Purpose:This study aims to explore the clinicopathological features related to extramedullary multiple myeloma (EMM) occurrence and evaluate prognosis differences between patients with primary EMM (PEMM) and those with relapsed or refractory EMM (R/REMM). Patients and Methods:The laboratory test results, clinical, histopathological and immunophenotypic characteristics, cytogenetic changes and prognosis of 203 patients with MM were obtained. The patients were categorized into EMM+ and EMM- groups. Patients in the EMM+ group were further categorized into the PEMM and R/REMM groups based on the time of EMM occurrence, for further comparison. Results:The incidence of EMM was 24.6% (50/203). Further classification of EMM showed that the incidence of PEMM was 16.3% (33/203), that of R/REMM was 8.4% (17/203).The proportion of CD20+ was significantly lower than that in the EMM- group (2.0% vs 15.0%, P =0.013).In the EMM+ group,70% (35/50) of patients had elevated levels of β2-MG (≥ 5.5 mmol/L), and 24% (12/50) had elevated levels of serum calcium (> 2.65 mmol/L), higher than that in the EMM- group (41.2% and 12.4%, respectively), and the differences were statistically significant (P < 0.001 and P = 0.049, respectively).Patients with R/REMM were more likely to have plasma cell leukemia and lower albumin levels than those with PEMM (P = 0.021 and 0.014, respectively). The median OS of patients in the EMM- group was longer than that of patients in the EMM+ group (59.6 vs 47.0 months, P=0.197).The median OS of patients in the PEMM group was longer than that of patients in the R/REMM group and the difference was statistically significant (53.3 vs 30.5 months,P= 0.015). Univariate and multivariate survival analyses revealed that R/REMM is an independent adverse prognostic factor (P = 0.003 and P < 0.001 respectively),and PEMM was not associated with OS in patients with MM (P = 0.503 and P = 0.545, respectively). Conclusion:R/REMM is an independent adverse prognostic factor for patients with MM. Patients with R/REMM are more likely to have plasma cell leukemia and lower albumin levels.

Aims In recent years, patients with programmed cell death-Ligand 1 (PD-L1)-positive oesophageal squamous cell carcinoma (OSCC) have been able to benefit from immunotherapy. However, method for improving the treatment efficacy of PD-L1-positive patients is a problem that needs further consideration. Studies on the relationship between human epidermal growth factor receptor 2 (HER2) and PD-L1 expression have recently been reported in certain cancers, but the relationship between PD-L1 and HER2 expression in OSCC is still unclear. Methods A total of 263 patients with OSCC were included in the study. PD-L1 protein expression and HER2 protein expression were analysed by immunohistochemistry (IHC), and fluorescence in situ hybridisation (FISH) was performed to assess HER2 gene amplification. The significance of differences between HER2 status, PD-L1 status and clinicopathological parameters was assessed. The relationship between PD-L1 status and HER2 status was examined. Results Of the 263 OSCC cases, the PD-L1-positive expression rates were 39.2% and 77.2% in OSCC for Tumour Proportion Score (TPS) and Combined Positive Score (CPS), respectively, and PD-L1 expression was associated with the degree of tumour differentiation. The HER2 expression was positive in 24% (63/263) of cases based on IHC and FISH. HER2 expression was not significantly associated with clinicopathological characteristics. PD-L1 TPS expression and CPS expression were significantly positively correlated with HER2 expression in OSCC. Conclusions PD-L1 expression was significantly positively correlated with HER2 expression in OSCC. The results provide valuable insight for the future application of HER2-targeted therapy combined with immunotherapy in OSCC.

AbstractOxidative stress and the immune microenvironment both contribute to the pathogenesis of esophageal squamous cell carcinoma (ESCC). However, their interrelationships remain poorly understood. We aimed to examine the status of key molecules involved in oxidative stress and the immune microenvironment, as well as their relationships with each other and with clinicopathological features and prognosis in ESCC. The expression of programmed death‐ligand 1 (PD‐L1), CD8, nuclear factor erythroid‐2 related factor‐2 (NRF2), and NAD(P)H quinone oxidoreductase 1 (NQO1) was detected using immunohistochemistry in tissue samples from 176 patients with ESCC. We employed both combined positive score (CPS) and tumor proportion score (TPS) to evaluate PD‐L1 expression and found a positive correlation between CPS and TPS. Notably, PD‐L1 expression, as assessed by either CPS or TPS, was positively correlated with both NRF2 nuclear score and NQO1 score in stage II–IV ESCC. We also observed a positive correlation between the density of CD8+ T cells and PD‐L1 expression. Furthermore, high levels of PD‐L1 CPS, but not TPS, were associated with advanced TNM stage and lymph node metastases. Moreover, both PD‐L1 CPS and the nuclear expression of NRF2 were found to be predictive of shorter overall survival in stage II–IV ESCC. By using the Mandard‐tumor regression grading (TRG) system to evaluate the pathological response of tumors to neoadjuvant chemotherapy (NACT), we found that the TRG‐5 group had higher NRF2 nuclear score, PD‐L1 CPS, and TPS in pre‐NACT biopsy samples compared with the TRG‐3 + 4 group. The NQO1 scores of post‐NACT surgical specimens were significantly higher in the TRG‐5 group than in the TRG 3 + 4 group. In conclusion, the expression of PD‐L1 is associated with aberrant NRF2 signaling pathway, advanced TNM stage, lymph node metastases, and unfavorable prognosis. The dysregulation of PD‐L1 and aberrant activation of the NRF2 signaling pathway are implicated in resistance to NACT. Our findings shed light on the complex interrelationships between oxidative stress and the immune microenvironment in ESCC, which may have implications for personalized therapies and improved patient outcomes.

Abstract Background Bone marrow fibrosis (BMF) severely impacts both the quality of life and the efficacy of diagnostic procedures. However, the correlation between BMF and clinicopathological features, cytogenetic changes, and prognosis of newly diagnosed multiple myeloma (NDMM) remains unclear. This study determined the incidence, patient characteristics, and clinical outcomes of patients with NDMM with BMF. Methods The clinical data, histological features, and clinical outcomes of patients with NDMM were collected. Reticular fiber staining was performed on the enrolled cases, and the degree of reticular fiber overgrowth was graded. Patients with MF-2 and MF-3 were classified as the BMF+ group, and those with MF-0 and MF-1 were classified as the BMF- group, and BMF incidence was calculated. The differences in clinical data, histological features, and clinical outcomes between the BMF+ group and the BMF– group were compared. Results A consecutive series of 146 patients with NDMM were included. The incidence of MF-0, MF-1, MF-2, and MF-3 was 7.53% (11/146), 34.93% (51/146), 51.37% (75/146), and 6.16% (9/146), respectively. The incidence of BMF—MF-2 and MF-3—was 57.53% (84/146). A significant correlation was identified between the pattern of infiltration and BMF (P < 0.001). In the BMF- group, the distribution of cases with interstitial, nodular, and diffuse infiltration of plasma cells was 16 (25.8%), 21 (33.9%), and 25 (40.3%), respectively. Conversely, in the BMF+ group, these values for interstitial, nodular, and diffuse tumor cells were 9 (10.7%), 15 (17.9%), and 60 (71.4%). Furthermore, BMF was associated with a diffuse infiltration pattern. The overall survival (OS) of the BMF+ group (39.1 months; 95% confidence interval [CI]: 34.0–44.3) was lower than that of the BMF- group (45.4 months; 95% CI: 39.5–51.3), but there was no significant difference between the two groups (P = 0.221). Univariate and multivariate analyses showed that the BMF+ status was not associated with OS in patients with NDMM (P = 0.381 and P = 0.748, respectively). Conclusions Our findings suggest that BMF is linked to a diffuse infiltration pattern, and its occurrence is not related to the prognosis of patients with NDMM, providing a basis for further exploring the BMF value in NDMM diagnosis and treatment.

INTRODUCTION:Molecular testing on advanced non-small cell lung cancer (NSCLC) often confront of limited specimen.The aim of the study is to compare the mutation frequency in adenocarcinoma samples with poor tumor cell content and the optimal samples, making the optimal strategy of mutation analysis. METHODS:In this retrospective study, mutation status of EGFR, ALK, ROS1, BRAF, KRAS, RET, HER2, CMET, NRAS and PIK3CA in 1594 NSCLCs were tested by ARMS-PCR and qRT-PCR, consists of 790 cases of surgical specimens, 741 cases of small biopsies, 63 cases of cytology cell blocks. We analyzed the discrepancies in mutation frequency with optimal specimens and the suboptimal ones. RESULTS:Comparing the gene mutation frequency in optimal and suboptimal samples, only the EGFR mutation rates of surgical samples (12.5 %, 1 out of 8) with < 10 % tumor cellularity was lower than in those with ≥ 10 % (57.1 %, 385 out of 674， p = 0.015). However, surgical specimens with low tumor cellularity (<20 %) were comparable to the qualified samples. The mutation frequency of EGFR in biopsy specimens with poor specimen adequacy( <20 %, <10 %, <5 %, <200, <100, <50) were comparable to the qualified samples. Low tumor cellularity (<20 %, <10 %, <5 %) and low tumor cell number (<200, <100, <50) was not associated with mutational rate for ALK, ROS1, BRAF, KRAS, RET, HER2, CMET, NRAS and PIK3CA mutations in small biopsy samples. CONCLUSIONS:In clinical practice, specimen with low adequacy could attempt in gene mutation testing, including biopsy and surgical specimen. However, the amount of tumor for molecular testing should be reported and suboptimal samples with a negative EGFR mutation result should be considered for combination using of other mutation test method or repeat testing of an alternate tumor sample, especially for the surgical samples.

Background: Homologous recombination repair gene (HRR) mutations have been proven to be effective biomarkers for PARP inhibitor therapy for metastatic castration resistant prostate cancer. However, the frequency of HRR mutations in patients with localized and locally advanced prostate cancer is still unclear. This study investigated the profile of HRR gene mutations in Chinese localized and locally advanced prostate cancer patients. Materials and Methods: 74 patients with localized and locally advanced prostate cancer patients in Beijing Chaoyang Hospital between May 2018 and September 2019 were retrospectively included. Matched prostate cancer and histologically normal tissues were subjected to next-generation sequencing. Pathogenic alterations of 19 HRR genes were examined. Results: Ten deleterious and suspected deleterious mutations (4 germline and 6 somatic mutations) were detected in 9 of 74 (12.16 %) patients, occurred in seven HRR-related genes, including CDK12, NBN, ATM, ATR, BRCA2, PALB2 and RAD51C. The mutation frequency of HRR genes in this study (12.16 %) was higher than TCGA cohort (7.29 %), and the mutation sites in 7 HRR genes detected in this cohort were different from those of TCGA data. Patients with HRR gene mutations had higher Gleason grade (>= 3) (P = 0.03) and risk level (very-high) (P = 0.03). Postoperative prostate specific antigen level and positive surgical margin rate was not associated with HRR gene mutation status. Conclusions: This study illustrated the mutation patterns of HRR genes in Chinese population with localized and locally advanced prostate cancer. These results provide further evidence that HRR gene mutations were more prevalent in patients with higher Gleason grade, or with very-high-risk level. Patients with these clinicopathologic characteristics may need more precise stratification through molecular detection.

The present study aimed to elucidate the genetic features of multiple lung cancer (MLC) and identify effective molecular markers for diagnosis using next generation sequencing (NGS). The present data may also inform patient treatment and prognosis. A total of 35 lesions were obtained from 17 patients with MLC. Based on lesion histology and NGS, 13 cases of multiple primary lung cancer (MPLC) were identified and 4 cases were classified as intrapulmonary metastasis (IPM). All 4 patients with IPM exhibited an epidermal growth factor receptor (EGFR) mutation and synchronous mutation of at least one tumor suppressor gene. The frequency and percentage of EGFR mutations, accompanied with tumor suppressor genes, were significantly higher in patients with IPM compared with MPLC. Furthermore, a high EGFR-heterogeneity score and male sex were risk factors of IPM occurrence. There were significant differences in mean EGFR mutation abundance alone, mutations of tumor suppressor genes and mutations of EGFR combined with tumor suppressor genes between patients with adenocarcinoma (ADC) and adenocarcinoma in situ (AIS). In conclusion, histological characteristics combined with genetic alterations may be an effective method for the diagnosis of MPLC and IPM, and NGS may serve as a useful diagnostic tool. MLC exhibited unique molecular characteristics, including higher rates of EGFR mutations, EGFR driver mutations accompanied with tumor suppressor gene mutations and the absence of anaplastic lymphoma kinase mutations, which may help distinguish between patients with MPLC or IPM. The present study hypothesized that the mean frequency of EGFR mutations, mutations of tumor suppressor genes and mutations of both EGFR and tumor suppressor genes may serve an important role in the development of AIS to ADC. The results of the present study highlight the potential underlying mechanisms of lung ADC development, which may assist with future elucidation of effective treatments to prevent the progression of lung cancer.