Impact of the adjuvant management and risk factors on survival in FIGO stage 3 endometrial cancer patients
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Patients with FIGO stage III endometrial cancer routinely receive adjuvant therapy. The purpose of this study was to evaluate overall survival (OS) and disease-free survival (DFS) in patients with stage IIIA to IIIC2 patients by treatment modality received and risk factors.Patients with stage III endometrial cancer treated from 2000-2010 were identified in the provincial cancer registry. Clinicopathologic characteristics, adjuvant treatments and outcomes were compared using descriptive and multivariable analyses.261 patients had stage 3 endometrial cancer, 132 with stage IIIA, 9 with IIIB, 85 with IIIC1 and 35 with IIIC2. 39 had FIGO grade 1 disease; 73, grade 2; 147, grade 3. 160 had endometrioid and 35 had serous carcinoma. 161 patients received sequential adjuvant chemotherapy (CT) and radiotherapy (RT); 33 received RT only; 32 received CT only; 35 received neither. 5-year (5Y) DFS and OS were similar among stage IIIA (DFS 46.7%, OS 58.5%), IIIB (DFS 50.8%, OS 58.5%), IIIC1 (DFS 44%, OS 49.9%) and IIIC2 (DFS 42%, OS 41.6%). Use of adjuvant RT was associated with improved median DFS (53.7 vs 14.7m, p<0.00001) and OS (61.9 vs 25.7m, p<0.00001) compared to no RT. Likewise, use of adjuvant CT was also associated with improved DFS (54.8 vs 16.5m, p<0.00001) and OS (62.9 vs 26.5m, p<0.00001) compared to no CT. Those who received both chemotherapy and radiotherapy had better outcomes with 5-year DFS (58.3%) and OS (65.2%), compared with those who received monotherapy. On multivariate analysis, grade 3 disease, deep myometrial invasion >50%, and no adjuvant RT or CT were identified as adversely impacting DFS and OS.In stage III endometrial cancer patients, use of both chemotherapy and radiation therapy was associated with improved DFS and OS and therefore should be recommended in all eligible patients after resection.Keywords:
Adjuvant Therapy
Adjuvant Therapy
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Adjuvants are a critical component for vaccines, especially for a poorly immunogenic antigen, such as nicotine. However, the impact of adjuvant release rate from a vaccine formulation on its immunogenicity has not been well illustrated. In this study, we fabricated a series of hybrid-nanoparticle-based nicotine vaccines to study the impact of adjuvant release rate on their immunological efficacy. It was found that the nanovaccine with a medium or slow adjuvant release rate induced a significantly higher anti-nicotine antibody titer than that with a fast release rate. Furthermore, the medium and slow adjuvant release rates resulted in a significantly lower brain nicotine concentration than the fast release rate after nicotine challenge. All findings suggest that adjuvant release rate affects the immunological efficacy of nanoparticle-based nicotine vaccines, providing a potential strategy to rationally designing vaccine formulations against psychoactive drugs or even other antigens. The hybrid-nanoparticle-based nicotine vaccine with an optimized adjuvant release rate can be a promising next-generation immunotherapeutic candidate against nicotine.
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Using the self-made Nano aluminum hydroxide as adjuvant,we immunized broilers with H5N1 vacine.As age increased,oil-adjuvant vaccine was absorbed,which left yellow traces.Nano adjuvant was absorbed quickly,and there were no yellow traces left.Alter 49 days,no inflammatory cells were observed in the nano adjuvant injected area except some around the blood capillarie.Inflammatory cells in the conventional aluminum group were also significantly reduced,while the oil group still had a lot of inflammatory cells observed in the injection area.Compared with oil adjuvant,nano adjuvant can reduce the side effects.
Vaccine adjuvant
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Endometrial cancer is the most common malignancy of the female genital tract. Surgical treatment includes hysterectomy, bilateral salpingo-oophorectomy, and an appropriate staging procedure. Relapse of endometrial cancer may occur in patients with high risk factors, such as old age, grade 3 cancer, deep myometrial invasion, and papillary serous and clear cell types. In recent years, several randomized trials reported the results of adjuvant therapy for patients with high risk factors. Nonetheless, some controversies still exist. This paper presents and discusses the results of important randomized trials of adjuvant therapy for endometrial cancer with risk factors.
Adjuvant Therapy
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Electrostatic interactions and phosphate exchange are the most important mechanisms for the adsorption of antigens onto aluminum-containing adjuvant. But the immunogenicity of the final vaccine is not proportional to the amount and the adsorption strength of antigens onto aluminum-containing adjuvant. The stability of aluminum adjuvant would be decreased while it is stored in room temperature. However, it does not affect immune enhancement activity. Usually, aluminum adjuvant should avoid exposure to elevated temperature in long time, and buffer salts such as phosphate could be used to protect vaccines containing aluminum adjuvant. Now the new formulation of aluminum-adjuvanted vaccine dry powder can increase the stability of vaccines. This review describes recent studies on the interaction between aluminum adjuvant and antigens, the stability of vaccines containing aluminum adjuvant and the development tendency of aluminum adjuvant.
Vaccine adjuvant
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Adjuvant Therapy
Gynecologic cancer
Clinical Practice
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An adjuvant (immunopotentiator), when added to a vaccine, will enhance the immunogenicity of the antigen with the stimulation of an elevated humoral immune response. Some adjuvants may also stimulate a cell-mediated response against the antigen. One advantage of including an adjuvant in the vaccine mixture is that smaller quantities of the antigen are usually required to stimulate a good response. New synthetic experimental vaccines may require the presence of an adjuvant to achieve an immunogenic response. There is no single universal adjuvant, but numerous adjuvants are available alone (e.g., muramyl dipeptide and Quil A derivatives), or conjugated to the antigen (e.g., Immune-stimulating complexes [ISCOMs]), or in mixtures (e.g., Montanides, Guildhay or MF-59 adjuvants). The adjuvant selected will be based on experimental data produced with a variety of antigen preparations, taking into consideration the nature and dose to be administered, the route of vaccine administration, and any contraindications. For human vaccines, it should be remembered that aluminum salt adjuvants have been the only licensed preparations for the past sixty yr.
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The adjuvant effects of CFNCpG on the humoral immune response of rabbits were investigated on the CFNCpG,Freund's complete adjuvant and aluminium hydroxide.An inactivated BVDV-1 was served as antigen.The neutralizing antibody titers were tested every 7 days after immunization to evaluate the immune adjuvant effects of CFNCpG on antigen of inactivated BVDV-1.The results showed that the antibody titer was 4.4(log_2SN_)(50))7 days and more than 7.0 14 days after CFNCpG was used as adjuvant alone. When CFNCpG combined with aluminium hydroxide was used as adjuvants,the antibody titer was higher than 7.0 after 21 days which was equal to the adjuvant effects of Freund's complete adjuvant.The CFNCpG is a useful adjuvant component in BVDV-1 inactivated vaccine in further research.
Antibody titer
Aluminium hydroxide
Antibody response
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Adjuvant Therapy
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Vaccine adjuvant
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