1.Spicy food consumption and risk of vascular disease: Evidence from a large-scale Chinese prospective cohort of 0.5 million people.
Dongfang YOU ; Dianjianyi SUN ; Ziyu ZHAO ; Mingyu SONG ; Lulu PAN ; Yaqian WU ; Yingdan TANG ; Mengyi LU ; Fang SHAO ; Sipeng SHEN ; Jianling BAI ; Honggang YI ; Ruyang ZHANG ; Yongyue WEI ; Hongxia MA ; Hongyang XU ; Canqing YU ; Jun LV ; Pei PEI ; Ling YANG ; Yiping CHEN ; Zhengming CHEN ; Hongbing SHEN ; Feng CHEN ; Yang ZHAO ; Liming LI
Chinese Medical Journal 2025;138(14):1696-1704
BACKGROUND:
Spicy food consumption has been reported to be inversely associated with mortality from multiple diseases. However, the effect of spicy food intake on the incidence of vascular diseases in the Chinese population remains unclear. This study was conducted to explore this association.
METHODS:
This study was performed using the large-scale China Kadoorie Biobank (CKB) prospective cohort of 486,335 participants. The primary outcomes were vascular disease, ischemic heart disease (IHD), major coronary events (MCEs), cerebrovascular disease, stroke, and non-stroke cerebrovascular disease. A Cox proportional hazards regression model was used to assess the association between spicy food consumption and incident vascular diseases. Subgroup analysis was also performed to evaluate the heterogeneity of the association between spicy food consumption and the risk of vascular disease stratified by several basic characteristics. In addition, the joint effects of spicy food consumption and the healthy lifestyle score on the risk of vascular disease were also evaluated, and sensitivity analyses were performed to assess the reliability of the association results.
RESULTS:
During a median follow-up time of 12.1 years, a total of 136,125 patients with vascular disease, 46,689 patients with IHD, 10,097 patients with MCEs, 80,114 patients with cerebrovascular disease, 56,726 patients with stroke, and 40,098 patients with non-stroke cerebrovascular disease were identified. Participants who consumed spicy food 1-2 days/week (hazard ratio [HR] = 0.95, 95% confidence interval [95% CI] = [0.93, 0.97], P <0.001), 3-5 days/week (HR = 0.96, 95% CI = [0.94, 0.99], P = 0.003), and 6-7 days/week (HR = 0.97, 95% CI = [0.95, 0.99], P = 0.002) had a significantly lower risk of vascular disease than those who consumed spicy food less than once a week ( Ptrend <0.001), especially in those who were younger and living in rural areas. Notably, the disease-based subgroup analysis indicated that the inverse associations remained in IHD ( Ptrend = 0.011) and MCEs ( Ptrend = 0.002) risk. Intriguingly, there was an interaction effect between spicy food consumption and the healthy lifestyle score on the risk of IHD ( Pinteraction = 0.037).
CONCLUSIONS
Our findings support an inverse association between spicy food consumption and vascular disease in the Chinese population, which may provide additional dietary guidance for the prevention of vascular diseases.
Humans
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Male
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Female
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Prospective Studies
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Middle Aged
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Aged
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Vascular Diseases/etiology*
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Risk Factors
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China/epidemiology*
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Adult
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Proportional Hazards Models
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Cerebrovascular Disorders/epidemiology*
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East Asian People
2.Comparative analysis of Aedes albopictus surveillance index in Yangpu District, Shanghai
Jie ZHANG ; Chonghua LU ; Xiaoyan LU ; Hongxia LIU
Shanghai Journal of Preventive Medicine 2024;36(2):173-178
ObjectiveTo analyze the interannual fluctuation, seasonal fluctuation, habitat distribution and the correlation of the 3 monitoring indicators of Aedes albopictus in Yangpu District of Shanghai from 2017 to 2021, and to provide a scientific basis for A. albopictus control and rational use of the indicators. MethodsThe density surveillance data of A. albopictus recorded by Breteau index (BI), Path index (PI) and the mosquito ovitrap index (MOI) from 2017 to 2021 in Yangpu District, Shanghai were compared. Microsoft Excel 2019 software was used for data summary and SPSS 25.0 software was used for statistical analysis. ResultsFrom 2017 to 2021, there were two months with BI>5, and the PI were all above the density control level of Class C, and there were nine months with MOI≥5. In 2017, BI was higher than in the other four years, with statistically significant differences (all P≤0.001). MOI in 2017 and 2020 was higher than in 2019 (P=0.029, P=0.004) and 2021 (P=0.005, P=0.001), with statistical significance. MOI for different types of habitats varied significantly, with a statistically significant difference (P=0.004). A linear correlation was observed between BI and PI (r=0.462, P=0.010). ConclusionBI, PI and MOI are used simultaneously to reflect the density of A. albopictus in Yangpu District of Shanghai. However, these three monitoring indicators show poor linear correlation. Comprehensively considering the scientific aspects of monitoring methods and seasonal fluctuations of indicators, it is suggested that MOI should be used as the main index to evaluate the density of A. albopictus. In the MOI, attention should be paid to factors such as the distribution of the habitats, the standardization of operating methods, and quality control, which are essential for enhancing the reliability of the MOI.
3.Serological analysis of severe acute respiratory syndrome coronavirus 2-specific immunoglobulin G antibodies level in Henan Province
Yujiao MU ; Haiyan WEI ; Yafei LI ; Yun SONG ; Shidong LU ; Bicong WU ; Ying YE ; Xueyong HUANG ; Hongxia MA
Chinese Journal of Infectious Diseases 2024;42(2):98-102
Objective:To analyze the specific immunoglobulin G (IgG) antibodies level in the population after the coronavirus disease 2019 (COVID-19) pandemic in Henan Province.Methods:A total of 5 178 peripheral venous blood samples were collected from 10 districts (counties) in Henan Province according to the national seroepidemiological survey program for COVID-19, and the method of cluster random sampling was adopted from March 6 to 15, 2023. Descriptive analysis was used for the basic data, history of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination, SARS-CoV-2 infection of the respondents. The specific IgG antibody of SARS-CoV-2 was detected using chemiluminescence method. Statistical analysis was performed by using rank sum test, Kruskal Wallis test, and Dunn′s test.Results:The overall positive rate of SARS-CoV-2-specific IgG antibody was 83.35%(4 316/5 178). There were statistically significant differences in the specific IgG antibodies against SARS-CoV-2 produced by people of different sexes, different ages, infected or not, vaccinated or not, and vaccinated with different doses of SARS-CoV-2 vaccine ( Z=3.60, H=195.32, Z=6.10, 18.08, H=382.70, respectively, all P<0.001). The specific IgG antibodies produced by unvaccinated+ uninfected group, unvaccinated+ infected group, vaccinated+ uninfected group, and vaccinated+ infected group were 3.54(0.98, 11.00), 60.65(2.33, 84.80), 133.00(59.80, 173.00), and 142.00(98.30, 176.00), respectively. And the difference was statistically significant( H=354.62, P<0.001). The specific IgG antibodies of uninfected people increased with the increase of inoculum times( H=287.00 and 98.48, both P<0.001). The specific IgG antibodies of people who were not infected with SARS-CoV-2 in the groups of whose interval from the last inoculation of SARS-CoV-2 vaccine to blood collection was less than three months, three to six months and more than six months were 171.86(156.04, 196.57), 71.71(17.08, 110.38) and 132.14(57.59, 172.25), respectively, and the difference was statistically significant ( H=19.93, P<0.001). Among them, the absolute difference between the less than three months group and the three to six months group was statistically significant ( Z=3.67, P<0.001), and the absolute difference between the less than three months group and the more than six months group was statistically significant ( Z=3.47, P<0.001). The specific IgG antibodies level in the less than three months group was the highest. Conclusions:There is a certain correlation between the number of SARS-CoV-2 vaccine doses and the specific IgG antibodies level in uninfected people. The specific IgG antibodies could maintain a high level for three months after immunization.
4.Study on Syndrome Research of Ischemic Stroke Combined with Obstructive Sleep Apnea-hypopnea Syndrome Based on Implicit Structure Method
Hongxia ZHOU ; Xiangzhe LIU ; Xinzhi WANG ; Yanhua WANG ; Yanping ZHANG ; Yongkun LU
Chinese Journal of Experimental Traditional Medical Formulae 2024;30(8):141-147
ObjectiveTo explore the common syndrome elements of cerebral ischemic stroke (CIS) complicated with obstructive sleep apnea-hypopnea syndrome (OSAHS), reveal the characteristics of traditional Chinese medicine (TCM) syndromes of the disease, clarify the syndrome differentiation and syndrome types, provide evidence for clinical syndrome differentiation, and provide reference for establishing the TCM syndrome type standards of CIS complicated with OSAHS. MethodThe clinical information form of CIS complicated with OSAHS formulated by the research group was used for syndrome survey, and the four-examination information of 300 patients with CIS complicated with OSAHS was collected. The four-examination information of patients was analyzed by latent structure method and comprehensive cluster analysis, and the common syndrome elements of CIS complicated with OSAHS were extracted by combining the TCM basic theory and clinical experience. On this basis, the characteristics of TCM syndromes and the syndrome types in line with reality were summarized. ResultThe top five syndrome elements in patients with CIS and OSAHS are sleep snoring, open mouth breathing, physical obesity, night awakening and dizziness. The top five tongue and pulse manifestations are enlarged tongue, slippery pulse, slippery coating, thick and white coating and purple tongue. The disease locations are the lung, spleen, stomach, kidney, liver and brain. The nature of disease includes deficiency, depression, blood stasis, phlegm, dampness and fire. The clinical syndrome types include the syndrome of stagnation of phlegm and dampness, syndrome of phlegm-dampness blocking the mind, syndrome of spleen deficiency with dampness, syndrome of Yin deficiency leading to fire hyperactivity, syndrome of Qi depression blocking collaterals, syndrome of liver depression and blood stasis, syndrome of Qi deficiency with dampness, and syndrome of Yang deficiency induced water retention. ConclusionIn addition to the common phlegm-, dampness- and blood stasis-related syndromes in patients with CIS and OSAHS, there are also depression- and deficiency-related syndromes. The main etiology and pathogenesis is the disturbance of Qi movement. In clinical practice, attention should be paid to the specific situation of individual patients to differentiate between deficiency and excess, and the treatment should be performed by the method of soothing and reinforcing, or unblocking and clearing, or both.
5.Effect of Jianpi Bushen Huoxue Prescription on Rat Brain Microvascular Endothelial Cells Based on HIF-1α/VEGF Signaling Pathway
Xuenan LIU ; Xiangzhe LIU ; Rui LAN ; Hongxia ZHOU ; Yongkun LU
Chinese Journal of Experimental Traditional Medical Formulae 2024;30(15):81-89
ObjectiveTo observe the effects of Jianpi Bushen Huoxue prescription (JPBSHX) on rat brain microvascular endothelial cells (RBMECs) based on hypoxia-inducible factor-1α (HIF-1α)/vascular endothelial growth factor (VEGF) signaling pathway, aiming to provide a theoretical basis for the treatment of ischemic stroke. MethodTwelve 8-week-old male SPF-grade SD rats were selected. Eight of them were randomly chosen and given 3.25 g·mL-1 JPBSHX solution by gavage at a dose of 10 mL·kg-1 for 5 consecutive days to prepare the medicated serum, which was then preserved for later use. The remaining four rats were given the same volume of normal saline. Follow-up operations were the same as those of the above eight rats. Normal rat serum was collected and stored for later use. RBMECs were revived, cultured, passaged, and randomly divided into five groups: normal group (20% normal rat serum+80% high glucose DMEM), model group (hypoxia-reoxygenation injury) (20% normal rat serum+80% glucose-free DMEM), medicated serum group (20% JPBSHX-medicated serum+80% glucose-free DMEM), medicated serum+HIF-1α inhibitor group (20% JPBSHX-medicated serum+HIF-1α inhibitor 1 mg +80% glucose-free DMEM), and medicated serum+VEGF inhibitor group (20% JPBSHX-medicated serum +VEGF inhibitor 1 mg+80% glucose-free DMEM). The relative protein expression levels of Claudin-1 and Claudin-5 in RBMECs, the expression levels of HIF-1α and VEGF in RBMEC culture supernatants, the repair ability of RBMECs, and the number of nodes, microvessels, and their lengths after 72 h of culture were observed in each group. ResultAfter 24 h of reoxygenation, the scratch healing rate in the model group was significantly lower than in the normal group (P<0.01). Compared with the result in the model group, the scratch healing rates significantly improved in the medicated serum group, medicated serum+HIF-1α inhibitor group, and medicated serum+VEGF inhibitor group (P<0.05). However, the healing rates in the medicated serum+HIF-1α inhibitor group and medicated serum+VEGF inhibitor group were significantly lower than that in the medicated serum group (P<0.05). The number of nodes, microvessels, and total length of microvessels in the model group were significantly lower than those in the normal group (P<0.01). These indicators significantly improved in the medicated serum group, medicated serum+HIF-1α inhibitor group, and medicated serum+VEGF inhibitor group compared with those in the model group (P<0.05), but were significantly lower in the medicated serum+HIF-1α inhibitor group and medicated serum+VEGF inhibitor group compared with those in medicated serum group (P<0.05). The relative expression levels of Claudin-1 and Claudin-5 proteins were significantly lower in the model group than in the normal group (P<0.01). These levels were significantly higher in medicated serum group, medicated serum+HIF-1α inhibitor group, and medicated serum+VEGF inhibitor group than those in the model group (P<0.05), but were significantly lower in the medicated serum+HIF-1α inhibitor group and medicated serum+VEGF inhibitor group than those in the medicated serum group (P<0.05). The expression levels of HIF-1α and VEGF in the RBMEC culture supernatants were significantly lower in the model group than those in the normal group (P<0.01). These levels were significantly higher in the medicated serum group, medicated serum+HIF-1α inhibitor group, and medicated serum+VEGF inhibitor group than those in the model group (P<0.05), but were significantly lower in the medicated serum+HIF-1α inhibitor group and medicated serum+VEGF inhibitor group than those in the medicated serum group (P<0.05). ConclusionJPBSHX can promote the proliferation, migration, and angiogenesis, such as tubule formation, of RBMECs damaged by hypoxia-reoxygenation injury, and this effect may be achieved through the regulation of the HIF-1α/VEGF signaling pathway.
6.Aprospective study of detection and clinical significance of bone marrow tumor cells in small cell lung cancer
Ying WANG ; Baohua LU ; Yuan GAO ; Yanxia LIU ; Mingming HU ; Nanying CHE ; Haifeng LIN ; Hongxia LI ; Hongmei ZHANG ; Tongmei ZHANG
Chinese Journal of Oncology 2024;46(5):419-427
Objective:To investigate the detection of bone marrow tumor cells in small cell lung cancer (SCLC) patients and their relationship with clinical features, treatment response and prognosis.Methods:A total of 113patients with newly diagnosed SCLC from January 2018 to October 2022 at Beijing Chest Hospital were prospectively enrolled. Before treatment, bone marrow was aspirated and separately submitted for tumor cells detection by liquid-based cytology and disseminated tumor cells (DTCs) detection by the substrction enrichment and immunostaining fluorescence in situ hybridization (SE-iFISH) platform. The correlation between the detection results of the two methods with patients' clinical features and treatment response was evaluated by Chi-square. Kaplan-Meier method was applied to create survival curves and the Cox regression model was used for multivariate analysis.Results:The positive rate of bone marrow liquid-based cytology in SCLC was 15.93% (18/113). The liver and bone metastases rates were significantly higher (55.56% vs 11.58% for liver metastasis, P<0.001; 77.78% vs 16.84% for bone metastasis, P<0.001) and thrombocytopenia was more common (16.67% vs 2.11%, P=0.033) in patients with tumor cells detected in liquid-based cytology than those without detected tumor cells. As for SE-iFISH, DTCs were detected in 92.92% of patients (105/113), the liver and bone metastasis rates were significantly higher (37.93% vs 11.90% for liver metastasis, P=0.002; 44.83% vs 20.23 % for bone metastasis, P=0.010), and the incidence of thrombocytopenia was significantly increased (13.79% vs 1.19%, P=0.020) in patients with DTCs≥111 per 3 ml than those with DTCs<111 per 3 ml. The positive rates of bone marrow liquid-based cytology in the disease control group and the disease progression group were 12.00% (12/100) and 46.15% (6/13), respectively, and the difference was statistically significant ( P=0.002). However, the result of SE-iFISH revealed the DTCs quantities of the above two groups were 29 (8,110) and 64 (15,257) per 3 ml, and there was no statistical difference between the two groups ( P=0.329). Univariate analysis depicted that the median progression-free survival (PFS) and median overall survival (OS) of liquid-based cytology positive patients were significantly shorter than those of tumor cell negative patients (6.33 months vs 9.27 months for PFS, P=0.019; 8.03 months vs 19.50 months for OS, P=0.019, P=0.033). The median PFS and median OS in patients with DTCs≥111 per 3 ml decreased significantly than those with DTCs<111 per 3 ml (6.83 months vs 9.50 months for PFS, P=0.004; 11.2 months vs 20.60 months for OS, P=0.019). Multivariate analysis showed that disease stage ( HR=2.806, 95% CI:1.499-5.251, P=0.001) and DTCs quantity detected by SE-iFISH ( HR=1.841, 95% CI:1.095-3.095, P=0.021) were independent factors of PFS, while disease stage was the independent factor of OS ( HR=2.538, 95% CI:1.169-5.512, P=0.019). Conclusions:Both bone marrow liquid-based cytology and SE-iFISH are clinically feasible. The positive detection of liquid-based cytology or DTCs≥111 per 3 ml was correlated with distant metastasis, and DTCs≥111 per 3 ml was an independent prognostic factor of decreased PFS in SCLC.
7.Association between prenatal exposure to PM 2.5 and fetal growth: a prospective cohort study
Lei HUANG ; Hong LYU ; Xin XU ; Tianyu SUN ; Yiyuan CHEN ; Yanjie ZHANG ; Bo YANG ; Qun LU ; Yangqian JIANG ; Tao JIANG ; Jiangbo DU ; Xiaoyan WANG ; Hongxia MA ; Zhibin HU ; Yuan LIN
Chinese Journal of Epidemiology 2024;45(6):794-801
Objective:To investigate the association of exposure to PM 2.5 and its constituents during pregnancy and fetal growth and to further identify critical windows of exposure for fetal growth. Methods:We included 4 089 mother-child pairs from the Jiangsu Birth Cohort Study between January 2016 and October 2019. Data of general characteristics, clinical information, daily average PM 2.5 exposure, and its constituents during pregnancy were collected. Fetal growth parameters, including head circumference (HC), abdominal circumference (AC), and femur length (FL), were measured by ultrasound after 20 weeks of gestation, and then estimated fetal weight (EFW) was calculated. Generalized linear mixed models were adopted to examine the associations of prenatal exposure to PM 2.5 and its constituents with fetal growth. Distributed lag nonlinear models were used to identify critical exposure windows for each outcome. Results:A 10 μg/m 3 increase in PM 2.5 exposure during pregnancy was associated with a decrease of 0.025 ( β=-0.025, 95% CI: -0.048- -0.001) in HC Z-score, 0.026 ( β=-0.026, 95% CI: -0.049- -0.003) in AC Z-score, and 0.028 ( β=-0.028, 95% CI:-0.052--0.004) in EFW Z-score, along with an increased risk of 8.5% ( RR=1.085, 95% CI: 1.010-1.165) and 13.5% ( RR=1.135, 95% CI: 1.016-1.268) for undergrowth of HC and EFW, respectively. Regarding PM 2.5 constituents, prenatal exposure to black carbon, organic matter, nitrate, sulfate (SO 42-) and ammonium consistently correlated with decreased HC Z-score. SO 42- exposure was also associated with decreased FL Z-scores. In addition, we found that gestational weeks 2-5 were critical windows for HC, weeks 4-13 and 19-40 for AC, weeks 4-13 and 23-37 for FL, and weeks 4-12 and 20-40 for EFW. Conclusions:Our findings demonstrated that exposure to PM 2.5 and its constituents during pregnancy could adversely affect fetal growth and the critical windows for different fetal growth parameters are not completely consistent.
8.Effectiveness of motor imagery training on functional exercise in patients after knee replacement
Juan ZHAO ; Hongxia XIANG ; Hongxia ZHANG ; Shuang HE ; Lu ZHANG ; Shanshan SHI
Chinese Journal of Modern Nursing 2024;30(23):3200-3204
Objective:To explore the effectiveness of motor imagery training (MIT) on knee function, kinesiophobia, and functional exercise compliance in patients after knee replacement.Methods:From June 2022 to August 2023, convenience sampling was used to select patients who underwent knee replacement and were admitted to the Fourth Clinical College of Xinxiang Medical University as participants. The patients were divided into control group ( n=98 cases) and observation group ( n=98 cases) according to their enrollment time. The control group received routine postoperative rehabilitation, while the observation group was treated with MIT in addition to the control group. The knee function, kinesiophobia, and functional exercise compliance of two groups of patients were compared before and after intervention. Results:After intervention, in observation group, the Western Ontario and McMaster Universities Osteoarthritis Index score was lower than that in control group, the score of Hospital for Special Surgery was higher than that in control group, the Tampa Scale of Kinesiophobia score was lower than that in control group, and the compliance with functional exercise was higher than that in control group, with statistical differences ( P<0.05) . Conclusions:Applying MIT on the basis of rehabilitation training can alleviate the kinesiophobia in patients after knee replacement, improve their exercise compliance and knee function.
9.Detection of PIK3CA gene mutation and its related prognosis in colorectal cancer based on next-generation sequencing
Xiao PENG ; Xin ZHANG ; Hongxia LU ; Lulu SHEN ; Ning GAO ; Likun ZAN
Chinese Journal of Pathology 2024;53(7):716-721
Objectives:To investigate the mutation of PIK3CA in colorectal cancer and to analyze their clinicopathological features, and evaluate their role in clinical treatment and prognostication.Methods:A total of 128 paraffin-embbeded tissue samples of colorectal cancer from Shanxi Cancer Hospital from 2018 to 2021 were collected. DNA was extracted from the samples, and next-generation sequencing (NGS) was used to detect PIK3CA mutation. The relationship between PIK3CA mutation, their clinicopathological features, and prognosis were analyzed.Results:Among the 128 colorectal cancer samples, there were 75 males and 53 females; with aged range 32-86 years, median 61.5 years, 27 (21.09%) had PIK3CA mutations. Colorectal cancer with PIK3CA mutation was more likely to occur in male patients ( P=0.007), which was related to tumor site ( P=0.032), tumor size ( P=0.029) and TP53 wild-type ( P=0.001). The common site mutations of PIK3CA mostly occurred in tumors with tumor mutation burden≥10 Muts/Mb ( P=0.031).PIK3CA mutation had no significant effect on the survival prognosis of patients, but the efficacy of anti-angiogenic therapy was poor in these patients. Conclusions:PIK3CA mutation is a common mutation in colorectal cancer and plays an important role in the occurrence and development of colorectal cancer. PIK3CA mutation may lead to resistance to anti-angiogenic drugs in colorectal cancer, but its impact on survival and prognosis to patients needs further study.
10.Aprospective study of detection and clinical significance of bone marrow tumor cells in small cell lung cancer
Ying WANG ; Baohua LU ; Yuan GAO ; Yanxia LIU ; Mingming HU ; Nanying CHE ; Haifeng LIN ; Hongxia LI ; Hongmei ZHANG ; Tongmei ZHANG
Chinese Journal of Oncology 2024;46(5):419-427
Objective:To investigate the detection of bone marrow tumor cells in small cell lung cancer (SCLC) patients and their relationship with clinical features, treatment response and prognosis.Methods:A total of 113patients with newly diagnosed SCLC from January 2018 to October 2022 at Beijing Chest Hospital were prospectively enrolled. Before treatment, bone marrow was aspirated and separately submitted for tumor cells detection by liquid-based cytology and disseminated tumor cells (DTCs) detection by the substrction enrichment and immunostaining fluorescence in situ hybridization (SE-iFISH) platform. The correlation between the detection results of the two methods with patients' clinical features and treatment response was evaluated by Chi-square. Kaplan-Meier method was applied to create survival curves and the Cox regression model was used for multivariate analysis.Results:The positive rate of bone marrow liquid-based cytology in SCLC was 15.93% (18/113). The liver and bone metastases rates were significantly higher (55.56% vs 11.58% for liver metastasis, P<0.001; 77.78% vs 16.84% for bone metastasis, P<0.001) and thrombocytopenia was more common (16.67% vs 2.11%, P=0.033) in patients with tumor cells detected in liquid-based cytology than those without detected tumor cells. As for SE-iFISH, DTCs were detected in 92.92% of patients (105/113), the liver and bone metastasis rates were significantly higher (37.93% vs 11.90% for liver metastasis, P=0.002; 44.83% vs 20.23 % for bone metastasis, P=0.010), and the incidence of thrombocytopenia was significantly increased (13.79% vs 1.19%, P=0.020) in patients with DTCs≥111 per 3 ml than those with DTCs<111 per 3 ml. The positive rates of bone marrow liquid-based cytology in the disease control group and the disease progression group were 12.00% (12/100) and 46.15% (6/13), respectively, and the difference was statistically significant ( P=0.002). However, the result of SE-iFISH revealed the DTCs quantities of the above two groups were 29 (8,110) and 64 (15,257) per 3 ml, and there was no statistical difference between the two groups ( P=0.329). Univariate analysis depicted that the median progression-free survival (PFS) and median overall survival (OS) of liquid-based cytology positive patients were significantly shorter than those of tumor cell negative patients (6.33 months vs 9.27 months for PFS, P=0.019; 8.03 months vs 19.50 months for OS, P=0.019, P=0.033). The median PFS and median OS in patients with DTCs≥111 per 3 ml decreased significantly than those with DTCs<111 per 3 ml (6.83 months vs 9.50 months for PFS, P=0.004; 11.2 months vs 20.60 months for OS, P=0.019). Multivariate analysis showed that disease stage ( HR=2.806, 95% CI:1.499-5.251, P=0.001) and DTCs quantity detected by SE-iFISH ( HR=1.841, 95% CI:1.095-3.095, P=0.021) were independent factors of PFS, while disease stage was the independent factor of OS ( HR=2.538, 95% CI:1.169-5.512, P=0.019). Conclusions:Both bone marrow liquid-based cytology and SE-iFISH are clinically feasible. The positive detection of liquid-based cytology or DTCs≥111 per 3 ml was correlated with distant metastasis, and DTCs≥111 per 3 ml was an independent prognostic factor of decreased PFS in SCLC.

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