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November 2021
Volume 17 | Issue 5
Page Nos. 1141-1288

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REVIEW ARTICLE  

Expert consensus on thermal ablation therapy of pulmonary subsolid nodules (2021 Edition) Highly accessed article p. 1141
Xin Ye, Weijun Fan, Zhongmin Wang, Junjie Wang, Hui Wang, Jun Wang, Chuntang Wang, Lizhi Niu, Yong Fang, Shanzhi Gu, Hui Tian, Baodong Liu, Lingxiao Liu, Lou Zhong, Yiping Zhuang, Jiachang Chi, Xichao Sun, Nuo Yang, Zhigang Wei, Xiao Li, Xiaoguang Li, Yuliang Li, Chunhai Li, Yan Li, Xia Yang, Wuwei Yang, Po Yang, Zhengqiang Yang, Yueyong Xiao, Xiaoming Song, Kaixian Zhang, Shilin Chen, Weisheng Chen, Zhengyu Lin, Dianjie Lin, Zhiqiang Meng, Xiaojing Zhao, Kaiwen Hu, Chen Liu, Cheng Liu, Chundong Gu, Dong Xu, Yong Huang, Guanghui Huang, Zhongmin Peng, Liang Dong, Lei Jiang, Yue Han, Qingshi Zeng, Yong Jin, Guangyan Lei, Bo Zhai, Hailiang Li, Jie Pan
DOI:10.4103/jcrt.jcrt_1485_21  PMID:34850761
The Expert Consensus reviews current literatures and provides clinical practice guidelines for thermal ablation of pulmonary subsolid nodules or ground-glass nodule (GGN). The main contents include the following: (1) clinical evaluation of GGN; (2) procedures, indications, contraindications, outcomes evaluation, and related complications of thermal ablation for GGN; and (3) future development directions.
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ORIGINAL ARTICLES Top

Effects of CT images at different reconstruction energies on radiotherapy planning of patients diagnosed with nonsmall cell lung cancer p. 1157
Tian Xiufang, Liu Kun, Wang Jing, Li Cuihua, Zhang Jiandong, Yong Hou,
DOI:10.4103/jcrt.jcrt_1030_21  PMID:34850762
Objective and Aims: We conducted this study to explore the influence of spectral computer tomography (CT) images at different reconstruction energies on the radiotherapy plan of patients with nonsmall-cell lung cancer (NSCLC). Subject and Methods: Here, 38 NSCLC patients were selected to undergo energy spectral scanning. All energy spectral images obtained were then transferred to the Discover™ CT postprocessing workstation to generate 40k eV, 60 keV, 80keV, 100keV, 120keV, and different 140keV single-energy images. Subsequently, the images were imported to the Eclipse planning system, after which an oncologist contoured the target area and organs at risk (OARs) on these single-energy images described above. Furthermore, a physicist then designed radiotherapy plans to conduct statistical analysis on the tissue CT value and target volume of each single-energy image, to compare the dosimetry of different plans about the OARs and the target area. Results: The CT values of gross tumor volumes (GTV), heart, lung, and spinal cord samples subjected to different energy CT images were statistically different (P < 0.05). Among them, the CT value of each tissue obtained in the 40 keV group was the largest and decreased with the increase in energy. As shown, no statistically significant differences were observed in the homogeneity index and conformity index, including the maximum, minimum, and average doses of GTV delineated on the CT images of different energies (P > 0.05), as well as the OARs. Conclusions: When CT images of different energies obtained from the energy spectral CT scans were used in the design of radiotherapy planning, no significant differences were observed in the target area outlines and in the doses caused by energy factors. However, the differences in tissue CT values had statistical significance.
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Dosimetry study of nasopharyngeal carcinoma based on Halcyon accelerator fixed-field intensity-modulated radiation therapy p. 1165
Kuo Li, Chengqiang Li, Ting Zhu, Jinhu Chen, Wentao Cao, Yong Yin, Changsheng Ma
DOI:10.4103/jcrt.jcrt_992_21  PMID:34850763
Objective: Halcyon accelerator applies the flattening filter (FF)-free mode instead of the lead gate and FF treatment mode for traditional C-type accelerators. We aimed at comparing and analyzing the quality and delivery of nasopharyngeal carcinoma (NPC) plans between Halcyon and VitalBeam (VB) accelerators in fixed-field intensity-modulated radiation therapy (IMRT). Methods: The IMRT plans for thirty patients with NPC who had received radiotherapy were optimized using the VB (Plan VB) and Halcyon (Plan H) accelerators. Quality assurance verification was then conducted. The dose coverage of the planning target volume (PTV) and organs at risk (OARs), monitor units (MUs), and delivery time were analyzed for each plan. Results: All PTV and OAR indexes of Plan H and Plan VB met the clinical requirements. In the exposure dose of bilateral optic nerves between Plan H and Plan VB, no difference was found. The maximum dose of the lens, brainstem, spinal cord were 1.13 Gy, 1.36 Gy, 1.35 Gy, 2.82 Gy lower than the plan using VB , and the mean dose of the parotid glands were 3.82 Gy, 5.56 Gy lower than the plan using VB respectively, and an insignificant difference was found in the brainstem (P > 0.05). The MU for Plan H (22.92 ± 1.58 Gy) was higher than that for Plan VB (19.69 ± 4.52 Gy), and the difference was significant (P < 0.05). Conclusions: The treatment plans designed by Halcyon can meet clinical requirements with better protection for OARs and show advantages over VB in the dosimetry of NPC IMRT plans.
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Adjuvant therapy fails to show survival benefit for patients with spindle cell carcinoma: Evidence from the surveillance, epidemiology, and end results database p. 1172
Ting Li, Qi Xie, Junwei Li, Zhen Li, Junjuan Xiao, Mingguo Liu, Jun Wang, Yan Li, Fang Tang, Jing Liang
DOI:10.4103/jcrt.JCRT_1701_20  PMID:34850764
Background: Spindle cell carcinoma (SpCC) is a rare tumor type with poor prognosis, and standard treatment modalities are not available yet. However, large-scale studies on this topic are sparse. In this study, data from the surveillance, epidemiology, and end results (SEER) database were used to determine cancer-specific survival (CSS) rates of SpCC and to investigate the impact of different therapeutic strategies including surgery with or without chemotherapy, radiotherapy, or chemoradiotherapy on patient outcome. Methods: A total of 665 cases of SpCC, diagnosed from 1996 to 2015, were extracted from the SEER database. Kaplan–Meier survival curves and log-rank tests were used to assess CSS rates and differences on survival curves. Multiple COX-proportional hazards models were used to analyze the association between various treatments and prognosis of SpCC patients classified by organs or systems. Results: Different treatments for SpCC in different organ or system were associated with prognosis of SpCC patients. Surgery alone exhibits survival benefit, whereas adjuvant therapy fails to show survival benefit for patients with SpCC. Conclusions: The prognosis of SpCC patients varied significantly with different clinical treatments. Adjuvant radiotherapy or chemotherapy did not show survival benefit, even increasing the risk of mortality for SpCC patients.
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The value of contrast-enhanced ultrasound and magnetic resonance imaging in the diagnosis of bladder cancer p. 1179
Cheng Li, Zhuoran Gu, Peiqian Ni, Wentao Zhang, Fuhan Yang, Wei Li, Xudong Yao, Yifan Chen
DOI:10.4103/jcrt.jcrt_1056_21  PMID:34850765
Objective: Imaging examination, tumor marker detection, bladder biopsy, and other methods are the common methods for the diagnosis of bladder cancer (BC). This study was aimed to assess the value of contrast-enhanced ultrasound (CEUS) and magnetic resonance imaging (MRI) in the diagnosis of BC. Materials and Methods: Fifty-nine patients with BC were recruited in our hospital from September 2012 to December 2015, who had CEUS and magnetic resonance diffusion-weighted imaging (MRI + DWI). All patients underwent surgical treatment and definite pathological stage. The series and parallel combined diagnosis methods were applied to calculate the diagnostic sensitivity, specificity, and accuracy through using quantitative apparent diffusion coefficient (ADC) and receiver operating characteristic curve. Results: The accuracies of CEUS and MRI + DWI examination for T staging of BC were 74.6% and 76.3%, respectively. Compared with the single diagnostic methods, the two combined diagnosis accuracy was 91.5%, which was significantly improved in diagnosis accuracy (P < 0.05). The diagnostic accuracies of CEUS, MRI + DWI, and ADC for muscle invasion of BC were 81.4%, 83.1%, and 84.7%, respectively. The diagnostic accuracy of CEUS parallel combined with MRI + DWI (91.5%) was obviously enhanced, compared with that with the single diagnostic method. Conclusion: The accuracy of CEUS and MRI + DWI combined diagnosis was higher than that with the single diagnostic method. CEUS and MRI + DWI combined diagnosis was a feasible and effective method for the clinical diagnosis of BC.
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Risk of pneumothorax caused by computerized tomography-guided percutaneous core needle biopsy of the lung in elderly and young patients p. 1186
Wei Zhou, Xuejuan Yu, Yang Song, Fengxia Yang, Chunhai Li, Bo Liu, Haipeng Jia, Dexiang Wang
DOI:10.4103/jcrt.jcrt_1058_21  PMID:34850766
Context: The incidences and risk factors caused by computed tomography (CT)-guided percutaneous computed tomography-guided needle biopsies (PCNBs) in elderly and young patients were not very clear. Aims: This study explored the different incidences of pneumothorax caused by PCNBs and related risk factors in elderly and young patients. Settings and Design: The medical records of 1100 patients who underwent CT-guided PCNBs in a hospital from January 2018 to December 2019 were retrospectively reviewed. Subjects and Methods: Data relating to the patients, lesions, techniques, and diagnoses were collected according to the ethical standards of the institutional research committee (registration number: KYLL-202008-145). Statistical Analysis Used: The variables were significant by univariate analysis and further analyzed by multivariate logistic regression analysis. Results: In the 1100 patients with PCNBs, the incidence of pneumothorax in groups ≥65 years old and <65 years old was 15.2% and 12.9%, respectively. There was no significant difference in the incidence of pneumothorax between the young and elderly patients. In elderly and young patients, emphysema along the needle path and dwell time was independent predictors. However, in young patients, lesion-abutting pleura was an independent risk factor for pneumothorax, but not in elderly patients. Conclusions: The risk of pneumothorax caused by CT-guided percutaneous core needle biopsy of the lung does not increase in elderly patients. Emphysema along the needle path and dwell time is independent predictors of pneumothorax in elderly and young patients.
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Human epidermal growth factor receptor 2 inhibits activating transcription factor 7 to promote breast cancer cell migration by activating histone lysine demethylase 1 p. 1192
Juli Lin, Hehui Mao, Zhuannan Ji, Weijie Lin, Tao Wang
DOI:10.4103/jcrt.jcrt_649_21  PMID:34850767
Background: Receptor tyrosine-protein kinase erbB-2 (human epidermal growth factor receptor 2 [HER2])-based therapies can improve the prognosis of HER2-positive breast cancer (BRCA) patients; however, HER2-positive patients with distal metastasis do not gain significant clinical benefit from molecular targeted therapy. Materials and Methods: A database analysis, immunohistochemistry, and quantitative real-time polymerase chain reaction were used to evaluate the expression of activating transcription factor 7 (ATF7) and its clinical value. A transwell chamber assay was used to assess migration and cell signaling was assessed by immunoblotting. Results: ATF7 was expressed at a low level in HER2-enriched BRCA specimens compared with normal or HER2-negative specimens, which was corroborated in HER2-positive tissue chips and cultured cells. ATF7 gradually decreased with increased tumor stage and low ATF7 was associated with poor prognosis in HER2-positive BRCA patients. ATF7-upregulation inhibited, whereas ATF7-knockdown promoted migration, activity of matrix metalloproteinase 9 (MMP9), MMP2, and uridylyl phosphate adenosine and plasminogen activator inhibitor-1 (PAI-1) expression in HER2-positive cells. HER2 overexpression markedly reduced ATF7 expression in MCF-10A mammary epithelial cells, along with decreased E-cadherin, and increased N-cadherin and migration, which were abrogated by exogenous ATF7 transfection. Mechanistically, HER2 upregulation mediated the decline of ATF7 and activated histone lysine demethylase 1 (LSD1), followed by elevation of histone H3K9 dimethylation (H3K9me2) and H3K4me2. However, the enhanced effects on LSD1 and H3K9me2, excluding H3K4me2, were abrogated by exogenous ATF7. ATF7 was negatively associated with KDM1A (encoding LSD1 protein) expression. Conclusions: ATF7 may be a useful diagnostic and prognostic marker for metastatic HER2-positive BRCA. The ATF7/LSD1/H3K9me2 axis may be responsible for metastasis in HER2-positive cells.
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Association between the rs2736100 polymorphisms of telomerase reverse transcriptase gene and digestive cancers: A meta-analysis p. 1202
Hongxia Song, Mei Han, Kun Li, Yingying Zhao, Changqing Xu, Xiaofei Lei
DOI:10.4103/jcrt.jcrt_1102_21  PMID:34850768
Aim of Study: The conclusions on the association between the rs2736100 polymorphisms of telomerase reverse transcriptase (TERT) gene polymorphism and digestive cancers risk are still debated. This meta-analysis was conducted to update the association between the TERT rs2736100 polymorphisms and the risk of digestive cancers. Materials and Methods: The association investigations were identified from PubMed and Cochrane Library, and eligible studies were included and synthesized using the meta-analysis method. Results: Eight case-control studies were included in this meta-analysis for associating TERT rs2736100 gene polymorphism and digestive cancer susceptibility. Pooled odds ratio with 95% confidence interval was calculated using a fixed or random-effects model. Overall, no evidence has shown that the TERT rs2736100 polymorphism was associated with the susceptibility to digestive cancers. Besides, stratified analysis with ethnicity also indicated no significant association between TRET rs2736100 and the risk of digestive cancers under all genetic models in both Asian and Caucasian populations were observed. Conclusion: According to the meta-analysis, TERT rs2736100 polymorphism might be unrelated to digestive cancer susceptibility. Evidence with adequate sample size is still needed.
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Association of miR-155 and MIR155HG polymorphisms with cancer risk: A meta-analysis p. 1209
Zhishan Zou, Hui Lu, Wenliang Zhang, Yiming Li, Yi He, Huancai Lin, Wei Zhao, Dongsheng Yu, Binghui Zeng
DOI:10.4103/jcrt.jcrt_913_21  PMID:34850769
Background: Analysis of emerging data shows that miRNAs, including miR-155, play important roles in tumorigenesis. Several studies have indicated that miR-155 and MIR155HG polymorphisms may be related to cancer risk, but the association was controversial. Therefore, we conducted this first-reported comprehensive meta-analysis of the association of miR-155 and MIR155HG polymorphisms with cancer risk. Materials and Methods: We searched several databases, including PubMed, Embase, and Web of Science, to identify the eligible studies reporting the association of miR-155 and MIR155HG polymorphisms with cancer risk. We calculated the pooled odds ratios (ORs) and 95% confidence intervals (CIs) to analyze the association. Stata software (version 16.0) was used to analyze the data we collected. Results: After being carefully and strictly screened, eight articles reporting on six common single-nucleotide polymorphisms consisting of 6184 cases and 6896 controls were included in this meta-analysis. The six polymorphisms included were rs767649 (T>A), rs928883 (A>G), rs2829803 (G>A), rs1893650 (T>C), rs4143370 (G>C), and rs12482371 (T>C). Our results showed that, in the overall analysis, heterozygotes increased cancer risk, with a marginal P value, compared with wild-type (OR = 1.06, 95% CI = 1.00–1.12, P = 0.062). Subsequent analyses showed that only rs767649 was associated with an increased risk of non-small-cell lung cancer (NSCLC) in an allele model (T vs. A: OR = 1.15, 95% CI = 1.04–1.26, P = 0.007), a homozygote model (TT vs. AA: OR = 1.31, 95% CI = 1.06–1.60, P = 0.011), and a recessive model (TT vs. AT + AA: OR = 1.30, 95% CI = 1.08–1.55, P = 0.005). Conclusion: The present meta-analysis indicates that the rs767649 polymorphism might be a potential factor for NSCLC risk; however, more studies should be conducted to confirm these findings.
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Clinicopathological factors affecting the prognosis of massive hemorrhage after radiotherapy for patients having nasopharyngeal carcinoma p. 1219
Yanqiu Huang, Donghui Yan, Maoxin Wang, Shiyan Chen, Fan Yang
DOI:10.4103/jcrt.jcrt_586_21  PMID:34850770
Aims: The aim of the study is to investigate the clinicopathological factors that determine prognosis of nasopharyngeal hemorrhage after radiotherapy in patients with nasopharyngeal carcinoma (NPC). Patients and Methods: The clinicopathological data of 539 patients with NPC, who received radiotherapy, were analyzed retrospectively. Parameters included gender; age; T-stage; N-stage; pathological type; type of radiotherapy; synchronous chemotherapy; secondary-course radiotherapy; radiation-induced skull base osteonecrosis; diabetes, hypertension, or other systemic diseases; results of nasopharyngeal bacterial culture; and nasopharyngeal tumor recurrence. Univariate and multivariate analyses were performed using the Chi-square test and logistic regression. Afterward, the Kaplan–Meier's method was applied to analyze the survival of patients with nasopharyngeal hemorrhage. Results: Among all patients examined, 64 (11.9%) had nasopharyngeal hemorrhage after radiotherapy. The univariate analysis showed that T-stage (P < 0.01), secondary-course radiotherapy (P < 0.01), radiation-induced skull base osteonecrosis (P < 0.01), nasopharyngeal bacterial culture results (P < 0.01), and nasopharyngeal tumor recurrence (P < 0.01) were associated with nasopharyngeal hemorrhage. Multivariate analysis showed that only radiation-induced skull base osteonecrosis was significantly associated with nasopharyngeal hemorrhage after radiotherapy (odds ratio = 41.83, P = 0.0001). Nevertheless, in patients with internal carotid artery hemorrhage, the survival rate was much lower than that in patients with external carotid artery bleeding. The main cause of death during follow-up was rebleeding. Conclusion: The rate of mortality in patients with nasopharyngeal hemorrhage after radiotherapy was high. The presence of radiation-induced skull base osteonecrosis was a decisive factor in these patients. However, after successful rescue, arterial embolization or stent implantation is proposed to prolong survival.
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Associations of rs1799794 and rs1799796 polymorphisms with risk of breast cancer: A meta-analysis p. 1225
Heng Niu, Jingyu Yang, Xin Chen
DOI:10.4103/0973-1482.331305  PMID:34850771
Background: The aim of this meta-analysis was to investigate the rs1799794 and rs1799796 polymorphisms of X-ray repair cross-complementing group 3 (XRCC3) in relation to breast cancer susceptibility. Materials and Methods: PubMed, Embase, the Cochrane Library, Web of Science, and Scopus were searched for eligible studies published until June 24, 2019. All analyses were carried out using Stata 14.0 software. Subgroup analyses were performed according to cancer types, ethnicity, source of controls, and method. Results: Our meta-analysis included articles reporting 13 studies of SNP rs1799794 and seven articles reporting 10 studies of SNP rs1799796. Overall, significant associations were observed between the XRCC3 rs1799794 polymorphism and breast cancer risk in the dominant model and heterozygote model (GG + AG vs. AA: odds ratio [OR] =1.06, 95% confidence interval [CI]: 1.00–1.11, P = 0.037, I2 = 47%; AG vs. AA: OR = 1.08, 95% CI: 1.02–1.13, P = 0.006, I2 = 42.3%) and between the XRCC3 rs1799796 polymorphism and breast cancer risk in the homozygote model (GG vs. AA: OR = 0.91, 95% CI: 0.84–0.99, P = 0.021, I2 = 33.3%). Conclusions: The results of this meta-analysis suggest that the variant G allele of the XRCC3 rs1799794 polymorphism is a low-penetrant risk factor for developing breast cancer, whereas the variant G allele of the XRCC3 rs1799796 polymorphism has a protective effect against breast cancer development.
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Efficacy and safety of sintilimab-based regimens against advanced gastric and gastroesophageal junction adenocarcinoma p. 1234
Yusheng Wang, Jian Zhao, Hongmei Yu, Jie Wang, Ninggang Zhang, Bangwei Cao
DOI:10.4103/jcrt.jcrt_856_21  PMID:34850772
Aims: Our study assessed the efficacy and safety of sintilimab-based regimens for real-world treatment of advanced gastric and gastroesophageal junction adenocarcinoma (G/GEJAC). Materials and Methods: Cases of advanced nonresectable G/GEJAC treated with sintilimab-based regimens in the Department of Gastroenterology of Shanxi Provincial Cancer Hospital between December 2018 and September 2020 were retrospectively examined. Endpoints included median progression-free survival (mPFS), median overall survival (mOS), disease control rate (DCR), objective response rate (ORR), and adverse events (AEs). Univariate and multivariate analyses were conducted to determine the effect of stratification factors on efficacy. Results: Among the 37 included patients, mPFS and mOS were 4.27 and 7.3 months, respectively. Efficacy was evaluated at least once in 32 of 37 patients. The ORR and DCR were 12.5% and 65.63%, respectively. Among four patients with mismatch repair deficiency/microsatellite instability-high (dMMR/MSI-H) lesions, two achieved partial remission, and two displayed stable disease, resulting in a DCR of 100%. The most observed AEs included leukopenia, neutropenia, thrombocytopenia, nausea, and skin rash. mPFS was 4.90 months in patients who received sintilimab in the first- or second-line setting, versus 3.00 months in other patients. A significant survival difference was found between these groups in univariate and multivariate analyses. Conclusions: The application of sintilimab-based regimens achieved good disease control and tolerability for the real-world treatment of advanced G/GEJAC. The treatment was more effective when administered in the first- or second-line setting. Patients with dMMR/MSI-H lesions may also benefit from sintilimab-based regimens.
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The impact of patient sex on characteristic-adjusted bladder cancer prognosis p. 1241
Chunchun Zhao, Kai Li, Mujia Zhu, Fei Wang, Ke Zhang, Caibin Fan, Jianqing Wang
DOI:10.4103/jcrt.jcrt_875_21  PMID:34850773
Context: Bladder cancer is one of the most common malignancies worldwide. Some studies noted sex differences in the prognosis of bladder cancer, but results are inconsistent. Subjects and Methods: In this study, we assessed whether women with bladder cancer exhibit a worse prognosis, after adjustment for disease stage, age, and body mass index (BMI), using clinical data from The Cancer Genome Atlas. We used a Student's t-test to compare age and BMI in groups with different sexes. Statistical Analysis Used: The Kaplan–Meier method with log-rank test was used to determine clinical prognosis. Results: The BMI (30.15 vs. 26.68, P = 0.0035) and age (67.54 years vs. 66.01 years, P = 0.045) of female patients with muscle-invasive bladder cancer (MIBC) were higher than those of male patients. The overall survival (OS) prognosis of female patients was worse than that of male patients. After grouping by disease characteristics, the disease-free survival (DFS) and OS prognoses of female patients under 60 years of age were worse than those of male patients. In the group with BMI >24, the OS prognosis of female patients was worse than that of male patients, but no difference was found in DFS prognosis. In the group with BMI ≤24, the DFS prognosis of female patients was worse than that of male patients, but no difference was found in OS prognosis. Compared to males, female patients with Stage III disease demonstrated a worse DFS prognosis and poorer OS prognosis, women with stage T3 demonstrated a worse DFS prognosis, and women with stage N0 demonstrated a poorer OS prognosis. No difference was found in prognosis between male and female patients in all other groups. Conclusions: In patients with MIBC, women tended to exhibit a worse prognosis than men. More specifically, we found a correlation between prognosis and sex after grouping patients by BMI.
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Comparing endoscopic thyroidectomy using the breast approach and conventional open thyroidectomy: A retrospective analysis p. 1248
Hanyuan Zhang, Weichen Shi, Jiqing Zhang, Jia Xu, Dongsheng Zhou, Wei Liu, Rongzhan Fu, Hongqiang Chen
DOI:10.4103/jcrt.jcrt_707_21  PMID:34850774
Aims: Endoscopic thyroidectomy (ET) using the breast approach and conventional open thyroidectomy (OT) are effective approaches to treating thyroid tumors. This study evaluates the effectiveness of ET and OT regarding safety, cosmetic effects, and feasibility. Subjects and Methods: Four hundred and fifty-six patients who underwent thyroidectomy in our department from January 2019 to August 2020 were included in this study. Based on the intraoperative rapid pathology, all patients with papillary thyroid carcinoma underwent unilateral thyroid lobectomy and central neck lymph node dissection. Whereas all benign patients underwent unilateral thyroid lobectomy. Differences in various factors such as clinical characteristics, operation time, postoperative drainage volume, parathyroid hormone (PTH) levels, calcium (Ca) levels, total number of central lymph nodes resected, the number of metastatic central lymph nodes resected, hospital duration, hospitalization costs, and cosmetic effects were compared in each group. Results: Baseline characteristics among the four groups were similar, except for patient age and tumor size. Patients in the malignant ET group were younger than those in the malignant OT group with smaller tumors (P < 0.05). There were no significant differences between the OT and ET groups in postoperative Ca levels, PTH levels, the total number of lymph nodes resected, and the number of metastatic central lymph nodes resected. Conclusions: Compared with conventional OT, ET is a feasible, practical, and safe procedure with excellent cosmetic benefits.
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Proteomic analysis of the influence of CO2 pneumoperitoneum in cervical cancer cells p. 1253
Hongtao Lv, Ting Zhou, Fengnian Rong
DOI:10.4103/jcrt.jcrt_638_21  PMID:34850775
Objective: The effect of CO2 pneumoperitoneum (CDP) on the oncology outcomes of patients undergoing laparoscopic radical hysterectomy for cervical cancer remains unclear. In this study, we investigated the effects of CDP on the proliferation of cervical cancer cells and examined the molecular mechanism. Materials and Methods: We established an in vitro CDP model to study the effects of CDP on the proliferation of cervical cancer cells by Cell Counting Kit-8 (CCK-8) assay, xenografted tumor assay. Tandem mass tag-based quantitative proteomics were used to study the proteomic changes in HeLa cells after CDP treatment. Western blot assay was used to detect the expressions of PI3K/Akt signaling pathway proteins. Results: CDP increased cell proliferation after a short period of inhibition in vitro and promoted tumorigenesis in vivo. Proteomic analysis showed that the expression levels of 177 and 309 proteins were changed significantly 24 and 48 h after CDP treatment, respectively. The acidification caused by CO2 inhibited the proliferation of cervical cancer cells by inhibiting the phosphorylation of PI3K and Akt. Conclusions: CDP promoted the proliferation of human cervical cancer cells after a short time of inhibition. The mechanism of which is related to the inhibition of phosphorylation of the PI3K/Akt signaling pathway.
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A novel irradiation stent versus conventional irradiation stent for malignant dysphagia: A prospective randomized controlled trial p. 1261
Guang-Yu Zhu, Jian Lu, Chao Wang, Jin-He Guo
DOI:10.4103/jcrt.jcrt_185_21  PMID:34850776
Aim: To evaluate whether a novel irradiation stent (NIS) could decrease the rate of recurrent dysphagia, compared to the conventional irradiation stent (CIS) in patients with malignant dysphagia. Materials and Methods: We performed an open-label randomized controlled trial of participants with malignant dysphagia. A total of 94 participants were parallelly allocated into the NIS group or the NIS group between April 2019 and April 2020. The primary endpoint was the rate of recurrent dysphagia. The secondary endpoints included technical success, clinical success, overall survival, and adverse events. Results: The technical success rate and the clinical success rate was 100.0% (47/47) in both groups. The median follow-up period was 189 days (range 14–422 days). Recurrent dysphagia was observed in 12.8% (6/47) of patients in the NIS group and 31.9% (15/47) in the CIS group (P = 0.026). Tissue/tumor growth occurred in 4 patients (8.5%) after NIS placement and 12 (25.5%) after CIS placement (P = 0.028). Stent migration occurred in 2 patients (4.3%) after NIS placement and 3 (6.4%) after CIS placement (P = 0.646). No food obstruction was found in both groups. The median overall survival was 177 days (95% confidence interval [CI] 139–214) in the NIS group and 168 days (95% CI 153–183) in the CIS group (P = 0.932). The incidence of severe adverse events was comparable between the two groups (21.3% vs. 17.0%, P = 0.600). Conclusions: In patients with malignant dysphagia, compared with CIS, NIS could decrease the rate of tissue/tumor growth without increase the rate of stent migration and therefore decrease the rate of recurrent dysphagia.
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Computed tomography-guided cryoablation for adrenal metastases secondary to lung cancer p. 1269
Wen-Long Zhang, Dong-Li Ruan, Li-Jun Sun, Tao Wang, Wei Zhang, Ya-Yong Huang
DOI:10.4103/jcrt.JCRT_1520_20  PMID:34850777
Objectives: The objective of the study was to assess the clinical efficacy of computed tomography (CT)-guided cryoablation as a means to treat adrenal metastasis (AM) secondary to lung cancer. Materials and Methods: This study was a single-center retrospective study that analyzed 39 consecutive patients with AM secondary to lung cancer who underwent CT-guided cryoablation in our center. The rates of complete ablation, local recurrence, local recurrence-free survival (RFS), and overall survival (OS) were analyzed. Results: The rates of primary and secondary complete ablation were 94.9% and 100%, respectively, and none of the patients suffered from a hypertensive crisis associated with the treatment. Over the follow-up period, 20.5% of the patients experienced local recurrence, and the median RFS duration was 26 months. The cumulative 1-, 3-, and 5-year local RFS rates in this study were 84.6%, 51.3%, and 5.9%, respectively. Extra-adrenal gland metastases were detected in five patients. Over the course of follow-up, 26 patients died. The mean OS duration was 34 months with cumulative 1-, 3-, and 5-year OS rates of 89.7%, 53.4%, and 8.3%, respectively. Advanced age (P = 0.001), primary adenocarcinoma (P = 0.006), other primary lung cancers (P = 0.038), and primary Stage III lung cancers (P = 0.007) were all found to be independent predictive factors of poor OS in these patients. Conclusion: CT-guided cryoablation can be safely and effectively used to control AM secondary to lung cancer, and patients with AM secondary to lung squamous cell carcinoma may be best suited for this form of treatment.
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Effect of microwave ablation on platelet and coagulation function in patients with BCLC-A hepatocellular carcinoma p. 1275
Wenpeng Zhao, Honglu Li, Wei Li, Jiang Guo, Liang Cai, Youjia Duan, Xiaopu Hou, Zhenying Diao, Xihong Shao, Hongliu Du, Wei Li, Changqing Li
DOI:10.4103/jcrt.JCRT_448_19  PMID:34850778
Aim: To preliminarily evaluate the effect of microwave ablation (MWA) alone on platelet (PLT) and coagulation function in patients with BCLC-A hepatocellular carcinoma (B-A-HCC) using a retrospective method. Materials and Methods: A total of 36 patients with 48 B-A-HCCs were radically treated with MWA alone under the guidance of ultrasound between April and October 2018. PLT coagulation indexes were measured before and after MWA at 1 day, 3 days, 1 week, and 2 weeks, and blood samples (after morning fasting) were collected from cubital veins. Coagulation indexes included prothrombin time (PT), prothrombin activity (PTA), thrombin time (TT), Activated Partial Thromboplastin Time (APTT), international standardized ratio (INR), plasma fibrinogen (FIB), plasma antithrombin III (AT-III), and D dimer (DD). Overall survival (OS), recurrence-free survival (RFS), local tumor progression (LTP), and adverse reactions were also recorded. Results: All patients were radically treated with MWA alone. The median size of the lesion was 2.6 (1.5–7.0) cm3. On the first day after MWA, the level of PLT decreased significantly compared with the values before MWA and gradually returned to preoperative levels one week after MWA. One day after MWA, the levels of PT, INR, and AT-III increased markedly and the level of PTA decreased significantly, all of them gradually returned to baseline after 3 days to a week of time. 1, 3, and 7 days after MWA, the levels of FIB, and DD increased significantly, and the level of TT decreased significantly; all of them gradually returned to baseline at 2 weeks. At 6 months posttreatment, the OS and RFS rates were 100% and 91.7%, the LTP rates was 5.6%, no significant adverse reactions. Conclusion: PLT and coagulation indexes were abnormal in patients with B-A-HCC who were radically treated with MWA alone after treatment; without specific treatment, they all gradually returned to baseline within a week or two.
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Roles of hydroxyacyl-CoA dehydrogenase trifunctional multienzyme complex subunit alpha, a lipid metabolism enzyme, in Wilms tumor patients p. 1281
Xiangyu Wu, Run Feng, Xiaoqing Wang, Feng Guo, Wei Liu
DOI:10.4103/jcrt.jcrt_1388_21  PMID:34850779
Objectives: Wilms tumor is a common pediatric malignant tumor that accounts for approximately 95% of kidney tumors in children. The role of lipid metabolism in tumors has attracted increased attention in recent years. We examined the role of hydroxyacyl-CoA dehydrogenase trifunctional multienzyme complex subunit alpha (HADHA), a lipid metabolism enzyme, in the pathogenesis of Wilms tumor. Materials and Methods: In a previous study, we screened Wilms tumors and adjacent normal tissues for differentially expressed proteins by mass spectrometry and verified the results by western blot analysis. The Oncomine database and quantitative reverse transcription–polymerase chain reaction were used to verify the expression of HADHA at the genetic level. Immunohistochemistry and immunofluorescence were also used to validate the differential expression of the HADHA protein. The relationship between histopathological typing, clinical pathology, and HADHA expression was analyzed in 65 paraffin-embedded specimens from pediatric Wilms tumor patients. Kaplan–Meier survival curves were used to analyze the relationship between the expression of HADHA and patient prognosis. Results: HADHA was expressed at low levels in Wilms tumor tissue compared with the corresponding normal tissue. The expression of HADHA was closely associated with histopathological typing (P = 0.030). The prognostic analysis of 65 children with Wilms tumor showed that high expression of HADHA was closely associated with poor prognosis (P = 0.046). Conclusions: HADHA expression is downregulated in Wilms tumor tissues, but high expression in tumor tissues is associated with clinical stage and the prognosis of children with this tumor.
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CASE REPORT Top

Percutaneous ultrasound-guided radiofrequency ablation for giant desmoid tumors of the intra-abdominal cavity in a patient with Gardner syndrome p. 1286
Liping Wang, Dong Xu, Liyu Chen, Pintong Huang
DOI:10.4103/jcrt.jcrt_316_21  PMID:34850780
Gardner syndrome (GS) is a rare variant of familial adenomatous polyposis, leading to numerous intra- and extracolonic lesions. Extracolonic lesions of GS are most common with desmoid tumors (DTs) in the abdominal wall, intra-abdominal cavity, and mesentery. Surgery remains the primary treatment for DTs; however, the patients are challenged with the high recurrence rate after surgical resection, and wide resection often results in debilitating loss of function. This study presents a case of a 47-year-old female with GS who had undergone total colectomy and ultra-low anastomosis of the ileal anal canal, and she developed giant DTs in the intra-abdominal cavity. The patient underwent ultrasound-guided percutaneous radiofrequency ablation (RFA) for intra-abdominal DTs in September 2014, October 2015, and January 2016. Palliative RFA significantly slowed the progression of the tumor and improved the symptoms of abdominal compression; thus, it is a possible therapeutic option for intra-abdominal unresectable DTs in patients with GS.
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