1
|
Garg R, Burke CA, Aggarwal M, Macaron C, Singh A, Kim MK, Regueiro M, Amit B, Chahal P, Garg S. Sessile serrated polyp detection rates after fecal immunochemical test or multitarget stool DNA test: Systematic review and meta-analysis. Endosc Int Open 2024; 12:E474-E487. [PMID: 38585019 PMCID: PMC10997425 DOI: 10.1055/a-2256-3411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/23/2024] [Indexed: 04/09/2024] Open
Abstract
Background and study aims Published studies report a higher adenoma detection rate (ADR) for FIT-DNA as compared with FIT. Data are less replete about the performance of stool-based tests for sessile serrated polyp (SSP) detection. We performed a meta-analysis to evaluate the performance of FIT and FIT-DNA testing for SSP detection rate (SSPDR) in patients undergoing colonoscopy for follow up of positive noninvasive tests. Methods A comprehensive literature search of multiple databases (until September 2022) was performed to identify studies reporting SSPDR in patients with positive FIT or FIT-DNA tests. The outcome was overall colonoscopy detection of any SSPs and advanced serrated polyps (ASP: SSP ≥ 10 mm and/or dysplasia). Results Included were 482,405 patients (52.4% females) with a mean age of 62.3 ± 4.4 years from 23 studies. The pooled SSPDR for all positive stool-based tests was 5.3% and higher for FIT-DNA (15.0%, 95% confidence interval [CI] 8.3-25.7) versus FIT (4.1%, 95% CI 3.0-5.6; P = 0.0002). The overall pooled ASP detection rate was 1.4% (95% CI 0.81-2.3) and higher for FIT-DNA (3.8 %, 95% CI 1.7-8.6) compared with FIT (0.71%, 95% CI 0.36-1.4; P <0.01). SSPDR with FIT-DNA was also significantly higher than FIT when the FIT cutoff was >10 ug/g and in FIT-positive patients in studies conducted in North America ( P <0.05). Conclusions FIT-DNA outperformed FIT in both SSP and ASP detection including FIT with a lower threshold cutoff of >10 ug/g. Further comparative studies are needed to assess the impact of our findings on colorectal cancer reduction.
Collapse
Affiliation(s)
- Rajat Garg
- Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, United States
| | - Carol A. Burke
- Internal Medicine, Cleveland Clinic Foundation, Cleveland, United States
| | - Manik Aggarwal
- Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, United States
| | - Carole Macaron
- Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, United States
| | - Amandeep Singh
- Internal Medicine, Cleveland Clinic Foundation, Cleveland, United States
| | - Michelle K. Kim
- Internal Medicine, Cleveland Clinic Foundation, Cleveland, United States
| | - Miguel Regueiro
- Internal Medicine, Cleveland Clinic Foundation, Cleveland, United States
| | - Bhatt Amit
- Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, United States
| | - Prabhleen Chahal
- Internal Medicine, Cleveland Clinic Foundation, Cleveland, United States
| | - Shashank Garg
- Medicine, University of Arkansas System, Little Rock, United States
| |
Collapse
|
2
|
Jiang L, Xu F, Feng W, Fu C, Zhou C. The value of hypersensitivity quantitative fecal immunochemical test in early colorectal cancer detection. Postgrad Med J 2024; 100:135-141. [PMID: 38055911 DOI: 10.1093/postmj/qgad114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 12/08/2023]
Abstract
At present, both the incidence and mortality rates of colorectal cancer are on the rise, making early screening a crucial tool in reducing the fatality rate. Although colonoscopy is the recommended method according to the guidelines, compliance tends to be poor. The fecal immunochemical test (FIT), a new technology that uses latex immunoturbidimetry to detect fecal blood, offers high specificity and sensitivity. Additionally, it is low-cost, easy to operate, and less likely to be affected by food and drugs, thus improving the compliance rate for population screening. Compared to other screening techniques, FIT represents a safer and more accurate option. This article reviews the application of FIT in early colorectal cancer screening.
Collapse
Affiliation(s)
- Lianghong Jiang
- Dalian University Affiliated Xinhua Hospital, Dalian, Liaoning 116000, China
| | - Fen Xu
- Dalian University Affiliated Xinhua Hospital, Dalian, Liaoning 116000, China
| | - Weiwei Feng
- Dalian University Affiliated Xinhua Hospital, Dalian, Liaoning 116000, China
| | - Chen Fu
- Dalian University Affiliated Xinhua Hospital, Dalian, Liaoning 116000, China
| | - Changjiang Zhou
- Dalian University Affiliated Xinhua Hospital, Dalian, Liaoning 116000, China
| |
Collapse
|
3
|
Zhang L, Feng Z, Li Y, Lv C, Li C, Hu Y, Fu M, Song L. Salivary and fecal microbiota: potential new biomarkers for early screening of colorectal polyps. Front Microbiol 2023; 14:1182346. [PMID: 37655344 PMCID: PMC10467446 DOI: 10.3389/fmicb.2023.1182346] [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: 03/08/2023] [Accepted: 07/31/2023] [Indexed: 09/02/2023] Open
Abstract
Objective Gut microbiota plays an important role in colorectal cancer (CRC) pathogenesis through microbes and their metabolites, while oral pathogens are the major components of CRC-associated microbes. Multiple studies have identified gut and fecal microbiome-derived biomarkers for precursors lesions of CRC detection. However, few studies have used salivary samples to predict colorectal polyps. Therefore, in order to find new noninvasive colorectal polyp biomarkers, we searched into the differences in fecal and salivary microbiota between patients with colorectal polyps and healthy controls. Methods In this case-control study, we collected salivary and fecal samples from 33 patients with colorectal polyps (CP) and 22 healthy controls (HC) between May 2021 and November 2022. All samples were sequenced using full-length 16S rRNA sequencing and compared with the Nucleotide Sequence Database. The salivary and fecal microbiota signature of colorectal polyps was established by alpha and beta diversity, Linear discriminant analysis Effect Size (LEfSe) and random forest model analysis. In addition, the possibility of microbiota in identifying colorectal polyps was assessed by Receiver Operating Characteristic Curve (ROC). Results In comparison to the HC group, the CP group's microbial diversity increased in saliva and decreased in feces (p < 0.05), but there was no significantly difference in microbiota richness (p > 0.05). The principal coordinate analysis revealed significant differences in β-diversity of salivary and fecal microbiota between the CP and HC groups. Moreover, LEfSe analysis at the species level identified Porphyromonas gingivalis, Fusobacterium nucleatum, Leptotrichia wadei, Prevotella intermedia, and Megasphaera micronuciformis as the major contributors to the salivary microbiota, and Ruminococcus gnavus, Bacteroides ovatus, Parabacteroides distasonis, Citrobacter freundii, and Clostridium symbiosum to the fecal microbiota of patients with polyps. Salivary and fecal bacterial biomarkers showed Area Under ROC Curve of 0.8167 and 0.8051, respectively, which determined the potential of diagnostic markers in distinguishing patients with colorectal polyps from controls, and it increased to 0.8217 when salivary and fecal biomarkers were combined. Conclusion The composition and diversity of the salivary and fecal microbiota were significantly different in colorectal polyp patients compared to healthy controls, with an increased abundance of harmful bacteria and a decreased abundance of beneficial bacteria. A promising non-invasive tool for the detection of colorectal polyps can be provided by potential biomarkers based on the microbiota of the saliva and feces.
Collapse
Affiliation(s)
- Limin Zhang
- Department of Stomatology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
| | - Ziying Feng
- Department of Stomatology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
| | - Yinghua Li
- Central Laboratory, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
| | - Cuiting Lv
- Central Laboratory, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
| | - Chunchun Li
- Department of Stomatology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
| | - Yue Hu
- Department of Stomatology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
| | - Mingsheng Fu
- Department of Gastroenterology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
| | - Liang Song
- Department of Stomatology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
| |
Collapse
|
4
|
Ze Y, Tu H, Zhang L, Bai Y, Ren Y, Chen X, Xue Y, Sun R, Yang Y, Yang J, Zhou X, Liu L. A Comparison of Single and Combined Schemes of Asia-Pacific Colorectal Screening, Faecal Immunochemical and Stool Deoxyribonucleic Acid Testing for Community Colorectal Cancer Screening. J Multidiscip Healthc 2023; 16:571-586. [PMID: 36883167 PMCID: PMC9985980 DOI: 10.2147/jmdh.s398997] [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: 12/05/2022] [Accepted: 02/13/2023] [Indexed: 03/05/2023] Open
Abstract
Objective To compare the screening efficacy of colonoscopy and pathologically confirmed single and combined Asia-Pacific colorectal screening (APCS), faecal immunochemical testing (FIT) and stool deoxyribonucleic acid (sDNA) testing protocols. Methods From April 2021 to April 2022, 842 volunteers participated in primary colorectal cancer (CRC) screenings using APCS scoring, FIT and sDNA testing and 115 underwent a colonoscopy. One hundred high-risk participants were then identified from the results of both processes. The differences in the three CRC screening tests in combination with the colonoscopy pathology diagnostics were evaluated using Cochran's Q test, the Dunn-Bonferroni test and area under the receiver operating characteristic curve (AUC) value analysis. Results Both FIT and sDNA testing demonstrated a 100% performance in detecting CRC. For advanced adenoma, the sensitivity of the FIT + sDNA test scheme (double positive) was 29.2%, and the sensitivities of the combined FIT + sDNA test and APCS scoring + sDNA test schemes were 62.5% and 95.8%, respectively. The FIT + sDNA testing kappa value of advanced colorectal neoplasia was 0.344 (p = 0.011). The sensitivity for nonadvanced adenoma of the APCS score + sDNA test scheme was 91.1%. In terms of positive results, the sensitivity of the APCS score + FIT + sDNA detection protocol was significantly higher than that of the APCS score, FIT, sDNA detection, and FIT + sDNA detection methods (adjusted p < 0.001, respectively). For the FIT + sDNA test, the kappa value was 0.220 (p = 0.015) and the AUC was 0.634 (p = 0.037). The specificity of the FIT + sDNA test scheme was 69.0%. Conclusion The FIT + sDNA test scheme demonstrated superior diagnostic efficacy, and the combined APCS score + FIT + sDNA test scheme demonstrated remarkable improvements in CRC screening efficiency and sensitivity for detecting positive lesions.
Collapse
Affiliation(s)
- Yuan Ze
- Wuxi School of Medicine, Jiangnan University, Wuxi, People's Republic of China
| | - Huiming Tu
- Department of Gastroenterology, Affiliated Hospital of Jiangnan University, Wuxi, People's Republic of China
| | - Lin Zhang
- Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, People's Republic of China.,School of Population Medicine and Public Health, Peking Union Medical College/Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Yu Bai
- Department of Gastroenterology, Changhai Hospital of Shanghai, Shanghai, People's Republic of China
| | - Yilin Ren
- Department of Gastroenterology, Affiliated Hospital of Jiangnan University, Wuxi, People's Republic of China
| | - Xin Chen
- Wuxi School of Medicine, Jiangnan University, Wuxi, People's Republic of China
| | - Yuzheng Xue
- Department of Gastroenterology, Affiliated Hospital of Jiangnan University, Wuxi, People's Republic of China
| | - Renjuan Sun
- Outpatient Nursing department, Affiliated Hospital of Jiangnan University, Wuxi, People's Republic of China
| | - Yuling Yang
- Nursing department of Geriatrics Ward, Affiliated Hospital of Jiangnan University, Wuxi, People's Republic of China
| | - Jie Yang
- Department of Gastroenterology, Affiliated Hospital of Jiangnan University, Wuxi, People's Republic of China
| | - Xuan Zhou
- Department of Gastroenterology, Affiliated Hospital of Jiangnan University, Wuxi, People's Republic of China
| | - Li Liu
- Data Center, Affiliated Hospital of Jiangnan University, Wuxi, People's Republic of China
| |
Collapse
|
5
|
Lv L, Ma J, Wu L, Zhang C, Wang Y, Wang G. New Studies of the Aberrant Alterations in Fibrillin-1 Methylation During Colorectal Cancer Development. Front Oncol 2022; 12:862887. [PMID: 35515111 PMCID: PMC9067271 DOI: 10.3389/fonc.2022.862887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/04/2022] [Indexed: 11/26/2022] Open
Abstract
Background Fibrillin-1 (FBN1) methylation risk from control to colorectal cancer (CRC), the variation regularities of FBN1 methylation, and DNA methyltransferase (DNMT) catalyzed with FBN1 methylation had not been reported yet; these were all studied in this paper. Methods FBN1 methylation roles were investigated with big data and meta-analysis. Results The 6 independent studies were searched including 702 tissue and 448 feces. FBN1 methylation frequencies of CRC, adenoma or polyp, and control in tissue were 79.1%, 69.4%, and 2.7%, respectively; those in feces were 74.6%, 50.7%, and 10.8%, respectively. FBN1 methylation of control samples was used as a standard reference; this study showed that ORs (95% CI) of FBN1 methylation in CRC and control tissues were 124.79 (62.86-248.35); those in feces were detected to be 30.87 (16.48-57.85). FBN1 methylation risk in tissue was higher than that in feces; there was a quadratic equation between the methylation rate of tissue and that of feces. There was another quadratic curve in the variation process of FBN1 methylation; this curve reflected the overall metabolism regularity of DNMT. Conclusions The transcriptional inactivation of FBN1 gene might start from normal colonic epithelium; the quadratic curve of FBN1 methylation catalyzed by DNMT can gradually produce powerful strength, accelerate expansion, and eventually lead to CRC. The overall metabolism regularity of DNMT maintains the changing process of FBN1 methylation; it has the changing feature of the same quadratic curve. FBN1 methylation is a promising biomarker. FBN1 methylation risk size in feces reflects that in tissue in non-invasive detection.
Collapse
Affiliation(s)
- Ling Lv
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jianzhong Ma
- School of Business, Xianda College of Economics & Humanities, Shanghai International Studies University, Shanghai, China
| | - Lina Wu
- Department of Medical Laboratory, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chao Zhang
- School of Business, Xianda College of Economics & Humanities, Shanghai International Studies University, Shanghai, China
| | - Yueping Wang
- Department of Infection Diseases, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Guang Wang
- Hepatobiliary Surgery Department, The First Affiliated Hospital, China Medical University, Shenyang, China
| |
Collapse
|
6
|
Zou J, Xiao Z, Wu Y, Yang J, Cui N. Noninvasive fecal testing for colorectal cancer. Clin Chim Acta 2021; 524:123-131. [PMID: 34756863 DOI: 10.1016/j.cca.2021.10.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/18/2021] [Accepted: 10/26/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Colorectal cancer (CRC) is the third most common malignancy worldwide, with the second highest mortality rate among all malignancies. In this review, we describe the current utility of stool diagnostic biomarkers for CRC. METHODS We reviewed stool-related tests and biomarker candidates for the diagnosis of CRC. The guaiac-based fecal occult blood test (gFOBT), fecal immunochemical test (FIT), and multitarget stool DNA test (MT-sDNA) have been used as clinical CRC screening tools. Although microRNAs, protein biomarkers, and microbiota have not yet been used in clinical CRC screening, there is growing evidence that they have the potential to function as CRC screening tools. RESULTS According to the literature, the sensitivity of MT-sDNA for detecting CRC was 87.0-100%, 32.7-82.0% for advanced adenomas, and the specificity was 86.1-95.2%. The sensitivity of individual biomarkers of fecal microRNAs for detecting CRC was 34.2-88.2%, 73.0% for advanced adenomas, and the specificity was 68-100%. The sensitivity of fecal protein markers for detecting CRC was 63.6-93.0%, 47.7-69.4% for advanced adenomas, and the specificity was 38.3-97.5%. The sensitivity of fecal microbiota for detecting CRC was 54.0-100.0%, 32.0-48.3% for advanced adenomas, and the specificity was 61.3-90.0%. CONCLUSION MT-sDNA is the most sensitive CRC screening test, and its sensitivity is the highest for advanced adenomas; however, its detection cost is high. MT-sDNA was more sensitive to CRC and advanced precancerous lesions than FIT, but compared to three years of MT-sDNA, annual FIT as the first non-invasive screening test for CRC seemed to be more effective.
Collapse
Affiliation(s)
- Jianhua Zou
- China Academy of Chinese Medical Sciences Xiyuan Hospital, Beijing, China
| | - Zhanshuo Xiao
- China Academy of Chinese Medical Sciences Guanganmen Hospital, Beijing, China
| | - Yu Wu
- China Academy of Chinese Medical Sciences Xiyuan Hospital, Beijing, China.
| | - Jingyan Yang
- China Academy of Chinese Medical Sciences Xiyuan Hospital, Beijing, China
| | - Ning Cui
- China Academy of Chinese Medical Sciences Xiyuan Hospital, Beijing, China
| |
Collapse
|
7
|
Grady WM, Yu M, Markowitz SD. Epigenetic Alterations in the Gastrointestinal Tract: Current and Emerging Use for Biomarkers of Cancer. Gastroenterology 2021; 160:690-709. [PMID: 33279516 PMCID: PMC7878343 DOI: 10.1053/j.gastro.2020.09.058] [Citation(s) in RCA: 116] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/24/2020] [Accepted: 09/28/2020] [Indexed: 02/06/2023]
Abstract
Colorectal cancer, liver cancer, stomach cancer, pancreatic cancer, and esophageal cancer are leading causes of cancer-related deaths worldwide. A fundamental trait of virtually all gastrointestinal cancers is genomic and epigenomic DNA alterations. Cancer cells acquire genetic and epigenetic alterations that drive the initiation and progression of the cancers by altering the molecular and cell biological processes of the cells. These alterations, as well as other host and microenvironment factors, ultimately mediate the clinical behavior of the precancers and cancers and can be used as biomarkers for cancer risk determination, early detection of cancer and precancer, determination of the prognosis of cancer and prediction of the response to therapy. Epigenetic alterations have emerged as one of most robust classes of biomarkers and are the basis for a growing number of clinical tests for cancer screening and surveillance.
Collapse
Affiliation(s)
- William M. Grady
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA,Division of Gastroenterology, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Ming Yu
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| | | |
Collapse
|
8
|
Fu X, Zhang Y, Chang L, Hui D, Jia R, Liu N, Zhang H, Han G, Han Z, Li Y, Liu H, Zhu H, Li Q. The JPJDF has Synergistic Effect with Fluoropyrimidine in the Maintenance Therapy for Metastatic Colorectal Cancer. Recent Pat Anticancer Drug Discov 2020; 15:257-269. [PMID: 32679021 DOI: 10.2174/1574892815666200717141205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/20/2020] [Accepted: 06/24/2020] [Indexed: 02/07/2023]
Abstract
Background:
Maintenance chemotherapeutic regimen with low toxicity is needed for
metastatic colorectal cancer. A recent patent has been issued on the spleen-strengthening and detoxification
prescription (JPJDF), a traditional Chinese herbal medicinal formula with anti-angiogenesis
effect. The clinical effect of JPJDF on the maintenance treatment of advanced colorectal cancer
has not been evaluated.
Objective:
This study aims to evaluate the effectiveness and safety of JPJDF in combination with
fluoropyrimidine compared to fluoropyrimidine alone as maintenance therapy for metastatic colorectal
cancer.
Methods:
We applied a prospective, randomized, double-blinded, single center clinical study design.
A total of 137 patients with advanced colorectal cancer were recruited. Patients received either
Fluoropyrimidine (Flu-treated group, n = 68), or Fluoropyrimidine plus JPJDF (Flu-F-treated
group, n = 69) as maintenance treatment after 6-cycle of FOLFOX4 or FOLFORI induction treatment.
The primary endpoints were Progression-Free Survival (PFS) and Overall Survival (OS).
The secondary endpoints were safety, Performance Status (PS) score and other symptoms.
Results:
The endpoint of disease progression was observed in 91.7% of patients. The PFS was 5.0
months and 3.0 months in the Flu-F-treated and Flu-treated groups, respectively. The OS was 15.0
months and 9.0 months in the Flu-F-treated and Flu-treated groups, respectively. Some common
symptoms, such as hypodynamia, anepithymia, dizziness and tinnitus and shortness of breath, were
improved in the Flu-F-treated group. There was no significant difference in the common adverse reactions
between the two groups.
Conclusion:
JPJDF and fluoropyrimidine have synergistic effect in the maintenance treatment of
mCRC.
Collapse
Affiliation(s)
- Xiaoling Fu
- Department of Oncology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No. 110, Ganhe Road, Shanghai 200437, China
| | - Yanbo Zhang
- Department of Oncology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, No. 528, Zhangheng Road, Shanghai 201203, China
| | - Lisheng Chang
- Department of Oncology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, No. 528, Zhangheng Road, Shanghai 201203, China
| | - Dengcheng Hui
- Department of Oncology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, No. 528, Zhangheng Road, Shanghai 201203, China
| | - Ru Jia
- Department of Oncology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, No. 528, Zhangheng Road, Shanghai 201203, China
| | - Ningning Liu
- Department of Oncology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, No. 528, Zhangheng Road, Shanghai 201203, China
| | - Huayue Zhang
- Department of Oncology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No. 110, Ganhe Road, Shanghai 200437, China
| | - Gang Han
- Department of Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, No. 528, Zhangheng Road, Shanghai 201203, China
| | - Zhifen Han
- Department of Oncology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, No. 528, Zhangheng Road, Shanghai 201203, China
| | - Yuan Li
- Department of Oncology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No. 110, Ganhe Road, Shanghai 200437, China
| | - Hui Liu
- Department of Oncology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, No. 528, Zhangheng Road, Shanghai 201203, China
| | - Huirong Zhu
- Department of Oncology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, No. 528, Zhangheng Road, Shanghai 201203, China
| | - Qi Li
- Department of Oncology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, No. 528, Zhangheng Road, Shanghai 201203, China
| |
Collapse
|