[The effect of peripheral blood cell score on the prognosis of multiple myeloma patients treated with bortezomib]

目的

评估外周血细胞检测结果在以硼替佐米为一线治疗的多发性骨髓瘤（MM）患者中的预后作用。

方法

回顾性分析2014年1月至2016年12月浙江大学医学院附属第一医院和浙江省舟山医院收治的155例初诊MM患者的临床数据，患者均一线接受以硼替佐米为基础方案的治疗。分析外周血细胞检测结果，包括ANC、单核细胞计数（AMC）、HGB、红细胞平均体积（MCV）、PLT以及其他临床特征对MM患者的预后评估作用。

结果

AMC（>0.6×10⁹/L）、MCV（>99.1fl）以及PLT（<150×10⁹/L）明显影响MM患者无进展生存（PFS）和总生存（OS），以上3个因子分别赋值1分，形成血细胞积分。结果显示，64例（41.3％）积分0，57例（36.8％）积分1，32例（20.6％）积分2，2例（1.3％）积分3，4组患者中位PFS时间分别为42.8、26.5、15.8、6.4个月（P<0.001），中位OS时间分别为未达到和48.2、31.1、31.4个月（P＝0.001）。多因素分析提示，血细胞积分（2～3对0～1）和骨髓浆细胞比例（>30％对≤30％）为PFS的独立预后因素（HR分别为1.95和1.76），而患者年龄（>65岁对≤65岁）、R-ISS分期（Ⅲ期对Ⅰ～Ⅱ期）和血细胞积分（2～3对0～1）是OS的独立预后因素（HR分别为2.08、2.13和2.12）。

结论

血细胞积分简单易得，可用于新药时代初治MM患者的预后评估，但仍需扩大病例并进行前瞻性研究进一步明确。

Death-associated protein kinase promoter methylation correlates with clinicopathological and prognostic features in nonsmall cell lung cancer patients: A cohort study

Objective

The objective was to study the correlation between death-associated protein kinase (DAPK) promoter methylation and the clinicopathological and prognostic features in nonsmall cell lung cancer (NSCLC) patients.

Materials and Methods

A total of 117 NSCLC patients were recruited into our study between December 2012 and December 2014. Methylation-specific polymerase chain reaction was employed to detect the methylation status of DAPK in cancer tissues, peficancerous tissues, and serum samples of 117 NSCLC patients. In addition, serum samples of 115 healthy subjects were analyzed as controls. A literature search of English and Chinese databases, based on predefined criteria, identified published studies closely related to this study. Data were extracted, and meta-analysis was performed using STATA 12.0 software (STATA Corporation, College Station, TX, USA).

Results

Our study results showed that DAPK promoter methylation frequency was significantly higher in NSCLC tissues compared to peficancerous normal tissues (58.1% vs. 12.8%, χ² = 52.45, P < 0.001). When serum samples were compared, DAPK methylation frequency in NSCLC patients was higher than the control group (27.4% vs. 0, χ² = 37.07, P < 0.001). Our meta-analysis results demonstrated that DAPK methylation frequency was lower in tumor node metastasis (TNM) stage I-II compared to TNM stage III-IV (relative risk [RR] =0.87, 95% confidence interval [CI] =0.76-0.99, P = 0.041). DAPK promoter methylation frequency in NSCLC patients with lymph node metastasis was significantly higher compared to the patients with no metastases (RR = 1.26, 95% CI = 1.04-1.52, P = 0.020). Finally, the 5-year survival rate was lower in NSCLC patient group with high frequency of DAPK methylation, compared to the patient group with unmethylated DAPK (RR = 0.71, 95% CI = 0.56-0.89, P = 0.004).

Conclusion

Our results showed that DAPK promoter methylation is tightly correlated with clinicopathological features of NSCLC and is associated with poor prognosis in patients.

DAPK promoter methylation status correlates with tumor metastasis and poor prognosis in patients with non-small cell lung cancer

OBJECTIVE

This meta-analysis investigated the correlation between the promoter methylation of death-associated protein kinase (DAPK) and the clinicopathological features in patients with non-small cell lung cancer (NSCLC).

METHOD

Scientific literature databases were exhaustively searched to retrieve published studies relevant to DAPK methylation and NSCLC. Retrieved studies published in English and Chinese languages were screened according to the stringent predefined inclusion and exclusion criteria, and high quality studies were selected for meta-analysis. All statistical analyses were performed utilizing STATA software (Version 12.0, Stata Corporation, College Station, TX, USA).

RESULTS

A total of 14 published studies (5 in English and 9 in Chinese) were enrolled in the present meta-analysis, and contained 1238 patients with NSCLC. The results indicated that NSCLC patients with metastatic phenotype were strongly associated with significantly higher methylation rate of DAPK compared to NSCLC patients without metastasis. Additionally, in NSCLC patients carrying tumors with DAPK methylation, the 5-year survival rate was remarkedly lower than NSCLC patients without DAPK methylation. However, we did not find significant correlation between DAPK methylation and histological stage or tumor node metastasis (TNM) stage in NSCLC patients.

CONCLUSION

Our meta-analysis results reveal that DAPK promoter methylation might be associated with tumor metastasis and poor prognosis in NSCLC patients, although no correlation with histological types and TNM stage in NSCLC patients were found.

[Inflammatory myofibroblastic tumor of the larynx: a case report]

Inflammatory myofibroblastic tumor(IMT) is a kind of mesenchymal tumor. It commonly occurs in the lungs. It rarely occurs in head and neck. A 81 years old man presented to the otolaryngology clinic with hoarseness for 40 days. Electron laryngoscopy revealed a right vocal mass(10 mm×10 mm). Under MRI, the lesion in right vocal fold was shown as soft tissue mass with unclear border, and had a slightly hyperintense on T1 weighted images and slightly hyperintense on T2 weighted images.The histopathological result showed that fibrous connective tissue was infiltrated by various kinds of inflammatory cells including lymphocytes and plasma cells with marked atypia and mitoses, and angiogenesis was also found in the lesion. Immunochemistry showed that smooth muscle actin(SMA) (+), Ki 67(40%), S 100(-), Desmin(-), CD34(-),CK(-), and anaplastic lymphoma kinase protein(-). The histopathological result suggested that the lesion was inflammatory myofibroblastic tumor.

Intensity-modulated radiotherapy and volumetric-modulated arc therapy have distinct clinical advantages in non-small cell lung cancer treatment

This study was conducted to compare the efficacy of intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) in delivering the planned dosage in the treatment of non-small cell lung cancer (NSCLC). Between September 2013 and March 2014, 125 NSCLC patients were randomly chosen and allocated to the IMRT group (n = 65) and VMAT group (n = 60). We compared multiple parameters such as target dose, organ dosimetry, monitor unit (MU) and time of therapy between IMRT and VMAT groups. The prescribed dose coverage of both planning techniques was 95 % of the planning target volumes (PTVs). PTV 95 % and homogeneous index in IMRT plan were greater than those in VMAT plan (both P < 0.05), while no significant difference in conformity index was observed (P > 0.05). The mean total lung V5 and V10 in VMAT group were markedly higher than those in IMRT group, but the V20, V30, and V40 in VMAT group were significantly lower (all P < 0.05), but no statistically significant difference was observed in V15 and V20 (P > 0.05). Furthermore, the planning spine and esophagus at risk volume showed no statistical significances in both groups (P > 0.05). MU of IMRT plan was about 4.2 % less than that of VMAT plan, which was statistically significant (P < 0.001). Both IMRT and VMAT had significant advantages in the treatment of NSCLC. The IMRT may be better for NSCLC patients with poor pulmonary function, and VMAT may be recommended for NSCLC patients with normal pulmonary function.

Bone marrow mesenchymal stem cells overexpressing human basic fibroblast growth factor increase vasculogenesis in ischemic rats

Administration or expression of growth factors, as well as implantation of autologous bone marrow cells, promote in vivo angiogenesis. This study investigated the angiogenic potential of combining both approaches through the allogenic transplantation of bone marrow-derived mesenchymal stem cells (MSCs) expressing human basic fibroblast growth factor (hbFGF). After establishing a hind limb ischemia model in Sprague Dawley rats, the animals were randomly divided into four treatment groups: MSCs expressing green fluorescent protein (GFP-MSC), MSCs expressing hbFGF (hbFGF-MSC), MSC controls, and phosphate-buffered saline (PBS) controls. After 2 weeks, MSC survival and differentiation, hbFGF and vascular endothelial growth factor (VEGF) expression, and microvessel density of ischemic muscles were determined. Stable hbFGF expression was observed in the hbFGF-MSC group after 2 weeks. More hbFGF-MSCs than GFP-MSCs survived and differentiated into vascular endothelial cells (P<0.001); however, their differentiation rates were similar. Moreover, allogenic transplantation of hbFGF-MSCs increased VEGF expression (P=0.008) and microvessel density (P<0.001). Transplantation of hbFGF-expressing MSCs promoted angiogenesis in an in vivo hind limb ischemia model by increasing the survival of transplanted cells that subsequently differentiated into vascular endothelial cells. This study showed the therapeutic potential of combining cell-based therapy with gene therapy to treat ischemic disease.