J. Jin

Unfavorable prognosis of elderly patients with early-stage extranodal nasal-type NK/T-cell lymphoma

BACKGROUNDnExtranodal nasal-type NK (natural killer)/T-cell lymphoma in elderly patients is rare, and its prognosis is unclear. This study aims to investigate the clinical characteristics and prognosis of this lymphoma.nnnPATIENTS AND METHODSnWe analyzed 24 patients (age, >60 years old) with early-stage extranodal nasal-type NK/T-cell lymphoma. Among these patients, 23 received radiotherapy alone (n = 15) or radiotherapy and chemotherapy (n = 8) and 1 received chemotherapy alone.nnnRESULTSnElderly patients with early-stage extranodal nasal-type NK/T-cell lymphoma were characterized by male predominance, good performance, large proportion of localized disease, more comorbidities, low-risk international prognostic index, and unfavorable prognosis. The 5-year cancer-specific survival (CSS), overall survival (OS), and progression-free survival (PFS) rates for all patients were 54.3%, 42.0%, and 40.2%, respectively. The 5-year CSS, OS, and PFS rates were 43.5%, 36.6%, and 34.1% in patients who received radiotherapy alone, and 50%, 50%, and 50% in patients who received radiotherapy and chemotherapy, respectively (P = 0.852 for CSS, P = 0.801 for OS, and P = 0.694 for PFS). Four patients died of treatment-related mortality.nnnCONCLUSIONnElderly patients with early-stage extranodal nasal-type NK/T-cell lymphoma exhibit poor prognosis and need special attention because of high treatment-related mortality.

A retrospective analysis of lung metastasis in 64 patients with alveolar soft part sarcoma

ObjectivesTo analyse the lung metastasis and possible factors influencing lung metastasis in alveolar soft part sarcoma (ASPS) patients.MethodsThe medical records of 64 consecutive ASPS patients were reviewed to analyse their treatments, features of lung metastasis, and possible factors influencing lung metastasis.ResultsThirty-six females and 28 males with a median age of 27xa0years were included. The primary disease sites were the extremities in 51 patients and other locations in 13 patients. The median primary tumour size was 5xa0cm. Wide local excision of the primary tumour was performed on 56 patients (87.5xa0%). Thirteen patients (20.3xa0%) received postoperative adjuvant radiotherapy, and nine patients (14.1xa0%) underwent adjuvant chemotherapy. Twelve patients (18.8xa0%) presented with metastatic lung disease. Twenty-nine patients (45.3xa0%) developed metastatic lung disease during follow-up. Lung metastasis occurred in 64.1xa0% of the patients. Lung metastasis was detected at a median interval of 20xa0months after primary ASPS diagnosis. Being male, >20xa0years of age, having a primary tumour size ≥5xa0cm, and local recurrence were associated with a greater rate of lung metastasis. Median survival after the diagnosis of lung metastasis was 34xa0months. The 5-year survival rates were 64.1 and 95.2xa0% for patients with and without lung metastasis (Pxa0<xa00.001). Thirty-seven patients with metastatic lung disease received anthracycline- and ifosfamide-based chemotherapy. One patient experienced a partial remission.ConclusionsASPS patients have a high prevalence of lung metastasis. Sex, age, primary tumour size, and local recurrence are major factors influencing lung metastasis. Chemotherapy is not efficacious in ASPS patients with lung metastasis.

Apoprotein C-III: A review of its clinical implications.

Apoprotein C-III (apoC-III), originating from the apoA-I/C-III/A-IV gene cluster affected by multiple regulating factors, has been demonstrated to have a validated link with hypertriglyceridemia in humans. Following genome studies establishing the impact of apoC-III on both plasma triglyceride (TG) level and cardiovascular disease (CVD), apoC-III offers us a novel explanation attempting to resolve the long-existing confusion with regard to the atherogenic effect of TG. Notably, apoC-III exerts its atherogenic effect by means of not only intervening in the function and metabolism of various lipid molecules, but also accelerating pro-inflammatory effects between monocytes and endothelial cells. Data have suggested that diabetes, a common endocrine disease, also correlates closely with apoC-III in its apoptosis process of islet βcells. In fact, apoC-III genes, with various mutations among individuals, are also found to have relevance to other diseases, including fatty liver disease. Fortunately, besides present day therapeutic strategies, such as lifestyle changes and lipid-lowering drug treatments, a promising new antisense drug specifically targeting on apoC-III gene expression opens up new avenues. This article mainly summarizes the clinical implication of apoC-III and its future directions of treatment.

The different relations of PCSK9 and Lp(a) to the presence and severity of atherosclerotic lesions in patients with familial hypercholesterolemia

BACKGROUND AND AIMSnThe relation of lipoprotein (a) [Lp(a)] and proprotein convertase substilisin/kexin type 9 (PCSK9) levels to coronary artery disease (CAD) has been well established in the general population, while little is known about the association between Lp(a) or PCSK9 and atherosclerotic lesions of different artery sites in patients with familial hypercholesterolemia (FH).nnnMETHODSnOne hundred and fifty-one patients with verified genotyped heterozygous FH (HeFH) were enrolled. There were available data regarding coronary angiography and carotid ultrasonography in 151 patients and femoral ultrasonography in 55 patients. Coronary and carotid severity was evaluated by Gensini score and Crouse score. PCSK9 and Lp(a) concentrations were determined by ELISA and immunoturbidimetry, respectively. Finally, the correlation of PCSK9 and Lp(a) with the presence and severity of CAD and peripheral artery disease (PAD) was assessed.nnnRESULTSnThe distributions of PCSK9 and Lp(a) were skewed and a close correlation between them in HeFH patients was found. PCSK9 levels were significantly higher in patients with coronary and carotid atherosclerotic lesions compared to their non-atherosclerotic groups, while no difference was found in femoral atherosclerotic lesions groups. Lp(a) levels only differed between patients with or without coronary atherosclerotic lesions. Patients with highest PCSK9 and Lp(a) concentrations had the highest prevalence and severity of atherosclerotic lesions. Multivariate regression analysis showed that PCSK9 was independently associated with CAD and PAD, while Lp(a) was only associated with CAD.nnnCONCLUSIONSnCirculating PCSK9 concentrations were associated with an increased risk of CAD and PAD, while Lp(a) was only a marker for CAD in HeFH patients.

Triglyceride glucose and haemoglobin glycation index for predicting outcomes in diabetes patients with new-onset, stable coronary artery disease: a nested case-control study

Abstract Aim: Previous studies have shown that both triglyceride glucose (TyG) and haemoglobin glycation indexes (HGI) are predictors of cardiovascular risk. However, the prognostic value of TyG index and HGI in patients with type 2 diabetes mellitus (T2DM) and stable coronary artery disease (CAD) is not determined. Methods: We conducted a nested case-control study among 1282 T2DM patients with stable CAD. Patients were followed up for 3846 person-years. A total of 160 patients with events (12.5%) were identified and matched individually on age, gender, previous use of lipid lowering agents and duration of follow-up with 640 controls. Results: In Kaplan–Meier analysis, the upper tertiles of TyG index and HGI had a significant lower event-free survival (pu2009=u2009.002; pu2009=u2009.036, respectively). Of the note, both TyG index and HGI were associated with increased risk of MACCEs after adjusting for confounding risk factors [adjusted HR (95% CI): 1.693 (1.238–2.316); 1.215 (1.046–1.411), respectively]. Moreover, adding TyG index to the Cox model increased the C-statistic to 0.638 (95%CI: 0.595–0.683, pu2009=u2009.002) while the C-statistic was not statistically improved when HGI was included (pu2009=u2009.240). Conclusions: Both TyG index and HGI could predict cardiovascular outcomes in T2DM patients with new-onset, stable CAD while TyG index might be better. Key messages Both TyG and HGI are predictors of cardiovascular risk. The prognostic value of TyG index and HGI in T2DM patients with stable coronary artery disease is not determined. Our study firstly indicates that TyG index might have better prognostic value than HGI in T2DM patients with new-onset, stable CAD.

Four-Dimensional CT-Based Evaluation of Intrafractional and Interfractional Anastomosis Motion During Postoperative Radiation Therapy in Gastric Cancer: A Prospective Study

greater than the CBCT ITV. It is feasible to generate the 3DCT ITV with an isotropic IM of 5 mm for tumors in the middle-lower lobe. Author Disclosure: F. Li: None. J. Li: None. M. Zhifang: None. Y. Zhang: None. J. Xing: None. Intrafractional motion (mean SD) 2.4 2.3 2.1 2.0 5.6 4.0 Interfractional motion (mean SD) 6.1 6.6 3.3 3.0 4.8 4.3 Intrafractional 95th percentile values 6.8 5.5 13.3 Interfractional 95th percentile values 15.4 10.1 10.7 3674

Repeated Endorectal Ultrasonographies Predict the Tumor Response of Preoperative Chemoradiation Therapy in Rectal Cancer

Purpose/Objective(s): Current NCCN guidelines for rectal cancer recommend tumor and nodal staging using endorectal ultrasound (EUS) or pelvic MRI. Studies demonstrate that EUS and MRI have similar accuracy for staging rectal cancers. The relative benefits of each modality for radiation therapy (RT) treatment planning have not yet been defined. The present study aims to compare gross target volumes (GTV)s contoured based on EUS to those contoured based on pelvic MRI. Materials/Methods: EUS, MRI, and treatment planning CTs were reviewed for 6 patients with locally advanced rectal cancer (LARC) treated with neoadjuvant chemotherapy and RT at our institution between 2011 and 2013. A total of 30 rectal GTVs were contoured; two GTVEUS for each patient (contoured independently by two radiation oncologists), two GTVMRI, and a GTVTx taken retrospectively from the original treatment plan. Radiation oncologists were blinded to all other contours. GTVEUS was contoured based upon the colonoscopy and EUS. GTVMRI was contoured based on T2 post gadolinium MRI sequences fused with treatment planning CT. GTVEUS and GTVMRI volume, craniocaudal (CC) length, and number of suspicious lymph nodes (LN) were then compared between staging modality (EUS vsMRI) and were retrospectively compared to GTVTx. Agreement between physician contours was calculated as the percentage of number of overlapping slices out of total number of slices for MRI and EUS-based contours. Paired t-test was used to assess relationships between imaging modality and treatment volume, CC length, and LN number. Results: Mean volume and CC length for GTVEUS, GTVMRI, and GTVTx are presented in Table.