Cancer recurrence and chemoresistance are the leading causes of death in high-grade serous ovarian cancer (HGSOC) patients. However, the unique role of the immune environment in tumor progression for relapsed chemo-resistant patients remains elusive. In single-cell resolution, we characterized a comprehensive multi-dimensional cellular and immunological atlas from tumor, ascites, and peripheral blood of a chemo-resistant patient at different stages of treatment. Our results highlight a role in recurrence and chemoresistance of the immunosuppressive microenvironment in ascites, including MDSC-like myeloid and hypo-metabolic γδT cells, and of peripheral CD8+ effector T cells with chemotherapy-induced senescent/exhaustive. Importantly, paired TCR/BCR sequencing demonstrated relative conservation of TCR clonal expansion in hyper-expanded CD8+ T cells and extensive BCR clonal expansion without usage bias of V(D)J genes after chemotherapy. Thus, our study suggests strategies for ameliorating chemotherapy-induced immune impairment to improve the clinical outcome of HGSOC.
ObjectiveTo explore the consistency of the Patient-generated Subjective Global Assessment (PG-SGA) and Nutritional Risk Screening-2002 (NRS-2002) for nutritional evaluation of patients with gynecologic malignancy and their predictive effect on the length of hospital stay (LOS).MethodsWe recruited 147 hospitalized patients with gynecologic malignancy from Nanfang Hospital in 2017. Their nutritional status was assessed using the PG-SGA and NRS-2002. The consistency between the two assessments was compared via the Kappa test. The relationship between malnutrition and LOS was analyzed using crosstabs and Spearman's correlation.ResultsThe PG-SGA demonstrated that 66.7% and 54.4% of patients scoring ≥ 2 and ≥ 4 were malnourished, respectively. Furthermore, the NRS-2002 indicated that 55.8% of patients were at nutritional risk. Patients with ovarian cancer had a relatively high incidence of malnutrition. However, this was only significant for patients who scored ≥ 4 in the PG-SGA (P = 0.001 and P = 0.019 for endometrial carcinoma and cervical cancer, respectively). The PG-SGA and NRS-2002 showed good consistency in evaluating the nutritional status of patients with gynecologic malignancy (0.689, 0.643 for PG-SGA score ≥ 2, score ≥ 4 and NRS-2002, respectively). Both the scores of PG-SGA and NRS-2002 were positively correlated with LOS. Furthermore, prolonged LOS was higher in patients with malnutrition than in those with adequate nutrition.ConclusionThe PG-SGA and NRS-2002 shared a good consistency in evaluating the nutritional status of patients with gynecologic malignancy. Both assessments could be used as predictors of LOS.
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