Yun Fei Xia

Haemoglobin, Neutrophil to Lymphocyte Ratio and Platelet Count Improve Prognosis Prediction of the TNM Staging System in Nasopharyngeal Carcinoma: Development and Validation in 3237 Patients from a Single Institution

AIMSnTo improve prediction efficiency by incorporating complete blood count (CBC) into the TNM system on 5 year disease-specific survival (DSS) for patients with nasopharyngeal carcinoma (NPC).nnnMATERIALS AND METHODSnThe CBC of 3237 patients undergoing radiotherapy was retrospectively evaluated. In total, 2820 patients treated with non-intensity-modulated radiotherapy (IMRT) were randomly divided into development (1895 patients) and validation cohorts (925 patients). The association of potential risk factors with 5 year DSS was tested by Cox proportional hazards analysis and a prognostic index was created by assigning weighted scores proportional to a regression coefficient to each factor. Each cohort was divided into low, intermediate and high prognostic index. The prognostic index was validated in the validation cohort and compared with the TNM system on prediction of 5 year DSS. Validation was repeated in another independent group of 417 patients treated with IMRT.nnnRESULTSnEight independent prognostic factors were identified: gender, age, T or N stages, anaemia or thrombocytosis during radiotherapy, continuous reduction in haemoglobin, high neutrophil-lymphocyte ratio before radiotherapy. Each was assigned a number of points. The area under curve (AUC) of the prognostic index was larger than that of Union Internationale Contre le Cancer/American Joint Cancer Committee TNM system 2009 (0.697 versus 0.619, P < 0.001).nnnCONCLUSIONnA CBC-based prognostic index was developed and had a higher prediction efficiency on 5 year DSS in NPC than the TNM system alone.

Studies on Pentoxifylline and Tocopherol Combination for Radiation-Induced Heart Disease in Rats

PURPOSEnTo investigate whether the application of pentoxifylline (PTX) and tocopherol l (Vit. E) could modify the development of radiation-induced heart disease and downregulate the expression of transforming growth factor (TGF)-beta1mRNA in rats.nnnMETHODS AND MATERIALSnA total of 120 Sprague-Dawley rats were separated into four groups: control group, irradiated group, experimental group 1, and experiment group 2. Supplementation was started 3 days before irradiation; in experimental group 1, injection of PTX (15 mg/kg/d) and Vit. E (5.5 mg/kg/d) continued till the 12th week postirradiation, whereas in experimental group 2 it was continued until the 24th week postirradiation. All rats were administrated a single dose of 20 Gy irradiation to the heart except the control group. Histopathologic evaluation was performed at various time points (Days 1, 2, 4, 8, and 12 and 24th week) up to 24 weeks after irradiation. Changes of levels of TGF-beta1 mRNA expression were also investigated at the same time points using competitive polymerase chain reaction.nnnRESULTSnCompared with the irradiated group, levels of TGF-beta1 mRNA of the rat hearts were relatively low in the two experimental groups on the 12th week postirradiation. In experimental group 1, there was a rebound expression of TGF-beta1 mRNA on the 24th week postirradiation, whereas that of the experimental group 2 remained low (p < 0.05). The proportions of collagen fibers of the two experimental groups were lower than that of irradiated group (p < 0.05). A rebound could be observed in the experimental group 1.nnnCONCLUSIONnPTX and Vit. E downregulated the expression of TGF-beta1 mRNA. The irradiated rat hearts showed a marked pathologic response to the drugs. The withdrawal of drugs in the 12th week postirradiation could cause rebound effects of the development of fibrosis.

Involvement of difference in decrease of hemoglobin level in poor prognosis of stage i and II nasopharyngeal carcinoma: Implication in outcome of radiotherapy

PURPOSEnTo investigate the effect of hemoglobin (Hb) concentration and the difference in its decrease during treatment on outcome of radiotherapy (RT) alone for patients with Stage I and II nasopharyngeal carcinoma.nnnMETHODS AND MATERIALSnA total of 572 patients with Stage I-II nasopharyngeal carcinoma with RT alone between January 2001 and December 2004 were retrospectively analyzed. Patient characteristics, tumor variables, and Hb level, including pre-RT Hb, mid-RT Hb, and dynamic change of Hb between pre- and post- RT and its difference in decrease (▵Hb) were subjected to univariate and multivariable analysis to identify factors that predict disease-specific survival (DSS), local regional recurrence-free survival (LRFS), and metastases-free survival (MFS).nnnRESULTSnThe 5-year DSS was poorer in the Hb continuous decrease group than in the Hb noncontinuous decrease group (84% vs. 89%; pxa0= 0.008). There was poorer 5-year DSS in patients with ▵Hb of >11.5 g/L than in those with ▵Hb of ≤11.5 g/L (82% vs. 89%; pxa0= 0.001), and poorer LRFS (79% vs. 83%; pxa0= 0.035). Univariate and multivariate analysis showed that Hb decrease difference with greater than 11.5 g/L was an independent prognostic factor for DSS and LRFS.nnnCONCLUSIONSnThe difference in decrease of Hb level during the course of radiation treatment appeared as a poor prognostic factor in Stage I and II nasopharyngeal carcinoma patients.