Malignant Tumor Patients Research Articles

A randomized trial evaluating the association between related gene polymorphism and nausea and vomiting induced by cisplatin multi-day chemotherapy

PurposeWe aim to investigate the correlation between gene polymorphisms and cisplatin chemotherapy-induced nausea and vomiting (CINV), which was prevented by olanzapine or aprepitant triple antiemetic regimen.MethodsBefore chemotherapy, the blood samples of 89 malignant tumor patients who received multi-day chemotherapy with cisplatin were collected for sequencing and typing. As there were duplicate patients enrolled in different chemotherapy cycles, there were a total of 190 cases. The patients were divided into two groups randomly, who received the triple antiemetic regimen of olanzapine or aprepitant combined with 5-HT3RA and dexamethasone. The main evaluation indicators were the total protection (TP) rate in the acute phase (0–24 h), the delayed phase (25–120 h) and the overall phase (0-120 h).ResultsUnivariate analysis was performed on genetic loci that reached H-W balance with TP. In the olanzapine group, increased TP in the acute phase was associated with HTR3A rs1176719 non-GG (P < 0.05) genotype etc. Increased TP in the delayed phase was associated with HTR3A rs1176719 non-GG (P < 0.05) genotype etc. In the aprepitant group, increased TP in the acute phase was associated with the MTHFR rs1801131 TT (P < 0.05) genotype etc. Increased TP in the delayed phase was associated with HTR3A rs1062613 CC (P < 0.05) genetype ect. Multivariate Logistic regression analysis showed that HTR3B rs7943062GG (P < 0.05) genotype etc. were correlated with increased TP in the delayed phase. MTHFR rs1801131TT genotype was associated with increased TP in the acute phase (P < 0.05) and delayed phase (P < 0.05).ConclusionThis study found that gene polymorphisms, including HTR3B (rs1062613, rs1176719, rs2276303), HTR3B (rs45460698, rs7943062), HTR3C (rs6766410), ERCC1 (rs3212986), ERCC4 (rs744154) and MTHFR(rs1801131), may be independent prognostic factors for CINV.

Estrogen sulfotransferase SULT1E1 expression levels and regulated factors in malignant tumours.

Estrogen plays a key role in the development and progression of many malignant tumours, and the regulation of estrogen levels involves several metabolic pathways. Among these pathways, estrogen sulfotransferase (SULT1E1) is the enzyme with the most affinity for estrogen and is primarily responsible for catalysing the metabolic reaction of estrogen sulphation. Relevant studies have shown significant differences in the expression of SULT1E1 in different malignant tumours, suggesting that SULT1E1 plays a dual role in malignant tumours, both inhibiting the growth of malignant tumours and promoting their development. In addition, the expression level of SULT1E1 may be regulated by a variety of factors, which in turn affect the growth and therapeutic effects of malignant tumours. The aim of this paper is to review the mechanism of action of SULT1E1 in malignant tumours and the mechanisms that are regulated, in order to provide potential targets for the treatment of malignant tumour patients in the future and theoretical support for the realisation of more personalised and effective therapeutic regimens.

Stereotactic Radiotherapy or Whole Brain Radiotherapy Combined with Pyrotinib and Capecitabine in HER2-Positive Advanced Breast Cancer Patients with Brain Metastases (BROPTIMA): A Prospective, Phase Ib/II Single-Arm Clinical Study

Approximately half of patients with advanced HER2-positive breast cancer (BC) will develop brain metastases (BM) over time. Local therapy including stereotactic radiotherapy (SRT) and whole brain radiotherapy (WBRT) is the main initial treatment in malignant tumor patients with BM. However, more than 50% patients after radiotherapy in one year suffered intracranial recurrence. Pyrotinib, a small molecule, irreversible, pan-ErbB receptor tyrosine kinase inhibitor (TKI), has a high potency for controlling BM and reducing the occurrence of brain metastases in advanced HER2-positive BC patients. We hypothesized that SRT or WBRT combined with pyrotinib and capecitabine could decrease intracranial progression in HER2 positive BC with newly diagnosed BM. In this prospective single-arm phase Ib/II trial (NCT04582968), eligible patients were assigned to either fractionated stereotactic radiotherapy (FSRT) or whole-brain radiation therapy (WBRT), combined with pyrotinib and capecitabine. The primary endpoint was one-year CNS progression-free survival (PFS) rate. Secondary endpoints included intracranial objective response rate (IC-ORR) according to RANO-BM criteria, progression-free survival (PFS), overall survival (OS) and evaluation of safety and neurocognitive function. From January 2020 to August 2022, 40 patients were enrolled. Twenty-nine patients were treated with FSRT in 8 Gy per fraction with 3 to 5 fractions and 11 were treated with WBRT in 3 Gy per fraction with 10 fractions, and then received chemotherapy in a time frame starting from 0 to 7 days after radiotherapy. At a median follow-up of 17.3 months, 1-year CNS-PFS rate was 74.9% (95% CI 61.9-90.7%) and median CNS-PFS was 18 months (95% CI, 15.5 to NA months). One-year PFS rate was 66.9% (53.1-84.2%) and median PFS time was 17.6 months (95% CI 12.8-34.1 months). The best intracranial response rate (IC-ORR: complete response and partial response) was 92.5% (37/40). The most common grade 3 or worse toxicity was diarrhea (7.5%) and asymptomatic radiation necrosis was detected in 4 of 67(6.0%) lesions treated with FSRT. No differences of neurocognitive function evaluated by MMSE (Mini-Mental State Exam) were observed between different groups at any time point. Radiotherapy combined with pyrotinib and capecitabine resulted in a promising efficacy that crossed the pre-specified boundary in patients with HER2-positive advanced breast cancer with brain metastases. This is the first prospective study showing the efficacy and safety of CNS radiotherapy concurrent with pyrotinib and capecitabine in patients with BM from HER2-positive breast cancer. Further investigation in a randomized controlled study is warranted.

AN AUDIT OF STEROID-INDUCED DIABETES IN PRIMARY BRAIN TUMOUR PATIENTS

Abstract AIMS Dexamethasone is an effective and commonly used treatment in patients with gliomas. However, it can also cause several metabolic side effects, including steroid-induced diabetes mellitus (SIDM), of which prevalence is estimated at 11-56%. We aimed to assess prevalence of SIDM in our local brain tumour population and audited adherence to recently published national guidance for monitoring and management of SIDM. METHOD Retrospective data review of all new primary malignant brain tumour patients seen in clinic over 12 months to assess local prevalence. Patients’ notes audited for 2 months pre- and post-adoption within the department of national guidelines focussing on how to screen and monitor for diabetes when initiating high dose steroids. RESULTS 71 new patients seen over 12 months. 66 patients with high grade and 5 with low grade gliomas. 82% were on steroids at first oncological visit. 14% known diabetic or pre-diabetic. 7% subsequently developed SIDM. 19 patient notes audited over 2 months prior to intervention (Group 1) and 11 post intervention (Group 2). All patients were taking dexamethasone. 40% of Group 1 and 36% of Group 2 had neither HbA1c nor lab glucose checked at baseline. 1 patient in Group 1 developed SIDM. CONCLUSIONS Diabetes mellitus in cancer patients increases risk of infections, cardiovascular comorbidities, and can reduce effcacy of treatment, leading to preventable admissions and decreased survival rates. Prevalence of SIDM in our local population is comparable to published data. Adoption of published guidance improved baseline monitoring but needs to be embedded within acute oncology pathways across the Trust.

Naples score: a novel prognostic biomarker for breast cancer patients undergoing neoadjuvant chemotherapy.

The Naples Score (NPS) is a novel prognostic indicator that has been used in various cancers, but its potential in breast malignant tumor patients receiving neoadjuvant chemotherapy (NAC) has not been discovered. This study aimed to investigate the relationship between NPS and overall survival (OS) and disease-free survival (DFS) in breast cancer patients. A total of 217 breast cancer patients undergoing NAC were incorporated into this retrospectively research. K-M survival curves and log-rank tests are used to determine OS and DFS. Cox regression model was used to evaluate the relationship between NPS and OS and DFS. Nomogram was developed based on the results of multivariate Cox regression analysis. Prognostic models were internally validated using bootstrapping and the consistency index (C-index). Age group was correlated with NPS (p < 0.05). Low and moderate Naples risk patients had higher 5-year OS and DFS rates than high risk Naples patients (93.8% vs. 75.4% vs. 60.0%; X2 = 9.2, P = 0.01; 82.4% vs 64.5% vs 43.7%; X2 = 7.4, P = 0.024; respectively). The nomogram based on demonstrated good performance in predicting OS and DFS (AUC = 0.728, 0.630; respectively). In breast cancer patients who have undergone NAC, NPS is a novel prognostic indicator. NPS combined with clinicopathological features showed good predictive ability, and its performance was better than that of traditional pathological TNM staging.

Neuropsychological impairment in primary malignant brain tumor patients with awake craniotomy: a hospital-based registration study.

Neuroplasticity is an ability to maintain neural circuit function when facing damages. It is one of the reasons that making brain tumors notorious. Therefore, we evaluated the characteristics of patients with primary brain tumors, compared neuropsychological deficits between patients who had awake craniotomy with left- or right-sided tumors, and analyzed the association between white matter tracts and neuropsychological deficits in patients with right-sided tumors. Using the registration dataset of Chang Gung Memory Hospital between 2014 and 2020, this study included a total of 698 adult patients who received craniotomy for primary brain tumors (538 of conventional craniotomy; 160 of awake craniotomy). Neuropsychological assessments were arranged in patients as preoperative evaluation for awake craniotomies. A lower proportion of right-sided tumors was noted in patient who had awake craniotomy than those who had conventional craniotomy (33.8% and 51.5%, p < 0.001). In awake craniotomy, 88.7% of patients with left-sided tumors and 77.8% of patients with right-sided tumors had neuropsychological impairment. Patients with left-sided tumors had worse preoperative performance compared to those with right-sided tumors in global function (36.2% and 8.0%, p < 0.001), language domain (57.6% and 22.2%, p < 0.001), and attention (36.0% and 18.5%, p = 0.02). Furthermore, in those with right-sided low-grade gliomas, patients involving pathway of superior longitudinal fasciculus (SLF) I had a higher risk of deficits than those without involvement in verbal memory (p = 0.001, Odd ratio = 11.2, 95% CI = 1.8 ~ 71.4) and visual memory (p = 0.048, Odd ratio = 10.5, 95% CI = 1.0 ~ 111). In awake craniotomy, patients with left-sided brain tumors had worse cognitive function than those with right-sided tumors in terms of global function, language, and attention. 77% of patients with right-sided tumors had neuropsychological impairment. Therefore, a comprehensive neuropsychological evaluation and awake craniotomy are necessary for patients with brain tumors.

Cerebrovascular Events During Treatment for Systemic Malignant Tumors in Patients with Moyamoya Disease

With the increasing incidence of malignancies, the importance of cancer-associated stroke is emphasized. Although moyamoya disease is a leading cause of stroke, no reports have documented cancer-associated stroke in patients with this condition. We aimed to investigate cerebrovascular events during malignancy treatments in patients with moyamoya disease. A total of 405 patients with moyamoya disease who visited our hospital between January 2000 and March 2022 were retrospectively examined. We evaluated the management of moyamoya disease, presence of the ring finger protein 213 p.Arg4810Lys variant, treatments for malignant tumors, presence of cerebrovascular events during treatment, and follow-up periods and outcomes. Among the 405 patients, 17 patients with moyamoya disease (4.2%) were diagnosed with malignancies. Among patients aged 60years and over, 7 out of 67 (10.4%) had malignancies. Of the 17 patients, 11 (64.7%) were symptomatic, and 7 (41.2%) had revascularization surgery. 9 patients were treated with oral antiplatelet drugs. There was no significant difference between the groups with and without malignancy regarding the presence of the ring finger protein 213 p.Arg4810Lys variant (80.0% vs. 62.7%, P= 0.33). All patients underwent surgical treatment, and 7 (41.2%) received chemotherapy. One death due to tumor progression was reported. No cerebrovascular event was observed during malignancy treatments and follow-up periods, which had a mean duration of 6years. In our cohort, malignancy treatments in patients with moyamoya disease were safely conducted without cerebrovascular events. However, it is advisable to avoid hypotension, dehydration, hyperventilation, and long-term discontinuation of antiplatelet drugs during the treatment of malignant tumors.

Coronavirus disease-19 is associated with decreased treatment access and worsened outcomes in malignant brain tumor patients.

The global coronavirus disease-19 (COVID-19) pandemic has resulted in procedural delays around the world; however, timely and aggressive surgical resection for malignant brain tumor patients is essential for outcome optimization. To investigate the association between COVID-19 and outcomes of these patients, we queried the 2020 National Inpatient Sample (NIS) for differences in rates of surgical resection, time to surgery, mortality, and discharge disposition between patients with and without confirmed COVID-19 infection. Patient data were taken from the NIS from April 2020 to December 2020. COVID-19 diagnosis was determined with the International Classification of Diseases, Tenth Revision, Clinical Modification code U07.1. A total of 30,671 malignant brain tumor patients met inclusion criteria and 738 (2.4%) patients had a confirmed COVID-19 diagnosis. COVID-19-positive patients had lower likelihood of receiving surgery (Odds ratio [OR] 0.43, 95% confidence interval [CI] 0.29-0.63, P < 0.0001), increased likelihood of mortality (OR 2.18, 95% CI 1.78-2.66, P < 0.0001), and increased likelihood of non-routine discharge (OR 1.25, 95% CI 1.13-1.39, P < 0.0001). Notably, COVID patients receiving surgery were not associated with surgical delay (P = 0.17). COVID-19 infection was associated with worse patient outcome in malignant brain tumor patients, including decreased likelihood of receiving surgery, increased likelihood of mortality, and increased likelihood of non-routine discharge. Our study highlights the need to balance the risks and benefits of delaying surgery for malignant brain tumor patients with COVID-19. Although the COVID-19 pandemic is no longer a public health emergency, understanding the pandemic's impact on outcome provides important insight in effective triage for these patients in the situations where resources are limited.

Effects of PC6 acupressure on acute and delayed nausea and vomiting induced by chemotherapy in patients with malignant neoplasm: a meta-analysis.

Evaluating the intervention effect of PC6 acupressure on chemotherapy-induced acute, delayed nausea, and vomiting in malignant tumor patients. Eleven databases had been retrieved from January 2010 through January 2022. The published meta-analysis literature was hand-searched, and the language was limited to English and Chinese. The protocol of this meta-analysis was registered with PROSPERO (registration number: CRD42022323693). Two reviewers independently selected relevant eligible articles, extracted data, and evaluated the risk of bias. Meta-analysis was statistically analyzed using software RevMan 5.3. Ten randomized controlled trials with 975 patients were included. Only two studies were assessed as high quality; eight studies were evaluated as moderate. Meta-analysis showed that compared with the control group, PC6 acupressure reduced the occurrence number of acute (SMD = -0.39,95CI (-0.73, -0.05) P= 0.02), delayed (SMD = -0.51, 95% CI (-0.96, -0.05) P= 0.03) nausea and acute (SMD = -0.42,95% CI (-0.79, -0.06) P= 0.02), delayed (SMD = -0.37, 95% CI (-0.77, 0.03) P= 0.07) vomiting; it reduced the severity of acute (SMD = -0.34, 95% CI (-0.57, -0.11) P= 0.004), delayed (SMD = -0.79, 95% CI (-1.33, -0.25) P= 0.004) nausea and acute (SMD = -0.51, 95% CI (-0.79, -0.23) P= 0.0004), delayed (SMD = -0.50, 95% CI (-0.84, -0.17) P= 0.003) vomiting, while it did not reduced the experience time on acute and delayed CINV. The meta-analysis shows the effectiveness of PC6 acupressure in preventing and treating nausea and vomiting. Large, high-quality, well-designed randomized controlled trials are needed in the future to determine the efficacy of PC6 acupressure on chemotherapy-induced nausea and vomiting.

Establish a whole-process comprehensive surveillance management mode for immune checkpoint inhibitor pneumonitis

The application of immune checkpoint inhibitors (ICIs) has shown impressive anti-tumor efficacy across multiple malignant tumors, leading to the prolonged survival period of tumor patients. However, immune-related adverse events should not be ignored. Checkpoint inhibitor pneumonitis (CIP) is a pulmonary adverse event that can occur in malignant tumor patients after receiving ICIs treatment. The incidence of CIP has been reported to range from 2.7% to 20.0% in clinical trials and real-world research. Furthermore, some patients might suffer from serious or fatal CIP, and the prognosis of such patients will be poor. Early detection, diagnosis and treatment may improve the prognosis of these patients. The establishment of a whole-process CIP comprehensive surveillance management mode covering the health care system and patients during ICIs treatment might be helpful to improve the early diagnosis and treatment capacity of CIP, which is a key measure to improve the prognosis of these patients.

Previous, simultaneous, or subsequent occurrence of malignant tumours in patients with primary hyperparathyroidism: a closer look at the single-tertiary-centre cases.

Our aims were to explore the relationship between primary hyperparathyroidism (pHPT) and malignant tumour development, to determine the frequency and the time of occurrence of malignant tumours in patients with pHPT, and to evaluate the characteristics of pHPT in these patients. This retrospective cohort study included consecutive individuals who were diagnosed with pHPT aged 18 years or older in a university hospital during a 7-year period. A total of 198 patients with pHPT were reviewed retrospectively. Demographic, clinical, biochemical, radiologic findings, and histopathological diagnosis were collected from the electronic medical records of the hospital system. The mean age of the study population was 58 ± 13 years and was predominantly female (female/male: 162/36). There were 42 (21.2%) patients with malignant tumours. Five (12%) out of 42 patients had metachronous double malignancies. The most common 2 concurrent malignancies were breast (36.1%) and thyroid (17.0%). Sixty-eight per cent of the malignant tumours occurred before the diagnosis of pHPT. A higher percentage (87.5%) of simultaneous tumours was seen in the thyroid gland. No statistically significant differences were observed between patients with and without malignant tumours in terms of demographic, clinical, biochemical, radiological, and histopathological features. The median follow-up duration was 24 months after parathyroid surgery. The results of this study revealed that pHPT was associated with various tumour types. The frequency of malignant tumours was 21.2%. Breast and thyroid cancers were the most common 2 cancers coexisting with pHPT. A large percentage of malignant tumours occurred before the diagnosis of pHPT. A higher percentage of simultaneous tumours was seen in the thyroid gland. pHPT patients with and without malignant tumours seemed to have similar characteristics.

Comparison of Muscle Mass Between Healthy Subjects and Patients With Malignant Tumors Undergoing Outpatient Treatment.

Background In recent years, advances in the treatment of malignant tumors have improved life expectancy and diversified treatment options. However, maintaining high activities of daily living in patients is essential for appropriately treating the primary disease, and interventions for patients with impaired motor function will lead to improved quality of life. Here, we compared the muscle mass of malignant tumor patients who are visiting bone metastasis outpatient clinics with that of healthy subjects. Methods We compared the muscle mass of 61 malignant tumor patients with an Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2 (mean 66.3 ± 12.0 years; 30 males and 31 females) attending our bone metastasis outpatient clinic since 2018 with that of 315 healthy subjects (mean 65.0 ± 17.7 years; 110 males and 205 females). Body mass index, skeletal muscle mass, and body fat percentage were assessed by bioimpedance analysis, and the skeletal muscle mass index (SMI) was calculated. Results To eliminate age bias in the malignant tumor patients and healthy subjects, 1:1 propensity score matching was performed separately for males and females. There was no significant difference in right upper limb, left upper limb, right lower limb, or left lower limb mass or SMI between the two groups, whereas trunk muscle mass and muscle mass were significantly higher in the healthy females compared with malignant tumor females. Conclusion There was no significant difference in the SMI measured by bioimpedance analysis between the two groups in either males or females, while muscle mass and trunk muscle mass were significantly lower in female malignant tumor patients than in healthy subjects. These results suggest that even malignant tumor patients whose performance status was maintained enough to allow outpatient visits still had impaired motor function.

Risk factors analysis and prediction model establishment of malignant tumor in patients with polymyositis/dermatomyositis

Objective: To analyze the risk factors of polymyositis/dermatomyositis (PM/DM) complicated with malignant tumor and to construct clinical prediction model. Methods: A total of 427 PM/DM patients, who were admitted to Rheumatism Immunity Branch, the Second Affiliated Hospital, Air Force Medical University from January 1, 2015 to January 1, 2021, were enrolled in the study, including 129 males and 298 females. The mean age was (51.4±12.2) years. The patients were divided into control group (without malignant tumor, n=379) and case group (with malignant tumor, n=48) according to whether they were complicated with malignant tumors. In the two groups, 70% of the patients' clinical data were randomly selected as the training set data, and the remaining 30% were used as the validation set data. The clinical parameters were retrospectively collected, and risk factors of PM/DM complicated with malignant tumor were analyzed by binary logistic regression. R software was used to construct a clinical prediction model for malignant tumors in PM/DM patients using training set data. Validation set data were used to assess the feasibility of the model. The area under the receiver operating characteristic (ROC) curve (AUC), calibration curve and decision curve analysis (DCA) were used to evaluate the predictive ability, accuracy and clinical applicability of the nomogram model. Results: The age of the control group was (50.4±11.8) years, and males accounted for 26.9%(102/379); the age of the case group was (59.1±12.7) years, and the proportion of males was 56.3% (27/48). The proportion of male, age, the positive rate of anti-transcription mediator 1-γ (TIF1-γ) antibody, glucocorticoid therapy resistance, and levels of creatine kinase (CK), carbohydrate antigen 125(CA125) and carbohydrate antigen 199 (CA199) were all higher in the case group than those in control group, while incidence of interstitial lung disease (ILD), arthralgia, Raynaud's phenomenon, serum albumin (ALB) level and lymphocyte (LYM) count were all lower than those in control group (all P<0.05). Binary logistic regression analysis showed that male (OR=2.931, 95%CI: 1.356-6.335), glucocorticoid therapy resistance (OR=5.261, 95%CI: 2.212-12.513), older age (OR=1.056, 95%CI: 1.022-1.091), elevated CA125 (OR=8.327, 95%CI: 2.448-28.319) and positive anti-TIF1-γ antibody (OR=7.529, 95%CI: 2.436-23.270) were risk factors of malignancy in PM/DM patients (all P<0.05); and complicated with ILD (OR=0.261, 95%CI: 0.099-0.689), complicated with arthralgia (OR=0.238,95%CI:0.073-0.779), elevated LYM count (OR=0.267, 95%CI: 0.103-0.691) were protective factors of malignancy in PM/DM patients (all P<0.05). The AUC of ROC curve predicting malignancy in PM/DM patients with the training concentrated prediction model was 0.887 (95%CI: 0.852-0.922), with a sensitivity of 77.9% and a specificity of 86.3%; it was 0.925 (95%CI: 0.890-0.960), 86.5% and 88.0% in the validated centralized prediction model, respectively. The correction curves of the training set and the validation set indicated that the predictive model had good calibration ability. Both the DCA curves of the training set and the validation set showed that the proposed predictive model had good clinical applicability. Conclusions: Older age, male, glucocorticoid therapy resistance, not complicated with ILD and arthralgia, elevated CA125, positive anti-TIF1-γ antibody, decreased LYM count are risk factors for malignancy in PM/DM patients, and the established nomogram model shows good predictive ability.

Determination of Ceruloplasmin Ferroxidase Activity, Iron &amp; Transferrin in Patients with Brain Tumor

Serum from healthy volunteers (n=30) was found to contain little ceruloplasmin (Cp) ferroxidase activity. Higher level of activity was found in the sera that obtained from patients (n=64) with benign and malignant brain tumors. The highest activity was measured in sera of malignant tumors patients. The differences were significant between Cp activity in sera of both type of patients in comparison to that of the control healthy group (p&lt;0.05), and between benign patients with that with malignant brain tumors (p&lt;0.01). Also the results of the current work illustrated the presence of a significant increase in [iron] (p&lt;0.01), as well as total iron binding capacity, in sera of the patients groups in comparison to that of healthy group. The increase in iron concentration was found to be accompanied with a significant decrease in transferrin concentration. This lead to an increase in the concentration of free iron, which is one of the pro oxidants that cause production of more free radicals.

Early surgical site infections in patients undergoing orthopaedic oncologic resection following change in perioperative antibiotic selection: A pre-post intervention study

BackgroundAt our institution, cefepime and vancomycin (FEP/VAN) were historically used for perioperative antimicrobial prophylaxis in malignant musculoskeletal tumor patients; however, prophylaxis was modified to cefazolin and vancomycin (CFZ/VAN) on June 6th, 2015. Due to the paucity of guidance and data, this study was conducted to optimize perioperative antimicrobial prophylaxis and compare early surgical site infection (SSI) rates within this patient population. MethodsThis was a single center, pre-post intervention, non-inferiority study. We included orthopedic surgery patients with musculoskeletal tumors who underwent resection and endoprosthetic or allograft replacement and received perioperative antibiotic prophylaxis. Perioperative antimicrobial prophylaxis included FEP/VAN or CFZ/VAN followed by oral antibiotic prophylaxis. The main outcome was the incidence of early culture-proven SSIs occurring within 90 days post-procedure. Results75 patients were included in each arm (150 total). Early SSI rates were low (FEP/VAN: 2.67% vs CFZ/VAN: 5.4%, P = 0.68) with no statistically significant differences. There was not a single independent factor associated with an increased odds of early SSI. ConclusionThis study supports CFZ/VAN as appropriate perioperative antibiotic prophylaxis in this patient population. There was no statistically significant change in SSIs with the change from FEP/VAN. Hospital length of stay differed but did not contribute to increased early SSI development odds.

CT-based radiomics models may predict the early efficacy of microwave ablation in malignant lung tumors

PurposeTo establish and validate radiomics models for predicting the early efficacy (less than 3 months) of microwave ablation (MWA) in malignant lung tumors.MethodsThe study enrolled 130 malignant lung tumor patients (72 in the training cohort, 32 in the testing cohort, and 26 in the validation cohort) treated with MWA. Post-operation CT images were analyzed. To evaluate the therapeutic effect of ablation, three models were constructed by least absolute shrinkage and selection operator and logistic regression: the tumoral radiomics (T-RO), peritumoral radiomics (P-RO), and tumoral-peritumoral radiomics (TP-RO) models. Univariate and multivariate analyses were performed to identify clinical variables and radiomics features associated with early efficacy, which were incorporated into the combined radiomics (C-RO) model. The performance of the C-RO model was evaluated by the area under the receiver operating characteristic (ROC) curve (AUC), calibration curve, and decision curve analysis (DCA). The C-RO model was used to derive the best cutoff value of ROC and to distinguish the high-risk group (Nomo-score of C-RO model below than cutoff value) from the low-risk group (Nomo-score of C-RO model higher than cutoff value) for survival analysis of patients.ResultsFour radiomics features were selected from the region of interest of tumoral and peritumoral CT images, which showed good performance for evaluating prognosis and early efficacy in three cohorts. The C-RO model had the highest AUC value in all models, and the C-RO model was better than the P-RO model (AUC in training, 0.896 vs. 0.740; p = 0.036). The DCA confirmed the clinical benefit of the C-RO model. Survival analysis revealed that in the C-RO model, the low-risk group defined by best cutoff value had significantly better progression-free survival than the high-risk group (p<0.05).ConclusionsCT-based radiomics models in malignant lung tumor patients after MWA could be useful for individualized risk classification and treatment.

Apatinib successfully administered in malignant tumour patients with severe hypotension: a case series, literature review, and considerations for treatment.

The most notable side-effect of apatinib, a novel antiangiogenic agent for the treatment of cancer, is hypertension, but there are few published studies regarding the use of apatinib to treat patients with cancer and severe hypotension. Here, the cases of three patients with tumours and severe hypotension are described: case 1, a 73-year-old male patient with lung squamous cell carcinoma who initially received radiotherapy and chemotherapy, and developed pneumonia and severe hypotension after 6 months; case 2, a 56-year-old male patient with nasopharyngeal carcinoma who was treated with chemotherapy and presented with fever and persistent hypotension; and case 3, a 77-year-old male patient with oesophageal cancer who was admitted with deglutition difficulty and severe hypotension. Apatinib was added to the treatment regimen of all three patients for antitumor therapy. Pneumonia, tumour progression, and severe hypotension improved noticeably in all patients within 1 month after receiving apatinib. Apatinib was associated with a positive effect on blood pressure stability, in synergy with other means of therapy, and the patients achieved satisfactory short-term clinical results. The role of apatinib in treating patients with cancer and hypotension merits further investigation.

Analysis of ATM germline mutations in solid tumors from Chinese patients.

10586 Background: Ataxia-telangiectasia mutated (ATM) is a tumor suppressor genes and plays an important role in the repair of DNA double-strand breaks (DSBs). Germ-line mutations of ATM gene result in the well-characterized ataxia telangiectasia syndrome, which manifests with an increased cancer predisposition, including a 20% to 30% lifetime risk of lymphoid, gastric, breast, central nervous system, skin, and other cancers. Novel therapies are in development that may improve the response to therapy of patients with ATM-deficient cancers including targeted therapy and immunotherapy. Nevertheless, the knowledge of incidence of ATM germline mutations in solid tumor remains poorly understood. Methods: We identified 19248 malignant solid tumors patients without selecting age or family history in a retrospective cohort. The pathogenicity of germline mutations was categorized based on American College of Medical Genetics and Genomics (ACMG) guidelines.The patients were divided into two groups, P/ LP group (with pathogenic or likely-pathogenic mutations), and Non-P/LP group (neither pathogenic nor likely-pathogenic mutation). Results: In 19248 patients with pan-cancer, 76 patients were found 76 heterozygous pathogenic or likely pathogenic germline mutations in ATM gene and the mutation frequency was 0.39%.Among these 76 carriers, 71 (93.4%) carried frameshift, nonsense or splice mutations (33 for frameshift,21 for missense and 17 for splice mutations). 4 carried missense mutations and 1 carried intron mutations. Eliminated a few types of cancers that had a smaller number (less than 50), the higher frequency of mutations contained cancers were pancreatic cancer (1.0%,7/692), breast cancer (0.71%,3/423), gastric cancer (0.6%,7/1094), The median age of group P/LP and non-P/LP group was 64 and 63 in pancreatic cancer，62 and 53 in breast cancer and 62 and 61 in gastric cancer. The three genes with the most somatic mutations were TP53, MUC16 and KRAS in P/LP group and were TP53, MUC16 and EGFR in non-P/LP group. There was no significant difference in mutation frequency of the four genes. The media TMB in P/LP group and non-P/LP group were 3.55 and 2.84 respectively and there was no statistical difference. In P/LP group，only one patients is high microsatellite instability who carryied a MLH1 and a ATM pathogenic mutation. Conclusions: This was the first report of the incidence of ATM germline mutations in Chinese solid tumors which expanded the understanding of ATM and provided a direction for clinical trial design of novel therapies. The relationship between germline mutations and cancer susceptibility will be studied in the future.

Antitumor regimens with gemcitabine are safe for tumor patients with COVID-19.

e18064 Background: COVID-19 infection is a worldwide health threatening disease, especially for malignant tumor patients. Systemic antitumor therapies may slower the body to clear virus, which results in delayed recovery from COVID-19. Thus, present guidelines or expert consensuses recommend to postpone antictumor therapies, which would unquestionablely retard treatment cycle and reduce therapeutic effect.Gemcitabine is a nucleoside analogue, which has shown antiviral activity as well as anticancer effect. Therefore, we assume that antitumor regimens with gemcitabine are also able to control COVID-19 reproduction. Such “kill two birds with one stone” regimen aims to not delay both anticancer treatment and COVID-19 turning negative. Methods: Four newly pathologically diagnosed advanced tumor patients from Department of Oncology, Second Xiangya Hospital, Central South University were collected, including three nasopharyngeal carcinoma (NPC) patients and one non-small cell lung cancer (NSCLC) patient. All of them were asymptomaticly infected with COVID-19 recently. Anticancer regimens with gemcitabine were adopted as initial treatment for these patiens. Three patients with NPC received gemcitabine combined with cisplatin (gemcitabine 1g/㎡ on day 1 and 8, cisplatin 25mg/㎡ from day 1 to 3).The patient with NSCLC accepted gemcitabine and PD-1 inhibitor (gemcitabine 1g/㎡ on day 1 and 8,tislelizumab 100mg on day 1 and 8). Throat swabs were performed to test the COVID-19 nucleic acid on day 1, 5, 9 and 21 during treatment. Results: Four patients are all middle-aged males of 43-59 years old. Their COVID-19 nucleic acid tests were positive on day 1 before infusing any drugs.The cycle count threshold (CT) of nucleic acid did not go down but gradually went up during antitumor treatment.Patients showed no COVID-19 related symptom during the whole treatment cycle. There were no greater than or equal to grade 3 adverse evens (AEs). Treatment related AEs included one patient with grade 2 leukopenia, and one patient with grade 2 fever. All patients normally finished the first anticancer cycle and successfully went to the second cycle. Conclusions: Antitumor regimens with gemcitabine is safe for patients both with manignancy and COVID-19. Cancer patients with COVID-19 can accept gemcitabine-related therapy as soon as possible intead of waiting until COVID-19 nucleic acid becoming negative.

Acupuncture and moxibustion for malignant tumor patients with psychological symptoms of insomnia, anxiety and depression: a systematic review and Meta-analysis.

To evaluate the efficacy and safety of acupuncture and moxibustion therapy (AMT) for cancer-related psychological symptoms (CRPS) of insomnia, depression and anxiety. Seven databases were searched for randomized controlled trials (RCT) comparing AMT to routine care or conventional drug for alleviating CRPS of insomnia, depression, and anxiety before April 2020. Two independent reviewers performed the data extraction and assessed the risk of bias. A total of 30 RCTs involving 2483 cancer patients were enrolled. The pooled analysis indicated that the treatment group was significantly better than the control group in improving the depression effective rate [= 1.29, 95% (1.12, 1.49), 0.0004], the quality of life (QOL) [1.11, 95% (0.80, 1.42), 0.000 01], and reducing Self-rating Anxiety Scale (SAS) [﹣7.75, 95% (﹣10.44, ﹣5.05), 0.000 01]. But there was no statistically significant difference between two groups in improving the insomnia effective rate [= 1.18, 95% (0.93, 1.51), 0.18]. The subgroup analysis showed the effectiveness of different intervention on CRPS. Compared with routine care, AMT helps relieve CRPS better evaluated by Pittsburgh Sleep Quality Index (PSQI), Hamilton Depression Scale (HAMD), and Self-rating Depression Scale (SDS), and depression effective rate. Compared with conventional drug, AMT performs better evaluated by SDS, depression effective rate and QOL. Moreover, the conventional drug showed higher treatment efficacy on improving insomnia effective rate compared with AMT. Compared to conventional drug, AMT plus conventional drug resulted in a significant reduction on CRPS such as PSQI, HAMD, SDS, and SAS, and also had a meaningful improvement on insomnia effective rate, depression effective rate and QOL. Fewer published reports were found on the adverse events of AMT than the conventional drug. The results suggested that AMT might be effective in improving CPRI; however, a definite conclusion could not be drawn because the quality of trials are low. Further large-scale and high-quality RCTs to verify the efficacy and safety of AMT on CRPS are still warranted.