Cancer Centers In China Research Articles

Prognostic nomogram for pediatric nasopharyngeal carcinoma in the intensity-modulated radiotherapy era.

e18036 Background: There was no prognostic nomogram model exclusive for pediatric nasopharyngeal carcinoma (NPC). This study aimed to establish a nomogram, incorporating clinical characteristics and MRI features, for predicting progression-free survival (PFS) and overall survival (OS) in pediatric NPC. Methods: Children with nonmetastatic NPC treated with intensity-modulated radiotherapy (IMRT) in Sun Yat-sen University cancer center in China between 2004 to 2018 were enrolled and separated in a 3:1 ratio into a training cohort and a validation cohort. The data of the training cohort were analyzed to identify the variables independently associated with PFS and OS, and these variables were used to construct the prognostic nomogram. The predictive accuracy and discriminative capability of the nomogram were evaluated by the calibration curve and the concordance index (C-index). The nomogram was validated in the validation cohort. Results: A total of 200 patients were enrolled: 152 in the training cohort and 48 in the validation cohort. Age, serum lactate dehydrogenase level, and invasion of the clivus were the independent prognostic factors for PFS in the training cohort. The C-index of the nomogram constructed using these variables was 0.86. The calibration curve showed consistency between the nomogram prediction and the actual observation for 5-, 6- and 7-year PFS. In the validation cohort, the C-index of the nomogram was 0.64, and the calibration curve showed good consistency between the nomogram and actual observation for 5-, 6- and 7-year PFS. For OS, no independent prognostic factors were identified. Conclusions: The prognostic nomogram could be a useful tool for predicting PFS in pediatric NPC patients treated with IMRT.

Neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy for the treatment of esophageal squamous cell carcinoma: a propensity score-matched study from the National Cancer Center in China.

The optimal mode of neoadjuvant treatment for esophageal squamous cell carcinoma (ESCC) has not been well characterized. Our study compared neoadjuvant chemotherapy (NCT) with neoadjuvant chemoradiotherapy (NCRT) for patients with ESCC. Data from ESCC patients receiving NCRT or NCT combined with esophagectomy between 2010 and 2018 from the National Cancer Center in China were retrospectively collected. Long-term survival, pathological response, and perioperative mortality and morbidity were compared between the NCRT and NCT groups. A Cox proportional hazards model and propensity score matching (PSM) were used to minimize bias due to potential confounding. Out of 327 eligible patients with ESCC in our study, 90 patients were identified in each group by PSM. The complete pathologic response (pCR) rate in the NCRT group was markedly higher than that in the NCT group (before PSM: 35.1% vs. 6.0%; after PSM: 38.9% vs. 5.6%; both P < 0.001). The rates of 30-day or 90-day mortality were comparable between the two groups, but the NCRT group had a longer postoperative hospital stay (P < 0.001 before PSM and P = 0.012 after PSM) and more postoperative complications (P < 0.001 before PSM and P = 0.014 after PSM), especially, anastomotic leaks (P = 0.001 before PSM and P = 0.013 after PSM). No significant differences in 5-year overall survival (OS) (P = 0.439) or 5-year relapse-free survival (RFS) (P = 0.611) were noted between unmatched groups, but the trend favored NCRT in the propensity score-matched group (77.3% vs. 61.3%; hazard ratio [HR] 1.57; 95% confidence interval [CI] 0.86-2.87; P = 0.141 for OS, and 77.8% vs. 60.5%; HR 1.72; 95% CI 0.95-3.11; P = 0.073 for RFS). Multivariate analysis showed that only ypT and ypN stages were independent predictors of OS before and after PSM (both P < 0.05). There was no difference in survival between the NCT and NCRT groups, although a trend favored NCRT related to the significantly higher pCR rates. Prospective head-to-head clinical trials to compare these two types of neoadjuvant therapies in ESCC are warranted.

A Model Combining Skeletal Muscle Mass and a Hematological Biomarker to Predict Survival in Patients With Nasopharyngeal Carcinoma Undergoing Concurrent Chemoradiotherapy.

BackgroundUsing the current tumor lymph node metastasis (TNM) staging system to make treatment decisions and predict survival in patients with nasopharyngeal carcinoma (NPC) lacks sufficient accuracy. Patients at the same stage often have different survival prognoses.MethodsIn the current study 802 NPC patients who underwent concurrent radiotherapy and chemotherapy from January 2010 to December 2014 at Sun Yat-sen University Cancer Center in China were retrospectively assessed. The optimal cut-off points for skeletal muscle index (SMI) and monocyte-to-lymphocyte ratio (MLR) were determined via receiver operating characteristic curves. SMI-MLR (S-M) grade and a nomogram were developed and used as clinical indicators in NPC patients. The consistency index (C-index) and a calibration curve were used to measure the accuracy and discriminative capacity of prediction.ResultsThe predictive performance of S-M grade was better than that of TNM staging (C-index 0.639, range 0.578–0.701 vs. 0.605, range 0.545–0.665; p = 0.037). In multivariate analysis S-M grade, T stage, and N stage were independent prognostic factors. These three factors were then combined, yielding a nomogram with a C-index of 0.71 (range 0.64–0.77), indicating good predictive capacity.ConclusionWe developed and validated a prognostic parameter, S-M grade, which increased prediction accuracy significantly and can be combined with TNM staging to predict survival in patients with NPC undergoing concurrent chemoradiotherapy.

Chemotherapy Plus Radiotherapy Versus Chemotherapy Alone for Patients With Peripheral T-Cell Lymphoma, Not Otherwise Specified.

PurposePeripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) is a clinically and biologically heterogeneous disease with poor prognosis. As the role of radiation therapy (RT) is still unclear, we carried out this study to evaluate the potential efficacy of RT in PTCL-NOS.MethodsPatients diagnosed with PTCL-NOS between 2000 and 2016 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching was used to balance the characteristics between patients who received radiotherapy and those who did not receive radiotherapy. In addition, we validated the findings in an external validation cohort retrospectively recruited from two high-capacity cancer center in China between 2006 and 2016. Kaplan-Meier curves and Cox regression models were used for survival analysis.ResultsOf the 2,768 patients with chemotherapy records in the SEER cohort, 27.6% of 844 patients with early-stage disease and 6.8% of 1,924 patients with advanced-stage disease received RT. The application of RT was significantly associated with an improvement in overall survival (5-year OS rate 58.5 versus 35.1%, P <0.001) and disease-specific survival (5-year DSS rate 66.3 versus 44.0%, P <0.001) in the early-stage subgroup, while no apparent survival benefit of adding RT was identified in patients with advanced-stage disease (5-year OS rate 28.7 versus 24.4%, P = 0.089; 5-year DSS rate 32.9 versus 31.3%, P = 0.223). After adjustment, a matched cohort of 1,044 patients (348 in the RT combined with CT group and 696 in the CT alone group) was created. And RT was still significantly associated with a survival benefit in the early-stage subset, but not in the advanced-stage disease group. In the validation cohort with more comprehensive data, RT also significantly improved the survival of early-stage PTCL-NOS patients.ConclusionAdding RT was associated with significant improvement in survival in early-stage PTCL-NOS, but the survival benefit of RT was not obvious in advanced-stage disease. The incorporation of RT for treatment in early-stage PTCL-NOS should be highly considered. Further prospective studies with more comprehensive data are needed to evaluate the effectiveness and toxicity of RT in PTCL-NOS.

Abstract PS6-28: Development and external validation of a clinical nomogram for individually predicting survival of metaplastic breast carcinoma

Abstract Background: Metaplastic breast cancer (MBC) is a rare subtype with distinct clinicopathological features, but few studies have concerned the prognosis of this rare and morphologically diverse malignancy. A prognostic index estimating the clinical outcomes for MBC would be attractive in current clinical practice. The aim of the present study was to develop and validate an effective nomogram for predicting survival of MBC. Methods: In current study, we retrospectively analyzed 1017 MBC patients between January 2005 and December 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. Prognostic factors were identified based on Cox regression analyses, and the final clinical nomogram was developed to predict the 1-, 3-, or 5-year overall survival (OS). The model was validated using bootstrap resampling of SEER validation set and a Chinese cohort for external validation. Calibration curves were provided to internally validate the performance of the nomogram and discriminative ability was appraised by concordance index (C-index). Results: A total of 1017 MBC patients were included for our analysis,whose clinical and tumor characteristics were shown in Table 1. Patients diagnosed between 2005 and 2015 were assigned into 3:1 as training set (n=763) and SEER validation set (n=254). An external validation was performed by an individual set of 94 MBC patients from National Cancer Center in China from 2005 to 2018. The nomogram finally consisted of seven independent prognostic factors including age, tumor grade, tumor size, AJCC Node stage, surgery, chemotherapy and radiotherapy. The nomogram presented a good accuracy for predicting the OS with the C-index of 0.77. Interestingly, the nomogram based on the western (including 92.5 %non-Asian) SEER validation population(C-index of nomogram: 0.76)also had an optimal discrimination in Asian population (C-index of nomogram: 0.70).The calibration plots of the nomogram predictions was also accurate and corresponded closely with the actual survival rates. Conclusions: In conclusion, this novel nomogram was accurate enough to predict the OS by using readily available clinicopathologic factors in MBC general population. This prognostic index proposed here could provide individualized recommendations for patients and clinical decisions for physicians. Table 1. Characteristic of primary metaplastic breast carcinoma cohort from SEER databaseCharacteristicsPatient with MBC (N=1017)%Univariable Analysis PAge, years59.9±13.20.001&amp;lt;6049448.6≥6052351.4Race0.331White71970.7Black22221.8Others767.5Laterality0.374Left51850.9Right49949.1Tumor grade0.001Grade I, II15014.7Grade III, IV86785.3Primary tumor size0.001&amp;lt;5cm80278.9≥5cm21521.1Pathological type0.753Metaplastic carcinoma91590.0Squamous cell carcinoma484.7Spindle cell carcinoma252.5Malignant myoepithelioma70.7Adenocarcinoma mixed222.1Molecular Subtype0.696Non-TNBC31130.6TNBC70669.4AJCC N stage0.001N075774.4N117417.1N2,N3868.5Primary tumor resection0.001No525.1Yes96594.9Radiotherapy0.001No53252.3Yes48547.7Chemotherapy0.003No28628.1Yes73171.9 Citation Format: Jiani Wang, Qing Li, Yang Luo, Fei Ma, Ruigang Cai, Qiao Li, Ying Fang, Jiayu Wang, Peng Yuan, Pin Zhang, Binghe Xu. Development and external validation of a clinical nomogram for individually predicting survival of metaplastic breast carcinoma [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS6-28.

Practices and Hindrances in Cancer Pain Management: Results of a National Multi-Cancer Center Survey Among Healthcare Professionals in China.

BackgroundInadequate control of cancer-related pain in China is an ongoing problem. This study investigated the practices of cancer pain (CP) management at major cancer centers in China and perceived hindrances and knowledge of CP management among health professionals.MethodsFrom September to October 2019, a survey was conducted using electronic questionnaires via the internet to investigate the practices, and perceived hindrances and knowledge in managing CP among healthcare professionals from 7 provincial cancer centers in China. The questionnaire included demographic data, the professionals’ practices among their own patients, their opinions regarding hindrances to CP management, and knowledge of CP management.ResultsWe gathered validated responses from 411 anonymous healthcare professionals, with 82.2% (411/500) of response rate. Based on the analysis of these 411 questionnaires, the results demonstrated that CP was prevalent among patients with cancer, while moderate-to-severe pain took a great proportion. CP management was inadequate for a significant proportion of the patients with CP. Pain assessment, analgesic treatment, attention to adverse effects of analgesic, and multidisciplinary management were usually ineffectual in many cases. The duration of work experience did not significantly affect CP management. The respondents considered that both patients and healthcare professionals were responsible for the undermanagement of CP. Only 26 (6.3%) respondents were able to answer correctly all 10 of the professional questions regarding CP.ConclusionCP is commonly undermanaged in China. Effective pain control requires the implementation of standards, and the sufficient attention and training of healthcare professionals.

Remote monitoring of patient recovery following lung cancer surgery: a messenger application approach.

BackgroundRepeated assessment of patient recovery after discharge is challenging. This study used a popular messenger application to remotely collect patient self-reported symptoms and their severity so as to monitor patient recovery and identify the factors affecting the recovery of symptoms following lung cancer surgery.MethodsThis prospective observational study was conducted at a single tertiary lung cancer center in China between November 2018 and June 2019. Participants received demonstration videos and repeated symptom surveys regarding pain and cough severity (assessed using numeric rating scores of 0–10 for pain and 0–6 for cough) at 2, 4, 6, 8, and 12 weeks after discharge via a smartphone program bound to the WeChat application. Patients who responded to at least 3 of the 5 post-discharge surveys were included in this study. The data were analyzed to investigate the symptom recovery and its related factors.ResultsOf the 826 patients enrolled, 589 (71.3%) responded to at least three surveys. The average pain score reduced from 4.1±2.5 at 2 weeks to 2.2±2.0 at 12 weeks (P<0.001). Factors associated with higher pain severity included the female gender, age over 60 years, thoracotomy, longer operation time (>90 minutes), and prolonged chest tube drainage (>7 days). The average cough score decreased from 2.34±1.30 at 2 weeks to 1.93±1.26 at 12 weeks (P<0.001). Being female and a prolonged operation time (>90 min) were related to increased cough severity. Sublobar resection and limited lymphadenectomy may contribute to lower cough severity post-surgery.ConclusionsThe messenger application-based remote monitoring successfully collected post-discharge symptom information and identified factors associated with recovery following lung surgery.

R-CHOP immunochemotherapy plus surgery is associated with a superior prognosis in Chinese primary intestinal diffuse large B-cell lymphoma.

The aim of the study was to compare the therapeutic strategies and prognostic factors of patients with primary intestinal diffuse large B-cell lymphoma (PI-DLBCL). A total of 50 PI-DLBCL patients who accepted standard first-line treatment at National Cancer Center in China were included in this retrospective study. Survival analysis was performed to evaluate the prognostic risk factors. The 3-year overall survival (OS) and 3-year progression-free survival (PFS) for the entire group were 76.0% and 65.9%, respectively. Univariate analysis showed that B symptom, advanced Lugano stage, elevated LDH status, poor ECOG PS and immunochemotherapy alone were significantly correlated with a poor PFS. Elevated LDH status, poor ECOG PS, advanced Lugano stage, high IPI score and immunochemotherapy alone were significantly correlated with a poor OS. Multivariate analysis revealed that ECOG PS (P=0.035; HR=0.233; 95% CI, 0.060-0.905), LDH level (P=0.010; HR=0.223; 95% CI, 0.072-0.693) and surgery (P=0.002; HR=5.584; 95% CI, 1.883-16.563) were independent prognostic factors for OS. LDH level (P=0.035; HR=0.210; 95% CI, 0.049-0.894) and surgery (P=0.003; HR=6.410; 95% CI, 1.903-21.593) were independent risk factors for PFS in PI-DLBCL. R-CHOP immunochemotherapy combined surgery treatment was also associated with a lower rate of refractory/relapsed (R/R) disease (P=0.004). Furthermore, stratified analysis revealed that partial resection or radical resection combined with immunochemotherapy had no significantly difference which affect OS (P=0.338) and PFS (P=0.207). R-CHOP immunochemotherapy plus surgery was associated with a superior prognosis compared with R-CHOP alone in Chinese PI-DLBCL population.

Epidemiology of mental health problems among patients with cancer during COVID-19 pandemic

The current study aimed to explore mental health problems in patients diagnosed with cancer during the COVID-19 pandemic. A cluster sampling, cross-sectional survey with 6213 cancer patients was conducted in one of the largest cancer centers in China. The socio-demographic and clinical characteristics, psychosomatic conditions, interpersonal relationships and social support, COVID-19 infection-related psychological stress, and mental health status were measured. Medical conditions were extracted from patients’ electronic healthcare records. Among the 6213 cancer patients, 23.4% had depression, 17.7% had anxiety, 9.3% had PTSD, and 13.5% had hostility. Hierarchical liner regression models showed that having a history of mental disorder, excessive alcohol consumption, having a higher frequency of worrying about cancer management due to COVID-19, having a higher frequency feeling of overwhelming psychological pressure from COVID-19, and having a higher level of fatigue and pain were the predominant risk factors for mental health problems in cancer patients. However, there were only 1.6% of them were seeking psychological counseling during COVID-19. We also revealed the protective factors associated with lower risk of mental health problems among cancer patients. The present study revealed a high prevalence of mental health problems and gaps in mental health services for cancer patients, which also indicated high distress from COVID-19-elevated risks. We call for systematic screening of mental health status for all cancer patients, and developing specific psychological interventions for this vulnerable population.

Clinical features and prognostic factors for extracranial oligometastatic breast cancer in China.

Evidence of an oligometastatic state in metastatic breast cancer (MBC) is relatively limited. The aim of our study was to investigate the clinical features and prognostic factors for extracranial oligometastatic breast cancer and to identify the best treatment approaches in this select population. Fifty postoperative inpatients diagnosed with extracranial oligometastatic breast cancer at the National Cancer Center in China between 2009 and 2014 were consecutively enrolled. Oligometastatic breast cancer was defined as MBC with three or fewer metastatic lesions confined to one organ; de novo Stage IV disease and local-regional recurrence were excluded. The median progression-free survival (PFS) and overall survival (OS) times were 15.2 and 78.9 months, respectively, and the 2-year PFS and 5-year OS rates were 40% and 58%, respectively. First-line treatment approach with standard systemic treatment + surgical resection for all metastatic lesions was an independent prognostic factor for prolonged PFS (hazard ratio = 0.32; 95% confidence interval [CI], 0.14-0.73; P = .006) and OS (hazard ratio = 0.35; 95% CI, 0.14-0.86; P = .022). Subgroup analysis showed that patients with a disease-free interval (DFI) ≥24 months, one metastatic lesion or the hormone receptor (HR) + subtype were more likely to get benefit from resection. Patients with oligometastatic breast cancer have a relatively good prognosis. Surgical resection for metastatic lesions could significantly improve PFS and OS. Further prospective research is warranted to confirm the results and to develop biomarkers for better patient selection.

The Asian Approach to the Management of Gastrintestinal Cancer Patients During the COVID-19 Pandemic Era

The Asian Approach to the Management of Gastrintestinal Cancer Patients During the COVID-19 Pandemic Era

Autoantibody signature in hepatocellular carcinoma using seromics

BackgroundAlpha-fetoprotein (AFP) is a widely used biomarker for hepatocellular carcinoma (HCC) early detection. However, low sensitivity and false negativity of AFP raise the requirement of more effective early diagnostic approaches for HCC.MethodsWe employed a three-phase strategy to identify serum autoantibody (AAb) signature for HCC early diagnosis using protein array-based approach. A total of 1253 serum samples from HCC, liver cirrhosis, and healthy controls were prospectively collected from three liver cancer centers in China. The Human Proteome Microarray, comprising 21,154 unique proteins, was first applied to identify AAb candidates in discovery phase (n = 100) and to further fabricate HCC-focused arrays. Then, an artificial neural network (ANN) model was used to discover AAbs for HCC detection in a test phase (n = 576) and a validation phase (n = 577), respectively.ResultsUsing HCC-focused array, we identified and validated a novel 7-AAb panel containing CIAPIN1, EGFR, MAS1, SLC44A3, ASAH1, UBL7, and ZNF428 for effective HCC detection. The ANN model of this panel showed improvement of sensitivity (61.6–77.7%) compared to AFP (cutoff 400 ng/mL, 28.4–30.7%). Notably, it was able to detect AFP-negative HCC with AUC values of 0.841–0.948. For early-stage HCC (BCLC 0/A) detection, it outperformed AFP (cutoff 400 ng/mL) with approximately 10% increase in AUC.ConclusionsThe 7-AAb panel provides potentially clinical value for non-invasive early detection of HCC, and brings new clues on understanding the immune response against hepatocarcinogenesis.

A multicenter, descriptive epidemiologic survey of the clinical features of spinal metastatic disease in China

ABSTRACT Objective Spinal metastases have unique epidemiological features and treatment methods. Unfortunately, the relative scarcity of spinal metastases has limited the widespread development of descriptive epidemiological studies, especially in Asian countries. The purpose of this study was to describe the epidemiological characteristics of patients with metastatic spinal tumors in China between 2007 and 2019. Methods From January 2007 and July 2019, data on patients with spinal metastases were collected from five cancer centers in China, and demographic characteristics, primary tumor types, segments and numbers of vertebral lesions, disease-related scores, and treatment methods were reviewed. Results A total of 2228 patients with spinal metastases were reviewed in this study, including 1279 male patients and 949 female patients, and the male to female ratio was 1.35: 1. More than half of patients developed metastatic diseases between the ages of 50 years and 69 years (64%). Overall, lung cancer (824 cases, 37%) was the most common primary tumor type and the most common level of spinal involvement was multi-level of metastases (860 cases, 39%). 705 patients (32%) had undergone surgical treatments, 1028 patients (46%) had undergone radiotherapy for metastatic vertebrae, and 855 patients (38%) had received systemic treatments. The age, primary tumor type, number of involved vertebrae, Frankel grade, and spinal instability neoplastic score would affect the surgical decision-making. Discussion This study provides insight into the epidemiological characteristics of spinal metastasis and health care service utilization in spinal metastasis patients in China. Abbreviations ICD-10: International Classification of Disease, Tenth Revision; VAS: Visual Analogue Scale; KPS: Karnofsky Performance Status; SINS: Spinal Instability Neoplastic Score; SOSG: Spine Oncology Study Group; MRI: Magnetic Resonance Imaging; CT: Computed Tomography; ECT: Emission Computed Tomography.

Unmet supportive care needs and associated factors among Chinese discharged patients with esophageal cancer after esophagectomy: A cross-sectional study.

After esophagectomy, patients experience a series of problems that severely affect their quality of life. Understanding their unmet needs could help medical staff provide better supportive care. The aim of this study was to investigate the supportive care needs of discharged patients with esophageal cancer after esophagectomy and explore the factors associated with these needs. A total of 167 discharged patients with esophageal cancer after esophagectomy were recruited from a University Cancer Center in China and investigated using a self-designed demographic and clinical characteristics questionnaire, the 34-item Supportive Care Needs Survey, and the M.D. Anderson Symptom Inventory Gastrointestinal Cancer Module. Approximately 95.2% of the patients had ≥1 unmet need(s). The overall level of supportive care needs of patients after esophagectomy was mild to medium. Most of the top 10 moderate-to-severe unmet needs were identified in the health and information domains. Age (β=-0.157, p=0.011), dysphagia (β=-0.178, p=0.005), recurrence (β=0.175, p=0.005), time since diagnosis (β=-0.150, p=0.018), and symptom interference (β=0.488, p<0.001) were significantly associated with supportive care needs. Discharged patients with esophageal cancer after esophagectomy had a wide range of unmet supportive care needs. It is essential to combine the associated factors to accurately evaluate patient needs. We should pay more attention to propose comprehensive measures for these patients and provide more individualized supportive care during the lengthy recovery period.

Retrospective analysis of immune checkpoint inhibitor-associated myocarditis from 12 cancer centers in China.

e15130 Background: Immune checkpoint inhibitor(ICI) -associated myocarditis is rare, but it could account for a very high mortality rate. This study reviewed the occurrence of ICI-associated myocarditis in Chinese cancer patients. Methods: A retrospective analysis was made on the occurrence of ICI-associated myocarditis in cancer centers of 12 3A-grade hospitals in China from January 1, 2018 to December 31, 2019. More than 100 patients were treated with ICIs in each center. Results: A total of 2373 patients were treated with ICI alone or in combination. The incidence of ICI-associated myocarditis was 1.05% (25/2373). Of all the data elicited from 16 patients in this study, the tumor types were listed, including: melanoma, lung cancer, renal cancer, urothelial cancer, liver cancer, gastric cancer, colorectal cancer, etc. The 16 patients included 8 male and 8 female with a median age of 65 (36-80). 3 of them had coronary heart disease. The ICI drugs included nivolumab, pembrolizumab and toripalimab, camrelizumab, sintilimab, tislelizumab, atezolizumab. Among them, there were 10 cases of PD-1 inhibitor, 1 case of PD-L1 inhibitor, 5 cases of PD-1 inhibitor combined with chemotherapy or molecular targeted drug. ICI-associated myocarditis occurred in a median of 38 days (2-420) after treatment during which 81.2% (13/16) of them received ICI 1-2 infusions. The common clinical symptoms were palpitation, chest distress and dyspnea, in addition to 8 cases with asthenia, 4 cases with respiratory failure, 2 cases without symptoms. ECG abnormality accounted for 87.5% (14/16). The common abnormalities included: 6 cases of atrial premature contraction, 4 cases of ventricular premature contraction, 3 cases of sinus tachycardia, 1 case of Grade 3 atrioventricular, 1 case of complete right bundle block, and 1 case of acute myocardial infarction. 15 cases of abnormal troponin I or T were observed, followed by CK, CK-MB, MYO and BNP increased. 14 patients were treated with glucocorticoid. 6 patients died with the mortality rate 37.5%(6/16) and 66.7% (4/6) were over 70 years old. Conclusions: The incidence of ICI-associated myocarditis in Chinese patients is low, but the mortality rate is high. Regular monitoring of cardiac biomarkers and ECG is helpful for early diagnosis.

Preliminary Efficacy and Safety of Reishi & Privet Formula on Quality of Life Among Non-Small Cell Lung Cancer Patients Undergoing Chemotherapy: A Randomized Placebo-Controlled Trial.

Background:Cancer patients often experience decreased quality of life during chemotherapy. This study aimed to determine the preliminary efficacy and safety of Reishi & Privet Formula (RPF) for maintaining quality of life among patients with non–small cell lung cancer (NSCLC) undergoing chemotherapy.Methods:We conducted a phase II randomized, double-blind, placebo-controlled clinical trial in China. Adults with NSCLC scheduled to receive chemotherapy were randomly assigned (3:1 ratio) to receive oral RPF (3.36 g/day) or placebo daily for 6 weeks. The main outcome was the Functional Assessment of Cancer Therapy–Lung (FACT-L). We evaluated RPF’s safety profile using the Common Terminology Criteria for Adverse Events and assessed changes in outcome measures from baseline to weeks 3 and 6 using a linear mixed effects model.Results:We enrolled 82 participants across 8 cancer centers in China. The median age was 59 years, 56 (68%) had advanced cancer. Compared with the placebo group, the RPF group had nonstatistically significant higher quality of life as measured by the FACT-L total score (P = .086) over 2 cycles of chemotherapy. The RPF group was associated with a nonsignificant better general health (P = .050) and emotional well-being (P = .090) than the placebo group. Adverse events rates did not differ between groups.Conclusions:This study demonstrated preliminary safety and suggests a promising trend in RPF’s effect on maintaining quality of life and emotional well-being among NSCLC patients undergoing chemotherapy. Future adequately powered randomized-controlled trials are needed to verify the efficacy and safety of RPF in cancer patients undergoing chemotherapy.

Stigma and its correlates in people living with lung cancer: A cross-sectional study from China.

This study aimed to examine the level of stigma and identify the correlates of stigma among lung cancer patients in China. In total, 283 lung cancer patients were recruited from a tertiary cancer center in China by the convenience sampling method and completed a demographic, disease-related information and situational characteristics questionnaire and self-reported measures assessing stigma, state self-esteem, and coping self-efficacy. The mean stigma score was moderate (2.38 ± 0.45). Stigma was significantly and negatively associated with state self-esteem (r = -0.607, P < .001) and coping self-efficacy (r = -0.424, P < .001). Multivariable linear regression showed that age, cancer stage, negative changes (ie, in financial burden, body image, and family relationship), cancer disclosure, perceived blame, state self-esteem, and coping self-efficacy accounted for 49.9% of the variance in stigma. Stigma is a widespread psychosocial phenomenon among patients with lung cancer in China. Health care policy-makers and professionals should pay more attention to this issue and take effective measures to address stigma among lung cancer patients by improving their state self-esteem and coping self-efficacy, encouraging cancer disclosure and providing support for adjusting to negative changes after diagnosis.

Integrative Analysis Reveals Across-Cancer Expression Patterns and Clinical Relevance of Ribonucleotide Reductase in Human Cancers.

Mining cancer-omics databases deepens our understanding of cancer biology and can lead to potential breakthroughs in cancer treatment. Here, we propose an integrative analytical approach to reveal across-cancer expression patterns and identify potential clinical impacts for genes of interest from five representative public databases. Using ribonucleotide reductase (RR), a key enzyme in DNA synthesis and cancer-therapeutic targeting, as an example, we characterized the mRNA expression profiles and inter-component associations of three RR subunit genes and assess their differing pathological and prognostic significance across over 30-types of cancers and their related subtypes. Findings were validated by immunohistochemistry with clinical tissue samples (n = 211) collected from multiple cancer centers in China and with clinical follow-up. Underlying mechanisms were further explored and discussed using co-expression gene network analyses. This framework represents a simple, efficient, accurate, and comprehensive approach for cancer-omics resource analysis and underlines the necessity to separate the tumors by their histological or pathological subtypes during the clinical evaluation of molecular biomarkers.

554P - Multicenter validation of the postoperative carcinoembryonic antigen combined prognostic model for stage III colon cancer

BackgroundThere are limitations in the prognosis stratification of stage III colon cancer patients using only the T and N stages, while other factors are unsure to be equally important. This study aimed to prove the prognostic importance of postoperative carcinoembryonic antigen (CEA) and stratify patients with stage III colon cancer more accurately by building a prognostic model combining CEA. MethodsThis was a retrospective cohort study. Patients with colon cancer who had CEA recorded within 100 days after resection at the centers from 2006 to 2017 were identified. The data included three different cancer centers in China: one training set and two validation sets, which were collected and analyzed in 2018. Postoperative CEA, T stage and N stage were combined to build the prognostic model, and patients with stage III colon cancer were divided into the high-risk group and the low-risk group. Harrell’s C-statistics, and net reclassification improvement (NRI) were used to assess the model performance. The disease-free survival (DFS) was compared between the high-risk group and the low-risk groups by the log-rank test. ResultsAmong patients with elevated postoperative CEA, we found that CEA tested within 20 days (early test group) after resection was not reliable, since DFS of the early test group was higher than that of the delayed test group (p=0.006). So, 834 patients with stage III disease which had CEA data for 21-100 days after resection were analyzed. In the training set, C-index for the model (combining T stage, N stage and postoperative CEA) was 0.74. Patients with elevated postoperative CEA, T4b, N2b or T4aN2a were classified as the high-risk group, with 3-year DFS of 55.8%, which was lower than the value of 86.0% in the low-risk group [hazard ratio (HR), 4.03; 95% CI, 2.49-6.54; p<0.001]. When compared to the TNM model, this new model achieved a 10% NRI. These results were confirmed in the validation sets. ConclusionsPatients with stage III colon cancer could be stratified much more accurately with the prognostic model combining T stage, N stage and postoperative CEA. Legal entity responsible for the studyThe authors. FundingHarbin Medical University Cancer Hospital Preeminence Youth Fund (JCQN2019-04). DisclosureAll authors have declared no conflicts of interest.

Comparison of Concurrent Cisplatin Chemoradiotherapy Plus Adjuvant Chemotherapy Versus Concurrent Chemoradiotherapy Alone in Locally Advanced Cervical Cancer

According to NCCN guidelines, concurrent chemoradiation (CCRT) is the standard care for locally advanced cervical cancer (LACC) patients , but the benefit of adjuvant chemotherapy (ACT) after CCRT for LACC patients is still controversial. This study is designed to answer the question by comparing the efficacy and toxicities of concurrent chemoradiation (CCRT) with adjuvant chemotherapy (ACT) (CCRT+ACT) versus concurrent chemoradiation (CCRT) alone in LACC. Patients with stage IB2,IIA2,IIB-IVA (2009 FIGO staging) cervical cancer were recruited from June 2013 to June 2018 at 4 cancer centers in China. The patients were randomly assigned to two arms: CCRT +ACT and CCRT alone. All patients were treated with IMRT (external-beam radiotherapy up to 50.4 Gy) with concurrent cisplatin, followed by intra-cavitary brachytherapy. The chemotherapy consisted of concurrent cisplatin(40 mg/m2 weekly) during IMRT, and 3 cycles of adjuvant CT with TP (docetaxel 75 mg/m2, day 1, and cisplatin 25 mg/m2, day 1-3 or carboplatin AUC 4-5 ,day 1)every 3 weeks. The primary endpoint was progression free survival(PFS), and the secondary endpoints included overall survival (OS), locoregional recurrence rate, distance metastasis rate , and toxicities. Survivals were calculated with Kaplan-Meier method. The differences between survivals were calculated with Log-rank test. Toxic effects were analyzed using the χ2 test. All statistical tests were two-sided. A total of 176 patients were recruited in the study and 161 were eligible for intent-for-treat analysis. 82patients were assigned to the CCRT+ACT arm and 79 in the CCRT alone arm. With a median follow-up of 60.1 months, the 5-year PFS and OS of all the patients were 68.32% and72.05%, respectively. The 5-year PFS was 75.61% in the CCRT+ACR arm, and was 60.76% in the CCRT arm. There was significant difference in PFS between the two arms （P=0.043). The 5-year OS was 76.83% in the CCRT+ACT arm and was, and was 67.09% in the CCRTarm. There was no significant difference in OS between the two arms （P=0.169). There was significant difference between the CCRT+ACT and CCRT arms in distant alone recurrence (p=0.048),but not in locoregional recurrence rate (p=0.752).There were significantly higher acute systemic side effects in the CCRT+ACT arm, especially the incidence of grade 3-4 hematologic and gastrointestinal reactions (P =0.000). Most of locoregional recurrence and distant metastases occurred with staging IIIB-IVA patients in the CCRT alone arm. Adjuvant chemotherapy after concurrent cisplatin chemoradiation for LACC patients improves PFS but not improves OS. It reduces distance metastasis but is correlated with poorer response to locoregional recurrence.There were more significant toxicities during adjuvant chemotherapy but it was well tolerated by patients. Further research and longer follow up is needed, especially for the staging IIIB-IVA LACC patients.