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BackgroundAddition of gemcitabine and cisplatin (GP) or docetaxel and cisplatin plus fluorouracil (TPF) to concurrent chemoradiotherapy (CCRT) significantly improved survival in locoregionally advanced nasopharyngeal carcinoma (NPC). However, an economic evaluation of these regimens remains unknown. The purpose of this study is to compare the cost-effectiveness of GP versus TPF regimen in the treatment of locoregionally advanced NPC in China.Materials and methodsA comprehensive Markov model was developed to evaluate the health and economic outcomes of GP versus TPF regimen for patients with locoregionally advanced NPC. Baseline and clinical outcome were derived from 158 patients with newly diagnosed stage III-IVA NPC between 2010 and 2015. We evaluated the quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs) from the perspective of the Chinese healthcare system. One-way sensitive analysis explored the impact of uncertainty in key model parameters on results, and probabilistic uncertainty was assessed through a Monte Carlo probabilistic sensitivity analysis.ResultsGP regimen provided an additional 0.42 QALYs with incremental cost of $3,821.99, resulting in an ICER of $9,099.98 per QALY versus TPF regimen at the real-world setting. One-way sensitivity analysis found that the results were most sensitive to the cost and proportion of receiving subsequent treatment in two groups. The probability that GP regimen being cost-effective compared with TPF regimen was 86.9% at a willingness-to-pay (WTP) of $31,008.16 per QALY.ConclusionUsing real-world data, GP regimen was demonstrated a cost-effective alternative to TFP regimen for patients with locoregionally advanced NPC in China. It provides valuable evidence for clinicians when making treatment decisions to improve the cost-effectiveness of treatment.

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Abstract.A meta-analysis was performed to evaluate the accuracy of optical coherence tomography (OCT) for diagnostic accuracy studies in bladder cancer patients. English language studies reporting the diagnostic accuracy of OCT for bladder cancer were retrieved from the PubMed, EMBASE and Cochrane Library databases in December 2014. Histopathology was a reference standard. Sensitivities, specificities, positive likelihood ratios and negative likelihood ratios were calculated, and summary receiver operating characteristic curves were drawn to determine the diagnostic accuracy of OCT. Finally, 9 eligible studies (468 patients) were included in our meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio and negative likelihood ratio of OCT were 0.96 [95% confidence interval (CI): 0.94-0.98], 0.82 (95% CI: 0.80-0.85), 6.83 (95% CI: 3.24-14.1) and 0.05 (95% CI: 0.02-0.16), respectively. The summary diagnostic odds ratio was 138.88 (95% CI: 29.63-650.89) and the overall area under the curve was 0.9735. These results suggest that OCT has excellent diagnostic performance in patients with bladder cancer and recurrent lesions.

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Background The definition of clinical target volume (CTV) in intensity modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC) has not been addressed. We performed this study to assess the feasibility and efficacy of using IMRT with reduced-volume CTV for the treatment of nasopharyngeal carcinoma. Methods We retrospectively reviewed 293 non-metastatic NPC patients treated with IMRT from 2002 to 2013. A total of 180 matched cases finally included with 90 received conventional-volume IMRT (CV-IMRT) and 90 received reduced-volume IMRT (RV-IMRT). Kaplan-Meier method and log-rank tests were used to compare NPC-specific survival. Multivariate analyses using the Cox proportional hazards model were conducted to detect independent predictors. Results With a median follow-up of 70 months, the 3-year overall survival, progression-free survival, distant metastasis-free survival, local recurrence-free survival, regional recurrence-free survival, locoregional recurrence-free survival rates were 88.9, 84.4, 92.2, 91.1, 98.9, 91.1% for the CV-IMRT arm and 92.2, 85.6, 90.0, 93.3, 98.9, 93.3% for the RV-IMRT arm, respectively. None significant survival difference was observed. Additionally, RV-IMRT was associated with reduced risk of late xerostomia ( P = 0.039) and hearing loss ( P = 0.008), compared versus CV-IMRT. Conclusions The use of RV-IMRT for the treatment of NPC led to comparable survival condition and truly reduced toxicity reactions compared versus CV-IMRT.

One of the goals of China’s supply-side structural reform is to improve total factor productivity (TFP). Considering the problems of environmental deterioration and income disparity faced by China, this paper first incorporates environmental pollution and income disparity as undesirable outputs into the TFP analysis framework, and extends the concept of inclusive green TFP (henceforth IGTFP).We measure and analyze the IGTFP in China’s provinces from 1995 to 2017 using the Malmquist–Luenberger index, and then examine, for the first time, the impacts of economic structural optimization in the supply-side structural reform on the IGTFP. The results are shown as follows. First, China’s national IGTFP index is significantly smaller than the traditional TFP index. That is, the traditional TFP without the constraints of environmental pollution and income disparity overestimates China’s real TFP. Second, there are significant regional differences in China’s IGTFP, the average annual growth rate of IGTFP shows a gradual downward trend from east to west. This would further exacerbate the regional imbalance in China’s economic development. Third, among the structural factors in economic structure optimization, industrial structure and energy structure are negatively correlated with the IGTFP, while factor structure, labor structure and urban–rural structure are all positively correlated with the IGTFP. These results imply that the economic structure optimization driven by supply-side structural reform will improve China’s IGTFP.

Tumor metastasis is the major cause of poor prognosis and mortality in colorectal cancer (CRC). However, early diagnosis of highly metastatic CRC is currently difficult. In the present study, we screened for a novel biomarker, GDNF family receptor alpha 1 (GFRA1) based on the expression and methylation data in CRC patients from The Cancer Genome Altlas (TCGA), followed by further analysis of the correlation between the GFRA1 expression, methylation, and prognosis of patients. Our results show DNA hypomethylation-mediated upregulation of GFRA1 in invasive CRC, and it was found to be correlated with poor prognosis of CRC patients. Furthermore, GFRA1 methylation-modified sequences were found to have potential as methylation diagnostic markers of highly metastatic CRC. The targeted demethylation of GFRA1 by dCas9-TET1CD and gRNA promoted CRC metastasis in vivo and in vitro. Mechanistically, demethylation of GFRA1 induces epithelial-mesenchymal transition (EMT) by promoting AKT phosphorylation and increasing c-Jun expression in CRC cells. Collectively, our findings indicate that GFRA1 hypomethylation can promote CRC invasion via inducing EMT, and thus, GFRA1 methylation can be used as a biomarker for the early diagnosis of highly metastasis CRC.