Objective To investigate the treatment and prognosis of patients with papillary thyroid microcarcinoma. Methods The clinical and following-up data of 124 patients with papillary thyroid microcarcinoma treated at the Department of Head and Neck Surgery of Cancer Centre, SUN Yat-sen University from Jan 1990 to Dec 1999 were analyzed retrospectively for mortality and survival rate ( KaplanMeier). A multivariate analysis was performed in these patients by Cox proportional hazard model. Results The overall 10-year and 15-year survival rate of all 124 patients with papillary thyroid microcarcinoma were 94.9% and 92.5% respectively. The univariate analysis showed the prognostic factors significantly influencing the survival of patients included age (being worse for those of 35 years and older) at presentation, and the status of distant metastasis ( all P ＜ 0. 05 ) , while gender, incidentally found at surgery, the size of primary tumor, the status of neck lymph node metastasis, recurrence after a primary resection, and the extent of surgical resection did not significantly effect the prognosis. Multivariate analysis showed the age more than 35 years at presentation was an independent risk factor indicating worse prognosis (P = 0. 045 ). Conclusioas The prognosis of patients with papillary thyroid microcarcinoma is satisfactory, but that is poor for those patients 35 years old and up at presentation and with distant metastasis.

Objective To investigate the prognostic factors of differentiated thyroid carcinoma (DTC) in patients younger than 45 years. Methods Clinical data of all patients less than 45 years old at presentation with DTC in our hospital from Jan 1985 to Dec 1997 were analyzed retrospectively. Single variable analysis was performed by life-table method. Multivariate analysis was performed by Cox proportional hazard model. Results Two hundred and seventy two cases were analyzed. The overall 10-year survival rate was 93. 0%. The main prognostic factors influencing survival were age at presentation, the status of lymph node metastasis and distant metastasis; distant metastasis was the risk factor independently influencing survival by multivariate analysis. Conclusions Distant metastasis is the factor influencing survival significantly. The prognosis of these patients without distant metastasis is good. Total or near-total thyroidectomy and postoperative 131I therapy may be essential for a better prognosis in patients with distant metastasis.

Objective To explore the therapeutic efficacy and adverse effects of decitabine combined with half dose CAG regimen and only CAG regimen for the elderly patients with acute myeloid leukemia (AML).Methods A total of 42 elderly patients with AML aged between 65 and 75 years old (except for acute promyelocytic leukemia) admitted into Heze Municipal Hospital from August 2013 to August 2017 were retrospectively analyzed.They were divided into treatment group and control group according to the different chemotherapy regimens.Twenty patients in the treatment group were treated with decitabine combined with half dose CAG regimen (recombinant granulocyte colony stimulating factor + cytarabine + aclarubicin),and 22 patients in the control group were treated with CAG regimen.Results After the first course of treatment,in treatment group,13 cases achieved complete remission (CR),3 cases achieved partial remission (PR),4 cases achieved non-remission (NR),and the total efficacy (CR+PR) rate was 80.0 ％ (16/20).In control group,8 cases (36 ％) achieved CR,2 cases achieved PR,12 cases achieved NR,and the total efficacy rate was 45.5 ％ (10/22).The difference in total effective rate between the two groups was statistically significant (x2 =3.707,P =0.035).There was no significant difference in the bone marrow recovery time,the infusion of red blood cells and platelets between the two groups (all P ＞ 0.05).Conclusion The therapeutic efficacy of decitabine combined with half dose CAG regimen is better than that of CAG regimen,the adverse effects are all tolerated,and it can be served as the prior therapy for elderly AML patients.

Objective:To explore the value of peripheral blood lymphocyte-to-monocyte ratio (LMR) after induction chemotherapy in patients with acute myeloid leukemia (AML) for the judgment of curative effect and prognosis.Methods:The clinical data of 63 newly-treated AML patients (except for acute promyelocytic leukemia) in Heze Municipal Hospital of Shandong Province from January 2015 to January 2020 were retrospectively analyzed. No blasts were seen on the blood films of all patients at one week after induction chemotherapy. The receiver operating characteristic (ROC) curve was used to determine the best cut-off value of LMR at one week after the completion of all induction chemotherapy for predicting complete remission (CR) of patients, and based on this value, the patients were divided into the low LMR group (LMR 0.05). The CR rates after 1 course of treatment in the low LMR group and the high LMR group were 65.0% (13/20) and 88.4% (38/43), respectively, and the difference was statistically significant ( χ2=4.836, P=0.028). In the low LMR group, 3 of the 13 patients who achieved CR within 1 course of treatment relapsed; in the high LMR group, 2 of the 38 patients who achieved CR within 1 course of treatment relapsed. The 3-year RFS rates of the low LMR group and the high LMR group were 64% and 80%, respectively, and the difference was not statistically significant ( χ2=2.897, P=0.089); the 3-year OS rates were 84% and 80%, respectively, and the difference was not statistically significant ( χ2=0.136, P=0.712). Conclusion:For newly-treated AML patients with no nucleated cells in blood smear microscopy at one week after the completion of induction chemotherapy, LMR may be used to evaluate the treatment efficacy and recurrence.

OBJECTIVETo investigate the mechanism of immune escape in renal cell carcinoma(RCC).

METHODSFas and FasL expressions were examined by immunohistochemical technique in 44 RCC patients, with the Ki67 expression and apoptosis of tumor infiltrating lymphocytes(TIL) monitored simultaneously. Cytokines including IL2 and IFN alpha were used to induce the expression of the renal carcinoma cell lines 786-0 cells. Combination treatment of 786-0 with cytokines and Anti-Fas monoclonal antibody (FasAb) was used to induce apoptosis. FasL function was assessed by in vitro co-culture assays using renal cancer cells 786-0 and Fas-sensitive Jurkat T-cells.

RESULTS(1) Fas expression rate in RCC(22.8%) was lower than that in the controlled normal kidney tissues(53.8%, P < 0.01). FasL expression rate in RCC (46.5%) was higher than that in the controlled normal kidney tissues (23.2%, P < 0.01). That of Ki67 was 32.8%, with the expressions of Fas and Ki67 showing a negative correlation (r = -0.62, P < 0.05). In contrast, the expressions of FasL and Ki67 showed a positive correlation. (r = 0.93, P < 0.01). The Fas expression of stage I was significantly higher than that of stages III and IV. The expression rate of FasL in RCC was significantly increased with RCC stage (P < 0.01). (2) The apoptotic rate of TIL in RCC (33.9%) was significantly higher than that of the normal kidney tissues (3.5%, P < 0.01). The expression of FasL and the apoptotic rate of TIL in RCC gave a positive correlation (r = 0.96, P < 0.01). (3) Fas expression rate in 786-0 cells was 13.7%. The apoptotic rate mediated by FAsAb was 9.6%. IFN alpha was able to up-regulate the Fas expression and subsequently augment the FasAb-mediated apoptosis in 786-0 cells. But IL2 did not show similar effects. (4) The FasL expression rate of 786-0 was 18.6%. FasL expressed by 786-0 cells was able to induce apoptosis of Jurkat T-cells in co-culture assays and the apoptosis of Jurkat T-cells was significantly lowered after blocking the effect of FasL with Fas-neutralizing antibody NOK-2, giving the apoptotic rates of 14.9% and 2.0%, respectively, the difference therein is statistically significant (P < 0.01).

CONCLUSIONDown-regulation of Fas expression and up-regulation of FasL-expression are the mechanisms through which the RCC cells escape from immune attack.

Adult ; Aged ; Carcinoma, Renal Cell ; immunology ; Fas Ligand Protein ; Female ; Humans ; Ki-67 Antigen ; immunology ; Kidney Neoplasms ; immunology ; Male ; Membrane Glycoproteins ; immunology ; Middle Aged ; fas Receptor ; immunology

Objective:To investigate the clinical efficacy and related adverse reactions of ixazomib-based chemotherapy regimens in the treatment of relapsed/refractory multiple myeloma (RRMM).Methods:Twenty-one patients with RRMM who received ≥2 courses of ixazomib-based chemotherapy regimens in Heze Municipal Hospital and Zoucheng People's Hospital of Shandong Province from October 2018 to February 2020 were collected. Among them, 15 patients had previously received the bortezomib-based regimens, 10 patients had received the lenalidomide-based regimens, and 6 patients had received the treatment regimens containing the above two drugs. The patients were treated by a two-drug or three-drug regimen: 4 mg ixazomib was taken orally on day 1, 8 and 15 in combination with other drugs (dexamethasone, cyclophosphamide or lenalidomide). The therapeutic efficacy and safety were evaluated after the 2nd and the 4th treatment cycles.Results:The overall response rate (ORR) of 21 patients with RRMM after 2 treatment cycles was 38.09% (8/21), including 6 cases of partial remission (PR) and 2 cases of very good partial remission (VGPR). After 4 cycles, ORR was 57.14% (12/21), including 7 cases of PR, 4 cases of VGPR, and 1 case of complete remission (CR). The incidence of grade 3-4 adverse reactions of the ixazomib-based chemotherapy regimens was 23.81% (5/21). Hematological adverse reactions included neutropenia, thrombocytopenia and anemia, and other common adverse reactions included the digestive tract reactions, fatigue, hypokalemia, etc., and the peripheral nerve adverse reactions were all grade 2 or below grade 2.Conclusion:The ixazomib-based chemotherapy regimens are effective and safe in treating RRMM.

Objective:To investigate the clinical characteristics of patients with multiple myeloma (MM) combined with kidney injury and the risk factors associated with the occurrence of kidney injury.Methods:The clinical data of 96 newly treated MM patients in Heze Municipal Hospital from January 2017 to June 2021 were retrospectively analyzed, and the patients were divided into the kidney injury group (33 cases) and the non-kidney injury group (63 cases) based on whether the blood creatinine was >177 μmol/L at the time of diagnosis. The general data and laboratory results of the two groups were compared. The risk factors for kidney injury in MM patients were analyzed by logistic regression method, and the receiver operating characteristic (ROC) curve was drawn to assess the predictive value of each risk factor for the occurrence of kidney injury in MM patients.Results:Compared with the non-kidney injury group, hemoglobin was lower in the kidney injury group, and white blood cell count, blood uric acid, urea nitrogen, β 2-microglobulin (β 2-MG), cystatin C, the proportion of patients with light chain type, and the proportion of patients with international staging system (ISS) stage Ⅲ were higher in the kidney injury group, and the differences were statistically significant (all P < 0.05). Thirty-four patients underwent fluorescence in situ hybridization (FISH) test, and 22 cases (64.7%) had abnormal results. In the non-kidney injury group, genetic testing were performed in 26 cases, and the results were abnormal in 14 cases, including 11 cases (42.3%) of IgH rearrangement, 4 cases (15.4%) of RB1 deletion, 4 cases (15.4%) of 1q21 amplification, and 1 case (3.8%) of P53 deletion; in the kidney injury group, 8 cases underwent genetic testing, and all results were abnormal, including 6 cases (75.0%) of IgH rearrangement, 5 cases (40.0%) of RB1 deletion, and 2 cases (25.0%) of 1q21 amplification. The rate of RB1 mutation in the kidney injury group was higher than that in the non-kidney injury group, and the difference was statistically significant ( χ2 = 4.43, P = 0.035). Logistic regression analysis showed that elevated blood uric acid ( OR = 1.009, 95% CI 1.002-1.016, P = 0.015) and ISS stage Ⅲ ( OR = 16.401, 95% CI 1.174-229.164, P = 0.038), elevated white blood cell count ( OR = 1.833, 95% CI 1.020-3.294, P = 0.043), elevated β 2-MG ( OR = 1.320, 95% CI 1.009-1.728, P = 0.043), and decreased hemoglobin ( OR = 0.900, 95% CI 0.832-0.922, P = 0.008) were independent risk factors for the development of kidney injury in MM patients. According to the area under the ROC curve (AUC), blood uric acid (AUC = 0.775, 95% CI 0.675-0.875, P < 0.001), white blood cell count (AUC = 0.696, 95% CI 0.583-0.809, P = 0.002), β 2-MG (AUC = 0.822, 95% CI 0.732-0.911, P < 0.001), hemoglobin (AUC = 0.755, 95% CI 0.652-0.857, P < 0.001), and ISS stage Ⅲ (AUC = 0.763, 95% CI 0.669-0.856, P < 0.001) had predictive value for kidney injury in MM. Conclusions:MM patients have a high incidence of combined kidney injury, and active monitoring and control of risk factors may improve the outcome and prognosis of patients.