Objective:To evaluate the effect of the radiation dose of thoracic cage bone structure on clinical prognosis in patients with locally advanced non‐small cell lung cancer (LA‐NSCLC) receiving chemoradiotherapy, and to develop and verify a combined model combining the radiation dose of bone structure, the estimated radiation dose of immune cells (EDRIC) and other related factors to predict the prognosis of LA‐NSCLC.Methods:Clinical data of 197 patients with LA‐NSCLC who underwent chemoradiotherapy were retrospectively analyzed. All patients were randomly divided into the training set and testing set at a ratio of 7:3 using computer random partitioning. The EDRIC value was calculated using the model developed by Jin et al. and modified by Ladbury et al. The scope of the thoracic cage structure includes the ribs, sternal manubrium, sternal body, thoracic vertebral body, thoracic vertebral appendages, and thoracic vertebrae. The tumor volume, ERDIC, and average bone structure dose (D mean) were categorized into two groups using the P25, P50, P75 value from the quartile method. Univariate and multivariate Cox proportional hazards regression were used to analyze the influencing factors of overall survival (OS), local progression‐free survival (LPFS), and distant metastasis‐free survival (DMFS) for predicting the outcome, and significant correlated variables were retained to construct a combined prediction model with EDRIC. The receiver operating characteristic (ROC) curve, decision curve analysis (DCA), and calibration curves were plotted for subjects at the 2‐year time point of the combined model to evaluate the predictive performance. The model was visualized through a nomograph. Results:In the thoracic cage bone structure, D mean > 47.3 Gy of the sternal manubrium was an independent risk factor of OS, LPFS, and DMFS of LA-NSCLC patients. D mean > 23.1 Gy of thoracic vertebral body was an independent risk factor of OS, and D mean > 14.4 Gy of thoracic vertebral body was an independent risk factor of DMFS. Among other variables, gross tumor volume (GTV) >50.2 cm 3 was a risk factor for OS, and GTV >87.0 cm 3 was a risk factor for LPFS. Planning target volume >571.9 cm 3 was a risk factor for DMFS. A combined prediction model for OS, LPFS, and DMFS was established with EDRIC using features significantly associated with these three predicted outcomes. The area under the ROC curve (AUC) of OS combined model in the training set and test set were 0.708 and 0.696, respectively, and the AUC of DMFS combined model were 0.675 and 0.639, respectively. The calibration curve and DCA curve of the two prediction endpoints showed that the combined model had good prediction accuracy and clinical benefit. However, the LPFS model was not good in accuracy and clinical applicability. Conclusions:The radiation dose of sternal manubrium and thoracic vertebral body in the thoracic cage bone structure is an independent influencing factor for the prognosis of LA‐NSCLC patients after chemoradiotherapy. The combined model has good predictive performance for OS and DMFS.

Objective:To evaluate the effect of the radiation dose of thoracic cage bone structure on clinical prognosis in patients with locally advanced non‐small cell lung cancer (LA‐NSCLC) receiving chemoradiotherapy, and to develop and verify a combined model combining the radiation dose of bone structure, the estimated radiation dose of immune cells (EDRIC) and other related factors to predict the prognosis of LA‐NSCLC.Methods:Clinical data of 197 patients with LA‐NSCLC who underwent chemoradiotherapy were retrospectively analyzed. All patients were randomly divided into the training set and testing set at a ratio of 7:3 using computer random partitioning. The EDRIC value was calculated using the model developed by Jin et al. and modified by Ladbury et al. The scope of the thoracic cage structure includes the ribs, sternal manubrium, sternal body, thoracic vertebral body, thoracic vertebral appendages, and thoracic vertebrae. The tumor volume, ERDIC, and average bone structure dose (D mean) were categorized into two groups using the P25, P50, P75 value from the quartile method. Univariate and multivariate Cox proportional hazards regression were used to analyze the influencing factors of overall survival (OS), local progression‐free survival (LPFS), and distant metastasis‐free survival (DMFS) for predicting the outcome, and significant correlated variables were retained to construct a combined prediction model with EDRIC. The receiver operating characteristic (ROC) curve, decision curve analysis (DCA), and calibration curves were plotted for subjects at the 2‐year time point of the combined model to evaluate the predictive performance. The model was visualized through a nomograph. Results:In the thoracic cage bone structure, D mean > 47.3 Gy of the sternal manubrium was an independent risk factor of OS, LPFS, and DMFS of LA-NSCLC patients. D mean > 23.1 Gy of thoracic vertebral body was an independent risk factor of OS, and D mean > 14.4 Gy of thoracic vertebral body was an independent risk factor of DMFS. Among other variables, gross tumor volume (GTV) >50.2 cm 3 was a risk factor for OS, and GTV >87.0 cm 3 was a risk factor for LPFS. Planning target volume >571.9 cm 3 was a risk factor for DMFS. A combined prediction model for OS, LPFS, and DMFS was established with EDRIC using features significantly associated with these three predicted outcomes. The area under the ROC curve (AUC) of OS combined model in the training set and test set were 0.708 and 0.696, respectively, and the AUC of DMFS combined model were 0.675 and 0.639, respectively. The calibration curve and DCA curve of the two prediction endpoints showed that the combined model had good prediction accuracy and clinical benefit. However, the LPFS model was not good in accuracy and clinical applicability. Conclusions:The radiation dose of sternal manubrium and thoracic vertebral body in the thoracic cage bone structure is an independent influencing factor for the prognosis of LA‐NSCLC patients after chemoradiotherapy. The combined model has good predictive performance for OS and DMFS.

Objective Comparing the difference in postoperative recurrence,complications,quality of life and cosmetic results between patients receiving radical mnastectomy and breast conserving surgery,provides an evidence of breast conserving surgery superior to radical mastectomy.Methods A retrospective analysis of 477 breast cancer patients cases in Department of General Surgery,Third People's Hospital of Baoji City from January 2009 to January 2012.These patients were divided into two groups:the control group 229 cases (48％) underwent conservative surgery treatment and the observation group 248 patients (52％) underwent radical surgery.Using SPSS15.0 statistical software analysis and compare with recurrence,postoperative complications,breast cosmetic effect and quality of life for these two groups of patients.Results In breast-conserving group compared with radical mastectomy group,the one and two year recurrence or metastasis rate were not statistically different between the two groups (P ＞ 0.05),the incidence of postoperative complications was significantly decreased (P ＜ 0.05).The scores for quality of life between the breast-conserving group and radical mastectomy group were all significantly different (P ＜ 0.05).Excellent cosmetic results in breast-conserving group was 78.52％,which was significantly higher than that in the radical mastectomy group (61.34％),the difference was statistically significant (x2 =5.86,P ＜ 0.05),The two groups are not significant in overall survival time (x2 =3.154,P ＞ 0.05) and progression free survival (x2 =4.243,P ＞ 0.05) as two indicator of long-term efficacy.Conclusions Conservative surgery compared with radical mastectomyhave less clinical complications,more breast cosmetic effect,better survival quality,and both of them share the same recurrence or metastasis and survival rate,so conservative surgery should be preferable in the clinical application.

Objective To investigate the ability of osteogenesis, repaired effects and possible mechanism of tissue engineered bone made in an approach of bionics as a transplantation biomaterial to repair a segmental defect of long bone. Methods HA/?-TCP was composed with PDLLA and then composed with rhBMP-2 and collagen of typeⅠ. The combined biomaterial was put in common culture with osteoblasts harvested from periosteum of rabbit and vascular endothelial cells from kidney of rabbit then transplanted this tissue engineered bone to total segmental periosteum-bone defect of 1.5 cm in the rabbits radius which were investigated 4, 8 and 12 weeks after operation respectively. Investigation of the bone defect was made by means of gross observation, X-ray examination, histology of HE and Masson staining, image pattern analysis, scanning electron microscopy, EDAX. Results In gross observation, the implantations were adhered to the host bone well in four weeks, the implantations was bony healed with host bone in eight weeks, and some of the implantations were replaced by new formation bone in 12 weeks. In histological examination of four weeks after operation, lamellar bone was found, and eight weeks after operation, implant was incorporated to host bone end by end through cortical bone, and new bone marrow was found to invade into the implant. Furthermore, the outer part of implant was completely substituted by new cortical bone 12 weeks after operation. In addition, the histological study pointed out that the new bone arranged in type of various bands which were in subsequent transition. There is significant difference between 4 weeks and 8 weeks, and 4 weeks and 12 weeks, but no significant difference between 8 weeks and 12 weeks of the quantity of new bone. The ratio of calcium to phosphorus in the transplants tended to approach that in the host cortical bone along with the period of time after operation. Conclusion Satisfied effects of remodeling appeared after this tissue engineered bone composed by bionics was transplanted to the segmental defect of long bone. The mechanism of bone regeneration was endochondral ossification.