CD151在垂体腺瘤中的表达及意义

目的:探讨CD151在垂体腺瘤中的表达及意义。方法:收集36例垂体腺瘤标本,5例正常垂体组织,通过Real time-PCR、Western blot及免疫组化方法,从mRNA和蛋白水平检测CD151在36例垂体腺瘤、5例正常垂体组织的表达。结果:Real time-PCR及Western blot、免疫组化发现CD151在垂体肿瘤组织中表达显著高于正常垂体组织(P0.01),在非侵袭性腺瘤和侵袭性腺瘤中的蛋白及mRNA表达量两者之间有显著差异(P0.01)。结论:CD151的表达与肿瘤大小及侵袭程度相关,表明CD151的表达与肿瘤的发生、发展密切相关,检测CD151有可能预测垂体腺瘤预后的重要指标。     

垂体腺瘤分类的免疫组织化学研究

目的：研究我国垂体腺瘤的功能分类及其与临床病理的联系。方法：采用Dako-Envision法进行免疫组织化学染色,检测45例手术切除垂体腺瘤中6种激素（GH,PRL,ACTH,TSH,LH,FSH）的表达情况,据此进行垂体腺瘤的分类及临床病理研究。结果：在45例垂体腺瘤中,生长激素细胞腺瘤为15例（33.3％）,催乳素细胞腺瘤6例（13.3％）,促肾上腺皮质激素细胞腺瘤9例（20％）,促性腺激素细胞腺瘤3例（6.7％）,多种激素细胞腺瘤4例（8.9％）,无功能细胞腺瘤8例（17.8％）。结论：垂体腺瘤中不同类型腺瘤所占的比例存在差异,生长激素腺瘤在外科切除的腺瘤中最常见。     

miR-134在人垂体腺瘤组织中的表达及其意义(英文)

目的:探讨垂体腺瘤患者miR-134的表达及意义,分析其表达水平与无功能垂体腺瘤(non-functioningpituitaryadenomas,NFPA)增殖侵袭能力的相关性。方法:选择2010年6月至2013年7月本院收集垂体腺瘤标本104例以及8例尸检正常腺垂体的临床资料。采用实时荧光定量PCR、免疫组织化学技术检测Ki-67、MEG3、miR-134等在NFPA组织中的表达水平,并分析数据。结果:miR-134在NFPA组织中表达水平显著低于正常腺垂体和其他类型垂体腺瘤(P0.01);miR-134的表达水平与NFPA患者肿瘤侵袭性、肿瘤细胞Ki-67阳性率及发病年龄呈负相关(P0.01)。结论:miR-134表达下调可能是NFPA肿瘤发生及肿瘤呈侵袭样生长的重要因素,miR-134可作为诊断和评估NFPA预后的参考指标。     

垂体腺瘤的临床与病理观察(附22例报告)

目的探讨垂体腺瘤(pituitary adenoma)的临床与病理特点。方法回顾性分析22例垂体腺瘤患者的临床资料。结果内分泌检查结果:22例垂体腺瘤患者中,催乳激素(PRL)值升高者8例;促性腺激素(GnH)水平改变者8例;生长激素(GH)升高者1例;出现Cushing综合症者2例;激素水平正常者3例。免疫组化结果:22例垂体腺瘤患者中8例PRL阳性;7例卵泡刺激素(FSH)/黄体生成素(LH)阳性;1例GH阳性;1例GH/PRL阳性;1例FSH/PRL阳性;无功能者4例。结论应用病理和内分泌功能分类相结合的方法,对垂体腺瘤进行分类,具有十分重要的实际应用价值。     

GSTP1、E-cadherin 在垂体腺瘤中的表达及临床意义

目的:研究谷胱甘肽S-转移酶P1(GSTP1)、上皮钙粘蛋白(E-cadherin)在垂体腺瘤中的表达及临床意义。方法:应用免疫组化SP染色法检测30例侵袭性垂体腺瘤与30例非侵袭性垂体腺瘤中GSTP1、E-cadherin的表达。结果:GSTP1在侵袭性垂体腺瘤中的表达较非侵袭性垂体腺瘤显著降低(P<0.05);E-cadherin在侵袭性垂体腺瘤中的表达较非侵袭性垂体腺瘤显著降低(P<0.05);GSTP1、E-cadherin在垂体腺瘤中的表达呈正相关(r=0.82,P<0.05)。结论:GSTP1、E-cadherin在垂体腺瘤中的表达与肿瘤侵袭程度显著相关,两者联合检测有助于判断垂体腺瘤侵袭性及预后。     

DDR1在人垂体腺瘤组织中的表达及其临床意义

目的:检测盘状结构域受体1(DDR1)在垂体腺瘤中的蛋白表达水平并探讨其临床意义。方法:收集81例手术切除的垂体腺瘤和5例正常垂体前叶组织标本及其临床资料,应用免疫组化SP法检测和比较其DDR1蛋白的表达情况,并分析垂体腺瘤组织中DDR1蛋白的表达与患者临床及病理特征的相关性。结果:垂体腺瘤组织中DDR1的阳性表达率为64.2%(52/81例);侵袭性垂体腺瘤组织中DDR1蛋白的阳性表达率显著高于非侵袭性垂体腺瘤(x2=16.40,P=0.000);功能性垂体腺瘤组织中DDR1蛋白的阳性表达率显著高于无功能性垂体腺瘤(x2=18.06,P=0.000);直径≥10 mm垂体腺瘤组织中DDR1蛋白的阳性表达率显著高于直径10 mm的垂体腺瘤(x2=11.68,P=0.003)。结论:DDR1的表达与垂体腺瘤的侵袭性、内分泌类型和肿瘤大小有关,可能在垂体腺瘤发病机制中起重要作用。     

HIF-1α 在垂体腺瘤中的表达及与垂体腺瘤侵袭性的关系

目的:研究缺氧诱导因子-1α(HIF-1α)在人垂体腺瘤中的表达,对HIF-1α蛋白表达与肿瘤分级进行相关性分析,探讨其表达水平与垂体腺瘤侵袭性的关系.方法:集影像学检查、内分泌学检查及病理诊断的垂体腺瘤60例,分为侵袭组和非侵袭组,其中侵袭组36例,非侵袭组24例;对照组正常脑组织5例.免疫组织化学技术检测HIF-1α蛋白的表达,结合临床资料进行统计学分析.分析垂体腺瘤HIF-1α蛋白的表达水平并与对照组进行比较,比较侵袭组和非侵袭组垂体腺瘤之间HIF-1α蛋白表达水平的差异.结果:HIF-1α蛋白在垂体腺瘤中的表达明显高于对照组,二者比较,x20.05,1=12.392,P＜0.001,有显著性差异;侵袭组HIF-1α蛋白的表达较非侵袭组显著增高,二者比较,x20.05.1=24.658,P＜0.001,有显著性差异.结论:H1F-1α是垂体腺瘤侵袭过程中的重要调控因子,与垂体腺瘤的大小、分级以及侵袭性密切相关,其作用机制有待进一步研究,其表达程度可用作垂体腺瘤预后的评估指标,为垂体腺瘤术后的复发以及相应的辅助治疗提供判断依据.有可能为人们靶向肿瘤缺氧来开发新药物提供新的作用靶点.     

免疫细胞与肿瘤微环境

肿瘤细胞和免疫细胞间的相互作用一直是肿瘤生物学关注的热点.流行病学与临床研究均表明,炎症反应与肿瘤的发生发展存在密切关联,但是其中的分子作用机理和遗传学机制尚未完全阐明.研究显示,T淋巴细胞、巨噬细胞、树突状细胞、巨大细胞等多种免疫细胞会浸润到肿瘤微环境中,协同调控肿瘤生长、免疫逃逸和侵袭转移.本文就近年对肿瘤微环境中免疫细胞功能研究的进展进行综述.正确认识这些免疫细胞在肿瘤发生发展中的作用,对于发展更优的肿瘤免疫治疗手段具有十分重要意义.     

免疫细胞与肿瘤微环境（英文）

肿瘤细胞和免疫细胞间的相互作用一直是肿瘤生物学关注的热点.流行病学与临床研究均表明,炎症反应与肿瘤的发生发展存在密切关联,但是其中的分子作用机理和遗传学机制尚未完全阐明.研究显示,T淋巴细胞、巨噬细胞、树突状细胞、巨大细胞等多种免疫细胞会浸润到肿瘤微环境中,协同调控肿瘤生长、免疫逃逸和侵袭转移.本文就近年对肿瘤微环境中免疫细胞功能研究的进展进行综述.正确认识这些免疫细胞在肿瘤发生发展中的作用,对于发展更优的肿瘤免疫治疗手段具有十分重要意义.     

草鱼催乳素抗血清的制备与鉴定

应用从草鱼垂体中分离纯化的催乳素免疫兔子制备了特异抗血清。用常规酶联免疫吸附测定法检测表明该抗血清与马哈鱼生长激素及促性腺激素完全没有交叉反应，而与草鱼生长湟级向弱交叉反应。免疫细胞化学染色表明该抗血清主要与草鱼垂体前叶催乳素细胞发生结合反应，与垂体间叶细胞有微弱染色反应，但与神经垂体琢垂体后叶细胞则完全没有免疫结合反应。     

SIRT7琥珀酰化修饰对肝癌生存、免疫浸润及预后的相关性分析

摘要 目的：探究SIRT7基因琥珀酰化修饰对肝癌患者的生存、免疫浸润及预后的相关性分析。方法：采用生物信息分析法对SIRT7在肝癌组织中的表达情况及其对肝癌患者预后的影响进行分析；采用蛋白免疫印迹法（Western blot）检测其转染效果。结果：（1）生物信息分析结果显示：SIRT7在多种肿瘤（包括肝癌）组织中呈高表达（P<0.05）；SIRT7的表达与肿瘤的生存曲线相关（P<0.05）；肝癌患者的SIRT7相对表达量与其预后相关，高表达组肝癌患者的总生存情况（P=0.017）和无进展生存情况较低表达组缩短（P=0.004）；免疫浸润和肿瘤微环境分析结果显示，SIRT7表达水平与多数免疫细胞浸润水平、肿瘤微环境(ESTIMATES core)均有明显负相关。（2）Western blot显示，SIRT7在肝癌细胞中表达高于正常细胞。因此，SIRT7 可作为肝癌的潜在预后标志物。结论：SIRT7表达水平与肝癌(HCC)患者的预后、免疫细胞浸润性、肿瘤微环境免疫细胞和基质细胞浸润等相关。     

LAMB3在头颈鳞癌中的表达及预后价值分析

摘要 目的：研究层黏连蛋白亚基β3（LAMB3）在头颈鳞癌（HNSCC）中的表达、预后价值、免疫相关性及作用机制。方法：利用基于癌症基因组图谱（TCGA）的多个在线数据库,分析LAMB3在HNSCC肿瘤组织中的差异表达、预后价值以及对免疫细胞浸润的影响;通过基因共表达及蛋白-蛋白相互作用网络分析,探究LAMB3参与HNSCC的生物过程以及相关信号通路;预测调控LAMB3基因的上游靶miRNA。结果：LAMB3在HNSCC中高表达,LAMB3表达水平与年龄分布、肿瘤病理分级、淋巴结转移状态和HPV病毒感染状态相关;预后分析显示LAMB3在HNSCC中高表达预示患者不良预后,在肿瘤分期为Stage3、白色人种、肿瘤病理分期为Grade1和Grade2以及肿瘤新生抗原高表达HNSCC患者中总生存期更短;LAMB3表达水平影响HNSCC肿瘤微环境,LAMB3高表达能够降低B细胞、CD8⁺T 细胞浸润程度,升高CD4⁺T细胞浸润程度;基因共表达和功能相关分析表明,LAMB3高表达与基底膜形成、细胞连接、细胞迁移等生物过程有关;LAMB3潜在靶miRNA是hsa-miR-24-3p。结论：LAMB3在 HNSCC中高表达与免疫细胞浸润和患者不良预后相关,可作为HNSCC发病风险和预后指标。     

Immune and Inflammatory Cell Composition of Human Lung Cancer Stroma

Recent studies indicate that the abnormal microenvironment of tumors may play a critical role in carcinogenesis, including lung cancer. We comprehensively assessed the number of stromal cells, especially immune/inflammatory cells, in lung cancer and evaluated their infiltration in cancers of different stages, types and metastatic characteristics potential. Immunohistochemical analysis of lung cancer tissue arrays containing normal and lung cancer sections was performed. This analysis was combined with cyto-/histomorphological assessment and quantification of cells to classify/subclassify tumors accurately and to perform a high throughput analysis of stromal cell composition in different types of lung cancer. In human lung cancer sections we observed a significant elevation/infiltration of total-T lymphocytes (CD3⁺), cytotoxic-T cells (CD8⁺), T-helper cells (CD4⁺), B cells (CD20⁺), macrophages (CD68⁺), mast cells (CD117⁺), mononuclear cells (CD11c⁺), plasma cells, activated-T cells (MUM1⁺), B cells, myeloid cells (PD1⁺) and neutrophilic granulocytes (myeloperoxidase⁺) compared with healthy donor specimens. We observed all of these immune cell markers in different types of lung cancers including squamous cell carcinoma, adenocarcinoma, adenosquamous cell carcinoma, small cell carcinoma, papillary adenocarcinoma, metastatic adenocarcinoma, and bronchioloalveolar carcinoma. The numbers of all tumor-associated immune cells (except MUM1⁺ cells) in stage III cancer specimens was significantly greater than those in stage I samples. We observed substantial stage-dependent immune cell infiltration in human lung tumors suggesting that the tumor microenvironment plays a critical role during lung carcinogenesis. Strategies for therapeutic interference with lung cancer microenvironment should consider the complexity of its immune cell composition.     

Intra-tumoral infiltration of adipocyte facilitates the activation of antitumor immune response in pancreatic ductal adenocarcinoma

Pancreatic ductal adenocarcinoma (PDAC) is a highly fatal malignancy that is characterized by an immunosuppressive microenvironment. The immune suppression in PDAC is largely driven by heterogeneous stromal and tumor cells. However, how adipocyte in the tumor microenvironment (TME) is related to the immune cell infiltration in PDAC has rarely been published. We identified adipocytes by performing bioinformatics analyses, and explored the clinical outcomes and TME characters in PDAC with different levels of adipocyte infiltration. Interestingly, in contrast to adiposity, high adipocyte infiltration in the TME was related to significantly increased median overall survival and a lower total tumor mutational burden. Functionally, high adipocyte infiltration was associated with the immune response, particularly with the abundant cytokine infiltration in PDAC samples. Moreover, adipocyte infiltration in the TME was positively associated with anticancer signatures in the immune microenvironment. Immunohistochemistry and RT-PCR were performed with PDAC tissue samples from our center to study the expression of adipocytes in PDAC. The mature adipocytes were strongly associated with the immune composition and prognosis of patients with PDAC. Primary adipocytes were isolated from mice to construct a PDAC transplantation tumor model. In vivo experiments showed that adipocytes elicited increased CD8+ T cell infiltration and potent antitumor activity in tumor-bearing mice. Overall, we innovatively found that adipocytes facilitated the antitumor immune response in the TME by performing mouse experiments and analyzing PDAC samples. This study provides a new perspective on the activation of the immune microenvironment in PDAC.     

Effective Predictor of Colorectal Cancer Survival Based on Exclusive Expression Pattern Among Different Immune Cell Infiltration

Tumor-infiltrating immune/inflammatory cells, the important components of the tumor microenvironment (TME), remarkably affect the progression of human cancers. To understand the actual conditions within the TME of colorectal cancer (CRC), the interrelationship among tumor-infiltrating neutrophils, M2 macrophages, and regulatory T-cells (T_regs) was systematically analyzed. The infiltration conditions of CD66b⁺ neutrophils, CD163⁺ M2 macrophages, and FOXP3⁺ T_regs in tissue microarrays including 1021 cases of CRC were determined by immunohistochemical analysis. The prediction power of these immune cells for CRC prognosis was evaluated by subgroup analysis of the CRC cohort. Results revealed the existence pattern of infiltrating neutrophils, and T_regs/M2 macrophages fulfilled a “X-low implies Y-high” Boolean relationship, indicative of a mutually exclusive correlation between neutrophils and M2 macrophages, and between neutrophils and T_regs in the TME of CRC. What’s more, the tumor-infiltrating M2 macrophages and T_regs were associated with adverse prognostic factors, whereas neutrophils were corelated with favorable factors. The high infiltration of neutrophils predicted longer survival and better chemotherapeutic response. Nonetheless, high infiltration of M2 macrophages and T_regs predicted poor prognosis. The combination of these tumor-infiltrating immune cells can serve as an effective predictor for the survival of CRC and for the chemotherapeutic outcomes of stage II–III patients.      

基于免疫性PTR的血小板膜糖蛋白及T/B淋巴细胞表达水平研究

摘要 目的：探究血小板膜糖蛋白及T/B淋巴细胞免疫在免疫性血小板输注无效发生机制中的重要作用。方法：采用血小板特异性抗体检测试剂盒及流式细胞技术检测免疫性PTR患者血小板特异性抗体（抗GPIIb/IIIa、抗GPIa/IIa、抗GPIb/IX、抗GPIV）、血小板膜糖蛋白（CD36、CD61、CD41a）表达情况及外周血T/B淋巴细胞数量,运用SPSS19.0软件及R软件分析免疫性PTR与血小板膜糖蛋白、外周血T/B淋巴细胞的相关性。结果：免疫性PTR与血小板输注有效者比较,血小板特异性抗体的产生无显著差异,血小板膜糖蛋白CD36和CD61的表达具有显著差异,CD36对免疫性PTR发生风险具有极大的预测价值,外周血CD8⁺T细胞比例增高,而CD4⁺T细胞比例减低。结论：免疫性PTR患者产生血小板抗体具体机制不明确,了解患者细胞免疫状态有助于明确免疫性PTR的发生机制,为患者提供更优质的诊疗策略。     

Immune Checkpoint Blockade to Improve Tumor Infiltrating Lymphocytes for Adoptive Cell Therapy

Tumor-infiltrating lymphocytes (TIL) has been associated with improved survival in cancer patients. Within the tumor microenvironment, regulatory cells and expression of co-inhibitory immune checkpoint molecules can lead to the inactivation of TIL. Hence, there is a need to develop strategies that disrupt these negative regulators to achieve robust anti-tumor immune responses. We evaluated the blockade of immune checkpoints and their effect on T cell infiltration and function. We examined the ability of TIL to induce tumor-specific immune responses in vitro and in vivo. TIL isolated from tumor bearing mice were tumor-specific and expressed co-inhibitory immune checkpoint molecules. Administration of monoclonal antibodies against immune checkpoints led to a significant delay in tumor growth. However, anti-PD-L1 antibody treated mice had a significant increase in T cell infiltration and IFN-γ production compared to other groups. Adoptive transfer of in vitro expanded TIL from tumors of anti-PD-L1 antibody treated mice led to a significant delay in tumor growth. Blockade of co-inhibitory immune checkpoints could be an effective strategy to improve TIL infiltration and function.     

神经内镜与显微镜下经鼻蝶入路手术切除垂体腺瘤的临床疗效比较及术中出现脑脊液漏的危险因素分析

摘要 目的：对比垂体腺瘤患者采用显微镜或神经内镜下经鼻蝶入路手术切除后的临床疗效,分析术中出现脑脊液漏的危险因素。方法：回顾性分析2018年3月~2022年2月期间来我院接受手术治疗的178例垂体腺瘤患者的临床资料。根据采用手术器械的不同将178例患者分为A组（显微镜,n=91）和B组（神经内镜,n=87）。比较两组的肿瘤有效切除率、临床指标、术中脑脊液漏发生率及术后并发症发生率。根据术中是否发生脑脊液漏分为脑脊液漏组和无脑脊液漏组。经单因素和多因素Logistic回归分析患者术中发生脑脊液漏的危险因素。结果：B组的手术时间、住院时间短于A组,术中出血量少于A组（P<0.05）。A组、B组的肿瘤有效切除率组间对比,无统计学差异（P>0.05）。B组术中脑脊液漏发生率、术后并发症发生率低于A组（P<0.05）。垂体腺瘤患者术中发生脑脊液漏与再次手术、肿瘤大小、年龄、肿瘤质地、美国麻醉医师协会（ASA）分级有关（P<0.05）。肿瘤大小为巨大腺瘤、再次手术、肿瘤质地为韧是垂体腺瘤患者术中发生脑脊液漏的危险因素（P<0.05）。结论：显微镜与神经内镜下经鼻蝶入路手术切除垂体腺瘤,治疗效果相当,但神经内镜下手术可缩短手术时间、住院时间,减少术中出血量,降低术中脑脊液漏发生率、术后并发症发生率。此外,肿瘤大小为巨大腺瘤、再次手术、肿瘤质地为韧是垂体腺瘤患者术中发生脑脊液漏的危险因素。     

Systemic Inflammation,Nutritional Status and Tumor Immune Microenvironment Determine Outcome of Resected Non-Small Cell Lung Cancer

Background

Hypothesizing that nutritional status, systemic inflammation and tumoral immune microenvironment play a role as determinants of lung cancer evolution, the purpose of this study was to assess their respective impact on long-term survival in resected non-small cell lung cancers (NSCLC).

Methods and Findings

Clinical, pathological and laboratory data of 303 patients surgically treated for NSCLC were retrospectively analyzed. C-reactive protein (CRP) and prealbumin levels were recorded, and tumoral infiltration by CD8+ lymphocytes and mature dendritic cells was assessed. We observed that factors related to nutritional status, systemic inflammation and tumoral immune microenvironment were correlated; significant correlations were also found between these factors and other relevant clinical-pathological parameters. With respect to outcome, at univariate analysis we found statistically significant associations between survival and the following variables: Karnofsky index, American Society of Anesthesiologists (ASA) class, CRP levels, prealbumin concentrations, extent of resection, pathologic stage, pT and pN parameters, presence of vascular emboli, and tumoral infiltration by either CD8+ lymphocytes or mature dendritic cells and, among adenocarcinoma type, tumor grade (all p<0.05). In multivariate analysis, prealbumin levels (Relative Risk (RR): 0.34 [0.16–0.73], p = 0.0056), CD8+ cell count in tumor tissue (RR = 0.37 [0.16–0.83], p = 0.0162), and disease stage (RR 1.73 [1.03–2.89]; 2.99[1.07–8.37], p = 0.0374- stage I vs II vs III-IV) were independent prognostic markers. When taken together, parameters related to systemic inflammation, nutrition and tumoral immune microenvironment allowed robust prognostic discrimination; indeed patients with undetectable CRP, high (>285 mg/L) prealbumin levels and high (>96/mm2) CD8+ cell count had a 5-year survival rate of 80% [60.9–91.1] as compared to 18% [7.9–35.6] in patients with an opposite pattern of values. When stages I-II were considered alone, the prognostic significance of these factors was even more pronounced.

Conclusions

Our data show that nutrition, systemic inflammation and tumoral immune contexture are prognostic determinants that, taken together, may predict outcome.     

Immune Adjuvant Activity of Pre-Resectional Radiofrequency Ablation Protects against Local and Systemic Recurrence in Aggressive Murine Colorectal Cancer

Purpose

While surgical resection is a cornerstone of cancer treatment, local and distant recurrences continue to adversely affect outcome in a significant proportion of patients. Evidence that an alternative debulking strategy involving radiofrequency ablation (RFA) induces antitumor immunity prompted the current investigation of the efficacy of performing RFA prior to surgical resection (pre-resectional RFA) in a preclinical mouse model.

Experimental Design

Therapeutic efficacy and systemic immune responses were assessed following pre-resectional RFA treatment of murine CT26 colon adenocarcinoma.

Results

Treatment with pre-resectional RFA significantly delayed tumor growth and improved overall survival compared to sham surgery, RFA, or resection alone. Mice in the pre-resectional RFA group that achieved a complete response demonstrated durable antitumor immunity upon tumor re-challenge. Failure to achieve a therapeutic benefit in immunodeficient mice confirmed that tumor control by pre-resectional RFA depends on an intact adaptive immune response rather than changes in physical parameters that make ablated tumors more amenable to a complete surgical excision. RFA causes a marked increase in intratumoral CD8⁺ T lymphocyte infiltration, thus substantially enhancing the ratio of CD8⁺ effector T cells: FoxP3⁺ regulatory T cells. Importantly, pre-resectional RFA significantly increases the number of antigen-specific CD8⁺ T cells within the tumor microenvironment and tumor-draining lymph node but had no impact on infiltration by myeloid-derived suppressor cells, M1 macrophages or M2 macrophages at tumor sites or in peripheral lymphoid organs (i.e., spleen). Finally, pre-resectional RFA of primary tumors delayed growth of distant tumors through a mechanism that depends on systemic CD8⁺ T cell-mediated antitumor immunity.

Conclusion

Improved survival and antitumor systemic immunity elicited by pre-resectional RFA support the translational potential of this neoadjuvant treatment for cancer patients with high-risk of local and systemic recurrence.