[Gemcitabine long-term maintenance chemotherapy benefits patients with survival: a multicenter, real-world study of advanced breast cancer treatment in China]

Objective: This study collected a real-world data on survival and efficacy of gemcitabine-containing therapy in advanced breast cancer. Aimed to find the main reasons of affecting the duration of gemcitabine-base therapy in advanced breast cancer patients. Methods: Advanced breast cancer patients who received gemcitabine-base therapy from January 2017 to January 2019 were enrolled(10 hospitals). The clinicopathological data, the number of chemotherapy cycles and the reasons for treatment termination were collected and analyzed. To identify the reasons related with continuous treatment for advanced breast cancer and the factors which affect the survival and efficacy. Results: A total of 224 patients with advanced breast cancer were enrolled in this study, with a median age of 52 years (26-77 years), 55.4%(124/224) was postmenopausal. Luminal type were 83 cases, TNBC were 97 cases, and human epidermal growth factor receptor 2 (HER's-2) overexpression were 44. At the analysis, 224 patients who received the gemcitabine-based regimens were evaluated, included 5 complete reponse (CR), 77 partial response (PR), 112 stable disease (SD) and 27 progressive disease (PD). The objective response rate (ORR) was 36.6%(82/224). Seventy patients had serious adverse diseases, including leukopenia (9), neutrophilia (49), thrombocytopenia (15), and elevated transaminase (2). The median follow-up time was 41 months (26~61 months), and the median PFS was 5.6 months. The reasons of termination treatment were listed: disease progression were 90 patients; personal reasons were 51 patients; adverse drug reactions were 18 patients; completed treatment were 65 patients. It was found that progression-free survival (PFS) was significantly longer in patients receiving >6 cycles than that in patients with ≤6 cycles (8.2 months vs 5.4 months, HR=2.474, 95% CI: 1.730-3.538, P＜0.001). Conclusions: Gemcitabine-based regimen is generally well tolerated in the Chinese population and has relatively ideal clinical efficacy in the real world. The median PFS is significantly prolonged when the number of treatment cycles are appropriately increased.

[Multicenter real world study on the efficacy and safety of eribulin for the treatment of advanced breast cancer]

Objective: To explore the efficacy and safety of real-world eribulin in the treatment of metastatic breast cancer. Methods: From December 2019 to December 2020, patients with advanced breast cancer were selected from Beijing Chaoyang District Sanhuan Cancer Hospital, Shandong Cancer Hospital, Peking University Cancer Hospital, Baotou Cancer Hospital, Shengjing Hospital Affiliated to China Medical University, and Cancer Hospital of Chinese Academy of Medical Sciences. Kaplan-Meier method and Log rank test were used for survival analysis, and Cox regression model was used for multivariate analysis. Results: The median progression-free survival (PFS) of 77 patients was 5 months, the objective response rate (ORR) was 33.8%, and the disease control rate (DCR) was 71.4%. The ORR of patients with triple-negative breast cancer was 23.1%, and the DCR was 57.7%; the ORR of patients with Luminal breast cancer was 40.0%, and the DCR was 77.8%; the ORR of patients with HER-2 overexpression breast cancer was 33.3%, and the DCR was 83.3%. ORR of 50.0% and DCR of 66.7% for patients treated with eribulin as first to second line treatment, ORR of 29.4% and DCR of 76.5% for patients treated with third to fourth line and ORR of 28.6% and DCR of 71.4% for patients treated with five to eleven line. The ORR of patients in the eribulin monotherapy group was 40.0% and the DCR was 66.0%; the ORR of patients in the combination chemotherapy or targeted therapy group was 22.2% and the DCR was 81.5%. Patients with a history of treatment with paclitaxel, docetaxel, or albumin paclitaxel during the adjuvant phase or after recurrent metastasis had an ORR of 32.9% and a DCR of 69.9% when treated with eribulin. The treatment efficacy is an independent prognostic factor affecting patient survival (P<0.001). The main adverse reactions in the whole group of patients were Grade Ⅲ-Ⅳ neutrophil decline [29.9% (23/77)], and other adverse reactions were Grade Ⅲ-Ⅳ fatigue [5.2% (4/77)], Grade Ⅲ-Ⅳ peripheral nerve abnormality [2.6% (2/77)] and Grade Ⅲ-Ⅳ alopecia [2.6% (2/77)]. Conclusions: Eribulin still has good antitumor activity against various molecular subtypes of breast cancer and advanced breast cancer that has failed multiple lines of chemotherapy, and the adverse effects can be controlled, so it has a good clinical application value.

[Multi-center real world study of the efficacy and safety of albumin-bound paclitaxel in the treatment of advanced breast cancer]

Objective: To observe the efficacy and safety of albumin-bound paclitaxel in the treatment of metastatic breast cancer. Methods: Multi-center data of patients who accepted single-drug albumin-bound paclitaxel or combination regimens from 2013 to 2019 were collected and the efficacy and safety were evaluated. Kaplan-Meier method was used for survival analysis, while Log-rank test was used to compare the survival rates. Results: A total of 203 advanced breast cancer cases were enrolled. The median progression-free survival time (PFS) lasted for 4 months, the median overall survival(OS)was 14 months, objective response rate (ORR) was 36.0% while the disease control rate (DCR) was 81.3%. The ORRs of Luminal, human epidermal growth factor receptor 2 (HER2) overexpression and triple-negative breast cancer patients underwent albumin-bound paclitaxel treatment were 37.3%, 45.5% and 31.0%, respectively, the DCRs were 85.5%, 68.2% and 78.9%, respectively. The OS of patients with relapse or metastasis who accepted less than two and more than two chemotherapy regimens were 22 months and 11 months (P<0.000 1), the ORRs were 44.9% vs 30.4%, DCRs were 87.2% vs 77.6% (P=0.018). The ORR and DCR of patients who accepted traditional paclitaxel treatment before the albumin-bound paclitaxel treatment were 35.8% and 82.1%, respectively. The common adverse reaction of these patients was numbness of limbs, which incidence rate was 64.5% (131/203), and 61.1% (124/203) were degree 1 to 2. Other adverse reactions including decreased white blood cells, which incidence rate was 56.1% (114/203); nausea and vomit, which incidence rate was 36.9% (75/203); anemia, which incidence rate was 21.2% (43/203); decreased platelet, which incidence rate was 18.7% (38/203); hepatic dysfunction, which incidence rate was 18.2% (37/203). Conclusions: Albumin-bound paclitaxel single or combination regimen is still significant efficient for various molecular subtypes of breast cancer patients or patients with traditional paclitaxel resistance or multi-line chemotherapy failure. Early usage has better prognosis, controllable adverse reaction and prominent clinical application value.

[Comparison of radiological and clinicopathological features of craniofacial fibro-osseous lesions]

Objective: To investigate the clinicopathological and radiological features of benign fibro-osseous lesion (BFOL). Methods: Sixty-five cases of craniofacial BFOL, eight cases of peripheral ossifying fibroma (POF) and one case of low-grade central osteosarcoma diagnosed at Sichuan Provincial People's Hospital between January 2010 and March 2019 were collected. The clinicopathologic features, hematoxylin-eosin and immunohistochemical (IHC) staining and radiographic features were analyzed. MDM2 gene amplification was detected by FISH in difficult borderline cases. Results: This cohort of BFOLs included 50 cases of fibrous dysplasia (FD), 12 cases of ossifying fibroma (OF), and three cases of juvenile psammomatoid ossifying fibroma (JPOF). The average ages of patients with FD,OF and JPOF were 31.7, 39.2 and 26.0 years respectively. The male to female ratio was 1.0∶1.8.The average age of POF was 47.0 years, with male to female ratio of 1∶7. Patient of low-grade central osteosarcoma was a 48-year-old man. Twenty-seven cases of FD were located in the jaw, and 23 cases were in other craniofacial bones. Nine cases of OF were located in the jaw, and three cases were in the nasal cavity. Two cases of JPOF were in the nasal sinus, and one was in the jaw. All POF were located in the gingiva, and low-grade central osteosarcoma was located in the mandible. The imaging features of FD were luffa-like or ground-glass like signal shadows with poorly defined borders with expansion. OF had clear borders or sclerosing margins. Both JOF and low-grade central osteosarcoma were expansile intraosseously and with focally invasive nodular masses with ground-glass like signal shadows; and POF showed soft tissue mass with bone formation. Histological features of BFOLs showed mixed fibrous and irregular osteoid lesions. FD had no clear relationship with the host bone and no osteoblasts surrounded the bone trabeculae. Osteoblasts rimming was found in OF, and the boundaries of the host bone were clear. JPOF and low-grade central osteosarcoma infiltrated the host bone focally, and the latter showed mild cellular atypia. MDM2 amplification was detected in low-grade central osteosarcoma. Conclusions: BFOLs are a group of fibro-osseous lesions with similar morphology in the head and neck and face, but their clinical features and prognosis are different; and their imaging and histological characteristics are also slightly different. Attentions should be given to the combination of clinical, imaging and pathologic features of BFOLs, especially the differential diagnosis between BFOLs and low-grade central osteosarcoma. Molecular detection could be used to assist the diagnosis in difficult cases.

Comparison of the sensitivity and specificity of p16/Ki-67 dual staining and HPV DNA testing of abnormal cervical cytology in the detection of histology proven cervical intraepithelial neoplasia grade 2 and above (CIN 2+)

INTRODUCTION

Human papillomavirus (HPV) testing is used as a means of triaging cervico-vaginal smears with low grade squamous abnormalities or as part of co-testing with cytology. While HPV testing has a high sensitivity, it has a low specificity in detecting cervical intraepithelial neoplasia grade 2 and above (CIN 2+) leading to unnecessary colposcopy referrals. We investigate the accuracy of the p16/Ki-67 dual immunocytochemical stain in determining the presence of CIN 2+ lesions on histology and its potential as a superior biomarker for triage.

METHODS

Liquid based cervico-vaginal cytology specimens with squamous abnormalities and corresponding histology from 97 women with subsequent colposcopy and biopsy were included. The specimens were then subjected to the dual stain and Roche Cobas 4800 multiplex real time PCR HPV DNA testing. The sensitivity and specificity of the dual stain and HPV testing were calculated using CIN 2+ on histology as a reference standard.

RESULTS

The sensitivity and specificity of the dual stain in detecting histology proven CIN 2+ was 93.7% and 76.5% while HPV testing was 85.7% and 14.7% respectively. Of the 44 women with ASCUS or LSIL on cytology, the dual stain also reduced the number of unnecessary colposcopy referrals from 27 to 7 when used as a triage marker compared to HPV testing.

CONCLUSION

p16/Ki-67 dual stain was more sensitive and specific than HPV testing in determining the presence of CIN 2+ on histology. It could triage low grade cervico-vaginal specimens more effectively and potentially help women avoid unnecessary colposcopies. Future studies are needed to further evaluate its role in cervical cancer screening programmes.

Identification of a natural intergenotypic recombinant hepatitis delta virus genotype 1 and 2 in Vietnamese HBsAg-positive patients

Hepatitis D virus (HDV) infection is acquired as a co- /superinfection of Hepatitis B virus (HBV) and can modulate the pathophysiology of chronic hepatitis B and related liver diseases including hepatocellular carcinoma. Among the eight distinct HDV genotypes reported, relatively few studies have attempted to investigate the prevalence of HDV mixed genotypes and RNA recombination of HDV. With a recorded prevalence of 10-20% HBV infection in Vietnam, this study investigated the HDV variability, HDV genotypes and HDV recombination among twenty-one HDV isolates in Vietnamese HBsAg-positive patients. HDV subgenomic and full-length genome sequences were obtained using newly established HDV-specific RT-PCR techniques. The nucleotide homology was observed from 74.6% to 99.4% among the investigated full-length genome of the HDV isolates. We observed HDV genotype 1 and HDV genotype 2 in the investigated Vietnamese patients. Although no HDV genotype mixtures were observed, we report here a newly identified recombinant of HDV genotypes (HDV 1 and HDV 2). The identified recombinant HDV isolate C03 revealed sequence homology to both HDV genotype 1 (nt1 to nt907) and HDV genotype 2 (nt908 to nt1675; HDAg coding region) with a breakpoint at nt908. Our findings demonstrate the prevalence of intergenotypic recombination between HDV genotypes 1 and 2 in a Vietnamese HBsAg-positive patient. Extended investigation on the distribution and prevalence of HDV, HDV mixed genotypes and recombinant HDV genotypes in a larger Vietnamese population offers vital insights into understanding of the micro-epidemiology of HDV and subsequent pathophysiology in chronic HBV- /HDV-related liver diseases.

Hepatitis B virus-induced hepatocellular carcinoma: functional roles of MICA variants

Hepatitis B virus infection is a high-risk factor for hepatocellular carcinoma. The human major histocompatibility complex class I chain-related gene A (MICA) is a ligand of the NKG2D receptor that modulates the NK and T-cell-mediated immune responses and is associated with several diseases. This study determined the effects of MICA polymorphisms during HBV infection and HBV-induced HCC. We conducted a case-controlled study in a Vietnamese cohort and genotyped ten functional MICA polymorphisms including the microsatellite motif in 552 clinically classified hepatitis B virus patients and 418 healthy controls. The serum soluble MICA levels (sMICA) were correlated with MICA variants and liver enzyme levels. We demonstrated a significant contribution of MICA rs2596542G/A promoter variant and nonsynonymous substitutions MICA-129Met/Val, MICA-251Gln/Arg, MICA-175Gly/Ser, triplet repeat polymorphism and respective haplotypes with HBV-induced HCC and HBV persistence. The circulating sMICA levels in HBV patient groups were elevated significantly compared with healthy controls. A significant contribution of studied MICA variants to sMICA levels was also observed. The liver enzymes alanine amino transferase (ALT), aspartate transaminase (AST), total bilirubin and direct bilirubin were positively correlated with sMICA levels suggesting sMICA as a biomarker for liver injury. We conclude that MICA polymorphisms play a crucial role in modulating innate immune responses, tumour surveillance and regulate disease susceptibility during HBV infection.

Low frequency of mutations in the X gene, core promoter and precore region of hepatitis B virus infected Vietnamese

Numerous mutations in the hepatitis B virus (HBV) genome have been described, but in most cases their role in the pathogenesis of HBV infection is still unclear. Therefore, we analysed specific mutations in HBV-infected Vietnamese patients and assessed their potential relationship with their clinical outcome. A total of 153 HBV-infected Vietnamese patients with well-characterised clinical profiles were enrolled. None of the study participants had a history of alcohol or drug use and none received any antiviral or immunosuppressive therapy before or during the course of this study. The HBx- and core promoter regions were analysed by sequencing. The majority of isolates corresponded to genotype A. The presence of hepatitis B e antigen (HBeAg) was associated with significantly higher viral loads in the chronic HBV-infection group (P = 0.026). Double mutations in the core promoter (1762/1764) were more frequent in those with cancer than in noncancer patients (P < 0.01). Mutations at nucleotide (nt) 1766/1773 were found at low prevalence but with no obvious association to clinical presentation. Cytosine at nt 1858 was predominant but the stop codon mutation in the precore region was not detected. In the study, 4/48 hepatocellular carcinoma (HCC) patients revealed truncated HBx, whilst the serine to alanine mutation (codon 31) of HBx was more prevalent in cancer patients than in asymptomatic HBV carriers (P < 0.01). Thus, the low frequency of mutations indicates the relation of the absence of antiviral pressure in this population. The exclusively found prevalence of certain mutations detected in those with HBV-related carcinoma nevertheless indicates a degree of association with disease progression.

Technical aspect of ThinPrep

AIM OF STUDY

To analyze the common technical problems encountered in ThinPrep preparations.

METHOD

A prospective and retrospective study of eight hundred and fifty (n = 850) conventional cervical smears with its corresponding paired ThinPrep specimens from July 1998 to December 1998.

RESULTS

139 ThinPreps were found to be technically suboptimal. Of these, 81 showed "patchy cells lost"; 18 showed "thick preparations"; 24 demonstrated "halo effect'" where the cellular material collected at the periphery of the cell circle, and 16 had "obscuring blood and amorphous debris", rendering the preparations "satisfactory for evaluation but limited" by the presence of the above artifacts.

CONCLUSION

Despite its many advantages in providing standardization of specimen preparation, superb cellular presentation, reduction in the number of unsatisfactory reports and increased lesion detection rate, ThinPrep has its own limitations in terms of technical problems, ease of operation and cost effectiveness.

Urban-rural comparison on cadmium exposure among general populations in Shandong Province, China

In 1996, peripheral blood samples and 24-h food duplicate samples together with samples of wheat, rice, foxtail millet and maize were collected from 50 non-smoking women each from Jinan (a provincial capital) and Baiquan (a nearby basically self-sustaining farming village) in China. The samples were analyzed for cadmium (Cd) contents by graphite furnace atomic absorption spectrometry after wet digestion. The dietary Cd intake of the people in the city was 6.4 micrograms/day as a geometric mean (GM) and 5.9 micrograms/day for the villagers. The Cd level in blood was 0.48 and 0.29micrograms/l (as GMs) for the city and village people, respectively. Thus, Cd burden of the people in the city tended to be greater than that for those in the village. Nevertheless, the Cd burden of the Jinan citizens was lower than the values published for people in large cities in China. When Cd intake via the four cereals was compared with Cd in total food to estimate the total contribution of the four cereals (combined) in total dietary Cd intake, the cereals accounted for 60% of total dietary Cd intake among the city people and as high as 78% among the villagers. Cadmium contents in the four cereals were in a narrow range and it was considered acceptable to combine all cereals in evaluating them as dietary Cd sources.

Inhibition of the specific 3H-DL-Glu binding in the hippocampus of rat brain by lead

The effect of Pb2+ on 3H-DL-Glutamate (3H-DL-Glu) binding in the membrane preparations from the hippocampus of rat brain was investigated with a view to explaining the cognitive and learning deficits produced by the heavy metal. The results indicated that Pb2+ (3.1-25.0 mumol.L-1) inhibited 3H-DL-Glu binding in a concentration-dependent manner. Scatchard analysis further revealed that at a concentration of 6.3 mumol.L-1 Pb2+ interfered with binding mainly through significantly decreasing the density of binding sites. This finding provided an important insight into Pb2(+)-induced impairments in learning and memory previously documented in children and in experimental animals chronically exposed to Pb2+.

Maize and foxtail millet as substantial sources of dietary lead intake

In 1996, 24-h food duplicate samples were collected from two groups of 50 non-smoking women each; one group was in Jinan, the capital city of Shandong Province in China, and the other in a farming village in the Zhangqiu area some 30 km away from the city. The people in the village took significantly more dietary lead (46 micrograms/day) than their counterparts in the city (26 micrograms/day), and blood lead concentrations (35 and 50 micrograms/l for the urban and the rural people, respectively) were in parallel with the dietary lead intake. Search for cereals as the determinants of dietary lead intake and blood lead concentration by multiple regression analysis showed that maize was the most influential source of dietary lead intake among the four common cereals of wheat, rice, foxtail millet (to be called just millet) and maize, whereas millet was the leading determinant of the blood lead level among the four cereals although the influential power was weaker than millet for dietary lead. Lead content in maize (47 ng/g) and millet (47 ng/g) was twice or even more times higher than the levels in wheat (26-30 ng/g) and rice (20-21 ng/g). The significant roles of non-rice/non-wheat cereals such as millet and maize as possible dietary lead sources for farming populations are discussed.

Urban-rural difference in cereal consumption by people in Shandong Province, China

In October, 1996, 24-hour food duplicate samples were collected from two groups of 50 adult women each; one group was in Jinan, the capital city of Shandong Province in China, and the other in a farming village of Baiquan in Zhangqiu area some 30 km away from the city. Perusal of food menus showed that wheat, rice, foxtail millet and maize were major cereals for the two groups. Nutritional analysis of the food duplicate samples were conducted taking advantage of weight of each food item and the standard food composition tables for Chinese populations. Whereas wheat was the leading source in both groups (73% of cereal-based energy in the city and 64% in the village), further urban-rural comparison showed that women in the village took substantial amounts of millet (19%) and maize (12%) in contrast to small consumption by the city people (millet by 5% and maize by 2%). Rice consumption was larger in the city (20%) than in the village (5%). The differences between the two groups were all significant for each of the four cereals. Nutritional significance of consumption of maize in particular and also that of millet were discussed.

Urban-rural comparison of nutrient intake by adult women in Shandong Province, China

In 1996, 24-hour food duplicate samples were collected from two groups of 50 nonsmoking women each; one group was in Jinan, the capital city for of Shandong Province in China, and the other in a farming village in Zhangqiu area some 30 km away from the city. They had also physical examinations including hematology and serum biochemistry tests. Nutritional analysis of the duplicate samples were conducted utilizing standard food composition tables for Chinese populations. The urban-rural comparison between the two groups showed that women in Zhangqiu took significantly less lipid (54 g/day) and more carbohydrate (335 g/day) than Jinan counterparts (76 g lipid and 254 g carbohydrate/day), although there was no significant difference in total energy and protein intake (1968 kcal/day in Jinan vs. 2071 kcal/day in Zhangqiu, and 67 g protein/day in Jinan vs. 61 g/day in Zhangqiu). The intakes of the three major nutrients were sufficient in majorities of members in both groups. Iron intake was also sufficient (22 and 25 mg/day in Jinan and Zhangqiu, respectively), but intake of calcium was insufficient in more than a half of the subjects in both groups. Zhangqiu women heavily depended on plant-based foods both for protein and lipid, whereas the dependency was less remarkable among Jinan women.

Urban-rural comparison of HBV and HCV infection prevalence among adult women in Shandong Province, China

In order to make urban-rural comparison of the prevalence of hepatitis B and C virus (HBV and HCV, respectively) infection in China, a twin survey was conducted in 1996 on two groups (50 subjects each) of 21-55 year-old, apparently healthy women for infection markers and serum enzyme levels; one group (the urban group) was in Jinan, the provincial capital of Shandong Province, and the other (the rural group) was in a farming village in Zhangqiu area some 30 km away from Jinan City. Comparison between the two groups showed that there was no significant (p > 0.10) difference in the prevalence of HBsAg+, anti-HBs+, anti-HBc+ and the cases positive to any of three HBV infection markers (i.e. HBV+). No age-dependent difference was detected within or between the groups. Thus the overall positivity rate was 8% for HBsAg+, 47% for anti-HBs+, 48% for anti-HBc+, and 64% for HBV+. No anti-HCV+ case was found either in the urban group or in the rural group. Liver function remained normal in all cases studied. The results together with perusal of published data suggest the urban-rural difference will not be remarkable, if present, in HBV and HCV infection in the regions studied, and possibly in China as a whole.