[Gemcitabine long-term maintenance chemotherapy benefits patients with survival: a multicenter, real-world study of advanced breast cancer treatment in China]

Objective: This study collected a real-world data on survival and efficacy of gemcitabine-containing therapy in advanced breast cancer. Aimed to find the main reasons of affecting the duration of gemcitabine-base therapy in advanced breast cancer patients. Methods: Advanced breast cancer patients who received gemcitabine-base therapy from January 2017 to January 2019 were enrolled(10 hospitals). The clinicopathological data, the number of chemotherapy cycles and the reasons for treatment termination were collected and analyzed. To identify the reasons related with continuous treatment for advanced breast cancer and the factors which affect the survival and efficacy. Results: A total of 224 patients with advanced breast cancer were enrolled in this study, with a median age of 52 years (26-77 years), 55.4%(124/224) was postmenopausal. Luminal type were 83 cases, TNBC were 97 cases, and human epidermal growth factor receptor 2 (HER's-2) overexpression were 44. At the analysis, 224 patients who received the gemcitabine-based regimens were evaluated, included 5 complete reponse (CR), 77 partial response (PR), 112 stable disease (SD) and 27 progressive disease (PD). The objective response rate (ORR) was 36.6%(82/224). Seventy patients had serious adverse diseases, including leukopenia (9), neutrophilia (49), thrombocytopenia (15), and elevated transaminase (2). The median follow-up time was 41 months (26~61 months), and the median PFS was 5.6 months. The reasons of termination treatment were listed: disease progression were 90 patients; personal reasons were 51 patients; adverse drug reactions were 18 patients; completed treatment were 65 patients. It was found that progression-free survival (PFS) was significantly longer in patients receiving >6 cycles than that in patients with ≤6 cycles (8.2 months vs 5.4 months, HR=2.474, 95% CI: 1.730-3.538, P＜0.001). Conclusions: Gemcitabine-based regimen is generally well tolerated in the Chinese population and has relatively ideal clinical efficacy in the real world. The median PFS is significantly prolonged when the number of treatment cycles are appropriately increased.

[Evaluation of the predictive effect of PD-L1 expression on survival in early triple-negative breast cancer]

Objectives: To find the prognostic factors related to early triple-negative breast cancer to optimize the therapeutic strategies, and explore the influence of programmed cell death ligand-1(PD-L1)expression in early triple-negative breast cancer on its prognosis, so as to provide support for clinical treatment decisions. Methods: Early triple-negative breast cancer patients treated at the National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences during 1st June, 2009 and 31st Oct, 2015 were enrolled in this study. All the clinicopathological data of patients were collected, and the paraffin sections of the surgical specimens were stained with estrogen receptor, progesterone receptor, human epidermal growth factor receptor-2, secreted protein acidic and rich in cysteine (SPARC), androgen receptor, PD-L1 and other antibodies by the immunohistochemical method. Kaplan-Meier survival and Cox regression curves were used for survival analysis of relevant clinical and pathological results and nomogram survival prediction models were established to explore the influence of relevant factors on the prognosis. Results: A total of 205 patients with triple-negative breast cancer were enrolled. Ninety patients (43.9%) were PD-L1 positive. The median follow-up time was 63 months. Thirty-seven patients were relapsed or recurrent and 16 patients were dead. The 5-year disease-free survival (DFS) rate and overall survival (OS) rate were 86.1% (95% CI: 81.4%-90.8%) and 93.6% (95% CI: 91.0%-97.6%), respectively, in the general population. Univariate Cox regression analysis showed that PD-L1 expression and lymph node metastasis were correlated with DFS and OS (P<0.05). In multivariate analysis, PD-L1 expression was an independent influencing factor of DFS, with PD-L1 positive patients possessing a significant survival benefit in DFS (HR=0.31, 95% CI: 0.13-0.73). Lymph node metastasis was an independent influencing factor of OS, and OS was significantly shortened in patients with positive lymph node metastasis (HR=3.24, 95% CI: 1.15-9.17). PD-L1, lymph node metastasis, menopausal status, Ki-67 index and adjuvant chemotherapy regimen were included to establish the 1- and 3-year DFS and OS nomogram prediction models, resulting in C indices of 0.698 and 0.748, respectively. Conclusions: PD-L1 expression is a predictive biomarker of good prognostic factor in triple-negative breast cancer patients. DFS is significantly prolonged in PD-L1 positive patients and OS also shows a prolongation trend. The nomogram prognosis prediction models have reference values for adjuvant chemotherapy in this patient group.

Up-Regulation of TCF21 Expression Reverses the Malignant Phenotype of Cancer-Associated Fibroblasts in Esophageal Squamous Cell Carcinoma

PURPOSE/OBJECTIVE(S)

Cancer-associated fibroblasts (CAFs), as one major component of tumor microenvironment (TME), are closely associated with tumor initiation and progression. Our previous studies have discovered that CAFs induced the resistance of esophageal squamous cell carcinoma (ESCC) cells to a variety of chemotherapeutic drugs such as cisplatin and paclitaxel. Furthermore, CAFs attenuated ionizing irradiation (IR)-induced cancer cells death by regulating DNA damage response. CAFs themselves are highly resistant to death stimuli due to enhanced antioxidant potential and DNA repair capacity. How to inhibit the malignant phenotype of CAFs is critically important for the radical treatment of ESCC.

MATERIALS/METHODS

By RNA-sequencing and DNA methylation analysis, the transcriptome and epigenome of CAFs and matched normal fibroblasts (NFs) have been integratively analyzed. By transfection of TCF21 cDNA plasmid, the expression of TCF21 in CAFs has been up-regulated. Using a cell counting kit and migration and invasion assay, the effect of TCF21 on the growth and migration and invasive ability of CAFs has been detected. Using immunofluorescence and flow cytometry (FCM) analysis and western blotting, the effect of TCF21 on the DNA damage repair and apoptotic death of CAFs following IR has been detected.

RESULTS

TCF21 is one of the top ten down-regulated genes in CAFs compared with NFs due to promoter methylation. Up-regulation of TCF21 expression inhibited the growth rate and migration and invasive ability of CAFs. The expression of α-SMA, as an indicator of CAFs activation, was down-regulated in CAFs which were transfected with TCF21 cDNA. Furthermore, when TCF21 cDNA was transfected into CAFs, IR-induced DNA damage was increased while DNA repair was inhibited in CAFs, suggesting that TCF21 was involved in DNA damage response of CAFs following IR. FCM analysis showed that up-regulation of TCF21 expression promoted IR-induced apoptotic death of CAFs.

CONCLUSION

TCF21 is a determinant of the malignant phenotype of CAFs in ESCC. Up-regulation of TCF21 expression is a promising approach of inhibiting the growth, migration and invasion, activation and radioresistance of CAFs in ESCC.

Single-Cell Analysis Reveals the Alteration of Immune Checkpoint Molecules Induced by Radiochemotherapy in Cervical Cancer Microenvironment

PURPOSE/OBJECTIVE(S)

Radiochemotherapy (RCT) could alter the function, activation state, and distribution of immune cells in tumor microenvironment (TME). This study aimed to decipher the alteration of immune checkpoint molecules induced by RCT in the TME of cervical cancer by single-cell RNA sequencing (scRNA-seq).

MATERIALS/METHODS

We analyzed the alterations of immune checkpoint molecules in the TME using scRNA-seq data of 32,116 cells from 3 pairs of tumor biopsies of cervical cancer patients pre- and post-RCT. Uniform Manifold Approximation and Projection was applied to demonstrate the heterogeneity of cell subclusters and differences in the distribution of immune checkpoint molecules. The Wilcoxon rank sum test was used to compare the expression level of the immune checkpoint molecules pre- and post-RCT.

RESULTS

VSIR was mainly expressed on cancer-associated fibroblasts and myeloid cells, of which the level can be reduced by RCT (both P < 0.05). RCT also inhibited the expression of co-inhibitory molecules, such as HAVCR2, TIGIT, CD244, and CD160 on CD4+ T, CD8+ T, and NK cells (all P < 0.05). The expression level of co-inhibitory molecules, LAG3, and co-stimulatory molecules, TNFRSF9 on CD8+ and CD4+ T cells were reduced post-RCT (all P < 0.05). Nonetheless, the expression level of co-stimulatory molecules CD28 was significantly increased on CD4+ and CD8+ T cells post-RCT (all P < 0.05). Intriguingly, the expression level of TNFRSF18 was increased on CD8+ T cells post-RCT while it was reduced on NK cells post-RCT (both P < 0.05).

CONCLUSION

This study unveils that RCT could induce complex alteration of the expression of immune checkpoint molecules on immune cells as well as stromal cells, which may help further understand the mechanism of anti-tumor effect of RCT and optimize treatment strategies.

Camrelizumab with Chemoradiotherapy for Locally Advanced Biliary Tract Cancer: Preliminary Results from A Phase II Study

PURPOSE/OBJECTIVE(S)

For locally advanced biliary tract cancer (BTC), capecitabine-based chemoradiotherapy (CRT) is commonly used but has limited benefits. Immunotherapy is potentially effective for BTC and may be synergized with CRT. Followed by gemcitabine and cisplatin (GP) consolidation chemotherapy (CT), we evaluated the safety and efficacy of combined camrelizumab and capecitabine-based CRT for locally advanced BTC.

MATERIALS/METHODS

Patients had stage II-III (T4N0M0, T1-4N+M0) BTC (per the 7th [2010] edition of the American Joint Committee on Cancer staging system) were eligible for CRT (capecitabine plus [50-60 Gy] radiotherapy), to be followed by GP CT. Camrelizumab was given concurrently with CRT. Safety was defined as the incidence and severity of adverse events (AEs), while efficacy was defined as overall survival (OS), progression-free survival (PFS), objective response rate (ORR) and disease control rate (DCR).

RESULTS

Ten patients completed the planned treatment. None experienced grade ≥3 treatment-related AEs during CRT. Grade ≥3 immune-related AEs occurred in 2 of 10 patients (20%) only during GP CT. The mean OS time was 18.2 months (95% confidence interval [CI] 12.9m-23.5m) while the median OS time was 14.1 months (95% CI 10.1m-18.1m). OS rates were 100%, 59%, 44% at 6 months, 1 year and 2 years, respectively. The ORR was 30% while the DCR was 90%. Two patients (20%) obtained OS over 2 years with partial response (25.9m, 29.1m). Median PFS time was 14.1 months (95% CI 9.3m-18.9m).

CONCLUSION

Camrelizumab in combination with concurrent CRT was well tolerated and did not impair delivery of CRT in patients with locally advanced BTC.

Hyperthermia Enhances the Radiosensitivity of Pancreatic Cancer Cells by Inhibiting Wnt2B Signaling

PURPOSE/OBJECTIVE(S)

Pancreatic cancer (PC) is a highly lethal human malignance. Due to unobvious symptoms at early stage, most of the patients with PC are diagnosed at late stages and lose the chance of surgical resection. Furthermore, PC patients are resistant to chemoradiotherapy and therefore show a dismal survival. Hyperthermia is commonly used as a sensitizer of chemotherapy or radiotherapy for the clinical treatment of human cancers. Our study aimed to investigate whether hyperthermia can improve the radiosensitivity of PC cells and uncover the involved mechanisms.

MATERIALS/METHODS

PC cells BxPC3, CFPAC-1 and PANC1 were heated to 43 ℃ 1 h before exposure to ionizing irradiation (IR). The radiosensitivity of PC cells were detected in vitro by colony formation assay, immunofluence analysis and western blotting. The mechanisms studies have been conducted using qRT-PCR analysis, cDNA/siRNA transfection and comet assay.

RESULTS

Hyperthermia significantly enhanced the radiosensitivity of PC cells by decreasing their colony formation and increasing DNA damage following IR. By qRT-PCR analysis of Wnt genes expressions, we found Wnt2B was significantly down-regulated in PC-3 cells which were treated with the combination of hyperthermia and IR compared with hyperthermia or IR alone. Functional assays showed that the expression level of Wnt2B was inversely associated with the radiosensitivity of PC-3 cells. Furthermore, we found hyperthermia inhibited the expression of DNA repair proteins such as p-BRCA1 and p-MRE11 in PC cells following IR CONCLUSION: Hyperthermia can significantly enhance the radiosensitivity of PC cells in a Wnt2B signaling-dependent manner.

A Multiomics Analysis of the Close Connection between Intratumoral Microbiota and Immune Cell Infiltration in Colorectal Cancer

PURPOSE/OBJECTIVE(S)

The colorectal intratumoral microbiome and its association with the expression of the tumor genome and immune cell infiltration remain poorly characterized. Our study aims to investigate the relationship between intratumoral microbiota with tumor immune infiltration, patient prognosis, and potential downstream signaling pathways.

MATERIALS/METHODS

We collected biopsy samples of tumor tissue and paracancerous tissue from 92 patients with colorectal cancer, and acquired microbiota profiling in these samples using 16s rRNA sequencing. Meanwhile, the immune markers including CD8, FOXP3, CD163, PD-1 and PD-L1 were stained by immunohistochemistry (IHC) to identify the immune infiltration in tumors. Furthermore, we used The Cancer Genome Atlas and The Cancer Microbiome Atlas databases to conduct multiomics analysis on tumor flora and patient survival, tumor gene expression profile and potential downstream pathways.

RESULTS

There was a significant difference in α-diversity (p = 0.00051) and β-diversity (p = 0.004) between tumor and paracancerous tissues. The β-diversity of intratumoral bacterial differed by colorectal cancer tumor stage (early vs. late stage, p = 0.049) and location (left vs. right colon, p = 0.04). Stage-related flora cluster (Porphyromonas, Lachnoclostridium, Bacteroides, Aggregatibacter, and Hungatella) were identified and found to be associated with poor prognosis in colorectal cancer patients (HR = 1.79, p = 0.015). By IHC staining, we found that expression of PD-1 and FOXP3 was significantly reduced at low abundance of stage-related bacterial cluster (p<0.05). Among of them, Hungatella was negatively associated with CD8+T cell infiltration (p<0.05) in tumor. Besides, tumor-location related flora cluster (Bacteroides and Blautia) were identified and found to be associated with good prognosis in colorectal cancer patients (HR = 0.52, p = 0.011). Expression of CD163 was decreased at high abundance of location-related bacterial cluster (p<0.05). Among of them, Blautia was negatively correlated with tumor-associated macrophage infiltration(p<0.05). Furthermore, we found that the stage-related flora cluster was positively connected with the pathway of bile acid metabolism, whereas the location-dependent cluster was negatively correlated with this pathway.

CONCLUSION

We found specific intratumoral bacterial clusters that were related to tumor stage and location, and the clusters were strongly associated with tumor immune infiltration and patient prognosis. Our findings may provide new viewpoint for future research between intratumoral microbiota, metabolism pathway and tumor microenvironment.

Perturbation of Gut Microbiota Modulated the Abscopal Effects of Immunoradiotherapy in Rectal Cancer

PURPOSE/OBJECTIVE(S)

The abscopal effect-the regression of malignancies outside the irradiation zone-can be increased by combining radiotherapy (RT) with immunotherapy. In this study, we aimed to investigate whether the gut microbiota affected the abscopal effect following immunoradiotherapy (iRT) in rectal cancer.

MATERIALS/METHODS

Bilateral MC38 subcutaneous tumors (primary and abscopal tumor) were established in C57/B6 mice with or without oral antibiotic treatment (preadministration of vancomycin, streptomycin, and ampicillin 14 days before therapy). Mice with or without antibiotic therapy were then randomized into eight groups to receive one of four treatments: (1) RT to the primary tumor + anti-PD-1 therapy (iRT), (2) RT to the primary tumor (RT), (3) anti-PD-1 therapy (anti-PD-1), and (4) no treatment. Flow cytometry was used to determine the composition and function of immune cells in the primary and abscopal tumors as well as in the spleen. 16S rRNA sequencing was used to assess the gut microbiome alteration following antibiotic intervention. Multiple bioinformatics were then explored to investigate the impact of specific flora that related to abscopal antitumor effect.

RESULTS

We found that radiation on primary tumors exhibited cytotoxic effect in nonirradiated (abscopal) tumors (p=0.0057, RT vs. untreated group; p=0.0037, iRT vs. anti-PD-1 group). In contrast, abscopal tumors were resistant to the anticancer effects of RT when antibiotics were given (p=0.5374, RT + antibiotics vs. untreated group + antibiotics; p=0.42, iRT + antibiotics vs. anti-PD-1 + antibiotics group). Comparing the RT+antibiotics group to the RT group, we discovered that the number of CD8+CD44+ T cells decreased significantly in both abscopal tumors (p<0.001) and spleens (p=0.0061). In anti-PD-1-treated groups, antibiotics significantly reduced the number of CD8+GranzymeB+ T cells in primary tumors (p=0.0061) and CD4+CD25+ T cells in spleens (p<0.001). In iRT-treated groups, the antibiotic reduced the fraction of CD4+INF-γ+ cells in abscopal tumors (p=0.0134), and increased the number of CD4+PD-1+ T cells in spleens (p<0.001). Moreover, we found that both α- and β-diversity decreased significantly in the gut microbiota after antibiotic treatment (p=0.0079 and p<0.001, respectively). The abundance of g_Alistipes, g_Lactobacillus, g_Lachnospiraceae and g__Lactobacillus fell dramatically in the presence of antibiotics. In addition, functional analyses of Picrust2 and KEGG revealed that antibiotic therapy had the most profound impact on the D-Alanine metabolism pathway (p<0.001).

CONCLUSION

We found that the alteration of the gut microbiome by antibiotics significantly affects the local and systemic antitumoral effect of iRT, our results may provide new insight on how gut modification converts the local anticancer effects of RT into a systemic response that targets metastatic tumors.

Single-Cell Dissection of Concurrent Chemoradiotherapy-Induced Immunosenescence in Cervical Cancer

PURPOSE/OBJECTIVE(S)

Immunosenescence could attenuate effective anti-tumor immune response, but it's role in the tumor microenvironment following concurrent chemoradiotherapy (CCRT) in cervical cancer (CC) remains largely unknown. We aimed to investigate CCRT induced immunosenescence and its clinical implications in CC at single-cell resolution.

MATERIALS/METHODS

A total of 11326 cells from single-cell RNA sequencing data derived from five post-CCRT CC tumor samples were analyzed by bioinformatics for immunosenescence. Functional enrichment analysis including Gene Ontology (GO) and Gene Set Variation analysis was performed to identify and assess the molecular heterogeneity of cell subclusters. Kaplan-Meier survival analysis was performed in the bulk RNA-sequencing data included 253 patients with CC obtained from the The Cancer Genome Atlas.

RESULTS

We identified senescent and non-senescent cell clusters in tumor-associated macrophages (TAMs), CD8+ T cells and NK cells after CCRT based on the senescence-related genes expression. GO analysis showed that antigen processing and presentation pathways were enriched in the non-senescent TAMs, while the response to hypoxia and oxidative stress were enriched in the senescent TAMs, which repressed the anti-tumor immunity. We further found that the abundance of senescent TAMs was associated with shorter overall survival (OS) of patients with CC (P<0.001). Moreover, compared to senescent CD8+ T, non-senescent CD8+ T exhibited higher cytotoxicity and exhausted signature scores, and increased enrichment of T cell proliferation, differentiation and activation pathways. In addition, the high proportion of non-senescent NK cell was also associated with better OS of CC patients (P = 0.008).

CONCLUSION

We revealed the potential immune suppressive characteristics of CCRT induced senescent immune cells at single-cell resolution, which provides promising therapeutic targets for CC patients.

Impact of FAPI-PET/CT on Target Volume Definition in Radiation Therapy of Locally Advanced Biliary Tract Cancer: Compared with MRI/CT

PURPOSE/OBJECTIVE(S)

A new radioactive positron emission tomography (PET) tracer uses inhibitors of fibroblast activation protein (FAPI) to visualize FAP-expressing cancer associated fibroblasts. Significant FAPI-uptake has recently been demonstrated in biliary tract cancer (BTC) patients. Target volume delineation for radiation therapy still relies on often less precise conventional magnetic resonance imaging (MRI) registered with computed tomography (CT) imaging, especially in locally advanced BTC patients. The need for improvement in precise tumor detection and delineation led us to innovatively use the novel FAPI-PET/CT for radiation treatment planning.

MATERIALS/METHODS

Gross tumor volumes (GTVs) of five locally advanced BTC cases were contoured under FAPI-PET/CT method. MRI/CT was used to delineate tumors additionally. The differentiation in target definition was analyzed between FAPI-PET/CT-based GTVs and the manually MRI/CT-based GTVs.

RESULTS

Target definition differed significantly between different imaging methods with mean dice similarity coefficients of 0.5527, mean Jaccard similarity coefficients of 0.4296 and mean volumetric overlap difference of 0.5704, while the mean volumes and standard deviations of GTVs were 18.12±15.10 cm3 and 38.44±24.72 cm3, based on FAPI-PET/CT and MRI/CT respectively (P = 0.102). There was a discordance and difference between the volumes of FAPI-GTVs-based GTVs and the manually contoured GTVs based on MRI/CT.

CONCLUSION

Due to its high tumor to background contrast, FAPI-PET/CT seems to be a superior imaging modality compared to the current gold standard MRI/CT in BTC. For the first time, we demonstrate how FAPI-PET/CT could facilitate target definition and increases accuracy in radiation oncology in BTC. Limited to the sample size, we still need more large-scale data to support this view.

Positive TIGIT and VISTA Expression Predict Worse Prognosis in Cervical Cancer Patients Treated with (Chemo)Radiotherapy

PURPOSE/OBJECTIVE(S)

Immune checkpoint inhibitors combined with (chemo)radiotherapy could be an attractive treatment strategy for patients with cervical cancer (CC), but the expression of some immune checkpoint proteins in cervical cancer and their impact on patient survival remains largely unknown. Here, we investigated the predictive value of T cell immunoreceptor with Ig and ITIM domain (TIGIT), V-domain Ig suppressor of T cell activation (VISTA), and lymphocyte-activation gene-3 (LAG-3) expression in pathological tissues of CC patients treated with (chemo)radiotherapy.

MATERIALS/METHODS

We enrolled 175 CC patients who received (chemo)radiotherapy and collected their pre-treatment tumor tissue sections for the immunohistochemical stain of TIGIT, VISTA, and LAG-3. The Kaplan-Meier method was used to calculate progression-free survival (PFS) and overall survival (OS) after (chemo)radiotherapy. Univariate and multivariate COX proportional hazards regression models were employed to analyze potential risk factors for patient survival.

RESULTS

Kaplan-Meier survival analyses showed that the PFS and OS of patients with positive expression of TIGIT and VISTA were significantly shorter than those patients with negative expression of the proteins (all p<0.05). However, we did not reach the same conclusion in the analysis of LAG-3 (both p>0.05). Univariate COX regression analysis showed that the positive expression of TIGIT and VISTA are related to poor PFS and OS (both HR>1.0 and p<0.05). Multivariate COX regression analysis showed that TIGIT positive and VISTA positive patients have shorter PFS and OS (both HR>1.0 and p<0.05). There is no significant correlation between LAG-3 expression and PFS or OS in these CC patients treated with (chemo)radiotherapy.

CONCLUSION

We revealed that positive TIGIT and VISTA expression could predict worse prognosis in cervical cancer patients treated with (chemo)radiotherapy, which may help to refine the treatment strategies of combining immune checkpoint inhibitors and radiotherapy.

18F-AlF-NOTA-FAPI-04 PET/CT can Predict Treatment Response and Survival in Patients with Inoperable Pancreatic Adenocarcinoma

PURPOSE/OBJECTIVE(S)

We investigated whether uptake of 18F-AlF-NOTA-FAPI-04 on positron emission tomography/computed tomography (PET/CT) could predict treatment response and survival in patients with pancreatic adenocarcinoma (PAAD).

MATERIALS/METHODS

We prospectively evaluated 47 patients with histopathologically confirmed primary PAAD and pretreatment 18F-FAPI PET/CT scans to determine uptake of fibroblast activation protein (FAP) and compare the findings with those from blood tests and immunohistochemically stained tumor specimens. Cox regression and Kaplan-Meier methods were used to assess relationships between disease progression and potential predictors. Receiver operating characteristic (ROC) curve analysis was used to define the optimal cutoff points for distinguishing patients according to good response vs poor response per RECIST v. 1.1.

RESULTS

The FAPI PET variables maximum and mean standardized uptake values (SUVmax, SUVmean); metabolic tumor volume (MTV); and total lesion FAP expression (TLF) were positively correlated with cancer-associated fibroblast (CAF) markers (FAP, α-smooth muscle actin, vimentin, S100A4, and platelet-derived growth factor receptor α/β, all P<0.05). MTV and Log2TLF were associated with survival in patients with inoperable PAAD (all P<0.05). Analyses controlling for sex, age, cTNM, and performance status showed that MTV and Log2TLF were associated with overall survival (MTV hazard ratio [HR] = 1.016, P = 0.016 and Log2TLF HR = 4.093, P = 0.003). ROC cutoff analysis indicated that elevated MTV and TLF were associated with poorer survival. Greater changes from before to after chemotherapy in SUVmax, MTV, and TLF were associated with good treatment response (all P<0.05). ΔMTV, ΔTLF and ΔSUVmax had larger areas under the curve than ΔCA19-9 for predicting treatment response. Kaplan-Meier analysis showed that the extent of change in MTV and TLF from before to after treatment predicted progression-free survival, with cutoff values (based on medians) of -4.95 for ΔMTV (HR = 8.09, P = 0.013) and -77.83 for ΔTLF (HR = 4.62, P = 0.012).

CONCLUSION

Higher baseline MTV on 18F-FAPI-04 PET/CT scans was associated with poorer survival in patients with inoperable PAAD. ΔMTV was more sensitive for predicting response than ΔCA19-9. These results are clinically meaningful for identifying patients with PAAD who are at high risk of disease progression.

PARP Inhibitor Plus Radiotherapy Reshapes IDH1 Mutation Tumor Immune Suppression Microenvironment Potentiating the Efficiency of Immune Checkpoint Inhibitor

PURPOSE/OBJECTIVE(S)

Isocitrate dehydrogenase 1 (IDH1) mutations confer gain-of-function activity by converting α-ketoglutarate (α-KG) to the oncometabolite D-2-hydroxyglutarate (D-2HG). IDH mutant tumors have fewer tumor-infiltrating CD8+ T cells and reduced PD-L1 expression compared with their wild type (WT) counterparts. In addition, 2-HG can directly inhibit the killing and proliferative functions of CD8+ T lymphocytes, and suggesting that 2-HG promotes an immunosuppressive TME. Several studies have shown that 2-HG can inhibit homologous recombination (HR) and weaken the DNA damage response (DDR), making them more sensitive to poly (ADP-ribose) polymerase (PARP) inhibitors and radiotherapy (RT). At the same time, RT and PARP inhibition (PARPi) have been considered to be a new direction to stimulate antitumor immunity. Therefore, our study intends to use RT + PARPi to reverse the immunosuppressive microenvironment caused by IDH1 mutations, thereby promoting the therapeutic effect of immune checkpoint inhibitors.

MATERIALS/METHODS

We compared the immune responses of clinical tissue samples and TCGA data from either IDH1mut or IDH1WT low-grade gliomas. We then established IDH1mut-overexpressing MC38 and GL261 cell lines to determine the antitumor effect of RT + PARPi. Apoptosis and immunogenic death markers were detected by flow cytometry, western blot (WB) and ELISA in these cell lines. Tumor growth and mouse survival curves were observed in both an MC38 subcutaneous and GL261 orthotopic tumor model. Changes in the composition of the immune microenvironment were assessed using flow cytometry. The mechanisms underpinning these compositional shifts were then further interrogated using various techniques, including WB, immunofluorescence, qRT-PCR, CRISPR/Cas9, and CD8+ T cell migration experiments.

RESULTS

We observed that CD8+ T cell infiltration and expression of the chemokines CXCL10 and CCL5 of CD8+ T cells in IDH1mut tumors were significantly downregulated by immunohistochemistry and TCGA analysis. Gene enrichment analysis using the TCGA database found that IDH1 mutations downregulated interferon (IFN)-related signaling pathways. RT + PARPi induces more DNA damage and actives the CGAS-STING pathway compared with monotherapy, leading to more expression of IFN-β, CXCL10 and CCL5 at mRNA and protein level. In the MC38 subcutaneous tumor model, we found that RT + PARPi increased the infiltration of CD8+ T cells while enhancing the killing function of CD8+ T cells. We observed these same effects in the GL261 orthoma model, as well as increased proliferation function of CD8+ T cells. In addition, RT + PARPi increased the expression of PD-L1 and enhanced the therapeutic effect of immune checkpoint inhibitors.

CONCLUSION

RT + PARPi reshapes the IDH1mut tumor immune suppression microenvironment, thereby potentiating the antitumor effect and efficiency of immune checkpoint inhibitor.

Single-Cell and Bulk RNA Sequencing Reveal the Potential Immune Suppressive Role of PODXL in Cervical Cancer Treated with Radiochemotherapy

PURPOSE/OBJECTIVE(S)

Our previous study identified the tumor-promoting role of PODXL in cervical cancer (CC), but it remains largely unknown for its impact on immune response and survival in CC patients received radiochemotherapy. Here, we investigated this issue using single-cell RNA-sequencing (scRNA-seq) and Bulk RNA-sequencing data.

MATERIALS/METHODS

We performed scRNA-seq on 29,453 cells in five tumor tissues from CC patients, employed 141 bulk RNA-seq data from TCGA, and included a cohort of 168 CC patients treated with radiochemotherapy for immunostaining of PODXL protein. Gene Ontology (GO) and Gene set enrichment analysis (GSEA) analysis were performed for functional annotation. Immune cell infiltration analysis by single sample GSEA. Immunostaining validation was performed on tumor tissues from 168 CC patients treated with radiochemotherapy.

RESULTS

Single-cell analyses revealed the specific expression of PODXL on endothelial cells and divided these cells into PODXLhigh and PODXLlow cells. GO and GSEA analyses showed that PODXLhigh cells had lower levels of leukocyte cell-cell adhesion, immunoglobulin mediated immune response and cytokine production than PODXLlow cells. We further found that PODXLhigh cells could reduce macrophage recruitment through PODXL-ACKR1 and ultimately shape the immune suppressive tumor microenvironment. Analyses of bulk RNA-seq data showed that PODXL expression was negatively correlated with survival of CC patients; moreover, compared to the PODXLlow group, the infiltration of CD8+ T cells, B cells, Th1, and follicular helper T cells were lower in the PODXLhigh group (all P values < 0.05). Furthermore, in the immunostaining validation cohort, multivariate Cox analysis showed that PODXL expression was negatively correlated with the survival for CC patients who underwent radiochemotherapy (all P values < 0.05).

CONCLUSION

We revealed the potential immune suppressive role of PODXL in CC patients treated with radiochemotherapy, which may provide a candidate therapy target combined with radiochemotherapy.

[Application value of DNA damage repair variants in adjuvant therapy of triple negative breast cancer]

Objective: To investigate the correlation between adjuvant chemotherapy with platinum-containing regimens and DNA damage repair (DDR) defects in early-stage triple negative breast cancer (TNBC), and to provide a basis for precise treatment of TNBC. Methods: Next-generation sequencing (NGS) testing was performed on postoperative breast cancer specimens selected from the Cancer Hospital of Chinese Academy of Medical Sciences from June 2009 to October 2015 to analyze the correlation between DDR gene variants and the efficacy of adjuvant chemotherapy with TNBC platinum-containing regimens, and thus to screen the superior population for adjuvant chemotherapy with TNBC platinum-containing regimens. The study used t-test, χ(2) test, Fisher's exact test, rank sum test and multifactorial logistic analysis to assess the associations between mutated genes and clinicopathological characteristics and prognosis, and Log-rank test and Cox proportional risk model were used for survival and correlation analysis. Results: NGS results were successfully obtained in 149 patients (74 in the platinum-containing group and 75 in the platinum-free group), with a 97.3% (145/149) DDR gene mutation rate and a median number of 4 mutations in all patients. 5-year disease-free survival (DFS) was 85.4% and 75.0% for patients with DDR gene mutations and DDR gene wild-type, respectively, without statistical difference (P=0.825). The 5-year DFS rates of patients with homologous recombination repair (HRR) pathway mutation were 84.6% in platinum-containing (TCb) group and 84.9% in platinum-free (EC-T) group (P=0.554), respectively. The 5-year DFS rates of patients with and without mutations in the platinite-containing HRR pathway were 84.9% and 85.0%, respectively (P=0.751). The number of DDR pathways with mutations and the number of DDR gene mutations were not associated with prognosis (both P>0.05). PIK3CA mutation patients in TCb group had a worse prognosis than wild-type patients (5-year DFS were 71.4% and 88.1%, P=0.037), and KMT2D mutation patients in EC-T group had a worse prognosis than wild-type patients (5-year DFS were 76.9% and 86.8%, P=0.039). Conclusions: DDR gene variation is common in TNBC, more clinical studies are needed to prove whether DDR variation can serve as effective biomarkers for treatment with platinum.

Genotype-genotype interactions of the OXTR gene polymorphisms are associated with self-reported daytime dysfunction, sleep latency and personal distress

The oxytocin receptors located in the corticotropin-releasing factor neurons of the paraventricular nucleus are stimulated by oxytocin. Oxytocin functions as the regulator of the corticotropin-releasing factor system and in turn promotes sleep quality. The objective of this study was to examine the main and genotype-genotype interactive effects of the oxytocin receptor gene (OXTR) polymorphisms on sleep quality. A total of 324 participants were randomly recruited from a university in Beijing, China. Sleep quality was measured with the Pittsburgh Sleep Quality Index. The OXTR single-nucleotide polymorphisms (rs2254298, rs2268498, rs13316193, rs2268490 and rs2268491) were genotyped. The results showed that gender and age were associated with various empathy traits (all p < 0.001). The Pittsburgh Sleep Quality Index was positively correlated with the Personal Distress subscale of empathy (p < 0.001). Both rs2254298 and rs2268491 interacted with rs13316193 to influence daytime dysfunction and Personal Distress (all p < 0.05), indicating that in individuals with rs13316193 CC/CT genotype, those with rs2254298 AA/AG or rs2268491 TT/TC genotypes displayed higher daytime dysfunction and Personal Distress scores than those with rs2254298 GG or rs2268491 CC genotypes. Conversely, among the individuals with rs2254298 GG or rs2268491 CC genotypes, the rs13316193 C allele carriers had lower daytime dysfunction and Personal Distress scores than rs13316193 TT homozygotes. There was also a significant interaction between rs2268490 and rs2268498 on the sleep latency dimension of the Pittsburgh Sleep Quality Index. Our findings reveal for the first time the genotype-genotype interactions of the OXTR gene on sleep quality, which may open new research avenues for studying psychopathology involving sleep problems.

Transitional Dynamics of Sarcopenia and Associations of Nutritional Indices with State Transitions in Chinese aged ≥ 50

OBJECTIVES

Sarcopenia's temporal profile can be regarded as a dynamic process with distinct states, in which malnutrition plays an important role. This study aimed to address two research gaps: sarcopenia's transitional dynamics and associations of nutritional indices with state transitions in community-dwelling Chinese adults aged 50 and older.

DESIGN

A prospective population-based cohort study.

SETTING

Community-based setting in western China.

PARTICIPANTS

The analytic sample included data from 1910 participants aged ≥ 50 in the West China Health and Aging Trend study between 2018-2022.

MEASUREMENTS

We defined three states: the initial normal state (normal muscle strength, physical performance and muscle mass), the worst sarcopenia state (low muscle mass plus low muscle strength and/or low physical performance) and the intermediate subclinical state (the other scenarios). The relevant measurement methods and cut-off points were based on the 2019 AWGS consensus. Using a continuous-time multistate Markov model, we calculated probabilities of transitions between different states over 1, 2 and 4 years; we also examined associations between nutritional indices and transitions, including body mass index (BMI), calf circumference (CC), mid-arm circumference (MAC), triceps skinfold thickness (TST), albumin (ALB), geriatric nutrition risk index (GNRI), vitamin D (VitD) and prealbumin (PA).

RESULTS

For individuals in the normal state, their probabilities of remaining stable versus progressing to a subclinical state were 53.4% versus 42.1% at 2 years, and 40.6% versus 49.0% at 4 years. In the subclinical population, their 2- and 4-year chances were 60.2% and 51.2% for maintaining this state, 11.8% and 16.2% for developing sarcopenia, 28.0% and 32.6% for reverting to normal. For sarcopenic individuals, the likelihood of staying stable versus retrogressing to the subclinical state were 67.0% versus 26.3% at 2 years, and 48.3% versus 36.3% at 4 years. Increased BMI, CC, MAC, TST, ALB, GNRI and PA correlated with reversion from the subclinical state, among which increased TST, ALB and PA were also paralleled with reversion from sarcopenia, while decreased BMI, CC, MAC, TST and GNRI were associated with progression to sarcopenia. VitD was not significantly associated with any transitions.

CONCLUSION

This study reveals how sarcopenia changes over time in a Chinese population. It also highlights the usefulness of simple and cost-effective nutritional status indices for indicating state transitions, which can help identify individuals at risk of sarcopenia and guide targeted interventions within the optimal time window.

Metagenomes of rectal swabs in larger, advanced stage cervical cancers have enhanced mucus degrading functionalities and distinct taxonomic structure

Background

Gut microbiome community composition differs between cervical cancer (CC) patients and healthy controls, and increased gut diversity is associated with improved outcomes after treatment. We proposed that functions of specific microbial species adjoining the mucus layer may directly impact the biology of CC.

Method

Metagenomes of rectal swabs in 41 CC patients were examined by whole-genome shotgun sequencing to link taxonomic structures, molecular functions, and metabolic pathway to patient’s clinical characteristics.

Results

Significant association of molecular functions encoded by the metagenomes was found with initial tumor size and stage. Profiling of the molecular function abundances and their distributions identified 2 microbial communities co-existing in each metagenome but having distinct metabolism and taxonomic structures. Community A (Clostridia and Proteobacteria predominant) was characterized by high activity of pathways involved in stress response, mucus glycan degradation and utilization of degradation byproducts. This community was prevalent in patients with larger, advanced stage tumors. Conversely, community B (Bacteroidia predominant) was characterized by fast growth, active oxidative phosphorylation, and production of vitamins. This community was prevalent in patients with smaller, early-stage tumors.

Conclusions

In this study, enrichment of mucus degrading microbial communities in rectal metagenomes of CC patients was associated with larger, more advanced stage tumors.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-022-09997-0.

[Susceptibility of drug-resistant staphylococci isolated from different parts of the ocular anterior segment to common ophthalmic antibiotics]

Objectie To investigate the susceptibility of drug-resistant staphylococci isolated from different parts of the anterior segment to levofloxacin, tobramycin, cefazolin sodium, fusidic acid and clindamycin. Methods: Experimental Study. A total of 67 patients with anterior segment infection (33 cases of conjunctivitis, 6 cases of bacterial keratitis, 7 cases of blepharitis, 9 cases of neonatal dacryocystitis, 9 cases of neonatal dacryocystitis, 1 case of adult dacryocystitis and 11 cases of other infectious eye diseases) were collected from the conjunctival sac, cornea, eyelid margin and lacrimal sac. Minimum inhibitory concentration (MIC) determination of methicillin-resistant Staphylococcus (MRS) strains and β-lactamase-producing (β-Lac) strains by a micro-liquid-based method, according to the M100 standard of the American Institute for Clinical and Laboratory Standardization Susceptibility and resistance determinations were made. Data were statistically analyzed using Chi-square or Fisher's exact test. Results: Thirty-five MRS, 30 β-Lac and 2 β-Lac MRS isolates were identified from 67 multidrug-resistant Staphylococcus . There were 3, 9, 4, and 19 MRS isolates isolated from the lacrimal sac, cornea, eyelid margin and conjunctival sac, accounting for 3/4, 9/12, 4/8, 19/43 (44.2%) of the isolated sites respectively. There were 1, 3, 3, and 23 β-Lac isolates, accounting for 1/4, 3/12, 3/8 and 23/43 (53.5%) of the isolated sites, respectively. The highest proportion of β-Lac isolates isolated from patients with a diagnosis of conjunctivitis was 17 (25.3%) from the conjunctival sac. Among the MRS strains isolated from the cornea and lacrimal sac, 5 (7.5%) and 3 (4.5%) were from patients diagnosed with bacterial keratitis and neonatal tear, respectively. The number of MRS strains and β-Lac isolates isolated from patients with a diagnosis of blepharitis were both 3 (4.5%) from the lid margin.Among the strains isolated from the eyelid margin and the conjunctival sac, drug-resistant Staphylococcus epidermidis was the main strain, the drug-resistant Staphylococcus aureus was the major isolates in lacrimal sac and cornea. Among the 35 MRS isoaltes, 25, 24, 12, 12, and 11 were sensitive to cefazolin sodium, fusidic acid, levofloxacin, clindamycin and tobramycin, and the sensitivity rates were 71.4%, 68.6%, 34.3%, 34.3% and 31.4%, the difference was statistically significant (χ²=22.756, P<0.001), The sensitivity rates of levofloxacin, tobramycin, cefazolin sodium, fusidic acid and clindamycin against MRS isolates from the anterior segment were both statistically significant differences (χ²=18.493, 11.594, 8.906, 9.841, 16.059; all P<0.05). The susceptibility rates of MRS isolates against five antibiotics was statistically significant differences (χ²=33.080, P<0.001). Among the 30 β-Lac isolates, 27, 22, 19, 16, and 8 were sensitive to cefazolin sodium, fusidic acid, levofloxacin, tobramycin and clindamycin, and the sensitivity rates were 90.0 % , 73.3%, 63.3%, 53.3% and 26.7%, the difference was statistically significant (χ²=28.280, P<0.001). The sensitivity rates of five antibiotics against β-Lac isolates from the anterior segment were both statistically significant differences (χ²=50.971, 24.543, 48.147, 44.899, 18.676; all P<0.001). The susceptibility rates of β-Lac isolates against five antibiotics was statistically significant differences (χ²=23.383, P<0.001). The sensitivity of cefazolin sodium and fusidic acid against β-Lac isolates were higher than MRS isolates. Conclusions: Cefazolin sodium and fusidic acid may be the best choice for the treatment of drug-resistant Staphylococcus isolated from anterior conjunctival sac, cornea, eyelid margin and lacrimal sac, especially for β-Lac-producing drug-resistant Staphylococcus infection.

Alpha power during task performance predicts individual language comprehension

Alpha power attenuation during cognitive task performing has been suggested to reflect a process of release of inhibition, increase of excitability, and thereby benefit the improvement of performance. Here, we hypothesized that changes in individual alpha power during the execution of a complex language comprehension task may correlate with the individual performance in that task. We tested this using magnetoencephalography (MEG) recorded during comprehension of German sentences of different syntactic complexity. Results showed that neither the frequency nor the power of the spontaneous oscillatory activity at rest were associated with the individual performance. However, during the execution of a sentences processing task, the individual alpha power attenuation did correlate with individual language comprehension performance. Source reconstruction localized these effects in left temporal-parietal brain regions known to be associated with language processing and their right-hemisphere homologues. Our results support the notion that in-task attenuation of individual alpha power is related to the essential mechanisms of the underlying cognitive processes, rather than merely to general phenomena like attention or vigilance.

Ultrafast soliton delivered by miniaturized mode-locker with MoTe2 and core-expanded fiber

Thermally expanded core (TEC) technology is an effective method of high-power fiber lasers. Miniaturization is also a major challenge for high-power lasers. We have proposed a miniaturized mode-locker based on TEC fiber and MoTe₂-polyvinyl alcohol (PVA) film. The proposed mode-locker is consisting of two TEC ferrules, a piece of MoTe₂-PVA film and a ceramic sleeve. The length of the proposed device is about 20 mm, and its outer diameter is about 2 mm. The relations between heating time, heating temperature, and mode field diameter (MFD) have been numerically simulated. The bending loss with respect to MFD has also been analyzed. The simulation results have revealed the trade-off relation between maximal tolerable intensity and low cavity loss, which means that there is an optimal MFD corresponding to optimal heating time and heating temperature. The proposed mode-locker has been applied in an integrated fiber laser, which has emitted ultrafast soliton with 3 times intensity larger than that of conventional sandwiched-type saturable absorber. The proposed mode-locker and fiber laser will find important applications in laser processing, laser ranging, and optical communication.

[Gender differences of genetic etiology in the incidence of major depressive disorder among Han freshmen]

Objective: To analyze the gender differences of genetic etiology in the incidence of major depression disorder among Han freshmen. Methods: A 1-year follow-up survey was carried out among 8 079 Han freshmen from Jining, Rizhao and Weifang without lifetime major depressive disorder (MDD) at baseline (April to October 2018) and 4 828 venous blood samples were also collected. After extracting DNA, Sequenom Mass Array time-of-flight mass spectrometry biochip technology was used to detect the genotypes of 17 single nucleotide polymorphisms (SNPs) MDD-related loci. Logistic regression was used for univariate analysis. Generalized multifactor dimension reduction was used to analyze gene-gene interactions. Composite International Diagnostic Interview (CIDI) 3.0 was used for MDD diagnosis. Results: The 1-year incidence of MDD among Han freshmen was 2.23% (95%CI: 1.91%-2.60%) and the gender difference of incidence between males (1.97%, 95%CI: 1.52%-2.56%) and females (2.39%, 95%CI: 1.98%-2.90%) was not statistically significant (P>0.05). AG genotype of rs768705 (nearby gene: TMEM161B) was a risk factor for MDD (OR=1.98, 95%CI: 1.24-2.83). The TC genotype of rs17727765 (nearby gene: CRYBA1) was only a risk factor for MDD in males (OR=9.61, 95%CI: 2.04-45.30). An 8-loci interaction model (PMFBP1, OLFM4, LHPP, ENOX1, TMEM161B, SPPL3, FBXL4 and L3MBTL2) could predict MDD in women with an accuracy rate of 60.05%. No effective prediction model was found for MDD in men. Conclusions: There might be gender differences in the genetic etiology of MDD. Further researches on the genetic causes of MDD in men should be explored.

[Clinical value of routine contrast esophagram in the diagnosis of anastomotic leakage for three-incision esophagectomy with cervical anastomosis]

Objective: To examine the clinical value of routine contrast esophagram (RCE) for the diagnosis of anastomotic leakage (AL) after three-incision esophagectomy with cervical anastomosis. Methods: Clinical data of 1 022 patients with esophageal cancer who underwent McKeown three-incision esophagectomy with cervical anastomosis from January 2015 to December 2019 at Department of Minimally Invasive Esophageal Surgery, Tianjin Medical University Cancer Hospital and Institute were analyzed retrospectively. There were 876 males and 146 females, aging(M(IQR)) 48(16) years (range: 36 to 84 years). There were 253 patients (24.8%) with neoadjuvant therapy, and 817 patients (79.9%) with minimally invasive esophagectomy. According to the diagnosis and treatment habits of the attending surgeons, 333 patients were included in the RCE group, and RCE was performed on the 7^th day postoperative, while 689 patients were included in the non-RCE group, and RCE was performed when the patients had suspicious symptoms. Taking clinical symptoms, RCE, CT, endoscopy and other methods as reference to the diagnosis of AL, the sensitivity and specificity were used to analyze and evaluate the efficacy of RCE for the diagnosis of AL. The data were compared by U test or χ² test between groups. Results: The incidence rate of AL after three-incision esophagectomy was 7.34% (75/1 022), including 30 cases in the RCE group and 45 cases in the non-RCE group (9.0%(30/333) vs. 6.5%(45/689), χ²=2.027, P=0.155). The diagnostic time of AL was 9(5) days postoperative (range: 4 to 30 days). Among them, 23 cases showed cervical leakages, 50 cases showed intro-thoracic leakages, and 2 cases both cervical and intro-thoracic leakages. The diagnostic time of patients with intro-thoracic leakages was longer than that of cervical leakages (10(4) days vs. 6(3) days, Z=-2.517, P=0.012). Among the 333 patients in the RCE group, 16 cases of RCE indicated leakages including 11 cases of true positive and 5 cases determined to be false positive, while 317 cases indicated no abnormalities including 19 cases developed leakages. The sensitivity and specificity of RCE to detect AL were 36.7%(11/30) and 98.3%(298/333), respectively. The Youden-index was 0.35, and the diagnostic accuracy was 92.8%(309/333). The positive and negative predictive value were 11/16 and 94.0%(298/317), respectively. Conclusions: Routine contrast esophagram after three-incision esophagectomy with cervical anastomosis has low sensitivity and high specificity in the diagnosis of AL. The diagnostic time of AL is the 9^th day after surgery. It is necessary to prolong the observation time clinically, and combine RCE with CT, endoscopy and other inspection methods for diagnosis.

Expansion of Candidate HPV-Specific T Cells in the Tumor Microenvironment during Chemoradiotherapy Is Prognostic in HPV16+ Cancers

Human papillomavirus (HPV) infection causes 600,000 new cancers worldwide each year. HPV-related cancers express the oncogenic proteins E6 and E7, which could serve as tumor-specific antigens. It is not known whether immunity to E6 and E7 evolves during chemoradiotherapy or affects survival. Using T cells from 2 HPV16⁺ patients, we conducted functional T-cell assays to identify candidate HPV-specific T cells and common T-cell receptor motifs, which we then analyzed across 86 patients with HPV-related cancers. The HPV-specific clones and E7-related T-cell receptor motifs expanded in the tumor microenvironment over the course of treatment, whereas non-HPV-specific T cells did not. In HPV16⁺ patients, improved recurrence-free survival was associated with HPV-responsive T-cell expansion during chemoradiotherapy.

[The prospects of DNA damage repair variants guiding platinum compounds in the treatment of triple negative breast cancer]

Triple negative breast cancer (TNBC) is prone to recurrence and metastasis, which is the subtype of poorest prognosis. Chemotherapy is the main treatment, although there is lack of effective adjuvant chemotherapy regimens. The unsatisfactory efficacy of chemotherapy has been a bottleneck in improving the outcome of TNBC. Platinum compounds act directly on DNA to kill tumor cells, and they have a stronger killing effect on tumor cells carrying DNA damage repair (DDR) defects, which is an important entry point to improve the efficacy of TNBC. Biomarkers for predicting the efficacy of platinum drugs in TNBC treatment have always been a hot topic. The DDR pathway contains a large number of related genes, and recent studies have shown that deficiencies in the DDR pathway may be associated with the efficacy of platinum drugs, which is expected to be a biomarker for predicting the efficacy of platinum drugs in breast cancer treatment.

[Evaluation of the efficacy and safety of combination of gemcitabine and nedaplatin for patients with HER-2 negative metastatic breast cancer]

Objective: To assess the therapeutic efficacy and safety of the gemcitabine combined with nedaplatin (GN) chemotherapy for metastatic human epidermal growth factor receptor-2 (HER-2) negative breast cancer patients. Methods: Forty-five patients with HER-2 negative recurrent metastatic breast cancer who had received prior adjuvant or neoadjuvant therapy with anthracycline and/or taxanes were enrolled. All the patients received GN regime from January 2014 to February 2019. The therapeutic efficacy was evaluated according to response evaluation criteria in solid tumors (RECIST) 1.1. The adverse response was evaluated and monitored according to common terminology criteria for adverse events (CTCAE). The progression-free survival (PFS) and overall survival (OS) and prognostic factors were also analyzed. Results: All of the 45 patients received 4 course GN, 1 of them achieved complete response, 21 achieved partial response. The objective response rate was 48.9 (95% CI: 33.7%-64.1%). Grade 3-4 hematological toxicities include leukopenia occurred in 10 (22.2%) of patients, neutropenia in 13 (28.9%) patients, and thrombocytopenia in 8 (17.6%) patients. The grade 3-4 hematological toxicities mainly manifested as nausea and vomiting, and the incidence was 4.4% (2/45). Among the 45 patients, 34 died, the median PFS was 5.1 (95% CI: 3.9-6.1) months and the median OS was 17.6 (95% CI: 13.1-20.9) months. Conclusion: The combination of gemcitabine and nedaplatin is an effective and tolerable treatment for metastatic breast cancer patients previously treated with anthracyclines and/or taxanes.

LncRNA RPPH1 predicts poor prognosis and regulates cell proliferation and migration by repressing P21 expression in gastric cancer

OBJECTIVE

The purpose of this study was to explore the expression and biological functions of long non-coding ribonucleic acid (lncRNA) ribonuclease P RNA component H1 (RPPH1) in gastric cancer (GC), and to analyze the correlations of lncRNA expression with the clinical features and prognosis of GC patients.

PATIENTS AND METHODS

The relative expression of RPPH1 in tissue specimens from 60 GC patients was measured via quantitative Reverse Transcription-Polymerase Chain Reaction (qRT-PCR), and the correlations of RPPH1 expression with tumor-node-metastasis (TNM) stage, lymph node metastasis, etc. in GC patients were analyzed. Then, qRT-PCR was performed to detect the relative expression level of RPPH1 in GC cells. Moreover, colony formation assay, 5-Ethynyl-2'-deoxyuridine (EdU) staining, wound-healing assay, and transwell assay were employed to investigate the influence of RPPH1 on GC cell functions. After interfering in the expression of RPPH1, the changes in p21 (CDKN1A, cyclin dependent kinase inhibitor 1A) expression were determined through qRT-PCR and Western blotting.

RESULTS

It was shown in qRT-PCR assay results that the expression of RPPH1 was upregulated in 60 cases of GC tissues. Statistical analysis revealed that RPPH1 expression was positively correlated with the TNM stage, lymph node metastasis, and infiltration depth in GC patients. Besides, highly expressed lncRNA RPPH1 suggested poor prognosis of GC patients. Based on the results of qRT-PCR assay, the expression of RPPH1 in GC cells was upregulated. After interfering in RPPH1 expression, both colony formation assay and EdU staining indicated that the proliferative capacity of GC cells was repressed. Furthermore, it was manifested in the results of wound-healing and transwell assays that the migratory and invasive abilities of GC cells were weakened. Finally, the qRT-PCR and Western blotting assay results demonstrated that p21 expression was upregulated after interfering in the expression of RPPH1 in GC cells.

CONCLUSIONS

The expression of lncRNA RPPH1 is upregulated in GC, suggesting that the prognosis of the patients is poor. Highly expressed RPPH1 promotes the proliferation and metastasis of GC cells by regulating p21 expression.

Diversity and composition of gut microbiome of cervical cancer patients: Do results of 16S rRNA sequencing and whole genome sequencing approaches align?

BACKGROUND

Next generation sequencing has progressed rapidly, characterizing microbial communities beyond culture-based or biochemical techniques. 16S ribosomal RNA gene sequencing (16S) produces reliable taxonomic classifications and relative abundances, while shotgun metagenome sequencing (WMS) allows higher taxonomic and functional resolution at greater cost. The purpose of this study was to determine if 16S and WMS provide congruent information for our patient population from paired fecal microbiome samples.

RESULTS

Comparative indices were highly congruent between 16S and WMS. The most abundant genera for 16S and WMS data did not overlap. Overlap was observed at the Phylum level, as expected. However, relative abundances correlated poorly between the two methodologies (all P-value>0.05). Hierarchical clustering of both sequencing analyses identified overlapping enterotypes. Both approaches were in agreement with regard to demographic variables.

CONCLUSION

Diversity, evenness and richness are comparable when using 16S and WMS techniques, however relative abundances of individual genera are not. Clinical associations with diversity and evenness metrics were similarly identified with WMS or 16S.

Cohort Profile: West China Health and Aging Trend (WCHAT)

OBJECTIVES

The West China Health and Aging Trends study (WCHAT) is intended to focus on the research that will guide efforts to reduce disability, maximize health and independent functioning, and enhance quality of life at older ages in different ethnicities. And provide the basis for understanding trends and dynamics in late-life functioning, how these differ in various ethnic subgroups, and the economic or social consequences of aging and disability in western China.

PARTICIPANTS

The cohort enrolled 7536 participants and 7439 participants aged 50 years and older in the baseline in 2018 and every year would be followed up. Finding to date: The data in WCHAT were prospectively collected from Yunnan, Guizhou, Sichuan and Xinjiang by 7 medical institutions. A number of age-related outcome measures were collected though corresponding geriatric assessments. Blood testing, saliva, urine and feces testing are available for all cohort participants. Future plans: The data in WCHAT can be used for various types of epidemiological research, particularly for examining how the culture specific life styles and diet influences geriatrics related outcomes. We are initially planning cohort studies and established a sample biobank in relation to the risk and prognosis of frailty, sarcopenia and other geriatric syndromes. Strengths and limitations of this study: It is a first multi-ethnic cohort study in West China that aimed to investigate the influence of culture specific life styles, diet and living environment on the prevalence of geriatric syndromes like frailty, sarcopenia and so on. This is a prospective multi-center observational study, which will be conducted in various ethnic groups gathering places. This study collected information that related to fatigue, falls, and cognition were obtained through self-reports, which might have recall bias and grouping errors. This study has problems such as the interviewees' refusal to visit, death, going out, and large population mobility may lead to high loss of visit rates. This study collected information from a comparatively healthier elderly population in which external validity was limited.

The Relationship between Sarcopenia and Vitamin D Levels in Adults of Different Ethnicities: Findings from the West China Health and Aging Trend Study

OBJECTIVES

Sarcopenia is a condition associated with progressive loss of skeletal muscle mass and function resulting in substantial negative health outcomes and disability in older adults. It is thus important that sarcopenia-related risk factors be explored. The present study was based upon the Asian Working Group on Sarcopenia 2019 (AWGS2019) criteria to assess whether vitamin D levels are a risk factor associated with sarcopenia in various ethnic groups in western China.

DESIGN

Cross-sectional study.

SETTING

Communities in Yunnan, Guizhou, Sichuan, and Xinjiang provinces.

PARTICIPANTS

We included 4236 individuals that were 50 years of age or older from the West China Health and Aging Trend (WCHAT) study.

MEASUREMENTS

An InBody 770 instrument was used for bioimpedance-based analyses of muscle mass, while a digital grip strength dynamometer was used for handgrip strength-based measurements of muscle strength. Physical performance was assessed based upon gait speed over 4 m. Other secondary variables were additionally analyzed as potentially relevant risk factors.

RESULTS

Sarcopenia affected an estimated 22.45% of studied individuals who were 50 years of age or older, with respective prevalence rates in the < 60, 60-64, 65-79, and ≥80 age groups of 11.78%,19.44%, 32.65%, and 67.97%. Rates in males and females were 26.66% and 20.05%, respectively. In males, a significant difference in vitamin D levels was detected when comparing individuals with and without sarcopenia, although no such relationship was detected in females. Following adjustment for confounding variables, binary logistic regression analyses revealed that inadequate vitamin D was able to independently predict sarcopenia risk only in males (OR=1.875,95%CI: 1.109-3.169, P=0.019).

CONCLUSIONS

Among middle-aged and older adults of multiple ethnicities in western China, we found that inadequate vitamin D was an independent predictor of sarcopenia risk specifically in males.

Comorbid Depressive Symptoms, Visual Impairment, and Sarcopenia among Middle-Aged and Older Women: Findings from the West China Health and Aging Trend study

Previous reports have described close relationships between sarcopenia and either visual impairment or depression, but there have been few analyses investigating the association between sarcopenia and the coexistence of both visual impairment and depression. Herein, we sought to explore the associations between sarcopenia and comorbid depressive symptoms and visual impairment among older females. A cross-sectional analysis of females between the ages of 50 and 95 (n = 2454) from the West China Health and Aging Trend (WCHAT) study was conducted. Patient muscle mass was assessed via a bioimpedance-based approach using an InBody 770 device, while muscle strength was estimated based on handgrip strength as quantified with a digital grip strength dynamometer. Depressive systems were evaluated with the 15-item Geriatric Depression Scale (GDS-15), and a questionnaire was employed to evaluate patient visual functionality. Associations between sarcopenia and comorbid depressive status and visual impairment were explored through logistic regression analyses. Comorbid depressive symptoms and visual impairment were observed in 6.2% of the women included in this study, while 18.9% suffered from sarcopenia. Following adjustment for covariates, relative to normal controls, study subjects with only depression (OR=1.45, 95%CI=1.04-2.02), only visual impairment (OR=1.69, 95%CI=1.27-2.26), or comorbid depression and visual impairment (OR=1.76, 95% CI=1.16-2.67) exhibited a higher risk of sarcopenia. These results suggest that comorbid depression and visual impairment are linked to the prevalence of sarcopenia in older Chinese women. As such, further efforts to screen older women for these two comorbid conditions may thus be necessary.

MiR-4513 mediates the proliferation and apoptosis of oral squamous cell carcinoma cells via targeting CXCL17

OBJECTIVE

Emerging evidence has indicated that microRNAs (miRNAs) play crucial roles in regulating cancer carcinogenesis; however, its role in oral squamous cell carcinoma (OSCC) remains largely unknown. Our work was aimed to investigate the role of miR-4513 in regulating OSCC cells behaviors.

MATERIALS AND METHODS

MiR-4513 expression in OSCC cells was analyzed by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). Cell proliferation, migration, invasion, and apoptosis were analyzed by the cell counting kit-8 (CCK-8) assay, wound-healing assay, transwell invasion assay, and flow cytometry, respectively. The connections of miR-4513 and CXC ligand 17 (CXCL17) were analyzed by luciferase reporter assay and Western blot assay.

RESULTS

MiR-4513 expression was found elevated in the OSCC cell lines. The downregulation of miR-4513 expression inhibits cell proliferation, migration, invasion and, at the same time, promotes apoptosis. Furthermore, we validated CXCL17 as a direct target of miR-4513. Knocking down the expression of CXCL17, inhibited the effects of miR-4513 on OSCC cell behaviors.

CONCLUSIONS

Our results suggested the oncogenic role of miR-4513 in OSCC, and therefore it might be used as a target for the OSCC treatment.

[Comparison study on sensitivity of five ophthalmic antibiotics to common drug-resistant Staphylococci on ocular surface]

Objective: To investigate the in vitro antibacterial sensitivity of levofloxacin, tobramycin, cefazolin sodium, clindamycin and fusidic acid to 67 strains of Staphylococci in ocular surface infection. The purpose of this study is to provide reference for clinical selection of drugs. Methods: Experimental study. Sixth-seven strains of drug-resistant Staphylococci isolated from the Department of Microbiology, Henan Provincial Ophthalmic Hospital during January 2018 and May 2019 were collected. There were 67 strains of Staphylococci including 28 strains of drug-resistant Staphylococcus epidermidi, 17 strains of drug-resistant Staphylococcus aureus, 15 strains of drug-resistant Staphylococcus intermedius and a few other kinds of drug-resistant Staphylococci. The minimum inhibitory concentrations (minimum inhibitory concentration, MIC) of levofloxacin, tobramycin, cefazolin sodium, clindamycin and fusidic acid in 67 strains of drug-resistant Staphylococci were determined by microliquid-based method. The sensitivity was determined according to the American CLSI-M100 standard. The statistical analysis of the data was carried out by using two-dimensional test and Fisher accurate test. Results: Fourteen strains of fusidic acid were sensitive to 17 strains of MRS-Meca-resistant Staphylococcus epidermidis, the difference between fusidic and levofloxacin is statistically significant; 14 strains of cefazolin sodium and 11 strains of fusidic acid were sensitive to 14 strains of β-Lac enzyme-producing Staphylococcus aureus, and there were significant differences between the two drugs and levofloxacin; 6 strains of cefazolin sodium and 5 strains of fusidic acid were sensitive to 10 strains of MRS-Meca-resistant Staphylococcus intermedius, as compared to levofloxacin, there were significant differences between cefazolin sodium and levofloxacin (P=0.011,0.033). Cefazolin sodium was sensitive to 5 strains of MRS-Meca-positive other drug-resistant Staphylococci, which was significantly different from levofloxacin (P=0.048); 54 and 48 strains of cefazolin sodium and fusidic acid were sensitive to 67 strains of drug-resistant Staphylococci, and the sensitive rates were 80.1% and 71.6%, respectively, which were significantly higher than those of levofloxacin, tobramycin and clindamycin. There were significant statistical differences between drug sensitivity (χ²=18.377,9.940；P=0.000,0.003). Conclusions: The sensitivity of cefazolin sodium and fusidic acid to 67 strains of drug-resistant Staphylococci is better than that of levofloxacin, tobramycin and clindamycin, these findings may provide guidance for the clinical treatment of drug-resistant Staphylococci in ocular infection. (Chin J Ophthalmol, 2020, 56: 621-625).

[An investigation of the fertility needs of young patients with breast cancer]

Objective: To investigate the fertility needs and outcome of pregnancy in patients with young breast cancer in China. Methods: A retrospective cross-sectional investigation was conducted on 374 young breast cancer women from Cancer Hospital, Chinese Academy of Medical Sciences. Young patients with breast cancer were defined as patients who got initial diagnosis of breast cancer at age no more than 40 years old. We conducted a questionnaire survey and collected clinical data from medical chart. Logistic regression model was used to analyze the possible factors influencing patients' fertility intention. Results: 308 young women with breast cancer completed questionnaires, and the response rate was 82.4%. 81 patients (26.3%) had fertility needs after diagnosis. Of them, 6 cases took active measures to preserve fertility. 72 patients (23.4%) received fertility counseling during treatment. 7 patients were successfully pregnant, including four cases who delivered normally. Multivariate logistic regression analysis showed that patients under 35 years old (OR=4.81), bachelor degree or above (OR=3.26), receiving breast-conserving surgery (OR=2.15) and childless patients (OR=3.03) were more likely to have fertility needs after diagnosis of breast cancer (all P<0.05). Conclusions: The fertility needs of young breast cancer women in China are gradually increasing. Healthcare providers associated with tumor patients should actively offer corresponding fertility consultation and individualized diagnosis and therapy plans for patients with fertility needs.

Comparison of bone structure and microstructure in the metacarpal heads between patients with psoriatic arthritis and healthy controls: an HR-pQCT study

Human cadaveric study has indicated that the metacarpal head (MCH) is intracapsular in location. We hypothesized that exposure to the intra-articular inflammatory milieu in psoriatic arthritis (PsA) will lead to bone loss in the MCH.

INTRODUCTION

To compare the bone structure and microstructure in the MCH between patients with PsA and healthy controls by high-resolution peripheral quantitative CT (HR-pQCT), and to ascertain factors associated with bone loss in PsA patients.

METHODS

Sixty-two PsA patients without joint destruction and 62 age-, gender-, and body mass index-matched healthy subjects underwent HR-pQCT imaging of the second and third MCH (MCH 2&3). The number and volume of bone erosion and enthesiophytes, as well as volumetric bone mineral density (vBMD) and microstructure at the MCH 2&3, were recorded. Correlation analysis and multivariable linear regression models were used to determine the association of demographic and disease-specific variables with compromised bone structure and microstructure in PsA.

RESULTS

At the MCH 2&3, bone erosion (p = 0.003) and enthesiophyte (p = 0.000) volumes in PsA patients were significantly larger than healthy controls. In PsA patients, older age was associated with a larger erosion and enthesiophyte volume. Concerning the mean vBMD and microstructure at the MCH 2&3, PsA patients had significantly lower mean vBMD (average vBMD - 6.9%, trabecular vBMD - 8.8%, peri-trabecular vBMD - 7.7%, meta-trabecular vBMD - 9.8%), trabecular bone volume fraction (- 8.8%), and trabecular thickness (- 8.1%) compared with control subjects. Multivariable regression analysis revealed that older age and a higher C-reactive protein level were associated with trabecular bone loss.

CONCLUSIONS

PsA patients had a higher burden of bone damages (erosions and enthesiophytes) and trabecular bone loss compared with healthy control at the MCH. Inflammation contributed to the deterioration in trabecular microstructure in these patients.

Diagnosis and Monitoring Value of Diffusion-Weighted Magnetic Resonance Imaging Using Neuroendocrine Analysis During Radiotherapy for Laryngeal Cancer

We used 1.5T magnetic resonance imaging (MRI) to investigate the role of semiquantitative parameters related to dynamic contrast-enhanced (DCE)-MRI and the apparent diffusion coefficient (ADC) of diffusion-weighted imaging (DWI) in predicting and monitoring the efficacy of concurrent radiotherapy and chemotherapy for laryngeal cancer. The data from 58 patients with newly diagnosed laryngeal cancer who had been treated at our hospital from August 2016 to March 2018 were collected. The 58 patients included 56 men and 2 women, with a median age of 57 years. The pathologic examination of the biopsy specimens revealed squamous cell carcinoma. The time signal curve (TIC) of the tumor and related semiquantitative parameters was measured before, during (radiation dose, 50 Gy), and at the end of treatment (monitoring value after treatment). The results revealed that the TIC types and DCE-MRI-related semiquantitative parameters can predict the efficacy of concurrent chemoradiotherapy for laryngeal and hypopharyngeal cancer. Of the semiquantitative parameters, the signal enhancement ratio at 56 seconds had the greatest predictive value. Patients with TIC type I before treatment had a better prognosis than those with TIC type III. The pre-ADC value was not enough to predict the efficacy. The ADC value, DCE-MRI-related semiquantitative parameters, and their change before treatment had a certain effect in monitoring the changes in water molecule diffusion movement and hemodynamic changes after tumor treatment. However, these were not enough to predict the efficacy.

ULK1 polymorphisms confer susceptibility to pulmonary tuberculosis in a Chinese population

OBJECTIVE

The autophagy pathway is a critical process in Mycobacterium tuberculosis infection, and can be regulated by uncoordinated 51-like kinase 1 (ULK1). We investigated the associations between single-nucleotide polymorphisms (SNPs) in ULK1 and risk of tuberculosis (TB) in a Chinese Han population.

DESIGN

We recruited 380 pulmonary tuberculosis (PTB) cases, 242 extra-pulmonary tuberculosis (EPTB) cases and 606 healthy controls from a Chinese Han population and sequenced ULK1. Five SNPs in ULK1 were selected to investigate the correlations between ULK1 polymorphisms and TB susceptibility.

RESULTS

The rs7138581 C allele was associated with a reduced risk of PTB (P = 0.001), whereas the rs9481 A allele was associated with an increased risk (P = 0.025). The rs7138581 CG genotype was significantly associated with a low risk of PTB, with a higher PTB disease severity in clinical parameters. Estimation of haplotype frequencies in ULK1 revealed a protective haplotype CCGAA (P = 0.007) and a potential risk haplotype TGAAA (P = 0.010) for PTB.

CONCLUSION

These results demonstrated that ULK1 polymorphisms have significant associations with susceptibility to PTB.