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   2015| October  | Volume 11 | Issue 6  
    Online since October 26, 2015

 
 
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ORIGINAL ARTICLES
Relationship between toxicities and clinical benefits of newly approved tyrosine kinase inhibitors in thyroid cancer: A meta-analysis of literature
Xiaobing Ye, Yiping Zhu, Juan Cai
October 2015, 11(6):185-190
DOI:10.4103/0973-1482.168182  PMID:26506873
Background: The aim of this meta-analysis was to analyze the relationship of toxicities and clinical benefits of newly approved lenvatinib and sorafenib to thyroid cancer (TC) in patients. Materials and Methods: Three major medical databases, PubMed, EMBASE, and ISI web of science were systematically searched to identify all studies on lenvatinib and sorafenib in TC. A meta-analysis was performed to clarify the toxicities and clinical benefits of newly Food and Drug Administration (FDA) approved lenvatinib and sorafenib to thyroid cancer. Results: Ten studies (n = 749) were included which evaluated the toxicities and clinical benefits of newly FDA approved lenvatinib and sorafenib to thyroid cancer. 537 (71.7%) of the 749 patients bearing TC (radioiodine-refractory, differentiated thyroid cancer) clinical benefits from lenvatinib or sorafenib, and serious adverse events occurred in 430 (57.4%) of the 749 patients ([risk ratio (RR) = 1.27, 95% confidence interval (CI) = (1.05–1.53), P = 0.01]). While 31 (4.1%) of the 749 patients died due to various reasons, that mainly accounts for severe bleeding events and cardiac arrest. The clinical benefit is obvious compared to deaths ([RR = 17.06, 95% CI = (12.08–24.11), P < 0.001]). Subgroup analyses were then conducted according to cancer type (radioiodine-refractory thyroid cancer [RR-TC] and TC). We found that in treating RR-TC, the clinical benefits are close to toxicities. While in treating TC, the clinical benefits are better than toxicities. And we found that sorafenib and lenvatinib might be proper to deal with TC (benefits rate 79.7%) compared to RR-TC (benefits rate 69.5%), taking consider of toxicities. Conclusions: Lenvatinib and sorafenib are useful in the treatment of TC. Although, their toxicities remain high (57.4%) in the patients, the death rate is controlled (4.1%). Take consider of toxicities, lenvatinib, and sorafenib are more useful for TC compared to RR-TC.
  4,186 254 -
Laryngeal cancer incidence and mortality in China, 2010
Shuang-Shuang Zhang, Qing-Min Xia, Rong-Shou Zheng, Wan-Qing Chen
October 2015, 11(6):143-148
DOI:10.4103/0973-1482.168175  PMID:26506866
Purpose: To analyze the incidence and mortality of laryngeal cancer in cancer registration areas of China in 2010. Materials and Methods: Until June 1, 2013, 219 population-based cancer registries submitted data of 2010 to the National Central Cancer Registry of China covering about 207,229,403 population, and 120 cancer registries were selected after quality evaluation for this analysis. Laryngeal cancer cases were selected from the database according to International Classification of Diseases 10th Revision coded as "C32." We calculated the crude incidence and mortality rates of laryngeal cancer by sex, age, and location (urban/rural). The China population in 2000 and Segi's population were used as standardized populations for the calculation of age-standardized rates. Results: In 2010, it was estimated that there were 20,272 new cases diagnosed as laryngeal cancer in China, including 17,703 males and 2569 females. The crude incidence rate of laryngeal cancer was 1.54/100,000 in 2010, accounting for 0.66% of overall new cancer cases. The age-standardized by China population (ASRcn) and by world population (ASRwld) were 1.18/100,000 and 1.20/100,000, respectively. Cumulative rate (0–74 years old) and truncated age-standardized rate (35–64 years old) were 0.15% and 1.98/100,000, respectively. Moreover, it was estimated that there were 11 914 cases died in laryngeal cancer in China, including 10,038 males and 1876 females. The crude mortality rate was 0.91/100,000, accounting for 0.61% of overall cancer deaths. The ASRcn and ASRwld were 0.68/100,000 and 0.69/100,000, respectively. Cumulative rate and truncated age-standardized rates were 0.08% and 0.88/100,000, respectively. Conclusions: Both incidence and mortality of laryngeal cancer in China were still low in 2010.
  4,016 213 -
Oral cavity cancer incidence and mortality in China, 2010
Chuan-Ming Zheng, Ming-Hua Ge, Shuang-Shuang Zhang, Zhuo Tan, Peng Wang, Rong-Shou Zheng, Wan-Qing Chen, Qing-Min Xia
October 2015, 11(6):149-154
DOI:10.4103/0973-1482.168176  PMID:26506867
Purpose: To analyze the incidence and mortality of oral cavity cancer in the cancer registration areas of China in 2010. Materials and Methods: Until June 1, 2013, 219 population-based cancer registries submitted the data of 2010 to the National Central Cancer Registry of China covering about 207,229,403 population, and 120 cancer registries were selected after the quality evaluation for this analysis. Oral cavity cancer cases were selected from the database according to the International Classification of Diseases-10 coded as "C00-C10, C11-C12." We calculated the crude incidence and mortality rates of oral cavity cancer by sex, age, and location (urban/rural). The China population in 2000 and Segi's population were used as standardized populations for the calculation of age standardized rates. Results: In 2010, it was estimated that there were 34,319 new cases diagnosed as oral cavity cancer in China, including 23,096 males and 11,223 females. The crude incidence rate of oral cavity cancer was 2.61/100,000 in 2010, accounting for 1.11% of overall new cancer cases, ranked the 20th in all cancer sites. The age standardized by China population (ASRcn) and by world population (ASRwld) were 2.06/100,000 and 2.02/100,000, respectively. Cumulative rate (0–74 years old) and truncated age standardized rate (35–64 years old) were 0.23% and 3.82/100 000, respectively. In 2010, it was estimated that there were 14,652 cases died in oral cavity cancer in China, including 10,363 males and 4289 females. The crude mortality rate of oral cavity cancer was 1.11/100,000 in 2010, accounting for 0.75% of overall cancer deaths, ranked the 20th in all cancer sites. The ASRcn and ASRwld were 0.86/100,000 and 0.85/100,000, respectively. Cumulative rate and truncated age standardized rates were 0.10% and 1.30/100,000, respectively. Conclusions: Both the incidence and mortality of oral cavity cancer in China were still low in 2010. Primary prevention such as smoking control, reducing alcohol consumption, changing the habit of chewing betel nut, and chemical prevention should be enhanced in the general population.
  3,942 232 -
Squamous cell carcinoma of cervical lymph nodes from an unknown primary site: The impact of neck dissection
Jianlin Lou, Shengye Wang, Kejing Wang, Chao Chen, Jianqiang Zhao, Liang Guo
October 2015, 11(6):161-167
DOI:10.4103/0973-1482.168178  PMID:26506869
Objective: To investigate the treatment strategies of squamous cell carcinoma of cervical lymph nodes from an unknown primary site (SCCUP) and the value of neck dissection (ND). Materials and Methods: The study included 133 patients referred to the Zhejiang Cancer Hospital from 2001 to 2012, with 109 males and 24 females. Distribution of patients by N status was as follows: N1 – 14 cases; N2a – 21 cases; N2b – 78 cases; N2c – 7 cases; and N3 – 13 cases. 104 patients underwent surgeries of ND while 29 patients underwent nonsurgical treatment. Among 104 patients, 24 underwent classic radical ND, 16 modified ND, 53 selective ND, and 11 extended ND. The selection of surgical strategy was determined by the extent and location of disease. According to the range of ND, 50 patients underwent ND for Levels I-V, 46 for Levels II-V, 4 for Levels I-III, 3 for Levels II-VI, and 1 for Levels I-VI. The data were analyzed with SPSS version 16.0. The differences between groups were calculated by χ2 tests. The actual overall survival (OS) rates were calculated by the Kaplan–Meier method. Different factors affecting the OS were determined by the log-rank test on univariate analysis. Cox regression was used to evaluate the multivariate analysis. Results: The 5-year OS rate of the whole cohort was 67.1%; and the median survival time was 70.0 months. The 5-year OS of ND group and of the non-ND group were 71.3% and 53.2%, respectively (P = 0.061). Cox analysis indicated that N stage (P = 0.000), bilateral neck metastasis (P = 0.001), extracapsular spread (ES) (P = 0.016), and ND (P = 0.028) were independent prognostic factors for the OS of SCCUP. 25 patients (18.8%) had neck recurrence or residue. The locoregional failure rate of ND group and of the non-ND group were 13.5% and 37.9%, respectively (P = 0.003). Logistic regression analysis indicated that higher N stage was the main risk factor for locoregional failure (P = 0.015). Conclusion: N stage, bilateral neck metastasis, ES, and ND were the main factors for the survival rate of SCCUP. N3 stage was the independent risk factor for locoregional failure. ND could significantly increase the locoregional control and may benefit the survival rate.
  3,927 228 -
Lower serum levels of bilirubin in the newly diagnosed lung cancer patients: A case-control study in China
Qian Song, Bing Wang, Sheng Wang, Yi-Min Zhang, Wen-Hu Chen
October 2015, 11(6):168-172
DOI:10.4103/0973-1482.168179  PMID:26506870
Purpose: A few prospective studies demonstrated that bilirubin levels were inversely associated with the risk of lung cancer. However, the retrospective study about the relationship between bilirubin levels and lung cancer in China was not available. So, we want to know whether there has a difference in serum bilirubin concentrations between normal people and lung cancer patients. Materials and Methods: Using a case-control study, we investigated the bilirubin levels in 317 patients with lung cancer and 317 age-, sex-matched controls from Zhejiang Cancer Hospital. Furthermore, we analyzed the associations between serum bilirubin expressions and baseline clinical features of lung cancer patients using a Wilcoxon rank sum test. Results: Bilirubin levels, including total bilirubin, direct bilirubin, and indirect bilirubin, were significantly lower in human lung cancer serum relative to normal control (P < 0.001), and the older (>50 years) had higher bilirubin levels compared with the younger (27–50 years) in lung cancer group. Besides, the duration of smoking was negatively related to bilirubin levels, but they did not reach statistical significance except for indirect bilirubin (P = 0.041). However, there was no difference in bilirubin levels between small cell lung cancer (SCLC) and non-SCLC (NSCLC), and we did not find that the bilirubin levels were correlated with sex, drinking status in patients of lung cancer. Conclusion: Serum total bilirubin, indirect bilirubin, and direct bilirubin levels of the patients with lung cancer were all significantly lower than those of control group (P < 0.001). Lower levels of bilirubin may be a risk factor for lung cancer, and it could serve as a potential screening biomarker for lung cancer. Large-scale investigations and additional improvements are urgently needed to demonstrate the mechanism and molecular pathway in order to achieve the clinical utility in the future.
  3,660 139 -
Long-term outcomes and failure patterns of patients with nasopharyngeal carcinoma staged by magnetic resonance imaging in intensity-modulated radiotherapy era: The Zhejiang Cancer Hospital's experience
Feng Jiang, Ting Jin, Xing-Lei Feng, Qi-Feng Jin, Xiao-Zhong Chen
October 2015, 11(6):179-184
DOI:10.4103/0973-1482.168181  PMID:26506872
Purpose: To study and report the clinical outcomes and patterns of failure in the patients with nasopharyngeal carcinoma (NPC) staged by magnetic resonance imaging (MRI) and treated with intensity-modulated radiotherapy (IMRT). Materials and Methods: From January 2007 to December 2011, 720 NPC patients without metastasis staged by MRI were treated with definitive IMRT at Zhejiang Cancer Hospital. The IMRT prescribed dose was 69 Gy to planning target volume (PTV) of gross disease in nasopharynx and 67.5 Gy to PTV of positive lymph nodes in 30 fractions, high risk, and low risk region PTV was 60 and 54 Gy in 30 fractions, respectively. The treatment outcomes and patterns of failure were observed. Results: Using the 7th edition of the American Joint Committee on Cancer staging system for NPC, the proportions of the 720 patients with Stages I, II, III, and IVa-b disease were 2.1% (15/720), 17.8% (128/720), 51.7% (372/720), and 28.5% (205/720), respectively. After the median follow-up period of 48 months (range: 3–89 months), a total of 146/720 (20.3%) patients had experienced failure: 37 (5.1%) at primary sites, 17 (2.4%) at regional sites, 79 (11.0%) at distant sites, and 13 (1.8%) at multiple sites. The 5-year overall survival, cancer-specific survival, disease-free survival, local relapse-free survival (LRFS), regional relapse-free survival, and distant metastasis (DM) free survival were 86.1%, 88.1%, 76.6%, 90.8%, 93.6%, and 87.2%, respectively. LRFS of T1 to T3 was all >90% and has no significant difference. In addition to N stage, T category, and neoadjuvant chemotherapy were independent predictors for DM in multivariate analysis. Conclusion: Our long-term outcome of large NPC series supports the effectiveness of IMRT for excellent local-regional control though up to 20% patients would develop DM, which becomes the main pattern of failure. T4 disease remained difficult to be cured not only for local recurrence but distant failure. A taxane-based combination chemotherapy might be useful to reduce DM in the induction setting and worth further studying.
  3,581 118 -
Genome-wide methylation profiling reveals new biomarkers for prognosis prediction of glioblastoma
Jiangong Ma, Xin Hou, Mingxuan Li, Hongyu Ren, Shumin Fang, Xiaobin Wang, Cheng He
October 2015, 11(6):212-215
DOI:10.4103/0973-1482.168188  PMID:26506879
Objective: To identify a specific hypermethylated molecular biomarker for human malignant glioblastoma prognosis. Materials and Methods: Genome-wide methylation profiling was performed on 33 tumors and 3 normal glioblastoma samples using the Infinium HumanMethylation450 microarray. Cluster analysis was carried out in these samples according to the differentiated methylated genes. DNA methylation of selected significant candidates was subsequently validated to analyze the association of methylation status of these genes with overall survival as well as gene expression. Results: We found 217 hypermethylated CpG sites located in 210 respective genes with significant differences in short- and long-term survival (STS and LTS) samples (P < 0.01). Cluster analysis revealed fine clustering of genes with LTS and STS. Of these, we selected 10 most hypermethylated genes, including IL11, RRAD, MS4A6A, SNAPC2, ALDH1A3, ADCY1, MMS19L, NDUFB8, POMC, and THSD4, to perform cluster analysis. It came out with the same fine classification and with survival time of these patients. The top ranking genes were further examined to compare their methylation status with the overall survival rate of patients, as well as with gene expression levels. Conclusion: We obtained a featured global profiling of DNA methylation in glioblastoma. Our findings strongly indicate that epigenetic silencing of IL11, RRAD, MS4A6A, SNAPC2, and ALDH1A3 are common events in glioblastoma which could be used as novel biomarkers for the prognosis of glioblastoma.
  3,495 173 -
Radiotherapy with temozolomide provides better survival in the newly diagnosed glioblastoma multiforme: A meta-analysis
Chonghao Wang, Na Zhu, Linshu Wang, Zhe An
October 2015, 11(6):196-201
DOI:10.4103/0973-1482.168184  PMID:26506875
Background: The optimal treatment for patients with newly diagnosed glioblastoma multiforme (GBM) remains controversial. The purpose of this meta-analysis was to systematically evaluate radiotherapy/temozolomide (TMZ) versus radiotherapy for treating newly diagnosed GBM. Materials and Methods: Six electronic databases (PubMed, EMBASE, MEDLINE, Web of Science, Cochrane Library, and CNKI) were searched for relevant publications up to November 05, 2014. RevMan version 5.2 software was used for statistical analysis. Results: A total of 9 studies were identified in this analyses, which included 986 patients. The summary risk ratio (RR) for overall survival and the progression-free survival (PFS) was the measure of interest. Results revealed that the addition of TMZ to radiotherapy resulted in a statistically significant survival benefit in poor prognosis patients with newly diagnosed glioblastoma (RR = 2.93 [95% confidence interval (CI) 2.29, 3.75], P < 0.00001). Moreover, radiotherapy plus TMZ was more beneficial than radiotherapy alone in improving PFS (RR = 3.52, [95% CI 2.53, 4.89], P < 0.00001). However, certain grade 3–4 hematological toxicities were significantly more common with TMZ. Conclusions: This meta-analysis suggests that radiotherapy/TMZ provides better survival than radiotherapy alone in treating GBM.
  3,425 232 -
Incidence and mortality of laryngeal cancer in Zhejiang cancer registry, 2000–2011
Huizhang Li, Youqing Wang, Chen Zhu, Xianghui Wang, Lingbin Du
October 2015, 11(6):155-160
DOI:10.4103/0973-1482.168177  PMID:26506868
Background: Laryngeal cancer is the one of the most prevalent cancer of the upper respiratory tract. Aiming to get a better understanding of the epidemiological characteristics and trends of laryngeal cancer in Zhejiang cancer registry in China during 2000–2011, we used the standardized quality control and statistical methods to analyze the incidence and mortality that were vital for making decision about laryngeal cancer prevention and control. Materials and Methods: Comparably high-quality data from eight population-based cancer registries in Zhejiang from 2000 to 2011 were qualified for analysis. The pooled data were stratified by area, sex, and age group. All incidence and mortality rates were age-standardized to the 2000 Chinese standard population and Segi's population, which were expressed per 100,000 populations. Average annual percent changes (AAPCs) and 95% confidence intervals of laryngeal cancer incidence and mortality were calculated for the temporal trends. The logarithmic trend line was also drawn to reflect the time trends of incidence and mortality. Results: During the 12 years, the 8 cancer registries covered a total of 81,758,277 person-year population (65,500,842 in urban and 16,257,435 in rural areas) including 41,315,911 person-year males and 40,442,366 person-year females. The age-standardized incidence rates were 1.10/105 by Chinese population and 1.12/105 by world population, respectively. The incidence of laryngeal cancer was relatively low in subjects under 44 years old. Then, it increased sharply after 45 years old and finally reached the peak in subjects of 75–79 years old. The age-standardized mortality rates of the Chinese population and world population were 0.28/105 and 0.35/105, respectively. The mortality of laryngeal cancer was at a low level in subjects under 49 years old. The rate dramatically increased in subjects over 50 years old, and then peaked in the age group of 80–84 years. The crude incidence of laryngeal cancer in Zhejiang cancer registration areas in 2000 was approximately 1.39/105, and it reached 1.78/105 in 2011, with the AAPC of 2.47%; the temporal trend line indicates that the incidence remained steady during the 12 years. The crude mortality of laryngeal cancer in Zhejiang registration areas in 2000 was about 0.30/105 and increased to 0.66/105, with the AAPC of 4.24% which showed no statistical significance; the temporal trend line indicates that mortality was going up to a certain extent, but not evident. Conclusions: Laryngeal cancer significantly influenced the quality of life for the patients. The comprehensive measures should be carried out to prevent the upward trend of laryngeal cancer.
  3,078 165 -
Serum level of interleukin-17 and interleukin-35 as a biomarker for diagnosis of thyroid cancer
Yi Lu, Ye Yuan
October 2015, 11(6):209-211
DOI:10.4103/0973-1482.168187  PMID:26506878
Objective: The aim of this study was to evaluate the serum level of interleukin-17 (IL-17) and IL-35 in thyroid cancer patients and its diagnostic value as a biomarker. Methods: Sixty-one thyroid carcinoma patients were recruited from January 2012 to December 2014 in our hospital. Of the 61 included cases, 42 subjects were pathology confirmed with thyroid cancer and other 19 cases were diagnosed with thyroid adenoma. The serum level of IL-17 and IL-35 were compared between the two groups. The diagnosed sensitivity, specificity, and receiver operating characteristic curve (ROC) for serum IL-17 and IL-35 were evaluated according to Bayes theorem. Results: The serum level of IL-17 were 16.3 ± 4.1 pg/ml and 9.4 ± 3.6 pg/ml for the thyroid cancer and thyroid adenoma patients respectively, with statistical difference (P < 0.05). The serum level of IL-35 were 48.8 ± 7.8 pg/ml and 62.3 ± 9.6 pg/ml for the thyroid cancer and thyroid adenoma patients, respectively, which indicated that the thyroid adenoma group was much higher with statistical difference (P < 0.05). The diagnosis sensitivity and specificity for serum IL-17 were 71.4% and 80.2% at the cutoff value of 12.1 pg/ml with the area under the ROC of 0.8239. The diagnosis sensitivity and specificity for serum IL-35 were 76.8% and 82.4% at the cutoff value of 57.6 pg/ml with the area under the ROC of 0.8722. Conclusion: The serum level of IL-17 and IL-35 was significantly different between thyroid cancer and thyroid adenoma patients, which could be a potential biomarker for the diagnosis of malignant thyroid tumor.
  2,958 203 -
Transoral laser microsurgery for recurrent laryngeal carcinoma after primary treatment: A systematic review and meta-analysis
Anqiao Zhong, Xiaohong Xu, Hongxia Fan, Lei Wang, Yikai Niu
October 2015, 11(6):173-178
DOI:10.4103/0973-1482.168180  PMID:26506871
Purpose: To evaluate the efficacy and oncologic outcomes of transoral laser microsurgery (TLM) for recurrent laryngeal carcinoma after previous treatment. Materials and Methods: A systematic search in PubMed was performed using mesh word for "laryngeal cancer," crossed with "recurrent," and "TLM." The primary endpoints, including overall survival (OS) rate, local control rate, and disease-specific survival (DSS) were summarized using RevMan software. Adverse events and complications were recorded if reported. Results: The pooled odds ratios (ORs) for main outcomes, including local control, 5-year OS, and DSS were 3.08 (95% confidential indexed [95% CI], 1.88–5.05), 2.29 (95% CI, 1.42–3.67), and 5.05 (95% CI, 2.75–9.27), respectively. The pooled OR for functional outcome, larynx preservation, was 3.82 (95% CI, 2.46–5.94), whereas the pooled risk difference of local recurrence was 45% (95% CI, 26–64%). Conclusions: It seems that TLM is an effective option for recurrent laryngeal cancer with regard to the high incidence of OS, local control, and especially organ preservation. However, more prospective studies are needed to confirm its efficiency.
  2,837 166 -
MicoRNA-451 is a novel tumor suppressor via targeting c-myc in head and neck squamous cell carcinomas
Huimin Wang, Guozheng Zhang, Zhiyan Wu, Baocai Lu, Dongjie Yuan, Xiao Li, Zhenmin Lu
October 2015, 11(6):216-221
DOI:10.4103/0973-1482.168189  PMID:26506880
Objective: Head and neck squamous cell carcinoma (HNSCC) represents as a common malignancy with increasing incidence in the worldwide. The fact of its poor survival rate urgently requires developing efficient predictive biomarkers for clinical use. MicroRNAs (miRNAs) recently represent as a novel direction for early diagnosis and prognosis prediction in HNSCC therapy. In this study, we comprehensively investigated the function and putative target of miRNA-451 in vitro. Methods: The expression of miRNA-451 was detected in HNSCC tissues and cell lines by real-time PCR. Forced expression or inhibition of miRNA-451 was done by transient transfection of mimics or inhibitor of miRNA-451 into indicated cells, respectively. Cell proliferation was evaluated by cell counting and crystal staining. Afterwards, we perform western blot to verify the expression of the miRNA-451 predicted target, c-myc, after miRNA-451 was overexpressed. Results: We showed that miRNA-451 was downregulated in paired HNSCC tissues as well as in cell lines. And overexpression of miRNA-451 in cells with low endogenous expression of miRNA-451 accelerated proliferation. To the contrast, knockdown of miRNA-451 in cells with high levels of miRNA-451 significantly reduced cell growth rate. Furthermore, we used bioinformatics and cellular methods to predict and prove that c-myc was targeted by miRNA-451, since forced expression of miRNA-451 leaded to decreased c-myc protein expression in HNSCC cells. Conclusion: Our findings identify miRNA-451 as a potential biomarker and suggest a key role of miRNA-451-c-myc pathway in HNSCC cell transformation, which could represent a novel therapeutic strategy in HNSCC treatment.
  2,824 167 -
A meta-analysis of neoadjuvant chemotherapy plus radiation in the treatment of locally advanced nasopharyngeal carcinoma
Xun He, Kairui Xu, Jiayi Guo, Yalan Zhu, Xiaomei Liang, Lixian Liu
October 2015, 11(6):205-208
DOI:10.4103/0973-1482.168186  PMID:26506877
Objective: We perform this meta-analysis was to evaluate the efficacy of neoadjuvant chemotherapy followed by radiation in the treatment of locally advanced nasopharyngeal carcinoma. Materials and Methods: We searched the database of Medline and Wanfang to screen and included the prospective, randomized controlled trials of neoadjuvant chemotherapy plus radiation versus radiotherapy in the treatment of locally advanced nasopharyngeal carcinoma. The pooled 5-year overall survival, 5 years disease free survival, recurrence rate, and metastasis rate were calculated by Stata version 11.0 statistical software. Results: Five prospective clinical studies were included in this meta-analysis. The total number of cases included in this study was 1277. The pooled 5 years overall survival and 5 years disease free survival were not statistical different between the neoadjuvant chemotherapy plus radiation group and radiotherapy group, respectively (P > 0.05). But the recurrence rate (odds ratio [OR] = 0.65, P < 0.05) and metastasis rate (OR = 0.61, P < 0.05) were significantly lower in the neoadjuvant chemotherapy plus radiation group compared to radiotherapy group. Conclusion: Neoadjuvant chemotherapy followed by radiation can decrease the risk of recurrence and metastasis but not improve the 5 years overall survival and 5 years disease free survival compared to radiotherapy alone in the patients with locally advanced nasopharyngeal carcinoma.
  2,715 164 -
Clinical and prognostic analysis in 32 pediatric nasopharyngeal carcinoma
Jing Chen, Fujun Hu
October 2015, 11(6):226-229
DOI:10.4103/0973-1482.168191  PMID:26506882
Objectives: To analyze the clinical outcome and prognostic factors of pediatric nasopharyngeal carcinomas, provide the basis for the rational treatment, and improve the cure rate. Materials and Methods: Thirty-two pediatric nasopharyngeal carcinoma patients with pathologically confirmed diagnosis and aged from 11 to 18 years old were retrospectively analyzed. All patients received intensity-modulated radiation therapy, dose of GTVnx 6400–7425 cGy, PGTVnx 6400–7050 cGy, PTV 15,400–6000 cGy, PTV 25,000–5490 cGy, and GTVnd 6000–6996 cGy were given. Among these patients, 29 received various chemotherapies. The Kaplan–Meier test and log-rank test of SPSS 17.0 statistic software package were used to calculate survival rate, compare and analyze the survival rates of each group. Cox model was used to analyzing the prognosis factors. Results: In this study, the median survival time was 44.5 months, and the median follow-up time is 62.5 months. The 1-, 3-, and 5-year overall survival rates were 100.0%, 93.2%, 85.7%, respectively, in stage III, and 94.8%, 88.3%, and 64.7% in stage IV. All patients 1-, 3-, and 5-year overall survival rates were 97.2%, 90.5%, and 74.2%. Univariate analysis resulted that N stage (P = 0.043), chemotherapy (P = 0.003) and the radiotherapy dose (P = 0.028) were significant factors for survival. On multivariate analysis, only the N stage influence survival. Conclusions: In pediatric nasopharyngeal carcinoma, the more important prognostic factors are N stage, chemotherapy, radiotherapy dose. Patients with N2-3 should be treated with combined chemotherapy and radiotherapy.
  2,669 150 -
Meta-analysis of concurrent chemoradiotherapy in the treatment of locoregionally advanced nasopharyngeal carcinoma
Yueshu Wang, Wei Ding, Chuang Chen, Zhihao Niu, Ming Pan, Hong Zhang
October 2015, 11(6):191-195
DOI:10.4103/0973-1482.168183  PMID:26506874
Background: With radiotherapy (RT) alone, the five-year overall survival (OS) rate for advanced nasopharyngeal carcinoma (NPC) can only reach 40%, the ratio of distant metastasis (DM) is 36–40%. This meta-analysis was performed to compare the clinical efficacy of concurrent chemoradiotherapy (CCRT) with RT alone in the treatment of locoregionally advanced NPC. Methods: The related literature were retrieved and reviewed by two independent investigators from the followed electronic databases: Review manager 5.3 software (Cochrane Collaboration, London, United Kingdom) was applied for statistical analysis. Results: A total of 16 trials with 2576 patients were recruited according to the criterion. The odds ratios of 3 and 5 years OS was 0.53 (95% confidence interval [95% CI]: 0.44–0.64) and 0.58 (95% CI: 0.48–0.71), which confirmed the significant improvement of CCRT compared with RT alone (P < 0.001). CCRT also reduced the risk of locoregional control failure and DM in locoregionally advanced NPC patients. Conclusions: The results suggested that CCRT was more beneficial when compared with RT alone in locoregionally advanced NPC patients. Further study is needed to perform to confirm this effect.
  2,621 145 -
Dua-energy virtual noncontrast imaging in diagnosis of cervical metastasis lymph nodes
Fei Fu, Anwei He, Yue Zhang, Baojiu Li, Yeda Wan
October 2015, 11(6):202-204
DOI:10.4103/0973-1482.168185  PMID:26506876
Objective: The aim of this study was to evaluate the clinical value of dua-energy virtual noncontrast imaging (DVNCT) in the diagnosis of cervical metastasis lymph nodes. Materials and Methods: From February 2014 to January 2015, 41 patients with 98 enlarged cervical lymph nodes were recruited in this study. All the enlarged lymph nodes were pathology confirmed. The patients received DVNCT and conventional noncontrast scan. The difference of average computed tomography (CT) value, signal to noise ratio, a contrast to noise ratio, image subjective assessment, and lesion detectability between virtual noncontrast imaging and conventional noncontrast scan were compared. The radiation dose of virtual noncontrast imaging and real noncontrast imaging of cervical lymph node were also compared. The diagnostic sensitivity and specificity for DVNCT was also evaluated. Results: No statistical difference of average CT value, signal to noise ratio, a contrast to noise ratio, image subjective assessment, and radiation dosage between virtual noncontrast imaging and conventional noncontrast scan were found. However, the radiation dosage of DVNCT was significant lower than that of conventional noncontrast scan (P < 0.05). The diagnostic sensitivity and specificity for malignant metastasis lymph node were 88.6% and 70.3% by DVNCT. Conclusion: DVNCT combined with contrast imaging can provide clear images in the diagnosis of enlarged cervical lymph nodes and reduce radiation dosage.
  2,131 84 -
Metronidazole amino acidum natrium combined with radiation in the treatment of nasopharyngeal carcinoma: A meta-analysis based on randomized controlled trials
Shengli Wei, Yizhuo Xing, Jixiang Liu, Lin Wang, Xiangli Yang, Fucun Song, Chunwei Yang, Lin Niu, Yang Yang, Fei Wu
October 2015, 11(6):222-225
DOI:10.4103/0973-1482.168190  PMID:26506881
Objective: We performed this meta-analysis to assess the metronidazole amino acidum natrium combined with radiation in the treatment of nasopharyngeal carcinoma. Materials and Methods: Two reviewers independently reviewed the databases of PubMed and CNKI. The prospective, randomized, controlled trials of metronidazole amino acidum natrium combined with radiation versus radiotherapy alone in the treatment of nasopharyngeal carcinoma were included in this meta-analysis. The objective response rate (RR) of 1-, 3-, and 5-year survival rates were pooled by statistical software. The publication bias was evaluated by Begg's funnel plot. Results: Sixteen prospective, randomized, controlled trials were finally included in this meta-analysis. The quality assessment showed that the method's quality was relatively poor. The pooled results showed that the metronidazole amino acidum natrium combined with radiation can significantly improve the objective RR for the primary lesion (RR = 1.37, 95% confidence interval [CI]: 1.23–1.53, P < 0.05) and neck metastasis lesion (RR = 1.36, 95% CI: 1.25–1.49, P < 0.05). For survival analysis, the combined treatment can significantly improve the 1-year survival (RR = 1.57, 95% CI: 1.28–1.93, P < 0.05), 3-year survival (RR = 1.23, 95% CI: 1.06–1.41, P < 0.05), and 5-year survival rates (RR = 1.27, 95% CI: 1.05–1.53, P < 0.05). Conclusion: Metronidazole amino acidum natrium combined with radiation can improve the objective RR and long-term survival compared to radiation therapy alone in the treatment of nasopharyngeal carcinoma.
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