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Ku CY, Yang XK, Xi LJ, Wang RZ, Wu BB, Dai M, Liu L, Ping ZG. Competing risks analysis of external versus internal radiation in patients with hepatocellular carcinoma after controlling for immortal time bias. J Cancer Res Clin Oncol 2023; 149:9927-9935. [PMID: 37249648 DOI: 10.1007/s00432-023-04915-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 05/22/2023] [Indexed: 05/31/2023]
Abstract
PURPOSE In cohort studies on liver cancer, there are often immortal time bias and interference of competing risk events. This study proposes to explore the role of internal and external radiotherapy for hepatocellular carcinoma using SEER data, using a competing risk model and controlling immortal time bias. METHODS Data of SEER from 2004 till 2015 was included. To analyze whether there was a difference in survival between HCC (hepatocellular carcinoma) patients receiving external radiation and internal radiation, we used a competing risk analysis after excluding immortal time bias, and created a nomogram to assess the risk of cancer-specific death (CSD) in hepatocellular carcinoma patients receiving radiotherapy. RESULTS Potential confounding factors adjusted, there was no significant difference in CSD between external and internal radiation therapy [HR and its 95% CI = 1.098 (0.874-1.380)]. The constructed nomogram performed better than the traditional AJCC model. The AUC and calibration curve results showed that this well-calibrated nomogram could be used to make clinical decisions regarding the prognosis and personalized treatment of hepatocellular carcinoma treated. There was no difference in the cumulative risk of death between patients with liver cancer treated with external radiation therapy and internal radiation therapy. CONCLUSION There is no difference in the cumulative risk of death between patients with liver cancer treated with external radiation therapy and internal radiation therapy. The nomogram predicts the results more accurately. These results can be used to guide the choice of treatment options for patients with HCC and to predict their survival prognosis.
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Affiliation(s)
- Chao-Yue Ku
- Department of Health Statistics, College of Public Health, Zhengzhou University, No. 100 Science Avenue, Zhengzhou, 450001, Henan Province, People's Republic of China
| | - Xue-Ke Yang
- Department of Health Statistics, College of Public Health, Zhengzhou University, No. 100 Science Avenue, Zhengzhou, 450001, Henan Province, People's Republic of China
| | - Li-Jing Xi
- Department of Health Statistics, College of Public Health, Zhengzhou University, No. 100 Science Avenue, Zhengzhou, 450001, Henan Province, People's Republic of China
| | - Rui-Zhe Wang
- Department of Health Statistics, College of Public Health, Zhengzhou University, No. 100 Science Avenue, Zhengzhou, 450001, Henan Province, People's Republic of China
| | - Bin-Bin Wu
- Department of Health Statistics, College of Public Health, Zhengzhou University, No. 100 Science Avenue, Zhengzhou, 450001, Henan Province, People's Republic of China
| | - Man Dai
- Department of Health Statistics, College of Public Health, Zhengzhou University, No. 100 Science Avenue, Zhengzhou, 450001, Henan Province, People's Republic of China
| | - Li Liu
- School of Basic Medical Sciences, Zhengzhou University, No.100 Science Avenue, Zhengzhou, 450001, Henan Province, People's Republic of China.
| | - Zhi-Guang Ping
- Department of Health Statistics, College of Public Health, Zhengzhou University, No. 100 Science Avenue, Zhengzhou, 450001, Henan Province, People's Republic of China.
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Shi X, Liu J, Wang G. A peroxidase-like magneto-gold nanozyme AuNC@Fe 3O 4 with photothermal effect for induced cell apoptosis of hepatocellular carcinoma cells in vitro. Front Bioeng Biotechnol 2023; 11:1168750. [PMID: 37034252 PMCID: PMC10076705 DOI: 10.3389/fbioe.2023.1168750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 03/14/2023] [Indexed: 04/11/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the most commonly diagnosed and malignant cancers worldwide. Conventional therapy strategies may not completely eradicate the tumor and may cause side effects during treatment. Nano-catalytic therapy, as a novel strategy, has attracted a great deal of attention. This study aimed to synthesize a multifunctional magneto-gold nanozyme AuNC@Fe3O4 and evaluate its anti-cancer potential in HepG2 cells in vitro. The characteristics of AuNC@Fe3O4 were assessed using a transmission electron microscope, dynamic light scattering, and energy-dispersive X-ray. The photothermal performance and peroxidase (POD)-like activity of AuNC@Fe3O4 were detected, using thermal camera and ultraviolet-visible spectrophotometer, respectively. The anti-cancer potential of AuNC@Fe3O4 was examined using cell counting kit-8, live/dead cell staining, and apoptosis analysis. Further research on HepG2 cells included the detection of intracellular reactive oxygen species (ROS) and lysosomal impairment. We observed that the AuNC@Fe3O4 had a small size, good photothermal conversion efficiency and high POD-like activity, and also inhibited cell proliferation and enhanced cell apoptotic ability in HepG2 cells. Furthermore, the AuNC@Fe3O4 enhanced ROS production and lysosomal impairment via the synergistic effect of photothermal and nano-catalytic therapies, which induced cell death or apoptosis. Thus, the magneto-gold nanozyme AuNC@Fe3O4 may offer a potential anti-cancer strategy for HCC.
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Affiliation(s)
- Xinglong Shi
- College of Medical Engineering & the Key Laboratory for Medical Functional Nanomaterials, Jining Medical University, Jining, China
| | - Jifa Liu
- College of Medical Engineering & the Key Laboratory for Medical Functional Nanomaterials, Jining Medical University, Jining, China
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Guannan Wang
- College of Medical Engineering & the Key Laboratory for Medical Functional Nanomaterials, Jining Medical University, Jining, China
- *Correspondence: Guannan Wang,
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Hassan A, Al-Salmi FA, Abuamara TMM, Matar ER, Amer ME, Fayed EMM, Hablas MGA, Mohammed TS, Ali HE, Abd EL-fattah FM, Abd Elhay WM, Zoair MA, Mohamed AF, Sharaf EM, Dessoky ES, Alharthi F, Althagafi HAE, Abd El Maksoud AI. Ultrastructural analysis of zinc oxide nanospheres enhances anti-tumor efficacy against Hepatoma. Front Oncol 2022; 12:933750. [PMID: 36457501 PMCID: PMC9706544 DOI: 10.3389/fonc.2022.933750] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 09/12/2022] [Indexed: 09/01/2023] Open
Abstract
Zinc oxide nanomaterial is a potential material in the field of cancer therapy. In this study, zinc oxide nanospheres (ZnO-NS) were synthesized by Sol-gel method using yeast extract as a non-toxic bio-template and investigated their physicochemical properties through various techniques such as FTIR, XR, DLS, and TEM. Furthermore, free zinc ions released from the zinc oxide nanosphere suspended medium were evaluated by using the ICP-AS technique. Therefore, the cytotoxicity of ZnO nanospheres and released Zn ions on both HuH7 and Vero cells was studied using the MTT assay. The data demonstrated that the effectiveness of ZnO nanospheres on HuH7 was better than free Zn ions. Similarly, ZnO-Ns were significantly more toxic to HuH7 cell lines than Vero cells in a concentration-dependent manner. The cell cycle of ZnO-Ns against Huh7 and Vero cell lines was arrested at G2/M. Also, the apoptosis assay using Annexin-V/PI showed that apoptosis of HuH7 and Vero cell lines by ZnO nanospheres was concentration and time-dependent. Caspase 3 assay results showed that the apoptosis mechanism may be intrinsic and extrinsic pathways. The mechanism of apoptosis was determined by applying the RT-PCR technique. The results revealed significantly up-regulated Bax, P53, and Cytochrome C, while the Bcl2 results displayed significant down-regulation and the western blot data confirmed the RT-PCR data. There is oxidative stress of the ZnO nanospheres and free Zn+2 ions. Results indicated that the ZnO nanospheres and free Zn+2 ions induced oxidative stress through increasing reactive oxygen species (ROS) and lipid peroxidation. The morphology of the HuH7 cell line after exposure to ZnO nanospheres at different time intervals revealed the presence of the chromatin condensation of the nuclear periphery fragmentation. Interestingly, the appearance of canonical ultrastructure features of apoptotic morphology of Huh7, Furthermore, many vacuoles existed in the cytoplasm, the majority of which were lipid droplets, which were like foamy cells. Also, there are vesicles intact with membranes that are recognized as swollen mitochondria.
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Affiliation(s)
- Amr Hassan
- Department of Bioinformatics, Genetic Engineering and Biotechnology Research Institute (GEBRI), University of Sadat City, Sadat, Egypt
| | - Fawziah A. Al-Salmi
- Biology Department, College of Sciences, Taif University, Taif, Saudi Arabia
| | | | - Emadeldin R. Matar
- Departments of Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed E. Amer
- Department of Histology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ebrahim M. M. Fayed
- Department of Histology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | - Tahseen S. Mohammed
- Department of Public Health and Community Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Haytham E. Ali
- Department of Histology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Fayez M. Abd EL-fattah
- Department of Anatomy and Embryology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Wagih M. Abd Elhay
- Department of Histology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohammad A. Zoair
- Department of Physiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Aly F. Mohamed
- Research and development department, Egyptian Organization for Biological Products and Vaccines [Holding Company for Vaccine and Sera Production (VACSERA)], Giza, Egypt
| | - Eman M. Sharaf
- Department of Bacteriology, Immunology, and Mycology, Animal Health Research Institute (AHRI), Shebin El Kom, Egypt
| | | | - Fahad Alharthi
- Biology Department, College of Sciences, Taif University, Taif, Saudi Arabia
| | | | - Ahmed I. Abd El Maksoud
- Department of Industrial Biotechnology, Genetic Engineering and Biotechnology Research Institute (GEBRI), University of Sadat City, Sadat, Egypt
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Zhan Y, Zhang Z, Liu Y, Fang Y, Xie Y, Zheng Y, Li G, Liang L, Ding Y. NUPR1 contributes to radiation resistance by maintaining ROS homeostasis via AhR/CYP signal axis in hepatocellular carcinoma. BMC Med 2022; 20:365. [PMID: 36258210 PMCID: PMC9580158 DOI: 10.1186/s12916-022-02554-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/06/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Radiotherapy (RT) is one of the major therapeutic approaches to hepatocellular carcinoma (HCC). Ionizing radiation (IR) inducing the generation of reactive oxygen species (ROS) leads to a promising antitumor effect. However, the dysregulation of the redox system often causes radioresistance and impairs the efficacy of RT. Increasing evidence indicates that nuclear protein 1 (NUPR1) plays a critical role in redox reactions. In this study, we aim to explore the role of NUPR1 in maintaining ROS homeostasis and radioresistance in HCC. METHODS The radioresistant role of NUPR1 was determined by colony formation assay, comet assay in vitro, and xenograft tumor models in vivo. Probes for ROS, apoptosis assay, and lipid peroxidation assay were used to investigate the functional effect of NUPR1 on ROS homeostasis and oxidative stress. RNA sequencing and co-immunoprecipitation assay were performed to clarify the mechanism of NUPR1 inhibiting the AhR/CYP signal axis. Finally, we analyzed clinical specimens to assess the predictive value of NUPR1 and AhR in the radiotherapeutic efficacy of HCC. RESULTS We demonstrated that NUPR1 was upregulated in HCC tissues and verified that NUPR1 increased the radioresistance of HCC in vitro and in vivo. NUPR1 alleviated the generation of ROS and suppressed oxidative stress, including apoptosis and lipid peroxidation by downregulating cytochrome P450 (CYP) upon IR. ROS scavenger N-acetyl-L-cysteine (NAC) and CYP inhibitor alizarin restored the viability of NUPR1-knockdown cells during IR. Mechanistically, the interaction between NUPR1 and aryl hydrocarbon receptor (AhR) promoted the degradation and decreased nuclear translation of AhR via the autophagy-lysosome pathway, followed by being incapable of CYP's transcription. Furthermore, genetically and pharmacologically activating AhR abrogated the radioresistant role of NUPR1. Clinical data suggested that NUPR1 and AhR could serve as novel biomarkers for predicting the radiation response of HCC. CONCLUSIONS Our findings revealed the role of NUPR1 in regulating ROS homeostasis and oxidative stress via the AhR/CYP signal axis upon IR. Strategies targeting the NUPR1/AhR/CYP pathway may have important clinical applications for improving the radiotherapeutic efficacy of HCC.
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Affiliation(s)
- Yizhi Zhan
- Department of Pathology, Nanfang Hospital and Basic Medical College, Southern Medical University, Guangzhou, 510515, Guangdong, China.,Guangdong Province Key Laboratory of Molecular Tumor Pathology, Guangzhou, 510515, Guangdong, China.,Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Zhanqiao Zhang
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Yuechen Liu
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Yuan Fang
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Yuwen Xie
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Yilin Zheng
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Guoxin Li
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China.
| | - Li Liang
- Department of Pathology, Nanfang Hospital and Basic Medical College, Southern Medical University, Guangzhou, 510515, Guangdong, China. .,Guangdong Province Key Laboratory of Molecular Tumor Pathology, Guangzhou, 510515, Guangdong, China.
| | - Yi Ding
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China.
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5
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Cho YY, Yu SJ, Lee HW, Kim DY, Kang W, Paik YH, Sung PS, Bae SH, Park SC, Doh YS, Kim KM, Jang ES, Kim IH, Kim W, Kim YJ. Clinical Characteristics of Long-Term Survivors After Sorafenib Treatment for Unresectable Hepatocellular Carcinoma: A Korean National Multicenter Retrospective Cohort Study. J Hepatocell Carcinoma 2021; 8:613-623. [PMID: 34169044 PMCID: PMC8219232 DOI: 10.2147/jhc.s304439] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/06/2021] [Indexed: 12/11/2022] Open
Abstract
Background/Aim Sorafenib is the first systemic therapy for the treatment of advanced-stage hepatocellular carcinoma (HCC) and progressive HCC after locoregional therapy. The aim of this study was to evaluate the prognostic factors of long-term survivors after sorafenib treatment. Methods This multicenter, retrospective, cohort study included 1,566 unresectable HCC patients who received sorafenib treatment between 2007 and 2014 in nine tertiary centers in Korea. The patients were classified into a long-term survivor group (survival more than two years, n = 257) or a control group (n = 1309). The primary outcomes were the prognostic factors affecting long-term survival. Secondary endpoints included time-to-progression and other safety profiles. Results The patients were predominantly men (83.8%) with chronic hepatitis B (77.3%) and Barcelona clinic of liver cancer-stage C (BCLC-C) (78.3%). The median overall survival was 9.0 months. After treatment, eight patients (0.4%) achieved complete response and 139 patients (8.8%) achieved partial response according to the mRECIST criteria. The prognostic factors predicting long-term survival were metformin use (adjusted hazard ratio [aHR] = 3.464; P < 0.001), hand-foot skin reaction (aHR = 1.688; P = 0.003), and concomitant treatment with chemoembolization or radiotherapy (aHR = 2.766; P < 0.001). Poor prognostic factors of long-term survival were a Child-Pugh score of B (HR = 0.422; P < 0.001), the presence of extrahepatic metastasis (HR = 0.639; P = 0.005), main portal vein invasion (HR = 0.502; P = 0.001), and elevated alpha-fetoprotein (>1,000 ng/mL; HR = 0.361; P < 0.001). Conclusion This large, multicenter, retrospective study showed an objective response rate of 9.1% and a proportion of long-term survivors of 16.4% in Korean patients. The prognostic factors derived in our study can be used in clinical practice during sorafenib treatment.
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Affiliation(s)
- Young Youn Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Su Jong Yu
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hye Won Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Do Young Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Wonseok Kang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong-Han Paik
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Pil Soo Sung
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Si Hyun Bae
- Department of Internal Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Su Cheol Park
- Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Young Seok Doh
- Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea.,Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kang Mo Kim
- Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Sun Jang
- Departments of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - In Hee Kim
- Department of Internal Medicine, Chonbuk National University Hospital, Chonbuk National University Medical School, Cheongju-si, Korea
| | - Won Kim
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Yoon Jun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Sun J, Zhu Z, Li W, Shen M, Cao C, Sun Q, Guo Z, Liu L, Wu D. UBE2T-regulated H2AX monoubiquitination induces hepatocellular carcinoma radioresistance by facilitating CHK1 activation. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2020; 39:222. [PMID: 33087136 PMCID: PMC7576867 DOI: 10.1186/s13046-020-01734-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/13/2020] [Indexed: 02/08/2023]
Abstract
Background Radioresistance is the major obstacle in radiation therapy (RT) for hepatocellular carcinoma (HCC). Dysregulation of DNA damage response (DDR), which includes DNA repair and cell cycle checkpoints activation, leads to radioresistance and limits radiotherapy efficacy in HCC patients. However, the underlying mechanism have not been clearly understood. Methods We obtained 7 pairs of HCC tissues and corresponding non-tumor tissues, and UBE2T was identified as one of the most upregulated genes. The radioresistant role of UBE2T was examined by colony formation assays in vitro and xenograft tumor models in vivo. Comet assay, cell cycle flow cytometry and γH2AX foci measurement were used to investigate the mechanism by which UBE2T mediating DDR. Chromatin fractionation and immunofluorescence staining were used to assess cell cycle checkpoint kinase 1(CHK1) activation. Finally, we analyzed clinical data from HCC patients to verify the function of UBE2T. Results Here, we found that ubiquitin-conjugating enzyme E2T (UBE2T) was upregulated in HCC tissues, and the HCC patients with higher UBE2T levels exhibited poorer outcomes. Functional studies indicated that UBE2T increased HCC radioresistance in vitro and in vivo. Mechanistically, UBE2T-RNF8, was identified as the E2-E3 pair, physically bonded with and monoubiquitinated histone variant H2AX/γH2AX upon radiation exposure. UBE2T-regulated H2AX/γH2AX monoubiquitination facilitated phosphorylation of CHK1 for activation and CHK1 release from the chromatin to cytosol for degradation. The interruption of UBE2T-mediated monoubiquitination on H2AX/γH2AX, including E2-enzyme-deficient mutation (C86A) of UBE2T and monoubiquitination-site-deficient mutation (K119/120R) of H2AX, cannot effectively activate CHK1. Moreover, genetical and pharmacological inhibition of CHK1 impaired the radioresistant role of UBE2T in HCC. Furthermore, clinical data suggested that the HCC patients with higher UBE2T levels exhibited worse response to radiotherapy. Conclusion Our results revealed a novel role of UBE2T-mediated H2AX/γH2AX monoubiquitination on facilitating cell cycle arrest activation to provide sufficient time for radiation-induced DNA repair, thus conferring HCC radioresistance. This study indicated that disrupting UBE2T-H2AX-CHK1 pathway maybe a promising potential strategy to overcome HCC radioresistance. Supplementary information Supplementary information accompanies this paper at 10.1186/s13046-020-01734-4.
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Affiliation(s)
- Jingyuan Sun
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Zhenru Zhu
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Wenwen Li
- Hepatology Unit and Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Mengying Shen
- Hepatology Unit and Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Chuanhui Cao
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Qingcan Sun
- Hepatology Unit and Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Zeqin Guo
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Li Liu
- Hepatology Unit and Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Dehua Wu
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
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The early evaluation of ultrasound-guided iodine-125 interstitial implants for high-risk hepatocellular carcinoma. Brachytherapy 2020; 18:733-739. [PMID: 31515049 DOI: 10.1016/j.brachy.2019.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/10/2019] [Accepted: 05/28/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION To evaluate the feasibility and safety of ultrasound-guided iodine-125 interstitial implants for high-risk hepatocellular carcinoma. METHODS From October, 2016, to August, 2018, 49 patients suffering from a total of 66 hepatocellular carcinoma lesions were treated with ultrasound-guided iodine-125 interstitial implantation. Treatment planning system was applied to make preoperative plan. The response evaluation criteria in solid tumors were used to evaluate the curative effect. The evaluated outcomes included postoperative complications and complete disease control rate, 6-month disease-free survival, and 6-month overall survival. RESULTS All 49 patients underwent iodine-125 seed implantation successfully. Patients were followed up for 5 to 27.5 months. No patients developed serious complications and only 2 (4.1%) patients had slight pain. The complete response was seen in 21 lesions (31.8%), partial response in 26 lesions (39.4%), stable disease in eight lesions (12.1%), and progressive disease in 11 lesions (16.7%). The overall disease control rate was reached to 83.3%. The 6-month disease-free survival rate was 46.4% with a median disease-free survival time of 5.0 months. The 6-month overall survival rate was 83.6% with a median overall survival time of 15.0 months. CONCLUSIONS Iodine-125 interstitial implantation is a kind of safe and feasible treatment for high-risk hepatocellular carcinoma.
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Wang X, Chen M, Wei R, Wang Z. External Radiation versus Internal Radiation for Patients with Advanced Unresectable HCC -A SEER Based Study. J Cancer 2019; 10:1171-1180. [PMID: 30854126 PMCID: PMC6400665 DOI: 10.7150/jca.28983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 12/05/2018] [Indexed: 12/19/2022] Open
Abstract
Hepatocellular carcinoma (HCC), 2nd most lethal cancer globally, is the major type of primary liver malignancies currently resulting in about 800,000 deaths globally per annum. Surgical resection remains the only curative treatment to HCC, which does not fit for many patients diagnosed with advanced HCC. Radiation therapy has been gradually concerned as an optional treatment for patients with advanced unresectable HCC. This study aimed to compare external radiation (beam radiation) and internal radiation as a single radiation therapy to advanced HCC patients (TNA stage III and IV according to the derived AJCC Stage, 6th edition) stratified by other risk factors, based on the data collected from the Surveillance, Epidemiology and End Results (SEER) national database. In this cohort study, we mainly clarified the following three points: 1. Choices of radiation therapy for advanced HCC patients vary in demographic and clinical factors. Among these, TNM classification is the key factor. 2. Internal radiation provides a better prognosis in both OS and CSS. 3. Patients in stage IV could benefit from internal radiation preferentially, while for patients in stage III, internal radiation therapy makes no difference compared with external radiation.
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Affiliation(s)
- Xuan Wang
- Department of General Surgery, Huashan Hospital & Cancer Metastasis Institute, Fudan University, Shanghai, China
| | - Mo Chen
- Department of General Surgery, Huashan Hospital & Cancer Metastasis Institute, Fudan University, Shanghai, China
| | - Ran Wei
- Department of General Surgery, Huashan Hospital & Cancer Metastasis Institute, Fudan University, Shanghai, China
| | - Zheng Wang
- Department of General Surgery, Huashan Hospital & Cancer Metastasis Institute, Fudan University, Shanghai, China
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9
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Rhee WJ, Hwang SH, Byun HK, Yun M, Han KH, Seong J. Risk stratification for locally advanced hepatocellular carcinoma using pretreatment alpha-foetoprotein and 18 F-fluoro-2-deoxyglucose positron emission tomography. Liver Int 2017; 37:592-599. [PMID: 27804192 DOI: 10.1111/liv.13297] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 10/25/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS We investigated the significance of 18 F-fluoro-2-deoxyglucose positron emission tomography (18 F-FDG PET) parameters and alpha-foetoprotein (AFP) levels in patients with locally advanced hepatocellular carcinoma (LA-HCC). METHODS We retrospectively analysed data of 228 patients with LA-HCC who underwent pretreatment 18 F-FDG PET between January 2003 and December 2013. All patients were treated using liver-directed therapy involving radiotherapy. The maximum standardized uptake values (SUVs) and tumour-to-extratumoural liver SUV ratios were calculated, and pretreatment AFP values were obtained. RESULTS Patients were divided into high and low maximum SUV (SUVmax) groups according to a SUV cut-off of 4.825 determined via receiver-operating characteristic analysis. High AFP level (>550 ng/mL) and high SUVmax were significant predictors of overall and progression-free survival. Better treatment responses and longer median progression-free and overall survival were observed in the low SUVmax group, compared to the high SUVmax group. Similar results were obtained for SUV ratio-based (cut-off value: 2.355) and AFP-based analyses (cut-off value: 550 ng/mL). Three risk groups were identified using the double biomarkers of SUVmax and AFP value as strong prognosticators predictive of survival outcomes. This risk stratification was identified as a prognosticator of survival outcomes, even after subgroup analyses. Furthermore, in high risk group, significantly high extrahepatic failure was shown while in low risk group, significantly low intrahepatic failure. CONCLUSIONS Clinical significance of double biomarkers, SUV and AFP, could be translated into risk stratification for LA-HCC. It could be a valuable tool for survival outcome prediction.
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Affiliation(s)
- Woo Joong Rhee
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Sang Hyun Hwang
- Department of Nuclear Medicine, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Hwa Kyung Byun
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Mijin Yun
- Department of Nuclear Medicine, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Kwang-Hyub Han
- Department of Internal Medicine, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Jinsil Seong
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
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10
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Lee JW, Oh JK, Chung YA, Na SJ, Hyun SH, Hong IK, Eo JS, Song BI, Kim TS, Kim DY, Kim SU, Moon DH, Lee JD, Yun M. Prognostic Significance of ¹⁸F-FDG Uptake in Hepatocellular Carcinoma Treated with Transarterial Chemoembolization or Concurrent Chemoradiotherapy: A Multicenter Retrospective Cohort Study. J Nucl Med 2016; 57:509-16. [PMID: 26742711 DOI: 10.2967/jnumed.115.167338] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 11/20/2015] [Indexed: 12/12/2022] Open
Abstract
UNLABELLED This study aimed to assess the prognostic value of (18)F-FDG uptake in hepatocellular carcinoma (HCC) patients who had transarterial chemoembolization (TACE) or concurrent intraarterial chemotherapy with external-beam radiotherapy (CCRT) and to compare the prognosis between patients treated with TACE and those with CCRT according to (18)F-FDG uptake. METHODS Two hundred fourteen intermediate-to-advanced-stage HCC patients without extrahepatic metastasis who underwent staging (18)F-FDG PET/CT before TACE (153 patients) or CCRT (61 patients) were recruited from 7 hospitals. Progression-free survival (PFS) and overall survival (OS) were compared using an optimal cutoff value for tumor-to-normal liver uptake ratio (TLR). Further, PFS and OS were compared according to treatment modalities (TACE vs. CCRT) using the same TLR cutoff value. RESULTS On multivariate analysis, age and TLR were independent prognostic factors for PFS (P< 0.050). For OS, Child-Pugh classification and TLR were independent prognostic factors (P< 0.050). When the TLR was greater than 2.0, patients treated with CCRT showed significantly better PFS and OS than those treated with TACE after adjusting for tumor size and number (P= 0.014, for all). In contrast, there was no significant difference in PFS and OS between patients treated with TACE or CCRT when the TLR was 2.0 or less. CONCLUSION (18)F-FDG uptake was an independent prognostic factor for PFS and OS in HCC patients treated with TACE or CCRT. Especially, in HCCs with high (18)F-FDG uptake, patients treated with CCRT showed better survival than those treated with TACE. (18)F-FDG PET/CT may help determine the treatment modality for intermediate-to-advanced-stage HCCs.
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Affiliation(s)
- Jeong Won Lee
- Department of Nuclear Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Jin Kyoung Oh
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Yong An Chung
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Sae Jung Na
- Department of Radiology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Seung Hyup Hyun
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Il Ki Hong
- Department of Nuclear Medicine, Kyung Hee University Hospital, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Jae Seon Eo
- Department of Nuclear Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Bong-Il Song
- Department of Nuclear Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Tae-sung Kim
- Department of Nuclear Medicine, National Cancer Center Research Institute and Hospital, Gyeonggi-do, Korea
| | - Do Young Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Up Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Hyuk Moon
- Department of Nuclear Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jong Doo Lee
- Department of Radiology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea; and
| | - Mijin Yun
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Korea
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11
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Zhang H, Patel N, Ding S, Xiong J, Wu P. Theranostics for hepatocellular carcinoma with Fe3O4@ZnO nanocomposites. Biomater Sci 2016; 4:288-98. [DOI: 10.1039/c5bm00361j] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
An Fe3O4@ZnO/Dox/TfR Ab was designed and synthesized as a theranostic agent for hepatocellular carcinoma, allowing for a targeted drug delivery with concurrent chemoradiotherapy and visual MRI evaluation of the therapeutic effect.
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Affiliation(s)
- Haijun Zhang
- Department of Oncology
- Zhongda Hospital
- School of Medicine
- Southeast University
- Nanjing
| | - Nishant Patel
- Department of Oncology
- Zhongda Hospital
- School of Medicine
- Southeast University
- Nanjing
| | - Shuang Ding
- Department of Oncology
- Zhongda Hospital
- School of Medicine
- Southeast University
- Nanjing
| | - Jian Xiong
- Department of Oncology
- Zhongda Hospital
- School of Medicine
- Southeast University
- Nanjing
| | - Pingping Wu
- Jiangsu Cancer Hospital
- Nanjing
- People's Republic of China
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12
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Zhuo Z, Hu J, Yang X, Chen M, Lei X, Deng L, Yao N, Peng Q, Chen Z, Ye W, Zhang D. Ailanthone Inhibits Huh7 Cancer Cell Growth via Cell Cycle Arrest and Apoptosis In Vitro and In Vivo. Sci Rep 2015; 5:16185. [PMID: 26525771 PMCID: PMC4630794 DOI: 10.1038/srep16185] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 10/12/2015] [Indexed: 01/02/2023] Open
Abstract
While searching for natural anti-hepatocellular carcinoma (HCC) components in Ailanthus altissima, we discovered that ailanthone had potent antineoplastic activity against HCC. However, the molecular mechanisms underlying the antitumor effect of ailanthone on HCC have not been examined. In this study, the antitumor activity and the underlying mechanisms of ailanthone were evaluated in vitro and in vivo. Mechanistic studies showed that ailanthone induced G0/G1-phase cell cycle arrest, as indicated by decreased expression of cyclins and CDKs and increased expression of p21 and p27. Our results demonstrated that ailanthone triggered DNA damage characterized by activation of the ATM/ATR pathway. Moreover, ailanthone-induced cell death was associated with apoptosis, as evidenced by an increased ratio of cells in the subG1 phase and by PARP cleavage and caspase activation. Ailanthone-induced apoptosis was mitochondrion-mediated and involved the PI3K/AKT signaling pathway in Huh7 cells. In vivo studies demonstrated that ailanthone inhibited the growth and angiogenesis of tumor xenografts without significant secondary adverse effects, indicating its safety for treating HCC. In conclusion, our study is the first to report the efficacy of ailanthone against Huh7 cells and to elucidate its underlying molecular mechanisms. These findings suggest that ailanthone is a potential agent for the treatment of liver cancer.
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Affiliation(s)
- Zhenjian Zhuo
- Guangdong Province Key Laboratory of Pharmacodynamic Constituents of TCM and New Drug Research, College of Pharmacy, Jinan University, Guangzhou 510632, China
| | - Jianyang Hu
- Guangdong Province Key Laboratory of Pharmacodynamic Constituents of TCM and New Drug Research, College of Pharmacy, Jinan University, Guangzhou 510632, China
| | - Xiaolin Yang
- Guangdong Province Key Laboratory of Pharmacodynamic Constituents of TCM and New Drug Research, College of Pharmacy, Jinan University, Guangzhou 510632, China
| | - Minfen Chen
- Guangdong Province Key Laboratory of Pharmacodynamic Constituents of TCM and New Drug Research, College of Pharmacy, Jinan University, Guangzhou 510632, China
| | - Xueping Lei
- Guangdong Province Key Laboratory of Pharmacodynamic Constituents of TCM and New Drug Research, College of Pharmacy, Jinan University, Guangzhou 510632, China
| | - Lijuan Deng
- Guangdong Province Key Laboratory of Pharmacodynamic Constituents of TCM and New Drug Research, College of Pharmacy, Jinan University, Guangzhou 510632, China
| | - Nan Yao
- Guangdong Province Key Laboratory of Pharmacodynamic Constituents of TCM and New Drug Research, College of Pharmacy, Jinan University, Guangzhou 510632, China
| | - Qunlong Peng
- Guangdong Province Key Laboratory of Pharmacodynamic Constituents of TCM and New Drug Research, College of Pharmacy, Jinan University, Guangzhou 510632, China
| | - Zhesheng Chen
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John's University, Queens, New York, United States
| | - Wencai Ye
- Guangdong Province Key Laboratory of Pharmacodynamic Constituents of TCM and New Drug Research, College of Pharmacy, Jinan University, Guangzhou 510632, China
| | - Dongmei Zhang
- Guangdong Province Key Laboratory of Pharmacodynamic Constituents of TCM and New Drug Research, College of Pharmacy, Jinan University, Guangzhou 510632, China
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13
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Impact of current staging systems on treatment strategy for HBV-related hepatocellular carcinoma. Cancer Lett 2015; 379:220-4. [PMID: 26282785 DOI: 10.1016/j.canlet.2015.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 08/01/2015] [Accepted: 08/07/2015] [Indexed: 12/11/2022]
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer and the second leading cause of cancer-related death worldwide. HCC incidence has increased over the last few years, with more than half of HCC cases being reported in China, where hepatitis B virus (HBV) infection is the main etiologic factor. The heterogeneity in HCC's worldwide distribution and the differences in its etiology in different locations may result in prognosis estimation and therapeutic decision making being more complicated for HCC patients. In the past decade, several clinical staging systems have been developed based on relevant prognostic factors. Among them, the Barcelona Clinic Liver Cancer (BCLC) and Hong Kong Liver Cancer (HKLC) staging systems are the only two classification systems that link prognostic classification to treatment indications. In this review, we mainly focus on the use of the BCLC and HKLC staging systems for guiding therapeutic decision making for HCC, the respective advantages and disadvantages of each classification system, and future perspectives for the improvement of the HKLC model.
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14
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Zhang H, Patel N, Xiong J, Ding S. Targeting and noninvasive treatment of hepatocellular carcinoma in situ by ZnO nanorod-mediated concurrent chemoradiotherapy. RSC Adv 2015. [DOI: 10.1039/c5ra16880e] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
TfR Ab/Dox/ZnO nanocomposites, in which transferrin receptor antibody (TfR Ab) functionalized ZnO nanorods, loaded with doxorubicin (Dox), were prepared to mediate concurrent chemoradiotherapy for the treatment of hepatocellular carcinoma.
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Affiliation(s)
- Haijun Zhang
- Department of Oncology
- Zhongda Hospital
- Medical School
- Southeast University
- Nanjing
| | - Nishant Patel
- Department of Oncology
- Zhongda Hospital
- Medical School
- Southeast University
- Nanjing
| | - Jian Xiong
- Department of Oncology
- Zhongda Hospital
- Medical School
- Southeast University
- Nanjing
| | - Shuang Ding
- Department of Oncology
- Zhongda Hospital
- Medical School
- Southeast University
- Nanjing
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