Background:Occupational exposure to asbestos remains a major public health concern in China, particularly due to the long latency of asbestos-related diseases and the persistent use of asbestos in male-dominated industries. However, the long-term trends and drivers of asbestos-related cancer burden have not been fully quantified. Methods:This study used data from the Global Burden of Disease Study 2021 to estimate the burden of total cancer attributable to occupational asbestos exposure in China from 1990 to 2021. Key indicators included deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs), disaggregated by age, sex, cancer type, and time period. Joinpoint regression and age-period-cohort analyses were conducted to explore temporal dynamics, while decomposition analysis assessed the contributions of population growth, aging, and epidemiological changes. Results:In 2021, occupational asbestos exposure led to 29,020 deaths and 535,732 DALYs in China, with a significantly higher burden among males. The number of cases rose steadily from 1990, with sharp increases between 2000 and 2010, plateauing thereafter and rising again after 2017. Age-standardized rates showed dynamic trends: increasing until 2010-2011, declining until 2018, and rebounding modestly, particularly among females. The burden was highest among individuals aged 85-94 and showed a rightward shift over time. Lung cancer accounted for over 85% of asbestos-related DALYs, followed by mesothelioma, ovarian, and laryngeal cancers. Joinpoint and age-period-cohort analyses highlighted long-latency effects and generational shifts, while decomposition showed that aging and epidemiological changes were the dominant drivers of increased deaths, whereas DALYs were primarily driven by epidemiological factors and population growth. Conclusion:The burden of asbestos-related cancers in China remains substantial and is rising due to demographic aging and persistent exposure risks. Stronger occupational safety regulations, exposure surveillance, and asbestos bans are urgently needed to curb future disease burden.

BACKGROUND:Circulating cell-free DNA (cfDNA) 5-hydroxymethylcytosine (5hmC) is a promising epigenetic biomarker in cancer. Its prognostic role in nasopharyngeal carcinoma (NPC), however, remains unclear. METHODS:Genome-wide 5hmC profiling was conducted using 5hmC-Seal sequencing on cfDNA from 174 newly diagnosed NPC patients. Patients were randomly assigned to training (n = 105) and test (n = 69) sets. Differential analysis was performed by survival outcome, EBV status, and tumor stage. The primary endpoint was overall survival (OS); the secondary endpoint was event-free survival (EFS). A prognostic score based on a seven-gene 5hmC signature was developed using LASSO-Cox regression in the training set and validated in the test cohort. A nomogram integrating the 5hmC score, tumor stage, and EBV status was constructed. Model performance was assessed via Kaplan-Meier survival analysis, time-dependent ROC curves, calibration plots, and decision curve analysis (DCA). RESULTS:Marked 5hmC differences were detected between survivors and non-survivors. The 5hmC score stratified OS with AUCs of 0.83 (3-year) and 0.87 (5-year) in the training set and 0.78 (3-year) and 0.80 (5-year) in the test set, and remained predictive across EBV and stage subgroups. The integrated nomogram demonstrated robust calibration and offered the greatest net clinical benefit in DCA, with a 5-year C-index of 0.796. CONCLUSIONS:cfDNA 5hmC profiling enables noninvasive prognostic risk stratification in NPC. The proposed model may support personalized treatment planning and long-term management.

BackgroundNutritional deficiencies remain a pressing public health concern, especially in countries undergoing rapid demographic and epidemiologic transitions. In China, understanding the long-term trends and sex- and age-specific burden of nutritional deficiencies is crucial for designing targeted prevention and intervention strategies.MethodsWe used data from the Global Burden of Disease Study 2021 to estimate the burden of nutritional deficiencies in China from 1990 to 2021. Indicators included incidence, prevalence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs), stratified by age, sex, and type of malnutrition. We applied Joinpoint regression to examine temporal trends and conducted age-period-cohort (APC) and decomposition analyses to explore underlying drivers. Projections through 2030 were generated using Bayesian APC modeling.ResultsIn 2021, nutritional deficiencies led to 46.0 million incident and 146.1 million prevalent cases in China, with a significantly higher burden among women. While males had higher mortality and YLL rates, females showed higher prevalence, YLDs, and DALYs. The age-standardized burden declined substantially from 1990 to 2021, particularly for protein-energy malnutrition. DALYs declined by 92.8% for protein-energy malnutrition, and vitamin A deficiency incidence dropped by 81.2%. APC analysis revealed that younger cohorts experienced dramatically lower burdens, especially among children under 5, although older adults continued to carry a growing burden due to aging. Decomposition analysis identified epidemiologic improvements as the primary driver of reduced burden, but demographic factors like population aging mitigated these gains. Forecasts indicate further declines in disease burden through 2030, with consistently higher prevalence and DALY rates projected among females.ConclusionDespite substantial progress in reducing the burden of nutritional deficiencies in China over the past three decades, disparities persist by sex and age. Continued surveillance, alongside interventions targeting women and older adults, is essential to sustain progress and address residual gaps.

BACKGROUND:Laryngeal cancer attributable to occupational asbestos exposure remains a significant public health concern, particularly in industrialized regions. This study analyzes the burden, trends, and contributing factors of laryngeal cancer due to asbestos exposure in China from 1990 to 2021. METHODS:Data were obtained from the Global Burden of Disease Study (1990-2021). We analyzed age-standardized death rates, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs). Temporal trends were assessed using joinpoint and decomposition analyses, and an age-period-cohort (APC) model was applied to examine mortality and DALY trends across different cohorts. RESULTS:In 2021, there were 234 deaths and 4,430 DALYs due to laryngeal cancer attributable to occupational asbestos exposure, predominantly affecting males. Mortality rates declined from 1990 to 2008, followed by a rise until 2012, and a subsequent decline. YLDs showed a consistent increase over time. APC analysis revealed higher mortality and DALY rates in older age groups and earlier birth cohorts. Decomposition analysis indicated that epidemiological changes were the largest driver of increased deaths in men, followed by population growth and aging. For DALYs, aging and population growth were key drivers, while epidemiological changes mitigated the burden. CONCLUSIONS:The burden of laryngeal cancer attributable to asbestos exposure has declined overall, but disability rates continue to rise, particularly among males. Effective strategies targeting prevention, early detection, and management of asbestos exposure are needed to reduce the disease burden in China.

Nasopharyngeal carcinoma (NPC) has high metastatic potential and is hard to detect early. This study aims to develop a deep learning model for NPC diagnosis using optical imagery. From April 2008 to May 2021, we analyzed 12,087 nasopharyngeal endoscopic images and 309 videos from 1,108 patients. The pretrained model was fine-tuned with stochastic gradient descent on the final layers. Data augmentation was applied during training. Videos were converted to images for malignancy scoring. Performance metrics like AUC, accuracy, and sensitivity were calculated based on the malignancy score. The deep learning model demonstrated high performance in identifying NPC, with AUC values of 0.981 (95% confidence of interval [CI] 0.965-0.996) for the Fujian Cancer Hospital dataset and 0.937 (0.905-0.970) for the Jiangxi Cancer Hospital dataset. The proposed model effectively diagnoses NPC with high accuracy, sensitivity, and specificity across multiple datasets. It shows promise for early NPC detection, especially in identifying latent lesions.

Nasopharyngeal carcinoma (NPC) has high metastatic potential and is hard to detect early. This study aims to develop a deep learning model for NPC diagnosis using optical imagery. From April 2008 to May 2021, we analyzed 12,087 nasopharyngeal endoscopic images and 309 videos from 1,108 patients. The pretrained model was fine-tuned with stochastic gradient descent on the final layers. Data augmentation was applied during training. Videos were converted to images for malignancy scoring. Performance metrics like AUC, accuracy, and sensitivity were calculated based on the malignancy score. The deep learning model demonstrated high performance in identifying NPC, with AUC values of 0.981 (95% confidence of interval [CI] 0.965-0.996) for the Fujian Cancer Hospital dataset and 0.937 (0.905-0.970) for the Jiangxi Cancer Hospital dataset. The proposed model effectively diagnoses NPC with high accuracy, sensitivity, and specificity across multiple datasets. It shows promise for early NPC detection, especially in identifying latent lesions.

Larynx cancer poses a significant public health challenge in China, with rising incidence and mortality rates over the past decades. Understanding the long-term trends and underlying factors is crucial for effective intervention and policy formulation. Data were utilized from the global burden of disease (GBD) Study 2021 to analyze the incidence, prevalence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) due to larynx cancer in China from 1990 to 2021. Joinpoint regression analysis identified key changes in trends, while age-period-cohort (APC) analysis and decomposition analysis quantified the contributions of aging, epidemiological changes, and population growth to these trends. Our study found a significant increase in the incidence and prevalence of larynx cancer in China, particularly among males. The age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) for males were substantially higher than those for females. Decomposition analysis revealed that aging was the primary driver of increasing incidence and mortality rates, while epidemiological changes had a mitigating effect. Joinpoint analysis identified periods of rapid urbanization and economic growth as key turning points for increased incidence. Bayesian APC models projected a continued upward trend in incidence rates up to 2030. The rising burden of larynx cancer in China underscores the need for targeted public health interventions, including smoking cessation programs, environmental pollution control, and early detection strategies. Addressing gender disparities and implementing effective prevention measures are crucial to mitigating the impact of larynx cancer in China.

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Background and Purpose: Nasopharyngeal carcinoma (NPC) is a significant public health issue in China, with distinctive epidemiological characteristics and evolving trends. This study aims to analyze long-term trends in NPC burden from 1990 to 2021 and provide projections. Materials and Methods: Data from the Global Burden of Disease (GBD) database (1990-2021) was utilized to evaluate NPC metrics, including incidence, prevalence, mortality, and disability-adjusted life years (DALYs). Joinpoint regression identified significant changes over time. Age-period-cohort (APC) analyses assessed the effects of age, period, and cohort. A decomposition analysis identified factors influencing changes in NPC incidence, prevalence, and DALYs. Projections were made for future trends up to 2030. Results: In 2021, NPC significantly impacted China, with males experiencing higher incidence (5.16 per 100,000) and mortality rates (2.32 per 100,000) than females. NPC prevalence was 342,477 cases, with males accounting for 260,164. DALYs totaled 982,657, predominantly affecting males. From 1990 to 2021, the age-standardized incidence rate (ASIR) in China decreased from 4.64 to 3.42 per 100,000, while globally it declined from 1.74 to 1.38 per 100,000. Between 1990 and 2021, trends showed an initial decline in ASIR and age-standardized prevalence rate (ASPR), followed by a steady increase from 2006 onwards, with males experiencing more significant rises. Mortality rates showed a general downward trend, yet males remained disproportionately affected. Comparative global data indicated that while NPC metrics are declining worldwide, the burden remains higher in China. Decomposition analysis highlighted aging and population growth as major contributors to the NPC burden. Bayesian age-period-cohort (BAPC) projections indicated a continuing rise in age-standardized incidence and prevalence rates for both males and females up to 2030. Conclusions: The burden of NPC in China remains significant, particularly among the male population. Despite declining mortality rates, the increasing prevalence suggests that more people are living with NPC. Targeted public health interventions are urgently needed to address these gender-specific trends and reduce the disease burden.

Abstract Background Nasopharyngeal carcinoma (NPC) is prevalent in southern China. EBV DNA is the most useful biomarker in NPC. However, the value of EBV DNA in posttreatment NPC patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains unclear. Methods Sixty-four eligible NPC patients were enrolled between December 2022 and February 2023. Patients who met the following criteria were included: had non-metastatic NPC, completed radical treatment, were first firstly infected with SARS-CoV-2 and their EBV DNA changed from undetectable to detectable. Results At the end of follow-up, 81.25% (52/64) of patients were confirmed not to relapse with undetectable EBV DNA (no-relapse). In addition, 18.75% (12/64) of patients experienced relapse with consistent detection of EBV DNA (yes-relapse). For all 64 patients, the average time from diagnosis of coronavirus disease 2019 (COVID-19) to detection of detectable EBV DNA was 35.41 days (2 to 139 days). For 52 no-relapse patients, the average time from EBV DNA changing from detectable to undetectable was 63.12 days (6 to 147 days). The levels of EBV DNA were greater in yes-relapse patients than that in no-relapse patients, and the average of EBV DNA levels were 1216 copies/ml and 53.18 copies/ml, respectively. Using 62.3 copies/mL as the threshold, the area under the curve for EBV DNA was 0.88 for distinguishing yes-relapse patients from no-relapse patients. The sensitivity and specificity were 81.97% (95% CI 0.71–0.95) and 86.67% (95% CI 0.70–0.95), respectively. Conclusion For NPC patients infected with SARS-CoV-2, EBV DNA alone is insufficient for monitoring relapse after radical therapy. Long-term follow-up and underlying mechanistic investigations of EBV DNA changes are urgently needed.

This study aimed to explore the selection of induction chemotherapy (IC) cycles for stage N3 nasopharyngeal carcinoma (NPC). We employed propensity score matching (PSM) to categorize patients into 3-cycle and 4-cycle IC groups (IC = 3 and IC = 4). The log-rank and chi-squared tests were used respectively to evaluate the differences in survival and acute toxicities. Survival outcomes including overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and locoregional relapse-free survival (LRRFS) were evaluated among the two groups. After PSM, each group comprised 99 patients. The IC = 4 group exhibited markedly improved survival outcomes compared with the IC = 3 group. Multivariate analysis revealed that pre-EBV DNA was an independent risk factor affecting PFS and DMFS. For high-risk patients with pre-EBV DNA ≥ 7800 copies/ml, the IC = 4 group demonstrated greater survival compared to the IC = 3 group. Among low-risk patients with pre-EBV DNA < 7800 copies/ml, both groups showed comparable survival outcomes. In terms of acute adverse reactions, the IC = 4 group experienced higher incidences, particularly with grade 2-4 alanine transaminase elevation and thrombocytopenia. For stage N3 NPC, pre-EBV DNA could be a powerful predictor for guiding the selection of IC cycles. The IC = 4 regimen is probably more beneficial to high-risk patients due to superior survival, while for low-risk patients, the IC = 3 regimen may be sufficient.

OBJECTIVE:To evaluate the diagnostic value of 5-hydroxymethylcytosines (5hmC) in circulating cell-free DNA (cfDNA) for nasopharyngeal carcinoma (NPC) and to develop a diagnostic model. METHODS:Genome-wide 5hmC profiles in cfDNA from 174 NPC patients and 146 non-cancer individuals were analyzed using the 5hmC-Seal technique. A cfDNA 5hmC-based diagnostic model to identify NPC patients was developed using least absolute shrinkage and selection operator (LASSO) logistic regression, and performance was evaluated with receiver operating characteristic (ROC) curves and confusion matrices. RESULTS:The 5hmC-Seal data from patients with NPC showed a different genome-wide distribution than non-tumor samples. Our initial analysis revealed a 12-gene-based 5hmC marker panel to be an accurate diagnostic model effectively distinguishing between NPC samples and non-cancerous samples (training set: area under curve (AUC)= 0.97 [95 % CI: 0.94-0.99]; and test set: AUC= 0.93 [95 % CI: 0.88-0.98]) superior to EBV DNA testing. The diagnostic score performed well in differentiating the non-cancer subjects from early-stage NPC (training set: AUC=0.99 [95 % CI: 0.98-1]; test set: AUC=0.98 [95 % CI: 0.95-1]), and advanced-stage NPC (training set: AUC=0.96 [95 % CI: 0.93-0.99]; test set: AUC=0.93 [95 % CI: 0.88-0.98]). Notably, in EBV-negative patients, the diagnostic scores showed excellent capacity for distinguishing EBV-negative patients with NPC from non-cancer subjects in both the training set (AUC= 0.94 [95 % CI: 0.88-1]) and test set (AUC=0.91 [95 % CI: 0.81-1]). CONCLUSION:5hmC modifications in cfDNA are promising noninvasive biomarkers for NPC, offering high sensitivity and specificity, particularly for early-stage and EBV-negative NPC.

Abstract Background Hypothyroidism (HT) and subclinical HT after radiotherapy is frequent in nasopharyngeal carcinoma (NPC) patients, results in negative impact on patients' quality of life. The percentage of thyroid volume receiving more than 40 Gy (V40) ≤ 85% was reported to be a useful dose constraint to adopt during intensity-modulated radiation therapy (IMRT) planning. This study aims to verify whether V40 ≤ 85% can be used as an effective dose constraint in IMRT planning in a randomized clinical trial. Methods This single-center 1:1 randomized clinical trial was conducted in Fujian province hospital between March 2018 and September 2022. All patients were treated with IMRT and randomized to induction chemo followed by concurrent chemo-IMRT or concurrent chemo-IMRT alone. Ninety-two clinically NPC patients were included in this study. The thyroid function tests were performed for all patients before and after radiation at regular intervals. Thyroid dose-constraint was defined as V40 ≤ 85%. The primary outcome in this study was subclinical HT. Results Median follow up was 34 months. Significant difference in the incidence of subclinical HT between the thyroid dose-constraint group and unrestricted group was observed (P = 0.023). The risk of subclinical HT in the thyroid dose-constraint group was lower than that in the unrestricted group (P = 0.022). Univariate and multivariate cox regression analysis indicated that thyroid dose-constraint was a protective effect of subclinical HT (HR = 0.408, 95% CI 0.184–0.904; HRadjusted = 0.361, 95% CI 0.155–0.841). Conclusion V40 ≤ 85% can be used as an effective dose constraint in IMRT planning to prevent radiation-induced subclinical HT.

(1) Background: Prophylactic percutaneous endoscopic gastrostomy (PEG) maintained nutritional status and improved survival of patients with locally advanced nasopharyngeal carcinoma (LA-NPC). However, the role of PEG in patients’ quality of life (QoL) is still controversial. We aimed to investigate the effect of PEG on the QoL of patients with LA-NPC without progression. (2) Methods: Patients with LA-NPC between 1 June 2010 and 30 June 2014 in Fujian Cancer Hospital were divided into PEG and non-PEG groups. The QoL Questionnaire core 30 (QLQ-C30), incidence of adverse effects, weight, and xerostomia recovery were compared between the two groups of patients without progression as of 30 June 2020. (3) Results: No statistically significant difference in the scores of each QLQ-C30 scale between the two groups (p > 0.05). The incidence of xerostomia was higher in the PEG group than in the non-PEG group (p = 0.044), but the association was not seen after adjusting for gender, age, T, and N stage (OR: 0.902, 95%CI: 0.485–1.680). No significant difference in the incidence of other adverse effects as well as in weight and dry mouth recovery (p > 0.05). (4) Conclusion: PEG seems not to have a detrimental effect on long-term Qol, including the self-reported swallowing function of NPC patients without progressive disease.

BACKGROUND:In intensity-modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC), priority is often given minimize dose to the critical organs at risk (OARs) to avoid potential morbid sequelae. However, in T4 NPC, dosimetric inadequacy enforced by dose constraints on OARs may significantly impact tumor control.METHODS:This was a single-institute cohort that patients diagnosed between July 2005 and December 2010 with T4 NPC treated with IMRT. All patients were re-classification according to the 7th-AJCC stage.RESULTS:Overall, the average doses such as Dmax , D1% , D2% and D1cc for various Central nervous system (CNS) OARs including brainstem, optic nerve, chiasm, temporal lobes and spinal cord were found to exceed published guidelines as RTOG0225. However, no clinical toxicities were seen during the follow-up period except for 13% patients with temporal lobe necrosis.CONCLUSION:Our retrospective review showed that its feasible to maximize gross tumor volume dose coverage while exceeding most CNS OAR constraint standards, with ideal local control and no obvious increase of craniocerebral toxicity.

Abstract Background The objective of this study was to examine the significance of pre-treatment Epstein-Barr virus DNA (pre-DNA) in determining the optimal number of induction chemotherapy cycles (ICC) prior to concurrent chemoradiotherapy (CCRT) in patients with stage N3M0 nasopharyngeal carcinoma (NPC). Methods In this research, we used propensity score matching to divide enrolled patients into 3 cycles (IC = 3) or 4 cycles (IC = 4) group based on the number of ICC. To assess the disparity in survival and toxicities, the log-rank and chi-squared tests were employed, respectively. The main endpoint was distant metastasis-free survival (DMFS). Additional endpoints included overall survival (OS), progression-free survival (PFS), and locoregional relapse-free survival (LRRFS). Multivariate cox proportional hazard analysis identified potential independent prognostic factors. Results Of 369 patients, 194 were enrolled, with 97 and 97 included in IC = 3 and IC = 4 group respectively. The IC = 4 group exhibited markedly superior 3-year OS, PFS, DMFS, and LRRFS compared to the IC = 3 group (all p < 0.05), while experiencing higher adverse reactions, although not statistically significant. Based on DMFS, the cut-off value of pre-DNA was 8700 copies/ml (area under curve, 0.593; sensitivity, 0.794; specificity, 0.481). For low-risk patients with pre-DNA < 8700 copies/ml, both groups demonstrated comparable survival results. Nonetheless, the IC = 4 group exhibited better survival in 3-year OS, PFS, DMFS, and LRRFS compared to the IC = 3 group among high-risk patients with pre-DNA ≥ 8700 copies/ml (78.2% vs 49.1%, 69.1% vs 40.0%, 74.5% vs 40.0%, 70.9% vs 47.3%, all p < 0.05). Additionally, in high-risk group, ICC was considered as a protective element for OS and DMFS according to multivariate analysis. Conclusions For N3M0 stage NPC, pre-DNA could be a powerful predictor to guide the optimum number of ICC. IC = 4 was recommended for high-risk patients due to superior survival, while for low-risk patients, IC = 3 might be sufficient.

Background: It remains controversial whether the application of chemotherapy has an impact on recurrent nasopharyngeal carcinoma (rNPC) patients with salvage radiotherapy. Here, we aimed to evaluate treatment outcomes of rNPC patients and derive a prognostic model to assess the benefit of chemotherapy in patients with re-radiotherapy. Methods: This study was conducted as a retrospective study. In total, 340 rNPC patients treated with salvage intensity-modulated radiotherapy (IMRT) or radiochemotherapy (RCT) from October 2006 to September 2019 were included in this study. Overall survival (OS) was the primary outcome. Kaplan-Meier method was employed to detect the prognostic difference with Log-rank tests. The Cox regression analysis was performed to explore the potential prognostic factors while the multivariate Cox analysis was used to identify candidate variables for the prognostic model of OS. Results: The 5-year actuarial rates of OS, progression-free survival, loco-regional progression-free survival, and distant metastases-free survival did not show significant difference between the IMRT and RCT groups ( P > .05). Age at recurrence and rT category were found to be the independent prognostic factors for OS. We found that rNPC patients suffered poor OS in the high-risk group (patients with higher age at recurrence and advanced rT category) (high-risk vs low-risk, HR = 1.87, 95% CI: 1.36-2.57, P < .001). Salvage RT alone may be superior to RCT for patients in the low-risk group (RCT group vs RT group, HR = 1.89, 95% CI: 1.11-3.20, P = .038). Conclusion: Salvage RT combined with chemotherapy cannot improve survival outcomes for rNPC. More novel clinical trials should be explored to develop individualized strategies to improve survival and minimize toxicities.

Purpose We aimed to analyse the correlation between prostaglandin D2 synthase (PTGDS) and a diffuse large B-cell lymphoma (DLBCL) prognosis. Methods We retrospectively collected two hundred paraffin-embedded tissue specimens that were pathologically diagnosed as DLBCL in the Fujian Tumour Hospital between January 2014 and December 2018. An abundance of paraffin-embedded tumour tissues were obtained. Twenty patients with lymphocyte-rich, benign, tissue-reactive, hypertrophic tonsillitis were selected as controls. Wax blocks were selected for primary cases and the controls were screened by professional pathologists. The levels of prostaglandin D2 synthase (PTGDS) and the EMT-related molecules, E-cadherin and vimentin, were detected by immunohistochemistry in clinical samples. A chi-square test revealed the correlations between PTGDS expression and clinicopathological characteristics, including age, sex, primary site, clinical stage, immunotyping, and International Prognostic Index (IPI) score. The Kaplan–Meier survival analysis was performed, and the diagnostic value was evaluated by receiver operating characteristic (ROC) curve analysis. Results A total of 138 cases (69%) were found to be PTGDS positive (> 30% positive cells). PTGDS staining was negative (< 30% positive cells) in 62 cases (31%). We collected the corresponding clinicopathological information and found that PTGDS expression was not significantly related to the patients’ age, tumour stage, presence of extranodal invasion, or IPI score. According to the follow-up data, patients with low PTGDS expression had poor progression-free survival (PFS) and overall survival (OS), with 2-year PFS and OS rates of 41.7% and 50%, respectively. The 2-year PFS and OS rates of PTGDS-positive patients were 89.3% and 92.9%, respectively ( P < 0.0001), and the differences were significant. Conclusion We found that the expression level of PTGDS is significantly correlated with the prognosis of diffuse large B-cell lymphoma.

Background and purposeTo investigate the feasibility of level Ib sparing in selected nasopharyngeal carcinoma (NPC) patients during intensity-modulated radiation therapy (IMRT) based on the International Guideline.Patients and materialsPatients with histologically-proven NPC who received definitive IMRT at our group were candidates for this analysis. Other eligibility criteria for analysis were designed according to the recommendation of International Guideline for selective coverage of level Ib. Survival outcomes focused on regional recurrence-free survival (RRFS) and level Ib recurrence rate were analyzed.ResultsA total of 450 patients were included, 60 of them received level Ib-covering IMRT due to the first three principles of the International Guideline according to our protocol. Of note, patients with level Ib involvement would receive ultrasound guided puncture, only those with positive pathological results would undergo level Ib-covering IMRT. For the remaining 390 patients who only fulfilled the last two criteria and/or level Ib involvement with negative pathological results, level Ib-sparing IMRT was delivered, with a median follow-up time of 112 months (range 6 to 194 months), reported 5- and 10-year RRFS were 95.4% and 92.9%, respectively. Twenty-two patients occurred regional recurrence at censorship (median 44.5 months), only 4(4/390, 1.03%) were recorded as level Ib recurrence.ConclusionLevel Ib-sparing IMRT should be safe and feasible for patients who only had level II involvement with ECE, and/or had a MAD of greater than 2 cm in level II, and/or level Ib involvement with negative pathological results. Further well-designed multi-center prospective trials should be conducted.

Background No standard radiotherapy regimens have been established for the treatment of de novo metastatic nasopharyngeal carcinoma (mNPC) with bone-only metastasis. The current study aimed to investigate the efficacy of palliative chemotherapy (PCT) plus locoregional radiotherapy (LRRT) with or without local radiotherapy (RT) for metastatic bone lesions in mNPC. Methods We retrospectively analysed 131 de novo patients with mNPC who had bone-only metastasis and received at least two cycles of PCT with LRRT. The difference in survival was evaluated by the log-rank test. Univariable and multivariable analyses were performed by Cox regression. Results The median overall survival (OS) and progression-free survival (PFS) were 33.0 months and 24.0 months, respectively. Patients with five or fewer metastatic bone lesions had significantly longer OS (72.0 months vs. 23.0 months, Hazard ratios (HR) = 0.45, p < 0.001) and PFS (48.0 months vs. 15.0 months, HR = 0.52, p = 0.004) than those who had more than five metastatic bone lesions. Patients who received four or more cycles of chemotherapy were associated with significantly longer OS (unreached vs. 19.0 months, HR = 0.27, p < 0.001) and PFS (66 months vs. 16.0 months, HR = 0.32, p < 0.001). Multivariate analysis confirmed that fewer bone metastases (≤ 5) and more chemotherapy cycles (≥ 4) were favourable prognostic factors for OS. Subgroup analysis revealed that RT to metastatic bone lesions tended to prolong OS (83.0 months vs. 45.0 months) and PFS (60 months vs. 36.5 months) in patients with five or fewer metastatic bone lesions than in those without RT to metastatic bone lesions ( p > 0.05). Patients who received a RT dose > 30 Gy had neither better OS (63.5 months vs. 32.0 months, p = 0.299) nor PFS (48.0 months vs. 28.0 months, p = 0.615) than those who received a RT dose ≤30 Gy. Conclusions Local RT to bone metastases may not significantly improve survival in patients with de novo mNPC with bone-only metastasis who have already received PCT plus LRRT. Receiving four or more cycles of chemotherapy can significantly prolong survival and is a favourable independent protective factor.