Background The currently utilized International Neuroblastoma Risk Group(INRG)staging system developed in 2009 uses image-defined risk factors as a measure of surgical risk,separating resectable neuroblastoma from tho...Background The currently utilized International Neuroblastoma Risk Group(INRG)staging system developed in 2009 uses image-defined risk factors as a measure of surgical risk,separating resectable neuroblastoma from those best preceded by chemotherapy.The previous International Neuroblastoma Staging System was based primarily on surgical findings.We hypothesized there would be a change to the role of the surgeon in neuroblastoma treatment in the more recent decade.Methods This is a single center 20-year retrospective analysis of 104 patients with International Classification of Diseases-9 and-10 codes for neuroblastoma.Patient demographics,tumor site,cancer treatment modality,survival,biopsy technique,surgical intervention,and pathology staging were collected.Data was analyzed by analysis of variance(ANOVA)and Student’s t test.Results There was a decrease in open surgeries for extra-adrenal neuroblastomas in the later decade(77%,31%,P=0.01).There was a narrowing of the time interval to surgery in the later cohort,likely as a result of uniformity in surgical timing on treatment protocols relying on INRG staging.Conclusions Our findings mirror changes in practice patterns globally.We found an increase in minimally invasive approaches but did not find a difference in the role of the surgeon under the INRG staging system.展开更多
The Revised International Staging System(R-ISS)is a simple and powerful prognostic tool for multiple myeloma(MM).However,heterogeneity in R-ISS stage is still poorly characterised,hampering improvement of treatments.W...The Revised International Staging System(R-ISS)is a simple and powerful prognostic tool for multiple myeloma(MM).However,heterogeneity in R-ISS stage is still poorly characterised,hampering improvement of treatments.We used single-cell RNA-seq to examine novel cellular heterogeneity and regular networks in nine MM patients stratified by R-ISS.Plasma cells were clustered into nine groups(P1–P9)based on gene expression,where P1–P5 were almost enriched in stage III.PDIA6 was significantly upregulated in P3 and LETM1was enriched in P1,and they were validated to be upregulated in the MM cell line and in 22 other patients’myeloma cells.Furthermore,in progression,PDIA6 was newly found and verified to be activated by UQCRB through oxidative phosphorylation,while LETM1 was activated by STAT1 via the C-type lectin receptor-signalling pathway.Finally,a subcluster of monocytes was exclusively found in stage III specifically expressed chemokines modulated by ATF3.A few ligand-receptor pairs(CCL3/CCL5/CCL3L1-CCR1)were obviously active in monocyte-plasma communications in stage III.Herein,this study identified novel molecules,networks and crosstalk pairs in different R-ISS stages of MM,providing significant insight for its prognosis and treatment.展开更多
目的探讨R2-ISS(The Second Revision of the International Staging System)分期在新诊断多发性骨髓瘤(NDMM)患者中的预后价值。方法收集自2012年12月至2022年3月在南京医科大学鼓楼临床医学院血液科就诊的326例以免疫调节药物和(或)...目的探讨R2-ISS(The Second Revision of the International Staging System)分期在新诊断多发性骨髓瘤(NDMM)患者中的预后价值。方法收集自2012年12月至2022年3月在南京医科大学鼓楼临床医学院血液科就诊的326例以免疫调节药物和(或)蛋白酶体抑制剂为一线治疗方案的NDMM患者临床资料,采用Kaplan-Meier法进行生存分析,Log-rank检验比较组间差异,Cox比例风险回归模型进行多因素分析。结果①326例NDMM患者中男性190例,中位年龄63岁,中位随访时间37个月。R2-ISS分期可进行有效的预后分层,特别是R-ISSⅡ期患者,R2-ISSⅠ期、Ⅱ期、Ⅲ期和Ⅳ期患者的中位无进展生存(PFS)期分别为52、29、20和15个月(P<0.001),中位总生存(OS)期分别为91、60、44和36个月(P<0.001)。多因素分析显示ISSⅡ期、ISSⅢ期、del(17p)、t(4;14)、1q^(+)、LDH升高、年龄>65岁是影响OS的独立不良预后因素;ISSⅡ期、ISSⅢ期、del(17p)、t(4;14)、1q^(+)、LDH升高是影响PFS的独立不良预后因素。②R2-ISS分期C-index得分为0.724,优于R-ISS分期的0.678,预测效能更高。③R2-ISSⅢ期和Ⅳ期中含1q^(+)在内的双打击患者中位PFS期分别为20、15个月(P=0.084),中位OS期为35、36个月(P=0.786)。Ⅲ期中含1q^(+)在内的双打击27例、1q^(+)单一异常61例、不含1q^(+)68例,三组的中位PFS期分别为20、18、21个月(P=0.974),中位OS期分别为35、47、56个月(P=0.042)。因此本研究将1q^(+)赋值调整至1,重新分组后R2-ISS不同分期的中位PFS期和OS期差异均有统计学意义(P<0.001)。结论R2-ISS分期预后分层价值优于R-ISS分期,特别是对异质性较强的R-ISSⅡ期人群,调整含1q^(+)在内的双打击赋值后可进一步优化R2-ISS分期。展开更多
In our study, we determined the efficacy of bortezomib-based induction therapy followed by autologous stem cell transplant （ASCT） in newly diagnosed and relapsed/refractory （R/R） multiple myeloma （MM） patients a...In our study, we determined the efficacy of bortezomib-based induction therapy followed by autologous stem cell transplant （ASCT） in newly diagnosed and relapsed/refractory （R/R） multiple myeloma （MM） patients and compared the advantages of early versus late transplant. We used a retrospective analysis to examine 62 patients, including 46 cases of newly diagnosed MM （early transplant group） and 16 cases of relapsed/refractory MM （late transplant group）. All of these patients received bortezomib-based induction therapy followed by ASCT. The efficacy and side effects of the treatment regimen were analyzed. Patients＇ overall survival （OS） and progression-free survival （PFS） times were determined. The ratio of complete remission to near-complete remission （CR/nCR） was 69.5% versus 56.2% （P=0.361）, respectively, for the early transplant group versus the late transplant group, respectively, after receiving bortezomib-based induction therapy; the overall response rates of the two group were 91.3 % and 81.2 %, respectively （P=0.369）. After receiving ASCT, the CR/nCR of the two groups increased to 84.8% and 81.3%, respectively. The median time required for neutrophil engraftment of the early transplant group and the late transplant group was 11 and 14.5 days, respectively （P=0.003）; the median time required for platelet engra^nent was 13 and 21.5 days （P=0.031）, respectively. There were no significant differences in the toxic side effects observed during induction therapy and ASCT between the two groups. The OS of the two groups was not statistically different （P=0.058）. The PFS of the early transplant group and the late transplant group was 41.6 and 26.5 months, respectively （P=0.008）. Multivariate analysis demonstrated that the time of receiving ASCT, the types of M protein, and the International Staging System （ISS） stage were all independent factors that influenced PFS. In conclusion, patients in a suitable condition for ASCT should be recommended to have a展开更多
目的从疾病特征、生存预后等方面,验证及评估子宫颈癌国际妇产科联盟(International Federation of Gynecology and Obstetrics,FIGO)2018年新分期体系对ⅠB期重新分期的合理性。方法参照FIGO 2018年新分期的修订内容,选取2010年1月1日...目的从疾病特征、生存预后等方面,验证及评估子宫颈癌国际妇产科联盟(International Federation of Gynecology and Obstetrics,FIGO)2018年新分期体系对ⅠB期重新分期的合理性。方法参照FIGO 2018年新分期的修订内容,选取2010年1月1日至2014年12月31日于首都医科大学附属北京妇产医院行首选手术治疗的子宫颈癌患者进行重新分期,共采集到427例ⅠB1~ⅠB3期的子宫颈癌患者进行回顾性分析。利用组间比较、多因素分析等统计学方法,对ⅠB期各个亚期患者的临床病例信息包括年龄、肿瘤特征(组织学类型、分化程度、深部间质受侵、淋巴脉管间隙浸润情况)、治疗方式(术后辅助放射治疗,化学药物治疗情况)以及5年生存率进行分析。结果鳞癌、高中分化癌以ⅠB1期患者居多,而腺癌、腺鳞癌及低分化癌多见于ⅠB2、ⅠB3期患者,差异有统计学意义(P均<0.001)。ⅠB2、ⅠB3期患者宫颈深部间质浸润率高于ⅠB1期,差异有统计学意义(P<0.001)。ⅠB2、ⅠB3期淋巴脉管间隙浸润阳性率高于ⅠB1期,差异有统计学意义(P<0.05)。ⅠB2、ⅠB3期患者术后补充放射治疗化学药物疗的比率高于ⅠB1期,差异有统计学意义(P均<0.001)。ⅠB2、ⅠB3期患者术后补充放射治疗,化学药物治疗的比率高于ⅠB1期,差异有统计学意义(P均<0.001)。ⅠB1、ⅠB2、ⅠB3期患者的5年总生存率依次减低,分别为97.9%、93.4%、81.5%,构建生存曲线显示各组曲线分离良好,差异有统计学意义(P<0.001)。结论2018年新分期体系在ⅠB期中增加肿瘤最大径线2 cm这一临界值,重新修订新分期为ⅠB1期(≤2 cm)、ⅠB2期(>2 cm~≤4 cm)和ⅠB3期(>4 cm)能够更精确地对疾病严重程度进行分层和评估预后,具有很好的临床指导意义。展开更多
文摘Background The currently utilized International Neuroblastoma Risk Group(INRG)staging system developed in 2009 uses image-defined risk factors as a measure of surgical risk,separating resectable neuroblastoma from those best preceded by chemotherapy.The previous International Neuroblastoma Staging System was based primarily on surgical findings.We hypothesized there would be a change to the role of the surgeon in neuroblastoma treatment in the more recent decade.Methods This is a single center 20-year retrospective analysis of 104 patients with International Classification of Diseases-9 and-10 codes for neuroblastoma.Patient demographics,tumor site,cancer treatment modality,survival,biopsy technique,surgical intervention,and pathology staging were collected.Data was analyzed by analysis of variance(ANOVA)and Student’s t test.Results There was a decrease in open surgeries for extra-adrenal neuroblastomas in the later decade(77%,31%,P=0.01).There was a narrowing of the time interval to surgery in the later cohort,likely as a result of uniformity in surgical timing on treatment protocols relying on INRG staging.Conclusions Our findings mirror changes in practice patterns globally.We found an increase in minimally invasive approaches but did not find a difference in the role of the surgeon under the INRG staging system.
基金This work was supported by the National Natural Science Foundation of China(82002212,81870683,82070928,81790643,82121003)the Science&Technology Department of Sichuan Province(19YJ0593,2020ZYD035,2020YJ0460,2020JDTD0028,2021JDGD0036,2021YFS0404,2021YFS0369,2022JDTD0024)+6 种基金Department of Sichuan Provincial Health(19PJ117)the Sichuan Provincial People’s Hospital(2018LY03)the Chengdu Science and Technology Bureau(2019-YF0500572-SN)the China Postdoctoral Science Foundation Grant(2019M663567)the foundation of Basic Scientific Research in Central Universities of University of Electronic Science and Technology(ZYGX2020J024)Medicine-engineering interdisciplinary grant of University of Electronic Science and Technology(ZYGX2021YGLH006)the CAMS Innovation Fund for Medical Sciences(2019-12M-5-032)。
文摘The Revised International Staging System(R-ISS)is a simple and powerful prognostic tool for multiple myeloma(MM).However,heterogeneity in R-ISS stage is still poorly characterised,hampering improvement of treatments.We used single-cell RNA-seq to examine novel cellular heterogeneity and regular networks in nine MM patients stratified by R-ISS.Plasma cells were clustered into nine groups(P1–P9)based on gene expression,where P1–P5 were almost enriched in stage III.PDIA6 was significantly upregulated in P3 and LETM1was enriched in P1,and they were validated to be upregulated in the MM cell line and in 22 other patients’myeloma cells.Furthermore,in progression,PDIA6 was newly found and verified to be activated by UQCRB through oxidative phosphorylation,while LETM1 was activated by STAT1 via the C-type lectin receptor-signalling pathway.Finally,a subcluster of monocytes was exclusively found in stage III specifically expressed chemokines modulated by ATF3.A few ligand-receptor pairs(CCL3/CCL5/CCL3L1-CCR1)were obviously active in monocyte-plasma communications in stage III.Herein,this study identified novel molecules,networks and crosstalk pairs in different R-ISS stages of MM,providing significant insight for its prognosis and treatment.
文摘目的探讨R2-ISS(The Second Revision of the International Staging System)分期在新诊断多发性骨髓瘤(NDMM)患者中的预后价值。方法收集自2012年12月至2022年3月在南京医科大学鼓楼临床医学院血液科就诊的326例以免疫调节药物和(或)蛋白酶体抑制剂为一线治疗方案的NDMM患者临床资料,采用Kaplan-Meier法进行生存分析,Log-rank检验比较组间差异,Cox比例风险回归模型进行多因素分析。结果①326例NDMM患者中男性190例,中位年龄63岁,中位随访时间37个月。R2-ISS分期可进行有效的预后分层,特别是R-ISSⅡ期患者,R2-ISSⅠ期、Ⅱ期、Ⅲ期和Ⅳ期患者的中位无进展生存(PFS)期分别为52、29、20和15个月(P<0.001),中位总生存(OS)期分别为91、60、44和36个月(P<0.001)。多因素分析显示ISSⅡ期、ISSⅢ期、del(17p)、t(4;14)、1q^(+)、LDH升高、年龄>65岁是影响OS的独立不良预后因素;ISSⅡ期、ISSⅢ期、del(17p)、t(4;14)、1q^(+)、LDH升高是影响PFS的独立不良预后因素。②R2-ISS分期C-index得分为0.724,优于R-ISS分期的0.678,预测效能更高。③R2-ISSⅢ期和Ⅳ期中含1q^(+)在内的双打击患者中位PFS期分别为20、15个月(P=0.084),中位OS期为35、36个月(P=0.786)。Ⅲ期中含1q^(+)在内的双打击27例、1q^(+)单一异常61例、不含1q^(+)68例,三组的中位PFS期分别为20、18、21个月(P=0.974),中位OS期分别为35、47、56个月(P=0.042)。因此本研究将1q^(+)赋值调整至1,重新分组后R2-ISS不同分期的中位PFS期和OS期差异均有统计学意义(P<0.001)。结论R2-ISS分期预后分层价值优于R-ISS分期,特别是对异质性较强的R-ISSⅡ期人群,调整含1q^(+)在内的双打击赋值后可进一步优化R2-ISS分期。
文摘In our study, we determined the efficacy of bortezomib-based induction therapy followed by autologous stem cell transplant （ASCT） in newly diagnosed and relapsed/refractory （R/R） multiple myeloma （MM） patients and compared the advantages of early versus late transplant. We used a retrospective analysis to examine 62 patients, including 46 cases of newly diagnosed MM （early transplant group） and 16 cases of relapsed/refractory MM （late transplant group）. All of these patients received bortezomib-based induction therapy followed by ASCT. The efficacy and side effects of the treatment regimen were analyzed. Patients＇ overall survival （OS） and progression-free survival （PFS） times were determined. The ratio of complete remission to near-complete remission （CR/nCR） was 69.5% versus 56.2% （P=0.361）, respectively, for the early transplant group versus the late transplant group, respectively, after receiving bortezomib-based induction therapy; the overall response rates of the two group were 91.3 % and 81.2 %, respectively （P=0.369）. After receiving ASCT, the CR/nCR of the two groups increased to 84.8% and 81.3%, respectively. The median time required for neutrophil engraftment of the early transplant group and the late transplant group was 11 and 14.5 days, respectively （P=0.003）; the median time required for platelet engra^nent was 13 and 21.5 days （P=0.031）, respectively. There were no significant differences in the toxic side effects observed during induction therapy and ASCT between the two groups. The OS of the two groups was not statistically different （P=0.058）. The PFS of the early transplant group and the late transplant group was 41.6 and 26.5 months, respectively （P=0.008）. Multivariate analysis demonstrated that the time of receiving ASCT, the types of M protein, and the International Staging System （ISS） stage were all independent factors that influenced PFS. In conclusion, patients in a suitable condition for ASCT should be recommended to have a
