BackgroundLung cancer (LC) patients account for 20% of all cancer-related venous thromboembolism (VTE) events, which is the second leading cause of mortality in these patients. However, there are no LC-specific risk scores for VTE prediction. Therefore, we considered that an LC-specific nomogram would more accurately predict VTE probability for these patients than the current widely used VTE risk scores.MethodsA total of 676 patients from the Guizhou Provincial People’s Hospital (January 2016 to September 2021) were included in this study, of which 169 LC patients who developed VTE were time-matched with 507 (1:3 ratio) LC patients without VTE. These patients were randomly divided at a 2:1 ratio to form primary (451) and validation (225) cohorts. The accuracy of six VTE risk scores was assessed by producing area under the receiver operating characteristic (ROC) curves (AUC). A multivariate analysis was employed to select predictive features, which were then used to construct a nomogram for VTE prediction.ResultsAmong the scoring methods, COMPASS-CAT had the highest AUC (0.799). The multivariate analyses revealed that acute infection, bed rest (>3 days), D-dimer level >1.47 μg/mL, adenocarcinoma, and carcinoembryonic antigen (CEA) >10.935 ng/mL were independent predictors of VTE risk for LC patients. The nomogram constructed using these factors enabled VTE prediction with a concordance index of 0.882 and an AUC of 0.894.ConclusionThis article describes the construction and validation of a new nomogram for VTE prediction in LC patients, which has a predictive performance that is higher than any of the widely used conventional risk assessment tools.

OBJECTIVE:Unresectable colorectal cancer liver metastasis (CRLM) remains a challenging obstacle that often prevents curative treatment. In this study, we retrospectively analyzed the efficacy and safety of high-intensity focused ultrasound (HIFU) as a local adjuvant therapy for systemic chemotherapy for patients with unresectable CRLM. HIFU is a noninvasive method previously demonstrated as efficacious for various solid malignancies.METHODS:Propensity score matching was used for the combination therapy group (HIFU group, n = 59) and the observation group receiving systemic therapy only (No-HIFU group, n = 59). In addition, the survival benefit, adverse effects, and factors affecting prognosis following HIFU were evaluated.RESULTS:The disease control rate was 77.9% and 62.7%, and the objective remission rate was 18.9% and 6.8% in the HIFU and non-HIFU groups, respectively. The survival analysis showed that median progression-free survival (mPFS) was 12.0 months and 11.0 months for the HIFU and non-HIFU groups, respectively (p = 0.002). The univariate and multivariate analysis showed that pre-treatment colorectal cancer liver metastasis lesion size was significantly associated with mPFS. In addition, patients that received a combination treatment for CRLM lesions <5.0 cm had a longer mPFS when compared to those receiving systemic therapy alone (13.0 months vs. 11.0 months, p = 0.001). In the HIFU group, patients with lesions <5.0 cm had a longer mPFS than patients with lesions ≥5.0 cm (13.0 months vs. 10.0 months, p = 0.04) (Figure 3B,C). Most treatment-related adverse events observed in both groups were grade 1-2. Only four cases (6.8%) of grade 1-2 skin burns were observed in patients in the HIFU group; no other statistically significant adverse events were observed.CONCLUSIONS:Our study showed that HIFU ablation targeting unresectable CRLM alongside systemic therapy safely and significantly improved local control rates and prolonged mPFS, especially for lesions smaller than 5.0 cm.

Background:It is now widely accepted that radiotherapy (RT) can provoke a systemic immune response, which gives a strong rationale for the combination of RT and immune checkpoint inhibitors (ICIs). However, RT is a double-edged sword that not only enhances systemic antitumor immune response, but also promotes immunosuppression to some extent. Nevertheless, many aspects regarding the efficacy and safety of this combination therapy remain unknown. Therefore, a systematic review and meta-analysis was performed in order to assess the safety and efficacy of RT/chemoradiotherapy (CRT) and ICI combination therapy for non-small cell lung cancer (NSCLC) patients.Methods:PubMed and several other databases were searched (according to specific criteria) to find relevant studies published prior to the 28th of February 2022.Results:3,652 articles were identified for screening and 25 trials containing 1,645 NSCLC patients were identified. For stage II-III NSCLC, the one- and two-year overall survival (OS) was 83.25% (95% confidence interval (CI): 79.42%-86.75%) and 66.16% (95% CI: 62.3%-69.92%), respectively. For stage IV NSCLC, the one- and two-year OS was 50% and 25%. In our study, the pooled rate of grade 3-5 adverse events (AEs) and grade 5 AEs was 30.18% (95% CI: 10.04%-50.33%, I2: 96.7%) and 2.03% (95% CI: 0.03%-4.04%, I2: 36.8%), respectively. Fatigue (50.97%), dyspnea (46.06%), dysphagia (10%-82.5%), leucopenia (47.6%), anaemia (5%-47.6%), cough (40.09%), esophagitis (38.51%), fever (32.5%-38.1%), neutropenia (12.5%-38.1%), alopecia (35%), nausea (30.51%) and pneumonitis (28.53%) were the most common adverse events for the combined treatment. The incidence of cardiotoxicity (0%-5.00%) was low, but it was associated with a high mortality rate (0%-2.56%). Furthermore, the incidence of pneumonitis was 28.53% (95% CI: 19.22%-38.88%, I2: 92.00%), grade ≥ 3 pneumonitis was 5.82% (95% CI: 3.75%-8.32%, I2: 57.90%) and grade 5 was 0%-4.76%.Conclusion:This study suggests that the addition of ICIs to RT/CRT for NSCLC patients may be both safe and feasible. We also summarize details of different RT combinations with ICIs to treat NSCLC. These findings may help guide the design of future trials, the testing of concurrent or sequential combinations for ICIs and RT/CRT could be particularly useful to guide the treatment of NSCLC patients.

Background Radiotherapy (RT)/Chemoradiotherapy (CRT) are important treatments for all stages of esophageal cancer (EC). The combination of immune checkpoint inhibitors (ICIs) with RT/CRT seems to be promising avenue for the treatment of EC. Therefore, a systematic review and meta-analysis was performed in order to assess the safety and efficacy of RT/CRT and ICI combination therapy for EC patients. Methods PubMed and several other databases were searched (according to specific criteria) to find relevant studies published prior to the 31st of December 2021. Results 1962 articles were identified for screening, and six trials containing 668 patients were identified and pooled to determine the one- and two-year overall survival (OS), which were 84.5% (95% confidence interval (CI): 69.9%-100%) and 68.3% (95% CI: 49.0%-95.1%), respectively. Additionally, the rate of pooled grade 3-5 adverse reactions was 41.0% (95% CI: 31.2%-51.2%). The rate of specific grade 3-5 adverse reactions are as follows: lymphopenia (36.8%-60%), esophagitis (20%), anastomotic leakage (18%), esophageal fistula (10%), pain (10%), leukopenia (5.3%-10%), esophageal hemorrhage (2.5%-5%), chyle leakage (3%), fatigue (5%), cough (2.7%-5%), diarrhea (2.7%), pulmonary embolism (2.5%) and allergic reaction (2.5%). The pooled rate of pneumonitis of grade 3-5 and grade 1-5 was 0.8% (95% CI: 0.1%-0.16%, I2: 0%) and 5.4% (95% CI: 2.0%-14.2%, I2: 82%). For thoracic complication, esophagitis was 63.6% (95% CI: 42.4%-80.6%), which appeared to be more frequent with the combination of ICIs to RT/CRT (12%-37.7%). Other thoracic complications include esophageal hemorrhage (2.5%-10%), esophageal fistula (6%-10%) and anastomotic leakage (6%-21%). Additionally, some of the trials did not report cardiac related adverse reactions. The subgroup analyses also revealed that the pooled rate patients with grade 3-5 pneumonitis was higher for CRT/RT with concurrent and sequential ICI treatment (1.9%) than other groups (0.8%). Conclusion This study suggests that the addition of ICIs to RT/CRT for EC patients may be both safe and feasible. However, larger randomized studies are needed to confirm these results.

目的 探讨肺癌合并静脉血栓栓塞症(Venous Thromboembolism,VTE)的危险因素;方法 收集我院2019年9月-2020年12月47例肺癌合并VTE患者(VTE组)的临床资料,选择同期入院但未合并VTE的353例患者(非VTE组)的临床资料,在Caprini血栓风险评估量表基础上,分析两组患者的一般情况、病理类型、临床分期、治疗方式、实验室检查等临床信息.结果 单因素分析结果提示,肺癌患者合并冠心病、下肢静脉曲张、既往有骨折病史,病理类型为腺癌、临床分期为IV期、接受置管、手术及抗血管生

目的 探讨ProGRP、NSE、CYFRA21-1、SCCAg和CEA表达水平的变化在晚期肺癌患者治疗中的意义.方法 回顾性研究2017年1月—2018年12月我院收治的晚期肺癌患者142例,动态监测其血清肿瘤标志物水平与病理类型、治疗效果以及复发预测的相关性.结果 血清肿瘤标志物水平在肺癌不同病理类型中存在差异,其中小细胞肺癌(SCLC)患者血清ProGRP、NSE水平均显著高于非小细胞肺癌(NSCLC)(P<0.05),肺鳞癌患者血清SCCAg水平显著高于其他病理类型(P<0.05),而不同病理类型患者的血清CYFRA21-1、CEA水平均无明显差异(P>0.05).治疗后,SCLC有效组和复发组血清ProGRP、NSE水平均显著降低(P<0.05),且ProGRP与SCLC患者的疗效及预后显著相关(P<0.05).治疗后,疗效评价达部分缓解(PR)的鳞癌患者血清CYFRA21-1、SCCAg水平均有所下降,其中血清CYFRA21-1水平较治疗前显著降低(P<0.05);但非鳞癌患者各项血清肿瘤标志物水平在不同疗效亚组中均未见明显差异(P>0.05).结论 动态联合监测血清肿瘤标志物对预测晚期肺癌患者的疗效有一定意义,值得深入研究.

目的 观察消癌平注射液联合化疗治疗老年晚期食管癌患者的临床疗效和安全性.方法 回顾性分析2016年9月至2018年12月贵州省人民医院收治的老年晚期食管癌患者59例,根据治疗方案的不同分为2组,治疗组予以消癌平注射液联合化疗,对照组予以单纯化疗,比较观察2组疗效和不良反应.结果 治疗组和对照组的有效率和疾病控制率比较差异均无统计学意义(χ2=0.136,P=0.712;χ2=0.031,P=0.861).2组不良反应均以消化道反应、血液学毒性为主.治疗组生活质量改善有效率优于对照组,差异有统计学意义(χ2=3.931,P=0.047).结论 消癌平注射液可以一定程度提高老年晚期食管癌患者的生活质量,减轻不良反应,安全性较高.