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Schmidt RFM, Harder Y, Rossi L, Canino P, Schiaffino S, Calcinotto A, Perriard U, Graffeo R, Decio R, Canonica C, Cuzzocrea M, Farooqi AA, Colombo GE, Diller M, Peradze N, Papadia A, Pagnamenta A, Gasparri ML. Albumin-To-Alkaline Phosphatase Ratio as a New Early Predictive Marker of Axillary Response in Breast Cancer Patients Undergoing Neoadjuvant Chemotherapy: A Pilot Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1767. [PMID: 39596952 PMCID: PMC11596826 DOI: 10.3390/medicina60111767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Accepted: 10/17/2024] [Indexed: 11/29/2024]
Abstract
Background and Objectives: The Albumin-to-Alkaline Phosphatase ratio (AAPR) is an easily applicable and cost-effective marker investigated as an outcome predictor in solid cancers. Preliminary evidence in breast cancer suggests that a low AAPR correlates with a poor response to neoadjuvant chemotherapy (NAC) in primary tumors. However, data regarding the axillary response are lacking. This study aims to evaluate whether the AAPR can predict the axillary response in initially nodal-positive (cN+) breast cancer patients undergoing NAC. Materials and Methods: Clinical and biochemical variables of cN+ breast cancer patients undergoing NAC were collected. Pre-NAC albumin and alkaline phosphatase serum values were utilized in the AAPR calculation. Fisher's exact test was performed to identify differences between the two groups of patients (high and low AAPR according to the cut-off reported in the literature). The primary outcome was the nodal pathologic complete response (pCR) rate in the two groups of patients. Results: Nodal pCR was achieved in 20/45 (44.4%) patients. A total of 36/45 (80%) patients had an AAPR > 0.583. Among patient and tumor characteristics, the only statistically significant difference between the two groups was the axillary pCR between the low and high AAPR groups (p-value = 0.03, OR = 0.129, 95% CI = 0.00-0.835). Conclusions: This pilot study suggests that the pre-treatment AAPR might be an early predictor of axillary response in cN+ breast cancer patients undergoing NAC. This result justifies further investigation in larger prospective trials to validate this finding.
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Affiliation(s)
- Rahel Felicia Mirjam Schmidt
- Faculty of Biomedical Science, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland; (R.F.M.S.); (S.S.); (A.C.); (A.P.); (A.P.)
| | - Yves Harder
- Department of Plastic, Reconstructive and Aesthetic Surgery and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), 1005 Lausanne, Switzerland;
- Faculty of Biology and Medicine, University of Lausanne (UNIL), 1011 Lausanne, Switzerland
| | - Lorenzo Rossi
- Centro di Senologia della Svizzera Italiana (CSSI), Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (L.R.); (P.C.); (U.P.); (R.G.); (R.D.); (C.C.); (M.C.); (N.P.)
- Istituto Oncologico della Svizzera Italiana (IOSI), Centro di Senologia della Svizzera Italiana, 6962 Lugano, Switzerland
| | - Paola Canino
- Centro di Senologia della Svizzera Italiana (CSSI), Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (L.R.); (P.C.); (U.P.); (R.G.); (R.D.); (C.C.); (M.C.); (N.P.)
- Servizio di Radio-Oncologia, Istituto Oncologico della Svizzera Italiana, Ente Ospedaliere Cantonale (EOC), Centro di Senologia della Svizzera Italiana, 6962 Lugano, Switzerland
| | - Simone Schiaffino
- Faculty of Biomedical Science, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland; (R.F.M.S.); (S.S.); (A.C.); (A.P.); (A.P.)
- Centro di Senologia della Svizzera Italiana (CSSI), Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (L.R.); (P.C.); (U.P.); (R.G.); (R.D.); (C.C.); (M.C.); (N.P.)
- Servizio di Radiologia, Istituto Imaging della Svizzera Italiana, Ente Ospedaliere Cantonale (EOC), Centro di Senologia della Svizzera Italiana, 6962 Lugano, Switzerland
| | - Arianna Calcinotto
- Faculty of Biomedical Science, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland; (R.F.M.S.); (S.S.); (A.C.); (A.P.); (A.P.)
- Cancer Immunotherapy Lab, Institute of Oncology Research (IOR), 6500 Bellinzona, Switzerland
| | - Ulrike Perriard
- Centro di Senologia della Svizzera Italiana (CSSI), Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (L.R.); (P.C.); (U.P.); (R.G.); (R.D.); (C.C.); (M.C.); (N.P.)
- Servizio di Istopatologia, Istituto Cantonale di Patologia, Ente Ospedaliere Cantonale (EOC), 6600 Locarno, Switzerland
| | - Rossella Graffeo
- Centro di Senologia della Svizzera Italiana (CSSI), Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (L.R.); (P.C.); (U.P.); (R.G.); (R.D.); (C.C.); (M.C.); (N.P.)
- Istituto Oncologico della Svizzera Italiana (IOSI), Centro di Senologia della Svizzera Italiana, 6962 Lugano, Switzerland
| | - Roberta Decio
- Centro di Senologia della Svizzera Italiana (CSSI), Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (L.R.); (P.C.); (U.P.); (R.G.); (R.D.); (C.C.); (M.C.); (N.P.)
- Dipartimento di Ginecologia e Ostetricia, Ente Ospedaliere Cantonale (EOC), Centro di Senologia della Svizzera Italiana, 6962 Lugano, Switzerland; (G.E.C.); (M.D.)
| | - Claudia Canonica
- Centro di Senologia della Svizzera Italiana (CSSI), Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (L.R.); (P.C.); (U.P.); (R.G.); (R.D.); (C.C.); (M.C.); (N.P.)
- Dipartimento di Ginecologia e Ostetricia, Ente Ospedaliere Cantonale (EOC), Centro di Senologia della Svizzera Italiana, 6962 Lugano, Switzerland; (G.E.C.); (M.D.)
| | - Marco Cuzzocrea
- Centro di Senologia della Svizzera Italiana (CSSI), Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (L.R.); (P.C.); (U.P.); (R.G.); (R.D.); (C.C.); (M.C.); (N.P.)
- Clinica di Medicina Nucleare, Ente Ospedaliere Cantonale (EOC), dell’Istituto Imaging della Svizzera Italiana, Ospedale Regionale di Bellinzona sede San Giovanni e Ospedale Regionale di Lugano sede Civico, 6900 Lugano, Switzerland
| | - Ammad Ahmad Farooqi
- Institute of Biomedical and Genetic Engineering (IBGE), Rashid Latif Medical College, Lahore 54000, Pakistan;
| | - Giorgia Elisabeth Colombo
- Dipartimento di Ginecologia e Ostetricia, Ente Ospedaliere Cantonale (EOC), Centro di Senologia della Svizzera Italiana, 6962 Lugano, Switzerland; (G.E.C.); (M.D.)
| | - Mirjam Diller
- Dipartimento di Ginecologia e Ostetricia, Ente Ospedaliere Cantonale (EOC), Centro di Senologia della Svizzera Italiana, 6962 Lugano, Switzerland; (G.E.C.); (M.D.)
| | - Nickolas Peradze
- Centro di Senologia della Svizzera Italiana (CSSI), Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (L.R.); (P.C.); (U.P.); (R.G.); (R.D.); (C.C.); (M.C.); (N.P.)
- Dipartimento di Ginecologia e Ostetricia, Ente Ospedaliere Cantonale (EOC), Centro di Senologia della Svizzera Italiana, 6962 Lugano, Switzerland; (G.E.C.); (M.D.)
| | - Andrea Papadia
- Faculty of Biomedical Science, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland; (R.F.M.S.); (S.S.); (A.C.); (A.P.); (A.P.)
- Dipartimento di Ginecologia e Ostetricia, Ente Ospedaliere Cantonale (EOC), Centro di Senologia della Svizzera Italiana, 6962 Lugano, Switzerland; (G.E.C.); (M.D.)
| | - Alberto Pagnamenta
- Faculty of Biomedical Science, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland; (R.F.M.S.); (S.S.); (A.C.); (A.P.); (A.P.)
- Clinical Trial Unit, Ente Ospedaliere Cantonale (EOC), 6900 Lugano, Switzerland
| | - Maria Luisa Gasparri
- Faculty of Biomedical Science, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland; (R.F.M.S.); (S.S.); (A.C.); (A.P.); (A.P.)
- Centro di Senologia della Svizzera Italiana (CSSI), Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (L.R.); (P.C.); (U.P.); (R.G.); (R.D.); (C.C.); (M.C.); (N.P.)
- Dipartimento di Ginecologia e Ostetricia, Ente Ospedaliere Cantonale (EOC), Centro di Senologia della Svizzera Italiana, 6962 Lugano, Switzerland; (G.E.C.); (M.D.)
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Xie J, Guo Z, Zhu Y, Ma M, Jia G. Peripheral blood inflammatory indexes in breast cancer: A review. Medicine (Baltimore) 2023; 102:e36315. [PMID: 38050296 PMCID: PMC10695498 DOI: 10.1097/md.0000000000036315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/03/2023] [Indexed: 12/06/2023] Open
Abstract
Immune and inflammatory responses play an important role in tumorigenesis and metastasis. Inflammation is an important component of the tumor microenvironment, and the changes in inflammatory cells may affect the occurrence and development of tumors. Complete blood count at the time of diagnosis and treatment can reflect the inflammatory status within the tumor. Studies have shown that the number of certain inflammatory cells in peripheral blood and their ratios are important prognostic factors for many malignancies, including neutrophil, lymphocyte, monocyte, and platelet counts, as well as neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, systemic immune-inflammation index, systemic inflammation response index and pan-immune-inflammation-value. The value of peripheral blood inflammation indexes in predicting the efficacy and prognosis of breast cancer neoadjuvant therapy is worth recognizing. This review details the application of peripheral blood inflammation indexes in the evaluation of efficacy and prediction of prognosis in neoadjuvant therapy for breast cancer, aiming to provide a more comprehensive reference for the comprehensive diagnosis and treatment of breast cancer.
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Affiliation(s)
- Jiaqiang Xie
- Department of Breast and Thyroid Surgery, Huaihe Hospital of Henan University, Kaifeng, Henan, China
- School of Clinical Medicine, Henan University, Kaifeng, Henan, China
| | - Zhenxi Guo
- Department of Breast and Thyroid Surgery, Huaihe Hospital of Henan University, Kaifeng, Henan, China
- School of Clinical Medicine, Henan University, Kaifeng, Henan, China
| | - Yijing Zhu
- Department of Breast and Thyroid Surgery, Huaihe Hospital of Henan University, Kaifeng, Henan, China
- School of Clinical Medicine, Henan University, Kaifeng, Henan, China
| | - Mingde Ma
- Department of Breast and Thyroid Surgery, Huaihe Hospital of Henan University, Kaifeng, Henan, China
| | - Guangwei Jia
- Department of Thyroid and Breast Surgery, Nanyang First People’s Hospital Affiliated to Henan University, Nanyang, Henan, China
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Maimaitiaili A, Chen H, Xie P, Liu Z, Ling R, Zhao Y, Yang H, Liu Y, Liu K, Zhang J, Mao D, Yu Z, Liu Y, Fu P, Wang J, Jiang H, Zhao Z, Tian X, Cao Z, Wu K, Song A, Jin F, He J, Fan Z, Zhang H. Nomogram for predicting axillary upstaging in clinical node-negative breast cancer patients receiving neoadjuvant chemotherapy. J Cancer Res Clin Oncol 2023; 149:8769-8778. [PMID: 37129606 DOI: 10.1007/s00432-023-04817-9] [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: 03/14/2023] [Accepted: 04/24/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE The prediction of axillary lymph node status after neoadjuvant chemotherapy (NAC) becoming critical because of the advocation of the de-escalation of axillary management. We investigate associated factors of axillary upstaging in clinical node-negative (cN0) breast cancer patients receiving NAC to develop and validate an accurate prediction nomogram. METHODS We retrospectively analyzed 1892 breast cancer patients with stage of cT1-3N0 treated by NAC and subsequent surgery between 2010 and 2020 in twenty hospitals across China. Patients randomly divided into a training set and validation set (3:1). Univariate and multivariate logistic regression analysis were performed, after which a nomogram was constructed and validated. RESULTS In total, pathologic node negativity (ypN0) achieved in 1406 (74.3%) patients and another 486 (25.7%) patients upstaged to pathologic node positive (ypN+). Breast pathologic complete response (bpCR) was achieved in 445 (23.5%) patients and non-bpCR in 1447 (76.5%) patients. A nomogram was established by ER, tumor histology, HER2 status, cycle of NAC treatment, and the bpCR, which were confirmed by multivariate logistic analysis as independent predictors of nodal upstaging in the training cohort (n = 1419). The area under the receiver operating characteristic curve (AUC) of the training cohort and validation cohort (n = 473) were 0.73 (95% CI 0.693-0.751) and 0.77 (95% CI 0.723-0.812) respectively. CONCLUSION We present a nomogram with a nationwide large sample data which can effectively predict axillary upstaging after neoadjuvant chemotherapy to give better advice for individualized axillary lymph node management of breast cancer.
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Affiliation(s)
- Amina Maimaitiaili
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi Province, China
| | - Heyan Chen
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi Province, China
| | - Peiling Xie
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi Province, China
| | - Zhenzhen Liu
- Department of Breast Disease, Henan Breast Cancer Center, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Dongming Road, Zhengzhou, 450008, Henan Province, China
| | - Rui Ling
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Yi Zhao
- Surgical Oncology Department, Shengjing Hospital of China Medical University, Shenyang, 110022, Liaoning Province, China
| | - Hongjian Yang
- Department of Breast Surgery, Institute of Basic Medicine and Cancer (IBMC), The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Chinese Academy of Sciences, Hangzhou, 310022, Zhejiang Province, China
| | - Yunjiang Liu
- Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 052360, Hebei Province, China
| | - Ke Liu
- Fourth Department of Breast Surgery, Jilin Cancer Hospital, Changchun, 130012, Jilin Province, China
| | - Jianguo Zhang
- Department of Breast Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, Heilongjiang Province, China
| | - Dahua Mao
- Department of Breast Surgery, Affiliated Wudang Hospital of Guizhou Medical University, Guiyang, 550009, Guizhou Province, China
| | - Zhigang Yu
- Department of Breast Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, Shandong Province, China
| | - Yinhua Liu
- Breast Disease Center, Peking University First Hospital, Beijing, 100034, China
| | - Peifen Fu
- Department of Breast Surgery, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, 310003, Zhejiang Province, China
| | - Jiandong Wang
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, 100852, China
| | - Hongchuan Jiang
- Department of Breast Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Zuowei Zhao
- Department of Breast Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, 116023, Liaoning Province, China
| | - Xingsong Tian
- Department of Breast and Thyroid Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, 250021, Shandong Province, China
| | - Zhongwei Cao
- Department of Thyroid, Breast, Hernia Surgery, The Inner Mongolia Autonomous Region People's Hospital, Hohhot, 010017, Inner Mongolia Autonomous Region, China
| | - Kejin Wu
- Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200433, China
| | - Ailin Song
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, 730000, Gansu Province, China
| | - Feng Jin
- Department of Breast Surgery, The First Hospital of China Medical University, Shenyang, 110002, Liaoning Province, China
| | - Jianjun He
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi Province, China.
| | - Zhimin Fan
- Department of Breast Surgery, The First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin Province, China.
| | - Huimin Zhang
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi Province, China.
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Li Y, Zhang J, Wang B, Zhang H, He J, Wang K. Development and Validation of a Nomogram to Predict the Probability of Breast Cancer Pathologic Complete Response after Neoadjuvant Chemotherapy: A Retrospective Cohort Study. Front Surg 2022; 9:878255. [PMID: 35756481 PMCID: PMC9218360 DOI: 10.3389/fsurg.2022.878255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/20/2022] [Indexed: 12/02/2022] Open
Abstract
Background The methods used to predict the pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) have some limitations. In this study, we aimed to develop a nomogram to predict breast cancer pCR after NAC based on convenient and economical multi-system hematological indicators and clinical characteristics. Materials and Methods Patients diagnosed from July 2017 to July 2019 served as the training group (N = 114), and patients diagnosed in from July 2019 to July 2021 served as the validation group (N = 102). A nomogram was developed according to eight indices, including body mass index, platelet distribution width, monocyte count, albumin, cystatin C, phosphorus, hemoglobin, and D-dimer, which were determined by multivariate logistic regression. Internal and external validation curves are used to calibrate the nomogram. Results The area under the receiver operating characteristic curve was 0.942 (95% confidence interval 0.892–0.992), and the concordance index indicated that the nomogram had good discrimination. The Hosmer–Lemeshow test and calibration curve showed that the model was well-calibrated. Conclusion The nomogram developed in this study can help clinicians accurately predict the possibility of patients achieving the pCR after NAC. This information can be used to decide the most effective treatment strategies for patients.
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Affiliation(s)
| | | | | | | | | | - Ke Wang
- Correspondence: Jianjun He Ke Wang
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Bi Z, Qiu PF, Zhang Y, Song XG, Chen P, Xie L, Wang YS, Song XR. A Three lncRNA Set: AC009975.1, POTEH-AS1 and AL390243.1 as Nodal Efficacy Biomarker of Neoadjuvant Therapy for HER-2 Positive Breast Cancer. Front Oncol 2021; 11:779140. [PMID: 34938660 PMCID: PMC8685269 DOI: 10.3389/fonc.2021.779140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/11/2021] [Indexed: 12/04/2022] Open
Abstract
Purpose The study aimed to explore whether the expression of lncRNAs in primary tumors could predict nodal efficacy after neoadjuvant therapy (NAT) for HER2+ breast cancer. Methods Total RNA was extracted from HER2+ breast cancer tissues before NAT (n=103) and from 48 pairs of cancers and para-cancers tissues that did not receive NAT. Different lncRNAs were selected by microarray, validated by qPCR, and analyzed to illuminate their potential as nodal efficacy biomarkers after NAT. Results Our results demonstrated that three lncRNA sets, lncRNA-AL390243.1, POTEH-AS1, and lncRNA-AC009975.1, were up-regulated in non-apCR tissues. The AUC value was 0.789 (95%CI: 0.703-0.876). The multivariate logistic regression analysis identified the expression of lncRNA-AL390243.1 (OR 5.143; 95% CI: 1.570-16.847), tumor type (OR 0.144; 95% CI: 0.024-0.855), and nodal stage (OR 0.507; 95% CI: 0.289-0.888) as independent predictors for apCR after NAT in HER2+ patients (all p<0.05). Then the three predictors were used to create a predictive nomogram. The AUC value was 0.859 (95%CI: 0.790-0.929). The calibration curve showed a satisfactory fit between predictive and actual observation based on internal validation with a bootstrap resampling frequency of 1000. Patients with higher expression of lncRNA-AL390243.1 had worse survival. LncRNA-AL390243.1 was up-regulated more in the nodal positive subgroup than in the nodal negative subgroup (p=0.0271). Conclusion The lncRNA-AL390243.1, POTEH-AS1, and lncRNA-AC009975.1 were upregulated in non-apCR breast cancer tissues. These three lncRNAs might have the potential to be used as predictive biomarkers of nodal efficacy of HER2+ breast cancer. Further studies are required to illuminate the underlying molecular mechanisms further.
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Affiliation(s)
- Zhao Bi
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Peng-Fei Qiu
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yue Zhang
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xing-Guo Song
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Peng Chen
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Li Xie
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yong-Sheng Wang
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xian-Rang Song
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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