Expression changes and clinical significance of serum neuron-specific enolase and squamous cell carcinoma antigen in lung cancer patients after radiotherapy

array:23 ["pii" => "S1807593222033361" "issn" => "18075932" "doi" => "10.1016/j.clinsp.2022.100135" "estado" => "S300" "fechaPublicacion" => "2023-01-01" "aid" => "100135" "copyright" => "HCFMUSP" "copyrightAnyo" => "2022" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Clinics. 2023;78C:" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S1807593222033427" "issn" => "18075932" "doi" => "10.1016/j.clinsp.2022.100141" "estado" => "S300" "fechaPublicacion" => "2023-01-01" "aid" => "100141" "copyright" => "HCFMUSP" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Clinics. 2023;78C:" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Original articles" "titulo" => "KCNK9 mediates the inhibitory effects of genistein on hepatic metastasis from colon cancer" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "en" ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0002" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1676 "Ancho" => 2833 "Tamanyo" => 356936 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0002" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "KCNK9 expression was upregulated in colon cancer and was associated with patients’ survival. (A) KCNK9 was overexpressed in tumor tissues than in normal tissues. (B) The mRNA and protein levels of KCNK9 in colon cancer cell lines (HT-29 and SW480) and the normal colon epithelial cell line (FHC) were examined by RT-qPCR and Western blotting. KCNK9 was overexpressed in colon cancer cell lines (p < 0.001); data were presented as mean ± Standard Deviation (SD); p-values were calculated using the Student's t-test. (C) Kaplan-Meier method was used to evaluate the overall survival in TCGA COAD according to KCNK9 expression level; (D) ROC curve of KCNK9 in TCGA COAD." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Yuan Cheng, Yi Tang, Yiming Tan, Juan Li, Xuping Zhang" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Yuan" "apellidos" => "Cheng" ] 1 => array:2 [ "nombre" => "Yi" "apellidos" => "Tang" ] 2 => array:2 [ "nombre" => "Yiming" "apellidos" => "Tan" ] 3 => array:2 [ "nombre" => "Juan" "apellidos" => "Li" ] 4 => array:2 [ "nombre" => "Xuping" "apellidos" => "Zhang" ] ] ] ] "resumen" => array:1 [ 0 => array:3 [ "titulo" => "Highlights" "clase" => "author-highlights" "resumen" => "<ul class="elsevierStyleList" id="celist0001"><li class="elsevierStyleListItem" id="celistitem0001">•High KCNK9 expression level is correlated with colon cancer patients' poor survival.</li><li class="elsevierStyleListItem" id="celistitem0002">•KCNK9 promotes proliferation, migration, invasion, EMT, and Wnt signaling pathway.</li><li class="elsevierStyleListItem" id="celistitem0003">•KCNK9 mediates the inhibitory effects of genistein on colon cancer liver metastasis.</li></ul>" ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222033427?idApp=UINPBA00004N" "url" => "/18075932/000000780000000C/v4_202409020811/S1807593222033427/v4_202409020811/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S1807593223000091" "issn" => "18075932" "doi" => "10.1016/j.clinsp.2023.100173" "estado" => "S300" "fechaPublicacion" => "2023-01-01" "aid" => "100173" "copyright" => "HCFMUSP" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Clinics. 2023;78C:" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Original articles" "titulo" => "The Hertel classification can't predict the risk of humeral head osteonecrosis after osteosynthesis using an anterolateral approach" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "en" ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0001" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1159 "Ancho" => 2500 "Tamanyo" => 155646 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0007" "detalle" => "Fig " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Radiographs showing initial fracture (a); one day after the surgery (b); six months after the surgery with radiological evidence of HHO (c)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Márcio Alves Cruz, Guilherme Grisi Mouraria, Fernando Kenji Kikuta, Daniel Romano Zogbi, Sérgio de Paula Coelho, Maurício Etchebehere" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Márcio Alves" "apellidos" => "Cruz" ] 1 => array:2 [ "nombre" => "Guilherme Grisi" "apellidos" => "Mouraria" ] 2 => array:2 [ "nombre" => "Fernando Kenji" "apellidos" => "Kikuta" ] 3 => array:2 [ "nombre" => "Daniel Romano" "apellidos" => "Zogbi" ] 4 => array:2 [ "nombre" => "Sérgio de Paula" "apellidos" => "Coelho" ] 5 => array:2 [ "nombre" => "Maurício" "apellidos" => "Etchebehere" ] ] ] ] "resumen" => array:1 [ 0 => array:3 [ "titulo" => "Highlights" "clase" => "author-highlights" "resumen" => "<ul class="elsevierStyleList" id="celist0001"><li class="elsevierStyleListItem" id="celistitem0001">•Proximal humeral fractures can progress to humeral head osteonecrosis</li><li class="elsevierStyleListItem" id="celistitem0002">•It's controversial if the Hertel classification can predict humeral head osteonecrosis.</li><li class="elsevierStyleListItem" id="celistitem0003">•Proximal Humeral Fractures can be fixed through the anterolateral approach.</li><li class="elsevierStyleListItem" id="celistitem0004">•Objective: to correlate the Hertel's predictors with the humeral head osteonecrosis.</li><li class="elsevierStyleListItem" id="celistitem0005">•Hertel's criteria were not able to predict the risk for humeral head osteonecrosis.</li><li class="elsevierStyleListItem" id="celistitem0006">•The overall prevalence humeral head osteonecrosis was 17.9%.</li></ul>" ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593223000091?idApp=UINPBA00004N" "url" => "/18075932/000000780000000C/v4_202409020811/S1807593223000091/v4_202409020811/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "Original articles" "titulo" => "Expression changes and clinical significance of serum neuron-specific enolase and squamous cell carcinoma antigen in lung cancer patients after radiotherapy" "tieneTextoCompleto" => true "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Lulu Sun, Qing Shao" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Lulu" "apellidos" => "Sun" ] 1 => array:4 [ "nombre" => "Qing" "apellidos" => "Shao" "email" => array:1 [ 0 => "sh_q9777@126.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0001" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "No.7 Departments of Oncology, The First People's Hospital of Lianyungang, Jiangsu, China" "identificador" => "aff0001" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0001" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0001" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1201 "Ancho" => 1433 "Tamanyo" => 124321 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0005" "detalle" => "Fig " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "ROC curves of NSE and SCC in serum on tumor recurrence and metastasis in lung cancer radiotherapy patients." ] ] ] "textoCompleto" => "IntroductionLung cancer is one of the most common malignant tumors of the respiratory system, and its morbidity and mortality rank first among all malignant tumors, becoming a global public health problem.<a class="elsevierStyleCrossRef" href="#bib0001">1</a>,<a class="elsevierStyleCrossRef" href="#bib0002">2</a> At this stage, surgery, radiotherapy, and chemotherapy are effective methods for the treatment of lung cancer, but most patients have developed into the middle and late stages when they were first diagnosed, thus losing the best time for surgery, making radiotherapy and chemotherapy the main treatment methods for lung cancer.<a class="elsevierStyleCrossRef" href="#bib0003">3</a> However, chemotherapy has serious side effects, so radiotherapy has become a commonly used clinical treatment method.<a class="elsevierStyleCrossRef" href="#bib0004">4</a> The poor prognosis of lung cancer patients after treatment is the main cause of death of patients, and the effect of radiotherapy will directly affect the prognosis of patients. Therefore, it is of great significance to seek relevant serum indicators to effectively predict the effect of radiotherapy for clinically taking corresponding prognostic treatment measures. Neuron-Specific Enolase (NSE) is an enzyme secreted by tumors originating from neuroendocrine tissues, especially overexpressed in small-cell lung cancer. It is the most sensitive and specific tumor marker for Small Cell Lung Cancer (SCLC).<a class="elsevierStyleCrossRef" href="#bib0005">5</a> Squamous Cell Carcinoma Antigen (SCC) was originally extracted from cervical squamous cell carcinoma in 1977 and is a sub-fragment of tumor-associated antigen TA-4, widely presenting in the cytoplasm of squamous cell carcinomas of the uterus, cervix, lung, head and neck, etc., especially in non-keratinizing carcinoma cells, the content is more abundant.<a class="elsevierStyleCrossRef" href="#bib0006">6</a> Related studies have shown that NSE and SCC in serum can predict the effect of chemotherapy in patients with lung cancer.<a class="elsevierStyleCrossRef" href="#bib0007">7</a>,<a class="elsevierStyleCrossRef" href="#bib0008">8</a> However, there is still a lack of relevant research on the changes and clinical significance of NSE and SCC in serum in patients with lung cancer before and after radiotherapy. Therefore, the levels of NSE and SCC in serum in patients with lung cancer before and after radiotherapy were monitored and their clinical significance was discussed in this study.Materials and methodsStudy populationLung cancer patients admitted to the present study's hospital from April 2020 to March 2021 were selected as the research subjects. The inclusion criteria were as follows: (1) All patients met the World Health Organization's diagnostic criteria for lung cancer and were diagnosed by imaging and pathological analysis; (2) The Tumor Node Metastasis (TNM) staging ranges from IIb to III; (3) With radiotherapy indications; (4) Underwent radiotherapy with the same regimen; (5) The survival period was more than 3 months; (6) The patients and their families were informed and agreed. The exclusion criteria were as follows: (1) Physically intolerant; (2) Combined with other malignant tumors; (3) With severe heart, liver, kidney, and other important organ dysfunction; (4) Pregnant and lactating women. According to the above inclusion and exclusion criteria, a total of 82 patients were included in this study, including 50 males and 32 females; age ranges from 37 to 73 years old, with an average of (55.08±9.14) years old; TNM staging: 45 cases of stage II and 37 cases of stage III; tumor types: adenocarcinoma in 35 cases, squamous cell carcinoma in 29 cases, and small cell carcinoma in 18 cases. Another 54 healthy volunteers examined in the hospital during the same period were selected as the control group, with 32 males and 22 females, with age ranges from 35 to 74 years old, with an average age of (54.88±9.76) years old. The control group was informed and voluntarily participated in the research. There was no significant difference in general data such as age and gender between the two groups (p > 0.05), which was comparable.Nursing methodA total of 82 patients were randomly divided into an intervention group and routine group, with 41 cases in each group. The routine group received routine clinical care, the main contents included health knowledge education before radiotherapy, close monitoring of the patient's condition, and a guide for treatment preparation. Among them, health education promotion includes basic knowledge of lung cancer, treatment methods, precautions for radiotherapy, possible adverse reactions, etc.The intervention group was given comprehensive clinical intervention: 24 hours after the patient was admitted to the hospital, the nursing staff explained the department system and specific situation to the patient and their family members, introduced the hospital and ward environment to the patient, and eliminated the discomfort of the patient to the unfamiliar environment. Professional nurses carry out health knowledge education for patients, including the pathogenesis of lung cancer, influencing factors, the necessity of radiotherapy, the purpose of radiotherapy, expected effects, and possible adverse reactions during radiotherapy, and teach patients emotional management content. Additionally, health education manuals are distributed to patients, so that patients can fully understand the contents of lung cancer and treatment and make them aware of the importance of radiotherapy. Apart from this, the patient's family background and social background were investigated in order to better understand the patient's cognition of the disease, and the targeted health education was carried out according to the cognition of different patients in nursing practice to strengthen patients' understanding of radiotherapy. During radiotherapy, nurses closely monitored the patient's condition, paid attention to the patient's psychological dynamics, corrected cognitive errors in patients during radiotherapy, and guided patients to actively and objectively evaluate their own state. For the nervousness, anxiety, fear and other negative emotions of patients, timely and effective psychological counseling was carried out to strengthen the emotional management of patients. At the same time, during radiotherapy, scientific and reasonable dietary plans were formulated for patients. For example, nutritional intervention can be performed if necessary for patients with poor appetite, and symptomatic treatment such as antiemetic treatment should be given to patients with severe vomiting. Furthermore, according to the actual situation, the patients were given anti-infection, anti-infection, sleep aid, and other symptomatic treatments. Moreover, ward nursing should be done well during radiotherapy, including basic temperature and humidity control, timely disinfection, etc., and keeping the room quiet.Measurement of NSE and SCCAt the time of admission and after radiotherapy, the cubital vein blood (3 mL) was drawn from patients in the study group. After centrifugation at 2000 r/min for 10 min, the upper serum was collected, and NSE and SCC levels in the serum of the patients were measured by Enzyme-Linked Immunosorbent Assay (ELISA). The NSE and SCC kits were purchased from Wuhan Fein Biotechnology Co., Ltd., and the operation process was carried out in strict accordance with the kit instructions.Measurement of T lymphocyte subsetsBefore and after the intervention, about 3 mL of cubital vein blood was drawn from the patients in the study group. After anticoagulation treatment, a monoclonal antibody was added and incubated at room temperature in the dark for 20 min, then red blood cell lysate was added, and the cells were protected from light for 15 min. After centrifugation at 2000 r/min for 5 min, the supernatant was discarded, and PBS buffer was added to mix well. Finally, the number of T lymphocyte subsets was determined by a cell analyzer (BD FACSCanto, USA).Follow-upThe patients in the study group were followed up by telephone for 1 year after discharge, and the follow-up time was until March 31, 2022. According to tumor recurrence and metastasis, they were divided into the recurrence and metastasis group (n = 28) and the non-recurrence and metastasis group (n = 54).Statistical analysisThe research data were imported into SPSS 22.0 software for statistical analysis. The levels of serum NSE, SCC and T lymphocyte subsets were expressed by mean ± standard deviation, and the comparison was performed by Student's t-test. The Receiver Operating Curve (ROC) was used to evaluate the predictive efficacy of NSE and SCC levels in serum after radiotherapy on the prognosis of patients. A difference was considered significant when the p-value was less than 0.05.ResultsComparison of NSE and SCC levels in serum between the control group and research group at admissionAt admission, the NSE and SCC levels in serum in the study group were significantly higher than those in the control group, and the difference was statistically significant (p < 0.001), as shown in <a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a>.<elsevierMultimedia ident="tbl0001"></elsevierMultimedia>Changes of NSE and SCC levels in serum in the study group before and after radiotherapyAfter radiotherapy, the NSE and SCC levels in the serum of the patients were significantly lower than those before radiotherapy (p < 0.001), as shown in <a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a>.<elsevierMultimedia ident="tbl0002"></elsevierMultimedia>Comparison of NSE and SCC levels in serum in patients with different prognosesAfter radiotherapy, NSE and SCC levels in serum in the recurrence and metastasis group were significantly higher than those in the non-recurrence and metastasis group (p = 0.013, 0.008), as seen in <a class="elsevierStyleCrossRef" href="#tbl0003">Table 3</a>.<elsevierMultimedia ident="tbl0003"></elsevierMultimedia>Predictive efficacy of NSE and SCC in serum on tumor recurrence and metastasis in lung cancer radiotherapy patientsThe ROC curve analysis showed that the AUC of NSE and SCC levels in serum for predicting tumor recurrence and metastasis in patients with lung cancer radiotherapy was 0.848 and 0.755, respectively, the critical values were 21.98 ng/mL and 1.59 ng/mL, and the sensitivity was 92.86% and 82.14%, and the specificity was 82.14%, 71.87%, 62.96%, as exhibited in <a class="elsevierStyleCrossRef" href="#fig0001">Fig. 1</a>.<elsevierMultimedia ident="fig0001"></elsevierMultimedia>Comparison of NSE, SCC and T lymphocyte subsets levels in serum before and after interventionAfter the intervention, the NSE and SCC levels in the serum of the two groups were significantly lower than those before intervention (p < 0.05), the levels of CD4+ and CD4+/CD8+ were obviously higher than those before intervention (p < 0.05); the CD8+ level was not significantly different from that before the intervention (p > 0.05); The levels of serum NSE and SCC in the intervention group were significantly lower than those in the routine group, and the levels of CD4+ and CD4+/CD8+ were significantly higher than those in the routine group (p < 0.05); there was no significant difference in CD8+ levels between the two groups compared with the routine group (p > 0.05), as seen from <a class="elsevierStyleCrossRef" href="#tbl0004">Table 4</a>.<elsevierMultimedia ident="tbl0004"></elsevierMultimedia>DiscussionLung cancer is one of the malignant tumors that threaten human life. Although radiotherapy and chemotherapy of lung cancer have made breakthroughs in recent years, which can prolong the life cycle of patients to a certain extent, there is still a high risk of recurrence and metastasis after treatment, which is the main reason for the poor prognosis.<a class="elsevierStyleCrossRef" href="#bib0009">9</a>,<a class="elsevierStyleCrossRef" href="#bib0010">10</a> In the occurrence and development process of tumor cells, a series of tumor markers will be synthesized or released. The existence or quantitative changes of such markers can effectively reflect the occurrence, cell differentiation, and function of tumors, so as to provide basis and guidance for clinical diagnosis and effective treatment of tumors, as well as the further prediction of prognosis.<a class="elsevierStyleCrossRef" href="#bib0011">11</a>,<a class="elsevierStyleCrossRef" href="#bib0012">12</a> NSE is enolase involved in the glycolytic pathway, mainly found in neural and neuroendocrine tissues. Wang's team found that NSE is useful for predicting liver metastasis of lung cancer.<a class="elsevierStyleCrossRef" href="#bib0013">13</a> Bai's team found that NSE has a certain value in judging the prognosis of lung cancer patients.<a class="elsevierStyleCrossRef" href="#bib0014">14</a> SCC is a squamous cell carcinoma antigen, its main component is a glycoprotein, which belongs to the tumor-associated antigen TA-4 subtype. SCC mainly exists in squamous cell carcinoma, with the most abundant content in lung cancer and uterine cancer.<a class="elsevierStyleCrossRef" href="#bib0015">15</a> Yang<a class="elsevierStyleCrossRef" href="#bib0016">16</a> research group found that SCC has certain clinical value for the diagnosis of lung cancer. The Cho<a class="elsevierStyleCrossRef" href="#bib0017">17</a> research group found that SCC is closely related to the prognosis of lung cancer patients. Based on the above research, this study evaluated the changes in NSE and SCC levels in patients with lung cancer before and after radiotherapy, in order to more accurately evaluate the effect of radiotherapy and provide theoretical guidance for prognosis evaluation and further treatment.The results showed that the levels of serum NSE and SCC in the study group were significantly higher than those in the control group, suggesting that NSE and SCC were related to the occurrence of lung cancer, which was consistent with the results of previous studies.<a class="elsevierStyleCrossRefs" href="#bib0018">18-19</a> The results showed that the levels of NSE and SCC decreased significantly after radiotherapy, suggesting that radiotherapy can improve the levels of NSE and SCC, which may be attributed to the killing and inhibitory effects of radiotherapy on tumors, further reducing the malignancy of tumors. The results showed that the levels of NSE and SCC in the recurrence and metastasis group were significantly higher than those in the non-recurrence and metastasis group, indicating that the levels of NSE and SCC were closely related to tumor recurrence and metastasis. It is speculated that the tumor metabolism level in lung cancer patients with recurrence and metastasis is high, which can promote the combination and release of NSE and SCC. Further ROC curve analysis showed that the AUC of NSE and SCC levels for predicting tumor recurrence and metastasis in Lung cancer radiotherapy patients was 0.848 and 0.755, the critical value was 21.98 ng/mL and 1.59 ng/mL, the sensitivity was 92.86% and 82.14%, and the specificity was 71.87% and 62.96%, respectively. The above results suggested that NSE and SCC levels in serum can initially predict the prognosis of patients with lung cancer radiotherapy patients. However, the specificity of SCC is low, other indicators can be considered for comprehensive prediction in the later stage.In this study, lung cancer patients were treated with routine nursing care and comprehensive clinical intervention. The results showed that after the intervention, the NSE and SCC levels in the serum of the two groups of patients were significantly lower than those before the intervention, and the levels of CD4+ and CD4+/CD8+ were apparently higher than those before the intervention; CD8+ level was not significantly different from that before intervention. Besides, the NSE and SCC levels in serum in the intervention group were significantly lower than those in the conventional group, the levels of CD4+ and CD4+/CD8+ were obviously higher than those in the conventional group. There was no apparent difference in CD8+ levels between the two groups. The above results show that effective clinical intervention can improve the NSE and SCC levels in serum in lung cancer patients and reduce the inhibitory effect of radiotherapy on the immune function of the body to a certain extent.In conclusion, NSE and SCC levels in serum can effectively reflect the radiotherapy effect of lung cancer patients and show a certain predictive value for the prognosis effect after radiotherapy, providing information for the clinical radiotherapy effect and prognosis, and the basis and guidance for further clinical treatment. Nevertheless, the detection of a single indicator may be insufficient, and the combined detection of multiple indicators should be considered in actual clinical practice. Importantly, effective clinical intervention for radiotherapy patients can effectively enhance the therapeutic effect and alleviate the immunosuppression caused by radiotherapy.Ethics Committee StatementThe authors have no Clinical Trial registration number because According to the regulations of our affiliation, the present research only needs the approval of our own affiliation to conduct research, but the study was approved by the ethics committee of The First People's Hospital of Lianyungang (n° 20200306).Authors’ contributionsSubstantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work: Lulu Sun, Qing Shao.Drafting the work or revising it critically for important intellectual content: Lulu Sun, Qing Shao.Final approval of the version to be published: Lulu Sun, Qing Shao." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres2232204" "titulo" => "Highlights" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abss0001" ] ] ] 1 => array:3 [ "identificador" => "xres2232205" "titulo" => "ABSTRACT" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abss0003" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abss0004" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abss0005" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abss0006" "titulo" => "Conclusion" ] ] ] 2 => array:2 [ "identificador" => "xpalclavsec1869044" "titulo" => "Keywords" ] 3 => array:2 [ "identificador" => "sec0001" "titulo" => "Introduction" ] 4 => array:3 [ "identificador" => "sec0002" "titulo" => "Materials and methods" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0003" "titulo" => "Study population" ] 1 => array:2 [ "identificador" => "sec0004" "titulo" => "Nursing method" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Measurement of NSE and SCC" ] 3 => array:2 [ "identificador" => "sec0006" "titulo" => "Measurement of T lymphocyte subsets" ] 4 => array:2 [ "identificador" => "sec0007" "titulo" => "Follow-up" ] 5 => array:2 [ "identificador" => "sec0008" "titulo" => "Statistical analysis" ] ] ] 5 => array:3 [ "identificador" => "sec0009" "titulo" => "Results" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Comparison of NSE and SCC levels in serum between the control group and research group at admission" ] 1 => array:2 [ "identificador" => "sec0011" "titulo" => "Changes of NSE and SCC levels in serum in the study group before and after radiotherapy" ] 2 => array:2 [ "identificador" => "sec0012" "titulo" => "Comparison of NSE and SCC levels in serum in patients with different prognoses" ] 3 => array:2 [ "identificador" => "sec0013" "titulo" => "Predictive efficacy of NSE and SCC in serum on tumor recurrence and metastasis in lung cancer radiotherapy patients" ] 4 => array:2 [ "identificador" => "sec0014" "titulo" => "Comparison of NSE, SCC and T lymphocyte subsets levels in serum before and after intervention" ] ] ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0016" "titulo" => "Ethics Committee Statement" ] 8 => array:2 [ "identificador" => "sec0017" "titulo" => "Authors’ contributions" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-06-19" "fechaAceptado" => "2022-10-15" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1869044" "palabras" => array:5 [ 0 => "Lung cancer" 1 => "Radiotherapy" 2 => "Neuron-specific enolase" 3 => "Squamous cell carcinoma antigen" 4 => "Clinical significance" ] ] ] ] "tieneResumen" => true "highlights" => array:2 [ "titulo" => "Highlights" "resumen" => "<ul class="elsevierStyleList" id="celist0001"><li class="elsevierStyleListItem" id="celistitem0001">•The aim is to explore NSE and SCC in patients with lung cancer before and after radiotherapy.</li><li class="elsevierStyleListItem" id="celistitem0002">•Total of 82 patients with lung cancer were selected as the study group.</li><li class="elsevierStyleListItem" id="celistitem0003">•NSE and SCC levels can preliminarily evaluate the effect of radiotherapy.</li></ul>" ] "resumen" => array:1 [ "en" => array:3 [ "titulo" => "ABSTRACT" "resumen" => "ObjectiveTo explore the changes and clinical significance of serum Neuron-Specific Enolase (NSE) and Squamous Cell Carcinoma antigen (SCC) in patients with lung cancer before and after radiotherapy. Methods82 patients with lung cancer were treated with radiotherapy, and effective clinical intervention was given during the radiotherapy process. The patients were followed up for 1 year after radiotherapy and were divided into a recurrence and metastasis group (n = 28) and a non-recurrence and metastasis group (n = 54) according to their prognosis. Another 54 healthy volunteers examined in the present study's hospital during the same period were selected as the control group. To compare the changes of NSE and SCC levels in serum in patients with lung cancer at admission and after radiotherapy, and to explore their clinical significance. ResultsAfter intervention, NSE and SCC levels in the serum of the two groups of patients were significantly lower than those before intervention, and the levels of CD4+ and CD4+/CD8+ were significantly higher than those before intervention (p < 0.05); the level of CD8+ was not significantly different from that before intervention (p > 0.05). And NSE and SCC levels in the intervention group were significantly lower than those in the routine group, the levels of CD4+, CD4+/CD8+ were significantly higher than those in the routine group (p < 0.05). ConclusionNSE and SCC in serum can preliminarily evaluate the effect of radiotherapy in patients with lung cancer and have a certain predictive effect on prognosis." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abss0003" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abss0004" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abss0005" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abss0006" "titulo" => "Conclusion" ] ] ] ] "multimedia" => array:5 [ 0 => array:8 [ "identificador" => "fig0001" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1201 "Ancho" => 1433 "Tamanyo" => 124321 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0005" "detalle" => "Fig " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "ROC curves of NSE and SCC in serum on tumor recurrence and metastasis in lung cancer radiotherapy patients." ] ] 1 => array:8 [ "identificador" => "tbl0001" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0001" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0001"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Groups \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0002"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">NSE (ng/mL) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0003"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">SCC (ng/mL) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0004"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Study group (n = 82) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0005"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">37.66 ± 9.25 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0006"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">1.72 ± 0.24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0007"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Control group (n = 54) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0008"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">10.14 ± 2.72 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0009"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.67 ± 0.12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0010"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">t \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0011"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">21.242 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0012"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">29.766 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0013"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">p \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0014"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">p < 0.001 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0015"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">p < 0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3639119.png" ] ] ] ] "descripcion" => array:1 [ "en" => "The NSE and SCC levels in serum between the control group and study group." ] ] 2 => array:8 [ "identificador" => "tbl0002" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0002" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0016"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Time \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0017"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">NSE (ng/mL) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0018"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">SCC (ng/mL) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0019"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Before radiotherapy (n = 82) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0020"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">37.66 ± 9.25 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0021"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">1.72 ± 0.24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0022"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">After radiotherapy (n = 82) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0023"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">25.33 ± 7.47 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0024"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">1.56 ± 0.35 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0025"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">t \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0026"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">9.391 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0027"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">3.414 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0028"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">p \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0029"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">p < 0.001 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0030"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">p < 0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3639121.png" ] ] ] ] "descripcion" => array:1 [ "en" => "The NSE and SCC levels in serum changes in the study group." ] ] 3 => array:8 [ "identificador" => "tbl0003" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0003" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0031"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Prognosis \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0032"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">NSE (ng/mL) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0033"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">SCC (ng/mL) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0034"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Recurrence and metastasis (n = 28) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0035"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">27.32 ± 5.36 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0036"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">1.71 ± 0.32 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0037"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Non-recurrence and metastasis (n = 54) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0038"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">24.30 ± 4.97 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0039"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">1.48 ± 0.38 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0040"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">t \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0041"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">2.540 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0042"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">2.737 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0043"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">p \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0044"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.013 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0045"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.008 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3639120.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Comparison of NSE and SCC levels in serum in patients with different prognosis." ] ] 4 => array:8 [ "identificador" => "tbl0004" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0004" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "Note: Compared with the same group before intervention." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0046"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Index</th><a name="en0047"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Intervention group (n = 41)</th><a name="en0048"></a><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Routine group (n = 41)</th></tr><tr title="table-row"><a name="en0050"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Before intervention \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0051"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">After intervention \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0052"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Before intervention \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0053"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">After intervention \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0054"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">CD4+ (%) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0055"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">28.21 ± 5.24 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0056"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">34.67 ± 5.77<a class="elsevierStyleCrossRef" href="#tb4fn1">a</a>,<a class="elsevierStyleCrossRef" href="#tb4fn2">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0057"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">28.55 ± 5.34 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0058"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">31.46 ± 6.37<a class="elsevierStyleCrossRef" href="#tb4fn1">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0059"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">CD8+ (%) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0060"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">24.67 ± 5.77 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0061"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">24.16 ± 5.17 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0062"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">24.88 ± 6.26 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0063"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">25.04 ± 7.71 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0064"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">CD4+/CD8+ \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0065"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">1.14 ± 0.13 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0066"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">1.43 ± 0.22<a class="elsevierStyleCrossRef" href="#tb4fn1">a</a>,<a class="elsevierStyleCrossRef" href="#tb4fn2">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0067"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">1.15 ± 0.11 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0068"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">1.26 ± 0.24<a class="elsevierStyleCrossRef" href="#tb4fn1">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0069"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">NSE (ng/mL) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0070"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">38.66 ± 8.25 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0071"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">27.54 ± 5.42<a class="elsevierStyleCrossRef" href="#tb4fn1">a</a>,<a class="elsevierStyleCrossRef" href="#tb4fn2">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0072"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">37.54 ± 9.26 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0073"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">31.24 ± 7.74<a class="elsevierStyleCrossRef" href="#tb4fn1">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0074"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">SCC (ng/mL) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0075"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">1.74 ± 0.24 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0076"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">1.48 ± 0.24<a class="elsevierStyleCrossRef" href="#tb4fn1">a</a>,<a class="elsevierStyleCrossRef" href="#tb4fn2">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0077"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">1.76 ± 0.34 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0078"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">1.62 ± 0.21<a class="elsevierStyleCrossRef" href="#tb4fn1">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3639122.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tb4fn1" "etiqueta" => "a" "nota" => "p < 0.05; compared with conventional group after intervention," ] 1 => array:3 [ "identificador" => "tb4fn2" "etiqueta" => "b" "nota" => "p < 0.05." ] ] ] "descripcion" => array:1 [ "en" => "Comparison of NSE, SCC and T lymphocyte subsets levels in serum before and after intervention." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec1" "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bib0001" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Personalising lung cancer screening: An 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Lulu Sun, Qing Shao

Corresponding author

sh_q9777@126.com

Corresponding author.

No.7 Departments of Oncology, The First People's Hospital of Lianyungang, Jiangsu, China

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          "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">ROC curves of NSE and SCC in serum on tumor recurrence and metastasis in lung cancer radiotherapy patients&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0008">Introduction</span><p id="para0008" class="elsevierStylePara elsevierViewall">Lung cancer is one of the most common malignant tumors of the respiratory system&#44; and its morbidity and mortality rank first among all malignant tumors&#44; becoming a global public health problem&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> At this stage&#44; surgery&#44; radiotherapy&#44; and chemotherapy are effective methods for the treatment of lung cancer&#44; but most patients have developed into the middle and late stages when they were first diagnosed&#44; thus losing the best time for surgery&#44; making radiotherapy and chemotherapy the main treatment methods for lung cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> However&#44; chemotherapy has serious side effects&#44; so radiotherapy has become a commonly used clinical treatment method&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a> The poor prognosis of lung cancer patients after treatment is the main cause of death of patients&#44; and the effect of radiotherapy will directly affect the prognosis of patients&#46; Therefore&#44; it is of great significance to seek relevant serum indicators to effectively predict the effect of radiotherapy for clinically taking corresponding prognostic treatment measures&#46; Neuron-Specific Enolase &#40;NSE&#41; is an enzyme secreted by tumors originating from neuroendocrine tissues&#44; especially overexpressed in small-cell lung cancer&#46; It is the most sensitive and specific tumor marker for Small Cell Lung Cancer &#40;SCLC&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a> Squamous Cell Carcinoma Antigen &#40;SCC&#41; was originally extracted from cervical squamous cell carcinoma in&#160;1977 and is a sub-fragment of tumor-associated antigen TA-4&#44; widely presenting in the cytoplasm of squamous cell carcinomas of the uterus&#44; cervix&#44; lung&#44; head and neck&#44; etc&#46;&#44; especially in non-keratinizing carcinoma cells&#44; the content is more abundant&#46;<a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a> Related studies have shown that NSE and SCC in serum can predict the effect of chemotherapy in patients with lung cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> However&#44; there is still a lack of relevant research on the changes and clinical significance of NSE and SCC in serum in patients with lung cancer before and after radiotherapy&#46; Therefore&#44; the levels of NSE and SCC in serum in patients with lung cancer before and after radiotherapy were monitored and their clinical significance was discussed in this study&#46;</p></span><span id="sec0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0009">Materials and methods</span><span id="sec0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0010">Study population</span><p id="para0009" class="elsevierStylePara elsevierViewall">Lung cancer patients admitted to the present study&#39;s hospital from April&#160;2020 to March&#160;2021 were selected as the research subjects&#46; The inclusion criteria were as follows&#58; &#40;1&#41;&#160;All patients met the World Health Organization&#39;s diagnostic criteria for lung cancer and were diagnosed by imaging and pathological analysis&#59; &#40;2&#41;&#160;The Tumor Node Metastasis &#40;TNM&#41; staging ranges from&#160;IIb&#160;to&#160;III&#59; &#40;3&#41;&#160;With radiotherapy indications&#59; &#40;4&#41;&#160;Underwent radiotherapy with the same regimen&#59; &#40;5&#41;&#160;The survival period was more than&#160;3&#160;months&#59; &#40;6&#41;&#160;The patients and their families were informed and agreed&#46; The exclusion criteria were as follows&#58; &#40;1&#41;&#160;Physically intolerant&#59; &#40;2&#41;&#160;Combined with other malignant tumors&#59; &#40;3&#41;&#160;With severe heart&#44; liver&#44; kidney&#44; and other important organ dysfunction&#59; &#40;4&#41;&#160;Pregnant and lactating women&#46; According to the above inclusion and exclusion criteria&#44; a total of&#160;82&#160;patients were included in this study&#44; including&#160;50&#160;males and 32&#160;females&#59; age ranges from&#160;37&#160;to&#160;73&#160;years old&#44; with an average of &#40;55&#46;08&#177;9&#46;14&#41;&#160;years old&#59; TNM staging&#58; 45&#160;cases of stage&#160;II and&#160;37&#160;cases of stage&#160;III&#59; tumor types&#58; adenocarcinoma in&#160;35&#160;cases&#44; squamous cell carcinoma in&#160;29&#160;cases&#44; and small cell carcinoma in&#160;18&#160;cases&#46; Another&#160;54&#160;healthy volunteers examined in the hospital during the same period were selected as the control group&#44; with&#160;32&#160;males and&#160;22&#160;females&#44; with age ranges from&#160;35&#160;to&#160;74&#160;years old&#44; with an average age of &#40;54&#46;88&#177;9&#46;76&#41;&#160;years old&#46; The control group was informed and voluntarily participated in the research&#46; There was no significant difference in general data such as age and gender between the two groups &#40;p &#62; 0&#46;05&#41;&#44; which was comparable&#46;</p></span><span id="sec0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0011">Nursing method</span><p id="para0010" class="elsevierStylePara elsevierViewall">A total of&#160;82&#160;patients were randomly divided into an intervention group and routine group&#44; with&#160;41&#160;cases in each group&#46; The routine group received routine clinical care&#44; the main contents included health knowledge education before radiotherapy&#44; close monitoring of the patient&#39;s condition&#44; and a guide for treatment preparation&#46; Among them&#44; health education promotion includes basic knowledge of lung cancer&#44; treatment methods&#44; precautions for radiotherapy&#44; possible adverse reactions&#44; etc&#46;</p><p id="para0011" class="elsevierStylePara elsevierViewall">The intervention group was given comprehensive clinical intervention&#58; 24&#160;hours after the patient was admitted to the hospital&#44; the nursing staff explained the department system and specific situation to the patient and their family members&#44; introduced the hospital and ward environment to the patient&#44; and eliminated the discomfort of the patient to the unfamiliar environment&#46; Professional nurses carry out health knowledge education for patients&#44; including the pathogenesis of lung cancer&#44; influencing factors&#44; the necessity of radiotherapy&#44; the purpose of radiotherapy&#44; expected effects&#44; and possible adverse reactions during radiotherapy&#44; and teach patients emotional management content&#46; Additionally&#44; health education manuals are distributed to patients&#44; so that patients can fully understand the contents of lung cancer and treatment and make them aware of the importance of radiotherapy&#46; Apart from this&#44; the patient&#39;s family background and social background were investigated in order to better understand the patient&#39;s cognition of the disease&#44; and the targeted health education was carried out according to the cognition of different patients in nursing practice to strengthen patients&#39; understanding of radiotherapy&#46; During radiotherapy&#44; nurses closely monitored the patient&#39;s condition&#44; paid attention to the patient&#39;s psychological dynamics&#44; corrected cognitive errors in patients during radiotherapy&#44; and guided patients to actively and objectively evaluate their own state&#46; For the nervousness&#44; anxiety&#44; fear and other negative emotions of patients&#44; timely and effective psychological counseling was carried out to strengthen the emotional management of patients&#46; At the same time&#44; during radiotherapy&#44; scientific and reasonable dietary plans were formulated for patients&#46; For example&#44; nutritional intervention can be performed if necessary for patients with poor appetite&#44; and symptomatic treatment such as antiemetic treatment should be given to patients with severe vomiting&#46; Furthermore&#44; according to the actual situation&#44; the patients were given anti-infection&#44; anti-infection&#44; sleep aid&#44; and other symptomatic treatments&#46; Moreover&#44; ward nursing should be done well during radiotherapy&#44; including basic temperature and humidity control&#44; timely disinfection&#44; etc&#46;&#44; and keeping the room quiet&#46;</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0012">Measurement of NSE and SCC</span><p id="para0012" class="elsevierStylePara elsevierViewall">At the time of admission and after radiotherapy&#44; the cubital vein blood &#40;3&#160;mL&#41; was drawn from patients in the study group&#46; After centrifugation at&#160;2000&#160;r&#47;min for&#160;10&#160;min&#44; the upper serum was collected&#44; and NSE and SCC levels in the serum of the patients were measured by Enzyme-Linked Immunosorbent Assay &#40;ELISA&#41;&#46; The NSE and SCC kits were purchased from Wuhan Fein Biotechnology Co&#46;&#44; Ltd&#46;&#44; and the operation process was carried out in strict accordance with the kit instructions&#46;</p></span><span id="sec0006" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0013">Measurement of T lymphocyte subsets</span><p id="para0013" class="elsevierStylePara elsevierViewall">Before and after the intervention&#44; about&#160;3&#160;mL of cubital vein blood was drawn from the patients in the study group&#46; After anticoagulation treatment&#44; a monoclonal antibody was added and incubated at room temperature in the dark for&#160;20&#160;min&#44; then red blood cell lysate was added&#44; and the cells were protected from light for&#160;15&#160;min&#46; After centrifugation at&#160;2000&#160;r&#47;min for&#160;5&#160;min&#44; the supernatant was discarded&#44; and PBS buffer was added to mix well&#46; Finally&#44; the number of T lymphocyte subsets was determined by a cell analyzer &#40;BD FACSCanto&#44; USA&#41;&#46;</p></span><span id="sec0007" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0014">Follow-up</span><p id="para0014" class="elsevierStylePara elsevierViewall">The patients in the study group were followed up by telephone for&#160;1&#160;year after discharge&#44; and the follow-up time was until March&#160;31&#44; 2022&#46; According to tumor recurrence and metastasis&#44; they were divided into the recurrence and metastasis group &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;28&#41; and the non-recurrence and metastasis group &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;54&#41;&#46;</p></span><span id="sec0008" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0015">Statistical analysis</span><p id="para0015" class="elsevierStylePara elsevierViewall">The research data were imported into SPSS&#160;22&#46;0 software for statistical analysis&#46; The levels of serum NSE&#44; SCC and T lymphocyte subsets were expressed by mean&#160;&#177;&#160;standard deviation&#44; and the comparison was performed by Student&#39;s <span class="elsevierStyleItalic">t</span>-test&#46; The Receiver Operating Curve &#40;ROC&#41; was used to evaluate the predictive efficacy of NSE and SCC levels in serum after radiotherapy on the prognosis of patients&#46; A difference was considered significant when the p-value was less than&#160;0&#46;05&#46;</p></span></span><span id="sec0009" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0016">Results</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0017">Comparison of NSE and SCC levels in serum between the control group and research group at admission</span><p id="para0016" class="elsevierStylePara elsevierViewall">At admission&#44; the NSE and SCC levels in serum in the study group were significantly higher than those in the control group&#44; and the difference was statistically significant &#40;<span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001&#41;&#44; as shown in <a class="elsevierStyleCrossRef" href="#tbl0001">Table&#160;1</a>&#46;</p><elsevierMultimedia ident="tbl0001"></elsevierMultimedia></span><span id="sec0011" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0018">Changes of NSE and SCC levels in serum in the study group before and after radiotherapy</span><p id="para0017" class="elsevierStylePara elsevierViewall">After radiotherapy&#44; the NSE and SCC levels in the serum of the patients were significantly lower than those before radiotherapy &#40;<span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001&#41;&#44; as shown in <a class="elsevierStyleCrossRef" href="#tbl0002">Table&#160;2</a>&#46;</p><elsevierMultimedia ident="tbl0002"></elsevierMultimedia></span><span id="sec0012" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0019">Comparison of NSE and SCC levels in serum in patients with different prognoses</span><p id="para0018" class="elsevierStylePara elsevierViewall">After radiotherapy&#44; NSE and SCC levels in serum in the recurrence and metastasis group were significantly higher than those in the non-recurrence and metastasis group &#40;p&#160;&#61;&#160;0&#46;013&#44; 0&#46;008&#41;&#44; as seen in <a class="elsevierStyleCrossRef" href="#tbl0003">Table&#160;3</a>&#46;</p><elsevierMultimedia ident="tbl0003"></elsevierMultimedia></span><span id="sec0013" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0020">Predictive efficacy of NSE and SCC in serum on tumor recurrence and metastasis in lung cancer radiotherapy patients</span><p id="para0019" class="elsevierStylePara elsevierViewall">The ROC curve analysis showed that the AUC of NSE and SCC levels in serum for predicting tumor recurrence and metastasis in patients with lung cancer radiotherapy was&#160;0&#46;848&#160;and&#160;0&#46;755&#44; respectively&#44; the critical values were&#160;21&#46;98&#160;ng&#47;mL and 1&#46;59&#160;ng&#47;mL&#44; and the sensitivity was&#160;92&#46;86&#37; and&#160;82&#46;14&#37;&#44; and the specificity was&#160;82&#46;14&#37;&#44; 71&#46;87&#37;&#44; 62&#46;96&#37;&#44; as exhibited in <a class="elsevierStyleCrossRef" href="#fig0001">Fig&#46;&#160;1</a>&#46;</p><elsevierMultimedia ident="fig0001"></elsevierMultimedia></span><span id="sec0014" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0021">Comparison of NSE&#44; SCC and T lymphocyte subsets levels in serum before and after intervention</span><p id="para0020" class="elsevierStylePara elsevierViewall">After the intervention&#44; the NSE and SCC levels in the serum of the two groups were significantly lower than those before intervention &#40;<span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#44; the levels of CD4<span class="elsevierStyleSup">&#43;</span> and CD4<span class="elsevierStyleSup">&#43;</span>&#47;CD8<span class="elsevierStyleSup">&#43;</span> were obviously higher than those before intervention &#40;<span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#59; the CD8<span class="elsevierStyleSup">&#43;</span> level was not significantly different from that before the intervention &#40;p &#62; 0&#46;05&#41;&#59; The levels of serum NSE and SCC in the intervention group were significantly lower than those in the routine group&#44; and the levels of CD4<span class="elsevierStyleSup">&#43;</span> and CD4<span class="elsevierStyleSup">&#43;</span>&#47;CD8<span class="elsevierStyleSup">&#43;</span> were significantly higher than those in the routine group &#40;<span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#59; there was no significant difference in CD8<span class="elsevierStyleSup">&#43;</span> levels between the two groups compared with the routine group &#40;p &#62; 0&#46;05&#41;&#44; as seen from <a class="elsevierStyleCrossRef" href="#tbl0004">Table&#160;4</a>&#46;</p><elsevierMultimedia ident="tbl0004"></elsevierMultimedia></span></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0022">Discussion</span><p id="para0021" class="elsevierStylePara elsevierViewall">Lung cancer is one of the malignant tumors that threaten human life&#46; Although radiotherapy and chemotherapy of lung cancer have made breakthroughs in recent years&#44; which can prolong the life cycle of patients to a certain extent&#44; there is still a high risk of recurrence and metastasis after treatment&#44; which is the main reason for the poor prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a> In the occurrence and development process of tumor cells&#44; a series of tumor markers will be synthesized or released&#46; The existence or quantitative changes of such markers can effectively reflect the occurrence&#44; cell differentiation&#44; and function of tumors&#44; so as to provide basis and guidance for clinical diagnosis and effective treatment of tumors&#44; as well as the further prediction of prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a> NSE is enolase involved in the glycolytic pathway&#44; mainly found in neural and neuroendocrine tissues&#46; Wang&#39;s team found that NSE is useful for predicting liver metastasis of lung cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a> Bai&#39;s team found that NSE has a certain value in judging the prognosis of lung cancer patients&#46;<a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a> SCC is a squamous cell carcinoma antigen&#44; its main component is a glycoprotein&#44; which belongs to the tumor-associated antigen TA-4 subtype&#46; SCC mainly exists in squamous cell carcinoma&#44; with the most abundant content in lung cancer and uterine cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a> Yang<a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a> research group found that SCC has certain clinical value for the diagnosis of lung cancer&#46; The Cho<a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a> research group found that SCC is closely related to the prognosis of lung cancer patients&#46; Based on the above research&#44; this study evaluated the changes in NSE and SCC levels in patients with lung cancer before and after radiotherapy&#44; in order to more accurately evaluate the effect of radiotherapy and provide theoretical guidance for prognosis evaluation and further treatment&#46;</p><p id="para0022" class="elsevierStylePara elsevierViewall">The results showed that the levels of serum NSE and SCC in the study group were significantly higher than those in the control group&#44; suggesting that NSE and SCC were related to the occurrence of lung cancer&#44; which was consistent with the results of previous studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0018"><span class="elsevierStyleSup">18-19</span></a> The results showed that the levels of NSE and SCC decreased significantly after radiotherapy&#44; suggesting that radiotherapy can improve the levels of NSE and SCC&#44; which may be attributed to the killing and inhibitory effects of radiotherapy on tumors&#44; further reducing the malignancy of tumors&#46; The results showed that the levels of NSE and SCC in the recurrence and metastasis group were significantly higher than those in the non-recurrence and metastasis group&#44; indicating that the levels of NSE and SCC were closely related to tumor recurrence and metastasis&#46; It is speculated that the tumor metabolism level in lung cancer patients with recurrence and metastasis is high&#44; which can promote the combination and release of NSE and SCC&#46; Further ROC curve analysis showed that the AUC of NSE and SCC levels for predicting tumor recurrence and metastasis in Lung cancer radiotherapy patients was&#160;0&#46;848&#160;and&#160;0&#46;755&#44; the critical value was&#160;21&#46;98&#160;ng&#47;mL and&#160;1&#46;59&#160;ng&#47;mL&#44; the sensitivity was&#160;92&#46;86&#37; and&#160;82&#46;14&#37;&#44; and the specificity was&#160;71&#46;87&#37; and&#160;62&#46;96&#37;&#44; respectively&#46; The above results suggested that NSE and SCC levels in serum can initially predict the prognosis of patients with lung cancer radiotherapy patients&#46; However&#44; the specificity of SCC is low&#44; other indicators can be considered for comprehensive prediction in the later stage&#46;</p><p id="para0023" class="elsevierStylePara elsevierViewall">In this study&#44; lung cancer patients were treated with routine nursing care and comprehensive clinical intervention&#46; The results showed that after the intervention&#44; the NSE and SCC levels in the serum of the two groups of patients were significantly lower than those before the intervention&#44; and the levels of CD4<span class="elsevierStyleSup">&#43;</span> and CD4<span class="elsevierStyleSup">&#43;</span>&#47;CD8<span class="elsevierStyleSup">&#43;</span> were apparently higher than those before the intervention&#59; CD8<span class="elsevierStyleSup">&#43;</span> level was not significantly different from that before intervention&#46; Besides&#44; the NSE and SCC levels in serum in the intervention group were significantly lower than those in the conventional group&#44; the levels of CD4<span class="elsevierStyleSup">&#43;</span> and CD4<span class="elsevierStyleSup">&#43;</span>&#47;CD8<span class="elsevierStyleSup">&#43;</span> were obviously higher than those in the conventional group&#46; There was no apparent difference in CD8<span class="elsevierStyleSup">&#43;</span> levels between the two groups&#46; The above results show that effective clinical intervention can improve the NSE and SCC levels in serum in lung cancer patients and reduce the inhibitory effect of radiotherapy on the immune function of the body to a certain extent&#46;</p><p id="para0024" class="elsevierStylePara elsevierViewall">In conclusion&#44; NSE and SCC levels in serum can effectively reflect the radiotherapy effect of lung cancer patients and show a certain predictive value for the prognosis effect after radiotherapy&#44; providing information for the clinical radiotherapy effect and prognosis&#44; and the basis and guidance for further clinical treatment&#46; Nevertheless&#44; the detection of a single indicator may be insufficient&#44; and the combined detection of multiple indicators should be considered in actual clinical practice&#46; Importantly&#44; effective clinical intervention for radiotherapy patients can effectively enhance the therapeutic effect and alleviate the immunosuppression caused by radiotherapy&#46;</p></span><span id="sec0016" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0023">Ethics Committee Statement</span><p id="para0025" class="elsevierStylePara elsevierViewall">The authors have no Clinical Trial registration number because According to the regulations of our affiliation&#44; the present research only needs the approval of our own affiliation to conduct research&#44; but the study was approved by the ethics committee of The First People&#39;s Hospital of Lianyungang &#40;n&#176;&#160;20200306&#41;&#46;</p></span><span id="sec0017" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0024">Authors&#8217; contributions</span><p id="para0026" class="elsevierStylePara elsevierViewall">Substantial contributions to the conception or design of the work&#59; or the acquisition&#44; analysis&#44; or interpretation of data for the work&#58; Lulu Sun&#44; Qing Shao&#46;</p><p id="para0027" class="elsevierStylePara elsevierViewall">Drafting the work or revising it critically for important intellectual content&#58; Lulu Sun&#44; Qing Shao&#46;</p><p id="para0028" class="elsevierStylePara elsevierViewall">Final approval of the version to be published&#58; Lulu Sun&#44; Qing Shao&#46;</p></span></span>"
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          "titulo" => "Introduction"
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          "titulo" => "Materials and methods"
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              "titulo" => "Study population"
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              "titulo" => "Nursing method"
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              "identificador" => "sec0005"
              "titulo" => "Measurement of NSE and SCC"
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              "titulo" => "Measurement of T lymphocyte subsets"
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            4 => array:2 [
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              "titulo" => "Comparison of NSE and SCC levels in serum between the control group and research group at admission"
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              "identificador" => "sec0011"
              "titulo" => "Changes of NSE and SCC levels in serum in the study group before and after radiotherapy"
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              "titulo" => "Comparison of NSE and SCC levels in serum in patients with different prognoses"
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              "titulo" => "Predictive efficacy of NSE and SCC in serum on tumor recurrence and metastasis in lung cancer radiotherapy patients"
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              "titulo" => "Comparison of NSE&#44; SCC and T lymphocyte subsets levels in serum before and after intervention"
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    "highlights" => array:2 [
      "titulo" => "Highlights"
      "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><p id="spara007" class="elsevierStyleSimplePara elsevierViewall"><ul class="elsevierStyleList" id="celist0001"><li class="elsevierStyleListItem" id="celistitem0001"><span class="elsevierStyleLabel">&#8226;</span><p id="para0001" class="elsevierStylePara elsevierViewall">The aim is to explore NSE and SCC in patients with lung cancer before and after radiotherapy&#46;</p></li><li class="elsevierStyleListItem" id="celistitem0002"><span class="elsevierStyleLabel">&#8226;</span><p id="para0002" class="elsevierStylePara elsevierViewall">Total of&#160;82&#160;patients with lung cancer were selected as the study group&#46;</p></li><li class="elsevierStyleListItem" id="celistitem0003"><span class="elsevierStyleLabel">&#8226;</span><p id="para0003" class="elsevierStylePara elsevierViewall">NSE and SCC levels can preliminarily evaluate the effect of radiotherapy&#46;</p></li></ul></p></span>"
    ]
    "resumen" => array:1 [
      "en" => array:3 [
        "titulo" => "ABSTRACT"
        "resumen" => "<span id="abss0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0003">Objective</span><p id="spara008" class="elsevierStyleSimplePara elsevierViewall">To explore the changes and clinical significance of serum Neuron-Specific Enolase &#40;NSE&#41; and Squamous Cell Carcinoma antigen &#40;SCC&#41; in patients with lung cancer before and after radiotherapy&#46;</p></span> <span id="abss0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">Methods</span><p id="spara009" class="elsevierStyleSimplePara elsevierViewall">82&#160;patients with lung cancer were treated with radiotherapy&#44; and effective clinical intervention was given during the radiotherapy process&#46; The patients were followed up for&#160;1&#160;year after radiotherapy and were divided into a recurrence and metastasis group &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;28&#41; and a non-recurrence and metastasis group &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;54&#41; according to their prognosis&#46; Another&#160;54&#160;healthy volunteers examined in the present study&#39;s hospital during the same period were selected as the control group&#46; To compare the changes of NSE and SCC levels in serum in patients with lung cancer at admission and after radiotherapy&#44; and to explore their clinical significance&#46;</p></span> <span id="abss0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0005">Results</span><p id="spara010" class="elsevierStyleSimplePara elsevierViewall">After intervention&#44; NSE and SCC levels in the serum of the two groups of patients were significantly lower than those before intervention&#44; and the levels of CD4<span class="elsevierStyleSup">&#43;</span> and CD4<span class="elsevierStyleSup">&#43;</span>&#47;CD8<span class="elsevierStyleSup">&#43;</span> were significantly higher than those before intervention &#40;<span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#59; the level of CD8<span class="elsevierStyleSup">&#43;</span> was not significantly different from that before intervention &#40;p &#62; 0&#46;05&#41;&#46; And NSE and SCC levels in the intervention group were significantly lower than those in the routine group&#44; the levels of CD4<span class="elsevierStyleSup">&#43;</span>&#44; CD4<span class="elsevierStyleSup">&#43;</span>&#47;CD8<span class="elsevierStyleSup">&#43;</span> were significantly higher than those in the routine group &#40;<span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#41;&#46;</p></span> <span id="abss0006" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0006">Conclusion</span><p id="spara011" class="elsevierStyleSimplePara elsevierViewall">NSE and SCC in serum can preliminarily evaluate the effect of radiotherapy in patients with lung cancer and have a certain predictive effect on prognosis&#46;</p></span>"
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        ]
      ]
    ]
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          0 => array:4 [
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          "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">ROC curves of NSE and SCC in serum on tumor recurrence and metastasis in lung cancer radiotherapy patients&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0001"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Groups&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">NSE &#40;ng&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0003"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">SCC &#40;ng&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0004"></a><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="top">Study group &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0005"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">37&#46;66 &#177; 9&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0006"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;72 &#177; 0&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0007"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Control group &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;54&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0008"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">10&#46;14 &#177; 2&#46;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0009"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;67 &#177; 0&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0010"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">t</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0011"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">21&#46;242&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0012"></a><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="top">29&#46;766&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0013"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0014"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0015"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001&nbsp;\t\t\t\t\t\t\n
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            "detalle" => "Table "
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        "tabla" => array:1 [
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              "tabla" => array:1 [
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0016"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Time&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">NSE &#40;ng&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0018"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">SCC &#40;ng&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0019"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Before radiotherapy &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0020"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">37&#46;66 &#177; 9&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0021"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;72 &#177; 0&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0022"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">After radiotherapy &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0023"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">25&#46;33 &#177; 7&#46;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0024"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;56 &#177; 0&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0025"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">t</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0026"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">9&#46;391&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0027"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;414&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0028"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0029"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0030"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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        "tabla" => array:1 [
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0031"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Prognosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0032"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">NSE &#40;ng&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0033"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">SCC &#40;ng&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0034"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Recurrence and metastasis &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0035"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">27&#46;32 &#177; 5&#46;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0036"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;71 &#177; 0&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0037"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Non-recurrence and metastasis &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;54&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0038"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">24&#46;30 &#177; 4&#46;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0039"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1&#46;48 &#177; 0&#46;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0040"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">t</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0041"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;540&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0042"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;737&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0043"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0044"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0045"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Intervention group &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;41&#41;</th><a name="en0048"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Routine group &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;41&#41;</th></tr><tr title="table-row"><a name="en0050"></a><th class="td" title="\n
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                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Before intervention&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">After intervention&nbsp;\t\t\t\t\t\t\n
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Article information

ISSN: 18075932
Original language: English

DOI:10.1016/j.clinsp.2022.100135

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