1.Mechanisms of Anemarrhenae Rhizoma Water Extract in Ameliorating Neuroinflammation in Alzheimer's Disease Model Rats via SIRT1/HMGB1/NF-κB Signaling Pathway
Fei WU ; Yuexia LI ; Qi HUANG ; Tianshi LI ; Chuanshan JIN ; Kai MA
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(7):230-240
ObjectiveTo investigate the therapeutic effects of the Anemarrhenae Rhizoma water extract (AR) on Alzheimer's disease (AD) model rats and to explore its potential underlying mechanisms. MethodsMale rats were intraperitoneally injected with D-galactose (100 mg·kg-1) for 42 days, and on day 14, 1 μL of β-amyloid (Aβ25-35, 2 g·L-1) solution was injected into the hippocampus. Rats were randomly divided into a model group, low-dose AR (0.6 g·kg-1), medium-dose AR (1.2 g·kg-1), high-dose AR (2.4 g·kg-1), and a positive control group (donepezil, 5 mg·kg-1). Healthy rats receiving only a hippocampal injection of 1 μL of sterile saline served as the sham-operated group. From day 21, rats in the treatment groups were administered the corresponding drugs by gavage once daily for 21 consecutive days, while the blank control and model groups received an equal volume of saline. Learning and memory abilities were assessed using the Morris water maze. Brain tissue damage was observed by hematoxylin and eosin (HE) staining, and neuronal apoptosis was evaluated by terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) staining. Levels of interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), and interleukin-10 (IL-10) in brain tissues were measured by enzyme-linked immunosorbent assay (ELISA). BV2 microglial cells were co-cultured with Aβ25-35 (40 μmol·L-1) for 2 h, and cell viability was determined by the CCK-8 assay to screen the optimal concentration of AR-containing serum (S-AR). Cells were divided into blank control, Aβ25-35, S-AR, EX527 [silent information regulator 1 (SIRT1) inhibitor], and S-AR+EX527 groups. Immunofluorescence staining was used to detect the expression of CD16, CD206, and high-mobility group box 1 (HMGB1). Western blot analysis was performed to measure the protein expression of CD16, inducible nitric oxide synthase (iNOS), CD206, arginase (Arg), and proteins related to the SIRT1/HMGB1/nuclear factor-κB (NF-κB) signaling pathway. ResultsIn vivo experiments showed that, compared with the sham-operated group, the model group exhibited reduced platform crossings and time spent in the target quadrant (P<0.01), prolonged escape latency, increased hippocampal neuronal apoptosis (P<0.01), and obvious hippocampal damage. The expression levels of IL-6, TNF-α, IL-10, CD16, and iNOS in brain tissues were significantly elevated (P<0.01), while CD206 and Arg protein expression showed an increasing trend without statistical significance. Compared with the model group, all AR-treated groups significantly increased platform crossings and target quadrant time (P<0.05, P<0.01), alleviated hippocampal damage, reduced escape latency and neuronal apoptosis, downregulated the expression of TNF-α, IL-6, CD16, and iNOS (P<0.05, P<0.01), and upregulated the expression of IL-10, CD206 and Arg (P<0.05, P<0.01). In vitro experiments demonstrated that, compared with the blank control group, the Aβ25-35 group showed increased fluorescence intensity of CD206, CD16, and HMGB1, as well as elevated protein expression of iNOS and CD16 (P<0.01), while CD206 and Arg protein expression exhibited an increasing trend without statistical significance. After S-AR intervention, CD206 fluorescence intensity and the protein expression of Arg and CD206 were significantly increased (P<0.01), whereas the fluorescence intensity of CD16 and HMGB1 and the protein expression of iNOS and CD16 were significantly decreased (P<0.01). These effects were reversed by EX527 (P<0.05, P<0.01). Furthermore, compared with the blank control group, the Aβ25-35 group showed significantly increased cytoplasmic HMGB1 expression and p-p65/p65 ratio (P<0.01), along with significantly decreased SIRT1 and nuclear HMGB1 expression (P<0.01). In contrast, the S-AR group exhibited opposite trends compared with the Aβ25-35 group, and the regulatory effects of S-AR on these proteins were reversed by EX527 (P<0.01). ConclusionAR exerts neuroprotective effects in AD model rats by regulating microglial polarization and alleviating neuroinflammation, potentially through modulation of the SIRT1/HMGB1/NF-κB signaling pathway.
2.Preparation and application of conductive fiber coated with liquid metal.
Chengfeng LIU ; Jiabo TANG ; Ming LI ; Shihao ZHANG ; Yang ZOU ; Yonggang LYU
Journal of Biomedical Engineering 2025;42(4):724-732
Flexible conductive fibers have been widely applied in wearable flexible sensing. However, exposed wearable flexible sensors based on liquid metal (LM) are prone to abrasion and significant conductivity degradation. This study presented a high-sensitivity LM conductive fiber with integration of strain sensing, electrical heating, and thermochromic capabilities, which was fabricated by coating eutectic gallium-indium (EGaIn) onto spandex fibers modified with waterborne polyurethane (WPU), followed by thermal curing to form a protective polyurethane sheath. This fiber, designated as Spandex/WPU/EGaIn/Polyurethane (SWEP), exhibits a four-layer coaxial structure: spandex core, WPU modification layer, LM conductive layer, and polyurethane protective sheath. The SWEP fiber had a diameter of (458.3 ± 10.4) μm, linear density of (2.37 ± 0.15) g/m, and uniform EGaIn coating. The fiber had excellent conductivity with an average value of (3 716.9 ± 594.2) S/m. The strain sensing performance was particularly noteworthy. A 5 cm × 5 cm woven fabric was fabricated using polyester warp yarns and SWEP weft yarns. The fabric exhibited satisfactory moisture permeability [(536.06 ± 33.15) g/(m 2·h)] and maintained stable thermochromic performance after repeated heating cycles. This advanced conductive fiber development is expected to significantly promote LM applications in wearable electronics and smart textile systems.
Wearable Electronic Devices
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Polyurethanes/chemistry*
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Electric Conductivity
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Gallium/chemistry*
;
Metals/chemistry*
3.Differential expressions of exosomal miRNAs in patients with chronic heart failure and hyperuricemia: diagnostic values of miR-27a-5p and miR-139-3p.
Zhiliang CHEN ; Yonggang YANG ; Xia HUANG ; Yan CHENG ; Yuan QU ; Qiqi HENG ; Yujia FU ; Kewei LI ; Ning GU
Journal of Southern Medical University 2025;45(1):43-51
OBJECTIVES:
To analyze the differentially expressed exosomal miRNAs in patients with chronic heart failure (CHF) complicated by hyperuricemia (HUA) and explore their potential as novel diagnostic molecular markers and their target genes.
METHODS:
This study was conducted among 30 CHF patients with HUA (observation group) and 30 healthy volunteers (control group) enrolled between September, 2020 and September, 2023. Peripheral blood samples were collected from 6 CHF patients with HUA for analyzing exosomal miRNAs by high-throughput sequencing, and the results were validated in the remaining 24 patients using qRT-PCR. GO and KEGG enrichment analyses were performed to predict the the target genes of the identified differential miRNAs. We also validated the differentially expressed miRNAs by animal experiment.
RESULTS:
A total of 42 differentially expressed exosomal miRNAs were detected in observation group by high-throughput sequencing; among them, miR-27a-5p was significantly upregulated (P=0.000179), and miR-139-3p was significantly downregulated (P=0.000058). In the 24 patients with both CHF and PUA, qRT-PCR validated significant upregulation of miR-27a-5p (P=0.004) and downregulation of miR-139-3p (P=0.005) in serum exosomes. When combined, miR-27a-5p and miR-139-3p had a maximum area under the curve (AUC) of 0.899 (95% CI: 0812-0.987) for predicting CHF complicated by HUA. GO and KEGG enrichment analyses suggested that the differential expressions of miR-27a-5p and miR-139-3p was associated with the activation of the AMPK-mTOR signaling pathway to activate the autophagic response. We obtained the same conclusion from animal experiment.
CONCLUSIONS
Upregulated exosomal miR-27a-5p combined with downregulated exosomal miR-139-3p expression can serve as a novel molecular marker for diagnosis of CHF complicated by HUA, and their differential expression may promote autophagy in cardiomyocytes by activating the AMPK-mTOR signaling pathway.
Humans
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Hyperuricemia/diagnosis*
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Heart Failure/genetics*
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MicroRNAs/metabolism*
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Exosomes/metabolism*
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Chronic Disease
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Male
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Female
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Middle Aged
;
Animals
4.Jiawei Xiaoyao Pills improves depression-like behavior in rats by regulating neurotransmitters, inhibiting inflammation and oxidation and modulating intestinal flora.
Ying LIU ; Borui LI ; Yongcai LI ; Lubo CHANG ; Jiao WANG ; Lin YANG ; Yonggang YAN ; Kai QV ; Jiping LIU ; Gang ZHANG ; Xia SHEN
Journal of Southern Medical University 2025;45(2):347-358
OBJECTIVES:
To explore the bioactive components in Jiawei Xiaoyao Pills (JWXYP) and their mechanisms for alleviating depression-like behaviors.
METHODS:
The active compounds, key targets, and pathways of JWXYP were identified using TCMSP and TCMIP databases. Thirty-six SD rats were randomized equally into 6 groups including a control group and 5 chronic unpredictable mild stress (CUMS)-induced depression groups. After modeling, the 5 model groups were treated with daily gavage of normal saline, 1.8 mg/kg fluoxetine hydrochloride (positive control drug), or JWXYP at 1.44, 2.88, and 4.32 g/kg. The depression-like behaviors of the rats were evaluated using behavioral tests, and pathological changes in the liver and hippocampus were examined with HE staining. The biochemical indicators in the serum and brain tissues were detected using ELISA. Serum metabolomics analysis was performed to identify the differential metabolites using OPLS-DA, and gut microbiota changes were analyzed using 16S rDNA sequencing.
RESULTS:
Network pharmacology revealed that menthone and paeonol in JWXYP were capable of penetrating the blood-brain barrier to regulate inflammatory pathways and protect the nervous system. In the rat models subjected to CUMS, treatment with JWXYP significantly improved body weight loss, sucrose preference and open field activities, reduced liver inflammation, alleviated structural changes in the hippocampal neurons, decreased serum levels of TNF‑α, IL-1β, IL-6 and LBP, and increased 5-HT and VIP concentrations in the serum and brain tissue, and these effects were the most pronounced in the high-dose group. Metabolomics analysis showed changes in such metabolites as indole-3-acetamide and acetyl-L-carnitine in JWXYP-treated rats, involving the pathways for bile acid biosynthesis and amino acid metabolism. 16S rDNA analysis demonstrated increased gut microbiota diversity and increased abundance of Lactobacillus species in JWXYP-treated rats.
CONCLUSIONS
JWXYP alleviates depression-like symptoms in rats by regulating the neurotransmitters, inhibiting inflammation and oxidation, and modulating gut microbiota.
Animals
;
Drugs, Chinese Herbal/therapeutic use*
;
Gastrointestinal Microbiome/drug effects*
;
Rats, Sprague-Dawley
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Depression/drug therapy*
;
Neurotransmitter Agents/metabolism*
;
Rats
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Inflammation
;
Male
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Hippocampus
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Behavior, Animal/drug effects*
5.A survey of clinical application of stereotactic radiotherapy technology in China in 2024
Xiaoxue KOU ; Jiayi YU ; Jingwei ZHANG ; Nan BI ; Xuwei CAI ; Guanghui CHENG ; Yufei LU ; Yanyang WANG ; Ligang XING ; Yonggang XU ; Jianxin XUE ; Li ZHANG ; Hongqing ZHUANG ; Anhui SHI
Chinese Journal of Radiation Oncology 2025;34(9):897-904
Objective:To investigate the current status of application of stereotactic body radiation therapy (SBRT) in China, aiming to provide reference for promoting the development of this technology.Methods:From January to March 2024, a questionnaire was designed and distributed online, targeting member units of the Professional Committee of Stereotactic Radiosurgery Treatment, which covers 175 radiotherapy units in 30 provinces and regions nationwide. The survey focused on the current application of SBRT technology and its utilization in the treatment of early-stage non-small cell lung cancer (NSCLC). A statistical description of the survey results was presented.Results:Of 175 questionnaires distributed, a total of 130 valid responses were collected, with an effective response rate of 74.3%. A total of 81.5% (106/130) of the units had implemented SBRT technology, and 99.1% of the respondents believed it was necessary to further promote SBRT technology, yet the actual training rate was only 67.0%. SBRT equipment configuration: there were a total of 267 SBRT equipment, featuring a diverse range of types, with traditional linear accelerators as the mainstays, accounting for 76.0% ( n=203), followed by 12.0% ( n=32) for TOMO, 6.4% ( n=17) for Cyber knife, 3.7% ( n=10) for Gamma knife, and proton/heavy ion equipment at 1.5% ( n=4), respectively. The percentage of units with multi-leaf collimator leaf widths ≤0.5 cm was 93.4% (99/106). The application of SBRT: the first radiotherapy unit commenced SBRT in 2000, and this technology entered a period of rapid growth after 2015, sustaining a steady increase over the past decade; SBRT technology was mainly applied in the brain, lung, liver, bone, adrenal gland, and kidney, with application rates of 97.2%, 94.3%, 86.8%, 71.7%, 56.6%, and 27.4%, respectively, while the application rates for the pancreas, metastatic lymph nodes, and other parts were less than 5%. Current status of SBRT technology application in early-stage NSCLC: 90.6% (96/106) of units had implemented SBRT; pre-treatment multi-disciplinary diagnosis and treatment accounted for 77% (74/96); the proportion of application units for peripheral and central type lung cancer lesions both exceeded 57.3%, whereas the application rate for ultra-central type and lesions > 5 cm lung cancer was less than 30%; there was significant variability in the selection of reference guidelines, dose fractionation patterns, and the concept of central type among units. Conclusions:The development of SBRT technology in China is in a period of steady growth, but several issues such as low training rate and lack of standardization still exist. The survey results provide important reference for clinical training and promotion of SBRT technology in China.
6.Gray Matter Volume Changes in Migraine Patients Using 7T Magnetic Resonance Imaging and Voxel-Based Morphometry
Xun PEI ; Yanliang MEI ; Xue ZHANG ; Yu'an LI ; Tong CHEN ; Yuanbin ZHAO ; Yonggang WANG ; Binbin SUI
Chinese Journal of Medical Imaging 2025;33(5):461-466
Purpose To explore the characteristics of gray matter(GM)volume changes in migraine patients using 7T MRI and voxel-based morphometry(VBM).Materials and Methods This prospective study enrolled 30 migraine patients and 41 age-and gender-matched healthy controls from Beijing Tiantan Hospital,Capital Medical University between November 2023 and November 2024.All participants underwent 7T MRI with 3D T1-weighted magnetization-prepared two rapid gradient-echo(MP2RAGE)sequences for structural brain imaging.VBM analysis was performed to quantify GM,white matter,cerebrospinal fluid and total brain volumes,followed by calculations of their relative percentages.The difference in GM volume between the two groups was compared to identify brain regions with characteristic GM volume changes in migraine patients.And the correlation between these characteristic GM volume alterations and clinical scales was analyzed.Results Migraine patients exhibited significantly lower total GM volume compared to healthy controls(t=2.096,P=0.040),while no group differences were observed in white matter or cerebrospinal fluid volumes(t=0.980,0.151;P=0.330,0.880).VBM analysis revealed reduced GM volume in the left orbitofrontal cortex(t=4.301,P=0.022),left hippocampus(t=5.226,P=0.006)and left parahippocampal gyrus(t=3.960,P=0.040)in the migraine group.Negative correlations were identified between:left orbitofrontal cortex GM volume and headache duration(r=-0.506,P=0.008),left hippocampal GM volume and patient health questionnaire-9 scores(r=-0.620,P=0.003),and left parahippocampal GM volume and visual analogue scale scores(r=-0.449,P=0.019).Conclusion VBM analysis based on 7T MP2RAGE data demonstrates characteristic GM volume reductions in the left orbitofrontal cortex,left hippocampus and left parahippocampal gyrus in migraine patients,with these structural alterations significantly correlate with depressive symptoms and headache burden.The observed microstructural abnormalities may reflect underlying pathophysiological mechanisms related to pain processing,emotional regulation and long-term disease burden in migraine.
7.Research Progress of Bioelectrical Signals in the Mechanism of Acupuncture Analgesia
Yonggang CAI ; Huamei REN ; Weiqi LI
Acta Medicinae Universitatis Scientiae et Technologiae Huazhong 2025;54(3):441-446
Pain is a distressing experience in sensory,emotional,cognitive,and social dimensions associated with existed or potential tissue damage.Studies have demonstrated the efficacy of acupuncture analgesia,but the underlying mechanisms are not fully understood.Bioelectrical signals,as one of the basic characteristics of life activities,play a key role in the process of acu-puncture analgesia.Through advanced neurophysiological techniques and multimodal imaging,it has been found that acupuncture can trigger specific changes in bioelectric signals,thus producing analgesic effects.With the rapid development of modern medi-cal technology,the study of bioelectrical signals has gradually delved into the cellular and molecular levels,providing more possi-bilities to reveal the analgesic mechanism of acupuncture.This review focuses on the close connection between bioelectrical sig-naling phenomena and acupuncture analgesia mechanism,summarizes the current research status of bioelectrical signaling phe-nomena in acupuncture analgesia mechanism by collating related literature.The future research directions were prospected,ai-ming to provide theoretical basis and new ideas for further understanding and applying acupuncture analgesia.
8.Application of DNA methylation risk scoring model for ferroptosis related genes in the prognosis and immune feature assess-ment of colon cancer
Dongsheng LI ; Zehao LI ; Yonggang CHEN
Practical Oncology Journal 2025;(3):224-234
Objective This study aimed to construct a risk scoring model based on DNA methylation featuresof ferroptosis-related gene,and systematically evaluate its predictive value for the prognosis and immunotherapy response of patients with colon canc-er.Methods Transcriptomic,DNA methylation,and clinical data of colon cancer patients were obtained from the Cancer Genome At-las(TCGA)and Gene Expression Omnibus(GEO)databases.Ferroptosis-related genes were identified from the FerrDb database.Fer-roptosis scores(FS)for each patient were calculated using the single-sample gene set enrichment analysis(ssGSEA)method,and con-struct a risk scoring model by combining differential methylation CpG sites with Cox regression analysis.The prognostic performance of the model was evaluated using receiver operating characteristic(ROC)curves,a nomogram,and decision curve analysis.The multiple algorithms were used to analyze the relationship between colon cancer models and immune cell infiltration,immunotherapy response,and chemotherapy sensitivity.Results A total of 49 ferroptosis-related genes significantly associated with overall survival(OS)were identified for calculating FS.The OS of colon cancer patients in the high-FS group was significantly shorter than that in the low-FS group(P=0.0075).The constructed DNA methylation risk score models included key CpG sites,and the ROC curves and multivariate Cox regression analysis at 1-,3-,and 5-years overall survival rate in the TCGA cohort and the GSE17536 validation cohort showed that the model was an independent prognostic factor for colon cancer patients.The low-risk group had higher immune scores and infil-tration levels of B cells and dendritic cells,while the high-risk group had a higher abundance of fibroblasts.Patients in the high-risk group showed upregulation of PD-L1 expression and higher immune phenotype scores.In addition,the model could also predict the sensitivity differences of commonly used chemotherapeutic drugs such as doxorubicin,gemcitabine,and paclitaxel.Conclusion The risk scoring model established using DNA methylation features of ferroptosis-related gene can be used to predict the prognosis of colon cancer patients and provide a new biomarker for achieving precision treatment.
9.Comparative efficacy of robot-assisted percutaneous reduction and screw fixation versus open reduction plate internal fixation via the sinus tarsi approach in the treatment of Sanders types II and III calcaneal fractures
Bin ZHAO ; Cunxiang MA ; Anjie SHEN ; Qi LIU ; Jinqi LI ; Fan YANG ; Yonggang SU ; Wei HAN ; Junqiang WANG
Chinese Journal of Trauma 2025;41(7):653-662
Objective:To compare the efficacy of robot-assisted percutaneous reduction and screw fixation versus open reduction and plate fixation via the sinus tarsi approach in the treatment of Sanders types II and III calcaneal fractures.Methods:A retrospective cohort study was conducted to analyze the clinical data of 82 patients (90 feet) with calcaneal fractures admitted to the Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Capital Medical University from January 2020 to April 2024, including 74 males and 8 females, aged 24-87 years [(46.4±12.1)years]. According to Essex-Lopresti classification, the fractures were classified as tongue-type in 43 patients and joint-collapse-type in 47. According to Sanders classification, 69 feet were classified as type II and 21 as type III. Forty-seven patients (52 feet) were treated with robot-assisted percutaneous reduction and screw fixation (screw fixation group) and 35 (38 feet) with open reduction and plate fixation via the sinus tarsi approach (plate fixation group). The two groups were compared in terms of the operation duration, intraoperative blood loss, length of hospital stay and time to weight-bearing. The width, height, length, B?hler angle and Gissane angle of the calcaneus before surgery and at 1 day after surgery were compared. The Maryland foot and ankle function score, American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot function score, and visual analogue scale (VAS) score at 1, 3 months postoperatively, and at the last follow-up were compared. The incidence of postoperative complications and removal rate of internal fixation were also detected in the two groups.Results:All the patients were followed up for 9-60 months [(30.0±14.5)months]. There was no significant difference in the operation duration between the two groups ( P>0.05). The intraoperative blood loss, length of hospital stay and time to weight-bearing in the screw fixation group were 10.0(10.0, 20.0)ml, 7.0(5.0, 8.0)days and (5.0±0.8)weeks, which were significantly less or shorter than 30.0(20.0, 50.0)ml, 8.0(6.0, 11.0)days and (6.9±0.7)weeks in the plate fixation group ( P<0.05). The width, height, length, B?hler angle and Gissane angle of the calcaneus at 1 day after surgery were (43.4±4.2)mm, (46.2±4.0)mm, (81.6±5.1)mm, 27.1(20.4, 30.4)° and (113.4±10.1)° in the screw fixation group, which were all improved compared with those before surgery [(47.8±4.6)mm, (39.3±4.8)mm, (79.2±5.9)mm, 9.5(0.0,16.5)° and (119.3±13.4)°] ( P<0.01). The width, height, length and B?hler angle of the calcaneus at 1 day after surgery were (41.6±5.7)mm, (48.4±4.8)mm, (83.1±5.7)mm and 27.3(21.3, 31.6)° in the plate fixation group, which were all improved compared with those before surgery [(47.8±5.0)mm, (41.7±5.1)mm, (80.1±5.9)mm and 12.9(7.2,19.8)°] ( P<0.01), with no significant difference in the Gissane angle ( P>0.05). Before surgery and at 1 day postoperatively, no significant differences were found in the width, length, B?hler angle or Gissane angle of the calcaneus between the two groups ( P>0.05), while the height of the calcaneus in the screw fixation group was lower than that in the plate fixation group ( P<0.05). At 1 month after surgery and at the last follow-up, there were no significant differences in the Maryland foot and ankle function score, AOFAS ankle and hindfoot function score, and VAS score between the two groups ( P>0.05). At 3 months after surgery in the screw fixation group, the Maryland foot and ankle function score was (79.7±3.8)points, significantly higher than (74.7±2.8)points in the plate fixation group ( P<0.01); the AOFAS ankle and hindfoot function score was (77.1±5.0)points, significantly higher than (70.1±3.6)points in the plate fixation group ( P<0.01); the VAS score was 1.0(1.0, 2.0)points, significantly lower than 2.5(2.0, 3.0)points in the plate fixation group ( P<0.01). No significant difference was detected in the incidence of postoperative complications between the two groups ( P>0.05). The removal rate of internal fixation was 10% (5/52) in the screw fixation group, significantly lower than 29% (11/38) in the plate fixation group ( P<0.05). Conclusion:Compared with open reduction and plate fixation via the sinus tarsi approach, robot-assisted percutaneous reduction and screw fixation has the advantages of less intraoperative blood loss, shorter hospital stay, earlier weight-bearing exercises, better early functional recovery and pain relief, and lower internal fixation removal rate in the treatment of Sanders types II and III calcaneal fractures.
10.Clinical features and prognosis of different primary sites in early-stage follicular lymphoma: an analysis of the SEER database
Qiuzi ZHONG ; Yunpeng WU ; Mingyuan ZHU ; Wenhui CAI ; Cui GAO ; Ting ZHAO ; Dazhi CHEN ; Gaofeng LI ; Yonggang XU ; Lipin LIU ; Xin LIU ; Siye CHEN ; Shunan QI ; Ye-Xiong LI ; Ye LIU
Chinese Journal of Radiation Oncology 2025;34(6):560-568
Objective:To investigate the clinical characteristics and prognosis of follicular lymphoma (FL) patients with different primary sites using the Surveillance, Epidemiology, and End Results (SEER) database.Methods:Clinical data of 7167 patients with early-stage FL (stage I-II) from the SEER database between 2000 and 2015 were respectively analyzed. Primary sites were divided into intranodal and extranodal types. Intranodal primary sites included supradiaphragmatic lymph nodes (LN), subphrenic lymph nodes and Waldeyer's ring. Extranodal primary sites consisted of skin, gastrointestinal tract, duodenum, head and neck, other sites. Prognostic factors and overall survival (OS) in patients with different primary sites were analyzed. OS rate was evaluated using Kaplan-Meier method and survival difference between primary sites was compared with log-rank test. Inverse probability treatment weighting (IPTW) and multi-variable analysis were applied to adjust for confounding factors. Multivariate Cox regression analysis of influencing factors of OS was performed.Results:The median age was 63 years old, with the median follow-up time of 63 months. There was no difference in prognosis among the intranodal groups or between the intranodal and extranodal groups. The 10-year OS rates of the supradiaphragmatic lymph LN ( n=2146), subdiaphragmatic LN ( n=2811), and the Waldeyer's ring ( n=151) groups were 70.7%, 69.9% and 73.4%, respectively ( P=0.422 for infradiaphragmatic LN vs. supradiaphragmatic LN, P=1.000 for Waldeyer's ring vs. supradiaphragmatic LN), and 70.3% and 68.9% for intranodal ( n=5108) and extranodal ( n=2059), respectively. There was no significant difference in OS between the groups ( P=0.581) after IPTW adjustment. The most common primary sites in extranodal disease were skin, gastrointestinal tract, head and neck, and duodenum. The 10-year OS for skin, gastrointestinal tract, and cutaneous was 74.2%, 74.7%, and 87.3%, respectively, significantly higher than 55.6% for other sites (duodenum vs. others sites, gastrointestinal vs. others sites, skin vs. others sites: all P<0.001). Multivariate Cox regression analysis revealed that difference in OS was not significant among the intranodal groups or between the intranodal and extranodal groups. However, different extranodal primary site was an independent prognostic factor for OS. Conclusions:Early FL patients with supradiaphragmatic LN, subdiaphragmatic LN and Waldeyer's ring, and between the intranodal and extranodal primary sites obtain similar prognosis. However, early-stage FL patients with different extranodal primary sites have prognostic differences. The prognosis of primary skin, gastrointestinal tract and duodenum is significantly better than that of other extranodal primary sites.

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