br Materials and methods br Results br Discussion
Materials and methods
Discussion Although EMT can be induced by different factors under exogenous stimuli, it is intriguing to consider whether these EMT inducers are redundant because of their mechanistic similarity in EMT induction. The interplay and underlying mechanism between EMT regulators during metastatic cholesterol absorption inhibitor remain elusive. Our results show that SIN3A is regulated by Twist1 through miR-29. Since SIN3A is a critical co-repressor in Snail-suppressed target genes, our finding suggests that miR-29-regulated SIN3A may play a critical role in the interplay between Snail and Twist1.
Conflict of interest
Acknowledgments This study is supported by the grant of Ministry of Science and Technology, Taiwan (103-2811-B-010-024). The authors declare no competing financial interests in this study.
Introduction In Taiwan, hematologic malignancies have become increasingly prevalent during recent decades, especially non-Hodgkin lymphoma. According to a report from the Taiwan Cancer registry, more than 80% of non-Hodgkin lymphoma patients suffered from the B-cell type disease. Since its approval by the Taiwan FDA in 2002, rituximab had been the most commonly prescribed drug used in combination with multi-agent chemotherapy for most patients with CD20-positive B-cell lymphoma. In the United States, based upon “real world” investigation, patient survival outcome significantly improved in the post-rituximab era; yet this new era has caused moving target-like results when trying to predict the prognosis of patients with lymphoma. While earlier models relied mainly on disease character, host character, and biomarker models, there was a distinct lack of socioeconomic models used to assess patient survival. In the pre-rituximab era, a growing body of literature suggests a persistent positive relationship existed between socioeconomic status (SES) and health status, with high SES correlating with better survival outcome in lymphoma, including Hodgkin and non-Hodgkin types. But the impact of SES on lymphoma survival in the post-rituximab era remains unconfirmed. SES is thought to impact cancer survival via various mechanisms, which was briefly divided into those aspects of disease or host, including but not limited to delayed diagnosis, differential health-seeking behavior, access to care, and the presence of co-morbid conditions, among other factors. According to a previous study focusing on patient SES, insurance coverage played an important role in health inequity. However, universal health coverage in Taiwan might have eliminated the practice of altering treatment modalities among patients with different SES. Otherwise, to limit the proxies of SES, several studies have explored the combined or cross-level interaction effect of individual SES and neighborhood SES in several malignancies; however, several of these studies have shown conflicting results. To date, there has been no large-scale study which explored the combined effect of individual and neighborhood SES on lymphoma.
Materials and methods
Discussion Our study had a number of strengths. First, it was a large nationwide population-based follow-up study, with nearly complete follow-up information about access to healthcare institutions by the entire study population (99%). The dataset was also routinely monitored for diagnostic accuracy by the National Health Insurance Bureau of Taiwan. Therefore, the data set was more generalized and truly reflected clinical practice in the real world, with minimal selection bias. Second, a large majority of the earlier research studied SES in patients aged 65 and older, before the era of rituximab, or in specific categories, just like patients with Hodgkin lymphoma or follicular lymphoma. Those results require validation in a cohort of the overall population. Our series didn\'t have any limitation in age and disease entity. Third, we focused on the role of SES and lymphoma survival in the post-rituximab era, and the results definitely reflected the real world circumstances of our current practice. Fourth, the combined effects of individual and neighborhood SES might eliminate the ordinary limitation of each proxy. We observed the prominent effects of combined SES on the overall survival of patients with lymphoma, and the result was not conflict between different proxies.