prognosis and gene expression profile in advanced nasopharyngeal carcinoma. Head Neck 2021; 43:3730-3742. [PMID: 34516714 DOI: 10.1002/hed.26867] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 07/25/2021] [Accepted: 08/31/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND To establish a radiomics nomogram for survival prediction and determine if genomic data were related to radiomics signature in advanced nasopharyngeal carcinoma (NPC). METHODS Radiomics features were extracted from contrast-enhanced T1-weighted images (CE-T1WI) in 316 patients. A progression-free survival (PFS) nomogram was developed and validated by the combination of the radiomics signature and clinicopathologic factors. Whole transcriptomics sequencing was performed in pretreatment tumor samples; correlation of gene expression and radiomics signature was further investigated. RESULTS A 24-feature-combined radiomics signature was highly correlated with PFS; its integration with clinical predictors showed good prediction performance in the training and the validation cohort (C-index: 0.80 and 0.73). A significant correlation was observed between certain gene expression and Rad-score, especially the mRNA expression of CDKL2, PLIN5, and SPAG1. CONCLUSION As a noninvasive method, the MRI-based radiomics signature might enable the pretreatment prediction of prognosis and gene expressions profile in advanced NPC.
Collapse
Affiliation(s)
- Yan Gao
- Department of Otolaryngology - Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China.,Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Changsha, China
| | - Yitao Mao
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Shanhong Lu
- Department of Otolaryngology - Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China.,Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Changsha, China
| | - Lei Tan
- College of Computer and Information Engineering, Hunan University of Technology and Business, Changsha, China
| | - Guo Li
- Department of Otolaryngology - Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China.,Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Changsha, China
| | - Juan Chen
- Department of Otolaryngology - Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China.,Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Changsha, China
| | - Donghai Huang
- Department of Otolaryngology - Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China.,Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Changsha, China
| | - Xin Zhang
- Department of Otolaryngology - Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China.,Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Changsha, China
| | - Yuanzheng Qiu
- Department of Otolaryngology - Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China.,Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| | - Yong Liu
- Department of Otolaryngology - Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China.,Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| |
Collapse
|
11
|
Spadarella G, Calareso G, Garanzini E, Ugga L, Cuocolo A, Cuocolo R. MRI based radiomics in nasopharyngeal cancer: Systematic review and perspectives using radiomic quality score (RQS) assessment. Eur J Radiol 2021; 140:109744. [PMID: 33962253 DOI: 10.1016/j.ejrad.2021.109744] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND MRI based radiomics has the potential to better define tumor biology compared to qualitative MRI assessment and support decisions in patients affected by nasopharyngeal carcinoma. Aim of this review was to systematically evaluate the methodological quality of studies using MRI- radiomics for nasopharyngeal cancer patient evaluation. METHODS A systematic search was performed in PUBMED, WEB OF SCIENCE and SCOPUS using "MRI, magnetic resonance imaging, radiomic, texture analysis, nasopharyngeal carcinoma, nasopharyngeal cancer" in all possible combinations. The methodological quality of study included ( = 24) was evaluated according to the RQS (Radiomic quality score). Subgroup, for journal type (imaging/clinical) and biomarker (prognostic/predictive), and correlation, between RQS and journal Impact Factor, analyses were performed. Mann-Whitney U test and Spearman's correlation were performed. P value < .05 were defined as statistically significant. RESULTS Overall, no studies reported a phantom study or a test re-test for assessing stability in image, biological correlation or open science data. Only 8% of them included external validation. Almost half of articles (45 %) performed multivariable analysis with non-radiomics features. Only 1 study was prospective (4%). The mean RQS was 7.5 ± 5.4. No significant differences were detected between articles published in clinical/imaging journal and between studies with a predictive or prognostic biomarker. No significant correlation was found between total RQS and Impact Factor of the year of publication (p always > 0.05). CONCLUSIONS Radiomic articles in nasopharyngeal cancer are mostly of low methodological quality. The greatest limitations are the lack of external validation, biological correlates, prospective design and open science.
Collapse
Affiliation(s)
- Gaia Spadarella
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy.
| | - Giuseppina Calareso
- Department of Radiology, Fondazione IRCCS, Istituto Nazionale Dei Tumori, Milan, Italy
| | - Enrico Garanzini
- Department of Radiology, Fondazione IRCCS, Istituto Nazionale Dei Tumori, Milan, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Renato Cuocolo
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy; Laboratory of Augmented Reality for Health Monitoring (ARHeMLab), Department of Electrical Engineering and Information Technology, University of Naples "Federico II", Naples, Italy
| |
Collapse
|
12
|
Wu J, You K, Chen C, Zhong H, Jiang Y, Mo H, Song J, Qiu X, Liu Y. High Pretreatment LDH Predicts Poor Prognosis in Hypopharyngeal Cancer. Front Oncol 2021; 11:641682. [PMID: 33777804 PMCID: PMC7991725 DOI: 10.3389/fonc.2021.641682] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/02/2021] [Indexed: 12/30/2022] Open
Abstract
Background Elevated pretreatment lactate dehydrogenase (LDH) has been associated with poor prognosis in various malignancies; however, its prognostic role in hypopharyngeal cancer remains elusive. In this study, we aimed to assess the association between pretreatment LDH and clinical outcome of hypopharyngeal cancer. Methods We retrospectively collected 198 hypopharyngeal cancer patients treated with surgery in our institution between 2004 and 2018. The prognostic role of pretreatment LDH was explored by using univariate and multivariate analyses. Besides, subgroup analysis was performed based on T stage. Results Three-year and Five-year of disease-free survival (DFS, 67.0 vs. 57.4%, 65.8 vs. 39.8%, p = 0.007) and overall survival (OS, 74.8 vs. 68.9%, 66.8 vs. 50.8%, p = 0.006) exhibited significant differences between low LDH level and high LDH level groups. Univariate analysis showed that pretreatment elevated serum LDH served as an unfavorable determinant with regard to DFS and OS. Further multivariate analysis also confirmed that LDH was an independent predictor for DFS and OS. Additionally, N status and age were also found to be significantly associated with both DFS and OS. Conclusion Pretreatment elevated serum LDH is an inferior prognostic factor for patients with hypopharyngeal cancer. These results should be validated by more multicenter and prospective studies.
Collapse
Affiliation(s)
- Jialing Wu
- Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Kaiyun You
- Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Changlong Chen
- Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Huimin Zhong
- Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yanhui Jiang
- Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Huaqian Mo
- Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Juanjuan Song
- Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xingsheng Qiu
- Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yimin Liu
- Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| |
Collapse
|
13
|
Huang D, Liu Q, Zhang W, Huang C, Zheng R, Xie G, Wang H, Jia B, Shi J, Yuan Y, Deng M. Identified IGSF9 association with prognosis and hypoxia in nasopharyngeal carcinoma by bioinformatics analysis. Cancer Cell Int 2020; 20:498. [PMID: 33061850 PMCID: PMC7552377 DOI: 10.1186/s12935-020-01587-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/01/2020] [Indexed: 12/24/2022] Open
Abstract
Background Despite improvements in nasopharyngeal carcinoma (NPC) treatment, patients with recurrence and metastasis still have a poor prognosis. Thus, the identification of novel biomarkers is urgently needed to predict outcomes and tailor treatment for NPC. Methods Four data sets were downloaded from Gene Expression Omnibus, and one data set GSE68799 of which was applied to filtrate key modules and hub genes by construction of a co-expression network. Other data sets (GSE12452 and GSE53819) were used to verify hub genes. The data set GSE102349 was devoted to identify prognostic hub genes by survival analysis. To explored whether prognostic hub genes are related to hypoxia signatures in NPC, correlation analysis was carried out, and followed by functional verification experiments of those genes in vitro. Results By co-expression network analysis, blue module was regarded as a key module in the benign and malignant group, and IGSF9 of the blue module was identified as a prognostic hub gene. Moreover, IGSF9 is expected to be a innovative hypoxia-related gene in NPC based on the strong associativity between expression of IGSF9 and hypoxia scores of three signatures (99-gene, 26-gene and 15-gene). Further functional studies verified that down-regulated expression of IGSF9 could reduce the proliferation, migration and invasion ability of NPC cells, and hypoxia could induce the expression of IGSF9. Conclusion IGSF9 was identified to be relevant to prognosis and involved in hypoxia in NPC. IGSF9 might serve as one novel prognostic indicator of NPC in the future.
Collapse
Affiliation(s)
- Donglan Huang
- Department of Radiation Oncology, Institute of Cancer Research, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Qianqian Liu
- Department of Radiation Oncology, Institute of Cancer Research, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China.,Department of Gynecological Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Weijun Zhang
- Department of Radiation Oncology, Institute of Cancer Research, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Chunyue Huang
- Department of Radiation Oncology, Institute of Cancer Research, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Ronghui Zheng
- Department of Radiation Oncology, Institute of Cancer Research, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Guofeng Xie
- Department of Radiation Oncology, Institute of Cancer Research, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Hongmei Wang
- Department of Radiation Oncology, Institute of Cancer Research, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Baochang Jia
- Department of Radiation Oncology, Institute of Cancer Research, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Jianjun Shi
- Department of Radiation Oncology, Institute of Cancer Research, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Yawei Yuan
- Department of Radiation Oncology, Institute of Cancer Research, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Min Deng
- Department of Radiation Oncology, Institute of Cancer Research, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| |
Collapse
|
14
|
Akcay M, Etiz D, Celik O, Ozen A. Evaluation of Prognosis in Nasopharyngeal Cancer Using Machine Learning. Technol Cancer Res Treat 2020; 19:1533033820909829. [PMID: 32138606 PMCID: PMC7066591 DOI: 10.1177/1533033820909829] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND AIM Although the prognosis of nasopharyngeal cancer largely depends on a classification based on the tumor-lymph node metastasis staging system, patients at the same stage may have different clinical outcomes. This study aimed to evaluate the survival prognosis of nasopharyngeal cancer using machine learning. SETTINGS AND DESIGN Original, retrospective. MATERIALS AND METHODS A total of 72 patients with a diagnosis of nasopharyngeal cancer who received radiotherapy ± chemotherapy were included in the study. The contribution of patient, tumor, and treatment characteristics to the survival prognosis was evaluated by machine learning using the following techniques: logistic regression, artificial neural network, XGBoost, support-vector clustering, random forest, and Gaussian Naive Bayes. RESULTS In the analysis of the data set, correlation analysis, and binary logistic regression analyses were applied. Of the 18 independent variables, 10 were found to be effective in predicting nasopharyngeal cancer-related mortality: age, weight loss, initial neutrophil/lymphocyte ratio, initial lactate dehydrogenase, initial hemoglobin, radiotherapy duration, tumor diameter, number of concurrent chemotherapy cycles, and T and N stages. Gaussian Naive Bayes was determined as the best algorithm to evaluate the prognosis of machine learning techniques (accuracy rate: 88%, area under the curve score: 0.91, confidence interval: 0.68-1, sensitivity: 75%, specificity: 100%). CONCLUSION Many factors affect prognosis in cancer, and machine learning algorithms can be used to determine which factors have a greater effect on survival prognosis, which then allows further research into these factors. In the current study, Gaussian Naive Bayes was identified as the best algorithm for the evaluation of prognosis of nasopharyngeal cancer.
Collapse
Affiliation(s)
- Melek Akcay
- Department of Radiation Oncology, Medical Faculty of Osmangazi University, Eskişehir, Turkey
| | - Durmus Etiz
- Department of Radiation Oncology, Medical Faculty of Osmangazi University, Eskişehir, Turkey
| | - Ozer Celik
- Department of Mathematics-Computer, Eskisehir Osmangazi University, Eskişehir, Turkey
| | - Alaattin Ozen
- Department of Radiation Oncology, Medical Faculty of Osmangazi University, Eskişehir, Turkey
| |
Collapse
|
15
|
Long G, Tang W, Fu X, Liu D, Zhang L, Hu G, Hu G, Sun W. Pre-treatment Serum Lactate Dehydrogenase Predicts Distant Metastasis and Poor Survival in Nasopharyngeal Carcinoma. J Cancer 2019; 10:3657-3664. [PMID: 31333783 PMCID: PMC6636291 DOI: 10.7150/jca.32716] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 05/16/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Pre-treatment serum lactate dehydrogenase (LDH) has emerged as prognostic factor for many cancers. In this study, we evaluated the value of LDH in predicting distant metastasis and poor survival for patients with nasopharyngeal carcinoma (NPC). Methods: Clinical data from 172 non-metastatic NPC patients were retrospectively collected and serum LDH levels were routinely measured before treatment. The independent-samples t test was used to calculate differences between serum LDH levels from the various patient groups. Receiver-operating characteristic (ROC) curve analysis was performed to select the optimal cutoff points. The Kaplan-Meier method and log-rank test were adopted to calculate and compare the distant metastasis free survival (DMFS) and overall survival (OS) rates. The Cox proportional hazards model was used to carry out univariate and multivariate analyses. Results: NPC patients progressed with distant metastasis often have higher pre-treatment serum LDH levels than those did not develop distant metastasis (mean LDH level was 237.1U/L and 108.8U/L, respectively, p=0.001). Elevated LDH level was identified as an independent prognostic factor for poor DMFS (hazard ratio (HR), 8.31; 95% confidence interval (CI), 2.44-28.32; p=0.001) and OS (HR, 4.45; 95% CI, 1.77-11.21; p=0.002). Moreover, subgroup analyses revealed significant associations between serum LDH level and worse survival in advanced stage patients. Conclusions: Pre-treatment serum LDH level can predict distant metastasis and associate with the poor survival in patients with NPC.
Collapse
Affiliation(s)
- Guoxian Long
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan 430030, People's Republic of China
| | - Wenhua Tang
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan 430030, People's Republic of China
| | - Xiugen Fu
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan 430030, People's Republic of China
| | - DongBo Liu
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan 430030, People's Republic of China
| | - LinLi Zhang
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan 430030, People's Republic of China
| | - Guangyuan Hu
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan 430030, People's Republic of China
| | - Guoqing Hu
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan 430030, People's Republic of China
| | - Wei Sun
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan 430030, People's Republic of China
| |
Collapse
|
16
|
Lactate Dehydrogenases as Metabolic Links between Tumor and Stroma in the Tumor Microenvironment. Cancers (Basel) 2019; 11:cancers11060750. [PMID: 31146503 PMCID: PMC6627402 DOI: 10.3390/cancers11060750] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/20/2019] [Accepted: 05/23/2019] [Indexed: 02/07/2023] Open
Abstract
Cancer is a metabolic disease in which abnormally proliferating cancer cells rewire metabolic pathways in the tumor microenvironment (TME). Molecular reprogramming in the TME helps cancer cells to fulfill elevated metabolic demands for bioenergetics and cellular biosynthesis. One of the ways through which cancer cell achieve this is by regulating the expression of metabolic enzymes. Lactate dehydrogenase (LDH) is the primary metabolic enzyme that converts pyruvate to lactate and vice versa. LDH also plays a significant role in regulating nutrient exchange between tumor and stroma. Thus, targeting human lactate dehydrogenase for treating advanced carcinomas may be of benefit. LDHA and LDHB, two isoenzymes of LDH, participate in tumor stroma metabolic interaction and exchange of metabolic fuel and thus could serve as potential anticancer drug targets. This article reviews recent research discussing the roles of lactate dehydrogenase in cancer metabolism. As molecular regulation of LDHA and LDHB in different cancer remains obscure, we also review signaling pathways regulating LDHA and LDHB expression. We highlight on the role of small molecule inhibitors in targeting LDH activity and we emphasize the development of safer and more effective LDH inhibitors. We trust that this review will also generate interest in designing combination therapies based on LDH inhibition, with LDHA being targeted in tumors and LDHB in stromal cells for better treatment outcome.
Collapse
|
17
|
Koukourakis MI, Giatromanolaki A. Warburg effect, lactate dehydrogenase, and radio/chemo-therapy efficacy. Int J Radiat Biol 2018; 95:408-426. [PMID: 29913092 DOI: 10.1080/09553002.2018.1490041] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The anaerobic metabolism of glucose by cancer cells, even under well-oxygenated conditions, has been documented by Otto Warburg as early as 1927. Micro-environmental hypoxia and intracellular pathways activating the hypoxia-related gene response, shift cancer cell metabolism to anaerobic pathways. In the current review, we focus on a major enzyme involved in anaerobic transformation of pyruvate to lactate, namely lactate dehydrogenase 5 (LDH5). The value of LDH5 as a marker of prognosis of cancer patients, as a predictor of response to radiotherapy (RT) and chemotherapy and, finally, as a major target for cancer treatment and radio-sensitization is reported and discussed. Clinical, translational and experimental data supporting the uniqueness of the LDHA gene and its product LDH5 isoenzyme are summarized and future directions for a metabolic treatment of cancer are highlighted.
Collapse
Affiliation(s)
- Michael I Koukourakis
- a Department of Radiotherapy and Oncology, Medical School, Democritus University of Thrace , Alexandroupolis , Greece
| | - Alexandra Giatromanolaki
- b Department of Pathology , Medical School, Democritus University of Thrace , Alexandroupolis , Greece
| |
Collapse
|
18
|
Wu X, Xiao J, Zhao C, Zhao C, Han Z, Wang F, Yang Y, Jiang Y, Fang F. Claudin1 promotes the proliferation, invasion and migration of nasopharyngeal carcinoma cells by upregulating the expression and nuclear entry of β-catenin. Exp Ther Med 2018; 16:3445-3451. [PMID: 30233694 PMCID: PMC6143911 DOI: 10.3892/etm.2018.6619] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 01/26/2018] [Indexed: 02/05/2023] Open
Abstract
The aim of the present study was to measure the expression of Claudin (CLDN) 1 in nasopharyngeal carcinoma (NPC) and to determine its biological function and mechanism of action. Reverse transcription-quantitative polymerase chain reaction and western blotting were performed to measure the expression of CLDN1 mRNA and protein, respectively, in the immortalized human nasopharyngeal epithelial cell line NP69 and NPC-TW01 cells. Subsequently, small interfering RNA against CLDN1 and the LV-GFP-PURO-CLDN1 lentivirus were transfected into NPC-TW01 cells. Western blotting was used to determine the effects of CLDN1 down- and upregulation on the expression of the epithelial mesenchymal transition (EMT) markers E-cadherin and vimentin. In addition, the effect of CLDN1 on the expression of β-Catenin was determined. The results demonstrated that levels of CLDN1 mRNA and protein in NPC cells were significantly higher than in NP69 cells. Furthermore, the downregulation of CLDN1 inhibited the proliferation, invasion and migration of NPC-TW01 cells. The results of western blotting demonstrated that the downregulation of CLDN1 resulted in the upregulation of E-cadherin and inhibition of vimentin in NPC-TW01 cells. By contrast, the overexpression of CLDN1 resulted in the downregulation of E-cadherin and upregulation of vimentin in NPC-TW01 cells. The downregulation of β-catenin attenuated the cancer-promoting effect of CLDN1 on NPC-TW01 cells, whereas the upregulation of β-catenin reversed the tumor-suppressing effect of CLDN1 downregulation on NPC-TW01 cells. The results of the present study therefore demonstrate that CLDN1 expression is elevated in NPC cells. As an oncogene, CLDN1 promotes the proliferation, invasion and migration of NPC cells by upregulating the expression and nuclear entry of β-catenin.
Collapse
Affiliation(s)
- Xin Wu
- Department of Head and Neck Cancer, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Jianghong Xiao
- Department of Radiation Physics, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Chong Zhao
- Department of Radiotherapy, Tumor Hospital of Chengdu, The Seventh People's Hospital of Chengdu, Chengdu, Sichuan 610041, P.R. China
| | - Chengjian Zhao
- State Key Laboratory of Biotherapy and Cancer Center, West China Medical School, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Zhongcheng Han
- Department of Oncology, Xinjiang Uygur Autonomous Region People's Hospital, Urumqi, Xinjiang 830001, P.R. China
| | - Feng Wang
- Department of Head and Neck Cancer, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Yuqiong Yang
- Department of Head and Neck Cancer, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Yu Jiang
- Department of Head and Neck Cancer, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Fang Fang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| |
Collapse
|
19
|
Takenaka Y, Oya R, Aoki K, Hamaguchi H, Takemura K, Nozawa M, Kitamura T, Yamamoto Y, Uno A. Pretreatment serum lactate dehydrogenase as a prognostic indicator for oral cavity squamous cell carcinoma. Acta Otolaryngol 2018; 138:433-436. [PMID: 29233054 DOI: 10.1080/00016489.2017.1398839] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To examine whether lactate dehydrogenase (LDH) can predict the prognosis of oral cavity squamous cell carcinoma (OSCC) and to determine the optimal cut-off values for LDH. METHODS This retrospective study included 184 patients with OSCC, treated with surgery between 2006 and 2014. The association between LDH and T, N classification was investigated using the Mann-Whitney test. Cut-off values for LDH were determined with a recursive partitioning analysis (RPA). Survival rates were estimated using the Kaplan-Meier method. A Cox hazard model was used to assess the prognostic capability of LDH. RESULTS There was no association between LDH and T or N classification (p = .657, .619, respectively). RPA determined the cut-off values for LDH as 160 and 220 IU/L. The five year survival for low-, moderate-, and high-LDH groups were 87.7, 73.7, and 50.9%, respectively (p < .001). The hazard ratios (HRs) for death in moderate- and high-LDH groups were 2.92 (95%CI =1.02-12.30, p = .001) and 7.36 (95%CI =2.54-31.20, p < .001), respectively. The model including LDH-based stratification (Akaike's information criterion (AIC) = 516) was better than the model including clinical stage (AIC =528). CONCLUSION Pretreatment serum LDH is an independent prognostic factor for overall survival in patients with OSCC.
Collapse
Affiliation(s)
- Yukinori Takenaka
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
| | - Ryohei Oya
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
| | - Kengo Aoki
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
| | - Hiroko Hamaguchi
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
| | - Kazuya Takemura
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
| | - Masayuki Nozawa
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
| | - Takahiro Kitamura
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
| | - Yoshifumi Yamamoto
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
| | - Atsuhiko Uno
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
| |
Collapse
|
20
|
Zhang B, Tian J, Dong D, Gu D, Dong Y, Zhang L, Lian Z, Liu J, Luo X, Pei S, Mo X, Huang W, Ouyang F, Guo B, Liang L, Chen W, Liang C, Zhang S. Radiomics Features of Multiparametric MRI as Novel Prognostic Factors in Advanced Nasopharyngeal Carcinoma. Clin Cancer Res 2017; 23:4259-4269. [PMID: 28280088 DOI: 10.1158/1078-0432.ccr-16-2910] [Citation(s) in RCA: 349] [Impact Index Per Article: 49.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 12/19/2016] [Accepted: 03/06/2017] [Indexed: 02/05/2023]
Abstract
Purpose: To identify MRI-based radiomics as prognostic factors in patients with advanced nasopharyngeal carcinoma (NPC).Experimental Design: One-hundred and eighteen patients (training cohort: n = 88; validation cohort: n = 30) with advanced NPC were enrolled. A total of 970 radiomics features were extracted from T2-weighted (T2-w) and contrast-enhanced T1-weighted (CET1-w) MRI. Least absolute shrinkage and selection operator (LASSO) regression was applied to select features for progression-free survival (PFS) nomograms. Nomogram discrimination and calibration were evaluated. Associations between radiomics features and clinical data were investigated using heatmaps.Results: The radiomics signatures were significantly associated with PFS. A radiomics signature derived from joint CET1-w and T2-w images showed better prognostic performance than signatures derived from CET1-w or T2-w images alone. One radiomics nomogram combined a radiomics signature from joint CET1-w and T2-w images with the TNM staging system. This nomogram showed a significant improvement over the TNM staging system in terms of evaluating PFS in the training cohort (C-index, 0.761 vs. 0.514; P < 2.68 × 10-9). Another radiomics nomogram integrated the radiomics signature with all clinical data, and thereby outperformed a nomogram based on clinical data alone (C-index, 0.776 vs. 0.649; P < 1.60 × 10-7). Calibration curves showed good agreement. Findings were confirmed in the validation cohort. Heatmaps revealed associations between radiomics features and tumor stages.Conclusions: Multiparametric MRI-based radiomics nomograms provided improved prognostic ability in advanced NPC. These results provide an illustrative example of precision medicine and may affect treatment strategies. Clin Cancer Res; 23(15); 4259-69. ©2017 AACR.
Collapse
Affiliation(s)
- Bin Zhang
- Department of Radiology, Guangdong General Hospital/Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
- Graduate College, Southern Medical University, Guangzhou, Guangdong, P.R. China
| | - Jie Tian
- Key Laboratory of Molecular Imaging, Chinese Academy of Science, Beijing, P.R. China
| | - Di Dong
- Key Laboratory of Molecular Imaging, Chinese Academy of Science, Beijing, P.R. China
| | - Dongsheng Gu
- Key Laboratory of Molecular Imaging, Chinese Academy of Science, Beijing, P.R. China
| | - Yuhao Dong
- Department of Radiology, Guangdong General Hospital/Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
- Shantou University Medical College, Guangdong, P.R. China
| | - Lu Zhang
- Department of Radiology, Guangdong General Hospital/Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
- Graduate College, Southern Medical University, Guangzhou, Guangdong, P.R. China
| | - Zhouyang Lian
- Department of Radiology, Guangdong General Hospital/Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
- Graduate College, Southern Medical University, Guangzhou, Guangdong, P.R. China
| | - Jing Liu
- Department of Radiology, Guangdong General Hospital/Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
- Graduate College, Southern Medical University, Guangzhou, Guangdong, P.R. China
| | - Xiaoning Luo
- Department of Radiology, Guangdong General Hospital/Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
- Graduate College, Southern Medical University, Guangzhou, Guangdong, P.R. China
| | - Shufang Pei
- Department of Radiology, Guangdong General Hospital/Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
- Graduate College, Southern Medical University, Guangzhou, Guangdong, P.R. China
| | - Xiaokai Mo
- Department of Radiology, Guangdong General Hospital/Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
- Shantou University Medical College, Guangdong, P.R. China
| | - Wenhui Huang
- Department of Radiology, Guangdong General Hospital/Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, P.R. China
| | - Fusheng Ouyang
- Department of Radiology, Guangdong General Hospital/Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
- Graduate College, Southern Medical University, Guangzhou, Guangdong, P.R. China
| | - Baoliang Guo
- Department of Radiology, Guangdong General Hospital/Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
- Graduate College, Southern Medical University, Guangzhou, Guangdong, P.R. China
| | - Long Liang
- Department of Radiology, Guangdong General Hospital/Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
- Graduate College, Southern Medical University, Guangzhou, Guangdong, P.R. China
| | - Wenbo Chen
- Department of Radiology, Huizhou Municipal Central Hospital, Huizhou, Guangdong, P.R. China
| | - Changhong Liang
- Department of Radiology, Guangdong General Hospital/Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China
| | - Shuixing Zhang
- Department of Radiology, Guangdong General Hospital/Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China.
| |
Collapse
|
21
|
Li JP, Chen SL, Liu XM, He X, Xing S, Liu YJ, Lin YH, Liu WL. A Novel Inflammation-Based Stage (I Stage) Predicts Overall Survival of Patients with Nasopharyngeal Carcinoma. Int J Mol Sci 2016; 17:E1900. [PMID: 27854304 PMCID: PMC5133899 DOI: 10.3390/ijms17111900] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 11/02/2016] [Accepted: 11/08/2016] [Indexed: 02/07/2023] Open
Abstract
Recent studies have indicated that inflammation-based prognostic scores, such as the Glasgow Prognostic Score (GPS), modified GPS (mGPS) and C-reactive protein/Albumin (CRP/Alb) ratio, platelet-lymphocyte ratio (PLR), and neutrophil-lymphocyte ratio (NLR), have been reported to have prognostic value in patients with many types of cancer, including nasopharyngeal carcinoma (NPC). In this study, we proposed a novel inflammation-based stage, named I stage, for patients with NPC. A retrospective study of 409 newly-diagnosed cases of NPC was conducted. The prognostic factors (GPS, mGPS, CRP/Alb ratios, PLR, and NLR) were evaluated using univariate and multivariate analyses. Then, according to the results of the multivariate analyses, we proposed a I stage combination of independent risk factors (CRP/Alb ratio and PLR). The I stage was calculated as follows: patients with high levels of CRP/Alb ratio (>0.03) and PLR (>146.2) were defined as I2; patients with one or no abnormal values were defined as I1 or I0, respectively. The relationships between the I stage and clinicopathological variables and overall survival (OS) were evaluated. In addition, the discriminatory ability of the I stage with other inflammation-based prognostic scores was assessed using the AUCs (areas under the curves) analyzed by receiver operating characteristics (ROC) curves. The p value of <0.05 was considered to be significant. A total of 409 patients with NPC were enrolled in this study. Multivariate analyses revealed that only the CRP/Alb ratio (Hazard ratio (HR) = 2.093; 95% Confidence interval (CI): 1.222-3.587; p = 0.007) and PLR (HR: 2.003; 95% CI: 1.177-3.410; p = 0.010) were independent prognostic factors in patients with NPC. The five-year overall survival rates for patients with I0, I1, and I2 were 92.1% ± 2.9%, 83.3% ± 2.6%, and 63.1% ± 4.6%, respectively (p < 0.001). The I stage had a higher area under the curve value (0.670) compared with other systemic inflammation-based prognostic scores (p < 0.001). The I stage is a novel and useful predictive factor for OS in patients with NPC.
Collapse
Affiliation(s)
- Jian-Pei Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Clinical Laboratory Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China.
| | - Shu-Lin Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Clinical Laboratory Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China.
| | - Xiao-Min Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Clinical Laboratory Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China.
| | - Xia He
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Clinical Laboratory Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China.
| | - Shan Xing
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Clinical Laboratory Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China.
| | - Yi-Jun Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Clinical Laboratory Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China.
| | - Yue-Hao Lin
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Clinical Laboratory Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China.
| | - Wan-Li Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Clinical Laboratory Medicine, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China.
| |
Collapse
|