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Fafliora E, Hatzoglou C, Gourgoulianis KI, Zarogiannis SG. Systematic review and meta-analysis of vascular endothelial growth factor as a biomarker for malignant pleural effusions. Physiol Rep 2017; 4:4/24/e12978. [PMID: 28039396 PMCID: PMC5210377 DOI: 10.14814/phy2.12978] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 08/22/2016] [Indexed: 01/18/2023] Open
Abstract
Conventional methods may fail to identify the cause of pleural effusion (PE), thus establishing reliable biomarkers is deemed necessary. This study aimed at examining the role of vascular endothelial growth factor (VEGF) as a biomarker in the differentiation between malignant and benign PEs in adults. A comprehensive literature search in PubMed (Medline), Scopus (ELSEVIER), and Cochrane Central Register of Controlled Trials (CENTRAL) databases was conducted using keywords. We included studies that evaluated pleural and/or serum levels of VEGF among patients presenting with undiagnosed PE and the association between these levels and the final diagnosis. We performed a meta‐analysis to calculate the summary effect using the random effects model. Statistical analysis was performed with the statistical package for meta‐analysis Comprehensive Meta‐Analysis. Twenty studies were included in the systematic review, while 11 of them in the meta‐analysis. Pleural fluid VEGF levels among patients with malignant PE were increased by 1.93 ng/mL as compared to patients with benign PE (95% CI: 1.32–2.54, Q = 173, df (Q): 10, I2 = 94.2%, P < 0.05). Serum VEGF levels among patients with malignant PE were increased respectively by 1.90 ng/mL (95% CI: 0.93–2.88, Q = 182, df (Q): 6, I2 = 96.7%, P < 0.05). This study showed that malignant PEs were associated with higher levels of both pleural fluid and serum VEGF. VEGF appears to represent a promising biomarker for the differential diagnosis between benign and malignant PEs.
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Affiliation(s)
- Eleftheria Fafliora
- Primary Health Care, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Chrissi Hatzoglou
- Primary Health Care, Faculty of Medicine, University of Thessaly, Larissa, Greece.,Department of Physiology, Faculty of Medicine, University of Thessaly, Larissa, Greece.,Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Konstantinos I Gourgoulianis
- Primary Health Care, Faculty of Medicine, University of Thessaly, Larissa, Greece .,Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Sotirios G Zarogiannis
- Primary Health Care, Faculty of Medicine, University of Thessaly, Larissa, Greece.,Department of Physiology, Faculty of Medicine, University of Thessaly, Larissa, Greece.,Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
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Kim S, Kim B, Song YS. Ascites modulates cancer cell behavior, contributing to tumor heterogeneity in ovarian cancer. Cancer Sci 2016; 107:1173-8. [PMID: 27297561 PMCID: PMC5021036 DOI: 10.1111/cas.12987] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 06/09/2016] [Accepted: 06/13/2016] [Indexed: 02/06/2023] Open
Abstract
Malignant ascites constitute a unique tumor microenvironment providing a physical structure for the accumulation of cellular and acellular components. Ascites is initiated and maintained by physical and biological factors resulting from underlying disease and forms an ecosystem that contributes to disease progression. It has been demonstrated that the cellular contents and the molecular signatures of ascites change continuously during the course of a disease. Over the past decade, increasing attention has been given to the characterization of components of ascites and their role in the progression of ovarian cancer, the most malignant gynecologic cancer in women. This review will discuss the role of ascites in disease progression, in terms of modulating cancer cell behavior and contributing to tumor heterogeneity.
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Affiliation(s)
- Soochi Kim
- Interdisciplinary Program in Cancer Biology, College of Medicine, Seoul National University, Seoul, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Boyun Kim
- Cancer Research Institute, Seoul National University, Seoul, Korea.,Nano System Institute, Seoul National University, Seoul, Korea
| | - Yong Sang Song
- Interdisciplinary Program in Cancer Biology, College of Medicine, Seoul National University, Seoul, Korea. .,Cancer Research Institute, Seoul National University, Seoul, Korea. .,Biomodulation, Department of Agricultural Biotechnology, Seoul National University, Seoul, Korea. .,Department of Obstetrics and Gynecology, Seoul National University, Seoul, Korea.
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Marquez-Medina D, Popat S. Closing faucets: the role of anti-angiogenic therapies in malignant pleural diseases. Clin Transl Oncol 2015; 18:760-8. [PMID: 26680633 DOI: 10.1007/s12094-015-1464-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 11/27/2015] [Indexed: 01/31/2023]
Abstract
Malignant pleural effusion (MPE) represents 15-35 % of pleural effusions and markedly worsens the prognosis and quality of life of patients with cancer. Malignant mesothelioma (MM) and lung adenocarcinoma are the most frequent primary and secondary causes, respectively, of MPE. Effective treatments for cancer-related MPE are warranted in order to improve symptoms, reduce the number of invasive pleural procedures, and prolong patient life. Since angiogenesis plays a key role in MPE development, the potential role of bevacizumab and other anti-angiogenic therapies have been explored in this review. No relevant phase III trials have specifically analysed the benefit from adding bevacizumab to platinum-based chemotherapy in lung cancer-related MPE. However, small retrospective series reported 71.4-93.3 % MPE control rate, a reduction in invasive procedures, and a safe profile with this combination. Being approved for the first-line treatment of non-squamous advanced NSCLC, the addition of bevacizumab should be considered for patients presenting with MPE. In addition, further studies in this are recommended. In MM, the addition of bevacizumab to platinum-based chemotherapy did not meet primary endpoints in two phase II trials. However, the beneficial results on OS reported in comparison with historical cohorts and the statistically significant benefit on PFS and OS observed in the phase III MAPS trial foretell an eventual role for the combination of platinum/pemetrexed/bevacizumab as front-line systemic therapy for pleural MM. To date, no other anti-angiogenic drug has showed significant benefit in the treatment of patients with either MPE or MM. However, new promising drugs such as ramucirumab or recombinant human endostar warrant further investigation.
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Affiliation(s)
- D Marquez-Medina
- Medical Oncology Department, Arnau de Vilanova University Hospital, Avda. Rovira Roure, 80, 25198, Lleida, Spain.
| | - S Popat
- Lung Cancer Unit, Royal Marsden Hospital, London, UK
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Zhu FL, Ling AS, Wei Q, Ma J, Lu G. Tumor markers in serum and ascites in the diagnosis of benign and malignant ascites. Asian Pac J Cancer Prev 2015; 16:719-22. [PMID: 25684514 DOI: 10.7314/apjcp.2015.16.2.719] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate the values of 4 tumor markers in serum and ascites and their ascites/serum ratios in the identification and diagnosis of benign and malignant ascites. MATERIALS AND METHODS A total of 76 patients were selected as subjects and divided into malignant ascites group (45 cases) and benign ascites group (31 cases). Samples of ascites and serum of all hospitalized patients were collected before treatment. The levels of carcinoembryonic antigen (CEA), alpha fetoprotein (AFP), cancer antigen 125 (CA125) and carbohydrate antigen 19-9 (CA19-9) were detected by chemiluminescence (CLIA) . RESULTS CEA, AFP and CA19-9 in both serum and ascites as well as CA125 in ascites were evidently higher in the malignant ascites group than in the benign ascites group (P<0.01). Malignant ascites was associated with elevated ascites/serum ratios for AFP and CA125 (P<0.01). The areas under receiver operating characteristic (AUROCs) of CEA and CA125 in ascites and the ratios of ascites/serum of AFP, CEA, CA125 and CA19-9 were all >0.7, suggesting certain values, while those of ascites CA19-9 and serum CEA were 0.697 and 0.629 respectively, indicating low accuracy in the identification and diagnosis of benign and malignant ascites. However, the AUROCs of the remaining indexes were <0.5, with no value for identification and diagnosis. Compared with single index, the sensitivity of combined detection increased significantly (P<0.05), in which the combined detection of CEA, CA19-9 and CA125 in ascites as well as the ratio of ascites/serum of CEA, CA19-9, CA125 and AFP had the highest sensitivity (98.4%) but with relevantly low specificity. Both sensitivity and specificity of combined detection should be comprehensively considered so as to choose the most appropriate index. CONCLUSIONS Compared with single index, combined detection of tumor markers in serum and ascites can significantly improve the diagnostic sensitivity and specificity.
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Affiliation(s)
- Fang-Lai Zhu
- Department of Gastroenterology, The First People's Hospital of Anqing, Anqing, China E-mail :
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Walia A, Yang JF, Huang YH, Rosenblatt MI, Chang JH, Azar DT. Endostatin's emerging roles in angiogenesis, lymphangiogenesis, disease, and clinical applications. BIOCHIMICA ET BIOPHYSICA ACTA 2015; 1850:2422-38. [PMID: 26367079 PMCID: PMC4624607 DOI: 10.1016/j.bbagen.2015.09.007] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 09/02/2015] [Accepted: 09/10/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Angiogenesis is the process of neovascularization from pre-existing vasculature and is involved in various physiological and pathological processes. Inhibitors of angiogenesis, administered either as individual drugs or in combination with other chemotherapy, have been shown to benefit patients with various cancers. Endostatin, a 20-kDa C-terminal fragment of type XVIII collagen, is one of the most potent inhibitors of angiogenesis. SCOPE OF REVIEW We discuss the biology behind endostatin in the context of its endogenous production, the various receptors to which it binds, and the mechanisms by which it acts. We focus on its inhibitory role in angiogenesis, lymphangiogenesis, and cancer metastasis. We also present emerging clinical applications for endostatin and its potential as a therapeutic agent in the form a short peptide. MAJOR CONCLUSIONS The delicate balance between pro- and anti-angiogenic factors can be modulated to result in physiological wound healing or pathological tumor metastasis. Research in the last decade has emphasized an emerging clinical potential for endostatin as a biomarker and as a therapeutic short peptide. Moreover, elevated or depressed endostatin levels in diseased states may help explain the pathophysiological mechanisms of the particular disease. GENERAL SIGNIFICANCE Endostatin was once sought after as the 'be all and end all' for cancer treatment; however, research throughout the last decade has made it apparent that endostatin's effects are complex and involve multiple mechanisms. A better understanding of newly discovered mechanisms and clinical applications still has the potential to lead to future advances in the use of endostatin in the clinic.
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Affiliation(s)
- Amit Walia
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
| | - Jessica F Yang
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
| | - Yu-Hui Huang
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
| | - Mark I Rosenblatt
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
| | - Jin-Hong Chang
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA.
| | - Dimitri T Azar
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
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Zhang Y, Yu LK, Lu GJ, Xia N, Xie HY, Hu W, Hao KK, Xu CH, Qian Q. Prognostic values of VEGF and endostatin with malignant pleural effusions in patients with lung cancer. Asian Pac J Cancer Prev 2015; 15:8435-40. [PMID: 25339042 DOI: 10.7314/apjcp.2014.15.19.8435] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AIMS Angiogenesis is important in malignant pleural effusion (MPE) formation and it is regulated by a number of pro- and anti-angiogenic cytokines. The purpose of this study was to evaluate the prognostic value of angiogenic factor vascular endothelial growth factor (VEGF) and angiogenesis inhibitor endostatin in lung cancer patients with MPE, and investigate the relationship between these two kinds of agent. METHODS Using enzyme-linked immunoadsorbent assay, the concentrations of VEGF and endostatin were measured in pleural effusions (PE) and serum from a total of 70 lung cancer patients with MPE and 20 patients with tuberculosis. RESULTS Compared to patients with tuberculosis, the levels of VEGF and endostatin in both PE and serum were significantly higher in patients with lung cancer. There were statistically significant correlations between VEGF levels in PE and serum (r=0.696, <0.001), endostatin levels in PE and serum (r=0.310, p=0.022), and VEGF and endostatin levels in PE (r=0.287, p=0.019). Cox multivariate analysis revealed that elevated pleural VEGF and endostatin levels and serum endostatin level were independent predictors of shorter overall survival. CONCLUSION Both pro- and anti-angiogenic factors are likely contributors to PE formation. Our results suggest that the levels of VEGF and endostatin in PE, together with endostatin in serum, may be potential prognostic parameters for lung cancer patients with MPE.
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Affiliation(s)
- Yu Zhang
- First Department of Respiratory Medicine, Nanjing Chest Hospital, Nanjing, Jiangsu Province, China E-mail :
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Tian P, Shen Y, Feng M, Zhu J, Song H, Wan C, Chen L, Wen F. Diagnostic accuracy of endostatin for malignant pleural effusion: A clinical study and meta-analysis. Postgrad Med 2015; 127:529-34. [PMID: 25979108 DOI: 10.1080/00325481.2015.1048180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The diagnosis of malignant pleural effusion (MPE) remains a clinical challenge. Many studies suggest that endostatin is a potential marker for MPE. This study aimed to determine the diagnostic value of endostatin with respect to MPE and to summarize the overall diagnostic performance of endostatin via a meta-analysis. METHODS Pleural effusion samples from patients with both malignant and nonmalignant disease were collected, and the pleural levels of endostatin and carcino-embryonic antigen (CEA) were subsequently measured. The diagnostic performances of endostatin and CEA were analyzed via standard receiver operator characteristic curve analysis methods, using the AUC as a measure of accuracy. The overall diagnostic accuracy of endostatin for MPE was summarized through a bivariate meta-analysis with standard method recommended. RESULTS Fifty-two patients with MPEs and 64 patients with benign pleural effusions (BPEs) were included this study. Pleural endostatin levels were significantly increased in the setting of MPE compared with BPE (104.78 ± 64.58 vs. 56.81 ± 28.84 ng/ml; p < 0.001). Using a cutoff value of 79.7 ng/ml, the sensitivity and specificity of endostatin in diagnosing MPE were shown to be 51.92% and 85.94%, respectively, and the AUC was 0.747. The combination of endostatin and CEA enhanced diagnostic performance with respect to MPE. In addition to this study, another eight studies were included in this meta-analysis. The pooled diagnostic estimates were 0.69 for sensitivity and 0.78 for specificity. The positive likelihood ratio and negative likelihood ratio for endostatin were 3.16 and 0.40, respectively. The diagnostic odds ratio was 7.89, and the AUC of the summary receiver operator characteristic curve was 0.79. CONCLUSION Pleural levels of endostatin are increased in the setting of MPE. However, endostatin exhibits a limited efficacy for the diagnosis of MPE and shows a relatively low sensitivity. The assessment of endostatin in combination with CEA may enhance diagnostic accuracy with respect to MPE.
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Affiliation(s)
- Panwen Tian
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University and Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China , Chengdu , China
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Effects of Intracavitary Administration of Endostar Combined with Cisplatin in Malignant Pleural Effusion and Ascites. Cell Biochem Biophys 2014; 70:623-8. [DOI: 10.1007/s12013-014-9965-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Fu ZZ, Sun XD, Li P, Zhang Z, Li GZ, Gu T, Shao SS. Relationship between serum VEGF level and radiosensitivity of patients with nonsmall cell lung cancer among asians: a meta-analysis. DNA Cell Biol 2014; 33:426-37. [PMID: 24628278 DOI: 10.1089/dna.2013.2249] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
This meta-analysis aims to evaluate the relationships between serum vascular endothelial growth factor (VEGF) level and radiosensitivity in patients with nonsmall cell lung cancer (NSCLC) among Asians. We searched CISCOM, CINAHL, Web of Science, PubMed, Google Scholar, EBSCO, Cochrane Library, and CBM databases from their inception through October 1, 2013. Meta-analysis was performed using the STATA 12.0 software. Fourteen clinical studies were included in this meta-analysis, including five case-control studies and nine cohort studies. Our meta-analysis results revealed that levels of serum VEGF in NSCLC patients were higher than that of healthy controls. There was a significant difference in serum VEGF levels between before and after radiotherapy in NSCLC patients. Further, we found significant differences in serum VEGF levels between effective and noneffective clinical response groups pre- and postradiotherapy. Serum VEGF levels showed no significant associations with tumor-node-metastasis (TNM) stage and histologic grade in NSCLC patients. NSCLC patients with positive VEGF expression had shorter overall survival than those with negative VEGF expression. Our meta-analysis suggests that serum VEGF level may be a useful biomarker in predicting radiosensitivity and prognosis of NSCLC patients among Asians.
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Affiliation(s)
- Zhan-Zhao Fu
- 1 Department of Oncology, The First Hospital of Qinhuangdao , Qinhuangdao, People's Republic of China
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Zhang Y, Wu JZ, Zhang JY, Xue J, Ma R, Cao HX, Feng JF. Detection of circulating vascular endothelial growth factor and matrix metalloproteinase-9 in non-small cell lung cancer using Luminex multiplex technology. Oncol Lett 2013; 7:499-506. [PMID: 24396477 PMCID: PMC3881935 DOI: 10.3892/ol.2013.1718] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 11/13/2013] [Indexed: 12/18/2022] Open
Abstract
It has been previously reported that vascular endothelial growth factor (VEGF) and matrix metalloproteinase (MMP)-9 are important for the occurrence and development of non-small cell lung cancer (NSCLC). The present study was designed to detect the serum levels of VEGF and MMP-9 in NSCLC, and to explore their diagnostic and prognostic values. A total of 543 cases were involved, of which 332 were NSCLC (272 cases in the pretreatment group and 60 cases in the postoperative group), 91 were patients with benign lung diseases and 120 were healthy controls. The serum levels of VEGF and MMP-9 were determined by Luminex multiplex technology. The serum levels of VEGF and MMP-9 were found to be significantly higher in the pretreatment group than those in the patients with benign lung diseases and healthy controls (VEGF, P<0.0001; MMP-9, P<0.0001). Compared with the pretreatment group, the serum levels of VEGF and MMP-9 in the postoperative group were significantly decreased (VEGF, P=0.005; MMP-9, P=0.002), and the levels of VEGF and MMP-9 in the pretreatment group of patients with stages III and IV were higher than those with stages I and II (VEGF, P<0.0001; MMP-9, P=0.021). In addition, the levels of VEGF and MMP-9 were found to closely correlate with lymph node metastasis (VEGF, P<0.0001; MMP-9, P<0.0001) in the pretreatment group, while being independent of other clinicopathological parameters (P>0.05). Furthermore, a positive correlation was observed between the serum levels of VEGF and MMP-9 (r=0.159; P=0.009). A receiver operating characteristic curve analysis showed that the diagnostic value of MMP-9 was higher than that of VEGF in the pretreatment group. The log-rank test indicated that the inoperable NSCLC patients with low levels of VEGF exhibited a significantly longer overall survival time than those with high VEGF levels (P<0.0001). Additionally, the serum levels of VEGF and lymph node metastasis were identified as independent prognostic factors of the inoperable NSCLC patients in a multivariate Cox regression analysis (P<0.05). These results indicated that VEGF and MMP-9 may be potential biomarkers for the diagnosis and prognosis of NSCLC.
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Affiliation(s)
- Ye Zhang
- Department of Chemotherapy, The Affiliated Jiangsu Cancer Hospital, Nanjing Medical University, Nanjing, Jiangsu 210009, P.R. China ; Research Center of Clinical Oncology, The Affiliated Jiangsu Cancer Hospital, Nanjing Medical University, Nanjing, Jiangsu 210009, P.R. China
| | - Jian-Zhong Wu
- Research Center of Clinical Oncology, The Affiliated Jiangsu Cancer Hospital, Nanjing Medical University, Nanjing, Jiangsu 210009, P.R. China
| | - Jun-Ying Zhang
- Department of Oncology, Xuzhou Medical College, Xuzhou, Jiangsu 221000, P.R. China
| | - Jing Xue
- Nanjing University of Technology, Nanjing, Jiangsu 210008, P.R. China
| | - Rong Ma
- Research Center of Clinical Oncology, The Affiliated Jiangsu Cancer Hospital, Nanjing Medical University, Nanjing, Jiangsu 210009, P.R. China
| | - Hai-Xia Cao
- Research Center of Clinical Oncology, The Affiliated Jiangsu Cancer Hospital, Nanjing Medical University, Nanjing, Jiangsu 210009, P.R. China
| | - Ji-Feng Feng
- Department of Chemotherapy, The Affiliated Jiangsu Cancer Hospital, Nanjing Medical University, Nanjing, Jiangsu 210009, P.R. China
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