Publications by authors named "Shijiang Wang"

17 Publications

  • Page 1 of 1

Experiences and attitudes of elementary school students and their parents toward online learning in China during the COVID-19 pandemic: Questionnaire Study.

J Med Internet Res 2021 Apr 16. Epub 2021 Apr 16.

Department of psychiatry, Chaohu Hospital, Anhui Medical University, 64 North Chaohu Road, Hefei, CN.

Background: Due to the widespread infection of COVID-19, an emergency homeschooling plan was rigorously implemented throughout China.

Objective: This study aimed to investigate the experiences and attitudes of elementary school students and their parents (two generations from the same family) toward online learning in China during the pandemic.

Methods: A 16-item questionnaire was distributed at the 10 day- and 40 day-mark after the first online course to 867 parent-child pairs and 141 parent-child pairs, respectively. The questionnaire comprised of questions pertaining to the course and homework's completeness, effectiveness, reliability, and abundance as well as the students' enthusiasm to take part in online classes and their satisfaction with the courses.

Results: The findings indicate that more than 91% of students exhibited high or moderate enthusiasm for participating in online classes. However, most students performed poorly in online learning classes and after school homework. Regarding satisfaction, parents' and students' average scores were 7.35 and 7.25, respectively (10-point scoring system). During the second stage of the study, parents' positive evaluations of online learning declined, including the effectiveness and reliability of the courses. Furthermore, the proportion of students who completed the courses and homework on time decreased; this difference proved statistically significant. The overall satisfaction of parents and students with online learning also declined during this second stage (7.21 vs. 7.23); however, the difference between the two stages was not statistically significant. Several of the parents (36.2%) indicated that assisting and supervising the students' online learning caused increased stress. Thirty-six percent of parents expressed dissatisfaction or suggestions concerning online learning; most parents and students hoped to return to face-to-face classes (94.9% vs. 93.5%). Finally, the results presented six main issues that parents are most concerned about: (1) disappointment regarding timely interaction in courses; (2) apprehensive about students understanding of the course; (3) increased burden of annoying adult responsibilities; (4) concern about the children's eyesight; (5) teachers' explanations were not detailed enough; (6) concerned about the decline of students' interest and attention.

Conclusions: Online learning could prevent the spread of infectious diseases while still allowing elementary school students to attain knowledge. However, children's completion of the courses and homework were not satisfactory. Furthermore, their parents often experienced stress and had many concerns and complaints. Measures such as increasing the interactivity of the courses and prohibiting teachers from assigning the task to parents could improve the effectiveness of these courses and the mental health level of parents and students.

Clinicaltrial:
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http://dx.doi.org/10.2196/24496DOI Listing
April 2021

Clinical implications of germline BCL2L11 deletion polymorphism in pretreated advanced NSCLC patients with osimertinib therapy.

Lung Cancer 2021 01 3;151:39-43. Epub 2020 Dec 3.

Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China. Electronic address:

Introduction: B-cell lymphoma 2-like 11 (BCL-2-like 11, BCL2L11, also known as BIM) deletion polymorphism (BIM-del) has been associated with resistance to first-generation epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs), and is a poor prognostic factor for EGFR-mutant non-small-cell lung cancer (NSCLC) patients. Nevertheless, the impact of BIM-del in advanced NSCLC patients treated with the third-generation EGFR-TKI osimertinib remains undetermined. This study aims to evaluate the relationship between BIM-del and therapeutic efficacy of osimertinib in pretreated NSCLC patients.

Methods: Patients subjected to EGFR T790 M detection and prior osimertinib treatment between December 2015 and December 2019 in our hospital were enrolled in this study. Peripheral blood samples from these patients were collected to detect BIM-del by polymerase chain reaction. Cox proportional hazards models were used to analyze the clinical outcomes of patients with and without BIM-del.

Results: In total, 152 Chinese Han NSCLC patients-including 143 T790M-positive and nine T790M-negative patients-were enrolled. BIM-del was detected in only 17.5 % of T790M-positive patients (25/143). The majority of patients were aged <65 years (81.8 %, 117/143), were female (58.7 %, 84/143), were non-smokers (82.5 %, 118/143), had Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0-1 (88.8 %, 129/143), and exhibited metastases in the central nervous system (CNS) (54.5 %, 78/143). There were no associations between the BIM-del and clinical characteristics (including age, sex, histology, smoking status, stage, ECOG PS score, and CNS metastases). Patients with BIM-del had a poorer objective response rate than those without (28.0 % versus 52.5 %, p = 0.026). Besides, BIM-del was associated with a significantly shorter progression-free survival (PFS) and a moderately shorter overall survival (OS) (8.3 versus 10.5 months, p = 0.031 and 15.9 versus 25.2 months, p = 0.1, respectively). Multivariate analysis indicated that BIM-del was an independent prognostic factor for PFS but not for OS in EGFR T790 M NSCLC patients.

Conclusions: BIM-del is associated with poor clinical responses and outcomes, and might be a negative predictive and prognostic biomarker in EGFR T790 M NSCLC patients with osimertinib treatment.
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http://dx.doi.org/10.1016/j.lungcan.2020.12.002DOI Listing
January 2021

Multiple Immune Features-Based Signature for Predicting Recurrence and Survival of Inoperable LA-NSCLC Patients.

Front Oncol 2020 14;10:571380. Epub 2020 Oct 14.

Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.

Introduction: The immune status of the tumor microenvironment is extremely complex. One single immune feature cannot reflect the integral immune status, and its prognostic value was limited. We postulated that the immune signature based on multiple immuno-features could markedly improve the prediction of post-chemoradiotherapeutic survival in inoperable locally advanced non-small-cell lung cancer (LA-NSCLC) patients.

Methods: In this study, 100 patients who were diagnosed as having inoperable LA-NSCLC between January 2005 and January 2016 were analyzed. A five immune features-based signature was then constructed using the nested repeat 10-fold cross validation with least absolute shrinkage and selection operator (LASSO) Cox regression model. Nomograms were then established for predicting prognosis.

Results: The immune signature combining five immuno-features was significantly associated with overall survival (OS) and progression-free survival (PFS) ( = 0.002 and = 0.014, respectively) in patients with inoperable LA-NSCLC, and at a cutoff of -0.05 stratified patients into two groups with 5-year OS rates of 39.8 and 8.8%, and 2-year PFS rates of 22.2 and 5.5% for the high- and low-immune signature groups, respectively. Integrating immune signature, we proposed predictive nomograms that were better than the traditional TNM staging system in terms of discriminating ability (OS: 0.692 vs. 0.588; PFS: 0.672 vs. 0.586, respectively) or net weight classification (OS: 32.96%; PFS: 9.22%), suggesting that the immune signature plays a significant role in improving the prognostic value.

Conclusion: Multiple immune features-based immune signature could effectively predict recurrence and survival of inoperable LA-NSCLC patients and complemented the prognostic value of the TNM staging system.
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http://dx.doi.org/10.3389/fonc.2020.571380DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7591766PMC
October 2020

Development and validation of a risk prediction model for radiotherapy-related esophageal fistula in esophageal cancer.

Radiat Oncol 2019 Oct 22;14(1):181. Epub 2019 Oct 22.

Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No.440, Ji Yan Road, Jinan, Shandong, 250012, People's Republic of China.

Objectives: We aimed to identify the risk factors and provide a nomogram for the prediction of radiotherapy-related esophageal fistula in patients with esophageal cancer (EC) using a case-control study.

Patients And Methods: Patients with esophageal fistula who received radiotherapy or chemoradiotherapy between 2003 and 2017 were retrospectively collected in two institutions. In the training cohort (TC), clinical, pathologic, and serum data of 136 patients (cases) who developed esophageal fistula during or after radiotherapy were enrolled and compared with 272 controls (1:2 matched with the diagnosis time of EC, sex, marriage, and race). After the univariable and multivariable logistic regression analyses, the independent risk factors were identified and incorporated into a nomogram. Then the nomogram for the risk prediction was externally validated in the validation cohort (VC; 47 cases and 94 controls) using bootstrap resampling.

Results: Multivariable analyses demonstrated that ECOG PS, BMI, T4, N2/3 and re-radiotherapy were independent factors for esophageal fistula. Then a nomogram was constructed with the C-index of 0.805 (95% CI, 0.762-0.848) for predicting the risk of developing esophageal fistula in EC patients receiving radiotherapy. Importantly, the C-index maintained 0.764 (95% CI, 0.683-0.845) after the external validation.

Conclusions: We created and externally validated the first risk nomogram of esophageal fistula associated with radiotherapy. This will aid individual risk stratification of patients with EC developing esophageal fistula.
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http://dx.doi.org/10.1186/s13014-019-1385-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6805370PMC
October 2019

The Kinetic Changes of Systemic Inflammatory Factors during Bevacizumab Treatment and Its Prognostic Role in Advanced Non-small Cell Lung Cancer Patients.

J Cancer 2019 28;10(21):5082-5089. Epub 2019 Aug 28.

Department of Radiation Oncology, Shandong Cancer Hospital and Institute Affiliated to Shandong University, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, China.

: Bevacizumab combined with chemotherapy is still one of the standard options for treatment of advanced non-small cell lung cancer (NSCLC) patients without driver mutations. Serum inflammatory factors, representing the systemic immune status, are shown to have complicated relationships with tumor angiogenesis, and proved to be associated with survival of advanced NSCLC patients. However, the information from the baseline factors is relatively limited, which cannot reflect the dynamic changes of systemic immune status during bevacizumab treatment. We, thus, attempted to evaluate longitudinal kinetics of systemic inflammatory factors during treatment of bevacizumab and to explore their predictive role in treatment response and patient outcomes in advanced NSCLC. : Systemic inflammatory factors (neutrophil/lymphocyte (NLR), platelet/lymphocyte (PLR), neutrophil×platelet/lymphocyte (SII) and lymphocyte/monocyte (LMR)) and clinical variables were collected and analyzed from 161 advanced NSCLC patients treated with bevacizumab. Mixed effect regression models were first performed for longitudinal analysis of the changes of serum inflammatory factors during bevacizumab treatment. Then, univariate and multivariate Cox models were used for overall survival (OS) and progression free survival (PFS) analyses to determine the independent prognostic factors. : In the first 6 cycles of bevacizumab treatment, patients with complete response/partial response (CR/PR) had a -0.11, -0.066, -0.15, and 0.073 change every 2 cycles in transformed NLR (95%CI: -0.19--0.03, p=0.008), PLR (95%CI: -0.12--0.013, p=0.015), SII (95%CI: -0.23--0.05, p<0.001) and LMR (95%CI: 0.049-0.14, p=0.036), respectively, compared to patients with progressive disease (PD). With respect to analysis of the longitudinal changes before progression, patients experienced a significant increase in transformed NLR (Coef=0.09, 95%CI: 0.019-0.17, p=0.014), PLR (Coef=0.05, 95%CI: 0.002-0.10, p=0.04), and SII (Coef=0.091, 95%CI: 0.015-0.17, p=0.019), but a decrease in transformed LMR (Coef=-0.08, 95%CI: -0.14-0.018, p=0.012). On multivariate Cox model analyses, decrease of LMR (HR=0.62, 95% CI: 0.4-0.96, p=0.033) was shown to be the independent risk factor for PFS; and low level of baseline LMR (HR=0.4, 95% CI: 0.17-0.94, p=0.036), increase of NLR (HR=2.36, 95%CI: 1.25-4.44, p=0.008), and decrease of LMR (HR=0.42, 95%CI: 0.18-0.97, p=0.041) were the independent risk factors for death. : The activation of systemic immune status evaluated by the kinetic changes of serum inflammatory factors was associated with good response to bevacizumab; however, the suppressive status may indicate the resistance to bevacizumab. Dynamic changes of systemic inflammatory factors also had prognostic value in predicting outcomes of advanced NSCLC patients treated with bevacizumab.
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http://dx.doi.org/10.7150/jca.30478DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6775608PMC
August 2019

Prognostic value of delta inflammatory biomarker-based nomograms in patients with inoperable locally advanced NSCLC.

Int Immunopharmacol 2019 Jul 24;72:395-401. Epub 2019 Apr 24.

Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong University, Jinan 250117, China; Shandong Academy of Medical Sciences, Jinan 250001, China. Electronic address:

Objective: Inflammation plays critical roles in tumor growth and progression, and can be adversely affected by chemotherapy and radiotherapy. However, there have been few studies on the prognostic value of delta (Δ) inflammatory biomarkers before and after chemoradiotherapy in patients with locally advanced non-small cell lung cancer (LA-NSCLC).

Methods: In this study, pre/post-treatment and Δ inflammatory biomarkers of 370 patients who were diagnosed as having inoperable LA-NSCLC in Shandong Cancer Hospital between January 2005 and January 2016 were analyzed. Nomograms were then established for predicting prognosis.

Results: Median overall survival (OS) and progression free survival (PFS) for all patients were 28.1 (range 1.9-129.0) months and 11.1 (range 1.7-58.7) months, respectively. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) significantly increased and the lymphocyte-to-monocyte ratio (LMR) significantly decreased during the concurrent chemoradiotherapy course (P < 0.001, P < 0.001, and P < 0.001, respectively). Multivariate analysis revealed that pre-LMR, ΔNLR, and minimum absolute lymphocyte counts were independent predictors of OS (P = 0.027, P = 0.012, and P = 0.015, respectively) and post-LMR, post-NLR, and ΔNLR were independent predictors of PFS (P = 0.014, P = 0.001, and P = 0.036, respectively). Nomograms for OS and PFS were established by combining all significant inflammatory markers and clinicopathological characteristics. The concordance indexes for OS and PFS were 0.709 and 0.688, respectively.

Conclusion: Post-treatment and Δ inflammatory biomarkers may have more prognostic significance than baseline measurements of inflammatory biomarkers in LA-NSCLC patients. The proposed nomograms based on the dynamic inflammatory biomarkers and clinicopathological factors may be practical and widely available for evaluating the prognosis of patients with inoperable LA-NSCLC.
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http://dx.doi.org/10.1016/j.intimp.2019.04.032DOI Listing
July 2019

Delineating the pattern of treatment for elderly locally advanced NSCLC and predicting outcomes by a validated model: A SEER based analysis.

Cancer Med 2019 05 3;8(5):2587-2598. Epub 2019 Apr 3.

Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China.

Introduction: Locally advanced nonsmall-cell lung cancer (LA-NSCLC) represented a highly heterogeneous group, with more than half of the patients aged ≥65 years at the time of diagnosis. However, the optimal treatment for elderly LA-NSCLC patients was still not defined.

Methods: A total of 33530 elderly patients (≥65 years) diagnosed with LA-NSCLC from 2004 to 2014 were identified from Surveillance, Epidemiology, and End Results (SEER) database.

Results: Locally advanced nonsmall-cell lung cancer patients aged 65-74 years were more frequently treated with chemoradiotherapy (CRT) (40%), while patients aged ≥75 years received more best supportive care (BSC) (36%). For age group of 65-74 years, patients who had surgery with or without (neo)adjuvant therapy had a median survival of 28 months, CRT 15 months, radiotherapy (RT) alone 6 months, chemotherapy alone 11 months, and BSC 3 months; while for patients aged ≥ 75 years, the median OS was 20, 13, 7, 9, and 2, respectively. Besides, independent clinicopathological factors were integrated into nomograms for OS and CSS prediction, C-indexes achieved 0.692 and 0.698, respectively. Importantly, the discrimination of nomogram was superior to that of the American Joint Committee on Cancer TNM classification (0.742 vs 0.572 for training set and 0.731 vs 0.565 for validation set).

Conclusion: For elderly patients with LA-NSCLC, the curative-intent treatment (surgery or CRT) conferred better survival compared to chemotherapy alone, RT alone and BSC. The proposed nomograms based on independent clinicopathological variables may be practical and helpful for precise evaluation of patient prognosis, and guiding the individualized treatment for elderly LA-NSCLC.
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http://dx.doi.org/10.1002/cam4.2127DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6537004PMC
May 2019

Effects of respiratory motion on volumetric and positional difference of GTV in lung cancer based on 3DCT and 4DCT scanning.

Oncol Lett 2019 Feb 18;17(2):2388-2392. Epub 2018 Dec 18.

Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong 250117, P.R. China.

Differences in gross target volume (GTV) and central point positions among moving lung cancer models constructed by CT scanning at different frequencies were compared, in order to explore the effect of different respiratory frequencies on the GTV constructions in moving lung tumors. Eight models in different shapes and sizes were established to stimulate lung tumors. The three-dimensional computed tomography (3DCT) and four-dimensional computed tomography (4DCT) scanning were performed at 10, 15 and 20 times/min in different models. Differences in GTV volumes and central point positions at different motion frequencies were compared by means of GTV3Ds (GTV, GTV, GTV) and IGTV4Ds (IGTV, IGTV, IGTV). Volumes of GTV, GTV, GTV were 12.41±14.26, 10.38±11.18 and 12.50±15.23 cm respectively (P=0.687). Central point coordinates in the x-axis direction were -8.16±96.21, -8.57±96.08 and -8.56±95.73 respectively (P=0.968). Central point coordinates in the y-axis direction were 108.22±25.03, 110.41±22.47 and 109.04±24.24 (P=0.028). Central point coordinates in the z-axis direction were 65.19±13.68, 65.43±13.40 and 65.38±13.17 (P=0.902). The difference was significant in the y-axis direction (P=0.028). Volumes of IGTV, IGTV, IGTV were 17.78±19.42, 17.43±19.56 and 17.44±18.80 cm (P=0.417). Central point coordinates in the x-axis direction were -7.73±95.93, -7.86±95.56 and -7.92±95.14 (P=0.325). Central point coordinates in the y-axis direction were 109.41±24.54, 109.60±24.13 and 109.16±24.28 (P=0.525). Central point coordinates in the z-axis direction were 65.52±13.31, 65.59±13.39 and 65.51±13.34 (P=0.093). However, the central point position of GTV in the head and foot direction by 3DCT scanning was severely affected by the respiratory frequency.
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http://dx.doi.org/10.3892/ol.2018.9844DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6341872PMC
February 2019

Prognostic value of dynamic albumin-to-alkaline phosphatase ratio in limited stage small-cell lung cancer.

Future Oncol 2019 Mar 15;15(9):995-1006. Epub 2019 Jan 15.

Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan, PR China.

Aim: To dynamically investigate the prognostic value of albumin-to-alkaline phosphatase ratio (AAPR) in limited stage small-cell lung cancer.

Materials & Methods:  The AAPR within 1 week before and after chemoradiation therapy (pre- and post-AAPR) was collected and analyzed.

Results: Patients with low pre- or post-AAPR had shorter overall survival and progression-free survival than the high groups (p-values all <0.05). Post-AAPR was an independent prognostic factor for progression-free survival (p = 0.007) and overall survival (p = 0.003). The integration of pre- or post-AAPR improved the prognostic ability of Tumor, Node, Metastasis stage alone (0.55-0.64 and 0.68, respectively).

Conclusion:  Post-AAPR is a reliable prognostic factor for limited stage small-cell lung cancer patients. The complementary value of AAPR to Tumor, Node, Metastasis stage is worth further validation in the future.
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http://dx.doi.org/10.2217/fon-2018-0818DOI Listing
March 2019

BIM Deletion Polymorphism Confers Resistance to Osimertinib in EGFR T790M Lung Cancer: a Case Report and Literature Review.

Target Oncol 2018 08;13(4):517-523

Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, NO.440 Ji Yan Road, Jinan, Shandong, 250117, People's Republic of China.

The third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) osimertinib (AZD9291) has shown significant clinical efficacy against the EGFR T790M mutation in non-small cell lung cancer (NSCLC) patients. However, resistance inevitably occurs, and the mechanisms leading to treatment failure need to be further investigated. The B-cell lymphoma 2 (BCL-2)-like 11 (BIM) deletion polymorphism, which occurs at a frequency of 21% in East Asians but is absent in African and European populations, has been associated with resistance to first-generation EGFR TKIs, such as gefitinib and erlotinib; and is a poor prognostic factor for NSCLC patients with EGFR mutations. Nevertheless, the significance of this BIM deletion polymorphism in the resistance to osimertinib has not been reported. Here, we show for the first time that a NSCLC patient harboring the EGFR L858R/T790M mutations, as well as the BIM deletion polymorphism, exhibited poor clinical outcomes with osimertinib treatment. This result suggests that the BIM deletion polymorphism might have prognostic value for determining NSCLC patient outcomes following osimertinib treatment.
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http://dx.doi.org/10.1007/s11523-018-0573-2DOI Listing
August 2018

High level of programmed death ligand 1 (PD-L1) predicts longer survival in patients with resectable small cell lung cancer.

Int J Clin Exp Pathol 2018 1;11(5):2675-2682. Epub 2018 May 1.

Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University Jinan 250117, Shandong Province, China.

The purpose of this study was to investigate the association between the expression of programmed cell death ligand 1 (PD-L1) and the survival of patients with small cell lung cancer (SCLC) who had undergone complete resection. Formalin-fixed, paraffin-embedded tumor tissue samples from 61 patients with resected SCLC were stained with an anti-PD-L1 antibody (SP142) by immunohistochemistry (IHC) and scored according to staining intensity and the percentage of tumor cells staining positive for PD-L1. The PD-L1 positive threshold in tumor cells was defined as ≥ 5%. The percentage of positive PD-L1 staining in all SCLC specimens was 44.3% (27/61). The median survival time of patients with PD-L1-positive tumors was significantly longer than those with PD-L1-negative tumors (not reached vs. 34 months, = 0.032). Multivariate analysis indicated that postoperative chemotherapy (HR = 0.322, = 0.023) and PD-L1 expression ≥ 5% (HR = 0.253, = 0.008) were independent prognostic factors for overall survival. The results suggest that PD-L1 expression is readily detectable in the tumor tissues of SCLC, and that PD-L1 expression can predict the survival of these patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6958263PMC
May 2018

Evaluation of factors associated with platinum-sensitivity status and survival in limited-stage small cell lung cancer patients treated with chemoradiotherapy.

Oncotarget 2017 Oct 7;8(46):81405-81418. Epub 2017 Jul 7.

Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong University, Jinan, 250117, China.

In this retrospective study, we analyzed the association of clinicopathological factors and therapeutic plans with platinum-sensitivity status and survival of limited-stage small cell lung cancer (LS-SCLC) patients. We enrolled 452 LS-SCLC patients with 279 platinum sensitive and 173 platinum refractory patients. The low serum neuro-specific enolase levels (NSE; = 0.011), neutrophil-to-lymphocyte ratios (NLR; = 0.013) and higher objective response rates ( = 0.003) were associated with sensitive group but not the refractory group. Multivariate analysis showed that treatment modality (HR = 0.267, < 0.001), serum lactate dehydrogenase (LDH; HR = 1.894, = 0.016), NLR (HR = 2.043, = 0.043) and platinum-sensitivity status (HR = 0.561, = 0.036) were independent prognostic factors for survival. We further showed that the numbers of chemotherapy cycles and response to first-line therapy were independent prognostic factors for refractory patients only. Our study demonstrates that platinum-sensitivity status is of prognostic importance, as it is strongly associated with survival in LS-SCLC patients.
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http://dx.doi.org/10.18632/oncotarget.19073DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5655295PMC
October 2017

18F-deoxyglucose positron emission tomography/computed tomography to predict local failure in esophageal squamous cell carcinoma.

Oncotarget 2017 May;8(21):34498-34506

Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China.

Esophageal squamous cell carcinoma (ESCC) patients are at risk for local failure (LF) following treatment. Predicting tumor regions at high risk for local failure before radiotherapy may increase treatment efficacy by permitting an escalated radiation dose specifically to those regions critical for tumor control. Forty-one patients with non-resectable locally advanced ESCC underwent 18F-deoxyglucose positron emission tomography/computed tomography (FDG PET/CT) imaging before concurrent chemoradiotherapy (CCRT). After CCRT, a second (failure) FDG PET/CT was performed in cases of relapse. Failure FDG PET/CT scans were fused to pre-treatment scans to identify tumor regions at high risk for LF. Within a median follow-up time of 26 months, 20 patients (48.8%) had LF. In 19 patients, the failure occurred within a pre-treatment high FDG uptake region; the failure occurred outside these regions in only one patient. Pre-treatment metabolic tumor volume (MTV) was independently associated with LF (P<0.001, HR 1.128, 95% CI: 1.061-1.198). LF was more likely in patients with MTVs ≥27 cm3. In initial PET/CT images, when 50% maximum standardized uptake value (SUVmax) was used as the threshold, delineated subvolumes overlapped LF regions. These results confirm that LF occurs most commonly within pre-treatment high FDG uptake regions.
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http://dx.doi.org/10.18632/oncotarget.15606DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5470985PMC
May 2017

Non-small cell lung cancer with concomitant intramuscular myxoma of the right psoas mimicking intramuscular metastasis: A case report and literature review.

Oncol Lett 2015 Nov 15;10(5):3059-3063. Epub 2015 Sep 15.

Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, P.R. China.

Intramuscular myxoma (IMM) as a rare soft-tissue tumor arising from the muscles is completely benign. When IMM accompanies malignance, it may be misdiagnosed as muscle metastasis, and for this extremely rare concurrence, the subsequent treatment would vary accordingly. The current study presents, to the best of our knowledge, the first case of non-small cell lung cancer (NSCLC) concomitant with IMM mimicking skeletal muscle metastasis. A 64-year-old female was hospitalized with a history of chest discomfort and right lumbar pain that had persisted for four months. The computed tomography scan showed a lesion in the left upper lobe of the lung and the right psoas, respectively. Serum biomarkers for NSCLC were abnormal. A presumptive clinical diagnosis was compatible with left NSCLC and right psoas muscle metastasis (cT2aN3M1b, stage IV). Stage IV lung cancer would receive palliative treatment. However, the final diagnosis of synchronous left lung squamous cell carcinoma (cT2aN3M0, stage IIIB) and IMM in the right psoas was confirmed by biopsy. The patient therefore underwent definitive chemoradiotherapy for lung carcinoma, and conservative treatment, including analgesics, for IMM. The diagnosis process for a malignant neoplasm concomitant with IMM is not straightforward due to a lack of clinical experience, and it significantly affects the tumor staging and subsequent treatment strategy. The present case suggests that IMM should be included in the differential diagnosis when an abnormal intramuscular lesion concomitant with malignancy is identified. The value of histopathological diagnosis prior to definitive treatment also requires highlighting.
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http://dx.doi.org/10.3892/ol.2015.3704DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4665957PMC
November 2015

(18)F-FDG avid volumes on pre-radiotherapy FDG PET as boost target delineation in non-small cell lung cancer.

Int J Clin Exp Med 2015 15;8(5):7561-8. Epub 2015 May 15.

Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences Jinan, China.

Background: To investigate whether during/post-radiotherapy FDG uptake locations within tumors is likely identified using a pre-radiotherapy scan for non-small cell lung cancer (NSCLC), ultimately enabling confirm that a suitable metabolically active sub-volume pre-radiotherapy of the primary tumor for radiation boosting target.

Methods: Patients with a pathologically proven inoperable stage II-III NSCLC were enrolled. For each patient, one pre-radiotherapy (pre-RT) plus one following 40Gy during-radiotherapy (during-RT) or post-radiotherapy (post-RT) FDG PET/CT scans were available. On pre-RT scan, the high FDG uptake region were auto-delineated using several percentage of the maximal standardized uptake value (SUVmax) thresholds, varying from 40% to 70%. On during-RT scan, FDG uptake region is delineated by 40% SUVmax, manual method respectively. With the FDG-positive areas on post-RT images is defined as 80% SUVmax. The overlap fractions (OFs) were calculated between pre-RT scan and during-RT or post-RT scan. Semi-quantitative assessment was used to determine SUVmax and metabolic tumor volume (MTV). The SUVmax changes during-RT representing the radiotherapy (RT) early metabolic response is attainable. Then, a spearman correlation was used to analysis the correlation between percentage changes in SUVmax during-RT and SUVmax-threshold definition volume pre-RT.

Results: Of those 7 patients, a total of 16 FDG-PET scans were acquired. 5 patients were received pre-RT and during-RT scan, while 2 of these 5 patients underwent both post-RT scan. 2 patients were received FDG-PET/CT scan pre-RT and post-RT. The pre-RT scan threshold delineations of 50% SUVmax had a large OF with the 40% SUVmax threshold and manual method delineation on the during-RT scan, 74.3% and 84.4%, respectively. Comparably, the 80% SUVmax on the post-RT scan also largely corresponded (OF > 72%) with the 50% SUVmax threshold and the volume was small compared to the gross tumor volume (GTV), accounting for 29.4%. However, the 50% SUVmax threshold was not correlate with the percentage change in SUVmax (P > 0.05).

Conclusions: A pre-RT FDG-PET scan allows for the identification of during- and post-RT FDG uptake locations. The volume defined by 50% SUVmax may be a suitable threshold for dose escalation.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4509245PMC
July 2015

Early detection of radiation-induced heart disease using (99m)Tc-MIBI SPECT gated myocardial perfusion imaging in patients with oesophageal cancer during radiotherapy.

Radiother Oncol 2015 May 7;115(2):171-8. Epub 2015 May 7.

Department of Radiation Oncology, Shandong Cancer Hospital & Institute, Shandong Academy of Medical Sciences, Jinan University, China. Electronic address:

Background And Purpose: The primary aim of this prospective study was to investigate the value of (99m)Tc-methoxyisobutylisonitrile (MIBI) single photon emission computed tomography (SPECT) gated myocardial perfusion imaging (GMPI) in the detection of radiation-induced heart disease (RIHD) as early as during radiotherapy (RT) for oesophageal cancer (EC). The second aim was to analyse the correlation between cardiac toxicity and the dose-volume factors.

Materials And Methods: The (99m)Tc-MIBI SPECT GMPI was performed both pre-RT and during RT (40Gray). The results of the SPECT were quantitatively analysed with QGS/QPS software and read by two experienced nuclear medicine physicians. The correlation between the changes in the SPECT parameters and the RT dosimetric data was analysed.

Results: Eighteen patients with locally advanced EC were enrolled in the study. Compared with the baseline, the imaging during RT showed not only significant decreases in the wall motion (WM) (1/20 segments), wall thickening (WT) (2/20 segments), end-diastolic perfusion (EDP) (5/20 segments) and end-systolic perfusion (ESP) (8/20 segments) (p<0.05) but also a significant increase in the heart rate (74.63±7.79 vs 81.49±9.90, p=0.036). New myocardial perfusion defects were observed in 8 of the 18 patients. The V37-V40 was significantly higher (p<0.05) in the patients with the new perfusion defects during RT than in the patients who did not exhibit these defects.

Conclusions: Radiotherapy for EC induces cardiac damage from an early stage. (99m)Tc-MIBI SPECT GMPI can detect the occurrence of cardiac impairment during RT. The WM, WT, EDP and ESP may be valuable as early indicators of RIHD. The percentage of the heart volume that receives a high dose is an important factor that is correlated with RIHD.
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http://dx.doi.org/10.1016/j.radonc.2015.04.009DOI Listing
May 2015

Knockdown of PKM2 Enhances Radiosensitivity of Non-small cell Lung Cancer.

Cell Biochem Biophys 2015 Sep;73(1):21-6

Department of Radiation Oncology, Shandong Cancer Hospital and Institute, No. 440 Ji Yan Road, Jinan, 250117, People's Republic of China.

Pyruvate kinase isoenzyme M2 (PKM2) is a key enzyme to regulate aerobic glycolysis in tumor cells and can be used as potential target for cancer therapy. Here, we investigated the effect of knockdown of PKM2 on non-small cell lung cancer (NSCLC) responses to ionizing radiation. Our results showed that PKM2 was greatly up-regulated in radioresistant cell lines and PKM2 knockdown leaded to increased radiosensitivity of radioresistant cell lines, which were associated with higher apoptosis rate and endoplasmic reticulum stress according to western blot analysis. Moreover, significant inhibition in tumor size under regular radiotherapy was found in Balb/c-nude mice bearing radioresistant NSCLC tumors with PKM2 knockdown. Our findings suggested that targeting PKM2 could effectively improve the efficacy of radiotherapy.
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http://dx.doi.org/10.1007/s12013-015-0567-yDOI Listing
September 2015