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Background Head and neck squamous cell carcinoma (HNSCC) is a type of invasive malignancy and the seventh most common cancer in the worldwide. Cancer stem cells (CSCs) are self‐renewal cells in tumors and can produce heterogeneous tumor cells, which play an important role in the development of HNSCC. In our research, we aimed to identify genes related to the CSCs characteristics in HNSCC. Methods Messenger RNA (mRNA) expression‐based stiffness index (mRNAsi) can be used as a quantitative characterization of CSCs. We used one‐class logistic regression machine learning algorithm (OCLR) to calculate the mRNAsi and investigate the relationship between mRNAsi and clinical characteristics of HNSCC. Then, a weighted gene co‐expression network analysis (WGCNA) and protein‐protein interaction (PPI) network was constructed to screen hub genes related to mRNAsi of HNSCC. Results The results indicated that the score of mRNAsi in HNSCC tissues is higher than in paracancer tissues, while the mRNAsi was not statistically correlated with the prognosis and clinical characteristics of HNSCC. Six positive and six negative hub genes related to mRNAsi of HNSCC were selected, which may act as therapeutic targets for inhibiting CSCs within HNSCC. Conclusions In conclusion, our research selected 12 hub genes related to mRNAsi of HNSCC through weighted gene co‐expression network analysis. These genes may become therapeutic targets to inhibit the CSCs of HNSCC in the future.

Objective To evaluate the efficacy and toxicity of intensity-modulated radiotherapy (IMRT) for the treatment of unresectable liver metastases. Methods Twenty-five patients with unresectable liver metastases treated with IMRT were enrolled from January 2003 to September 2016. The median longest diameter of the lesions was 3.3 cm (range, 1.6–16.7 cm). The fraction dose ranged from 2 to 5.2 Gy, with a median total dose of 50 Gy (range, 30–60 Gy). Results The median follow-up was 9.2 months (range, 2.1–48.8 months). The overall survival rates at 1 and 2 years were 46.4% and 27.4%, respectively. The 1-year local control rate was 69.8%. The 1-year progression-free survival rate was 26.3%. One patient had grade 4 liver dysfunction. One case of grade 4 leukopenia and one case of grade 3 leukopenia occurred, and one case of grade 3 leukopenia and thrombocytopenia was observed. Conclusion IMRT may be a promising and safe treatment for unresectable liver metastases and can be used as a treatment option.

PurposeTo investigate dosimetry of submandibular glands on xerostomia after intensity-modulated radiotherapy for nasopharyngeal carcinoma (NPC).MethodsFrom September 2015 to March 2016, 195 NPC patients were investigated. Xerostomia was evaluated at 12 months after treatment via the RTOG/EORTC system. The least absolute shrinkage and selection operator regression model was used to optimize feature selection for grades 2–3 xerostomia. Multivariable logistic regression analysis was applied to build a predicting model incorporating the feature selected in the least absolute shrinkage and selection operator regression model. Discrimination, calibration, and clinical usefulness of the predicting model were assessed using the C-index, calibration plot, and decision curve analysis.ResultsThe V30 of the parotid glands was selected based on the least absolute shrinkage and selection operator regression. The nomogram displayed good discrimination with a C-index of 0.698 (95% confidence interval [CI]: 0.626–0.771) and good calibration (model 1). Addition of the dosimetric parameters including the mean dose to the submandibular glands, V50 of the submandibular glands, and volume of the submandibular glands to the model 1 failed to show incremental prognostic value (model 2). The model 2 showed a C-index of 0.704 (95% CI: 0.632–0.776). Decision curve analysis demonstrated that the model 1 was clinically useful when intervention was decided at the possibility threshold of > 20%. Within this range, net benefit was comparable between the model 1 and model 2.ConclusionPGv30 was a major predictive factor of grades 2–3 xerostomia for NPC. In contrast, the mean dose to the submandibular glands, V50 of the submandibular glands, and volume of the submandibular glands were not independent predictive factors.

The available evidence suggests that TAE can be considered safe for elective managment of HCA as well as for management of bleeding HCA. Elective TAE can be regarded as a reasonable alternative to surgery. High-quality prospective studies with long-term follow-up are needed to corroborate and strengthen available evidence.

Objective: To compare the 7th edition of the International Union Against Cancer (UICC) and the Chinese 2008 staging systems for nasopharyngeal carcinoma (NPC), and to provide evidence for further updates to these NPC staging systems.Methods: A retrospective analysis was carried out on 767 patients with newly diagnosed, pathologically confirmed non-metastatic NPC who were treated with intensity-modulated radiotherapy between 2006 and 2012. The prognostic value of the T category, N category, and clinical stage for the main survival outcomes of overall survival (OS), local relapse-free survival and distant metastasis-free survival were compared between the two staging systems. The Kaplan-Meier method was used to calculate survival rates, the log-rank test was used to compare survival rates, and the Cox model was used for the multivariate prognostic analysis. Results:The T categories of the Chinese 2008 staging system had a significantly better prognostic value for OS and local relapse-free survival than those of the 7th edition of the UICC staging system. The N categories of both staging systems had a comparable prognostic value for OS and distant metastasis-free survival. The clinical stages of the 7th edition of the UICC staging system had a significantly better prognostic value for OS than those of the Chinese 2008 staging system. Based on these analyses, the T categories, N categories, and clinical stages of our proposed staging system had a significantly better prognostic value compared with the original staging system. Conclusions:The 7th edition of the UICC staging system and the Chinese 2008 staging system for NPC each has its own advantages with respect to prognostic prediction. The recommended staging system proposed in the present study could contribute to the next update of the current staging systems for NPC.

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