Table of Content

  

10 February 2017
Volume 55 Issue 2

Radioactive seeds implantation in tumor treatment

SHEN Wenjiang

JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES). 2017, 55(2):  1-3.  doi:10.6040/j.issn.1671-7554.0.2016.1240

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Radioactive seed brachytherapy is one of the most promising salvage therapies for many malignant tumors. Brachytherapy has advantages of high local control rate of tumors and low complication rate. Recently, the procedure of 3D print individual template and CT-guided ¹²⁵I seed implantation is normalized and the dosage is accurate. Based on evidence-based medicine, 3D print individual template and CT-guided implantation of ¹²⁵I seeds will produce satisfying clinical results.

Current status and technical innovation of radioactive seed brachytherapy in the treatment of bronchial lung cancer in China

CHAI Shude

JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES). 2017, 55(2):  4-7.  doi:10.6040/j.issn.1671-7554.0.2016.1237

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Radioactive seed implantation therapy, introduced into China as a new treatment for lung cancer since the beginning of the 21st century, has achieved remarkable development in clinical practice. Scholars in this field have made 山 东 大 学 学 报 (医 学 版)55卷2期 -柴树德.我国放射性粒子植入治疗支气管肺癌现状与技术创新 \=-in-depth exploration into the indications, surgical procedures and methods, dosimetry and other issues. In recent years, with the applications of template guidance, 3D printing and other technology, radioactive seed implantation therapy has gained a rapid development. This article summarizes and analyzes the present situation and technical innovations of the technology.

Prevention and treatment of complications of abdominal tumor by radioactive seeds implantation

WANG Juan, ZHANG Hongtao, GAO Zhen, DI Xuemin, WANG Zeyang

JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES). 2017, 55(2):  8-13.  doi:10.6040/j.issn.1671-7554.0.2016.1477

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Abdominal malignant tumors such as liver cancer, gastric cancer, pancreatic cancer and colorectal cancer have high morbidity and mortality due to easy recurrence and metastasis but hard resection. Most of them are already advanced once detected. Whats more, some tumors are resistant to chemotherapy. Targeted medicine therapy can improve the prognosis to a certain extent, but it will inevitably lead to resistance. Radioactive seeds are a new and effective method for patients with advanced malignant tumors because it is highly conformal, durable and safe. Besides, it can accurately locate the tumor. However, the mechanism and prevention of complications still need to be explored, such as common complications including gastrointestinal reaction, infection, bleeding, ulcers, and life-threatening complications including bleeding and pulmonary embolism. Great attention should be paid to the management of these complications.

Technical procedure of template combined with CT-guided radioactive seeds implantation for lung cancer

HAN Mingyong, HUO Bin, ZHANG Ying, LIN Qi, DAI Jianjian, XU Ruicai, YANG Qi, GENG Baocheng, ZHENG Guangjun, WANG Haitao, HUO Xiaodong, CHEN Baoming(Reviewed by CHAI Shude, WANG Junjie), 山, 东, 大, 学, 学, 报, (医, 学, 版)55卷2期, -韩明勇,等.CT联合模板引导放射性粒子植入治疗肺癌技术流程, \=-

JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES). 2017, 55(2):  14-20.  doi:10.6040/j.issn.1671-7554.0.2016.1537

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Lung cancer is one of the most malignant health-threatening tumors. In China, CT-guided iodine-125 seed implantation has been applied in the treatment of lung cancer, and has shown significant efficacy. However, the technical procedure is still not normalized. Northern China Radioactive Seeds Multi-center Cooperative Group(Lung Cancer Group)summarized the technical procedure of CT-guided iodine-125 seed implantation in the treatment of lung cancer, illustrating the surgical steps with graphs, hoping to provide guidance and reference for future work.

1.0T open MRI-guided ¹²⁵I seeds percutaneous implantation for advanced pancreatic cancer

XU Yujun, LIU Ming, HE Xiangmeng, LI Chengli

JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES). 2017, 55(2):  21-25.  doi:10.6040/j.issn.1671-7554.0.2016.1476

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Objective To evaluate the feasibility, safety and efficacy of 1.0T open MRI-guided ¹²⁵I seeds percutaneous implantation in the treatment of unresectable advanced pancreatic cancer. Methods A group of 31 patients with confirmed unresectable advanced pancreatic cancer were enrolled. The treatment plan was designed with treatment plan system(TPS)before implantation. With prescription dose(PD)being 120~160 Gy, D90>90%PD, V100>90%, V200<50%, under the 1.0T open MRI guidance, ¹²⁵I seeds were implanted. Dosimetric verification was conducted within 24 h after surgery. Results All 31 procedures were successful. After implantation, TPS showed D90, V100 and V200 ranged 91%-112%PD, 92%-106%, and 21%-49%, respectively. The patients were rechecked 1, 3, 6 and 12 months after operation, and after that once a year. The median survival was 14.7, 16.3 and 5.9 months for the whole group, for patients with stage Ⅲ cancer and stage Ⅳ cancer. The effective rate was 83.8%, local control rate was 93.5%, and pain relief rate was 91.6%. No serious complications such as pancreatitis, pancreatic fistula, intestinal fistula and hemorrhage were observed. Conclusion 1.0T open MRI-guided ¹²⁵I seeds percutaneous implantation is safe, feasible and effective for unresectable advanced pancreatic cancer.

Feasibility of radioactive seed implantation in the treatment of lung cancer assisted by template combined with rib drilling technique

HUO Bin, WANG Lei, WANG Haitao, HUO Xiaodong, CAO Qiang, WANG Lili, ZANG Li, WANG Jinhuan, ZHENG Guanjun, CHAI Shude

JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES). 2017, 55(2):  26-31.  doi:10.6040/j.issn.1671-7554.0.2016.1451

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Objective To assess the feasibility of using radioactive seeds implantation assisted by template combined with rib drilling technique under CT guidance in the treatment of lung cancer. Methods The study involved 21 patients with lung cancer who underwent radioactive seeds implantation in our hospital during Jan. 2015 and Jun. 2016. Dicom data were acquired by chest CT scan before implantation, brachytherapy radiation treatment planning system(BTPS)was introduced to carry out the plan, and the prescription dose was 120 Gy. In addition to the conventional needle design, the special design of penetrating rib was adopted in the dose cooling zone due to rib occlusion, rib drilling tech- 山 东 大 学 学 报 (医 学 版)55卷2期 -霍彬,等.模板联合肋骨钻孔技术辅助放射性粒子植入治疗肺癌的可行性 \=-nique was used to establish the real channel, and template was used to control implantation. The distribution of implanted needles and seeds were observed with CT scan. Dose verification was performed immediately after the operation. Intraoperative and postoperative complications were observed and recorded. Results All patients tolerated brachytherapy well. The mean gross tumor volume(GTV), seed number, needle number, D90, V100 and V200 in postoperative verification and preplan were 47.6 vs 46.4 cc, 33 vs 33, 10 vs 10, 12 765.1 vs 12 433.8 Gy, 92.6% vs 95.2% and 34.8% vs 28.8%, respectively(P=0.012, 0.930, 0.267, 0.179, 0.032, and 0.003). The satisfaction rate was 90.5% after operation. The incidence of pneumothorax, pulmonary hemorrhage, pleural cavity, bloody sputum and particle displacement were 19%, 9.5%, 4.7%, 19% and 9.5%. No massive hemoptysis or other complications occurred. Conclusion Template combined with rib drilling technique in radioactive seeds implantation is safe and feasible. The precise positioning can significantly improve the preoperative plan conformity and avoid the blindness of manual operation. It has important value for the standardization and quality control in the treatment of lung cancer.

CT-guided percutaneous ¹²⁵I seed implantation brachytherapy in patients with stage Ⅲ non-small-cell lung cancer

DAI Jianjian, YUAN Bing, ZHANG Ying, LIN Qi, YUAN Yuan, HAN Mingyong

JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES). 2017, 55(2):  32-37.  doi:10.6040/j.issn.1671-7554.0.2016.1487

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Objective To assess the efficacy and complications of CT-guided percutaneous ¹²⁵I seed implantation brachytherapy in the treatment of stage Ⅲ non-small-cell lung cancer(NSCLC). Methods Clinical date of 19 stage Ⅲ NSCLC cases were retrospectively analyzed. All cases were pathologically confirmed. The median age of patients was 57 years. Preoperative chest enhanced CT scan was performed to show the location and size of the tumor and its relation with surrounding organs. Hematologic studies were conducted to exclude patients with coagulant or hepatic and renal function abnormality. The treatment planning system(TPS)was used preoperatively to calculate the estimated seed number and distribution. The prescription dose(PD)was 120 Gy. ¹²⁵I seeds were implanted percutaneously under CT guidance and local anesthesia. Follow-up CT scan was performed 1, 3 and 6 months after surgery. Therapeutic effect was evaluated according to response evaluation criteria in solid tumors(RECIST). Results The median volume of tumors was 20 cm³. Local tumor control rate(CR+PR+SD)was 94.7%(18/19), 94.7%(18/19), 87.5% 山 东 大 学 学 报 (医 学 版)55卷2期 -戴建建,等.CT引导下¹²⁵I粒子植入治疗Ⅲ期非小细胞肺癌疗效与并发症的临床观察 \=-(14/16), 83.3%(10/12), 85.7%(6/7)and 83.3%(5/6)1, 2, 5, 7, 8 and 9 months after operation. The median follow-up was 7 months(4-24), and the median time to progression was 7 months(2-21). No major complications were observed. Minor complications included pulmonary hemorrhage(n=7, 37%), subcutaneous hematoma(n=1, 5%), mild pneumothorax(n=1, 5%), closed drainage of thoracic cavity(n=5, 26%), late-onset pneumothorax(n=1, 5%), hemoptysis(n=3, 16%), and subcutaneous emphysema(n=1, 5%). Conclusion Safe and effective, CT-guided percutaneous ¹²⁵I seed implantation brachytherapy can serve as an adjuvant option in the treatment of stage Ⅲ NSCLC.

CT-guided ¹²⁵I seed brachytherapy for superficial lymph node metastases: a report of 23 cases

LIN Qi, ZHANG Ying, DAI Jianjian, XU Ruicai, YANG Qi, GENG Baocheng, HAN Mingyong

JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES). 2017, 55(2):  38-44.  doi:10.6040/j.issn.1671-7554.0.2016.1350

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Objective To evaluate the efficacy and complications of CT-guided permanent ¹²⁵I seed brachytherapy in patients with the superficial lymph node metastases. Methods Clinical data of 23 patients with 28 superficial lymph node metastases who underwent CT-guided ¹²⁵I seed brachytherapy during Dec. 2014 and Jun. 2016 were retrospectively reviewed. Brachytherapy was preplanned for all patients using a 3-dimensional radiation therapy planning system. With CT guidance, ¹²⁵I seed was placed into the metastases. Dosimetry verification was performed immediately after operation. Efficacy and complications were evaluated 1, 3, 6, 9 and 12 months postoperatively. Results The median local control rate of 1, 3, 6, 9 and 12 months was 84.6%, 82.4%, 81.2%, 83.3% and 85.7%, respectively. The median follow-up was 9 months(1-16 months), during which 8 patients died and 15 survived. The local control time was 12 months(95% CI: 7.4, 16.5), the median progression-free-survival(PFS)was 3 months(95% CI: 0.3, 5.7), P=0.194. No major complications occurred during or after brachytherapy except for Ⅰ/Ⅱ acute skin radioreaction in 6 cases. Conclusion CT-guided ¹²⁵I seed brachytherapy is a safe and effective treatment for superficial lymph node metastases with few complications.

A dosimetric study of 3D print individual template combination with CT-guided ¹²⁵I seed implantation for malignant tumors

ZHANG Ying, LIN Qi, YUAN Yuan, DAI Jianjian, GENG Baocheng, XU Ruicai, LIU Yakun, HAN Mingyong

JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES). 2017, 55(2):  45-49.  doi:10.6040/j.issn.1671-7554.0.2016.1238

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Objective To explore the use of 3D print individual template and CT-guided ¹²⁵I seed implantation in dosimetry by comparing the parameters before and after implantation. Methods A total of 37 patients treated during Feb. and Oct. 2016 were involved. Before implantation, all patients underwent CT scan and the data were saved in digital imaging and communications in medicine(DICOM)format. The individual template was designed by brachytherapy treatment planning system(BTPS), and printed by 3D print technique. Patients received ¹²⁵I seeds interstitial implantation with the guide of individual template and CT. After implantation, CT scan was performed immediately for dosimetric verification. The pre- and post-operative parameters were compared. Results All 37 individual templates were successfully designed and printed. The range of clinical target volume(CTV)was 5.9-133.1 cc［averaged(36.1±31.3)cc］ vs 5.9-133.6 cc［averaged(37.1±36.6)cc］ in preplan and post implantation, and there was significant difference 山 东 大 学 学 报 (医 学 版)55卷2期 -张颖,等.3D打印个体化模板联合CT引导¹²⁵I粒子植入治疗肿瘤术前术后剂量学比较 \=-(P<0.001). The prescription dose(PD)was 100-160 Gy. The numbers of preplan seeds and actually implanted seeds were 18-80 vs 24-84. Patients No.2, 6, 12, 14, 15, and 21 received 1-9 complemented seeds during the surgery. The range of D90 was 107.1-187.8 Gy［averaged(144.7±18.8)Gy］ vs 103.9-189.3 Gy［averaged(143.3±20.3)Gy］ in preplan and post implantation, and there was no significant difference(P=0.06). The range of V100 was 83.7%-99.9% ［averaged(96.4±3.1)%］ vs 85.2%-100% ［averaged( 96.9±3.3)%］ in preplan and post implantation, and there was significant difference(P=0.002). Conclusion 3D print individual template and CT-guided ¹²⁵I seed implantation can ensure the dosimetric quality control in the treatment of malignant tumors, but there are some differences between the preplan and postoperative parameters. Therefore, more clinical experiences still need to be summarized and analyzed.

CT-guided interstitia ¹²⁵I seed implantation in the treatment of long bone metastasis: a primary clinic study

LI Yang, HE Chuang, CHEN Yuxiao, YANG Li, LI Liangshan, LI Tingyuan, HUANG Xuequan

JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES). 2017, 55(2):  50-54.  doi:10.6040/j.issn.1671-7554.0.2016.1239

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Objective To evaluate the clinical efficacy of the implantation of ¹²⁵I radioactive seeds in the treatment of long bone metastasis. Methods The clinical data of 18 cases were collected along with their imaging data. The lesions located in the humerus(n=8), thighbone(n=14), and fibula(n=1). The patients pain was observed by using the numerical rating scale(NRS), and the functions of patients were investigated with the Musculoskeletal Tumor Society(MSTS)scoring system before and after surgery. The survival rate was described with Kaplan-Meier survival curve. Results All of the 23 radiotherapy targets were implanted with ¹²⁵I seeds. The gross tumor volume(GTV)was(29.25±22.06)cc, and the radioactive activity of seed was 0.80 mCi. Median number of seeds implanted in lesions was 27(15, 36). The postoperative target verified dose D90 was(11 538.1±1 888.6)cGy. The mean follow-up was 9 months(ranging from 3 to 48 months).The NRS and MSTS scores were both improved significantly during the follow-up(P<0.001, P<0.05). Medium survival time was 10 months, while the survival rate for 6, 12 and 24 months was 70.8%, 41.3% and 23.6%, respectively. Conclusion CT-guided ¹²⁵I seed implantation is an effective and safe palliative care for long bone metastasis, which can effectively relieve the pain and improve the functions of patients.

Effects of different doses of perindopril on endothelial progenitor cells and systolic cardiac function in rabbits with acute myocardial infarction

TAN Hong, MENG Nan, JIN Qun, SU Li, ZHANG Xiaxiao, CHEN Yingjian, HAO Zhe, LIU Xiaohong

JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES). 2017, 55(2):  55-60.  doi:10.6040/j.issn.1671-7554.0.2016.288

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Objective To investigate the effects of different doses of perindopril on mobilization of endothelial progenitor cells(EPCs)and the impact on cardiac systolic function in rabbits with acute myocardial infarction(AMI). Methods Rabbit models of acute myocardial infarction were established and randomly divided into 4 groups: sham-operated group(n=7), AMI group(n=6), low dose perindopril group(n=6, 0.218 mg/kg of perindopril was given a day after the model of AMI was built), high dose perindopril group(n=6, 0.436 mg/kg of perindopril was given a day after the model of AMI was built). The number of EPCs in circulating blood on day 1, 3, 7, 14, and 28 was counted with flow cytometry. On day 28, the stroke volume(SV), left ventricular ejection fraction(LVEF)and left ventricular fractional shortening(LVFS)were examined with cardiac Doppler ultrasound. The necrosis and disarrangement 山 东 大 学 学 报 (医 学 版)55卷2期 -谈红,等.不同剂量培哚普利对兔急性心肌梗死后内皮祖细胞及心功能的影响 \=-of cardiomyocytes in each group was observed after HE staining of infarcted cardiac areas. Results After perindopril treatment, there were significant increases of EPCs level in AMI rabbits, especially in high perindopril dose group(P<0.05). On day 28, there were significant decreases of LVFS, SV and LVEF in AMI group compared with sham-operated group(P<0.05). LVFS, SV and LVEF significantly increased after perindopril treatment, especially in high perindopril dose group(P<0.05). There was correlation between EPCs level and LVEF in all groups(R=0.468, P=0.05). HE staining showed that the normal cardiomyocytes in AMI group were replaced by large numbers of scar tissues with lymphocyte infiltration. Small quantity of pycnosis cardiomyocytes and relatively more scar tissues were seen in low dose perindopril group, and the degree of necrosis and disarrangement was lower than that in AMI group. The changes were more obvious in high dose perindopril group, in which more normal cardiomyocytes and fewer scar tissues were observed. Conclusion Perindopril can promote the mobilization of EPCs, elevate LVEF, LVFS and SV, and improve cardiac systolic function in AMI rabbits. High dose of perindopril is more efficient. There is correlation between EPCs level and the improvement of cardiac systolic function.

Protective effects of Tamarix chinensis Lour on mice with alcoholic liver injury and its mechanism

ZHANG Yu, HAN Chen, WANG Zhaoxia, WANG Zhaopeng, ZHANG Yueying, ZHOU Shuping, MA Ranran, WANG Hengxiao

JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES). 2017, 55(2):  61-67.  doi:10.6040/j.issn.1671-7554.0.2016.995

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Objective To study the protective effects and mechanism of the ethanol extract of Tamarix chinensis Lour on mice with alcoholic liver injury. Methods Alcoholic liver injury was induced in mice through chronic plus binge alcohol feeding. Eighty male C57BL/6J mice were randomly divided into 5 groups: normal control group, model group, positive control group, Tamarix chinensis Lour with low dose group and Tamarix chinensis Lour with high dose group. The body weight, liver weight and liver index of mice were compared between these groups. The liver fat accumulation and liver injury situation were observed by HE staining and oil red O staining. Biochemical markers of hepatic damage such as serum glutamic pyruvic transaminase(ALT), serum triglyceride(TG), heptic glutamic oxaloacetic transaminase(AST), superoxide dismutase(SOD)and malondialdehyde(MDA)were determined in all groups. The protein expression levels of NOD-like receptor family, pyrin domain containing3(NLRP3), apoptosis-associated speck-like protein containing a CARD(ASC), cysteinyl aspartate specific proteinase-1(caspase-1)and proinflammatory cytokines IL-1β were determined by immunohistochemistry method. Results Compared with the model group, the liver index of mice in Tamarix chinensis Lour with low dose and high dose groups decreased significantly(P<0.05), 山 东 大 学 学 报 (医 学 版)55卷2期 -张钰,等.柽柳对小鼠酒精性肝损伤的保护作用及机制 \=-hepatic fat accumulation and inflammation alleviated significantly, and the levels of ALT in serum and AST in liver tissues were significantly decreased(P<0.01); MDA content decreased significantly(P<0.05), the activity of SOD increased significantly(P<0.05), the expressions of NLRP3, ASC, caspase-1 and IL-1β in liver was significantly reduced(P<0.05)in Tamarix chinensis Lour with low dose group. Conclusion Tamarix chinensis Lour can prevent alcohol-induced liver injury occurrence and development, whose mechanism may be related to the inhibition of NLRP3-caspase-1-IL-1β signaling.

Effect of ar-turmerone derivatives on proliferation and apoptosis in human melanoma WM35 cells

TU Yunhua, CHEN Liyuan, WANG Xi, ZHOU Ying, KANG Yingqian, XUE Yuecui, RONG Dongyun, YE Zhenyuan, CAO Yu

JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES). 2017, 55(2):  68-73.  doi:10.6040/j.issn.1671-7554.0.2015.486

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Objective To investigate the effect of ar-turmerone derivatives(ATD)on proliferation and apoptosis in human melanoma WM35 cells, and to explore its mechanism. Methods WM35 cells were incubated with different concentrations of ATD(5-80 μmol/L)in vitro. Cell proliferation was measured by cell counting kits(CCK-8)assay. The cell morphology of WM35 was observed by inverted microscope after AO/EB staining. Apoptosis was detected by DNA fragmentation. Caspase-3 cellular activities were measured by a colorimetric method. The apoptosis rate was analyzed by flow cytometry. The expression of apoptosis associated protein, Bcl-2 and Bax, in WM35 cells were examined by 山 东 大 学 学 报 (医 学 版)55卷2期 -涂云华,等.芳姜黄酮衍生物对WM35细胞增殖及凋亡的影响 \=-Western blotting. Results ATD exhibited obvious proliferation inhibition effect on the growth of WM35 cells in a time-and-dose dependent manner(P<0.05). Meanwhile, ATD exhibited an apoptosis-inducing effect on WM35 cells in a drug-and-dose dependent manner(P<0.05). Expression of Bax increased while Bcl-2 decreased with the increase of the concentration of ATD(P<0.05). Conclusion ATD exhibites marked effect of proliferation inhibition and apoptosis-inducing on WM35 cells. ATD activates the apoptosis pathway of key enzyme. The apoptosis associated protein Bax is up-regulated while that of Bcl-2 is down-regulated, which may be the mechanism of ATD in affecting the proliferation and differentiation of tumors.

Antifungal effects and relevant mechanisms of metabolites of Lactobacillus casei against Candida albicans biofilms in vitro

FENG Fan, HU Xiaoyan, WU Weifang, SUN Xiaolin, SUN Yundong, CAO Qian, XIAO Ying, YAN Shikun, SHI Peikun, ZENG Beini, ZHOU Yabin

JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES). 2017, 55(2):  74-78.  doi:10.6040/j.issn.1671-7554.0.2015.373

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Objective To detect the antifungal effects and relevant mechanisms of metabolites of Lactobacillus casei against Candida albicans biofilms in vitro. Methods Metabolites of Lactobacillus casei were obtained by extraction and distillation. MIC₈₀ of metabolites of Lactobacillus casei against planktonic cells and biofilms were determined with the tetrazolium salt(XTT)reduction assay. The metabolic activity of Candida albicans biofilms against metabolites of Lactobacillus casei was assessed quantitatively. Yeast-to-hypha morphological transition was examined qualitatively with inverted microscope. Two-dimensional gel electrophoresis(2-DE)was used to search differentially expressed protein spots against metabolites of Lactobacillus casei-treated Candida albicans. Results MIC₈₀ of metabolites of Lactobacillus casei against Candida albicans planktonic cells and biofilms were 1∶256 and 1∶128, respectively. When the dilution ratio was 1∶256, metabolites of Lactobacillus casei blocked the yeast-to-hypha transition. Compared with six significant protein spots achieved from the 2-DE maps, four of them were indentified. The expressions of enolase, ubiquitin ligase and malate dehydrogenase were increased, while the expression of hexokinase was decreased under the stimulation of metabolites of Lactobacillus casei. Conclusion Metabolites of Lactobacillus casei can inhibit Candida albicans biofilms in vitro.

Clinical characteristics and prognosis of 48 patients with mixed phenotype acute leukemia

ZHOU Lanlan, PAN Xueyi, GUO Yu

JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES). 2017, 55(2):  79-83.  doi:10.6040/j.issn.1671-7554.0.2015.533

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Objective To investigate the clinical and biological characteristics and prognosis of mixed phenotype acute leukemia(MPAL). Methods Forty-eight patients diagnosed with MPAL(MPAL group)by WHO 2008 criteria and 50 patients diagnosed with Ly+AML(Ly+AML group), which is defined as the control group, in the same period were retrospectively analyzed. The cell morphology analysis was performed by swiss and cytochemical staining, the cell immunophenotype was detected by the flow cytometry, the fusion gene of leukemia was detected by fluorescence in situ hybridization, and the chromosome karyotype was analyzed by the standard technique of G-banding. Results The median age of MPAL group was larger than that of Ly+AML group significantly(54 y vs 30 y, P<0.05). The incidence of CD34 positive expression, bnormal karyotype and ph+ in the MPAL group were significantly higher than those in the Ly+AML group(85.4% vs 50%, 65.3% vs 35.7%, 23% vs 0%, all P<0.05). The OS and RFS of MPAL group were significantely lower than those of Ly+AML group(both P<0.05). Conclusion Compared with Ly+AML group, MPAL group has lower OS and RFS; the poor prognosis of MPAL may due to the age, and high incidence of CD34 positive expression and ph+.

Expression of EZH2 in Chinese Ewing sarcoma patients and its relationship with clinicopathological parameters and prognosis

ZHANG Xiying, ZHAI Chunyan, LI Jingsong, HAN Bo

JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES). 2017, 55(2):  84-91.  doi:10.6040/j.issn.1671-7554.0.2016.446

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Objective To explore the expression of enhancer of zeste homolog 2(EZH2)in Chinese Ewing sarcoma(EWS)patients, and to analyze its correlation with the clinicopathological parameters and prognosis. Methods Tissues from 67 cases of Ewing sarcoma/primitive neuroectodermal tumor(EWS/PNET)and other small round cell malignant tumors were collected and microarrayed. Gene rearrangement in EWS region 1(EWSR1)was evaluated using fluorescence in situ hybridization(FISH). The expressions of EZH2, P53 and Ki-67 were determined using immunohistochemical method. Survival analysis was performed with Kaplan-Meier and Cox method. Results A total of 44 cases were confirmed EWS. EZH2 expression was closely related to lung metastasis(P=0.023)and prognosis(P=0.004)in EWS tissues, and positively correlated to the expression of Ki-67(R=0.406, P=0.006). There was significant correlation between poor prognosis and high expression of EZH2(P=0.06)and high proliferation index of Ki-67(P=0.023). Cox multivariate analysis revealed that there was no significant correlation between P53 expression and overall survival(P>0.05); EZH2 and Ki-67 were independent risk factors for overall survival(HR=3.467, 95%CI=1.138-10.563, P=0.029; HR=2.140, 95%CI=0.439-10.423, P=0.046). In addition, a subset of EWS patients with overexpression of both EZH2 and Ki-67 had the shortest survival time (P=0.012). Conclusion EZH2 and 山 东 大 学 学 报 (医 学 版)55卷2期 -张希英,等.中国尤文肉瘤患者EZH2蛋白表达与临床病理学参数及预后的关系 \=-Ki-67 are independent prognostic factors in Chinese EWS patients. A combined detection of EZH2 and Ki-67 can help to identify the subset with extremely poor prognosis. EZH2 may serve as a novel prognostic marker of Ewing sarcoma.