Global lung cancer mortality trends and lifestyle modifications: preliminary analysis

CD147 TagSNP is associated with the vulnerability to lung cancer in the Chinese population: a case-control study

BACKGROUND

Lung cancer, with its high morbidity and mortality, presents a major significant public health challenge. CD147, linked to cancer progression and metastasis, is a promising therapeutic target, including for lung cancer. The genetic variation may influence the expression of the gene and consequently the risk of lung cancer. This study aims to investigate single nucleotide polymorphisms (SNPs) in CD147 to understand their association with the risk of developing lung cancer in the Han Chinese population.

METHODS

A hospital-based case-control investigation was conducted, enrolling 700 lung cancer patients and 700 cancer-free controls. TagSNPs were selected using Haploview v4.2, and genotype data from the 1000 Genomes Project database were utilized. The selected SNPs (rs28992491, rs67945626, and rs79361899) within the CD147 gene were evaluated using the improved multiple ligation detection reaction method. Statistical analysis included chi-square tests, logistic regression models, and interaction analyses.

RESULTS

Baseline characteristics of the study population showed no significant differences in gender distribution between cases and controls, but there was a notable difference in smoking rates. No significant associations were found between the three TagSNPs and lung cancer susceptibility in the codominant model. However, stratification analyses revealed interesting findings. Among females, the rs79361899 AA/AG genotype was associated with an increased risk of lung cancer. In individuals aged ≥ 65 years old, the rs28992491 GG and rs79361899 AA genotypes were linked to a higher susceptibility. Furthermore, an interaction analysis demonstrated significant genotype × gender interactions in the rs79361899 recessive model, indicating an increased lung cancer risk in female carriers of the heterozygous or homozygous polymorphic genotype.

CONCLUSIONS

CD147 polymorphisms play an important role in lung cancer development, particularly in specific subgroup of age and gender. These findings highlight the significance of incorporating genetic variations and their interactions with demographic factors in comprehending the intricate etiology of lung cancer.

Ambient air pollution, lifestyle, and genetic predisposition on all-cause and cause-specific mortality: A prospective cohort study

BACKGROUND

Although it is widely acknowledged that long-term exposure to ambient air pollution is closely related to the risk of mortality, there were inconsistencies in terms of cause-specific mortality and it is still unknown whether lifestyle and genetic susceptibility could modify the association.

METHODS

This population-based prospective cohort study involved 461,112 participants from the UK Biobank. The land-use regression model was used to estimate the concentrations of particulate matter (PM2.5, PMcoarse, PM10), and nitrogen oxides (NO2 and NOx). The association between air pollution and mortality was evaluated using Cox proportional hazard models. Furthermore, a lifestyle score incorporated with smoking status, physical activity, alcohol consumption, and diet behaviors, and polygenic risk score using 12 genetic variants, were developed to assess the modifying effect of air pollution on mortality outcomes.

RESULTS

During a median follow-up of 14.0 years, 33,903 deaths were recorded, including 17,083 (2835; 14,248), 6970, 2429, and 1287 deaths due to cancer (lung cancer, non-lung cancer), cardiovascular disease (CVD), respiratory and digestive disease, respectively. Each interquartile range (IQR) increase in PM2.5, NO2 and NOx was associated with 7 %, 6 % and 5 % higher risk of all-cause mortality, respectively. Specifically, for cause-specific mortality, each IQR increase in PM2.5, NO2 and NOx was also linked to mortality due to cancer (lung cancer and non-lung cancer), CVD, respiratory and digestive disease. Furthermore, additive and multiplicative interactions were identified between high ambient air pollution and unhealthy lifestyle on mortality. In addition, associations between air pollution and mortality were modified by lifestyle behaviors.

CONCLUSION

Long-term exposure to air pollutants increased the risk of all-cause and cause-specific mortality, which was modified by lifestyle behaviors. In addition, we also revealed a synergistically detrimental effect between air pollution and an unhealthy lifestyle, suggesting the significance of joint air pollution management and adherence to a healthy lifestyle on public health.

Quantitative Evaluation of Cancer Stigma among Non-Patient Population in Oman

BACKGROUND

Cancer is widely considered as one of the most stigmatized diseases globally, despite scientific advances in the medicine. While most existing literatures focuses on cancer stigma as perceived by patients, there has been limited research on  stigma towards cancer among the non-cancer population. In 2014, Marlow et al developed and validated the "Cancer Stigma Scale" (CASS) specifically for the non-Cancer population. This study aims to quantitatively evaluate cancer stigma within the non-patient population in Oman.

METHODS

This is a cross-sectional study conducted in Oman. The Cancer Stigma Scale (CASS) has been used to evaluate the cancer-related stigma among the non-cancer patient population in Oman.

RESULTS

A total of 510 participants completed the survey of whom 57.6% were male. The personal responsibility section had the highest mean score, followed by the avoidance and financial discrimination. The lowest mean scores were observed in the danger and policy opposition sections. Female participants showed ore disagreement  with cancer stigma statements compared to males. Participants who knew someone with cancer expressed more disagreement with stigma statements than those  who did not know anyone with cancer.

CONCLUSION

This study provides a baseline measurement of  cancer-related stigma among non-cancer patients in Oman, tilizing the CASS in a representative sample of the population. The results indicate generally low levels of stigma, though certain aspects are more pronounced, varying according to the participants' gender, age, and personal connections to someone with cancer.

Phytotherapeutics in Cancer: From Potential Drug Candidates to Clinical Translation

Annually, a significant number of individuals succumb to cancer, an anomalous cellular condition characterized by uncontrolled cellular proliferation and the emergence of highly perilous tumors. Identifying underlying molecular mechanism(s) driving disease progression has led to various inventive therapeutic approaches, many of which are presently under pre-clinical and/or clinical trials. Over the recent years, numerous alternative strategies for addressing cancer have also been proposed and put into practice. This article delineates the modern therapeutic drugs employed in cancer treatment and their associated toxicity. Due to inherent drug toxicity associated with most modern treatments, demand rises for alternative therapies and phytochemicals with minimal side effects and proven efficacy against cancer. Analogs of taxol, Vinca alkaloids like vincristine and vinblastine, and podophyllotoxin represent a few illustrative examples in this context. The phytochemicals often work by modifying the activity of molecular pathways that are thought to be involved in the onset and progression of cancer. The principal objective of this study is to provide an overview of our current understanding regarding the pharmacologic effects and molecular targets of the active compounds found in natural products for cancer treatment and collate information about the recent advancements in this realm. The authors' interest in advancing the field of phytochemical research stems from both the potential of these compounds for use as drugs as well as their scientific validity. Accordingly, the significance of herbal formulations is underscored, shedding light on anticancer phytochemicals that are sought after at both pre-clinical and clinical levels, with discussion on the opportunities and challenges in pre-clinical and clinical cancer studies.

Lung cancer mortality and associated predictors: systematic review using 32 scientific research findings

Background

Cancer is a chronic disease brought on by mutations to the genes that control our cells' functions and become the most common cause of mortality and comorbidities. Thus, this study aimed to assess the comprehensive and common mortality-related risk factors of lung cancer using more than thirty scientific research papers.

Methods

Possible risk factors contributing to lung cancer mortality were assessed across 201 studies sourced from electronic databases, including Google Scholar, Cochrane Library, Web of Science (WOS), EMBASE, Medline/PubMed, the Lung Cancer Open Research Dataset Challenge, and Scopus. Out of these, 32 studies meeting the eligibility criteria for meta-analysis were included. Due to the heterogeneous nature of the studies, a random-effects model was applied to estimate the pooled effects of covariates.

Results

The overall prevalence of mortality rate was 10% with a 95% confidence interval of 6 and 16%. Twenty studies (62.50%) studies included in this study considered the ages of lung cancer patients as the risk factors for mortality. Whereas, eighteen (56.25%) and thirteen (40.63%) studies incorporated the gender and smoking status of patients respectively. The comorbidities of lung cancer mortality such as cardiovascular disease, hypertension, diabetes, and pneumonia were also involved in 7 (21.90%), 6 (18.75%), 5 (15.63%), and 2 (6.25%) studies, respectively. Patients of older age are more likely to die as compared to patients of younger age. Similarly, lung patients who had smoking practice were more likely to die as compared to patients who hadn't practiced smoking.

Conclusion

The mortality rate of lung cancer patients is considerably high. Older age, gender, stage, and comorbidities such as cardiovascular, hypertension, and diabetes have a significant positive effect on lung cancer mortality. The study results will contribute to future research, management, and prevention strategies for lung cancer.

Targeted therapy of RET fusion-positive non-small cell lung cancer

Lung cancer has very high morbidity and mortality worldwide, and the prognosis is not optimistic. Previous treatments for non-small cell lung cancer (NSCLC) have limited efficacy, and targeted drugs for some gene mutations have been used in NSCLC with considerable efficacy. The RET proto-oncogene is located on the long arm of chromosome 10 with a length of 60,000 bp, and the expression of RET gene affects cell survival, proliferation, growth and differentiation. This review will describe the basic characteristics and common fusion methods of RET genes; analyze the advantages and disadvantages of different RET fusion detection methods; summarize and discuss the recent application of non-selective and selective RET fusion-positive inhibitors, such as Vandetanib, Selpercatinib, Pralsetinib and Alectinib; discuss the mechanism and coping strategies of resistance to RET fusion-positive inhibitors.

Carbon Nanotubes as Carriers in Drug Delivery for Non-Small Cell Lung Cancer, Mechanistic Analysis of Their Carcinogenic Potential, Safety Profiling and Identification of Biomarkers

Non-small cell lung cancer (NSCLC) is a global burden leading to millions of deaths worldwide every year. Nanomedicine refers to the use of materials at the nanoscale for drug delivery and subsequent therapeutic approaches in cancer. Carbon nanotubes (CNTs) are widely used as nanocarriers for therapeutic molecules such as plasmids, siRNAs, antisense agents, aptamers and molecules related to the immunotherapy for several cancers. They are usually functionalized and loaded with standard drug molecules to improve their therapeutic efficiency. Functionalization and drug loading possibly decrease the genotoxic and carcinogenic potential of CNTs. In addition, the targeted cytotoxic properties of the drug improve and undesired toxicity decreases after drug loading and/or conjugation with proteins, including antibodies. For intended drug delivery, a lysosomal pH of 5.5 is more suitable and effective for the slow and extended release of cytotoxic drugs than a physiological of pH 7.4. Remarkably, CNTs possess intrinsic antitumor properties and are usually internalized by endocytosis. After being internalized, several mechanisms are involved in the therapeutic and carcinogenic effects of CNTs. They are generally safe for therapy, and their toxicity profile remains dependent on their physicochemical properties. Moreover, the dose, route, duration of exposure, surface properties and degradative potential determine the toxicity outcomes of CNTs locally or systemically. In summary, the use of CNTs in drug delivery and NSCLC therapy, as well as their genotoxic and carcinogenic potential and the possible mechanisms, has been discussed in this review. The therapeutic index is generally high for NSCLC cells treated with drug-loaded CNTs; therefore, they are effective carriers in implementing targeted therapy for NSCLC.

Hsa_circ_0129047 regulates the miR-375/ACVRL1 axis to attenuate the progression of lung adenocarcinoma

BACKGROUND

Circular RNAs (circRNAs) are attractive candidates to be used as biomarkers of human cancers, including lung adenocarcinoma (LUAD). Our study aimed to investigate the functions and regulatory mechanisms of hsa_circ_0129047 in the tumorigenesis of LUAD.

METHODS

Reverse transcription-quantitative polymerase chain reaction was performed to determine the circRNA, microRNA (miRNA), and mRNA expression levels in LUAD cell lines and tissues. Tumor xenografts were established in nude mice to evaluate whether hsa_circ_0129047 affected LUAD tumor development in vivo. Cell counting kit-8 and transwell assays were performed to assess the mechanisms by which hsa_circ_0129047 influenced the viability and migration of LUAD cells, respectively. Apoptosis was evaluated via determination of the levels of the apoptotic markers, B-cell lymphoma-2, and Bcl-2-associated X, via Western blotting. Dual-luciferase reporter assay, RNA immunoprecipitation assay, and Pearson's correlation analysis were performed to determine the relationships among miR-375 and hsa_circ_0129047 and activin A receptor-like type 1 (ACVRL1).

RESULTS

Downregulation of hsa_circ_0129047 levels was observed in LUAD cell lines and tissues. Meanwhile, the upregulation of hsa_circ_0129047 levels repressed the proliferative, migratory, and survival capacities of LUAD cells in vitro. Hsa_circ_0129047 exerted antitumor effects during in vivo tumor development. Finally, we demonstrated that hsa_circ_0129047 sponged miR-375. This interaction facilitated the expression of the downstream target of miR-375, ACVRL1, whose upregulation inhibited the development and malignancy of LUAD.

CONCLUSION

These findings demonstrate that hsa_circ_0129047 functions as a tumor inhibitor in LUAD by modulating the miR-375/ACVRL1 axis. Hence, hsa_circ_0129047 may be a promising biomarker and gene target for LUAD treatment.

KRAS G12C-Mutant Non-Small-Cell Lung Adenocarcinoma: First Documented Report in the Arabian Gulf

We report the first documented case series of two lung adenocarcinoma patients demonstrating Kirsten rat sarcoma viral oncogene homolog (KRAS) G12C mutations by reverse transcription-polymerase chain reaction techniques from Saudi Arabia. Both patients were males aged 64 and 76 years. The first had a heavy smoking history, while the second did not report any history of smoking. The tumor subtype was identified to be non-mucinous lung adenocarcinoma in both cases. The younger patient presented with generalized lymphadenopathy and a right-sided lung mass lesion, while the older patient exhibited stage III-A left lung adenocarcinoma that required rapid response. An initial examination of the first case showed a right-sided mediastinal shift, bilateral neck lymphadenopathy, and poorly differentiated neoplasm from a right supraclavicular core biopsy, leading to treatment with palliatives along with regular checkups. The second case was afebrile after being confirmed to be vitally stable and laboratory testing (Neutr 100). Further studies, specifically on large numbers of patients from the Arabian Gulf, are needed to confirm significant differences between the national and international populations. Additionally, future studies should investigate more differences in the differentiation of KRAS-mutant lung adenocarcinoma between patients from the Arabian Gulf and others.

Trend analysis of lung cancer incidence and mortality in Grande Cuiabá, Mato Grosso, Brazil, 2000 to 2016

OBJECTIVE

To analyses lung cancer incidence and mortality trends to gender and age group in Grande Cuiabá between 2000 to 2016.

METHODS

Study of times series applying incidence data from the Population-Based Cancer Registry of Cuiabá, and mortality data from Mortality Information System. Annual Percentage Change and the Average Annual Percentage Change were calculated in the incidence and mortality rate through the Joinpoint regression.

RESULTS

It was observed between men a decrease of -2,2% in the overall incidence of lung cancer during the term of 2000-2016 and by age range: 40 to 49 years (-4,2%), 60 to 69 years (-2,0%) and 70 to 79 years (-9,4%), in this last age group it was between 2000-2009. The general mortality was stable on historical series, nonetheless, a decline between men of 50 to 59 years (-3,5%) among 2006 to 2016 and of 70 to 79 years among 2002-20011 (-6,3%) were observed. The incidence trends among female individuals maintained stable whereas the overall mortality trends had an increase of 7,2% between 2000-2012 and decrease of -34,1% between 2012-2016. Amid women from 50 to 79 years, there was a raise, ranging from 3,5% to 3,9% between 2000-2016.

CONCLUSIONS

There is an evident disparity between the trends analysis of incidence and mortality of lung cancer among men and women, that can be explained by changes in smoking over time, for example, the adherence or not of the smoking withdraw program besides social, cultural, economics differences and even biological.

Análise de tendência da incidência e da mortalidade por câncer de pulmão na Grande Cuiabá, Mato Grosso, Brasil, 2000 a 2016

RESUMO: Objetivo: Analisar as tendências de incidência e de mortalidade por câncer de pulmão por sexo e faixa etária, na Grande Cuiabá, Mato Grosso, entre 2000 e 2016. Métodos: Estudo de séries temporais utilizando informações de incidência do Registro de Câncer de Base Populacional Cuiabá e de mortalidade do Sistema de Informação sobre Mortalidade. Foram calculadas a variação percentual anual e a variação percentual média anual das taxas de incidência e de mortalidade, pela regressão por joinpoint. Resultados: Observou-se entre homens decréscimo de -2,2% na incidência geral de câncer de pulmão entre 2000-2016 e por faixa etária: 40 a 49 anos (-4,2%), 60 a 69 anos (-2%) e 70 a 79 anos (-9,4%), sendo nesta última faixa entre 2000-2009. A mortalidade geral foi estável na série histórica, porém verificou-se decréscimo entre os homens de 50 a 59 anos (-3,5%) entre 2006-2016 e de 70 a 79 anos entre 2002-2011 (-6,3%). Para as mulheres, as tendências de incidência mantiveram-se estáveis, enquanto nas tendências de mortalidade geral houve aumento de 7,2% entre 2000-2012 e decréscimo de -34,1% entre 2012-2016. Entre mulheres de 50 a 79 anos, houve aumento, variando de 3,5 a 3,9% entre 2000-2016. Conclusão: Existe evidente disparidade nas análises de tendências de incidência e de mortalidade de câncer de pulmão entre homens e mulheres, que pode ser explicada por mudanças do tabagismo ao longo do tempo, por exemplo, adesão ou não ao programa de abandono do tabagismo, além de diferenças sociais, culturais, econômicas e até mesmo biológicas.

How to achieve the UN Sustainable Development Goals in the field of noncommunicable diseases by 2030, according to research in 49 countries

Goal. To analyze chronic noncommunicable diseases (NCD) mortality dynamics and associated efforts to reach UN sustainable development goals (SDG) in the area of NCD “by 2030, reduce by one third premature mortality from NCD through prevention and treatment“.

Methods. WHO statistics, based on the unified mortality and cause -of- death reports of Member-States countries along with the latest information from global WHO programmes, were used to evaluate NCD mortality trends in 49 countries in 2000, 2010 and 2016 and make comparisons and assessments of different types of community -based, country-wide interventions. Only countries with multiple years of national death registration data and high completeness and quality of cause-of-death assignments were included in the analysis. Cardiovascular disease (CVD) ischemic heart disease (IHD) and stroke, chronic respiratory disease (CRD) bronchial asthma and chronic obstructive pulmonary disease (COPD) lung cancer and diabetes mortality were analysed in 36 high income countries (HIC) and 13 middle income countries (MIC).

Results. The most visible decline was achieved for bronchial asthma 54%, stroke 43% IHD 30% and COPD 29%. Lung cancer and diabetes mortality decline were not statistically significant. Prevalence of tobacco smoking gradually declined in 84% of countries, 55% of countries demonstrated declining prevalence of raised blood pressure. Obesity prevalence was increasing in all countries. CVD and CRD mortality were higher in MIC. HIC better implemented tobacco and diet reduction measures. Same concerns NCD management approach. Air pollution level was higher in MIC.

Conclusions. NCD mortality decline is associated with multiple WHO global life style modifications campaigns, global coordinated prevention and control programmes for hypertension, asthma and COPD and WHO developed “best buy” approach. In order to achieve better results in lung cancer mortality together with early detection, more efforts should be concentrated on early diagnosis, strengthening tobacco cessation, clean air and diet actions. Diet and physical activities along with adequate management and patient education remain key elements to improve diabetes prognosis by the year 2030. Air pollution control could also facilitate achievement of the UN SDG 3.4.

Potential chemotherapeutic effect of betalain against human non-small cell lung cancer through PI3K/Akt/mTOR signaling pathway

This work focuses on evaluating the therapeutic ability of betalain and its causal mechanisms in NSCLC both in vivo and in vitro. The experimental results demonstrated that betalain was able to reduce the viability of A549 cells dose dependently with undetectable toxicity toward normal human cells. Betalain also augmented the apoptotic cells of A549 and cell cycle arrest which was evidenced via increased in level of p53/p21 and decreasing levels of cyclin-D1 complex. Moreover, betalain also reduced the levels of p-PI3K, p-Akt, and mammalian target of rapamycin significantly, justifying the pro-apoptotic effect on A549 cells. The in vivo anticancer activity of betalain was determined further in nude mice injected with A549 cells. Xenograft in vivo experiments confirmed betalain administration of ameliorates the expression of pro-inflammatory cytokines, tumor markers with reduced toxic effect. Accordingly, this combined study provides significant insight on betalain as a therapeutic agent.

Biomarkers or factors for predicting the efficacy and adverse effects of immune checkpoint inhibitors in lung cancer: achievements and prospective

Immune checkpoint inhibitors (ICIs) are widely used in lung cancer therapy due to their effectiveness and minimal side effects. However, only a few lung cancer patients benefit from ICI therapy, driving the need to develop alternative biomarkers. Programmed death-ligand 1 (PD-L1) molecules expressed in tumor cells and immune cells play a key role in the immune checkpoint pathway. Therefore, PD-L1 expression is a prognostic biomarker in evaluating the effectiveness of programmed death-1 (PD-1)/PD-L1 inhibitors. Nevertheless, adverse predictive outcomes suggest that other factors are implicated in the response. In this review, we present a detailed introduction of existing biomarkers concerning tumor abnormality and host immunity. PD-L1 expression, tumor mutation burden, neoantigens, specific gene mutations, circulating tumor DNA, human leukocyte antigen class I, tumor microenvironment, peripheral inflammatory cells, and microbiome are discussed in detail. To sum up, this review provides information on the current application and future prospects of ICI biomarkers.

Phytochemicals as a Complement to Cancer Chemotherapy: Pharmacological Modulation of the Autophagy-Apoptosis Pathway

Bioactive plant derived compounds are important for a wide range of therapeutic applications, and some display promising anticancer properties. Further evidence suggests that phytochemicals modulate autophagy and apoptosis, the two crucial cellular pathways involved in the underlying pathobiology of cancer development and regulation. Pharmacological targeting of autophagy and apoptosis signaling using phytochemicals therefore offers a promising strategy that is complementary to conventional cancer chemotherapy. In this review, we sought to highlight the molecular basis of the autophagic-apoptotic pathway to understand its implication in the pathobiology of cancer, and explore this fundamental cellular process as a druggable anticancer target. We also aimed to present recent advances and address the limitations faced in the therapeutic development of phytochemical-based anticancer drugs.

The Effect of Thoracic Radiotherapy on the Quality of Life in Lung Cancer Patients

Introduction

This study aimed to investigate changes in respiratory symptoms and quality of life (QoL) in patients with locally advanced and metastatic lung cancer receiving thoracic radiotherapy (RT). We investigated the correlation between the level of symptom relief and tumor response.

Methods

Thirty-two patients were included in this study. The European Organization for Research and Treatment of Cancer (EORTC) Quality of Life (QoL) Questionnaire (QLQ)-C30 and EORTC QLQ-LC13 were used to investigate QoL changes. Assessments were performed on the first day of RT, on the last day of RT, routinely monthly follow-ups, and three months after RT.

Results

The median age of the patients was 62; 88% of the patients were male. For the symptom scale, fatigue and dyspnea provided significant improvement at the end of RT (p=0.000, p=0.047). No significant improvement was observed at the end of RT in pain and insomnia. While coughing showed substantial improvement at the end of RT (p=0.004), the maximum improvement was achieved during the third-month follow-up (p<0.001). No significant improvement was observed at the end of RT in hemoptysis, but a considerable improvement was observed during the third-month follow-up (p=0.008).

Conclusion

This study confirms that RT offered palliation of respiratory symptoms and improved QoL in a substantial proportion of patients with lung cancer.

Down-regulation of RCC1 sensitizes immunotherapy by up-regulating PD-L1 via p27kip1 /CDK4 axis in non-small cell lung cancer

In recent years, although Immune Checkpoint Inhibitors (ICIs) significantly improves survival both in local advanced stage and advanced stage of non-small cell lung cancer (NSCLC), the objective response rate of ICI monotherapy is still only about 20%. Thus, to identify the mechanisms of ICI resistance is critical to increase the efficacy of ICI treatments. By bioinformatics analysis, we found that the expression of regulator of chromosome condensation 1 (RCC1) in lung adenocarcinoma was significantly higher than that in normal lung tissue in TCGA and Oncomine databases. The survival analysis showed that high expression RCC1 was associated with the poor prognosis of NSCLC. And the expression of RCC1 was inversely related to the number of immune cell infiltration. In vitro, knockdown of RCC1 not only significantly inhibited the proliferation of lung adenocarcinoma cells but also increased the expression levels of p27^kip1 and PD-L1, and decreased the expression level of CDK4 and p-Rb. In vivo, knockdown of RCC1 significantly slowed down the growth rate of tumour, and further reduced the volume and weight of tumour model after treated by PD-L1 monoclonal antibody. Therefore, RCC1 could up-regulate the expression level of PD-L1 by regulating p27^kip1 /CDK4 pathway and decrease the resistance to ICIs. And this study might provide a new way to increase the efficacy of PD-L1 monoclonal antibody by inhibiting RCC1.