Real-world treatment patterns and survival for locally advanced esophageal squamous cell carcinoma

The "real world" treatment mode and clinical efficacy of locally advanced esophageal squamous cell carcinoma (LAESCC) are unclear. Meanwhile, the role of immunotherapy in the clinical practice is also puzzling. We conducted the research to investigate the statue of "real world" LAESCC. The clinical data of patients with locally advanced esophageal squamous cell carcinoma which met the criteria from January 2010 to December 2019 have been retrospectively analyzed, and the distribution of clinical treatment patterns has been analyzed. They cover such aspects as dfferences in survival time and further analysis of the differences in overall survival (OS) and progression-free survival (PFS) between patients who received immunotherapy and those who did not receive immunotherapy. What is more, Cox risk regression model has also been used to evaluate the risk factors affecting the prognosis of LAESCC. The cases of a total of 5328 newly diagnosed patients with esophageal cancer were collected, and a total of 363 patients were included in the study, with a median age of (46.2 ± 7.8) years old; 84 (23.1%) and 279 (76.9%) patients received 1L and ≥ 2L, respectively; Concurrent chemoradiotherapy (74.1%) and paclitaxel combined with platinum-based chemotherapy (14.3%) were the main first-line treatment options; fluorouracil combined with cisplatin regimen-based chemotherapy (63.8%) was the main treatment option for ≥ 2L, of which 69 patients (25.3%) received immunization treatment; OS of patients with 1 line of therapy and ≥ 2L were (22.4 ± 7.2) months and (38.7 ± 8.5) months, respectively, and the comparison between groups was statistically significant (P < .05); among 69 patients with ≥ 2L who received immunotherapy, PFS and The OS was (14.6 ± 6.9) and (45.3 ± 9.7) respectively, and the comparison between the groups was statistically significant (all P < .05). Cox multivariate analysis has shown that clinical stage, immunotherapy, concurrent chemoradiotherapy, and ≥ 2L are the main factors affecting OS. and immunotherapy, concurrent chemoradiotherapy, and ≥ 2L are independent factors affecting PFS. Concurrent chemoradiotherapy is currently one of the standard treatments for LAESCC, and most patients are still willing to receive second-line or above treatments. Adding immunotherapy to standard treatment modalities may further optimize clinical treatment modalities and improve patient outcomes.

Influence of UGT1A1 gene methylation level in colorectal cancer cells on the sensitivity of the chemotherapy drug CPT-11

OBJECTIVE

To study the influence of the methylation level of UGT1A1 gene related to CPT-11 metabolic enzymes in colorectal cancer cells on the sensitivity of chemotherapy drugs.

METHODS

Test the changes in sensitivity of seven colorectal cancer cell strains that have been/not been subject to DAC treatment to CPT-11, analyze its correlation with CES2, UGT1A1 and GUSB mRNA expression according to IC50; screen the effective interference sequence of UGT1A1 siRNA, test the changes in cytotoxicity of CPT-11 after UGT1A1 siRNA is transfected, select RK0 cells and make them transfected with the chemosynthetic UGT1A1 siRNA after their UGT1A1 expression is restored with or without demethylation treatment.

RESULTS

The sensitivity of different colorectal cancer cell strains to CPT-11 showed difference (P<0.05), UGT1A1 expression in colorectal cell lines had a negative correlation with the IC50 (r=0.790648, P<0.05), the interference efficiency of the screened UGT1A1 siRNA was up to 78%. The IC50 value of siRNA decreased by nearly one time after transfected with HT-29 (P<0.01); which of methylated RK0 cells of UGT1A1 gene increased instead after the demethylation treatment. However, the IC50 value of the demethylation treatment group increased compared with the non-demethylation treatment group after UGT1A1 siRNA was transfected.

CONCLUSIONS

The cytotoxicity of CPT-11 to colorectal cancer cells has a negative correlation with UGT1A1 expression, and positive correlation with CES2 and GUSB. The specific silencing UGT1A1 gene of siRNA could significantly increase the sensitivity of CPT-11 to the chemotherapy of colorectal cancer cells. UGT1A1 methylation was an important factor affecting the chemosensitivity of CPT-11.

Relationship between the expression of CES2, UGT1A1, and GUSB in colorectal cancer tissues and aberrant methylation

Irinotecan (CPT-11) is considered an important drug in the treatment of colorectal cancer, but its continuous administration reduces its sensitivity and influences the curative effect. The metabolism of CPT-11 is mainly controlled by carboxy-lesterase (CES), UDP-glucuronosyltransferase 1A (UGT1A), and β-glucuronidase (GUSB). Studies to date have shown that methylation acts as an important mechanism for gene expression to suppress the metabolic enzymes of many chemotherapeutics. This study, which selected 99 colorectal cancer patients, 23 of whom had paracancerous tissues and eight of whom had large intestine adenomas, aimed to investigate the correlation between the protein expression of the CPT-11 metabolic enzyme genes CES2, UGT1A1, and GUSB and various clinical pathological parameters of colorectal cancer tissues, as well as the relationship between methylation regulation and the gene expression of CES2, UGT1A1, and GUSB. We used immunohistochemistry staining, methylation-specific PCR, and clinical status to reveal the possible regulatory targets of chemotherapeutic resistance in colorectal cancer and to provide new ideas and countermeasures to reverse anti-cancer drug resistance and chemosensitization. The results showed that the expression of CES2, UGTA1A1, and GUSB varies in colorectal pathology tissues and that the expression of CES2 is somewhat related to tumor staging. This relationship is likely caused by the gene regulation of UGT1A1 and GUSB, and other regulation mechanisms may also be involved. The methylation of the CES2 gene is irrelevant to the morbidity associated with colorectal cancer. The GUSB gene showed no significant differences in methylation, and the hemi-methylation was also positive, the regulating ability of which needs to be verified. The potential role of these genes in the colorectal cancer progression, which may be directly related to the methylation regulation of UGT1A1, requires further research. The promoter of the UGT1A1 gene in colorectal cancer cells is methylated, which is an important mechanism of UGT1A1 gene silencing and can be regarded as the target point of research for CPT-11 drug resistance and control mechanisms for the reversal of drug resistance.

Regulation and expression of aberrant methylation on irinotecan metabolic genes CES2, UGT1A1 and GUSB in the in-vitro cultured colorectal cancer cells

OBJECTIVE

To evaluate the aberrant methylation gene expression related to the irinotecan (CPT-11) metabolic enzymes in different colorectal cancer cell strains; provide new thoughts and measures for reverse of tumor drug resistance.

METHODS

Studied the aberrant methylation state of CES2, UGT1A1 and GUSB in eight colorectal cancer cell strains through MSP method; and analyze the expression of the target gene after being dealt with DAC.

RESULTS

UGT1A1 showed methylation in five cell strains, while CES2 and GUSB respectively showed consistent unmethylation or hemimethylation. After being dealt with DAC, CES2 and GUSB mRNA showed different expressions but not significant. The expression quantity of UGT1A1mRNA in the low-expression cell strains increased significantly. The expression of UGT1A1 protein where POSITIVE presented low expression was up-regulated to different degrees. Negative tropism was found in CES2 and UGT1A1.

CONCLUSION

Methylation in UGT1A1 gene expression silencing as an important mechanism; methylation could provide an effective target for methylation regulation intervening in the treatment of CPT-11. Meanwhile, studies found that the changes in expressions of CES2 and GUSB might be resulted from some unknown target that still existed during the regulation, or from the influence of methylation in the non-core zone of promoters on the gene transcription.

Influence of Skp2-targeted siRNA on characteristics of human colorectal cancer cell line

AIM: To design and construct the RNAi eukaryotic vector of Skp2 gene and to study its interfering effect on characteristics of human colorectal carcinoma cell line HCT116.

METHODS: DNA oligonucleotide for small interfering RNA expression targeting Skp2 gene was synthesized and inserted into pRNAT-U6.1/Neo plasmid after annealing. The inserted sequences were verified by DNA sequencing, and transfected into HCT116 cells with liposome-mediated transfection. The positive transfected cell clones were screened with G418 and the expression of Skp2 mRNA was detected by semi-quantitive RT-PCR. Distribution of cell cycle was assessed by flow cytometry. The cell growth suppression was analyzed by MTT assay.

RESULTS: The sequence of specific siRNA was correct by sequence analysis. Compared with the negative control cells, RT-PCR showed the expression of Skp2 mRNA was down-regulated in the transfected cells (P < 0.05). The subcloned recombinant plasmid expressing shRNA effectively inhibited HCT116 cell growth and proliferation while empty plasmid had no such specific effect. Decreased cellular proliferation activity was observed by MTT (29.21% ± 1.40%, 30.10% ± 1.50% vs 49.05% ± 4.50%, 53.03% ± 4.92%, all P < 0.05). Flow cytometry revealed significant G₁ arrest in cell cycle.

CONCLUSION: The siRNA eukaryotic expression vector of Skp2 gene was constructed successfully which effectively down-regulate the expression of Skp2 in HCT116 cell line, and inhibit the cellular proliferation. It provides a powerful evidence for colorectal carcinoma gene therapy.

[Gemcitabine combined with capecitabine in the treatment for 41 patients with relapsed or metastatic biliary tract carcinoma]

OBJECTIVE

To investigate the efficacy of the combination of gemcitabine with capecitabine in the chemotherapy for patients with relapsed or metastatic biliary tract carcinoma.

METHODS

Forty-one patients with unresectable relapsed or metastatic carcinoma of the biliary tract were treated from March 2000 to December 2004. The regimen consisted of intravenous administration of gemcitabine plus oral intake of capecitabine every 3 weeks for more than 2 cycles. The parameters including tumor response, clinical benefit rate,survival and safety were observed.

RESULTS

Thirty-six patients were valuable and 5 patients were excluded from this series due to various reasons. Eleven patients (30.1%) had a partial response and another 11 patients (30.1%) experieced stable disease with a clinical benefit rates of 61.1%. The median overall survival time and time to progression were 10 months and 6 months, respectively. The one-year survival rate was 40.0%. The adverse events including nausea, diarrhea and hand-foot syndrome, fatigue, neutropenia, thrombocytopenia were frequently observed, which were usually in grade I or II, rarely in grade III and none in grade IV (NCI-CTC).

CONCLUSION

Our results show that the regimen of gemcitabine combined with capecitabine is effective and well tolerated in patients with unresectable relapsed or metastatic carcinoma of the biliary tract.

Effects of PD98059 on proliferation of rat cultured hepatic stellate cells stimulated by acetaldehyde

AIM

To study the effects of PD98059, the specific blocking agent of MEK1, on the proliferation of hepatic stellate cells and expression of Proliferating Cell Nuclear Antigen in rat hepatic stellate cells (HSC).

METHODS

HSC stimulated by acetaldehyde were cultured. The cell growth was evaluated by MTT colorimetric assay. Proliferating cell nuclear antigen (PCNA) was examined by immunocytochemical staining.

RESULTS

PD98059 of 20 μmol/L had an inhibitory effect on proliferation of HSC (P<0.05, 0.109±0.020 vs 0.146±0.030), which was more obvious when cells exposed to PD98059 at 50 and 100 μmol /L (P<0.05, 0.081±0.010, 0.056±0.020 vs 0.146±0.030), and the expression of PCNA also showed a descending tendency with the increase of PD98059 concentration (P<0.05, 0.62±0.09, 0.47±0.04, 0.34±0.04 vs 0.740.05)

CONCLUSION

PD98059 inhibits proliferation of HSC and expression of PCNA, which is correlated with the decreased activity of PCNA.

[CT findings in "fresh" cerebral paragonimiasis]

There are few reports on CT findings in "fresh" cerebral paragonimiasis. We have experienced four cases of "fresh" cerebral paragonimiasis examined by CT scan. Three patients were children aged 7, 9, and 14 years, and one was an adult aged 25 years. Three patients were examined by CT scan 2 to 6 months after the onset of high grade fever, convulsion and focal deficit signs, and a patient was examined one month after his progressive visual disturbance. The unique CT findings are multilocular cystic lesions in temporo-occipital or in temporo-parietal lobes with extensive brain edema. Two cases were also associated with "soap-bubble" calcifications. The cysts were more dense than CSF and enhanced by contrast media. The histopathological specimen showed that the eggs of paragonimus were in the abscess cavity, of which the wall was composed with highly vascular gliomesenchymal capsule and numerous cell infiltration. Three patients underwent craniotomy for removal of abscess and decompression. Bitionol were administered and all patients recovered well. We also discussed the differential diagnosis of cerebral parasitic granulomas.