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Bao Y, Men Y, Yang X, Sun S, Yuan M, Ma Z, Liu Y, Wang J, Deng L, Wang W, Zhai Y, Bi N, Lv J, Liang J, Feng Q, Chen D, Xiao Z, Zhou Z, Wang L, Hui Z. Efficacy of Postoperative Radiotherapy for Patients with New N2 Descriptors of Subclassification in Completely Resected Non-Small Cell Lung Cancer: A Real-World Study. Int J Radiat Oncol Biol Phys 2023; 117:e5. [PMID: 37785570 DOI: 10.1016/j.ijrobp.2023.06.657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Patients with N2 non-small cell lung cancer (NSCLC) were heterogeneous groups and required further stratification. The International Society for the Study of Lung Cancer (IASLC) added new descriptors of three sub-stages for stage N2 NSCLC: N2 at a single station without N1 involvement (N2a1), N2 at a single station with N1 involvement (N2a2), and N2 at multiple stations (N2b). This study aimed to investigate the efficacy of postoperative radiotherapy (PORT) for patients with these N2 descriptors. MATERIALS/METHODS Patients with histologically confirmed NSCLC after complete resection and divided into PORT group and non-PORT group. The primary endpoint was DFS. The second endpoints were overall survival (OS) and locoregional recurrence-free survival (LRFS). Propensity-score matching (PSM) of baseline characteristics between the PORT and non-PORT groups was used for validation. RESULTS Totally 1832 patients were enrolled, including 308 N2a1 patients, 682 N2a2 patients, and 842 N2b patients. The median follow-up time was 50.1 months. The survival outcomes of the PORT and non-PORT groups before PSM were shown in Table 1. For patients with N2a1, PORT could not improve the DFS (median DFS of the PORT group and the non-PORT group: not reached vs. 46.8 months, P = 0.41), OS (P = 0.85), or LRFS (P = 0.32), which were consistent with the multivariate analysis and data after the PSM. For patients with N2a2, PORT significantly improved the DFS (median DFS 29.7 vs. 22.2 months, P = 0.02), OS (P = 0.03), and LRFS (P = 0.01). The multivariate analysis and data after the PSM confirmed the benefits in DFS and LRFS, but no benefit was observed in OS (multivariate analysis: HR 0.79, P = 0.18; median OS after PSM: 103.7 vs. 63.1 months, P = 0.34). For patients with N2b, PORT could not improve the DFS (median DFS 20.6 vs. 21.2 months, P = 0.39) but significantly improved the OS (P<0.001) and LRFS (P<0.001). However, the multivariate analysis showed that PORT significantly improved DFS (HR 0.81, P = 0.03), consistent with the data after the PSM (median DFS 20.6 and 17.6 months, P = 0.04). CONCLUSION PORT significantly improved the DFS and LRFS in patients with N2a2 and significantly improved the DFS, LRFS, and OS in patients with N2b. Patients with N2a1 could not benefit from PORT.
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Wen W, Qian L, Xie Y, Zhang X, Wang J, Zhou J, Liu R, Yu J, Chen D. Targeting XPO1 Combined with Radiotherapy to Enhance Systemic Anti-tumor Effects in Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e221-e222. [PMID: 37784904 DOI: 10.1016/j.ijrobp.2023.06.1124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The combination of radiation and radiosensitizing chemotherapeutic agents have shown promising anti-tumor effects in NSCLC. Acting as an oncogenic driver, XPO1 is frequently overexpressed and/or mutated in lung cancer. Thus, suppression of XPO1-mediated nuclear export presents a unique therapeutic strategy. We hypothesize that XPO1 inhibition combined with radiotherapy (XRT) may remodel the tumor immune microenvironment (TIME) and reduce radioresistance, thus enhance systemic anti-tumor effects. MATERIALS/METHODS Herein, we optimized a small molecule inhibitor, WJ01024, which can bind to XPO1 and antagonize its activity to inhibit nuclear export. In the C57BL/6 mouse subcutaneous tumor model, we evaluated the ability of different treatment regimens containing oral WJ01014 single or combined with XRT (one fractions of 15 Gy) in tumor control and tumor recurrence inhibition. The effects of each treatment regimen on the alterations of immunophenotypes, including the quantification, activation, proliferative capacity, exhaustion marker expression, and memory status, were evaluated by flow cytometry. RESULTS In our study, we found that the overexpression of XPO1 was associated with poor prognosis and survival in radioresistant patients with NSCLC. The combination therapy of WJ01024 and XRT resulted in an increase of apoptosis and a decrease of proliferation compared to monotherapy, which was closely correlated with tumor regression and improved survival in the C57BL/6 mouse subcutaneous tumor model. Notably, we found that WJ01024 were shown to enhance the therapeutic effect of XRT by remodeling TIME. Compared with XRT, the addition of WJ01024 increased the infiltration and proliferation of radiation-stimulated CD8+ T cells, which especially promoted the production of interferon-γ and granzyme B. Moreover, the combination therapy also reversed the immunosuppressive effect of radiation on the percentage of Tregs and exhausted T cells in mouse xenografts. Thus, the TIME was significantly improved in combination therapy. Strikingly, mechanistic studies suggested that the activation of cyclic GMP-AMP synthase/stimulator of interferon genes (cGAS/STING) signaling pathway is required to reshape TIME and produce synergistic anti-tumor effect with the combination of WJ01024 and XRT. CONCLUSION Our findings suggest that WJ01024 might be a potential synergistic treatment for radiotherapy to control the proliferation of NSCLC cells, promote tumor regression and prolong survival in mouse model of NSCLC by activating cGAS/STING signaling, and this in turn potentiate the immune microenvironment.
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Mo Y, Zhou J, Ma Y, Wen W, Wu M, Yu J, Chen D. Single-Cell RNA Sequencing Reveals a Subset of cMAS can Aggravate RIHD through CXCL1-CXCR2 Axis. Int J Radiat Oncol Biol Phys 2023; 117:S120. [PMID: 37784313 DOI: 10.1016/j.ijrobp.2023.06.457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Radiation induced heart disease (RIHD) is any form of cardiac toxicity induced by radiation therapy (RT) for thoracic cancers. Our previous studies have shown that RT obviously contributed to cardiovascular diseases-specific death over 3 years while RT became protective in the short term within 2 years survival in non-small cell lung cancer patients. Here, single cell RNA sequencing (scRNA-seq) was performed to identify various cell subsets and investigate their functions and dynamics in RIHD which offered several targets for early clinical interventions to alleviate RIHD. MATERIALS/METHODS Based on evaluation of histopathological characteristics, ejection fraction and serum levels of cardiac injury biomarkers, we have established mouse models during different stages to simulate clinical RIHD progression. Hence, we performed single cell RNA-sequencing of RIHD models to characterize the diversity within specific cell types and obtain basic information of differently expressed genes (DEGs). We investigated the role of several cell clusters and DEGs in RIHD through bioinformatics analysis and experimental verification. In vivo, mouse models were given intraperitoneal injection of CXCR2 inhibitor. Bone marrow macrophages and primary cardiac fibroblasts were extracted for in vitro experiments. RESULTS RIHD processes were divided into acute injury, compensation and decompensation stage. Transcriptomes of 31769 single cells from cardiac suspension have been profiled. Analysis of scRNA-seq revealed that there were 30 cell clusters participating in RIHD. The fraction of cell populations varied greatly at three stages which indicated RIHD was a dynamic process and each cell cluster functioned differently at different stages. Notably, we observed cardiac resident macrophages (cMAS) subset accounted for the highest fraction during the compensatory period and decreased in decompensation period. Pseudotime analysis showed cMAS had a different developmental trajectory compared to myeloid derived cells. Moreover, CXCR2 was significantly expressed in cMAS cluster. Ligand-receptor interaction results suggested that CXCL1 secreted by cardiac fibroblasts bind primarily to CXCR2+ cMAS and participated in the formation of the extracellular matrix (ECM) related to cardiac fibrosis. Moreover, cardiac fibrosis of RIHD models were relieved after CXCR2 inhibitor treatment. CXCL1 expression in primary cardiac fibroblast elevated after RT. CONCLUSION The identification of main cell clusters provided a new insight to investigate RIHD through dynamics of cell phenotypes and cell-cell communications during RIHD processes. In compensation stage, CXCR2+ cMAS could be activated by CXCL1 secreted by cardiac fibroblasts. Both were associated with ECM and contribute to the decompensation stage.
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Chen M, Ren Z, Wu M, Ma Y, Yu J, Chen D. IL-1β + Tumor Associated Macrophages Induced by Type I Interferon Initiates Radiotherapy-Mediated Abscopal Effect. Int J Radiat Oncol Biol Phys 2023; 117:e220-e221. [PMID: 37784902 DOI: 10.1016/j.ijrobp.2023.06.1122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Both experimental and clinical studies have proved that radiotherapy can lead to not only local control of irradiated tumors, but also tumor regression of non-irradiated area, termed as abscopal effect. Abscopal effect has been attributed to radiotherapy-induced innate and adaptive anti-tumor immune responses. However, the detailed molecular mechanisms and key cellular components are still unclear. So, the purpose of this study is to reveal the key molecular mechanisms and essential cells in inducing abscopal effect. MATERIALS/METHODS Bilateral MC38 subcutaneous tumor mouse models were established, and primary tumors were subjected to one fraction of 15Gy. CD45+ cells were sorted from both primary and abscopal tumors 3-, 7-, 17- and 24-day post radiotherapy respectively and subjected to single-cell RNA sequencing followed by standard bioinformatic analysis with R studio. To verify the findings, flow cytometry, mIHC and real-time qPCR were carried out to analyze the cellular and molecular components in tumor microenvironments. Cellular depletion experiments and conditional knockout mice were finally employed to confirm key mechanisms that contribute to abscopal effect. RESULTS The primary and abscopal immune microenvironments showed different repertoires time-dependently. Radiotherapy induced durable type I interferon (IFN-I) responses with dramatic infiltration and activation of CD8+ T cells and tumor associated macrophages (TAMs) in primary tumors. However, in abscopal tumors, we found that TAMs rather than CD8+ T cells were the predominant population activated in early stages (3- and 7-day post radiotherapy), and functional CD8+ T cells enriched until late stages (24-day post radiotherapy). Thorough analysis of scRNA-seq and experimental validation discovered a unique subset of TAMs characterized by high expression of IL-1β emerged as early as 3-day post radiotherapy in both primary and secondary tumor immune microenvironments, termed as IL-1β+ TAMs herein. IL-1β+ TAMs were the main activated component in abscopal tumors in early stage, and strongest respondent to IFN-I pathway. Abscopal effect was significantly attenuated when IFN-I response was abolished in either primary or abscopal tumors or TAMs were depleted from abscopal tumors. CONCLUSION Our data identified a subset of immune cells, IL-1β+ TAMs, and IFN-I as the essential cellular and molecular components that contribute to abscopal effect. Mechanically, radiotherapy-induced dramatical IFN-I response in primary tumors lead to enrichment of IL-1β+ TAMs, which initiated the anti-tumor immune response in abscopal tumors. All these findings provided theoretical basis for understanding and improving radiotherapy-induced abscopal effect.
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Yan W, Zhang R, Yu J, Chen D. Spatial Proteome Analysis Identifies Lymphocyte CD44 as a Biomarker Associated with SBRT Resistance in Early-Stage Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e222. [PMID: 37784905 DOI: 10.1016/j.ijrobp.2023.06.1125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To discover and validate spatially-resolved protein markers associated with resistance to SBRT in early-stage NSCLC patients. MATERIALS/METHODS We initially evaluated a discovery cohort of 44 early-stage NSCLC patients treated with SBRT as first-line treatment at the Shandong cancer hospital. Using the GeoMx DSP system, 71 proteins were measured in five molecular compartments (tumor, leukocyte, lymphocyte, macrophage, and stroma) on pre-treatment samples. Candidate biomarkers were orthogonally validated with the Gem AQUA method of quantitative immunofluorescence (QIF). For internal independent cohort validation, we assessed pre-treatment samples derived from 150 NSCLC patients who receive radiotherapy. We further analyzed 100 radiotherapy untreated patients with operable NSCLC to address prognostic significance. RESULTS Using continuous log-scaled data, we identified CD44 expression in the lymphocyte compartment (CD3+) as a novel predictor of poor progression-free survival (PFS) (multivariate HR = 7.323, p = 0.0079) and overall survival (OS) (multivariate HR = 8.65, p = 0.028) in the discovery set. High CD44 expression in the tumor compartment (pan-cytokeratin, CK+) predicted significantly shorter OS (multivariate HR = 2.208, p = 0.0212), with no significant difference in PFS. We validated by QIF that lymphocyte CD44 levels were associated with resistance to SBRT therapy and prognostic for poor outcomes. Using QIF in an independent radiotherapy treated cohort, we validated that CD44 levels in the lymphocyte compartment were associated with poor PFS and OS. High lymphocyte cell CD44 was not prognostic in non-radiotherapy-treated cohort. Using DSP data, intratumoral regions with elevated lymphocyte cell CD44 expression showed prominent upregulation of CD127, ARG1 and VISTA in the discovery Cohort. CONCLUSION In conclusion, we identified and validated lymphocyte cell CD44 as a biomarker indicative of resistance to SBRT or radiotherapy in patients with NSCLC. Further evaluation is warranted to address the predictive value of lymphocyte cell CD44 in multi-institutional studies and clinical trials.
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Liu X, Yu J, Chen D. Irradiated Tumor Cells-Derived Exosomes Modulate Macrophage Polarization by Targeting SHP-2 Mediated Metabolic Reprogramming. Int J Radiat Oncol Biol Phys 2023; 117:S167. [PMID: 37784418 DOI: 10.1016/j.ijrobp.2023.06.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Tumor-associated macrophages (TAMs) constitute a plastic and heterogeneous cell population of the tumor microenvironment (TME) that can regulate tumor proliferation and support resistance to therapy, constituting promising targets for the development of novel anticancer agents. The efficacy of radiotherapy, a mainstay of cancer treatment, can strongly influence TAMs recruitment and phenotype. Our previous results demonstrated that SHP-2 and PD-L1 inhibition combined with radiotherapy enhances systemic antitumor effects in non-small cell lung cancer (NSCLC). Especially, SHP-2 has an important effect on the polarization of TAM in the context of radiotherapy. However, the immune mechanisms of SHP-2 in TAM remain largely unknown, and this leads us to implement this project. MATERIALS/METHODS Transmission electron microscopy and differential ultracentrifugation were used to verify the existence of exosomes. The bone marrow-derived macrophages (BMDM) and peritoneal macrophages (PM) were derived from C57BL/6 mice for vitro tests. In vivo and in vitro assays were used to identify roles of exosomal miRNA targeting SHP-2. To investigate the regulating function of SHP-2 in TAMs, co-culture experiments, qPCR, Western Blot, Flow Cytometry and Oxygraph-2k were employed. And we also explore tumor growth and tumor environment changes in SHP-2 flox/floxLyz-Cre+/- (CKO) mice. RESULTS We found that irradiated tumor cells-derived exosomes reprogramed their energy metabolism and polarized primary macrophages to an anti-inflammatory phenotype. Furthermore, SHP-2 in macrophages was a direct target of exosomal miR-138-5p from irradiated tumor cells. In vitro study also demonstrates that miR-138-5p can down-regulate SHP-2 in the BMDMs and PMs. Further research has shown that SHP-2 negatively regulated glycolysis through dephosphorylating Pyruvate kinase M2 (PKM2) at the Tyr105 site. In addition, SHP-2 can inhabit PKM2 translocation to the nucleus by dephosphorylating PKM2 at the Ser37 site. Thus, the SHP099 (a SHP-2 inhibitor) can uptake and utilization of glucose by SHP-2/PKM2(Tyr105) (Ser37)/β-catenin/LDHA/Glut-1 axis, suggesting that SHP099 plays positive roles on glycolysis and M1-polarized. In vivo study showed that SHP-2 flox/floxLyz-Cre+/- (CKO) mice display enhanced control of solid tumor growth, accompanied by increased the proportion of M1-like macrophages. CONCLUSION Our study demonstrates that exosomal miR-138-5p from irradiated tumor cells can modulate macrophage polarization by targeting SHP-2. And SHP-2 negatively regulates glycolysis and polarize macrophage to an M2 phenotype by SHP-2/PKM2(Tyr105) (Ser37)/β-catenin/LDHA/Glut-1 axis.
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Wang J, Wu M, Yu J, Chen D. Carm1 Inhibition Potentiates Irradiation-Induced Antitumor Immunity via Tumor Intrinsic STING Pathway Activation. Int J Radiat Oncol Biol Phys 2023; 117:e221. [PMID: 37784903 DOI: 10.1016/j.ijrobp.2023.06.1123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Radiotherapy is commonly applied in multiple cancer types. Besides irradiation induced direct cell death, radiotherapy stimulated significant immune responses for tumor control. Intact and functional cGAS-STING pathway in both tumor cells and host cells is indispensable for efficient irradiation-induced anti-tumor effects. Coactivator-associated arginine methyltransferase 1 (Carm1) is emerging as an attractive therapeutic target and a biomarker for prognosis in various types of cancer. It has been reported that Carm1 inhibition could improve immunotherapy induced anti-tumor effects. However, it remains unclear how tumor cell intrinsic Carm1 affects irradiation-induced anti-tumor immunity. MATERIALS/METHODS Carm1 deficient cell lines were established in MC38 and B16F10 murine cancer cells using the CRISPR/Cas9 technology. To verify the effects of tumor `subcutaneous tumor mouse models were established and one fraction of 15Gy was administrated when the tumor volume reached 200mm3, followed by flow cytometry assays. Transcriptome sequencing, protein mass spectrometry, single-cell sequencing, Digital Spatial Profiling (DSP), real-time qPCR, western blotting, immunofluorescence and co-immunoprecipitation were carried out to explore and verify possible molecular mechanisms. RESULTS Here we found Carm1 deficiency in tumor cells dramatically enhanced irradiation-induced anti-tumor immune responses. Transcriptome sequencing of irradiated tumor cells and further experiments then validated that cGAS-STING pathway was significantly activated after irradiation in the absence of Carm1 in tumor cells, which contributed to enhance anti-tumor immunity after irradiation. Mechanistically, Carm1 deficiency in tumor cells attenuated autophagy, resulting in increased cytoplasmic mtDNA enrichment and enhanced cGAS-STING pathway activation. On the other hand, we also found that Carm1 caused asymmetric arginine methylation (ADMA) modification of TBK1 with reduced phosphorylation level, and Carm1 deficiency could activate cGAS-STING pathway by reducing AMDA modification and enhancing phosphorylation of TBK1. Finally, Carm1 inhibitor EZM2302 was applied in combination with radiotherapy in vitro, and it's indicated that combination therapy resulted in intensive anti-tumor immunity and prominent abscopal effects. CONCLUSION In this study, we identified that Carm1 ablation in tumor cells could promote irradiation-induced antitumor immunity through tumor cell intrinsic STING pathway activation. Mechanically, Carm1 deficiency directly activated the cGAS-STING pathway by interacting with TBK1 and increased mtDNA accumulation in cytoplasm by inhibiting autophagy. These findings provided new strategies for targeting Carm1 to boost the efficacy of radiotherapy.
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Xiao C, Xie X, Chen X, Chen M, Lu J, Zhang X, Wei L, Wu M, Yu J, Chen D. RUNX1 as a Potential Target for Combined Radioimmunotherapy of Lung Adenocarcinoma. Int J Radiat Oncol Biol Phys 2023; 117:e268. [PMID: 37785017 DOI: 10.1016/j.ijrobp.2023.06.1231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Radioimmunotherapy for non-small cell lung cancer has good clinical application prospects. The role and mechanism of RUNX1 in DNA damage repair were explored for its potential role in lung adenocarcinoma radioimmunotherapy. MATERIALS/METHODS To study the effect of RUNX1 expression level on the expression of DNA damage repair system related factors and radiation sensitivity of lung adenocarcinoma cells. As an important nuclear transcription factor, RUNX1 was explored whether directly regulating the expression of Nrf2, Rad51, BRCA1, and verifying their respective DNA binding sites in the promoter region through relevant databases. To observe the effect of RUNX1 knockout and overexpression on the expression level of PD-L1 in tumor cells at the cell level; The effect of RUNX1 expression level on the sorting and presentation of PD-L1 cells was investigated by the method of nucleocytoplasmic separation. According to literature reports, CMTM6 and ALIX play a key role in the process of PD-L1 cell sorting and presentation, and explore whether RUNX1 plays a role through this factor. The effect of phosphorylation level of different splicing bodies of RUNX1 (RUNX1a/b/c) on the expression level and DNA damage repair system related factors on tumor radiosensitivity were also explored. RESULTS According to TCGA database, RUNX1 is highly expressed and phosphorylated in lung adenocarcinoma. Through gene comparison with the database, it was found that RUNX1 binding sites existed in the promoter region of several factors related to this study, including ALIX, Nrf2, BRCA1, RAD51, ATM, H2AX, etc. After being activated by MAPKp38 phosphorylation, RUNX1a can positively regulate Nrf2 signal pathway. The expression of RUNX1 and p-RUNX1 is time-dependent on ionizing radiation. At the same time, it was found that the expression of RUNX1 and p-RUNX1 was dose-dependent on ionizing radiation, and the expression trend of Nrf2 signal pathway related factors was consistent with RUNX1. RUNX1 regulates the expression of PD-L1, BRCA1, ALIX and Nrf2. Bioinformatics analysis and flow cytometry data show that RUNX1 has inhibitory effect on tumor microenvironment of lung adenocarcinoma. CONCLUSION RUNX1 regulates DNA damage repair system and has inhibitory effect on tumor immunity. Inhibiting the expression of RUNX1 in lung adenocarcinoma cells can enhance the effect of radioimmunotherapy.
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Wang L, Zou B, Huang W, Shao Q, Meng X, Tang X, Zhang P, Hu X, Zhang Y, Guo J, Fu L, Zhao W, Zhao C, Yuan J, Yu J, Chen D. Safety and Efficacy Analysis of Patients with Extensive-Stage Small Cell Lung Cancer (ES-SCLC) Treated with SHR-1316 Plus Chemotherapy and Sequential Chest Radiotherapy as First-Line Therapy from a Phase II Trial. Int J Radiat Oncol Biol Phys 2023; 117:S58-S59. [PMID: 37784531 DOI: 10.1016/j.ijrobp.2023.06.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) CAPSTONE-1, a phase 3 trial, showed that SHR-1316 (PD-L1 antibody) combined with standard first-line chemotherapy could prolong overall survival (OS) in patients (pts) with ES-SCLC. The CREST trial reported consolidative thoracic radiotherapy (TRT) of 30 Gy in 10 fractions provided a 10% 2-year OS benefit and more intensive TRT should be investigated in ES-SCLC. In the era of immunotherapy, the role of TRT also needs further exploration. Therefore, we designed this clinical trial to investigate the efficacy and safety of SHR-1316 plus first-line chemotherapy followed by TRT combined with SHR-1316. MATERIALS/METHODS Key inclusion criteria were pts aged 18-75 years, with previously untreated histologically or cytologically confirmed ES-SCLC, and an ECOG performance status of 0-1. Eligible pts would receive 4∼6 cycles of SHR-1316 (20mg/kg, D1, q3w) combined with EP/EC (etoposide, 100mg/m2, D1-5, q3w and cisplatin, 75mg/m², D1-3, q3w or carboplatin, AUC = 5, D1, q3w), followed by SHR-1316 combined with TRT (≥3 Gy*10 f or ≥2 Gy*25 f, involved-field irradiation), and then the maintenance therapy with SHR-1316 until disease progression or intolerable adverse events (AEs). The main endpoints included ORR, PFS and safety. RESULTS From October 2020 to January 2023, 33 pts received SHR-1316 and sequential consolidative TRT. Among them, 19 pts received high-dose TRT (>3 Gy*10 f or ≥2 Gy*25 f) and 14 pts received low-dose TRT (≤3 Gy*10 f or<2 Gy*25 f). The median age was 62 (range: 38-73). Most pts were male (28, 84.8%), former smokers (22, 66.7%) with an ECOG performance status 1 (32, 97%). Ten (30.3%) pts were diagnosed with brain metastasis and 10 (30.3%) pts had liver metastasis at baseline. At the data cutoff date, 9 pts remained on treatment, the average number of treatment cycles was 9.2. 33 pts had at least one 1 post-treatment tumor assessment. The confirmed ORR and DCR were 90.9% (30/33) and 100% (33/33) in all pts, were 89.5% (17/19) and 100% (19/19) in high-dose TRT group, and were 92.9% (13/14) and 100% (14/14) in low-dose TRT group. The median PFS was 10.2(CI: 5.8∼14.7) months in all pts, was 7 (CI: 3.8∼10.2) months in high-dose TRT group and 10.4 (CI: 8.4∼12.3) months in low-dose TRT group. AEs occurred in 27 (81.8%) pts and grade 3 or 4 AEs occurred in 20 (60.6%) pts. The most common grade 3 or 4 AEs included neutropenia (15, 45.5%), leukopenia (8, 24.2%), lymphocytopenia (5, 15.2%), pneumonia (3, 9.1%), anemia (3, 9.1%) and thrombocytopenia (2, 6.1%). CONCLUSION SHR-1316 plus chemotherapy and sequential TRT as first-line therapy for ES-SCLC showed promising efficacy and acceptable safety. There is no significant difference between high-dose and low-dose TRT groups in terms of safety and efficacy according to current data.
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Guo YX, An Q, Chen LL, Li TY, Chen D, Liang J, Wang L, Jiang W. Role and Modality of Combining Radiotherapy with Immunotherapy in Stage III-IV Unresectable Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e22. [PMID: 37784898 DOI: 10.1016/j.ijrobp.2023.06.695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The combination of radiotherapy and immunotherapy was rarely reported in the management of small cell lung cancer (SCLC). We retrospectively assessed the role and modality of this combination in Stage III-IV unresectable SCLC. MATERIALS/METHODS Patients with stage III and IV SCLC were enrolled according to AJCC 8th edition. Both efficacy and safety of immunotherapy combined with radiotherapy were evaluated. Thereinto, patients received first-line chemo-immunotherapy and sequential thoracic consolidation radiotherapy (TCRT) were further evaluated. Survival and descriptive analyses were performed. RESULTS Between January 1, 2019 and December 31, 2021, 51 patients were included in our analysis. Median follow-up was 28.0 months (95% CI 22.8-33.2). Patients received radiotherapy in treatment course had a prolonged 2-year overall survival (OS). And in the first-line immunotherapy cohort of 27 patients, the addition of TCRT significantly improved 2y-OS (72.22% vs. 13.89%, p = 0.0048), 2y-locoregional recurrence free survival (LRRFS) (90.00% vs 48.00%, p = 0.011), and 2y-distance progression free survival (DPFS) (66.67% vs. 16.67%, p = 0.039). Subgroup analyses showed that TCRT rendered superior outcomes regardless of brain metastases. Dose-escalation (45 Gy/15f) and earlier radiotherapy seemed to improve the benefit. Of 70.37% (19/27) patients experienced disease progression in the TCRT evaluation cohort, 63.16% (12/19) patients failed in brain. A tendency toward better OS and superior brain metastases free survival (BMFS) were observed after receiving prophylactic cranial irradiation (PCI). Finally, the most common grade 2 or higher toxic effects were pneumonitis in all patients (11.76% of immune-related vs. 7.84% of radiation related). CONCLUSION Earlier addition of TCRT to immunotherapy could significantly improve survival and extracranial control for stage IIIA-IVB unresectable SCLC patients, with no increased risk of adverse events. In the era of immunotherapy, PCI may still be a recommended strategy. Further investigation is warranted.
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Zhang J, Wang F, Shang S, Yan W, Ma Y, Ren Z, Wu M, Ma J, Zhang Y, Yu J, Chen D. HPK1 Inhibition Enhancing HFRT Anti-Tumor Immune Response. Int J Radiat Oncol Biol Phys 2023; 117:S120-S121. [PMID: 37784312 DOI: 10.1016/j.ijrobp.2023.06.458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Radiation therapy, as one of the canonical treatments for classic tumors, results in impressive clinical responses. Stereotactic body radiotherapy (SBRT) has been increasingly used as one main therapy in early-stage non-small-cell lung cancer (NSCLC). SBRT affords good local tumor control, however, recurrence and metastasis are still the main causes of treatment failure. With the continuous deepening of the relationship between radiotherapy (RT) and immunity, reversing RT induced immunosuppression is considered to be a promising strategy to improve radiotherapy efficacy. Hematopoietic progenitor kinase 1 (HPK1) is mainly expressed in immune cells while rarely expressed in tumor cells. It has been proven to play a negative regulatory role in T cell receptor (TCR) signal. Therefore, we hypothesized that the combination of HPK1 inhibitor with SBRT would boost local and systemic anti-tumor immune responses by potentiating the anti-tumor effects of SBRT. MATERIALS/METHODS Using Digital Spatial Profiler (DSP), we analyzed HPK1 expression in the tumor specimens of 39 NSCLC patients treated with SBRT. By establishing mice subcutaneous tumor models, we assessed the combination of a HPK1 inhibitor and local hyper-fractionated radiotherapy (HFRT) on local and systemic tumor control and mouse survival. Using Single-cell RNA sequencing, Flow cytometry and pharmacological treatment, we analyzed and verified Tumor-infiltrating lymphocytes (TILs), and excavated the specific mechanism of the HPK1 inhibitor enhancing HFRT -induced anti -tumor immune response. RESULTS In the tumor specimens of NSCLC patients treated with SBRT, we found that high expression HPK1 in TILs predicted poor progression-free survival (PFS). Among the C57BL/6 mice model, HFRT combined with a HPK1 inhibitor promoted local response, and improved the survival rate of mice, showing better anti-tumor curative effects. We further showed that HFRT promoted CD8+ T cell cytotoxic activity, and also aggravated CD8+ T cell exhaustion. After the intervention of HPK1 small molecular inhibitors, the proportion of exhaustion CD8+T cells was significantly reduced, while CD8+T cell cytotoxic activity was further enhanced in the later period. Single-cell RNA sequencing and pharmacological inhibition of HPK1 revealed that HPK1 mediated the exhaustion of CD8+T cells by regulating RGS16. In abscopal effects preclinical models, BGB-15025 induced obvious abscopal effect. CONCLUSION Thus, we demonstrate that HPK1 mediates HFRT-induced CD8+T cell exhaustion by regulating RGS16, and HPK1 is an attractive drug target for enhancing local and systemic radiotherapy.
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Chen D, Zhao M, Jiang W, Liang J. Dosimetric Analysis of Proton Beam Therapy vs. Photon Radiotherapy for Cardiac Tumors with or without Deep Inspiratory Breath Holding: A Case Report. Int J Radiat Oncol Biol Phys 2023; 117:e650-e651. [PMID: 37785935 DOI: 10.1016/j.ijrobp.2023.06.2073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Proton beam therapy (PBT) has been demonstrated to deliver equivalent dosimetric radiation with the benefit of improved sparing of organs at risk (OAR). Deep inspiration breath holding (DIBH) is a commonly used method for reducing the radiation dose to the heart and lungs. However, few studies have ever reported the usage of DIBH combined with proton beam therapy in cardiac tumors. The purpose of this case report is to compare the dosimetric differences between photon radiotherapy and proton radiation therapy (PBT) with or without deep inspiration breath holding. MATERIALS/METHODS A 66-year-old female patient with cardiac tumors was recruited, and the prescribed dose of radiotherapy for cardiac tumors was 95%PGTV 50Gy/2.5Gy/20f. Two simulation CT scans were collected during free breath (FB) and DIBH. And the target area was delineated on deep inspiratory breath holding image (DIBH-CT) and free breathing image (FB-CT). The target area of FB-CT was modified by referring to the ten-time phases of 4D-CT. Finally, IMRT, VMAT and PBT plans (DIBH-IMRT, DIBH-VAMT, DIBH-PBT, FB-IMRT, FB-VAMT, FB-PBT) were generated on the above images, and the organs at risk were limited as follows: lungs V20 ≤20%, lungs mean ≤11 Gy, heart V30 ≤40%, coronary artery mean ≤26 Gy, spinal cord ≤30 Gy, and left breast mean ≤5 Gy. RESULTS All of the six plans satisfied most of the treatment planning goals. DIBH resulted in a dose reduction in all organs at risk including the heart, lungs, coronary artery (CA), spinal cord and breasts, when compared with FB using IMRT, VMAT, or PBT. Compared with the FB, DIBH provided a significant reduction in the mean dose of coronary artery (CA mean for DIBH-IMRT vs FB-IMRT = 28.32 Gy vs 42.66 Gy, CA mean for DIBH-VMAT vs FB-VAMT = 26.44Gy vs 40.85Gy, CA mean for DIBH-PBT vs FB-PBT = 27.71Gy vs 39.51Gy). Similarly, when compared with IMRT or VMAT in either FB or DIBH, PBT reduced radiation doses for all of the OAR. In comparison, the difference was less significant between IMRT and VMAT technique. Pitmen compared with IMRT and VMAT, reduced significantly the max dose of spinal cord, lungs V5, breast-L/R mean. Totally, DIBH-PBT was observed sufficient dose coverage and better sparing of organs at risk. CONCLUSION PBT combined with DIBH technique gained an advantage in the sparing of OAR for cardiac tumors, especially in coronary protection. The possibility of broader application of PBT with DIBH in clinical practice is currently being evaluated and further studies are needed.
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Lu J, Chen X, Zhang X, Wang M, Wu M, Yu J, Chen D. IKBKE Promotes Radioresistance of Glioblastoma through AKT/FOXO3a Pathway. Int J Radiat Oncol Biol Phys 2023; 117:S139. [PMID: 37784354 DOI: 10.1016/j.ijrobp.2023.06.547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Glioblastoma is an intracranial highly malignant primary tumor, and postoperative radiotherapy is a common treatment of glioblastoma. While radiotherapy resistance of glioblastoma is an important reason for treatment failure. IKBKE is overexpressed in gliomas, but its role in radiotherapy is unknown. This study confirmed that IKBKE can directly phosphorylate AKT protein to regulate FOXO3a, thus promoting the radioresistance of glioblastoma, and proposed a new therapeutic strategy to enhance the efficacy of radiotherapy. MATERIALS/METHODS We used flow cytometry, tunel staining, plate cloning, a cell counting kit and WB to confirm the effects of IKBKE and FOXO3a on radioresistance of glioblastoma, and immunofluorescence and WB were used to detect the expression of γ-H2AX. Subcutaneous tumor formation in mice and immunohistochemical staining was performed. IP combined with mass spectrometry, immunofluorescence, endogenous and exogenous IP were used to confirm the interaction between IKBKE and AKT. Point mutation, IP and WB were used to confirm the phosphorylation site of AKT. IP and some small molecule inhibitors were used to confirm the relationship between IKBKE, AKT and PI3K. The effect of IKBKE on FOXO3a was confirmed by WB and qPCR. The protein relationship among IKBKE, FOXO3a and 14-3-3 was confirmed by CHX, MG132, ubiquitin test, immunofluorescence and IP. The above experiments were carried out to verify the effect of Amlexanox, an IKBKE inhibitor, on glioblastoma. And its pharmacokinetics in the brain was determined by LC-MS to provide a theoretical basis for further clinical use. RESULTS It was found that IKBKE could increase the radioresistance of glioblastoma in vitro and in vivo. IKBKE could directly phosphorylate AKT, and its phosphorylation sites were Ser473 and Thr308. We also certified that IKBKE activated AKT independent of PI3K. IKBKE inhibited the expression of FOXO3a on protein level, promoted its ubiquitin degradation, enhanced its interaction with 14-3-3, and inhibited its transportation into the nucleus. FOXO3a can increase the radiosensitivity of glioblastoma. Amlexanox, an IKBKE inhibitor, can inhibit the radiosensitivity of glioblastoma and partially pass through the blood-brain barrier to enhance the radiosensitivity of intracranial tumors. CONCLUSION IKBKE can activate AKT independent of PI3K by directly phosphorylating AKT Ser473 and Thr308, thus increasing the phosphorylation of FOXO3a. Phosphorylated FOXO3a promoted its ubiquitin degradation, and inhibited its transportation into the nucleus, causing radioresistance in glioblastoma. IKBKE inhibitor Amlexanox can pass through the blood-brain barrier and increase the radiosensitivity of intracranial tumor cells.
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Yu N, Li J, Chen X, Wang Z, Kang X, Zhang R, Qin J, Zheng Q, Feng G, Deng L, Zhang T, Wang W, Liu W, Wang J, Feng Q, Lv J, Chen D, Zhou Z, Xiao Z, Li Y, Bi N, Li Y, Wang X. Chemoradiotherapy Combined with Nab-Paclitaxel plus Cisplatin in Patients with Locally Advanced Borderline Resectable or Unresectable Esophageal Squamous Cell Carcinoma: A Phase I/II Study. Int J Radiat Oncol Biol Phys 2023; 117:e354. [PMID: 37785224 DOI: 10.1016/j.ijrobp.2023.06.2433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To evaluate the efficacy and safety of nanoparticle albumin-bound paclitaxel (nab-PTX) plus cisplatin as the regimen of conversional chemoradiotherapy (cCRT) in locally advanced borderline resectable or unresectable esophageal squamous cell carcinoma (ESCC). MATERIALS/METHODS Patients with locally advanced ESCC (cT3-4, Nany, M0-1, M1 was limited to lymph node metastasis in the supraclavicular area) were enrolled. All the patients received the cCRT of nab-PTX plus cisplatin. After the cCRT, those resectable patients received esophagectomy; those unresectable patients continued to receive the definitive chemoradiotherapy (dCRT). The locoregional control (LRC), overall survival (OS), progression-free survival (PFS), distant metastasis free survival (DMFS), pathological complete response (pCR), R0 resection rate and adverse events (AEs) were calculated. RESULTS A total of 45 patients with ESCC treated from October 2019 to May 2021 were finally included. The median follow-up time was 30.3 months. The LRC, OS, EFS, DMFS at 1and 2 years were 81.5%, 86.6%, 64.3%, 73.2% and 72.4%, 68.8%, 44.8%, 52.7% respectively. 21 patients (46.7%) received conversional chemoradiotherapy plus surgery (cCRT+S). The pCR rate and R0 resection rate were 47.6% and 84.0%. The LRC rate at 1 and 2 years were 95.0%, 87.1% in cCRT+S patients and 69.3%, 58.7% in dCRT patients respectively (HR, 5.14; 95% CI, 1.10-23.94; P = 0.021). The OS rate at 1 and 2 years were 95.2% and 84.2% in resectable patients compared to 78.8% and 54.4% in unresectable patients (HR, 3.41; 95% CI, 1.10-10.61; P = 0.024). The toxicities during chemoradiotherapy were tolerated, the most common grade 3-4 toxicities were radiation esophagitis (15.6%). CONCLUSION Nab-PTX plus cisplatin were effective and safe as the regimen of conversional chemoradiotherapy of ESCC. The patients receiving conversional chemoradiotherapy plus surgery (cCRT+S) were prone to have a better survival.
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Zhang J, Shang S, Wang F, Wang R, Shangguan J, Zhang Y, Wu M, Ma J, Yu J, Chen D. The Baseline Serum Lipid Levels and Outcomes of NSCLC Patients Receiving Immunotherapy Combined or Non-Combined with Radiotherapy: A Single Center Retrospective Study. Int J Radiat Oncol Biol Phys 2023; 117:e11. [PMID: 37784645 DOI: 10.1016/j.ijrobp.2023.06.670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) In recent years, many studies have shown that lipids and lipid-like substances are key regulatory factors in tumor development and play an important role in immune regulation. However, it remains unclear whether serum lipids influence the outcome of immunotherapy. Therefore, determining the serum lipid levels of the immune treatment-beneficiary population may be valuable. The aim of this study is to evaluate the prognostic value of baseline serum lipid levels in non-small cell lung cancer (NSCLC) patients receiving immunotherapy. MATERIALS/METHODS We retrospectively included 294 patients with stage III-IV NSCLC who received immunotherapy continuously from December 2018 to November 2021 at our hospital, collecting their pre-treatment lipid levels, such as total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). Of these, 160 receiving immunotherapy without combined radiotherapy (ICIs-nRT) and 134 combined with radiotherapy (iRT). The endpoint was the correlation between pre-treatment serum lipid levels and overall survival (OS), as well as progression-free survival (PFS). The X-tile tool was used to determine the optimal cut-off value of the indicators. The Kaplan-Meier survival curves were used to calculate OS and PFS and log rank tests were used for comparison. And the Cox proportional hazard model were used for univariate and multivariate analysis. RESULTS In all 294 patients, low TG, low TC, and low HDL-C predicted poor OS (P<0.001) and poor PFS (P<0.05). Low LDL-C was associated with poor OS (P = 0.0001). Among 160 patients receiving ICIs-nRT and 134 iRT patients, low levels of TG (P = 0.0134, 0.0024), TC (P = 0.0003, 0.0023), HDL-C (P = 0.0004, 0.0043), and LDL-C (P = 0.0003, 0.0419) were associated with worse OS compared to high levels of them. In the ICIs-nRT patients, low HDL-C predicted poor PFS (P = 0.0011). In 134 iRT patients, low levels of TG (P = 0.0017), TC (P = 0.0028), and LDL-C (P = 0.0330) were poor prognostic factors for PFS. In the univariate and multivariate analysis with OS in all patients, TG and HDL-C were independent risk factors, while TG was an independent risk factor in the analysis with PFS. In ICIs-nRT patients, HDL-C was an independent prognostic factor for patients' OS and PFS. In iRT patients, both TG and HDL-C were prognostic risk factors for OS. CONCLUSION These data confirm that higher serum lipid levels are associated with better outcomes in patients with NSCLC undergoing immunotherapy. Serum lipids may identify tumors that are more likely to respond to immunotherapy. Radiation therapy may affect lipid metabolism within the body to enhance the efficacy of immunotherapy.
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Yuan J, Yu J, Chen D. The Updated Landscape of Tumor Microenvironment and Pre-Metastasis Niches for Radiotherapy Resistant Tumors. Int J Radiat Oncol Biol Phys 2023; 117:S166-S167. [PMID: 37784415 DOI: 10.1016/j.ijrobp.2023.06.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) In the current clinical work, hypo-fractionated radiotherapy (HFRT) and conventional fractionated radiotherapy (CFRT) are considered to be completely different treatments. However, the difference between the HFRT and CFRT in reprogramming the tumor immune microenvironment (TIME) is still inconclusive. Our previous work found that compared with HFRT, CFRT is more inclined to trigger immunosuppressive phenotype, but the underlying mechanism is still unclear. Based on this, we use single-cell mRNA sequencing to describe the landscape of TIME with HFRT and CFRT, and find the key targets or pathways to combine with radiotherapy. MATERIALS/METHODS By simulating the in vivo radiotherapy strategy, we built recurrent murine cell lines mimicking CFRT and HFRT recurrent tumors (CFRT_R and HFRT_R tumors) with small animal radiation research platform (SARRP). RESULTS Based on this unique model, we found that CFRT_R tumors can promote local relapse and lung metastasis significantly compared to HFRT_R tumors. Results of single-cell mRNA sequencing and FCAS also indicate that CFRT_R tumors possess more macrophages in the tumor site and neutrophils in the metastatic site. By using quantitative proteomics of secreted proteins, we prove that CFRT_R tumors secret more Ccl2, S100a11 and Slpi. Mechanically, CFRT_R tumors influence the polarization of M2 TAMs leading to tumor growth through secretion of Ccl2 and S100a11. Meanwhile, CFRT_R tumors also augment the infiltration of neutrophils in the lung through Slpi altering the lung immune landscape to support metastasis. ChIP and EMSA results also reveal that RelB is the core transcription factor of Ccl2, S100a11 and Slpi. Furthermore, local relapse and lung metastasis can be reversed by targeting non-canonical NF-kB pathway. CONCLUSION The effect of CFRT_R and HFRT_R tumors in reprogramming TIME is different, CFRT_R tumors can trigger immunosuppressive phenotype compared to HFRT_R tumors by possessing more M2 TAMs in the tumor site and neutrophils in the metastatic site. The killing function of tumor infiltrated T cells can be inhibited by accumulated M2 TAMs, and abundant neutrophils in lungs contribute to the formation of the pre-metastatic niche. Targeting non-canonical NF-kB pathway can reverse local relapse and lung metastasis in CFRT_R tumors by suppressing Ccl2, S100a11 and Slpi secretion. In short, our study not only deepens the understanding of the immune landscape of CFRT and HFRT recurrence tumors, but also provides a novel therapy of CFRT recurrence patients.
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Ma J, Zhang J, Shang S, Wang F, Yu J, Chen D. A Dosimetric Study Indicates the Spinal Cord Irradiation Contributes to Acute Hematologic Toxicities in Non-Small Cell Lung Cancer Patients Receiving Radiotherapy Combined with Immunotherapy. Int J Radiat Oncol Biol Phys 2023; 117:S154-S155. [PMID: 37784388 DOI: 10.1016/j.ijrobp.2023.06.577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To assess the radiation therapy (RT) dose to radiation-associated hematologic toxicities (HTs) in patients with non-small cell lung cancer (NSCLC) after RT combined with immunotherapy. MATERIALS/METHODS Cases of NSCLC treated with RT combined with immunotherapy at Shandong Cancer Hospital in China were identified. The mean dose and the volume of the spinal cord receiving at least 5 to 40 Gy (V5-V40) were retrospectively recorded. Logistic regression was used to estimate associations between grade ≥3 HT (HT3+) and dosimetric/clinical parameters. Receiver operating characteristic analysis was used to determine dosimetric cut-points. RESULTS Ninety-nine patients were analyzed. The majority were male (n = 78, 78.8%) and received chemotherapy (n = 83, 83.9%). All patients received either anti-PD-1 immune checkpoint (n = 89, 89.9%) or anti-PD-L1 immune checkpoint (n = 10, 10.1%) therapy. The rate of HT3+ was 24.2% (n = 24). Spinal cord mean dose, V5 to V40 and BMI parameters associated with HT3+ were included in the multivariate analysis. On multivariate analysis, increasing mean spinal cord dose (per Gy) was associated with higher odds of developing HT3+ (odds ratio 1.053, 95% confidence interval 1.002-1.105, P = .041), as were increasing spinal cord V5 to V20 (As show in the Table below). The optimal cut-points identified were V5 = 52.5%, V10 = 47.5%, V20 = 39.4%, and mean dose = 23.3 Gy. Patients with values above these cut-points had an approximately 2-fold increased risk of HT3+. CONCLUSION We found that mean spinal cord dose and low-dose parameters (V5-V20) were associated with HT3+ in NSCLC patients after RT and immunotherapy. The mean dose of the spinal cord should be kept lower than 23.3 Gy for these patients. These data suggested that efforts to spare doses to the spinal cord might reduce rates of severe HT.
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Hands JM, Whalen M, Haji-Momenian S, Frazier H, Andrawis R, Jarrett T, Provenzano D, Bauman JE, Estephan F, Aghdam H, Chen D, Goyal S, Ojong-Ntui M, Rao YJ. Focal Boosted IMRT Treatment of Prostate Cancer to 84 Gy in 28 Fractions: Preliminary Clinical Outcomes and Dosimetry. Int J Radiat Oncol Biol Phys 2023; 117:e390. [PMID: 37785313 DOI: 10.1016/j.ijrobp.2023.06.2513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The FLAME trial reported that focal boosting of prostate tumor to 95 Gy in 35 fractions improves biochemical control. However, this treatment is not commonly used in the United States. We investigated a focally boosted treatment of 84 Gy in 28 fractions (EQD2 108 Gy, BED 252 Gy). MATERIALS/METHODS Between 2019-2022, men with unfavorable intermediate risk (uIR) and high risk (HR) prostate cancer were enrolled on a prospective registry and received a novel IMRT regimen. The dose levels were 84 Gy to the gross tumor volume (GTV) as defined on mpMRI (T2W and ADC) with no added margin, 70 Gy to the prostate and proximal seminal vesicles, and optional 50.4 Gy to elective pelvic lymph nodes (all 28 fractions). Patients received fiducial markers and hydrogel spacer. The treatment planning goal was to cover 95% of the GTV at 84 Gy, and also meet the target and normal tissue dosimetry criteria of the hypofractionated treatment arm of NRG-GU005. VMAT was used for treatment delivery. ADT was given at the discretion of the treating physician. RESULTS A total of 20 men were included in the study, 2 (10%) uIR and 18 (90%) HR. 9 (45%) tumors were GS 7, 7 (35%) were GS 8, and 4 (20%) were GS 9. There were 13 (65%) stage cT1, 4 (20%) cT2 and 3 (15%) cT3. One (5%) patient received short term ADT, 18 (95%) long term ADT, and 1 (5%) refused ADT. 18 (90%) men received elective nodal radiation. The mean baseline PSA was 25.1 (range 4.2-73.4). The median baseline IPSS score was 11.1 (IQR 4.5-12), and 4 patients had severe baseline urinary symptoms (IPSS ≥20). The mean baseline prostate volume was 57.4 cc (range 26.8-198.3). The mean volume of the 84 Gy boost target was 7.1 cc (range 2.3-15.0) and the mean proportion of the prostate boosted was 14.8% (range 2% - 47%). There were 10 (50%) men with 1 boost target, 6 (30%) with two, 3 (15%) with three, and 1 (5%) had 4 boost targets. Targets were located in peripheral zone (85%), transition zone (30%), and central zone (5%). Patients met all per-protocol normal tissue criteria of NRG-GU005, except for bladder D0.03cc. The mean±SD (Gy) rectum D15%, D25%, and D30% were 51±5, 45±5, 42±4. The mean±SD (Gy) bladder D0.03cc, D30%, D50% were 79±4, 50±8, 38±10. At a median follow up time of 21.3 months (range 7.1-38.2), no patients have developed biochemical progression, local recurrence, distant progression, or death from prostate cancer. One patient died at 18 months from metastatic colorectal cancer, unrelated to prostate cancer treatment. Acute grade 1-2 GU toxicity occurred in 13 (65%) patients, and acute grade 1-2 GI toxicity occurred in 4 (20%) patients. No patients developed grade 3+ acute or late GU or GI toxicity. Two patients required temporary foley catheter for obstruction during RT, and both had IPSS >20 at baseline. The patient who refused ADT had a PSA bounce of magnitude 2.2 ng/mL at 14 months, PSA values declined without additional treatment. CONCLUSION A novel 28-fraction focal boosted IMRT treatment is feasible and has an acceptable early toxicity profile. Oncologic results are promising but require longer follow up.
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Chen D, Xu Q, Mao X, Zhang J, Wu L. Reproductive history does not compromise subsequent live birth and perinatal outcome following in-vitro fertilization: analysis of 25 329 first frozen-thawed embryo transfer cycles without preimplantation genetic testing for aneuploidy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:430-438. [PMID: 37058394 DOI: 10.1002/uog.26220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/22/2023] [Accepted: 03/30/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To investigate the effect of women's reproductive history on live-birth rate and perinatal outcome after first frozen-thawed embryo transfer (FET) without preimplantation genetic testing for aneuploidy. METHODS This was a retrospective cohort study of women who had undergone their first FET cycle between January 2014 and December 2020 at a university-affiliated fertility center. No transferred embryo underwent preimplantation genetic testing for aneuploidy. The women were categorized into five groups based on their reproductive history: no previous pregnancy; previous termination of pregnancy (TOP); previous pregnancy loss; previous ectopic pregnancy (EP); and previous live birth. The women with no previous pregnancy were considered as the reference group. The primary outcome was the live-birth rate and secondary endpoints included rates of positive pregnancy test, clinical pregnancy, pregnancy loss and EP as well as perinatal outcomes such as birth weight and preterm birth. Multivariable logistic regression analyses were used to control for a number of potential confounders, including age, body mass index, education level, duration and cause of infertility, insemination method, type of endometrial preparation, number of embryos transferred, embryo developmental stage, quality of the embryos transferred, year of treatment and endometrial thickness. Additionally, propensity score matching (PSM) was used to check the robustness of the main findings. RESULTS In total, 25 329 women were included in the final analysis. On univariate analysis, each reproductive-history type except for previous EP was significantly associated with worse pregnancy outcome following in-vitro fertilization (IVF), including rates of positive pregnancy test, clinical pregnancy, pregnancy loss and live birth, when compared with the group of women with no previous pregnancy. However, after correcting for several potential confounders, the differences in rates of live birth, pregnancy loss, positive pregnancy test and clinical pregnancy were no longer significant between the study and control groups on multivariable regression models, while the risk of EP after embryo transfer was elevated among women with a previous TOP or EP. There was no increased risk of adverse perinatal outcome associated with reproductive history compared with the control group. Notably, similar results were obtained from the PSM models, confirming the robustness of the main findings. CONCLUSION Relative to women without a previous pregnancy, those with a prior TOP, pregnancy loss, EP or live birth did not have compromised live-birth rate or perinatal outcomes following FET without preimplantation genetic testing for aneuploidy, with the exception of an increased risk of EP in those with prior TOP or EP. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Adam J, Adamczyk L, Adams JR, Adkins JK, Agakishiev G, Aggarwal MM, Ahammed Z, Alekseev I, Anderson DM, Aparin A, Aschenauer EC, Ashraf MU, Atetalla FG, Attri A, Averichev GS, Bairathi V, Barish K, Behera A, Bellwied R, Bhasin A, Bielcik J, Bielcikova J, Bland LC, Bordyuzhin IG, Brandenburg JD, Brandin AV, Butterworth J, Caines H, Calderón de la Barca Sánchez M, Cebra D, Chakaberia I, Chaloupka P, Chan BK, Chang FH, Chang Z, Chankova-Bunzarova N, Chatterjee A, Chen D, Chen J, Chen JH, Chen X, Chen Z, Cheng J, Cherney M, Chevalier M, Choudhury S, Christie W, Chu X, Crawford HJ, Csanád M, Daugherity M, Dedovich TG, Deppner IM, Derevschikov AA, Didenko L, Dong X, Drachenberg JL, Dunlop JC, Edmonds T, Elsey N, Engelage J, Eppley G, Esumi S, Evdokimov O, Ewigleben A, Eyser O, Fatemi R, Fazio S, Federic P, Fedorisin J, Feng CJ, Feng Y, Filip P, Finch E, Fisyak Y, Francisco A, Fulek L, Gagliardi CA, Galatyuk T, Geurts F, Ghimire N, Gibson A, Gopal K, Gou X, Grosnick D, Guryn W, Hamad AI, Hamed A, Harabasz S, Harris JW, He S, He W, He XH, He Y, Heppelmann S, Heppelmann S, Herrmann N, Hoffman E, Holub L, Hong Y, Horvat S, Hu Y, Huang HZ, Huang SL, Huang T, Huang X, Humanic TJ, Huo P, Igo G, Isenhower D, Jacobs WW, Jena C, Jentsch A, Ji Y, Jia J, Jiang K, Jowzaee S, Ju X, Judd EG, Kabana S, Kabir ML, Kagamaster S, Kalinkin D, Kang K, Kapukchyan D, Kauder K, Ke HW, Keane D, Kechechyan A, Kelsey M, Khyzhniak YV, Kikoła DP, Kim C, Kimelman B, Kincses D, Kinghorn TA, Kisel I, Kiselev A, Kocan M, Kochenda L, Kosarzewski LK, Kramarik L, Kravtsov P, Krueger K, Kulathunga Mudiyanselage N, Kumar L, Kumar S, Kunnawalkam Elayavalli R, Kwasizur JH, Lacey R, Lan S, Landgraf JM, Lauret J, Lebedev A, Lednicky R, Lee JH, Leung YH, Li C, Li C, Li W, Li W, Li X, Li Y, Liang Y, Licenik R, Lin T, Lin Y, Lisa MA, Liu F, Liu H, Liu P, Liu P, Liu T, Liu X, Liu Y, Liu Z, Ljubicic T, Llope WJ, Longacre RS, Lukow NS, Luo S, Luo X, Ma GL, Ma L, Ma R, Ma YG, Magdy N, Majka R, Mallick D, Margetis S, Markert C, Matis HS, Mazer JA, Minaev NG, Mioduszewski S, Mohanty B, Mooney I, Moravcova Z, Morozov DA, Nagy M, Nam JD, Nasim M, Nayak K, Neff D, Nelson JM, Nemes DB, Nie M, Nigmatkulov G, Niida T, Nogach LV, Nonaka T, Nunes AS, Odyniec G, Ogawa A, Oh S, Okorokov VA, Page BS, Pak R, Pandav A, Panebratsev Y, Pawlik B, Pawlowska D, Pei H, Perkins C, Pinsky L, Pintér RL, Pluta J, Pokhrel BR, Porter J, Posik M, Pruthi NK, Przybycien M, Putschke J, Qiu H, Quintero A, Radhakrishnan SK, Ramachandran S, Ray RL, Reed R, Ritter HG, Rogachevskiy OV, Romero JL, Ruan L, Rusnak J, Sahoo NR, Sako H, Salur S, Sandweiss J, Sato S, Schmidke WB, Schmitz N, Schweid BR, Seck F, Seger J, Sergeeva M, Seto R, Seyboth P, Shah N, Shahaliev E, Shanmuganathan PV, Shao M, Sheikh AI, Shen WQ, Shi SS, Shi Y, Shou QY, Sichtermann EP, Sikora R, Simko M, Singh J, Singha S, Smirnov N, Solyst W, Sorensen P, Spinka HM, Srivastava B, Stanislaus TDS, Stefaniak M, Stewart DJ, Strikhanov M, Stringfellow B, Suaide AAP, Sumbera M, Summa B, Sun XM, Sun X, Sun Y, Sun Y, Surrow B, Svirida DN, Szymanski P, Tang AH, Tang Z, Taranenko A, Tarnowsky T, Thomas JH, Timmins AR, Tlusty D, Tokarev M, Tomkiel CA, Trentalange S, Tribble RE, Tribedy P, Tripathy SK, Tsai OD, Tu Z, Ullrich T, Underwood DG, Upsal I, Van Buren G, Vanek J, Vasiliev AN, Vassiliev I, Videbæk F, Vokal S, Voloshin SA, Wang F, Wang G, Wang JS, Wang P, Wang Y, Wang Y, Wang Z, Webb JC, Weidenkaff PC, Wen L, Westfall GD, Wieman H, Wissink SW, Witt R, Wu Y, Xiao ZG, Xie G, Xie W, Xu H, Xu N, Xu QH, Xu YF, Xu Y, Xu Z, Xu Z, Yang C, Yang Q, Yang S, Yang Y, Yang Z, Ye Z, Ye Z, Yi L, Yip K, Yu Y, Zbroszczyk H, Zha W, Zhang C, Zhang D, Zhang S, Zhang S, Zhang XP, Zhang Y, Zhang Y, Zhang ZJ, Zhang Z, Zhang Z, Zhao J, Zhong C, Zhou C, Zhu X, Zhu Z, Zurek M, Zyzak M. Erratum: Global Polarization of Ξ and Ω Hyperons in Au+Au Collisions at sqrt[s_{NN}]=200 GeV [Phys. Rev. Lett. 126, 162301 (2021)]. PHYSICAL REVIEW LETTERS 2023; 131:089901. [PMID: 37683178 DOI: 10.1103/physrevlett.131.089901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Indexed: 09/10/2023]
Abstract
This corrects the article DOI: 10.1103/PhysRevLett.126.162301.
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Yuan ZL, Wang WQ, Chen D. [Clinical features and causative genes of dentin dysplasia type Ⅰ with a 13-year follow-up]. ZHONGHUA KOU QIANG YI XUE ZA ZHI = ZHONGHUA KOUQIANG YIXUE ZAZHI = CHINESE JOURNAL OF STOMATOLOGY 2023; 58:829-833. [PMID: 37550044 DOI: 10.3760/cma.j.cn112144-20230331-00129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
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Ruan WY, Zhang YL, Zheng SG, Sun Y, Fan ZP, Song YL, Sun HC, Wang WM, Dai JW, Zhao ZJ, Zhang TT, Chen D, Pan YC, Jiang YG, Wang XD, Zheng LW, Zhu QL, He M, Xu BS, Jia ZL, Han D, Duan XH. [Expert consensus on the biobank development of oral genetic diseases and rare diseases and storage codes of related biological samples from craniofacial and oral region]. ZHONGHUA KOU QIANG YI XUE ZA ZHI = ZHONGHUA KOUQIANG YIXUE ZAZHI = CHINESE JOURNAL OF STOMATOLOGY 2023; 58:749-758. [PMID: 37550034 DOI: 10.3760/cma.j.cn112144-20230523-00210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
The biological samples of oral genetic diseases and rare diseases are extremely precious. Collecting and preserving these biological samples are helpful to elucidate the mechanisms and improve the level of diagnose and treatment of oral genetic diseases and rare diseases. The standardized construction of biobanks for oral genetic diseases and rare diseases is important for achieving these goals. At present, there is very little information on the construction of these biobanks, and the standards or suggestions for the classification and coding of biological samples from oral and maxillofacial sources, and this is not conducive to the standardization and information construction of biobanks for special oral diseases. This consensus summarizes the background, necessity, principles, and key points of constructing the biobank for oral genetic diseases and rare diseases. On the base of the group standard "Classification and Coding for Human Biomaterial" (GB/T 39768-2021) issued by the National Technical Committee for Standardization of Biological Samples, we suggest 76 new coding numbers for different of biological samples from oral and maxillofacial sources. We hope the consensus may promote the standardization, and smartization on the biobank construction as well as the overall research level of oral genetic diseases and rare diseases in China.
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Abdulhamid MI, Aboona BE, Adam J, Adams JR, Agakishiev G, Aggarwal I, Aggarwal MM, Ahammed Z, Aitbaev A, Alekseev I, Anderson DM, Aparin A, Aslam S, Atchison J, Averichev GS, Bairathi V, Baker W, Ball Cap JG, Barish K, Bhagat P, Bhasin A, Bhatta S, Bordyuzhin IG, Brandenburg JD, Brandin AV, Cai XZ, Caines H, Calderón de la Barca Sánchez M, Cebra D, Ceska J, Chakaberia I, Chan BK, Chang Z, Chatterjee A, Chen D, Chen J, Chen JH, Chen Z, Cheng J, Cheng Y, Choudhury S, Christie W, Chu X, Crawford HJ, Dale-Gau G, Das A, Daugherity M, Dedovich TG, Deppner IM, Derevschikov AA, Dhamija A, Di Carlo L, Didenko L, Dixit P, Dong X, Drachenberg JL, Duckworth E, Dunlop JC, Engelage J, Eppley G, Esumi S, Evdokimov O, Ewigleben A, Eyser O, Fatemi R, Fazio S, Feng CJ, Feng Y, Finch E, Fisyak Y, Flor FA, Fu C, Geurts F, Ghimire N, Gibson A, Gopal K, Gou X, Grosnick D, Gupta A, Hamed A, Han Y, Harasty MD, Harris JW, Harrison-Smith H, He W, He XH, He Y, Hu C, Hu Q, Hu Y, Huang H, Huang HZ, Huang SL, Huang T, Huang X, Huang Y, Huang Y, Humanic TJ, Isenhower D, Isshiki M, Jacobs WW, Jalotra A, Jena C, Ji Y, Jia J, Jin C, Ju X, Judd EG, Kabana S, Kabir ML, Kalinkin D, Kang K, Kapukchyan D, Kauder K, Ke HW, Keane D, Kechechyan A, Kelsey M, Kimelman B, Kiselev A, Knospe AG, Ko HS, Kochenda L, Korobitsin AA, Kravtsov P, Kumar L, Kumar S, Kunnawalkam Elayavalli R, Lacey R, Landgraf JM, Lebedev A, Lednicky R, Lee JH, Leung YH, Lewis N, Li C, Li W, Li X, Li Y, Li Y, Li Z, Liang X, Liang Y, Lin T, Liu C, Liu F, Liu G, Liu H, Liu H, Liu L, Liu T, Liu X, Liu Y, Liu Z, Ljubicic T, Llope WJ, Lomicky O, Longacre RS, Loyd EM, Lu T, Lukow NS, Luo XF, Luong VB, Ma L, Ma R, Ma YG, Magdy N, Mallick D, Margetis S, Matis HS, Mazer JA, McNamara G, Mi K, Minaev NG, Mohanty B, Mondal MM, Mooney I, Morozov DA, Mudrokh A, Nagy MI, Nain AS, Nam JD, Nasim M, Neff D, Nelson JM, Nemes DB, Nie M, Nigmatkulov G, Niida T, Nishitani R, Nogach LV, Nonaka T, Odyniec G, Ogawa A, Oh S, Okorokov VA, Okubo K, Page BS, Pak R, Pan J, Pandav A, Pandey AK, Panebratsev Y, Pani T, Parfenov P, Paul A, Perkins C, Pokhrel BR, Posik M, Protzman T, Pruthi NK, Putschke J, Qin Z, Qiu H, Quintero A, Racz C, Radhakrishnan SK, Raha N, Ray RL, Ritter HG, Robertson CW, Rogachevsky OV, Rosales Aguilar MA, Roy D, Ruan L, Sahoo AK, Sahoo NR, Sako H, Salur S, Samigullin E, Sato S, Schmidke WB, Schmitz N, Seger J, Seto R, Seyboth P, Shah N, Shahaliev E, Shanmuganathan PV, Shao T, Sharma M, Sharma N, Sharma R, Sharma SR, Sheikh AI, Shen DY, Shen K, Shi SS, Shi Y, Shou QY, Si F, Singh J, Singha S, Sinha P, Skoby MJ, Söhngen Y, Song Y, Srivastava B, Stanislaus TDS, Stewart DJ, Strikhanov M, Stringfellow B, Su Y, Sun C, Sun X, Sun Y, Sun Y, Surrow B, Svirida DN, Sweger ZW, Tamis A, Tang AH, Tang Z, Taranenko A, Tarnowsky T, Thomas JH, Tlusty D, Todoroki T, Tokarev MV, Tomkiel CA, Trentalange S, Tribble RE, Tribedy P, Tsai OD, Tsang CY, Tu Z, Ullrich T, Underwood DG, Upsal I, Van Buren G, Vasiliev AN, Verkest V, Videbæk F, Vokal S, Voloshin SA, Wang F, Wang G, Wang JS, Wang X, Wang Y, Wang Y, Wang Y, Wang Z, Webb JC, Weidenkaff PC, Westfall GD, Wieman H, Wilks G, Wissink SW, Wu J, Wu J, Wu X, Wu Y, Xi B, Xiao ZG, Xie G, Xie W, Xu H, Xu N, Xu QH, Xu Y, Xu Y, Xu Z, Xu Z, Yan G, Yan Z, Yang C, Yang Q, Yang S, Yang Y, Ye Z, Ye Z, Yi L, Yip K, Yu Y, Zha W, Zhang C, Zhang D, Zhang J, Zhang S, Zhang W, Zhang X, Zhang Y, Zhang Y, Zhang Y, Zhang ZJ, Zhang Z, Zhang Z, Zhao F, Zhao J, Zhao M, Zhou C, Zhou J, Zhou S, Zhou Y, Zhu X, Zurek M, Zyzak M. Measurements of the Elliptic and Triangular Azimuthal Anisotropies in Central ^{3}He+Au, d+Au and p+Au Collisions at sqrt[s_{NN}]=200 GeV. PHYSICAL REVIEW LETTERS 2023; 130:242301. [PMID: 37390421 DOI: 10.1103/physrevlett.130.242301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/27/2023] [Accepted: 05/15/2023] [Indexed: 07/02/2023]
Abstract
The elliptic (v_{2}) and triangular (v_{3}) azimuthal anisotropy coefficients in central ^{3}He+Au, d+Au, and p+Au collisions at sqrt[s_{NN}]=200 GeV are measured as a function of transverse momentum (p_{T}) at midrapidity (|η|<0.9), via the azimuthal angular correlation between two particles both at |η|<0.9. While the v_{2}(p_{T}) values depend on the colliding systems, the v_{3}(p_{T}) values are system independent within the uncertainties, suggesting an influence on eccentricity from subnucleonic fluctuations in these small-sized systems. These results also provide stringent constraints for the hydrodynamic modeling of these systems.
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Liu R, Chen D, Dong F, Wang H, Shang JF, Teng F. [Primary cardiac angiosarcoma: a clinicopathological and molecular genetic analysis of thirteen cases]. ZHONGHUA BING LI XUE ZA ZHI = CHINESE JOURNAL OF PATHOLOGY 2023; 52:599-605. [PMID: 37263925 DOI: 10.3760/cma.j.cn112151-20221019-00874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Objective: To investigate the clinicopathological and molecular features of primary cardiac angiosarcoma (PCAS), and to analyze the correlation between KDR mutation and the clinicopathological features of PCAS. Methods: Thirteen cases of PCAS were collected at Beijing Anzhen Hospital, Capital Medical University from January 2007 to December 2021. The clinicopathological features, diagnosis, differential diagnosis and outcome were retrospectively analyzed. KDR mutation was detected by next-generation sequencing (NGS) and then the expression of KDR (VEGFR2) was determined by immunohistochemistry (IHC), with review of relevant literatures. Results: There were eight males and five females with a mean age of 45 years. The primary tumor was in the right atrium in 10 cases, left atrium in two cases and right ventricle in one case. The histomorphology was mainly poorly differentiated angiosarcoma (11 cases), with highly pleomorphic spindle or round cells in solid sheets, brisk mitotic activity and extensive necrosis. Vascular lumen formation was observed in two cases of high to moderate differentiation, and biphenotypic differentiation was seen in five cases. IHC staining showed CD34, CD31, Fli1, ERG and vimentin were diffusely positive, pan-cytokeratin was positive, Ki-67 index ranged from 3% to 90%, which was positively correlated with the differentiation degree and grade of the PCASs (P<0.05). At the end of follow-up period, one patient was alive, two patients were lost to follow-up, and the remaining 10 patients had an average survival time of 4.6 months. Finally, NGS sequencing was performed on seven samples after screening, and the results showed that KDR and NF1 mutations were both present in three cases. VEGFR2 expression had no significant correlation with the differentiation degree and grade of PCAS (P>0.05), and it was not related to KDR mutation. Conclusions: PCASs mainly occur in the right atrium, and are mainly poorly differentiated. Ki-67 index is helpful to assess the degree and grade of tumor differentiation. The occurrence and development of PCAS may be related to the pathway involved in KDR mutation, but KDR mutation has no clear correlation with clinicopathological characteristics of PCAS, and immunohistochemical staining can not replace gene detection to determine whether the tumor had KDR mutation.
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Zhang Y, Wang K, Yu H, Zhao T, Lin L, Qin X, Wu T, Chen D, Hu Y, Wu Y. Incidence and characteristics of aspiration pneumonia in adults in Beijing, China, 2011-2017. Public Health 2023; 220:65-71. [PMID: 37270854 DOI: 10.1016/j.puhe.2023.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVES This study aimed to estimate aspiration pneumonia (AP) incidence and describe comorbid characteristics and mortality in Beijing, China. STUDY DESIGN A historical cohort study was conducted based on medical claim records. METHODS Patients admitted with a primary diagnosis of AP were identified from approximately 12 million adults who enrolled in the Urban Employee Basic Medical Insurance program in Beijing, China, from January 2011 to December 2017. The incidences of AP and pneumonia with risk factors for aspiration (PRFA) were estimated by a Poisson distribution. The estimated annual percentage change was reported to represent the average percentage change in incidence per year. Characteristics and 6-month and 1-year all-cause mortality rates for AP and suspected AP patients were described and compared with community-acquired pneumonia (CAP). RESULTS The incidence rates of hospitalized AP and PRFA were 9.4 (95% confidence interval [CI]: 7.6, 11.3) and 102.9 (95% CI: 95.8, 110.3) per 100,000 person-years, respectively. The incidences increased rapidly with age and were stable across the observed years. Patients with AP and PRFA possessed a greater burden of comorbidities than CAP (mean age-adjusted Charlson comorbidity indices for AP: 7.72, PRFA: 7.83, and CAP: 2.84). The 6-month and 1-year all-cause mortality rates for those with AP and PRFA were higher than those for patients with CAP (6-month mortality, AP: 35.2%, PRFA: 21.8%, CAP: 11.1%; 1-year mortality, AP: 42.7%, PRFA: 26.6%, CAP: 13.2%). CONCLUSIONS The incidence of AP and PRFA in Beijing was reported, presenting a full picture of the disease burden. The results provide baseline information for AP prevention.
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