Percutaneous Endoscopic Intercostal Neurectomy regarding Refractory Intercostal Neuralgia

Background Lymph node metastasis (LNM) status is of key importance for the decision-making on treatment and survival prediction. There is no reliable method to precisely evaluate the risk of LNM in NSCLC patients. This study aims to develop and validate a dynamic nomogram to evaluate the risk of LNM in small-size NSCLC. Methods The NSCLC ≤ 2 cm patients who underwent initial pulmonary surgery were retrospectively reviewed and randomly divided into a training cohort and a validation cohort as a ratio of 73. The training cohort was used for the least absolute shrinkage and selection operator (LASSO) regression to select optimal variables. Based on variables selected, the logistic regression models were developed, and were compared by areas under the receiver operating characteristic curve (AUCs) and decision curve analysis (DCA). The optimal model was used to plot a dynamic nomogram for calculating the risk of LNM and was internally and externally well-validated by calibration curves. Results LNM was observed in 12.0% (83/774) of the training cohort and 10.1% (33/328) of the validation cohort (P = 0.743). The optimal model was used to plot a nomogram with six variables incorporated, including tumor size, carcinoembryonic antigen, imaging density, pathological type (adenocarcinoma or non-adenocarcinoma), lymphovascular invasion, and pleural invasion. #link# The nomogram model showed excellent discrimination (AUC = 0.895 vs. 0.931) and great calibration in both the training and validation cohorts. At the threshold probability of 0-0.8, our nomogram adds more net benefits than the treat-none and treat-all lines in the decision curve. Conclusions This study firstly developed a cost-efficient dynamic nomogram to precisely and expediently evaluate the risk of LNM in small-size NSCLC and would be helpful for clinicians in decision-making.The hallmarks of renal cell carcinoma (RCC) are angiogenesis and immunogenic tumor microenvironment. Over the past decades, treatment options for metastatic RCC (mRCC) have been expanding, from the inhibition of vessel formation via antiangiogenic agents (AAs) to the stimulation of immune system by immune checkpoint inhibitors (ICIs). Since 2005, the introduction of antiangiogenic agents targeting vascular endothelial growth factor (VEGF), its receptors (VEGFRs), and mammalian target of rapamycin (mTOR) pathway have experienced moderate success in the therapeutics of mRCC, but patient outcomes remain suboptimal. Recently, the development of ICIs targeting cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and the programmed death-1/programmed death ligand 1 (PD-1/PD-L1) pathways has dramatically changed the treatment landscape of mRCC. Expressly, the combination of ipilimumab and nivolumab has been confirmed to improve clinical outcomes and approved as a standard care for intermediate- or poor-risk mRCC patients. Nevertheless, innate or adaptive drug resistance is observed within both treatment approaches, limiting overall clinical benefit. This phenomenon will underscore the urgent need for new combinational therapy strategies with different mechanisms of action, which can improve efficacy in an extended patient population without severe toxic effects. In 2019, as the results of two critical phase III trials came to light, FDA approved axitinib plus avelumab, or pembrolizumab as first-line standard management for mRCC, which cements the combination of AAs plus ICIs and advances the mRCC treatment field. This review summarizes current evidence on the interplay and synergies between AAs and immunomodulating drugs in mRCC, focusing on the theoretical background and the status of current clinical development.Magnolia officinalis is widely used in Southeast Asian countries for the treatment of fever, headache, diarrhea, and stroke. Magnolol is a phenolic compound extracted from M. officinalis, with proven antibacterial, antioxidant, anti-inflammatory, and anticancer activities. In this study, we modified magnolol to synthesize a methoxylated derivative, 2-O-methylmagnolol (MM1), and investigated the use of MM1, and magnolol in the treatment of liver cancer. We found that both magnolol and MM1 exhibited inhibitory effects on the growth, migration, and invasion of hepatocellular carcinoma (HCC) cell lines and halted the cell cycle at the G1 phase. MM1 also demonstrated a substantially better tumor-suppressive effect than magnolol. Further analysis suggested that by inhibiting class I histone deacetylase expression in HCC cell lines, magnolol and MM1 induced p21 expression and p53 activation, thereby causing cell cycle arrest and inhibiting HCC cell growth, migration, and invasion. Subsequently, we verified the significant tumor-suppressive effects of magnolol and MM1 in an animal model. Collectively, these findings demonstrate the anti-HCC activities of magnolol and MM1 and their potential for clinical use.Deleterious variants in the BRCA1/BRCA2 genes and homologous recombination deficiency (HRD) status are considered strong predictors of response to poly (ADP-ribose) polymerase (PARP) inhibitors (PARPi). The introduction of PARPi in clinical practice for the treatment of patients with advanced ovarian cancer imposed changes in the molecular diagnosis of BRCA1/BRCA2 variants. link2 BRCA1/BRCA2 tumor testing by next-generation sequencing (NGS) can detect simultaneously both somatic and germline variants, allowing the identification of more patients with higher likelihood of benefiting from PARPi. Our main goal was to determine the frequency of somatic and germline BRCA1/BRCA2 variants in a series of non-mucinous OC, and to define the best strategy to be implemented in a routine diagnostic setting for the screening of germline/somatic variants in these genes, including the BRCA2 c.156_157insAlu Portuguese founder variant. link3 We observed a frequency of 19.3% of deleterious variants, 13.3% germline, and 5.9% somatic. A higher prevalence of pathogenic variants was observed in patients diagnosed with high-grade serous ovarian cancer (23.2%). Considering the frequencies of the c.3331_3334del and the c.2037delinsCC BRCA1 variants observed in this study (73% of all BRCA1 pathogenic germline variants identified) and the limitations of NGS to detect the BRCA2 c.156_157insAlu variant, it might be cost-effective to test for these founder variants with a specific test prior to tumor screening of the entire coding regions of BRCA1 and BRCA2 by NGS in patients of Portuguese ancestry.Low response rates to immunotherapy have been reported in soft tissue sarcoma (STS). There are few predictive biomarkers of response, and the tumor immune microenvironment associated with progression and prognosis remains unclear in STS. Gene expression data from the Cancer Genome Atlas were used to identify the immune-related prognostic genes (IRPGs) and construct the immune gene-related prognostic model (IGRPM). The tumor immune microenvironment was characterized to reveal differences between patients with different prognoses. Furthermore, selleck kinase inhibitor and DNA methylation data were analyzed to understand the underlying mechanism leading to different prognoses. The IGRPM was constructed using five IRPGs (IFIH1, CTSG, STC2, SECTM1, and BIRC5). Two groups (high- and low-risk patients) were identified based on the risk score. Low-risk patients with higher overall survival time had higher immune scores, more immune cell infiltration (e.g., CD8 T cell and activated natural killer cells), higher expressiot and progression of STS, and thereby improve treatment.Background The 21-gene recurrence score (RS) assay has been proven prognostic and predictive for hormone receptor-positive/HER2-negative, node-negative early breast cancer patients. However, whether primary 21-gene RS can predict prognosis in recurrent breast cancer patients remained unknown. Patients and Methods Consecutive breast cancer patients operated in Comprehensive Breast Health Center, Shanghai Ruijin Hospital between January 2009 and December 2018 were retrospectively analyzed. Patients with available 21-gene RS result for the primary tumor and reporting disease recurrence during follow-up were included. Association of 21-gene RS and overall survival (OS), post-recurrence overall survival (PR-OS), post-recurrence progression-free survival (PR-PFS), and first-line systemic treatment after recurrence were compared among different groups. Results A total of 74 recurrent patients were included, with 10, 27, 37 patients in the RS less then 18, 18-30, and ≥ 31 groups, respectively. Recurrent patients with RS ≥ 31 were more likely to receive chemotherapy as their first-line treatment compared to those with RS less then 31 (P = 0.025). Compared to those with RS less then 31, patients with RS ≥ 31 had significantly worse OS (P = 0.025), worse PR-OS (P = 0.026), and a trend of inferior PR-PFS (P = 0.106). Multivariate analysis demonstrated that primary ER expression level (OS P = 0.009; PR-OS P = 0.017) and histological grade (OS P = 0.003; PR-OS P = 0.009), but not primary 21-gene RS (OS P = 0.706; PR-OS P = 0.120), were independently associated with worse OS and PR-OS. Conclusions High primary 21-gene RS tended to be associated with worse disease outcome in loco-regional and distant recurrent breast cancer patients, which could influence the first-line systemic treatment after relapse, warranting further clinical evaluation.Purpose To explore the efficacy of concomitant chemotherapy in intensity-modulated radiotherapy (IMRT) to treat stage II nasopharyngeal carcinoma (NPC). Methods and Materials In this randomized phase 2 study [registered with ClinicalTrials.gov (NCT01187238)], eligible patients with stage II (2010 UICC/AJCC) NPC were randomly assigned to either IMRT alone (RT group) or IMRT combined with concurrent cisplatin (40 mg/m2, weekly) (CCRT group). The primary endpoint was overall survival (OS). The second endpoints included local failure-free survival (LFFS), regional failure-free survival (RFFS), disease-free survival (DFS), distant metastasis-free survival (DMFS), and acute toxicities. Results Between May 2010 to July 2012, 84 patients who met the criteria were randomized to the RT group (n = 43) or the CCRT group (n = 41). The median follow-up time was 75 months. The OS, LFFS, RFFS, DFS, and DMFS for the RT group and CCRT group were 100% vs. 94.0% (p = 0.25), 93.0% vs. 89.3% (p = 0.79), 97.7% vs. 95.1% (p = 0.54), 90.4% vs. 86.6% (p = 0.72), and 95.2% vs. 94.5% (p = 0.77), respectively. A total of 14 patients experienced disease failure, 7 patients in each group. The incidence of grade 2 to 4 leukopenia was higher in the CCRT group (p = 0.022). No significant differences in liver, renal, skin, or mucosal toxicity was observed between the two groups. Conclusion For patients with stage II NPC, concomitant chemotherapy with IMRT did not improve survival or disease control but had a detrimental effect on bone marrow function.Gastric cancer remains third leading cause of global cancer mortality and is the fifth most common type of cancer in the United States. A select number of gastric cancers harbor alterations in EGFR and/or have amplification/overexpression in the HER2; 2-35 and 9-38%, respectively. The advent of next-generation sequencing of tissue and circulating tumor DNA has allowed for the massive expansion of targeted therapeutics to be employed in many settings. There have been a handful of trials using EGFR inhibitors with modest outcomes. Using novel strategies to target multiple co-mutations as well as identifying immunoregulatory molecule expression patterns will potentially drive future trials and improve gastric cancer patient outcomes.