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Clinical value of plasma Epstein-Barr virus DNA test in patients with nasopharyngeal carcinoma in non-high-incidence area

ObjectiveTo explore the application value of plasma Epstein-Barr virus (EBV) DNA test in the clinical diagnosis of patients with nasopharyngeal carcinoma in non-high-incidence areas of Southwest China and its significance for monitoring patients after treatment. MethodsA total of 235 patients diagnosed with non-keratinized nasopharyngeal carcinoma between January 2014 and December 2015 were retrospectively collected. The plasma EBV-DNA test rate of the nasopharyngeal carcinoma patients before treatment, the positive rates of the plasma EBV-DNA test before treatment and within 6 months of treatment, and the relationship between the positivity of plasma EBV-DNA within 6 months of treatment and the prognosis of nasopharyngeal carcinoma were analyzed. ResultsThe plasma EBV-DNA test rate of the nasopharyngeal carcinoma patients before treatment was 69.79% (164/235), with a positive rate of 90.85% (149/164). A total of 131 patients were tested for EBV-DNA within 6 months of treatment, whose positive rate was 89.31% (117/131) before treatment and 21.37% (28/131) within 6 months of treatment, respectively, with a statistically significant difference (P<0.001). Comparing the prognosis of EBV-DNA positive patients and negative patients within 6 months of treatment, the difference in 3-year recurrence rate between the two groups was not statistically significant (10.71% vs. 3.88%, P=0.341); however, the 3-year metastasis rate (21.43% vs. 4.85%, P=0.016) and the 3-year disease progression rate (32.14% vs. 6.80%, P=0.001) of the EBV-DNA positive patients were higher than those of the EBV-DNA negative patients, and the log-rank test slao showed that the 3-year progression-free survival rate (67.86% vs. 93.20%, P<0.001) and the 3-year metastasis-free survival rate (78.57% vs. 95.15%, P=0.004) of the EBV-DNA positive patients were lower than those of the EBV-DNA negative patients. There was no statistically significant between-group difference in the 3-year progression-free survival curve when grouped by age, gender, or TNM staging (P>0.05).ConclusionsFor patients with non-keratinized nasopharyngeal carcinoma in non-high-incidence areas of Southwest China, EBV-DNA detection is important for the screening and diagnosis of nasopharyngeal carcinoma, and the positivity of EBV-DNA test within half a year of treatment is an important factor affecting the prognosis and progression of patients. Plasma EBV-DNA levels should be monitored regularly before and after treatment.

Evidence-based treatment for local advanced nasopharyngeal carcinoma

Objective　We searched and reviewed medical evidence to find the guide of treatment for local advanced nasopharyngeal carcinoma. Methods　Firstly, we put forward clinical questions. Secondly, we searched medical evidence from Medline (1985-2002), Embase (1984-2000), Cochrane library (2002.1) and ACP. And then we reviewed the results. The key words we used were "nasopharyngeal carcinoma, chemotherapy and radiotherapy randomized" and "meta analysis or randomized control trial". Results　Through searching, we got 17 papers including 1 systematic review and 16 randomized control trials, in which there were 8 prospective randomized phase Ⅲ trials. Most of these trials concluded that combination chemo-radiotherapy were better than radiotherapy alone. We think these results were suitable for our patient’treatment decision. Conclusion　To treat our patients,we choosed the method of the mutimodality of squeitial neoadjuvant chemotherapy, concurrent chemo-radiotherapy and adjuvant chemotherapy with the drug doses down-adjusted.

Mechanism of Epstein-Barr virus latent infection-related genes in tumors caused by them

Epstein-Barr (EB) virus infection is associated with various tumors of lymphoid and epithelial origin. EB virus exists in most humans as a latent infection. EB virus latent infection-related genes play a key role in the EB virus latent infection, and also play an important role in promoting the occurrence and development of related tumors. This article will briefly introduce the characteristics of EB virus latent infection, the protein coding genes and non-coding genes related to EB virus latent infection (including EB virus nuclear antigen genes, EB virus latent membrane protein genes, EB virus encoded small RNA genes and EB virus microRNA genes), and the main functional mechanism of these EB virus latent infection-related genes in EB virus latent infection and subsequent tumorigenesis. The purpose is to providea theoretical basis for a comprehensive understanding of the EB virus latent infection and the mechanism of tumors caused by EB virus.

Clinical Research on Submandibular Gland Transposition Intervening Acute Radiation Induced Oral Mucosal Reaction and Xerostomia

【摘要】目的探討頜下腺移位術對預防急性放射性口腔黏膜反應及口干燥癥的臨床效果。方法2007年7月2009年6月間選擇40例患者進行前瞻性臨床對照研究。治療組20例,在放療前將頜下腺移位至頰下區。對照組20例不行頜下腺移位術。觀察放療中兩組急性口腔黏膜反應,測定放療前后唾液分泌量的變化,放療后3個月進行口干燥程度問卷調查。結果治療組急性口腔黏膜反應明顯輕于對照組(Plt;0.05)。治療組放療后3個月移位術側頜下腺攝取、排泌功能均明顯較對照好,兩組比較有統計學意義(Plt;0.05)。結論頜下腺移位術預防鼻咽癌放療后口干燥癥的臨床近期療效較好,可改善鼻咽癌患者放療后的生活質量。

同期放化療治療中晚期鼻咽癌50例療效觀察

摘要:目的：探討同期放化療治療中晚期鼻咽癌的療效。方法: 我院2003年6月至2006年10月中晚期鼻咽癌患者95例回顧分析, 兩組放射治療相同, 用6 MV-X線外照射和6～12 MeV電子線, 觀察組放療始PF方案同步化療。結果：兩組治療結束后3個月觀察組鼻咽癌原發病灶療效有效率高于對照組(Plt;0.05), 頸部淋巴結療效有效率高于對照組(Plt;0.05), 兩組患者不良反應主要為急性黏膜反應、骨髓抑制、胃腸道反應等。觀察組的毒副作用發生率明顯高于對照組(Plt;0.05)。結論：同期放化療治療中晚期(Ⅲ或Ⅳa期)鼻咽癌是目前較為理想的治療方案, 其毒性反應可以耐受。

放射性腦損傷所致精神障礙一例

Expression of VEGF, CD34 and CXCR4 and Their Prognostic Significance in Metastatic Nasopharyngeal Carcinoma

目的　檢測血管內皮生長因子（VEGF）、白細胞分化抗原34（CD34）及CXC趨化因子受體4（CXCR4）在轉移性鼻咽癌患者鼻咽部腫瘤組織中的表達，探討它們與鼻咽癌各種臨床病理因素的關系以及它們之間的相互聯系。 方法　采用免疫組織化學鏈霉素抗生物素蛋白-過氧化物酶連結法檢測2003年3月－2009年5月35例轉移性鼻咽癌患者VEGF、CD34及CXCR4在鼻咽部腫瘤組織中的表達情況，結合患者臨床病理特征進行分析。 結果　轉移性鼻咽癌患者鼻咽部腫瘤組織中的VEGF及CXCR4陽性表達率分別為62.9%（22∕35）和42.9%（15∕35），CD34計數為11～92，平均43.2 ± 20.5。無肺轉移較有肺轉移的患者VEGF的陽性表達率高（78.9%、43.8%，P=0.043），多器官轉移較單器官轉移的患者CXCR4的表達強度高（62.5%、26.3%，P=0.044）。 結論　VEGF表達陽性的患者易發生肺轉移；CXCR4強表達的患者易發生多器官轉移。

Analysis of Delayed Diagnosis in 324 Cases of Nasopharyngeal Carcinoma

目的:探討鼻咽癌延誤診斷的原因。從而提高鼻咽癌患者的早期診斷率,改善治療效果。方法: 回顧性分析324例在我科接診前因各種因素而延誤診斷的鼻咽癌患者首發癥狀、首診誤診科室、誤診疾病。結果: 本組病例首發癥狀分別為頸部包塊138例(42.5%)、鼻部癥狀148例(45.6%)、耳部癥狀66例(20.3%)、頭痛46例(14.2%)、其他17例(5.2%),有兩種首發癥狀的病例為91例。首診誤診的疾病有頸部淋巴結炎、慢性鼻鼻竇炎、鼻出血、分泌性中耳炎、腦動脈硬化等27種疾病。涉及普外科、耳鼻咽喉科、神經內科、骨科、呼吸內科、口腔科、燒傷科、眼科、中醫科等9個科室。結論: 加強鼻咽癌知識普及,完善繼續醫學教育及住院醫師培訓,積極尋找鼻咽癌的早期診斷方法能減少鼻咽癌的延誤診斷。

Response of circulating tumor cells and circulating tumor endothelial cells to treatment modalities of nasopharyngeal carcinoma and its significance

Objective To investigate the relationships between circulating tumor cells (CTCs), circulating tumor endothelial cells (CTECs) and treatment methods in patients with nasopharyngeal carcinoma (NPC) at different stages of treatment. Methods The data of NPC patients at different treatment periods in West China Hospital of Sichuan University from March 2016 to November 2019 were retrospectively collected. The patients received CTCs test and part of those patients received CTECs test, by subtraction enrichment-immunostaining-fluorescence in situ hybridization. The relationships of CTCs and CTECs with radiotherapy and chemotherapy, and the correlations between CTCs and CTECs in NPC patients were analyzed. Results A total of 191 patients were included. Among them, there were 66 cases before initial treatment, 38 cases after induction chemotherapy, and 87 cases after concurrent chemoradiotherapy. A total of 127 patients received CTECs test, including 41 cases before initial treatment, 29 cases after induction chemotherapy, and 57 cases after concurrent chemoradiotherapy. The positive rates of CTCs were 89.4%, 81.6% and 69.0% respectively in the three stages of treatment, and the difference was statistically significant only between the pre-treatment group and the post-concurrent chemoradiotherapy group (P=0.003). The number of CTCs in the post-concurrent chemoradiotherapy group was lower than that in the pre-treatment group and the post-induction chemotherapy group (P<0.001, P=0.002). The number of triploid CTCs in the post-concurrent chemoradiotherapy group was significantly different from that in the pre-treatment group and the post-induction chemotherapy group (P=0.009, P=0.013). The number of tetraploid CTCs in the post-concurrent chemoradiotherapy group was significantly different from that in the post-induction chemotherapy group (P=0.007). The number of polyploidy (pentaploid or > 5 copies of chromosome 8) CTCs in the post-concurrent chemoradiotherapy group was significantly different from that in the pre-treatment group (P<0.001). The positive rates of CTECs were 70.7%, 82.8% and 64.9% respectively in the three stages of treatment, and the difference was not statistically significant (P>0.05). The number of CTECs in the post-concurrent chemoradiotherapy group was only lower than that in the post-induction chemotherapy group (P=0.009). There was no significant difference in the number of triploid or tetraploid CTECs among the three groups (P=0.265, P=0.088). The number of polyploid CTECs was statistically different only between the post-concurrent chemoradiotherapy group and the post-induction chemotherapy group (P=0.007). Spearman correlation analysis showed that there was a significant positive correlation between CTCs and CTECs (rs=0.437, P<0.001). Conclusions Concurrent chemoradiotherapy plays a decisive role in reducing the number of CTCs in the blood of NPC patients, while induction chemotherapy does not appear to directly cause changes in the number of CTCs. In NPC patients, different types of CTCs have different responses to different treatments. There is a significant positive correlation between CTECs level and CTCs level in NPC.

Protective Effects of Decoction Plus Radiotherapy on Nasopharyngeal Carcinoma: A Meta-analysis of Randomized Controlled Trials

【摘要】　目的　評價中藥復方（益氣養陰、清熱活血方Yiqi Yangyin Qingre Huoxue decoction，YYQHD）聯合放射療法治療鼻咽癌在減毒增效方面的療效。　方法　采用Cochrane系統評價方法，電子檢索Cochrane圖書館臨床對照試驗資料庫（Cochrane Central Register of Controlled Trials，CENTRAL）、PubMed、EMBASE、中國生物醫學文獻數據庫（CBM）、中文科技期刊全文數據庫（CNKI）和中國期刊全文數據庫（VIP）以及萬方數據庫等數據庫2010年3月前所發表的相關文獻。同時互聯網檢索Current Controlled Trial、Clinical Trials和中國臨床試驗注冊網。手工檢索部分腫瘤類核心期刊。采用Cochrane協作網推薦的 “偏倚風險評估”工具，評估納入研究的質量，使用RevMan 5.0.23.0軟件對納入的研究進行定量系統評價。　結果　最終納入符合標準的中文文獻9篇共795例患者。定量分析結果顯示:與單純常規放射治療相比較，中藥復方（YYQHD）聯合常規放射治療能顯著提高腫瘤近期療效、生存率，并且能顯著減少放射治療常見毒副反應的發生，從而提高放射治療按時完成率確保放射治療療效、改善患者生存質量。　結論　雖現有研究尚不能得出可以將中藥復方（YYQHD）作為標準治療手段輔助放射治療的結論，但提示益氣養陰、清熱活血類中藥聯合放射治療治療鼻咽癌是值得繼續探索的研究方向，期待設計科學合理、高質量的多中心、大樣本、雙盲、隨機對照臨床試驗以進一步驗證其療效。【Abstract】　Objective　To compare the efficacy of traditional Chinese medicine (TCM) plus radiotherapy (RT) with RT alone on nasopharyngeal carcinoma (NPC) by Yiqi Yangyin Qingre Huoxue decoction (YYQHD) through a meta-analysis of all available randomized controlled trials.　Methods　Literature retrieval was conducted using the Cochrane Library, PubMed, EMBASE, CBMdisk, CNKI, VIP, and Wanfang Database electronically. Relevant journals and conference proceedings were also hand-searched until March 31, 2010. The quality of included studies was assessed according to the criteria recommended by the Cochrane handbook, and the Meta-analysis was performed for homogeneous studies using RevMan 5.0.23.0 Software.　Results　Basing on our search criteria, we found nine trials (795 patients) which all published in Chinese. Our results showed that TCM (YYQHD) plus RT compared with RT alone, improved immediate tumor response, survival, completion rate of RT, quality of life, and alleviation of adverse effect of patients with NPC.　Conclusions　Considering the limitations related to this Meta-analysis, it nevertheless presents credible evidence that TCM (YYQHD) plus RT is worthy of additional study. Therefore, further large-scale, muti-center, randomized, and double-blind trials are warranted.