***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The prognostic value of immunosuppressive acidic protein ( IAP ) , which is known to suppress various immune responses in cancer patients , was studied in a prospect i ve r and omized trial of advanced gastric cancer patients , design ed to evaluate the effect of PSK , a kind of biological response modifier with protein-bound polysaccharides . Preoperative serum IAP levels were determined in 228 patients who received radical gastric resection and tests conducted in one laboratory by the single radial immunodiffusion ( SRID ) method . All patients were followed up for 24 months or more . There was an overall significant difference in disease-free survival time in favour of the PSK-treated group compared with the control group . Preoperative IAP values were strongly associated with disease-free survival time . The statistical analysis to define an appropriate cut-off level for IAP was performed using Cox 's proportional hazards model . The most significant difference was observed at the threshold value of 580 μg/ml , the hazard ratio being 2.13 with a 95 % confidence interval [ 1.17 , 3.88 ] ( P=0.013 ) . Patients in the PSK-treated group with a preoperative IAP of lower than 580 μg/ml showed improved disease-free survival ( P=0.029 ) , however , no significant difference was seen between the two groups when the preoperative IAP exceeded the threshold level . From these results , 580 μg/ml is postulated to be the most appropriate threshold value for predicting the prognosis of advanced gastric cancer patients , and it is suggested that PSK would be most effective in patients whose preoperative IAP level is lower than the threshold level Protein-bound polysaccharide K ( PSK ) increased the 5-year disease-free survival rate and reduced the risk of recurrence in a r and omised , controlled study for stage II and III colorectal cancer . In order to eluci date the disease-free survival benefits with PSK and what immunological markers could indicate a PSK responder , serial changes in immunological parameters were monitored in the study . PSK decreased the mean serum immunosuppressive acidic protein ( IAP ) level , and increased the mean population of natural killer ( NK ) cells compared with the controls . The 5-year disease-free and overall survival rate for patients with serum IAP values < or=500 microg ml(-1 ) , which represents the normal value , were 75.5 % ( 95 % CI : 66.8 - 84.2 % ; p=0.016 ) and 85.1 % ( 95 % CI : 77.9 - 92.3 % ; p=0.032 ) , respectively , in the  PSK group compared with 57.5 % ( 95 % CI : 43.3 - 71.6 % ) and 70.2 % ( 95 % CI : 57.1 - 83.3 % ) in the control group . In patients with NK cell population > or=8 % at 3 months after surgery , PSK conferred a significantly better ( p=0.038 ) 5-year disease-free survival ( 86.7 % ; 95 % CI : 74.5 - 98.8 % ) compared to the control group ( 60.0 % ; 95 % CI : 29.6 - 90.4 % ) . In the proportional hazards model , the presence of regional metastases ( relative risk , 3.595 ; 95 % CI : 1.518 to 8.518 ; p=0.004 ) and omission of PSK treatment ( relative risk , 3.099 ; 95 % CI : 1.202 to 7.990 ; p=0.019 ) were significant indicators of recurrence . PSK acts as an immunomodulatory activity and biochemical modulator in stage II or III colorectal cancer . Pre-operative serum IAP values < or=500 microg ml(-1 ) and an NK cell population > or=8 % at 3 months after surgery are possible PSK response predictors Intravenous fluorouracil and leucovorin is the st and ard adjuvant treatment for stage III colon cancer . However , oral adjuvant chemotherapy is attractive because it has low toxicity and greater convenience . We investigated the benefits of oral protein-bound polysaccharide K ( PSK ) with tegafur/uracil ( UFT ) as an adjuvant in stage II and III colorectal cancer . Patients were assigned to groups that received either 3 g PSK plus 300 mg UFT , or 300 mg UFT alone orally each day for a 2-year period following intravenous mitomycin C. Of 207 registered patients , 205 with stage II ( n=123 ) or III ( n=82 ) were analysed .  The 5-year disease-free survival was 73.0 % ( 95 % CI 65.6–80.4 % ) with PSK ( n=137 ) and 58.8 % ( 95 % CI 47.1–70.5 % ) in the controls ( n=68 ) ( P=0.016 ) . Polysaccharide K reduced the recurrence by 43.6 % ( 95 % CI 4.5–66.7 % ) and mortality by 40.2 % ( 95 % CI −12.5 to 68.3 % ) . The 5-year survival was 81.8 % ( 95 % CI 75.3–88.2 % ) in the PSK group and 72.1 % ( 95 % CI 61.4–82.7 % ) in the control group ( P=0.056 ) . In stage III patients , disease-free and overall survivals in patients receiving PSK were increased significantly : 60.0 % ( 95 % CI 47.1–72.9 % ) and 74.6 % ( 95 % CI 63.0–86.1 % ) in the PSK group as compared with 32.1 % ( 95 % CI 14.8–49.4 % ) and 46.4 % ( 95 % CI 28.0–64.9 % ) in the controls ( P=0.002 and 0.003 , respectively ) . Polysaccharide K prevented recurrence , particularly lung metastases ( P=0.02 ; odds ratio 0.27 ; 95 % CI 0.09–0.77 ) . In the models , the presence of regional metastases ( relative risk , 2.973 ; 95 % CI 1.712–5.165 ; P<0.001 ) , omission of PSK ( relative risk , 2.106 ; 95 % CI 1.221–3.633 ; P=0.007 ) , and higher primary tumour ( relative risk , 4.398 ; 95 % CI 1.017–19.014 ; P=0.047 ) were each significant indicators of recurrence . Adverse effects were mild and compliance was good . Oral PSK with UFT reduced recurrence in stage II and III colorectal cancer , and increased survival in stage III Background Protein-bound polysaccharide ( PSK ) is derived from the CM-101 strain of the fungus Coriolus versicolor and has shown anticancer activity in vitro and in in vivo experimental models and human cancers . Several r and omized clinical trials have demonstrated that PSK has great potential in adjuvant cancer therapy , with positive results in the adjuvant treatment of gastric , esophageal , colorectal , breast and lung cancers . These studies have suggested the efficacy of PSK as an immunomodulator of biological responses . The precise molecular mechanisms responsible for its biological activity have yet to be fully eluci date d. Methods The in vitro cytotoxic anti-tumour activity of PSK has been evaluated in various tumour cell lines derived from leukaemias , melanomas , fibrosarcomas and cervix , lung , pancreas and gastric cancers .  Tumour cell proliferation in vitro was measured by BrdU incorporation and viable cell count . Effect of PSK on human peripheral blood lymphocyte ( PBL ) proliferation in vitro was also analyzed . Studies of cell cycle and apoptosis were performed in PSK-treated cells . Results PSK showed in vitro inhibition of tumour cell proliferation as measured by BrdU incorporation and viable cell count . The inhibition ranged from 22 to 84 % . Inhibition mechanisms were identified as cell cycle arrest , with cell accumulation in G0/G1 phase and increase in apoptosis and caspase-3 expression . These results indicate that PSK has a direct cytotoxic activity in vitro , inhibiting tumour cell proliferation . In contrast , PSK shows a synergistic effect with IL-2 that increases PBL proliferation . Conclusion These results indicate that PSK has cytotoxic activity in vitro on tumour cell lines . This new cytotoxic activity of PSK on tumour cells is independent of its previously described immunomodulatory activity on NK cells Background : Despite the small but significant survival benefit of adjuvant chemotherapy in locally advanced gastric cancer ( LAGC ) , the optimal regimen remains to be determined . We conducted a r and omized trial comparing oral ( PO ) chemoimmunotherapy ( CITX ) with intravenous ( IV ) CITX in LAGC patients ( stages IB-IIIB ) with curative resection ( ≥ D2 dissection ) . Methods : The patients were r and omized to the IV ( 5-fluorouracil 500 mg/m2 weekly for 24 weeks , mitomycin-C 8 mg/m2 every 6 weeks × 4 ) or the PO ( uracil-ftorafur ( UFT ) 400 - 600 mg/day for 12 months ) group . Patients in both groups received PO polysaccharide-K ( 3 g/day for 4 months ) . The planned number of patients was 368 for proving the non-inferiority of PO CITX compared to IV CITX for overall survival . Results : The trial was closed prematurely after enrolling 82 patients ( 44 in the IV group , 38 in the PO group ) . With a median follow-up of 82 months , there were no significant differences in the 5-year disease-free survival ( 73 % vs. 55 % , p = 0.358 ) and overall survival ( 77 % vs. 66 % , p = 0.159 ) between the 2 groups . The IV group demonstrated a higher incidence of grade 2 or 3 neutropenia , thrombocytopenia , and vomiting . Conclusions : PO CITX with UFT appeared to be at least non-inferior to 5-fluorouracil and mitomycin-C CITX , with lower toxicity in the adjuvant treatment for LAGC Summary To examine the clinical efficacy and the mechanism of action of polysaccharide K ( PSK ) , a proteinbound polysaccharide extracted from a Basidiomycetes fungus , a r and omized double-blind trial was performed by administering  PSK to 56 patients and a placebo to another group of 55 patients after surgical operations on their colorectal cancers . The rate of patients in remission ( or disease-free ) was significantly higher in the PSK group than in the placebo group ; the difference between both groups was statistically significant atP < 0.05 by the logrank test . The survival rate of patients was also significantly ( P < 0.05 ) higher in the PSK group than in the control group . The most significant laboratory finding was that polymorphonuclear leukocytes from PSK-treated patients showed remarkable enhancement in their activities , such as r and om and /or chemotactic locomotion , and phagocytic activity , when compared with those in the control group . In conclusion , PSK was useful as a maintenance therapy for patients after their curative surgical operations for colorectal cancer . The beneficial effects were probably due to the activation of leukocyte functions as one of the many biological-response-modifying ( activities induced by PSK ) Abstract PURPOSE : Intravenous fluorouracil and leucovorin for six to eight months is currently a st and ard adjuvant treatment for Stage III colon cancer ; however , this regimen is complex , inconvenient , and has a high intolerability . Adjuvant chemotherapies are cl aim ed for objective response rates with an acceptable safety profile and complexity . We investigated the benefits of oral protein-bound polysaccharide K added to oral tegafur/uracil on curatively resected Stage II or III colorectal cancer . METHODS : We prospect ively r and omized 207 patients to treatments of either oral 3.0 g protein-bound polysaccharide K plus 300 mg tegafur/uracil or 300 mg tegafur/uracil alone for two years following 12 mg/m2 and 8 mg/m2 mitomycin treatment on postoperative Days 1 and 2 , respectively . The primary end points were disease-free and overall survival , and recurrence rates . RESULTS : Three ( 1.4 percent ) patients were declared ineligible , and three patients did not start treatment . In total , 201 patients were analyzed . The three-year , disease-free survival rate was 80.6 percent ( st and ard error = 3.4 percent ) in the protein-bound polysaccharide K group ( P = 0.02 ) compared with 68.7 percent ( SE = 5.7 percent ) in the control group after a median follow-up of 3.7 years . The estimated relative risk of recurrence in the control group was 1.87 ( 95 percent confidence interval , 1.10–3.20 ) at three years 
    Output:
    
PSK treatment significantly increased 1 - 5 year OS and result ed in positive trends in 6 - 7 year OS ; significant increases were also found in 1 - 7 year DFS , while no increase in side effects was observed .
Significant efficacy outcomes obvious in colorectal and gastric cancer groups , as well as PSK combined with chemotherapy groups ( iv , po , iv+po ) .
Network meta- analysis revealed that PSK combined with chemotherapy was superior , with significantly increased 3-year and 5-year OS .
The study is registered with PROSPERO ( CRD42017065193 ) Conclusions : The adjuvant immunochemotherapy agent PSK is effective and safe for patients with GIC .
PSK combined with chemotherapy appears to be the preferred application of PSK