Background/Aims: The chitinase 3-like 1 (CHI3L1) has an important role in cancer progression, and high CHI3L1 expression is associated with the development and progression of cancers. Previous studies had been controversial with respect to the association between CHI3L1 expression and lung cancer prognosis. Thus, we performed a meta-analysis to investigate the prognostic value of CHI3L1 expression in lung cancer. Methods: We searched Pubmed, Embase, and Wanfang databases to identify eligible studies. Overall survival and disease free survival were collected from included studies. Pooled hazard ratios (HRs) with 95% confidence interval (95%CI) were calculated to estimate the association. Seven studies comprising 911 lung cancer patients were included in this meta-analysis. Results: The results showed high CHI3L1 expression was independently associated with poorer overall survival in lung cancer patients (HR = 1.71, 95%CI 1.24-2.37, P = 0.001). Subgroup analysis by histological type showed that high CHI3L1 expression was independently associated with poorer overall survival in both non small-cell lung cancer patients (HR = 2.23,95%CI 1.43-3.47, P < 0.001) and small-cell lung cancer patients (HR = 1.45, 95%CI 1.06-2.00, P = 0.021). In addition, sensitivity analysis by omitting single study by turns did not change the pooled outcomes obviously. Conclusion: Our results suggest that elevated serum CHI3L1 concentration is an independent prognostic biomarker for poorer survival in lung cancer patients.

Hemophagocytic lymphohistiocytosis (HLH) has been recognized as a potentially life-threatening syndrome. This is the first case of acquired HLH caused by dual infections with Candida albicans and reactivated EBV infections, which focuses on the importance of morphological awareness of peripheral blood and bone marrow because sometimes they are the only locations that HLH and fungal microorganisms can be diagnosed. A 29-year-old woman with a history of abdominal distension and 9 months of intermittent fevers ($38.8°C) was admitted to the hematology department with treatment for leukopenia and thrombocytopenia. Severe infection of bilateral pulmonary and marked hepatosplenomegaly were detected by computed tomography. EB virus-CA IgG, EB virus-NA IgG and EB virus-CA IgM were positive. Scattered yeast-like fungi were found on peripheral blood and bone marrow (BM) smears. BM smears indicated prominent hemophagocytosis. Cultures of bronchoalveolar lavage and BM confirmed the growth of C. albicans. A diagnosis of HLH caused by dual infections with Candida albicans and reactivated EBV infections was established based on the clinical features of the patient because 7 of the 8 diagnostic criteria were met. She was treated with etoposide, dexamethasone for HLH, as well as highly active antifungal and antiviral therapies for the underlying etiology of dual infections. The patient eventually recovered following the effective treatment. A timely and accurate diagnosis is crucial to the prognosis of the dangerous disease.