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• An index of open-access tumor content relevant to primary care

  
  

  Establishment of the Norms of Proactive Prevention Behavior Scale in the Population at High Risk of Digestive System Cancer in Heilongjiang　

  XIN Bo1，ZHAO Qiuli1*，WANG Nannan1，YU Yang2，MA Dexin3，ZHANG Yukun3    

  1.School of Nursing，Harbin Medical University，Harbin 150086，China

  2.Nursing Department，the Fourth Affiliated Hospital of Harbin Medical University，Harbin 150086，China

  3.Department of Colorectal Surgery，the 2nd Affiliated Hospital of Harbin Medical University，Harbin 150086，China

  *Corresponding author：ZHAO Qiuli，Professor，Master supervisor；E-mail：zhaoqiuli1957@163.com

  Abstract: Background　The prevention and control of digestive system cancer is under tough conditions，but there are differences in prevention awareness and behaviors in the population at high risk of digestive system cancer. There is a lack of reference for physicians and nurses to evaluate the prevention ability among them. Therefore，it is of great significance to establish the regional norm of the proactive cancer prevention behavior scale，which may greatly promote cancer prevention. Objective　To establish the norms for the proactive prevention behavior scale in the population at high risk of digestive system cancer（DSC-PPBS），to provide references for the evaluation of high-risk population of digestive system cancer. Methods　From May 2019 to January 2020，DSC-PPBS was used to investigate high-risk population of digestive system cancer from 6 grade A tertiary hospitals，3 grade A secondary hospitals，and 3 community health centers in Heilongjiang. The characteristics of their DSC-PPBS scores were used to develop the mean，percentile and threshold norms for this specific population. Results　Of the 1 400 cases surveyed，1 236 returned responsive questionnaires with a response rate of 88.29%. The mean norms of DSC-PPBS were established according to gender and age groups（40-45，46-65，≥66 years）. The percentile norms of DSC-PPBS from the 5th percentile to 95th percentile were established with 5% as interval. The threshold norms were based on the four critical points（-s、-0.5s、+0.5s、+s），the cancer prevention status of the subjects was divided into five categories：poor，relatively poor，general，good，excellent，and the four demarcation standards were in closed with the 15th，30th，70th and 85th of the percentiles norm. Conclusion　The mean norm，percentile norm，and threshold norm of DSC-PPBS in the population at high risk of digestive system cancer in Heilongjiang are well-represented，which lay a foundation for further promotion of the scale. It can be used as a reference for clinical and community physicians and nurses to evaluate the intervention of prevention behaviors in the population at high risk of digestive system cancer.

   

  Lung Cancer with Dizziness as the Initial Symptom：a Case Report and Literature Review　

  LI Jiarong，LIAO Yu，LI Jianwei，LIU Feiqi*    

  Department of General Medicine，Xiangtan Central Hospital，Xiangtan 411100，China

  *Corresponding author：LIU Feiqi，Chief physician；E-mail：2579947388@qq.com

  Abstract: Dizziness is an undifferentiated disease commonly encountered in outpatient settings，which is difficult to diagnose and treat due to complex and diverse causes.Presently，patients with small-cell lung cancer with dizziness as the initial symptom are very rare.They may be missed if having no typical symptoms of lung caner as specialists may tend to pay attention to dizziness，and neglect important laboratory examinations of abnormalities.In this article，a patient who hospitalized in Department of General Medicine，Xiangtan Central Hospital on September 25，2019 was retrospectively reported.She was diagnosed with lung cancer although dizziness was the chief complaint.The diagnostic and therapeutic process of this case indicates that，if a dizziness patient with laboratory-detected hyponatremia shows poor response to symptomatic treatment，whether he has small-cell lung cancer manifested by syndrome of inappropriate antidiuretic hormone secretion（SIADH） should be carefully considered.It is hoped that this study can provide help for reducing the possibilities of missed diagnosis and misdiagnosis of atypical lung cancer patients，so that they may obtain early diagnosis and treatment，which is beneficial to their prognosis.

   

  Impact of Shared Decision Making on Quality of Life in Breast Cancer Patients Partially Mediated by Functional Exercise Adherence　

  ZENG Jie，JIN Lei，LI Qian，WU Wenjing，SHI Baoxin*    

  School of Nursing，Tianjin Medical University，Tianjin 300070，China

  *Corresponding author：SHI Baoxin，Professor，Master supervisor；E-mail：shibaoxintj@163.com

  Abstract: Background　Shared decision making（SDM） can improve the quality of life and treatment compliance of breast cancer patients，but there is no study on whether functional exercise compliance as a mediator variable between SDM and quality of life. Objective　To investigate the perceived level of involvement in SDM of breast cancer patients with modified radical mastectomy，and discussed the correlation of SDM，exercise adherence and life of quality. Methods　During the period from January to April 2019，277 breast cancer patients who accepted modified radical mastectomy in Tianjin Medical University Cancer Institute & Hospital were enrolled by means of convenience sampling. A set of questionnaires including socio-demographic questionnaire，the Chinese version of the 9-item Shared Decision Making Questionnaire（SDM-Q-9），the Postoperative Functional Exercise Compliance Scale-Breast Cancer（PFECS-B），and the Chinese version of Functional Assessment of Cancer Therapy-Breast（FACT-B） were used to collect data in a survey. Spearman correlation analysis was used to explore the relationships between SDM，functional exercise adherence and quality of life. AMOS 25.0 was applied to analyze the mediating effect of functional exercise adherence between SDM and quality of life，and to establish a structural equation model containing these three indicators. Results　The median scores of SDM-Q-9 and PFECS-B，and average score of FACT-B for these breast cancer patients were 27（18，34），49（46，53），and （89.38±9.073），respectively. The score of SDM-Q-9 showed a statistically significant positive correlation with that of PFECS-B and FACT-B（P<0.05）. The partial mediating effect of functional exercise compliance between SDM and quality of life was significant（P<0.05）. The direct effect of SDM on quality of life was 0.391 and the mediating effect was 0.299（accounting for 43.3% of the total effect），the total effect was 0.690. Conclusion　Breast cancer patients with modified radical mastectomy may have a low perceived level of involvement in SDM. SDM may directly affect their quality of life，and also may affect it indirectly through the mediating effect of functional exercise adherence.

   

  Mechanism and Management of Primary Resistance to Targeted Therapy in NSCLC Patients Harboring EGFR Sensitive Mutations　

  LIANG Wenhua1*，LI Caichen1，LIANG Hengrui1，ZHAO Yi1，LI Feng1，ZHONG Ran1，XIONG Shan1，LI Jianfu1，CHENG Bo1，CHEN Zisheng1，2，LIU Xiwen1，CAI Xiuyu3，XIE Zhanhong1，WANG Wei1，LIU Jun1，HE Jianxing1*    

  1.National Center for Respiratory Medicine/The First Affiliated Hospital of Guangzhou Medical University/Guangzhou Institute of Respiratory Health/National Clinical Research Center for Respiratory Disease/State Key Laboratory of Respiratory Disease，Guangzhou 510120，China

  2.The Sixth Affiliated Hospital of Guangzhou Medical University，Qingyuan 511518，China

  3.Sun Yat-sen University Cancer Center，Guangzhou 510060，China

  *Corresponding authors：HE Jianxing，Chief physician，Professor，Doctoral supervisor；E-mail：drjianxing.he@gmail.com

  LIANG Wenhua，Associate chief physician，Associate professor，Doctoral supervisor；E-mail：liangwh1987@163.com

  LIANG Wenhua，LI Caichen，LIANG Hengrui and ZHAO Yi are co-first authors

  Abstract: Clinical evidence has showed that targeted therapy with small molecule inhibitors produces good efficacy in patients with non-small cell lung cancer（NSCLC）harboring epidermal growth factor receptor（EGFR）sensitive mutations，but there are also some patients who display primary resistance or insensitivity to the therapy.As the response rate and level to the initial therapy are determinants for patients'long-term survival，we reviewed evidence about major mechanisms leading to primary resistance，including the impact of the structure of EGFR mutation subtypes，primary EGFR T790M mutation，concurrent EGFR mutations，and immune status on the therapy response，as well as their associations，then proposed targeted management strategies，such as treatment targeting the genetic mutation or the mutation site，precise targeted therapy，cocktail therapy and so on，and evaluated the development trend of treatment for primary resistance to targeted therapy.All these aimed at helping medical workers with clinical practice and research.

   

  TSH Suppression Therapy May Affect Bone Health，How to Manage Differentiated Thyroid Cancer Scientifically？

  SUN Lei，LI Mei*    

  Department of Endocrinology，Chinese Academy of Medical Science/Peking Union Medical College Hospital/Key Laboratory of Endocrinology of National Health and Family Planning Commission，Beijing 100730，China

  *Corresponding author：LI Mei，Chief physician，Professor；E-mail：limeilzh@sina.com

  Abstract: Differentiated thyroid cancer（DTC）is the most common type of thyroid cancer.TSH suppression therapy after thyroidectomy can reduce the risk of tumor recurrence and metastasis.However，long-term TSH suppression therapy can reduce bone mineral density and increase the risk of osteoporosis and bone fracture，which should be highly valued.We analyze the effects and mechanism of TSH suppression therapy on bone，and suggest the physicians to choose individualized treatment based on consideration of DTC recurrence risk，treatment responses and bone imaging information，risks of side effects and to monitor bone metabolic biomarkers，bone mineral density，risk of bone fracture，so as to take effective measures for the protection of bone，which including maintaining a healthy lifestyle，supplementing calcium and vitamin D，and using anti-osteoporosis drugs when necessary.

   

  Circulating Tumor Cells Detection and Progress in Nasopharyngeal Carcinoma　

  ZENG Lei，YANG Kaixuan*    

  Department of Head and Neck Oncology，West China Hospital，Sichuan University，Chengdu 610041，China

  *Corresponding author：YANG Kaixuan，Lecturer，Attending physician；E-mail：kaixuanyangmd@hotmail.com

  Abstract: Circulating tumor cells （CTCs） refer to tumor cells that have shed into the circulatory system from primary tumors or metastases，which are closely related to tumor recurrence and metastasis.CTCs，emerging as novel tumor biomarkers，whose value has been confirmed in the early diagnosis，efficacy evaluation and prognosis evaluation of various types of tumors，such as breast cancer，prostate cancer and colorectal cancer.In recent years，CTCs have also been studied in nasopharyngeal carcinoma.This review mainly focuses on CTCs' characteristics，detection and the research progress in nasopharyngeal carcinoma，aiming to give a reference for clinical application of CTCs.

   

  Research Progress in the Treatment of Hormone Receptor/Human Epidermal Growth Factor Receptor 2-positive Breast Cancer　

  WU Yanqi1，2，LUO Ting1，2*    

  1.Department of Head and Neck Oncology，West China Hospital，Sichuan University，Chengdu 610041，China

  2.Clinical Research Center for Breast，West China Hospital，Sichuan University，Chengdu 610041，China

  *Corresponding author：LUO Ting，Associate professor；E-mail：tina621@163.com

  Abstract: Breast Cancer is the most common cancer among women in China.According to the expression of estrogen receptor（ER）and progesterone receptor（PR） and the status of human epidermal growth factor receptor 2（HER2） gene amplification，breast cancer has been classified into various molecular subtypes.And the prognosis of different subtypes is also different.HER2 positive breast cancer behaves more aggressively and has a worse prognosis than HER2 negative breast cancer.Moreover，there are interactive crosstalks between HR and HER2 signaling pathways so that endocrine therapy and anti-HER2 therapy could influence and restrict each other.Nowadays，how to treat HR+/HER2+ breast cancer reasonably and effectively has been one of the difficulties in the treatment of breast cancer.In this article，the treatment situation of HR+/HER2+ breast cancer and the exploration of anti-HER2 therapy，endocrine therapy，immunotherapy，PI3K/mTOR pathway inhibitors，and other aspects associated with HR+/HER2+ breast cancer have been briefly described.

   

  Liver Carcinoma-related Mortality and Potential Years of Life Lost among Residents in Pudong New Area of Shanghai between 2002 and 2019　

  CHEN Yichen，QU Xiaobin，SUN Lianghong，LI Xiaopan，CHEN Hanyi，CHEN Hua，ZHOU Yi，XIAO Shaotan*    

  Shanghai Pudong New Area Center for Disease Control and Prevention/Fudan University Pudong Institute of Preventive Medicine，Shanghai 200136，China

  *Corresponding author：XIAO Shaotan，Associate chief physician；E-mail：stxiao@pdcdc.sh.cn

  Abstract: Background　Liver carcinoma is a common digestive malignancy worldwide.There is still lack of epidemiological data of liver carcinoma-related deaths of residents in Pudong New Area.Objective　To explore liver carcinoma-related mortality and potential years of life lost（PYLL） among residents in Pudong New Area of Shanghai between 2002 and 2019，to provide a reference for the development of targeted interventions.Methods　Data of people who died of liver carcinoma （ICD-10 C22） during 2002—2019 were collected from Pudong New Area' Residents Death Surveillance Database with death causes classified by the ICD-10.The crude mortality rate，age-standardized mortality rate，PYLL，rate of PYLL，average PYLL，age-standardized PYLL，and age-standardized PYLL rate were calculated and used to analyze the deaths and PYLL from liver carcinoma.The tendency of mortality and PYLL were estimated by annual percent change （APC）.Results　During 2002—2019，12 522 cases died of liver carcinoma in Pudong New Area，with 25.38/100 000 and 12.29/100 000 as the average annual crude mortality rate and average annual standardized mortality rate，respectively.Both the crude mortality rate and the age-standardized mortality rate of liver carcinoma declined over the years （APC=-1.88%，Z=-12.468，P<0.001；APC=-4.71%，Z=-10.601，P<0.001）.And these two indicators also showed a downward trend either among males or females （P<0.001）.The crude mortality of liver carcinoma declined over years for those aged 15-59 and those aged 60-79 （P<0.001），but kept stable for those over 80 years old （P=0.053）.The PYLL of liver carcinoma was 98 580 years，the PYLL rate was 2.00‰，the average PYLL was 7.87 years per person，age-standardized PYLL was 61 767 years and age-standardized PYLL rate was 1.25‰，respectively.The PYLL rate，age-standardized PYLL rate and average PYLL due to liver carcinoma on total showed a downward trend during 2002 to 2019（P<0.001）.However，the trend of average PYLL kept stable between 2002 and 2010 （P=0.853）.The PYLL，PYLL rate，average PYLL，age-standardized PYLL，and age-standardized PYLL rate of liver carcinoma were 81 126 years，3.29‰，9.20 years per person，50 225 years and 2.04‰，respectively，among males，and were 17 454 years，0.71‰，4.72 years per person，10 942 years and 0.44‰，respectively，among females.All the above-mentioned 5 indicators of males were higher.Conclusion　The crude mortality rate and age-standardized mortality rate of liver carcinoma in Pudong New Area showed a tendency to descend during 2002—2019，but still caused severe life loss.More attention should be paid to the harm of liver carcinoma to males and the aged population over 80 years old.So interventions should be delivered according to the conditions of different populations：priority should be given to improving liver carcinoma-related behavioral risk factors to reduce the harm of this disease in males，and should be given to hospice care and supportive care to improving survival status in aged liver carcinoma patients.

   

  Hospice Care Resource Utilization Related to Cancer Management and Hospice Care Physicians and Nurses' Occupational Satisfaction：a Survey from Community Healthcare Institutions in Shanghai's Central Districts　

  YANG Sen1，2，3，ZHAO Huaxin4，NIU Xiaomin5，CHEN Chen6，ZHANG Wenjing 7，GE Xuhua1，2，3，LU Yuan1，2，3，MA Le1，2，3，SHI Xiaoxiao 1，2，3，YU Dehua1，2，3*    

  1.Department of General Practice，Yangpu Hospital，Tongji University School of Medicine，Shanghai 200090，China

  2.Academic Department of General Practice，Tongji University School of Medicine，Shanghai 200090，China

  3.Shanghai General Practice and Community Health Development Research Center，Shanghai 200090，China

  4.Tongji University，Shanghai 200082，China

  5 Shanghai Lung Tumor Clinical Medical Center/Shanghai Chest Hospital，Shanghai Jiao Tong University，Shanghai 200030，China

  6.Jiangning Road Sub-district Community Health Center，Jing'an District，Shanghai 200052，China

  7.Yangpu District Daqiao Community Health Center，Shanghai 200090，China

  *Corresponding author：YU Dehua，Professor，Chief physician；E-mail：ydh1404@sina.com

  Abstract: Background　Hospice care has been implemented in Shanghai for over 30 years，and currently it can be accessed from all the community health centers（CHCs） （n=246） in the city.Actions taken in these years by Shanghai such as pilot projects promotion，development of standards for hospice care and hospice care-related trainings for medical workers，have promoted the sustainable，standardized and efficient development of hospice care.Objective　To investigate hospice care resource use related to cancer management and hospice care physicians and nurses' occupational satisfaction based on a survey in community healthcare settings in Shanghai's central districts Methods　This survey was conducted from March to September 2019.From seven central districts（Huangpu District，Xuhui District，Yangpu District，Putuo District，Jing'an District，Changning District and Hongkou District） selected by simple random sampling，14 CHCs delivering hospice care as the pilot institutions were extracted by stratified sampling，from which 42 hospice care physicians and nurses were sampled by use of simple random sampling.Data about hospice care resource use，such as occupancy rate of hospice beds，average length of hospice care per capita，average medical expense per capita and average daily medical expense per capita in the hospice care center were collected from the 2018 health statistics and financial statements of these CHCs.A self-developed questionnaire named Hospice Care Physicians and Nurses' Occupational Satisfaction in Shanghai's Pilot Institutions for Hospice Care，involving general demographics，occupational satisfaction（evaluated in terms of salary and welfare，career development，professional identity，turnover intention，peer relationships，job satisfaction） and associated factors，was used to survey the participants.Results　In 2018，the occupancy rate of hospice beds，average length of hospice care per capita，average medical expense per capita and average daily medical expense per capita in the hospice care center were （48.42±2.34）%，（41.8±3.5） days，（7 632.8±234.7） yuan，（182.6±22.6） yuan，respectively.The average length of home hospice care per capita，average home medical expense per capita and average home daily medical expense per capita were （56.2±7.5） days，（1 371.3±186.4） yuan，and （24.4±4.2） yuan，respectively.Physicians and nurses showed low satisfaction with salary and welfare and career development，but high satisfaction with peer relationships and professional identity in delivering institution-based hospice care.They showed similar satisfaction with delivering home hospice care.The main factors associated with the delivery of institution-based hospice care by physicians and nurses were：the contradiction between heavy workload and low salary，the delivery of hospice care relying on the institution's own operating subsidies without enough special funds，high level of negative emotions and great mental burdens caused by long-term caring dying patients.The major factors associated with the delivery of home hospice care by physicians and nurses were：too much trivial details in care but low payment，insufficient number of hospice care practitioners，and insufficient attentions to home hospice care from all walks of life.Conclusion　The institution-based and home hospice care services delivered by CHCs in central districts of Shanghai may effectively reduce the social and family burden，but there are aspects need to be improved：low occupancy rate of hospice beds，low payment and occupational satisfaction of hospice care physicians and nurses，and unsatisfied referrals for cancer patients with hospice care between medical institutions.

   

  Diagnostic Value of Plasma SEPT9 Methylation Test for Colorectal Cancer　

  WU Xiufang，NAN Qiong*，ZHANG Xiaohong，GENG Ting，CHEN Zihong    

  Department of Gastroenterology，First Affiliated Hospital of Kunming Medical University，Kunming 650032，China

  *Corresponding author：NAN Qiong，Professor，Chief physician；E-mail：nanqiong75@163.com

  Abstract: Background　Colorectal cancer（CRC）is a common malignant tumor of the digestive system，its morbidity and mortality present a year-by-year ascending tendency.Early diagnosis and treatment are the key to CRC prevention and treatment.However，there is short of noninvasive，simple，convenient and effective detecting methods for clinical diagnosis of CRC.Objective　To probe into the diagnostic value of plasma SEPT9 methylation test（mSEPT9）for CRC，to provide evidence for the diagnosis of this disease.Methods　Two hundred and seventy-two（126 cases of CRC，146 cases of non-CRC）cases of patients who visited the gastroenterology，gastrointestinal surgery and oncology departments of First Affiliated Hospital of Kunming Medical University between December 2017 and December 2018 were enrolled.They were divided into control group（82 cases），colorectal adenoma group（64 cases），early CRC group（72 cases）and progressive CRC group（54 cases）according to colonoscopy and pathological examination results.The relationship between positive expression of plasma mSEPT9 and the clinical characteristics of CRC patients was analyzed.The diagnostic performance of plasma mSEPT9 and serum carcinoembryonic antigen（CEA），and the combination of the two for early and progressive CRC was compared，and the accuracy of these three tests were evaluated.Results　The positive rate of plasma mSEPT9 was not related to CRC patients' age，gender，tumor location or tumor diameter（P>0.05）.The positive rate of plasma mSEPT9 was significantly lower in early CRC patients than that of progressive CRC patients（P<0.001）.The positive rate of plasma mSEPT9 was significantly higher in CRC patients with lymph node metastasis than that of those without（P<0.001）.The positive rate of plasma mSEPT9，serum CEA and the combination of the two for CRC showed significant differences across the four groups（P<0.001）.The combination of plasma mSEPT9 and serum CEA for CRC diagnosing was superior to either plasma mSEPT9 or serum CEA in terms of sensitivity，accuracy，negative predictive values，and its Kappa value was 0.514，indicating a moderate level of agreement with the gold standard.Conclusion　In the diagnosing for early and progressive CRC，the plasma mSEPT9 showed higher accuracy than serum CEA，but the accuracy of the combination of these two may be higher（in terms of sensitivity，accuracy，negative predictive values，and level of agreement with the gold standard），which may be used as a new thought or method for the diagnosis of CRC.

   

  The Value of Ultrasound Elastography and Molybdenum Target X-ray in the Diagnosis of Breast Invasive Ductal Carcinoma　

  FANG Kaifeng*，DING Guanbao，HAN Lu    

  Department of Ultrasound，Anhui Wanbei Coal Electricity Group General Hospital，Suzhou 234000，China

  *Corresponding author：FANG Kaifeng，Associate chief physician；E-mail：fangkaifeng707@163.com

  Abstract: Background　Breast cancer is one of the most common malignant tumors in women，so it is extremely important to find an effective method for early diagnosis of breast cancer.Objective　To investigate the value of ultrasonic elastography and molybdenum target X-ray in the diagnosis of breast invasive ductal carcinoma.Methods　From October 2017 to December 2019，102 female patients with suspected breast invasive ductal carcinoma treated in the Wanbei Coal Electricity Group General Hospital were selected as research objects.Ultrasonic elastography and molybdenum target X-ray examination were performed before operation or biopsy，with pathological diagnosis as the gold standard.The correlation between histological grade and ultrasonic elasticity score of breast invasive ductal carcinoma was analyzed.The ROC curves of ultrasound elastography and molybdenum target X-ray in the diagnosis of breast invasive ductal carcinoma were drawn.Results　98 cases of invasive ductal carcinoma of breast were confirmed by the gold standard.The histological grade of breast invasive ductal carcinoma was positively correlated with ultrasonic elasticity score（rs= 0.452，P=0.003）.When the optimal cutoff value of ultrasound elastography was 4，the sensitivity，specificity and AUC in diagnosis of breast invasive ductal carcinoma were 88.1%，92.1% and 0.953〔95%CI（0.912，0.995）〕；when the optimal cutoff value of molybdenum target X-raywas 4b，the sensitivity，specificity and AUC in diagnosis of breast invasive ductal carcinoma were 72.4%，83.3% and 0.855〔95%CI（0.805，0.893）〕.AUC of ultrasound elastography in the diagnosis of breast invasive ductal carcinoma was higher than that of molybdenum target X-ray（Z=3.337，P<0.05）.Conclusion　The diagnostic value of ultrasound elastography is higher than molybdenum target X-ray in the diagnosis of breast invasive ductal carcinoma，and ultrasound elastography is positively correlated with the histological grade of breast invasive ductal carcinoma，which is greatly significant in the evaluation of maligant degree of clinical diagnosis of breast invasive ductal carcinoma.

   

  Expert Recommendations on Community-based Management of Women with Abnormal Cervical Cancer Screening Test Results　

  Chinese Medical Doctor Association（CMDA）'s General Practitioners Sub-association，the Primary Care Branch of Beijing Institute of Obstetrics & Gynecology.Expert recommendations on community-based management of women with abnormal cervical cancer screening test results

  Abstract: Chinese Medical Doctor Association（CMDA）'s General Practitioners Sub-association，the Primary Care Branch of Beijing Institute of Obstetrics & Gynecology To reduce the incidence of cervical cancer via standardizing the prevention and control of cervical cancer in primary care，and the management and follow-up of women with abnormal cervical cancer screening test results and those with treatment for cervical lesions，China General Practitioner Association，Chinese Medical Doctor Association，and Community and Primary Care Branch，Beijing Institute of Obstetrics & Gynecology，invited relevant experts to develop the Expert Recommendations on Community-based Management of Women with Abnormal Cervical Cancer Screening Test Results，on the basis of reviewing guidelines on cervical cancer screening and managing women with abnormal cervical cancer screening test results，mainly involving cervical cancer prevention and control issues in primary care，such as creating personal health records，health education，classified management and bi-directional referrals.The recommendations will be vital to the improvement of community-based management of women with abnormal cervical cancer screening test results.

   

  Effect of Hyperthermia on M2 Polarization of Macrophages and Invasion and Migration of Lung Cancer Cells：an in Vitro Experimental Study　

  RAO Ziqi，LIU Jing，CHEN Binglin，DENG Yongran，LIU Wenqi*    

  Department of Radiotherapy，the Second Affiliated Hospital of Guangxi Medical University，Nanning 530000，China

  *Corresponding author：LIU Wenqi，Professor，Master supervisor；E-mail：liuwenqigx@163.com

  Abstract: Background　Hyperthermia is a safe adjuvant therapy that can suppress the occurrence and progression of tumor cells by inhibiting DNA repair，promoting cell apoptosis and improving immunity．However，little is known about whether hyperthermia can indirectly affect tumor cells by interfering with macrophages．Objective　This study aimed to examine the regulatory efficacy of M2 macrophages on lung cancer cells（LCCs）under in vitro hyperthermia．Methods　This study was implemented from June to December，2019．RAW264.7 cells were stimulated with interferon-γ（INF-γ，10 000 ng/L）+lipopolysaccharide（LPS，100 000 ng/L），and interleukin-4（IL-4，20 000 ng/L）for 72 h to induce M1 and M2 macrophages，respectively．The expression of surface antigens CD86 and CD206 in M1 and M2 macrophages were evaluated by flow cytometry．Secretion levels of IL-10 and IL-12 were measured by ELISA．Then，CCK-8 assay was used to detect the proliferation inhibition of M2 macrophages at 24，48 and 72 h after hyperthermia at different temperatures of 41℃，42℃ and 43℃．Real-time polymerase chain reaction（RT-PCR）and Western blotting were performed to determine the mRNA and protein expression of Arg-1，Fizz-1 and Ym-1 in M0 macrophages，M2 macrophages and M2 macrophages after hyperthermia（42 ℃），respectively．Transwell assay was utilized to measure the invasion and migration abilities of LCCs in LCCs+M2 and LCCs+M2+42℃ hyperthermia groups．Results　IFN-γ+LPS-and IL-4-induced RAW264.7 cells were successfully transformed into M1 and M2 macrophages，respectively．Flow cytometry results showed that the expressions of CD86 and CD206 in M2 macrophages were higher than those in M0 and M1 macrophages（P<0.001）．ELISA results revealed that the secretion level of IL-10 in M2 macrophages was higher than that of M0 and M1 macrophages（P<0.001）．The secretion level of IL-12 in M1 macrophages was higher than that of M0 and M2 macrophages（P<0.001）．Besides，we also found that the inhibition level of macrophages by hyperthermia at 42℃ was higher than that at 41℃ and 43℃（P<0.001）．RT-PCR results showed that M0 macrophages，the mRNA expressions of Ym-1，Arg-1 and Fizz-1 in M2 macrophages were increased（P<0.001）．But the mRNA and protein expressions of Ym-1 and Arg-1 in M2 macrophages were decreased after hyperthermia（42 ℃，P<0.001）．In addition，compared with LCCs+M2 group，hyperthermia（42 ℃）significantly decreased the invasion and migration abilities of LCCs（P<0.001）．Conclusion　In summary，hyperthermia may inhibit the invasion and migration of LCCs by downregulating the mRNA expression of Arg-1 and Ym-1 in M2 macrophages．

   

  Malignant Perivascular Epithelioid Cell Tumor of the Uterus：a Case Report and Literature Review　

  ZHENG Yongfei，ZHENG Hailan，WANG Sheng，HUANG Danjiang*    

  Department of Radiology，the First People's Hospital of Taizhou，Taizhou 318020，China

  *Corresponding author：HUANG Danjiang，Chief physician ；E-mail：zjhyhdj@163.com

  Abstract: Malignant perivascular epithelioid cell tumor （PEComa） of the uterus is a rare gynecologic tumor，which is easy to be misdiagnosed before operation.We retrospectively analyzed the clinical data，imaging presentations and pathological characteristics of a patient with PEComa of the uterus，and reviewed available studies about the disease，in order to improve the knowledge of the disease among medical workers.

   

  Prognostic Value of Partial Ephrectomy in Patients with Localized Ⅰ Clear Cell Renal Cell Carcinoma　

  CAI Menghui，LIU Feng，GE Tianyu，FENG Zihao，HUANG Kunping，GE Bo*    

  Department of Urology，the Second Affiliated Hospital of Guilin Medical University，Guilin 541199，China

  *Corresponding author：GE Bo，Professor，Chief physician；E-mail：ge1123@sina.com

  Abstract: Background　At present，partial nephrectomy（PN）is preferred for patients with localized T1a clear cell renal cell carcinoma（ccRCC）.However，it remains controversial whether PN is the first-choice surgical procedure for patients with localized T1b ccRCC.Objective　To estimate the effects of PN on overall survival（OS）and cancer-specific survival（CSS）of patients with localized Ⅰ ccRCC.Methods　From April to May 2020，we downloaded the clinicopathological data of patients diagnosed with ccRCC pathologically from 1975 to 2016（year of diagnosis，age，sex，race，marital status，tumor laterality，pathological stage，T stage，surgical method）from SEER after getting permission to use the database.According to the use of surgical techniques，the patients were divided into PN group and radical nephrectomy（RN）group.Cox proportional hazards regression model was used to identify independent prognostic factors of CSS in patients with localized I ccRCC.Multivariate Logistic regression analysis was used to explore the the influencing factors of surgical methods in patients with ccRCC.Propensity score matching method was used to adjust samples.Kaplan-Meier curve and multivariate Cox proportional hazards regression model were used to estimate the effects of two surgical methods on the OS and CSS of patients before and after matching.Results　The results of univariate Cox proportional hazard regression model showed that age，marital status，pathological stage，T stage and surgical method were factors associated with CSS in patients with localized ⅠccRCC（P<0.05）.The results of multivariate Cox proportional hazard regression model showed that age，marital status，pathological stage，T stage and surgical method were all independent factors for CSS in patients with localizedⅠ ccRCC（P<0.05）.In terms of evaluating the prognostic value of surgical method by overall survival population and tumor specific survival population，localized T1b stage ccRCC with PN and those with RN had statistically significant differences in the year of diagnosis，age，tumor laterality and pathological stage（P<0.05）.Multivariate Logistic regression analysis revealed that year of diagnosis，age，tumor laterality and pathological stage were associated with the use of surgery method in patients with localized T1b stage ccRCC（P<0.05）.Kaplan-Meier survival analysis found that either before or after propensity score matching，PN significantly prolonged the OS（P<0.05），but showed similar effect on the CSS（P>0.05）of patients compared with RN.After propensity score matching，multivariate Cox regression analysis found that PN was independently associated with prolonged OS of patients（HR=0.695，P=0.009），but was not significantly associated with CSS（HR=0.804，P=0.301）.Conclusion　When surgery is feasible，PN is recommended as the first-choice surgical mode for patients with stage ⅠccRCC in light of long-term survival.

   

  Diagnostic Value of Circulating Cell-free DNA to Prostate Cancer：a Meta-analysis　

  LI Fan1，XU Bin1，XIANG Hui2，CHEN Zejia1，PANG Zisen1，ZHANG Tianyu1*    

  1.Department of Urology，Affiliated Hospital of Guilin Medical University，Guilin 541001，China

  2.Department of Respiratory and Critical Care Medicine，Affiliated Hospital of Guilin Medical University，Guilin 541001，China

  *Corresponding author：ZHANG Tianyu，Professor，Chief physician，Master supervisor；E-mail：zhangtianyu64@qq.com

  LI Fan and XU Bin are co-first authors

  Abstract: Background　Numerous studies have shown that circulating free DNA（cfDNA）has diagnostic value in prostate cancer，but there is no consensus on its accuracy.Objective　To evaluate the diagnostic value of cfDNA in prostate cancer by a Meta-analysis.Methods　Articles in Chinese and English regarding diagnosing prostate cancer using cfDNA were collected by searching databases of PubMed，EMBase，Web of Science，The Cochrane Library，CNKI，and WANFANG DATA from inception to February 2020，and were enrolled according to the inclusion and exclusion criteria.Data were extracted，including the first author's name，year of publication，country of publication，sample size，detection method and accuracy assessment indices（true-positive，false-positive，false-negative，true-negative）.Spearman correlation was used to assess whether there was a threshold effect.The SROC plot was used to examine whether the diagnostic performance curve of cfDNA presenting a “shoulder-arm” shape.The heterogeneity between the included studies was measured by the Cochran's Q test and I2 test and used for selecting an appropriate model for pooling data.Meta-analysis and Fagan's nomogram were used to estimate the diagnostic efficiency and probability of cfDNA，respectively.Results　 Twenty-two articles were included，involving 2 774 cases，1 936 of whom were diagnosed with prostatic cancer by cfDNA and 838 were not.The overall quality of the included literature was good.The pooled sensitivity，specificity，positive likelihood ratio，negative likelihood ratio，diagnostic odds ratio of cfDNA for prostate cancer diagnosis were 0.49〔95%CI（0.47，0.51）〕，0.91〔95%CI（0.89，0.92）〕，6.04〔95%CI（4.39，9.31）〕，0.52〔95%CI（0.45，0.60）〕，and 18.19〔95%CI（12.33，26.85）〕，respectively.The AUC of the SROC curve was 0.898 2.Subgroup analysis showed that the AUC value of cfDNA in the diagnosis of prostate cancer did not change significantly in each subgroup（P>0.05）.Fagan's nomogram demonstrated that using cfDNA to detect prostatic cancer increased the posttest probability to 88% from the pretest probability of 20%.Conclusion　cfDNA might be a diagnostic biomarker for prostate cancer.It may be used as a helper for prostate-specific antigen screening，but it still needed a large number of prospective stuides to support this.

   

  Laboratory Test Indices and Survival Status in Patients with Advanced Cancer　

  YU Wenkai1，CHEN Jianlin1*，WANG Jianfang2，NI Xiaorong3，LIU Deng4，PAN Jumei1，SHI Yongxing5    

  1.Hospice Ward，Linfen Community Health Center，Shanghai 200435，China

  2.Department of Traditional Chinese Medicine，Huangpu District Hospital of Integrated Traditional Chinese and Western Medicine，Shanghai 200011，China

  3.Department of Gynecology，Hospital of Traditional Chinese Medicine Affiliated to Shanghai University of Traditional Chinese Medicine，Shanghai 200071，China

  4.Bachu County People's Hospital，Kashgar 843800，China

  5.Research Department，Chinese Association for Life Care，Beijing 100026，China

  *Corresponding author：CHEN Jianlin，Chief physician；E-mail：944500063@qq.com

  Abstract: Background　Accurate assessment of expected survival in patients with advanced cancer is important to improve their quality of life.However，current tools for predicting the survival of these patients need to be improved.Objective　To explore the relationship between laboratory test indices and survival status of advanced cancer patients.Methods　Totally 175 advanced cancer patients were recruited from Hospice Ward，Linfen Community Health Center，Shanghai's Jing'an District，from 2018-11-01 to 2019-06-31.Admission laboratory test results were collected，including white blood cell count，hemoglobin，lymphocyte count，neutrophil count，platelet count，C-reactive protein，serum albumin，neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio.The follow-up was conducted until September 30，2019.The end point for follow-up was death.Cox regression analysis was used to examine the association of each laboratory indicator with the survival status.Results　Of the 175 cases，150 died in hospital，with a median survival of 8 days（range，1-29 days），other 25 were lost to follow-up after discharge，with a median length of stay of 67.5 days（range，30-167 days）.Univariate Cox regression analysis showed that high white blood cell count，neutrophils count and C-reactive protein，and low lymphocyte count，platelet count，and serum albumin were associated with the survival status of advance cancer patients（P<0.05）.Multivariate Cox regression analysis showed that lymphocyte count 〔low：HR=1.498，95%CI （1.035，2.170），P=0.032；high：HR=8.490，95%CI （1.894，38.057），P=0.005〕，neutrophil count 〔high：HR=2.227，95%CI （1.478，3.357），P<0.001〕，platelet count 〔low：HR=2.185，95%CI （1.418，3.366），P<0.001〕，and C-reactive protein 〔high：HR=1.478，95%CI （1.005，2.201），P=0.047〕 were independently associated with the survival status of advance cancer patients.Conclusion　Lymphocyte count，neutrophil count，platelet count and C-reactive protein are independently associated with survival status of patients with advanced cancer，may have a certain value in assessing the survival status.

   

  Recent Advances in Molecular Mechanism of Metformin against Gastrointestinal Cancer in Type 2 Diabetics　

  TAN Zhiqiang1，HE Li2，JIANG Yanxia3*    

  1.Department of Gastroenterology，the First Affiliated Hospital of Nanchang University，Nanchang 330006，China

  2.Department of Pathology，Jingdezhen No.1 People's Hospital，Jingdezhen 333000，China

  3.Department of Endocrinology，the First Affiliated Hospital of Nanchang University，Nanchang 330006，China

  *Corresponding author：JIANG Yanxia，Attending physician；E-mail：760580768@qq.com

  Abstract: The morbidity and mortality rates of gastrointestinal cancers are increasing with the aging of population in China，such as esophageal cancer，gastric cancer，pancreatic cancer and colorectal cancer，seriously endangering people's health.Metformin has been used for type 2 diabetes since 1995，and has become a first-line drug for type 2 diabetes for its safe and stable anti-hyperglycemic and cardiovascular protective effects favored by endocrinologists.Meanwhile，epidemiological and clinical studies at home and abroad have confirmed that metformin can reduce the incidence rate of various tumors and improve the prognosis in type 2 diabetics，suggesting that chemoprophylaxis of gastrointestinal cancer may be a breakthrough obtained in cancer chemoprophylaxis.In this paper，the molecular mechanism of metformin against gastrointestinal cancer in diabetics was reviewed.

   

  Gemcitabine Has a Lower Recurrence Rate and Less Side Effects than Mitomycin for Non-muscular Invasive Bladder Cancer after TURBT：a Meta-analysis of Randomized Controlled Trials　

  PENG Lei1，MENG Chunyang1，LI Jinze2，LI Yunxiang1*，LI Jinming3*，ZHAO Pan1，WEI Tangqiang1，WU Ji1    

  1.Department of Urology，Nanchong Central Hospital/the Second Clinical Medical College，North Sichuan Medical College，Nanchong 637000，China

  2.Department of Urology，West China Hospital of Sichuan University/Institute of Urology，Chengdu 610041，China

  3.Department of Urology，Affiliated Hospital of North Sichuan Medical College，Nanchong 637000，China

  *Corresponding authors：LI Yunxiang，Chief physician；E-mail：liyunxiang369@126.com

  LI Jinming，Attending physician；E-mail：ljm1012@qq.com

  Abstract: Background　Gemcitabine and mitomycin are both chemotherapy drugs for non-muscular invasive bladder cancer（NMIBC）after transurethral resection of bladder tumor（TURBT）. However，no final conclusion has been reached on these two drugs in terms of differences in clinical efficacy and safety. Objective　To evaluate the effectiveness and safety of gemcitabine versus mitomycin in the treatment of NMIBC after TURBT. Methods　Published randomized controlled studies（RCT）comparing gemcitabine and mitomycin for NMIBC after TURBT were searched in databases of PubMed，EMBase，Web of Science，The Cochrane Library，CNKI，Wanfang Data，SinoMed，and CQVIP from inception to 2020-10-01，and enrolled according to the inclusion and exclusion criteria.Data of included RCT were extracted，including the first author，publication year，design，level of evidence，sample age，sample size，tumor growth，WHO classification，TNM staging，drug infusion dosage，cancer recurrence（recurrence within one and two years after surgery），and chemotherapy perfusion-related adverse events（bladder irritation，hematuria，liver and kidney damage，rash，nausea and vomiting，suprapubic pain）. The patients were divided into GEM group and MMC group according to the drug use after TURBT. Meta-analysis of recurrence within one and two years after surgery and incidence of chemotherapy perfusion-related adverse events was performed in two groups. Results　A total of seven RCT were included，involving 484 patients，with high quality rated by the Jadad Scale. Meta-analysis showed no statistically significant difference in one-year recurrence rate between the two groups of patients〔OR=0.86，95%CI（0.29，2.56），P=0.17〕. But gemcitabine group gained more benefits in reducing the two-year recurrence rate〔OR=0.37，95%CI（0.23，0.59），P=0.01〕. Furthermore，gemcitabine group demonstrated lower overall incidence of chemotherapy perfusion-related adverse events〔OR=0.28，95%CI（0.18，0.43），P=0.01〕，lower incidence of bladder irritation〔OR=0.30，95%CI（0.17，0.54），P=0.04〕as well as lower incidence of other complications（rash，nausea and vomiting，suprapubic pain）〔OR=0.46，95%CI（0.24，0.88），P=0.01〕. There were no statistically significant intergroup differences in the incidence of postoperative hematuria〔OR=0.52，95%CI（0.21，1.26），P=0.22〕and liver and kidney damage〔OR=0.51，95%CI（0.29，0.85），P=0.16〕. Conclusion　Gemcitabine may be more effective and safe for NMIBC after TURBT，owing to its better effects on lowering the recurrence rate and incidence of adverse events.

   

  The Chinese Version of the Demoralization Scale-Ⅱ：Development，Reliability and Validity in Chinese Cancer Patients　

  OU Na1，HU Xiaoping2*，QI Sanyang3，LUO Xiaoyan2，NIE Wenjie1    

  1. School of Nursing，University of South China，Hengyang 421001，China

  2. Department of Nursing，Affiliated Nanhua Hospital，University of South China，Hengyang 421000，China

  3. Department of Geriatric Rehabilitation，the Second People's Hospital of Hengyang，Hengyang 421000，China

  *Corresponding author：HU Xiaoping，Chief superintendent nurse，Associate professor；E-mail：huxiaoping7726@163.com

  Abstract: Background　Demoralization syndrome is a kind of psychological pain caused by a series of negative life events. It is a new psychiatric diagnosis，and closely related to suicidal ideation. It has a high incidence in cancer patients，but relevant effective evaluation may be an early warning indicator for intervention. However，there is a lack of assessment tools for demoralization syndrome in China. Objective　 To develop a Chinese version of the Demoralization Scale-Ⅱ（DS-Ⅱ）and test its reliability and validity. Methods　From August 2019 to January 2020，410 cancer inpatients from Affiliated Nanhua Hospital，University of South China，Hengyang，Hunan Province were recruited and investigated with a self-compiled questionnaire named Socio-demographic and Disease-related Information（Cronbach's α=0.87），Chinese version of the DS-Ⅱ（formed by forward and backward translation，expert review and pre-testing research），Hospital Anxiety and Depression Scale（HADS），and Edmonton Symptom Assessment Scale（ESAS）. Item scores of the DS-Ⅱ were compared between high and low score groups（the top-ranked and bottom-ranked 27% of patients）. The content validity，construct validity，convergence validity，discrimination validity and internal consistency of the Chinese version of DS-Ⅱ were evaluated. Results　 Two groups showed significant differences in the score of each of the 16 items of the DS-Ⅱ（P<0.05）. The item-total correlation coefficients of the DS-Ⅱ ranged from 0.532 to 0.663（P<0.05）. The items of the scale had adequate content validity（I-CVI=0.83-1.00，S-CVI=0.94）. Exploratory factor analysis showed that KMO value was 0.887，Bartlett spherical test χ2=4 018.126，P<0.001. Two common factors with an eigenvalue greater than 1 were extracted by varimax rotation，which could explain 61.342% of the total variation. The load value of each item was more than 0.400，without double load. Both factors 1 and 2 contain 8 items，and the factor attribution of the item is consistent with the original scale. The item-domain correlation coefficients ranged from 0.60 to 0.86，and the inter-domain correlation coefficient was 0.15. The total score of the Chinese version of DS-Ⅱ was positively correlated with the total score（r=0.581），and the anxiety（r=0.443）and depression （r=0.655）subscales scores of the HADS，and also positively correlated with the total score of the ESAS（r=0.512） and its items including pain（r=0.393），tiredness（r=0.266），depression（r=0.497）and anxiety（r=0.418），but was negatively correlated with the score of KPS（r=-0.249，P<0.05）. The Cronbach's coefficient of the Chinese version of DS-Ⅱ was 0.877. Conclusion　The Chinese version of DS-Ⅱ has good psychometric properties，which may be a reliable tool for evaluating demoralization syndrome in Chinese cancer patients.

   

  Expression of MOS Gene and Its Correlations with Clinicopathological Features and Prognosis of Patients with Colorectal Cancer　

  PENG Junfu1，PENG Jisheng2*，WANG Rui3，LIU Chao1，WANG Zhenbiao1    

  1.Department of TCM Surgery，Beijing Shijitan Hospital，Capital Medical University，Beijing 100038，China

  2.Department of Traditional Chinese Medicine，Peking University Shougang Hospital，Beijing 100144，China

  3.Department of Anorectal Surgery，Dongzhimen Hospital，Beijing University of Chinese Medicine，Beijing 100007，China

  *Corresponding author：PENG Jisheng，Associate chief physician；E-mail：naitao847424021@163.com

  Abstract: Background　The specific pathogenesis of colorectal cancer is not completely clear at present，and there are few reports about the relationship of MOS gene with biological characteristics and prognosis of colorectal cancer patients. Objective　To examine the expression of MOS gene and its correlations with clinicopathological features and prognosis of patients with colorectal cancer. Methods　Data of 86 newly diagnosed colorectal cancer patients were selected from Beijing Shijitan Hospital，Capital Medical University from October 2009 to June 2019. The expression of MOS gene and its correlations with clinicopathological features and prognosis of colorectal cancer patients were analyzed. Results　The relative expression quantity of MOS gene was（4.56±2.17）in colorectal cancer tissues，which was significantly higher than that（3.12±1.65） in paracancerous tissues（P<0.001）. Subgroup analysis based on MOS expression found that，high and low MOS expression subgroups（stratified equally by the mean value of relative expression quantity of MOS gene）had no significant differences in gender ratio，distributions of age，cancer differentiation，prevalence of lymphatic metastasis or distant metastasis（P>0.05）. High MOS expression subgroup had much higher proportion of T3-4 colorectal cancer patients（P<0.05）. The median survival for high and low MOS expression subgroups was 101 months〔95%CI（92.4，112.6）〕and 116 months〔95%CI（105.6，128.7）〕，respectively，with significant intergroup difference in Kaplan-Meier survival curve（P=0.029）. Cox proportional hazards regression analysis showed that，high expression of MOS gene〔HR=7.695，95%CI（1.377，43.003）〕，lymphatic metastasis〔HR=28.585，95%CI（1.401，583.297）〕and distant metastasis〔HR=47.852，95%CI（3.527，649.257）〕were independently associated with increased risk of poor prognosis of patients with colorectal cancer（P<0.05）. Conclusion　As one of the independent risk factors of poor prognosis of patients with colorectal cancer，high expression of MOS gene may be closely correlated with the degree of colorectal cancer infiltration and prognosis，which may be a valuable predictive and prognostic biomarker，and a potential therapeutic target for colorectal cancer.

   

  Analysis of Risk Factors of Lung Cancer Patients Combined with Sarcopenia and Their Correlation with Clinical Prognosis　

  LI Zhouhua1，JI Shuang 1，2，HU Xianwei1，YOU Qinghai1，FEI Guanghe1，2*    

  1.Department of Respiratory and Critical Care Medicine，the First Affiliated Hospital of Anhui Medical University，Hefei 230022，China

  2.Key Laboratory of Respiratory Diseases Research and Medical Transformation of Anhui Province，Hefei 230022，China

  *Corresponding author：FEI Guanghe，Chief physician，Professor，Doctoral supervisor；E-mail：guanghefei@126.com

  Abstract: Background　Patients with lung cancer often suffer from sarcopenia，but the relationship between sarcopenia and quality of life，emotional status is unclear. Objective　To investigate the incidence of sarcopenia in lung cancer patients，analyze its risk factors and their impact on the clinical prognosis including emotional status，quality of life，etc，so as to provide evidence for the overall improvement of the clinical prognosis of lung cancer patients. Methods　87 patients with lung cancer who attended the Department of Respiratory and Critical Care Medicine，the First Affiliated Hospital of Anhui Medical University from December 2019 to July 2020 were recruited，and their age，gender，education level，smoking status，tumor pathological type，PS score，length of illness，treatment status，comorbidities，body mass index（BMI）were collected，their hemoglobin，lactate dehydrogenase，prealbumin，albumin were measured. The body composition analyzer was used to measure the muscle mass of the limbs and calculate skeletal muscle mass index （SMI），and the patients were divided into sarcopenia group（46 cases）and no sarcopenia group（41 cases）according to the diagnostic criteria of the Asia Working Group on Sarcopenia in Older People（AWGSOP）. The Nutritional Risk Screening 2002（NRS2002）was used to evaluate the patients' malnutrition risk，the Quality-of-Life Questionnaire-Core 30（QLQ-C30）was used to evaluate the quality of life of the patients，and the Hospital Anxiety and Depression Scale（HADS）was used to evaluate the emotional state of the patients. Binary logistic regression analysis was used to explore the influencing factors of lung cancer combined with sarcopenia，and Pearson correlation analysis was used to explore the correlation between sarcopenia and quality of life，emotional status. Results　The prevalence of sarcopenia in lung cancer patients was 52.9%. Age，proportion of long-term smoking，Charlson comorbidity index，NRS2002 score，and risk of malnutrition in the sarcopenia group were higher than the non-sarcopenia group，while BMI，limb muscle mass，and SMI were lower than the non-sarcopenia group（P<0.05）. The results of binary logistic regression analysis showed that long-term smoking history〔OR=5.515，95%CI（1.234，24.646）〕，duration of illness〔OR=1.132，95%CI（1.007，1.272）〕，BMI 〔OR=0.676，95%CI（0.519，0.880）〕，NRS2002 score 〔OR=1.773，95%CI（1.012，3.108）〕 are the influencing factors of lung cancer combined with sarcopenia. The scores of anxiety scale，depression scale，fatigue，pain，shortness of breath，and loss of appetite in the sarcopenia group were higher than the no sarcopenia group（P<0.05）. The total score of QLQ-C30，the scores of physical function，role function，emotional function，and social function in sarcopenia group were lower than the no sarcopenia group（P<0.05）. Pearson correlation analysis results showed that sarcopenia was positively correlated with the scores of anxiety，depression，fatigue，pain，shortness of breath，and appetite loss（P<0.05），but negatively correlated with the scores of global quality of life，role functioning，physical functioning，emotional functioning，social functioning（P<0.05）. Conclusion　Longer disease duration，long term smoking history，higher NRS2002 score and lower BMI has higher risk for developing sarcopenia. Sarcopenia is significantly associated with poorer quality of life，and anxiety and depressive symptoms in patients with lung cancer.

   

  Study on the Effect of Baseline Blood Lipid Level on the Prognosis of Patients with Non-triple-negative Breast Cancer　

  WU Wenxia，ZHANG Meng*    

  Department of General Practice，Sun Yat-sen Memorial Hospital，Sun Yat-sen University，Guangzhou 510289，China

  *Corresponding author：ZHANG Meng，Associate chief physician；E-mail：zmeng78@sina.com

  Abstract: Background　Dyslipidemia is one of high risk factors of breast cancer. Current studies have found that the level of blood lipid metabolism may also be closely related to the stage，pathology，overall survival（OS） and disease free survival（DFS） of breast cancer，but the results were stil controversial. Objective　To explore the effect of baseline blood lipid metabolism on the prognosis of non-Triple Negative Breast Cancer（TNBC）. Methods　Retrieved from January 2019 to March 2021 in Sun Yat-sen memorial Hospital from January 2016 to March 2017 in the electronic medical record system，202 cases of non-triple-negative breast cancer patients were included. All the patients had no history of diabetes，dyslipidemia，cardiovascular or cerebrovascular disease. The clinical general information including age，menopausal status，history of hypertension，body mass index（BMI），fasting blood glucose，blood lipids〔including total cholesterol（TC），triacylglycerol（TG），low-density lipoprotein cholesterol（LDL-C），high-density lipoprotein cholesterol（HDL-C），apolipoprotein A1（APOA1），apolipoprotein B（APOB），apolipoprotein E（APOE）〕，high-sensitivity C-reactive protein （hsCRP），uric acid，pathological results 〔including tumor size（T stage），lymph node metastasis（N stage），ER，PR，HER-2，Ki-67，tissue grade〕were collected. The OS and DFS time until three years of diagnosis were recorded. The patients were divided into two groups according to the breast cancer stage. Group 1was stage Ⅰ-Ⅱ and group 2 was stage Ⅲ. Kaplan-Meier curves were used to determine OS and DFS rates. Log rank-tests were performed to compare differences in survival curves. Multivariable Cox proportional hazards regression models were used to study the associations between pre-diagnostic lipids and DFS，OS of non-TNBC. Results　The TG level of group 2 was higher than that of group 1，while the level of HDL-C was lower than that of group 1

  （P<0.05）. The optimal cutoff values of the TG level and HDL-C were determined to be 1.39 mmol/L〔AUC=0.626，95%CI（0.562，0.690）〕 and 1.14 mmol/L〔AUC=0.599，95%CI（0.531，0.668）〕，respectively. The proportion of stage Ⅲ was higher in patients with TG≥1.39 mmol/L or HDL-C<1.14 mmol/L than TG<1.39 mmol/L or HDL-C≥1.14 mmol/L（P<0.05）. Patients with TG≥1.39 mmol/L had higher proportion of lymph node metastasis than with TG<1.39 mmol/L. Patients had more advanced T stage in group with HDL-C<1.14 mmol/L than HDL-C≥1.14 mmol/L. Patients with HDL-C≥1.14 mmol/L had higher OS（98.1%）and DFS（89.8%） than HDL-C<1.14 mmol/L，which was 90.9% and 77.4% respectively（χ2=4.669，P=0.031；χ2=3.859，P=0.049）. After adjusting for menopausal status，BMI，blood pressure and blood glucose levels，baseline HDL-C<1.14 mmol/L is considered recurrence，metastasis〔HR=2.907，95%CI（1.024，8.255），P=0.045〕 and death〔HR=8.718，95%CI （1.148，66.198），P=0.036〕 influencing factors. Conclusion　HDL-C<1.14 mmol/L might be an influencing factor for the poor clinical prognosis of non-triple-negative breast cancer.

   

  Risk Factors for Breast Cancer-related Lymphedema in Chinese Women：a Meta-analysis　

  ZHANG Hao，LIU Ruirui，ZHU Lin，BO Dingxi，ZHONG Yizhu，LIANG Yun，GAO Jing*    

  School of Nursing，Chengdu University of TCM，Chengdu 611137，China

  *Corresponding author：GAO Jing，Professor；E-mail：729012934@qq.com

  Abstract: Background　Breast cancer-related lymphedema （BCRL）is the most common postoperative complication of breast cancer，which cannot be cured clinically at present. Early identification of the risk factors for BCRL may improve the outcome significantly，yet it is still controversial in existing relevant studies，and there is no relevant systematic review in China. Objective　To systematically evaluate the risk factors for BCRL in Chinese women. Methods　We searched the databases of CINAHL，PubMed，EMBase，Web of Science，The Cochrane Library，CNKI，CQVIP，Wanfang Data and SinoMed for articles about the risk factors of BCRL among Chinese women published from inception to June 2020.Two researchers independently screened the studies based on the inclusion and exclusion criteria，extracted data 〔including the first author，time of publication，type of studies，sample size，measurement methods for edema，degree of edema，follow-up time，and BCRL-related factors（age，BMI，hypertension prevalence，lymph node metastasis prevalence，scope of axillary lymph node dissection，having a lymph node dissection，number of lymph nodes dissected，postoperative healing complication，chemotherapy，radiation therapy）〕，and performed risk of bias assessment using the Newcastle-Ottawa Scale. Meta-analysis was performed using RevMan 5.3. Results　31 studies involving 2 618 subjects were included，with moderate or high methodological quality. Meta-analysis showed that older age〔OR=2.59，95%CI（1.95，3.45），P<0.000 01〕，increased BMI〔OR=2.33，95%CI（1.91，2.85），P<0.000 01〕，hypertension〔OR=4.76，95%CI（2.53，8.94），P<0.000 01〕，lymph node metastasis〔OR=1.22，95%CI（1.06，1.39），P=0.005〕，extended axillary lymph node dissection〔OR=2.30，95%CI（1.88，2.81），P<0.000 01〕，having a lymph node dissection〔OR=8.29，95%CI（2.32，29.60），P=0.001〕，number of dissected lymph nodes ≥15〔OR=1.12，95%CI（1.06，1.19），P<0.000 1〕，postoperative healing complication〔OR=4.11，95%CI（3.26，5.17），P<0.000 01〕，chemotherapy〔OR=3.17，95%CI（2.16，4.63），P<0.000 01〕，radiation therapy〔OR=2.69，95%CI（2.32，3.13），P<0.000 01〕were risk factors of BCRL. Conclusion　BCRL among Chinese women may be associated with various risk factors，such as age>40，BMI≥24 kg/m2，hypertension，lymph node metastasis，extended axillary lymph node dissection，having a lymph node dissection，number of dissected axillary lymph nodes ≥15，postoperative healing complication，chemotherapy，and radiation therapy. Due to limited quality and quantity of the included studies，more large-sample prospective cohort studies are required to verify the above conclusion.

   

  The Treatment Value of Taking Twice Abiraterone Acetate for the Metastatic Prostate Cancer　

  WANG Hui*，ZHAO Shankun，LIU Shixiong，LI Xin    

  Department of Urology，Taizhou Central Hospital（Taizhou University Hospital），Taizhou 318000，China

  *Corresponding author：WANG Hui，Associate chief physician，Associate professor；E-mail：wangh1498@tzzxyy.com.

  Abstract: Abiraterone acetate（AA），a new antiandrogen，has just recently been introduced into the Chinese market，and used once for most patients. We retrospectively analyzed the diagnosis and treatment process of two cases of metastatic prostate cancer（mPC）treated using a comprehensive treatment scheme including the “sandwich” therapy with AA，and found this scheme may be effective for mPC. Moreover，we also found that the response time of the first AA treatment may be longer if the first AA treatment was stopped as early as possible at the end of the hormone-sensitive period，but that may be shorter if being stopped later in the castrate-resistant period. Furthermore，early discontinuation of the first AA treatment significantly prolonged the overall drug response period and the cancer-specific survival. Therefore，the "sandwich" regimen of AA could be used as a new strategy to improve the efficacy of mPC. And the earlier discontinuation regimen will be more conducive to optimizing the existing sequential treatment of mPC than the later discontinuation regimen.

   

  Summary of the Best Evidence Regarding Perioperative Exercise Improving the Health Outcome in Patients with Non-small Cell Lung Cancer　

  WANG Tingting，ZHANG Xinqiong*，WANG Aimei，HAN Shiyu，ZHANG Honghui    

  School of Nursing，Anhui Medical University，Hefei 230032，China

  *Corresponding author：ZHANG Xinqiong，Professor；E-mail：hixqzhang@163.com

  Abstract: Background　Appropriate perioperative exercise can effectively improve the health outcome of non-small cell lung cancer （NSCLC） patients，but the related best evidence about the effectiveness of various intervention programs has not been summarized. Objective　To search and evaluate studies about perioperative exercise improving the health outcome of NSCLC patients，then summarize the best evidence. Methods　We searched Up To Date，BMJ Best Practice，Joanna Briggs Institute Evidence-Based Practice Database，China National Guideline Clearinghouse，National Guideline Clearinghouse，The Cochrane Library，PubMed，CNKI and other databases to collect evidence summaries，guidelines，expert consensuses and systematic reviews regarding perioperative exercise improving the health outcome in patients with NSCLC from inception to July 2020. Methodological quality and evidence level were assessed by researchers systematically trained on evidence-based medicine. Results　Totally 22 studies were included，including 1 evidence summary，3 guidelines，1 expert consensus，14 systematic reviews and 3 randomized controlled trials. Their methodological qualities were rated high overall. Finally 22 pieces of best evidence involving 7 dimensions were summarized，namely，necessity of perioperative exercise，population suitable for performing perioperative exercise，pre-exercise health evaluation，preoperative exercise program，postoperative exercise program，precautions and effectiveness evaluation. Conclusion　This summary indicates that clinical healthcare workers should value the exercise management for NSCLC patients，and develop personalized intervention programs（including preoperative and postoperative exercise programs） with the patient's individual features〔such as comprehensive health evaluation（including per-exercise evaluation） and preference〕，precautions and effectiveness evaluation regarding the exercise taken into account.

   

  Intracranial Failure Analysis in Patients with Brain Metastasis from Lung Adenocarcinoma Harboring Epidermal Growth Factor Receptor Mutation　

  SONG Yuzhi1，ZHEN Chanjun1，BAI Wenwen1，LI Bo2，QIAO Xueying1，ZHOU Zhiguo1*    

  1. Radiotherapy Department，the Fourth Hospital of Hebei Medical University，Shijiazhuang 050011，China

  2. Radiology Department，the Fourth Hospital of Hebei Medical University，Shijiazhuang 050011，China

  *Corresponding author：ZHOU Zhiguo，Chief physician；E-mail：chenk777@126.com

  Abstract: Background　The treatment of patients with brain metastasis（BM） from lung adenocarcinoma（LAC） with epidermal growth factor receptor（EGFR） mutation is a hot and controversial issue，as no standard treatment modality currently exists. Objective　To analyze the clinical factors associated with intracranial failure following BM treatment in BM patients from LAC with EGFR mutation. Methods　In this study，we retrospectively enrolled 282 patients with a confirmed diagnosis of BM from LAC with EGFR mutation from the Fourth Hospital of Hebei Medical University between January 2011 and June 2018. Baseline characteristics were obtained，containing age，gender，smoking history，Karnofsky Performance Status Scale score，extracranial disease control status，number of involved extracranial organs，number and symptoms of BMs，timing of BM development，treatment modality for BMs，treatment strategy for the primary lung tumor，and Lung-molGPA. At four weeks after the end of whole-brain radiation therapy（WBRT） or targeted oral therapy using tyrosine kinase inhibitors（TKIs），we assessed the intracranial response，and delivered a follow-up to patients，during which the overall survival-BM（OS-BM），intracranial progression-free survival（iPFS） and time of intracranial control were recorded. We plotted Kaplan-Meier curves for OS-BM and iPFS. We used multivariate Logistic regression analysis to explore clinical factors associated with intracranial failure and to further investigate the associated factors between two subgroups divided by the median time to intracranial failure〔early failure subgroup（≤10.0 months） and late failure subgroup（>10.0 months）〕. Results　（1） Baseline characteristics：the median follow-up time was 28.4 months（range，3.0 to 94.8 months）. The median OS-BM was 45 months，and the 3-year OS-BM rate was 28.5%. The median iPFS time was 24 months，and the 3-year iPFS rate was 38.4%. （2）Group analysis of intracranial failure：in all，48.9% of the patients developed intracranial failure. BM symptoms and related treatment modality as well as Lung-molGPA were significantly different for those who developed intracranial failure as compared to those who did not in the baseline characteristics（P<0.05）. Other baseline data showed no intergroup differences（P<0.05）. Multivariate Logistic regression analysis showed that BM treatment modality was associated with intracranial failure〔OR=1.992，95%CI（1.308，3.437），P=0.004〕. The patients receiving WBRT combined with TKIs or not had a higher 3-year iPFS rate as compared to those receiving TKIs alone（51.6% vs 26.7%）（χ2=10.769，P=0.001）. （3）Subgroup analysis of intracranial failure：early failure subgroup（n=71） had a lower 3-year OS-BM rate than late failure subgroup（n=67）（5.9% vs 42.1%）（χ2=51.888，P<0.001）. By the multivariable analyses，the number of involved extracranial organs was associated with early intracranial failure〔OR=0.336，95%CI（0.126，0.894），P=0.029〕. The 3-year iPFS rate was 4.2% in patients with ≥4 involved extracranial organs，and 14.0% in those with ≤3（χ2=4.993，P=0.025）. Conclusion　For patients with EGFR-mutated LAC with BM，BM treatment modality was associated with intracranial failure. Compared to the use of TKIs alone，using WBRT in combination with TKIs or not may delay the time to develop intracranial failure with an around 50% reduced risk. In addition，the number of involved extracranial organs was associated with early intracranial failure. The higher the number（≥4），the earlier intracranial failure occurred.

   

  Efficacy and Safety of Tumor-treating Fields Versus Angiogenesis Inhibitors in Combination with Stupp Protocol for Newly Diagnosed Glioblastoma：a Network Meta-analysis　

  SU Dongpo1，ZUO Zhengyao1，LI Mei1，HAN Qian1，ZHANG Weihong2，FU Aijun1，ZHU Jun1，CHEN Tong1*    

  1.Department of Neurosurgery，North China University of Science and Technology Affiliated Hospital，Tangshan 063000，China

  2.Department of Nursing，North China University of Science and Technology Affiliated Hospital，Tangshan 063000，China

  *Corresponding author：CHEN Tong，Professor，Chief physician；E-mail：ct.1973@ 163.com

  Abstract: Background　Tumor-treating fields（TTFields）with Stupp protocol and angiogenesis inhibitors with Stupp protocol have proved to be effective in the treatment of newly diagnosed glioblastoma，but there are few studies directly comparing their efficacies and safety. Objective　To compare the efficacy and safety of TTFields versus angiogenesis inhibitors in combination with Stupp protocol for newly diagnosed glioblastoma. Methods　The databases of PubMed，The Cochrane Library，EMBase and OVID were comprehensively searched from January 1，2004 to January 1，2020 for studies about newly diagnosed glioblastoma treated by TTFields with Stupp protocol compared with those treated by angiogenesis inhibitors with Stupp protocol. The literature information was extracted and stored in the Excel file，including the first author，country of the author，year of publication，number and age of participants，treatment scheme（experimental groups：Stupp protocol in combination with bevacizumab，cilengitide，or TTFields combined with other treatment regimens；control group：Stupp protocol），outcome indicators〔overall survival（OS），progression-free survival（PFS）〕 and adverse events. The quality of the included literatures was evaluated. Revman 5.3 and Stata 13.1 were used for network meta-analysis. Results　Seven studies were included，involving 1 859 cases and 1 566 controls，with a relatively high methodological quality. Seven therapies from studies were included in the network meta-analysis：TTFields with Stupp protocol，bevacizumab with Stupp protocol，bevacizumab with irinotecan，bevacizumab with irinotecan and Stupp protocol，cilengitide（twice a week）with Stupp protocol，cilengitide（five times a week）with Stupp protocol，and Stupp protocol. Through network meta-analysis，the 6-month OS rate of each treatment modality was ranked from high to low：TTFields with Stupp protocol > cliengitide（five times a week）with Stupp protocol > bevacizumab with Stupp protocol > cliengitide（twice a week）with Stupp protocol > bevacizumab with irinotecan and Stupp protocol > bevacizumab with irinotecan > Stupp protocol. The one-year OS rate was ranked from high to low as follows：TTFields with Stupp protocol > bevacizumab with irinotecan> bevacizumab with Stupp protocol> cliengitide（twice a week）with Stupp protocol > cliengitide（five times a week）with Stupp protocol > bevacizumab with irinotecan and Stupp protocol > Stupp protocol. The 6-month PFS rate of each treatment modality was ranked from high to low：bevacizumab with irinotecan> bevacizumab with Stupp protocol > TTFields with Stupp protocol > bevacizumab with irinotecan and Stupp protocol > cliengitide（five times a week）with Stupp protocol > cliengitide（twice a week）with Stupp protocol > Stupp protocol. The one-year PFS rate of each treatment modality was ranked from high to low：bevacizumab with irinotecan > bevacizumab with Stupp protocol > bevacizumab with irinotecan and Stupp protocol > TTFields with Stupp protocol > cliengitide（twice a week）with Stupp protocol > cliengitide（five times a week）with Stupp protocol > Stupp protocol. In terms of adverse events，Bevacizumab and irinotecan increased the incidence of treatment-related adverse events，but TTFields and cilengitide did not. Conclusion　TTFields with Stupp protocol seems to be safer and more effective，but whether it can be used as an alternative to other six therapies still needs to be verified.

   

  High-risk HPV Infection Analysis in 18 378 Cervical Cancer Screening Participants in Urban Areas of Shihezi，Xinjiang　

  WEI Yan1，2，BAI Rui1，RUAN Yangyang1，SUN Qianyu1，DIAO Bowen1，YANG Ping1*    

  1.Department of Gynecology，First Affiliated Hospital，School of Medicine，Shihezi University，Shihezi 832008，China

  2.Shihezi People's Hospital，Shihezi 832008，China

  *Corresponding author：YANG Ping，Chief physician，Professor，Doctoral supervisor；E-mail：pingy2018@163.com

  Abstract: Background　Cervical cancer is a highly prevalent malignancy in women，which can be effectively prevented through standardized screening based on its clarified etiology. However，cytology-based cervical cancer screening programs are unfeasible in Xinjiang Uyghur Autonomous Region，where medical resources are inadequate. So it would be meaningful to understand the status of high-risk human papilloma virus（hrHPV）infection in Shihezi region for optimizing the primary hrHPV screening. Objective　To investigate the hrHPV infection status in cervical cancer screening participants aged 30-65 years from urban areas，Shihezi，Xinjiang Uygur Autonomous Region. Methods　The cervical cancer screening data （results of hrHPV DNA testing，ThinPrep cytologic test，colposcopy and histopathology）of 18 378 women，who underwent primary hrHPV screening at First Affiliated Hospital，School of Medicine，Shihezi University，Shihezi People's Hospital，and Shihezi Maternal and Child Health Hospital during December 2018—May 2019，were retrospectively collected. The prevalence of hrHPV subtypes（hrHPV16 and/or 18 positive versus other hrHPV positive）were comparatively analyzed. The prevalence of hrHPV was compared between four age groups（30-39，40-49，50-59，and 60-65）. Results　Among the participants，the hrHPV prevalence was 15.32%（2 816/18 378），with single infections accounting for 11.38%（2 092/18 378）and multiple infections for 3.94%（724/18 378）. The five most common hrHPV subtypes of single infections were hrHPV52（2.37%），hrHPV16（1.65%），hrHPV53（0.97%），hrHPV51（0.90%），and hrHPV39/68（0.87%），hrHPV18 was ranked 11th（0.36%）. Participants infected with both hrHPV16 and hrHPV18 had higher prevalence of cervical lesions than those infected with only hrHPV18（35.71% vs 8.95%），and so did those infected with hrHPV16（30.86% vs 8.95%）（P<0.05）. Although the hrHPV52 was the most frequent subtype，no precancerous cervical lesion or cervical cancer was detected in the cohort with hrHPV52 infection. Among the people with infections of other hrHPV subtypes and histology ≥LSIL revealed by colposcopic cervical biopsies，hrHPV58，hrHPV56，hrHPV51，hrHPV33，and hrHPV39 were more common than other subtypes. In addition，there was a statistically significant difference in hrHPV infection rates between different age groups（χ2=7.866，P=0.049）. Conclusion　The prevalence of hrHPV infection among women in urban areas，Shihezi is high，and infections with single hrHPV are predominant，where infections of hrHPV16 need to be given special attention.

   

  Advances in the Key Oncogene and Tumor-suppressor Gene in Early Lung Adenocarcinoma　

  YANG Rong，LIAO Xiaoyang，LEI Yi*，YUAN Mengyi    

  General Practice Ward，International Medical Center，West China Hospital，Sichuan University，Chengdu 610041，China

  *Corresponding author：LEI Yi，Associate chief physician；E-mail：leiyi111@scu.edu.cn

  Abstract: Lung cancer is a malignant tumor with high incidence and mortality rates，causing a heavy socio-economic burden worldwide. Lung adenocarcinoma is the main type of lung cancer with a poor prognosis，but most early lung adenocarcinomas cases may have a high rate of 5-year survival. So it is vital to early evaluate condition and prognosis，and based on this，to choose an appropriate personalized regimen for early lung adenocarcinoma patients. And the research on key oncogenes and tumor-suppressor genes in early lung cancer has become a hot topic. We reviewed five key genes in lung cancer，including four oncogenes （EGFR，ALK，ROS1 and KRAS） and a tumor-suppressor gene（TP53），with a description of clinical features，prognosis evaluation and targeted therapies of early lung adenocarcinoma patients with mutations of the genes，and a summary of other small molecular biomarkers related to the disease，with a view to advancing general practitioners' understanding of key genes related to early lung adenocarcinoma，thereby improving the personalized management of these patients.

   

  Latest Developments in Natural History and Tumor Growth Rate of Breast Cancer　

  GAO Ying1*，WEI Wei1，ZHANG Peng2，ZHANG Qing1    

  1.Health Management Center，Tianjin Medical University General Hospital，Tianjin 300052，China

  2.Department of Rehabilitation Medicine，Tianjin Medical University General Hospital，Tianjin 300052，China

  *Corresponding author：GAO Ying，Assistant professor；E-mail：gaoying301@tmu.edu.cn

  Abstract: In developed countries，early screening for breast cancer is already part of health services. The screening effect is greatly affected by the screening interval，which is determined by the natural history and tumor growth rate of breast cancer in the target population. In this review，we systematically reviewed the previous global studies on natural history of breast cancer，analyzed the most important parameter of tumor progression，namely，tumor growth rate，and its influencing factors，and summarized that most natural history progression models of breast cancer are multi-phased，usually covering four-phases of non-detectable，pre-clinical，clinical and death，with more potentially associated tumor characteristic parameters incorporated；the growth rate of breast tumor is assessed by pre-clinical sojourn time and doubling time；tumor growth rate is influenced by age，BRCA1/2 gene mutation，family history of breast cancer，other traditional breast cancer risk factors，tumor histopathology features，other clinical information and so on. Understanding the growth pattern of breast cancer and its influencing factors will help to formulate the optimal screening strategy and improve early screening effects. As tumor growth rate is associated with the survival of breast cancer patients，effective assessment of tumor growth will give support to develop new treatment strategies and personalized screening interval.

   

  A Multimodal Ultrasound-based Decision-making Tree Model for the Diagnosis of Papillary Thyroid Carcinoma：Development and Efficacy Evaluation　

  LI Ning，KAN Yanmin*，LI Xiaosong，WANG Yihua，ZHANG Man，MENG Jian，MA Lin    

  Department of Ultrasound，Affiliated Hospital of North China University of Technology，Tangshan 063000，China

  *Corresponding author：KAN Yanmin，Professor，Chief physician；E-mail：wuxiny_2009@163.com

  Abstract: Background　The detection rate of papillary thyroid carcinoma（PTC）is increasing in recent years，which may be due to advances in various ultrasonic imaging technologies and residents’ increased awareness of participating in the screening for PTC. The development of a decision-making tree model is helpful for identifying and diagnosing PTC timely. Objective　To develop a multimodal ultrasound-based decision-making tree model for the diagnosis of PTC，and to assess its efficacy. Methods　One hundred and eighty inpatients with excision of thyroid nodules were recruited from North China University of Technology Affiliated Hospital from January 2018 to October 2020. One hundred and eighty-six thyroid nodules were found in them，and 87 of which were malignant（PTC group），and other 99 were benign（non-PTC group）. The results of routine ultrasound，shear wave elastography（SWE），and contrast-enhanced ultrasound（CEUS）of PTC and non-PTC groups were compared. And the imaging parameters of PTC detected by routine ultrasound，SWE，CEUS，and the combination of routine ultrasound，SWE and CEUS（hereinafter referred to as “multimodal ultrasound”）were used to develop a decision-making tree model，respectively，then the efficacies of these four models were evaluated. Results　There were significant differences in nodule echo，aspect ratio，edge，focal hyperecho，maximum elasticity（Emax），minimum elasticity（Emin），mean elasticity（Emean），standard deviation of elasticity（Esd），elasticity ratio to normal surrounding tissue（Eratio），enhancement degree，enhancement characteristics，contrast medium distribution，contrast medium arrival time，contrast medium subsidence time，peak concentration（Peak），area under the time-intensity curve（AUCt）and mean transit time（MTT）between PTC and non-PTC groups（P<0.05）. Root nodes of decision-making tree models based on imaging parameters of PTC measured by routine ultrasound，SWE，CEUS and multimodal ultrasound were focal hyperecho，Emax，AUCt and Emax，respectively. Ten-fold cross-validation test showed that，misdiagnosis rates of decision-making tree models for PTC based on routine ultrasound，SWE，CEUS and multimodal ultrasound were 33.9%，19.4%，37.6% and 7.0%，respectively. The sensitivity，specificity，accuracy rate，positive likelihood ratio，negative likelihood ratio and Kappa value of multimodal ultrasound-based decision-making tree model for PTC were 88.5%，99.0%，94.1%，88.5，0.12 and 0.880，respectively. And it had higher diagnostic efficiency than other three models. Conclusion　We successfully constructed the multimodal ultrasound-based decision-making tree model for PTC with relatively high diagnostic efficiency. Moreover，it contributes to the improvement of diagnostic accuracy of PTC，which may be considered as a new approach to diagnosing PTC.

   

  Different Medications for Preventing 131I-induced Salivary Gland Damage in Thyroid Cancer Patients：a Network Meta-analysis　

  MA Dan1，YIN Xinbo2，LIU Jiahui1，FANG Qunyao1，HE Qiu1，XIONG Yu3*，GONG Fanghua4    

  1.Medical College，Hunan Normal University，Changsha 410013，China

  2.Nursing Teaching and Research Department，Xiangya Hospital of Central South University，Changsha 410013，China

  3.Department of Endocrinology，the Second Affiliated Hospital of Hunan Normal University，Changsha 410013，China

  4.Department of Nursing，Hunan Provincial People's Hospital，Changsha 410013，China

  *Corresponding author：XIONG Yu，Chief superintendent nurse；E-mail：951435416@qq.com

  Abstract: Background　Although 131I adjunctive therapy can significantly improve the survival rate of patients with thyroid cancer，its induced salivary gland damage seriously affects the quality of life. Currently，there are a variety of drugs for the prevention and treatment of 131I-induced salivary gland damage，but it needs to conduct a network Meta-analysis to fill the gap of comparison of these medications. Objective　To perform a network Meta-analysis of different medications for preventing 131I-induced salivary gland damage in thyroid cancer patients. Methods　Randomized controlled trials（RCTs） or non-RCTs about different medications for preventing 131I-induced salivary gland damage in thyroid cancer patients were searched in databases of Cochrane Central Register of Controlled Trials，Web of Science，PubMed，and EMBase，VIP，CNKI，Wanfang Data and SinoMed from inception to January 2021. Literature screening and data extraction were performed by two researchers，separately. The literature quality was evaluated using the risk of bias assessment tool in the Cochrane Handbook for Systematic Reviews of Interventions（Version 5.1.0） and MINORS. Consistency test，publication bias analysis and graph drawing were carried out using Stata 16.0. OpenBUGS 3.2.3 was used for network Meta-analysis. Results　A total of 11 articles were included，involving 7 intervention schemes：amifostine，vitamin C，amifostine with vitamin C，citric acid，vitamin E，selenium and propylthiouracil. Network Meta-analysis revealed that in terms of preventing 131I-induced loss of salivary excretion fraction in the parotid gland，amifostine with vitamin C was superior to citric acid and propylthiouracil，so was amifostine（P<0.05）. Amifostine was also superior to the regular treatment（P<0.05）. The SUCRA score for the schemes in preventing 131I-induced loss of salivary excretion fraction in the parotid gland ranked from highest to lowest was：amifostine with vitamin C> amifostine > vitamin C>regular treatment > vitamin E> selenium >citric acid > propylthiouracil. In terms of preventing 131I-induced loss of salivary excretion fraction in the submandibular gland，propylthiouracil was inferior to vitamin E，amphostine with vitamin C，amphostine and regular treatment（P<0.05）. The SUCRA score for the schemes in preventing 131I-induced loss of salivary excretion fraction in the submandibular gland ranked from highest to lowest was：vitamin E>amphostine with vitamin C> amphostine>selenium> vitamin C> citric acid> regular treatment > propylthiouracil. The funnel plot of comparing different medications for preventing 131I-induced loss of salivary excretion fraction in the parotid gland or submandibular gland was obviously symmetrical. Conclusion　Amphostine with vitamin C may be the best intervention for preventing 131I-induced loss of salivary excretion fraction in the parotid gland. And vitamin E may be the best scheme for preventing 131I-induced loss of salivary excretion fraction in the submandibular gland，followed by amphostine with vitamin C. Due to limitations of this study，these results should be taken with caution，which still need to be verified by more large-sample，high-quality clinical studies.

   

  Prognostic Value of Prognostic Nutritional Index and a Prognostic Nomogram Developed Based It for Gastric Cancer Patients with Lung Metastasis　

  DILINUER·Aierken1，ZHANG Hua2，ABUDUSHATAER·Kadier2，KALIBINUER·Aierken2，MAYINUER·Aili1*    

  1.Cancer Center，the First Affiliated Hospital of Xinjiang Medical University，Urumqi 830011，China

  2.Xinjiang Medical University，Urumqi 830011，China

  *Corresponding author：MAYINUER?Aili，Professor，Chief physician；E-mail：mayinur224@126.com

  Abstract: Background　Gastric cancer is a common digestive tract cancer worldwide that seriously endangers the life and health of residents. Nutritional status has been reported to be closely related to cancer patients' prognosis，which is assessed by prognostic nutritional index（PNI） in increasing studies to predict long-term prognosis of cancer patients. Objective　To evaluate the prognostic value of PNI in gastric cancer patients with lung metastasis，and to establish a PNI-based prognostic nomogram. Methods　Participants were 245 gastric cancer patients with lung metastasis who were admitted to the First Affiliated Hospital of Xinjiang Medical University from July 2010 to July 2018. By reviewing medical records and test reports，demographic and clinicopathological data were collected，including age，sex，primary lesion，histological grade，T stage，N stage，type of lung metastasis，timing of lung metastasis，chemotherapy status，tumor diameter，prevalence of pleural effusion and intravascular tumor thrombus，primary lesion surgery，serum CEA，serum CA199，number of peripheral lymphocytes and albumin level one week before operation，and calculated PNI. Follow-up data were collected through a telephone or clinic follow-up till April 2019. The influencing factors of PNI and its association with the prognosis were analyzed. A prognostic nomogram was constructed based on potential prognostic factors of gastric cancer patients with lung metastasis. Results　The optimal cut-off value of PNI for predicting 3-year survival in gastric cancer patients with lung metastasis was 46.1 with 71.7% sensitivity and 67.8% specificity. Multivariate Logistic regression analysis showed that age >65 years old〔OR=2.123，95%CI（1.201，3.752）〕，advanced T stage〔OR=2.104，95%CI（1.336，3.313）〕，advanced N stage〔OR=1.876，95%CI（1.286，2.735）〕 and tumor diameter> 5 cm 〔OR=1.839，95%CI（1.054，3.208）〕were independent risk factors for PNI<46.1（P<0.05）. The 1-year，2-year and 3-year survival rates of gastric cancer patients with lung metastasis were 33.3%，15.1% and 4.3%，respectively. The 3-year survival rate of low PNI group（n=114，PNI<46.1） was lower than that of high PNI group（n=131，PNI>46.1）（P=0.001）. Multivariate Cox regression analysis showed that histological grade〔HR=1.414，95%CI（1.059，1.887）〕，type of lung metastasis〔HR=1.647，95%CI（1.213，2.237）〕，chemotherapy〔HR=0.740，95%CI（0.559，0.981）〕，primary lesion surgery 〔HR=0.649，95%CI（0.475，0.886）〕 and PNI〔HR=0.733，95%CI（0.550，0.978）〕 were independent prognostic factors for gastric cancer patients with lung metastasis（P<0.05），and all of which were used to construct the prognostic nomogram to predict the 1-year，2-year and 3-year overall survival with a C-index of 0.755. Conclusion　PNI may be a major prognostic factor for gastric cancer patients with lung metastasis. And the prognostic nomogram based on PNI is helpful for individualized prognosis analysis.

   

  The Role of m6A RNA Methylation Modification in Esophageal Cancer　

  ZHU Lingyan，SHEN Yi，SHAO Yi，LIU Fen*    

  Department of Epidemiology and Health Statistics，School of Public Health，Beijing Municipal Key Laboratory of Clinical Epidemiology，Capital Medical University，Beijing 100069，China

  *Corresponding author：LIU Fen，Professor；E-mail：liufen05@ccmu.edu.cn

  Abstract: N6-methyladenosine （m6A），as the most abundant epitranscriptomic modification in eukaryotic cells，plays an important role in the occurrence and development of tumors. At present，domestic and foreign research on how m6A methylation modification participates in the occurrence and development of esophageal cancer mainly focuses on the biological functions of cell malignant proliferation，migration and invasion. Research on the differential expression of m6A methylation modification regulators in esophageal cancer suggests that m6A methylation modification regulators are expected to become potential prognostic molecular markers for esophageal cancer. This review focuses on the biological functions of m6A methylation modification，as well as the prognostic value of m6A methylation in esophageal cancer，postoperative treatment and other aspects of research progress，aiming to provide new ideas for the prognosis and targeted therapy of esophageal cancer.

   

  Colorectal Cancer Screening：Current Strategies and Thoughts　

  HU Xiyue，LIU Zheng*，WANG Xishan*    

   

  Department of Colorectal Surgery，National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital，Chinese Academy of Medical Sciences and Peking Union Medical College，Beijing 100021，China

  *Corresponding authors：LIU Zheng，Chief physician；E-mail：zheng.liu@cicams.ac.cn

  WANG Xishan，Chief physician；E-mail：wxshan1208@126.com

  Abstract: The incidence of colorectal cancer has shown an upward trend in China. Colorectal cancer turns to be a great threat to people's health，and also brings serious negative socio-economic impacts. The screening for colorectal cancer using effective strategies has been proven efficacious for reducing colorectal cancer burden in many countries. In China，due to incomplete coverage of colorectal cancer screening programs implemented using non-uniform strategies，there is a need to develop a comprehensive colorectal cancer screening system used throughout the country. We overviewed colorectal cancer screening researches at home and abroad，and discussed the common screening strategies based on the reviewing of the latest guidelines and consensuses on colorectal cancer screening，then predicted the prospects of colorectal cancer screening in China，with a view to assisting the development of colorectal cancer screening strategies with Chinese characteristics.

   

  Colorectal Cancer Screening Program in China：Recent Advances and Screening Dilemma　

  HAN Xi1，LIU Jun2，MA Qi3，HU Shengjuan2*    

  1.Ningxia Medical University，Yinchuan 750002，China

  2.Department of Gastroenterology，People's Hospital of Ningxia Hui Autonomous Region，Yinchuan 750002，China

  3.Northwest Minzu University，Lanzhou 730030，China

  *Corresponding author：HU Shengjuan，Master supervisor，Chief physician；E-mail：hsj.judy@163.com

  Abstract: In recent years，the incidence and mortality of colorectal cancer （CRC） in China are increasing rapidly. But CRC screening is quite feasible，because its development from normal intestinal mucosa to abnormal growth and to malignancy can last for decades，which makes early screening and removal of precancerous colorectal lesions before cancerization become possible. Increasing countries aim to reduce high incidence and mortality of CRC and enhance its current low early diagnosis rate via implementing CRC screening programs. We reviewed recent advances in the common methods and means as well as relevant studies regarding CRC screening，providing a reference for clinical practice.

   

  Recent Advances in Research on Cost-effectiveness of Colorectal Cancer Screening　

  GUAN Yazhe，WU Siqi，ZHANG Xue，HE Yutong*    

  Cancer Institute，the Fourth Hospital of Hebei Medical University，Shijiazhuang 050011，China

  *Corresponding author：HE Yutong，Professor，Chief physician；E-mail：hytong69@yahoo.com

  Abstract: Colorectal cancer is one of common cancers that threatens human health seriously. Early screening has been a global focus as an effective measure to reduce the incidence and mortality of colorectal cancer，and an important prevention and treatment strategy. The key issues for colorectal cancer screening include delivering interventions specially focusing on populations at high risk for colorectal cancer，determining the appropriate screening interval for populations with different levels of risk for colorectal cancer，raising residents' health awareness from the community level，increasing screening participation，and performing health economic evaluation of the optimal screening strategy. Introducing colorectal cancer screening guidelines helps to identify people at high risk for colorectal cancer，explore appropriate screening ages and screening intervals，and improve the recognition of valuing screening participation，consequently increasing the cost-effectiveness of colorectal cancer screening，so we summarized the recent colorectal cancer screening guidelines and studies about the cost-effectiveness of colorectal cancer screening.

   

  Development of a Individual Rothman-Keller-type Risk Prediction Model for Colorectal Cancer in Chinese People　

  QIN Chengjie，SHU Ting，YAO Qiang，LI Mandi，LIN Yidie，SUN Yue，ZHOU Ling，JIANG Min，ZHU Cairong*    

  West China School of Public Health，West China Fourth Hospital，Sichuan University，Chengdu 610041，China

  *Corresponding author：ZHU Cairong，Professor；E-mail：cairong.zhu@hotmail.com

  Abstract: Background　Colorectal cancer is a malignancy seriously threatening the health of Chinese people.Effective risk prediction model for colorectal cancer is an important tool to guide people to develop a healthy lifestyle by screening morbidity risk and identifying high-risk people，to prevent or reduce the mortality of colorectal cancer. Objective　To develop a Rothman-Keller-type model for predicting and classifying individual risk of colorectal cancer suitable for Chinese population. Methods　We did a review of studies about risk factors for colorectal cancer that were collected from databases of CNKI，Wanfang Data，VIP，PubMed，EMBase，and OVID from inception to 2020-08-31 to quantitatively examine the relationship of colorectal cancer with its major risk factors，then used the results to develop a Rothman-Keller-type model for predicting individual risk of colorectal cancer in Chinese population. We applied binomial distribution function to further rate the risks. Results　In total，there were 15 risk factors included in the Rothman-Keller-type model，including family history of colorectal cancer，smoking，drinking，obesity，excessive intake of red meat，high intake of preserved food，history of appendicitis，history of diabetes，history of chronic colorectitis，history of chronic diarrhea，history of chronic constipation，and low vegetable intake，low fruit intake，use of aspirin and take of physical exercise. We generated 10 000 random data sets using binomial distribution function，and using segmented gradient comparison method，we found the risk threshold for women was 0.033 7% and for men was 0.046 3%. Conclusion　This risk prediction model is easy-to-use，which facilitates high-risk people to undergo colonoscopy，and help them to develop healthy lifestyles，promoting the prevention of colorectal cancer.

   

  Research Progresses on the Role of Glucose-6-phosphate Dehydrogenase in Tumors　

  SUN Jian1，2，MAO Xingxing1，2，LONG Yuanyuan1，2，SHA Mengqi1，2，LIU Xiping3，CHEN Yan1，2*，HUANG Pei1，2*    

  1.No. 2 Department of Pediatric Medicine，Affiliated Hospital of Zunyi Medical University，Zunyi 563000，China

  2.Department of Hematology and Oncology，Guizhou Children's Hospital，Zunyi 563000，China

  3.Department of Neurology，Affiliated Hospital of Zunyi Medical University，Zunyi 563000，China

  *Corresponding authors：CHEN Yan，Chief physician，Professor；E-mail：cyz600@163.com

  HUANG Pei，Assistant researcher；E-mail：fenglin4620@163.com

  Abstract: Tumorigenesis is a dynamic and complex progress． The change in energy and metabolism is one of the basic characteristics of the tumor. Metabolic reprogramming meets the needs of energy and biosynthesis of rapidly proliferated tumor cells. The pentose phosphate pathway（PPP）with glucose-6-phosphate dehydrogenase（G6PD）as the rate-limiting enzyme is an important branch of glucose metabolism，and play a vital role in the synthesis of nucleotides，lipids，and other biomolecules and the maintenance of redox homeostasis. However，our understanding of the role of G6PD in tumors needs to be further strengthened. We reviewed the metabolic changes and signal pathways associated with the expression and activity of G6PD in tumors，and found that targeting G6PD could not only inhibit the rapid development of tumor but also could enhance the sensitivity of tumors to other chemotherapeutics and radiotherapy.

   

   

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