Detección de la infiltración de la cadena mamaria interna en pacientes con cáncer de mama mediante PET/RM con 18F-FDG y sus implicaciones terapéuticas / Detection of internal mammary chain infiltration in breast cancer patients by [18F]FDG PET/MRI: Therapy implications

Objetivo: Evaluar la tasa de detección y la implicación terapéutica de la infiltración de la cadena mamaria interna (ICMI) mediante tomografía por emisión de positrones (PET) y resonancia magnética (RM) con 18F-fluorodesoxiglucosa (18F-PET/RM) en la estadificación de pacientes con cáncer de mama. Método: Estudio prospectivo, 41 mujeres con cáncer de mama (estadio ≥ IIB) estadificadas mediante 18F-FDG-PET/RM. Estudio en dos fases: imágenes mamarias (decúbito prono), cuerpo completo (supino). Estadificación TNM por consenso entre especialista en Medicina Nuclear y Radiología. Estudio vaso aferente (VA) a cadena mamaria interna (CMI) por RM mamaria. Correlación ICMI con edad, VA-CMI, estadificación T, cuadrante, infiltración axilar y a distancia. Revaloración terapéutica en comité multidisciplinar. Resultados: Tasa de detección de ICMN de 34% (14/41), siendo 8/14 < 55 años. Todas las 14 pacientes con ICMI muestran VA-CMI, en seis de ellas (43,9%) sin VA-axilar. De 27/41 sin ICMI, en 13 (48,1%) solo VA-axilar, en los 14 restantes (51,9%) VA-axilar y VA-CMI. Un total de 57% (8/14) son multicéntricos y 42% (6/14) focales, en cuadrantes internos en 4/6 (66,7%). En 1/14 (7,1%) solo ICMI, en 9/14 (64,3%) axilar y CMI y en 4/14 (28,6%) lesiones a distancia. Decisión del comité: sin tratamiento adicional en 27/41 (65,8%), radioterapia torácica en 10/41 (24,4%) y terapia sistémica en 4/41 (9,7%). Conclusión: La tasa de detección de la ICMI en la estadificación del cáncer de mama mediante 18F-FDG PET/RM es de 34%. Son factores asociados la edad, los tumores multicéntricos, los de cuadrantes internos, la existencia de VA-CMI, la estadificación NM. La evidencia de ICMI permite la individualización de la terapia, indicando la radioterapia torácica en 24,4%.(AU)

Objective: To evaluate the detection rate and therapeutic implication of the infiltration of the internal mammary chain (IMCI) by [18F]FDG PET/MRI for staging of patients with breast cancer. Methods: Prospective study including 41 women with breast cancer (stage ≥IIB) staged by [18F]FDG PET/MR. Two-phase exam: breast imaging (prone), whole-body (supine). TNM stage assessed by peer consensus with Nuclear Medicine and Radiology specialists. Study of the afferent vessel (AV) to IMC by breast MRI. IMCI was correlated with age, AV-IMC, T stage, breast quadrants, axillary and distant infiltration. Therapeutic re-evaluation by a multidisciplinary committee. Results: IMCI detection rate of 34% (14/41), with 8/14 patients under 55 years of age. All 14 patients with IMCI showed AV-IMC, 6 of them (43.9%) without VA-axillary. Of 27/41 patients without IMCI, in 13 (48.1%) only AV-axillary was found, in the remaining 14 (51.9%), AV-axillary and AV-IMC was found. In 57% (8/14) tumours were multicentric and 42% (6/14) focal, in inner quadrants in 4/6 (66.7%). In 1/14 patient (7.1%) only IMCI was found, in 9/14 (64.3%) axillary and IMC, in 4/14 patients (28.6%) distant lesions were detected. Committee re-evaluation: no further treatment in 27/41 patients (65.8%), thoracic radiotherapy in 10/41 patients (24.4%), systemic therapy in 4/41 patients (9.7%). Conclusion: Our detection rate of IMCI in breast cancer staging by [18F]FDG PET/MR was 34%. Related factors were age, multicentric tumours, inner quadrants, detection of AV-IMC, NM staging.The evidence of IMCI allowed tailored therapy, with thoracic radiotherapy implementation in 24.4% of patients.(AU)

Impact of Pleural Lavage Cytology Positivity on Early Recurrence After Surgery for Non-Small Cell Lung Cancer / Impacto de la positividad de la citología del lavado pleural en la recurrencia temprana después de la cirugía por cáncer de pulmón de células no pequeñas

Objective: The aim of this study was to elucidate the impact of pleural lavage cytology positivity on early recurrence in patients operated on non-small cell lung cancer (NSCLC). Methods: This is a multicentre prospective cohort study of 684 patients undergoing an anatomical lung resection for NSCLC between October 2015 and October 2017 at 12 national centres. A pleural lavage was performed before and after lung resection. The association between the different predictors of early recurrence and PLC positivity was performed using univariate and multivariate logistic regression models. A propensity score analysis was performed by inverse probability weighting (IPSW) using average treatment effect (ATE) estimation to analyse the impact of PLC positivity on early recurrence. Results: Overall PLC positivity was observed in 15 patients (2.2%). After two years, 193 patients (28.2%) relapsed, 182 (27.2%) with a negative PLC and 11 (73.3%) with a positive PLC (p<0.001). Factors associated to early recurrence were adenocarcinoma histology (OR=1.59, 95%CI 1.06–2.38, p=0.025), visceral pleural invasion (OR=1.59, 95%CI 1.04–2.4, p=0.03), lymph node involvement (OR=1.84, 95%CI 1.14–2.96, p=0.013), advanced pathological stage (OR=2.12, 95%CI 1.27–3.54, p=0.004) and PLC positivity (OR=4.14, 95%CI 1.25–16.36, p=0.028). After IPSW, PLC positivity was associated with an increased risk of early recurrence (OR=3.46, 95%CI 2.25–5.36, p<0.001). Conclusions: Positive pleural lavage cytology was found to be the strongest predictor of early recurrence.(AU)

Has the 8th American joint committee on cancer TNM staging improved prognostic performance in oral cancer? A systematic review / ¿Ha mejorado la estadificación TNM del octavo comité conjunto estadounidense sobre cáncer? ¿Rendimiento pronóstico en el cáncer oral? Una revisión sistemática

Background: The 8th edition of the American Joint Committee on Cancer (AJCC) classification has introduced two new parameters: depth of invasion (DOI) and extranodal extension (ENE). The aim of this systematic review was to determine whether this 8th edition referred to oral squamous cell carcinoma (OSCC) offers performance superior to that of the 7th edition in relation to overall survival (OS) and disease-specific survival (DSS). Material and Methods: The review was carried out following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. The PubMed (MEDLINE), Scopus and Cochrane Library databases were searched covering the period up until April 7th, 2022.Results: Thirteen retrospective cohort studies were finally included. The introduction of DOI and ENE in the 8th edition of the AJCC classification resulted in improved prognostic performance of the classification. Conclusions: Patients with OSCC can be better classified in relation to OS and DSS, while maintaining the simplicity and ease of use of the classification. This allows more appropriate treatment protocols to be applied and affords a better estimation of the prognosis of each patient.(AU)

Bone metastatic cancer of unknown primary at initial presentation

Introduction Cancer of unknown primary (CUP) is a challenging malignancy. The purpose of this study was to investigate the clinical characteristics and prognosis of bone metastatic CUP using the population-based Surveillance, Epidemiology, and End Results (SEER) database. Methods From the SEER database, we identified 1908 patients with bone metastatic CUP at initial presentation between 2010 and 2018. Histology was subdivided following International Classification of Diseases for Oncology codes as Adenocarcinoma, Squamous cell, Neuroendocrine, or Carcinoma not otherwise specified (NOS). Cox proportional hazard modeling was applied using factors of age, sex, ethnicity, histological subtype, and therapeutic intervention. Results Among the 1908 patients, histology was Neuroendocrine in 240 patients, Squamous cell in 201 patients, Adenocarcinoma in 810 patients and NOS in 657 patients. In each subtype, patients tended to be predominantly male and white. Chemotherapy was introduced for 28% of patients and radiation for 34% in the entire cohort. Survival in patients with bone metastatic CUP was unfavorable, with a median survival of 2 months. Among the histological subtypes, Adenocarcinoma showed shorter survival than the other groups. In addition, treatment interventions such as chemotherapy and radiation therapy prolonged survival, particularly for Squamous cell, Adenocarcinoma and NOS, but not for Neuroendocrine. Discussion Bone metastatic CUP showed extremely poor prognosis, but treatment interventions such as chemotherapy and radiation generally offered survival benefits. Further randomized clinical research is needed to confirm the present results (AU)

Clinical characteristics and prognosis analysis of postoperative patients with stage I–III colon cancer based on SEER database

Purpose To identify the relevant factors affecting the prognosis and survival time of colon cancer and construct a survival prediction model. Methods Data on postoperative stage I–III colon cancer patients were obtained from the Surveillance, Epidemiology, and End Results database. We used R project to analyze the data. Univariate and multivariate Cox regression analyses were performed for independent factors correlated with overall survival from colon cancer. The C-index was used to screen the factors that had the greatest influence in overall survival after surgery in colon cancer patients. Receiver operating characteristic (ROC) curve was made according to the Risk score and calculated to validate the predictive accuracy of the model. In addition, we used decision curve analysis (DCA) to evaluate the clinical benefits and utility of the nomogram. We created a model survival curve to determine the difference in prognosis between patients in the low-risk group and those in the high-risk group. Results Univariate and multifactor COX analyses showed that the race, Grade, tumor size, N-stage and T-stage were independent risk factors affecting survival time of patients. The analysis of ROC and DCA showed the nomogram prediction model constructed based on the above indicators has good predictive effects. Conclusion Overall, the nomogram constructed in this study has good predictive effects. It can provide a reference for future clinicians to evaluate the prognosis of colon cancer patients (AU)

Correlation between the ultrasound and laparoscopic findings in deep endometriosis staging: A narrative review / Correlación entre la ecografía y los hallazgos laparoscópicos en la estadificación de la endometriosis profunda: una revisión narrativa

Many women across the world suffer from endometriosis. This disease should be staged by laparoscopy in order to know the extent of disease. Ultrasound may be a reliable diagnostic tool that could complement laparoscopy for endometriosis staging. The aim of this study is to perform a narrative review of the current status of studies comparing ultrasound findings and laparoscopic staging according to American Society Reproductive Medicine (ASRM) and ENZIAN classifications. A search in PubMed and Web of Science databases from 2004 to 2022 was performed using the following terms “endometriosis”, “ultrasound”, “laparoscopy”, “ENZIAN” and “ASRM”. We focused on the accuracy of sonography using laparoscopy as gold standard. Seven studies were ultimately included. We observed that ultrasound is accurate and correlates well with advanced stages in the case of ASRM classification, and correlates well with ENZIAN classification. However, some limitations came up. There is little scientific information out there regarding this specific topic. Some of the studies have a retrospective design and one of them has a small sample size. In addition to this, even if ultrasound could have a relevant role in staging deep endometriosis, this method is highly dependent on the operator's experience. We conclude that diagnostic performance of transvaginal ultrasound (TVS) for evaluating the extent of disease in women with pelvic endometriosis is high. However, evidence is still limited and further studies are needed.(AU)

Muchas mujeres en todo el mundo sufren de endometriosis. Esta enfermedad debe ser estadificada por laparoscopia para conocer la extensión de la enfermedad. La ecografía puede ser una herramienta de diagnóstico fiable que podría complementar la laparoscopia para la estadificación de la endometriosis. El objetivo de este estudio es realizar una revisión narrativa del estado actual de los estudios que comparan los hallazgos ecográficos y la estadificación laparoscópica según las clasificaciones de la Sociedad Americana de Medicina Reproductiva (ASRM) y ENZIAN. Se realizó una búsqueda en las bases de datos PubMed y Web of Science de 2004 a 2022 utilizando los siguientes términos: «endometriosis», «ultrasonido», «laparoscopia», «ENZIAN» y «ASRM». Nos enfocamos en la precisión de la ecografía utilizando la laparoscopia como estándar de oro. Finalmente, se incluyeron siete estudios. Observamos que la ecografía es precisa y se correlaciona bien con estadios avanzados en el caso de la clasificación ASRM, y se correlaciona bien con la clasificación ENZIAN. Sin embargo, surgieron algunas limitaciones. Hay poca información científica sobre este tema específico: algunos de los estudios tienen un diseño retrospectivo y uno de ellos tiene un tamaño de muestra pequeño. Además de esto, si bien la ecografía podría tener un papel relevante en la estadificación de la endometriosis profunda, este método depende en gran medida de la experiencia del operador. Concluimos que el rendimiento diagnóstico de la ecografía transvaginal para evaluar la extensión de la enfermedad en mujeres con endometriosis pélvica es alto. Sin embargo, la evidencia aún es limitada y se necesitan más estudios.(AU)

Nivel de hemoglobina y fuerza de prensión manual en pacientes oncológicos adultos de un hospital público / Hemoglobin level and handgrip strength deficit in adult cancer patients from a public hospital

Introducción: La anemia en el adulto se caracteriza por ladebilidad y cansancio e influye en el aumento de tasa de mortalidad, discapacidad, disminución en el nivel de actividad física y calidad de vida. Condición que agrava el riesgo de mortalidad en pacientes oncológicos. Objetivo: Determinar la correlación entre el nivel de he-moglobina y la fuerza de prensión manual en pacientes oncológicos de un hospital público. Materiales y métodos: Investigación de enfoque cuanti ta-tivo, diseño no experimental, transversal de tipo correla cional-causal. La muestra final del estudio estuvo conformada por 90pacientes adultos con diagnóstico de enfermedad oncológica; hospitalizados durante el periodo noviembre a diciembre del2022, en el servicio de cirugía del Hospital Cayetano Heredia deLima-Perú. La fuerza de prensión manual se determinó utili-zando un dinamómetro hidráulico y los valores de hemoglobinase recabaron de la historia clínica del paciente al ingreso al hospital. Para evaluar la correlación de las variables, se utilizó laprueba estadística no paramé trica RHO de Spearman. Resultados: El 51,1% presentó anemia moderada, el16.7% anemia leve y el 31.1% presentó un valor de hemoglobina normal. Asimismo, el 53.3% presentó una fuerza deprensión manual disminuida. Al determinar la correlación entre el nivel de hemoglobina y el déficit de fuerza de prensiónmanual en pacientes oncológicos adultos se obtuvo un valorde Rho = 0.274 y p=0.009 (p<0.05). Conclusiones: Existe correlación directa entre nivel de hemoglobina y la fuerza de prensión manual. Los pacientes oncológicos adultos con mayor valor de hemoglobina presenta-ron mayor fuerza de prensión manual (AU)

Introduction: Anemia in adults is characterized by weakness and tiredness and influences the increase in the mortality rate, disability, decrease in the level of physical activity andquality of life, a condition that aggravates the risk of mortality in cancer patients. Objective: To determine the correlation between the he-moglobin level and the handgrip strength in cancer patients from a public hospital. Materials and methods: Research with a quantitative approach, non-experimental, cross-sectional design of a cor-relational-causal type. The final sample of the study consistedof 90 adult patients diagnosed with oncological disease, hospitalized from November to December 2022, in the surgery service of the Cayetano Heredia Hospital in Lima-Peru. Handgrip strength was determined using a hydraulic dynamometer, and hemoglobin values were collected from the patient’s medical history upon admission to the hospital. Forthe correlation of the variables, the non-parametric statisticaltest Spearman’s Rho was used. Results: 51.1% presented moderate anemia, 16.7% mild anemia and 31.1% presented a normal hemoglobin value. Likewise, 53.3% presented a decreased handgrip strength. When determining the correlation between the hemoglobin level and the handgrip strength deficit in adult cancer patients, a value of Rho = 0.274 and p=0.009 (p<0.05). Conclusions: There is a direct correlation between hemoglobin level and handgrip strength. Adult cancer patients with higher hemoglobin values presented greater handgrip strength (AU)

Una perspectiva diferente sobre la radiómica con 18F-FDG-PET en pacientes con cáncer colorrectal; la relación entre el análisis intra y peritumoral y los hallazgos patológicos / A different perspective on18F-FDG PET radiomics in colorectal cancer patients: The relationship between intra & peritumoral analysis and pathological findings

Objetivo El objetivo de nuestro estudio fue determinar el valor de la tomografía por emisión de positrones/tomografía computarizada con 18F-fluorodesoxiglucosa (PET/TC con18F-FDG) basada en la radiómica del tumor primario y peritumoral en la predicción de depósitos tumorales (TD), crecimiento tumoral (TB) e invasión venosa extramural (EMVI) del cáncer colorrectal (CCR). Métodos Nuestro estudio retrospectivo incluyó a 77 pacientes con CCR a los que se les realizó un 18F-FDG PET/TC preoperatoria entre junio de 2020 y febrero de 2022. Se extrajeron un total de 131 características radiómicas del tumor primario y áreas peritumorales en imágenes de fusión PET/TC. Se investigó la relación entre TD, TB, EMVI y estadio T en el estudio patológico postoperatoria de los tumores y las características radiómicas. Las características con un coeficiente de correlación (CC) inferior a 0,8 se analizaron con regresión logística. El rendimiento del modelo se evaluó mediante el área bajo la curva (AUC) obtenida del análisis de las características operativas del receptor. Resultados Se desarrolló un modelo a partir de datos de radiómica peritumoral y tumor primario para predecir el estadio T (AUC 0,931), y también se construyó un modelo predictivo a partir de radiómica derivada del tumor primario para predecir EMVI (AUC 0,739). Los datos radiómicos derivados del tumor primario se obtuvieron como factor pronóstico predictivo del DT y se encontró que una característica peritumoral era un factor pronóstico en la predicción de TB. Conclusiones La radiómica intratumoral y peritumoral derivada de la PET con18F-FDG es útil para la predicción preoperatoria no invasiva de propiedades patológicas que tienen implicaciones importantes en el manejo del CCR (AU)

Objective We aimed to determine the value of 18F-fluorodeoxyglucose positron emission tomogra-phy/computed tomography (18F-FDG PET/CT) based primary tumoral and peritumoral radiomics in the prediction of tumor deposits (TDs), tumor budding (TB) and extramural venous invasion (EMVI) of colorectal cancer (CRC). Methods Our retrospective study included 77 CRC patients who had preoperative18F-FDG PET/CT between June 2020 and February 2022. A total of 131 radiomic features were extracted from primary tumors and peritumoral areas on PET/CT fusion images. The relationship between TDs, TB, EMVI and T stage in the postoperative pathology of the tumors and radiomic features was investigated. Features with a correlation coefficient (CC) less than 0.8 were analyzed by logistic regression. The area under curve (AUC) obtained from the receiver operating characteristic analysis was used to measure the model performance. Results A model was developed from primary tumoral and peritumoral radiomics data to predict T stage (AUC 0.931), and also a predictive model was constructed from primary tumor derived radiomics to predict EMVI (AUC 0.739). Radiomic data derived from the primary tumor was obtained as a predictive prognostic factor in predicting TDs and a peritumoral feature was found to be a prognostic factor in predicting TB. Conclusions Intratumoral and peritumoral radiomics derived from18F-FDG PET/CT are useful for non-invasive early prediction of pathological features that have important implications in the management of CRC (AU)

Valor pronóstico de los parámetros metabólicos volumétricos del tumor primario y ganglios linfáticos en el PET/TC pretratamiento en el carcinoma nasofaríngeo / Prognostic value of primary tumor and lymph node volumetric metabolic parameters at pre-treatment F-18 FDG PET/CT in nasopharyngeal carcinoma

Objetivo El objetivo de este estudio fue evaluar el significado pronóstico de los parámetros metabólicos volumétricos de la PET/TC pretratamiento junto con las características clínicas en pacientes con carcinoma nasofaríngeo no metastásico. Material y métodos Setenta y nueve pacientes con carcinoma nasofaríngeo se sometieron a una PET/TC con [18F]FDG para evaluación previa al tratamiento y se incluyeron en este estudio. Se analizaron las características del paciente (edad, histopatología del tumor, estadio T/N, tamaño del tumor primario y ganglio cervical más grande) y parámetros PET: valores de captación estandarizados máximo, medio y pico (SUVmáx, SUVmean, SUVpico), volumen tumoral metabólico (MTV) y glucólisis de lesión total (TLG) para el tumor primario y el ganglio linfático cervical más grande. El análisis de supervivencia para la supervivencia libre de progresión (PFS) y la supervivencia global (OS) se realizó con el método de Kaplan-Meier utilizando los hallazgos de PET y las características clínicas. Resultados La mediana de duración del seguimiento fue de 29,7 meses (rango 3-125 meses). El MTV del tumor primario y el MTV de los ganglios linfáticos cervicales fueron factores pronósticos independientes para la PFS (p = 0,025 y p = 0,004, respectivamente). Los pacientes con MTV del tumor primario > 19,4 y los pacientes con MTV de los ganglios linfáticos > 3,4 tuvieron una PFS más corta. Para OS, la edad y el tamaño del ganglio linfático fueron factores pronósticos independientes (p = 0,031 y p = 0,029). Los pacientes mayores de 54 años y los pacientes con ganglios linfáticos > 1 cm se asociaron con una OS disminuida. Conclusión El MTV del tumor primario y el MTV de los ganglios linfáticos en la PET/TC previa al tratamiento son factores pronósticos significativos para la PFS a largo plazo en el carcinoma nasofaríngeo no metastásico (AU)

Background The aim of this study was to evaluate the prognostic significance of volumetric metabolic parameters of pre-treatment PET/CT along with clinical characteristics in patients with non-metastatic nasopharyngeal carcinoma. Material and methods Seventy-nine patients with nasopharyngeal carcinoma underwent F18-FDG PET/CT for pretreatment evaluation and included in this study. The patient features (patient age, tumor histopathology, T and N stage, size of primary tumor and the largest cervical lymph node) and PET parameters were analyzed: maximum, mean and peak standardized uptake values (SUVmax, SUVmean, SUVpeak), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) for primary tumor and largest cervical lymph node. After treatment, patients were evaluated for disease progression and mortality. Survival analysis for progression-free survival (PFS) and over-all survival (OS) was performed with Kaplan–Meier method using PET findings and clinical characteristics. Results The median follow-up duration was 29.7 months (range 3–125 months). Among clinical characteristics, no parameters had significance association for PFS. Primary tumor-MTV and cervical lymphnode-MTV were independent prognostic factors for PFS (p = 0.025 and p = 0.004, respectively). Patients with primary tumor-MTV > 19.4 and patients with lymph node-MTV > 3.4 had shorter PFS. For OS, age and the size of the lymph node were independent prognostic factor (p = 0.031 and p = 0.029). Patients with age over 54 years and patients with lymph node size > 1 cm were associated with decreased OS. Conclusion Primary tumor-MTV and lymph node-MTV on pre-treatment PET/CT are significant prognostic factors for long-term PFS in non-metastatic nasopharyngeal carcinoma (AU)

La linfogammagrafía in vivo de los tumores del seno nasal identifica el ganglio retrofaríngeo y el nivel I como ganglios centinela predominantes / In-vivo lymphoscintigraphy of sinonasal tumors identifies retropharyngeal node and level I as predominant sentinel nodes

Objetivo Evaluar mediante linfogammagrafía in vivo y con detección SPECT/TC los patrones de drenaje linfático de los tumores del seno paranasal (SPN). Confirmar o rebatir la creencia de que el ganglio linfático retrofaríngeo (GLRF) se erige en el ganglio de drenaje índice para dichos tumores. Métodos Estudio de cohorte prospectivo realizado en pacientes con tumores del SPN no tratados previamente y sin evidencia clínico-radiológica de metástasis a nivel ganglionar. La linfogammagrafía se realizó mediante la inyección peritumoral de sulfuro coloidal marcado con [99m]TcO4 y asistida por endoscopia nasal. Las inyecciones se clasificaron como anteriores o posteriores en función de una línea vertical que pasaba por el orificio del seno maxilar. Resultados Se incluyeron 17 pacientes. La linfogammagrafía identificó satisfactoriamente 17 ganglios centinelas en 15 pacientes, y no pudo evidenciarlo (fracaso de la linfogammagrafía) en 2 pacientes. Se observó que los lugares predominantes de drenaje del ganglio centinela fueron el GLRF (n=8; 47%) y el nivel I (n=7; 42%). Se identificó drenaje ocasional en el ganglio periparotídeo (n=1) y en el nivel II (n=1). Se observó drenaje linfático contralateral en 2 pacientes (en el nivel I y GLRF, respectivamente). Las inyecciones anteriores drenaron predominantemente hacia el nivel I (6/8) y a GLRF (2/8), mientras que las inyecciones posteriores drenaron predominantemente a GLRF (6/7). El riesgo relativo de que el GLRF fuera identificado como ganglio centinela fue significativamente mayor en las inyecciones administradas posteriormente respecto a las administradas anteriormente (RR: 3,43; IC 95%: 1,0-11,8; p=0,05). Conclusión El GLRF es considerado un ganglio de drenaje frecuente asociado a los tumores del seno nasal, y merece su atención rutinaria en todos los casos de tumor del seno nasal (AU)

Objective To evaluate by in vivo lymphoscintigraphy and SPECT-CT imaging, the lymphatic drainage patterns of para-nasal sinus (PNS) tumours. To confirm or refute the belief of the retropharyngeal lymph node (RPLN) being the significant draining lymph node for such tumours. Methods Prospective cohort study conducted on previously untreated PNS tumours with no clinico-radiological evidence of lymph node metastasis. Lymphoscintigraphy undertaken by nasal endoscopic assisted peritumoral injection of 99mTc sulphur colloid. Injections were classified as anterior or posterior as per a vertical line along the maxillary sinus ostium. Results Seventeen patients were included. Lymphoscintigraphy successfully identified 17 sentinel nodes in 15 patients and was unsuccessful (lymphoscintigraphy failure) in 2 patients. Predominant sites of sentinel lymphatic drainage were noted to be the RPLN (n=8; 47%) and level I (n=7; 42%). Occasional drainage was identified at the peri-parotid node (n=1) and at level II (n=1). Contralateral drainage was noted in 2 patients (level I-1 and RPLN-1). Anterior injections drained predominantly to level I (6/8) and RPLN (2/8), while posterior injections drained predominantly to the RPLN (6/7). The relative risk of RPLN being identified as the sentinel node was significantly higher for posteriorly placed injections than for anteriorly placed injections (RR: 3.43; 95% CI: 1.0-11.8; P=.05). Conclusion The RPLN is noted as a frequent draining node for sino-nasal tumours and merits routine attention in all sino-nasal tumours. The radio-colloid SPECT-CT technique described here offers an excellent in vivo technique to further explore and validate the lymphatic drainage pathways of these tumours (AU)

Un reto multidisciplinar: tratamiento con fósforo-32 en el carcinoma de páncreas localmente avanzado / A multidisciplinary challenge: Therapy with phosphorus-32 for locally advanced pancreatic cancer

El cáncer de páncreas es una enfermedad de pronóstico precario, siendo su supervivencia global la que menos ha mejorado en los últimos 40 años entre todos los cánceres. El adenocarcinoma de páncreas localmente avanzado, sin metástasis a distancia, pero con una afectación vascular limitante, constituye casi un tercio de estos pacientes. En este grupo se concentran gran parte de los esfuerzos investigadores para introducir tratamientos que permitan un aumento de las tasas de rescate quirúrgico y/o de la supervivencia, con 2 objetivos fundamentales: el del control local y el de la prevención de la progresión sistémica. El tratamiento intratumoral con micropartículas de fósforo-32, guiado por ecoendoscopia y combinado con quimioterapia estándar puede tener beneficios significativos y clínicamente relevantes en estos pacientes y, por tanto, una opción valiosa de tratamiento en una enfermedad en la que existe una necesidad urgente de desarrollar nuevas terapias que nos ayuden a mejorar los resultados (AU)

Pancreatic cancer is a disease with a poor prognosis, and overall survival has improved the least in the last 40 years of all cancers. Locally advanced pancreatic adenocarcinoma, without distant metastasis but with limiting vascular involvement, constitutes almost one third of these patients. This group is the focus of most research efforts to introduce treatments to increase surgical salvage rates and/or survival, with two main objectives: local control and prevention of systemic progression. Intratumoural treatment with phosphorus-32 microparticles, guided by echoendoscopy and combined with standard chemotherapy may have significant and clinically relevant benefits in these patients, and therefore a valuable treatment option in a disease where there is an urgent need to develop new therapies to help improve outcomes (AU)

The Value of Combined Detection of Serum PSA, MALAT1 and TMPRSS2-ETV1 in Evaluating the Progress and Prognosis of Prostate Cancer

Objective: To explore the prognostic value of combined detection of serum prostate specific antigen (PSA), lung cancer metastasis-associated transcript 1 (MALAT1), transmembrane serine protease 2 (TMPRSS2), and erythropoietin-specific transforming gene variant 1 (ETV1) in prostate cancer. Methods: Ninety patients with prostate cancer who were treated in hospital were divided into two groups according to tumor node metastasis stage: Stage I−II group (n = 34) and stage III−IV group (n = 56). The serum levels of PSA, MALAT1, and TMPRSS2-ETV1 were detected in both groups and correlated with prostate cancer status to determine their value as indicators of disease progression and prognosis. Results: Age, body mass index (BMI), and Gleason score differed significantly between the study group and the control group (p < 0.05). The expression levels of serum PSA and MALAT1 were higher in group III–IV than in group I–II, and the positive expression rate of TMPRSS2-ETV1 was significantly higher in group III–IV than in the control group (p < 0.05). Pearson’s correlation analysis showed that serum PSA, MALAT1, and TMPRSS2-ETV1 were significantly correlated with prostate cancer (p < 0.05). Differences in PSA levels correlated with differences in age, BMI, type of pathology, and Gleason score, whereas differences in serum MALAT1 levels correlated with differences in age, BMI, and type of pathology. Gleason scores differed significantly between patients with positive and negative TMPRSS2-ETV1 indicators (p < 0.05). Multivariate logistic regression analysis showed that serum PSA, MALAT1, and TMPRSS2-ETV1 were independent risk factors affecting the prognosis of prostate cancer (p < 0.05). The areas under the curve (AUCs) of serum PSA, MALAT1, and TMPRSS2-ETV1 as prognostic predictors in prostate cancer were 0.692, 0.731, and 0.709, respectively, whereas the AUC of the combination was 0.819 (AU)

Could the New pN Staging Classification Better Predict the Prognosis of Penile Cancer? A Population-Based Analysis

Background: The 8th edition of the American Joint Committee on Cancer (AJCC) has made new revisions to the N staging of penile cancer (PeCa). This study aimed to evaluate the prognostic value of the new N staging classification. Methods: This cohort was included from the Surveillance, Epidemiology, and End Results (SEER) database (1988–2016). Overall survival (OS) and cancer-specific survival (CSS) were evaluated using Kaplan–Meier survival curve. The Cox proportional hazards model was employed to calculate hazard ratio (HR) and 95% confidence intervals (CI). Results: Among the included 583 patients, 270 patients had only one positive inguinal lymph node (ILNP), 115 had two ILNPs, and 198 had 3 or more ILNPs. Kaplan–Meier analysis indicated that The OS and CSS of patients with ILNP = 2 were not statistically different from those with ILNP = 1 (p = 0.394; p = 0.760), but had OS and CSS benefit over those with ILNP ≥3 (p = 0.017; p = 0.020). Cox proportional hazards regression analysis indicated that patients with ILNP = 2 and ILNP = 1 have similar OS and CSS (HR = 0.80, p = 0.153; HR = 0.74, p = 0.148), but patients with ILNP ≥3 had worse OS and CSS than patients with ILNP = 2 (HR = 1.56, p = 0.007; HR = 1.86, p = 0.003). Conclusions: PeCa patients with only one or two lymph node metastases had similar survival outcomes. AJCC 8th edition pN staging has a better discriminative ability to predict the prognosis and can accurately stratify mortality risk in PeCa (AU)

Metabolic Syndrome is Associated with Prostate Cancer Diagnosed on Biopsy but not the Gleason Score and the Number of Cancer-Positive Cores: A Prospective Controlled Study

Objective: We aimed to investigate the association between metabolic syndrome (MetS) and prostate cancer (PCa) in patients undergoing prostate biopsy. Materials and Methods: Between January 2018 and December 2022, MetS was investigated according to Adult Treatment Panel III (ATP III) criteria in men who underwent prostate biopsy with transrectal ultrasound (TRUS). Clinicopathological factors such as, digital rectal examination (DRE), prostate-specific antigen (PSA), prostate volume, waist circumference, body mass index (BMI), age, blood pressure, testosterone, lipid profiles, fasting blood glucose level, C-reactive protein (CRP) and MetS were analyzed. Results: A total of 908 men underwent biopsies, of which 492 (51.5%) had MetS according to ATP III criteria. The number of patients diagnosed with PCa in biopsy was 270 (29.7%). PCa cases were significantly older, with a lower prostate volume and a higher PSA value and higher blood pressure compared to patients without PCa (p < 0.001). 146 of 416 (35.0%) patients with MetS had PCa while 124 of 492 (25.2%) patients without MetS had PCa (p < 0.001). Out of 270 patients with PCa, 174 (64.4%) had Gleason score <7 and 96 (35.6%) had Gleason score ≥7. In patients with a Gleason score ≥7, PSA, DRE(+) and core positive number were significantly higher compared to patients with Gleason score <7, while glycemia and high-density lipoprotein (HDL) cholesterol levels were significantly lower (p < 0.001). Multivariate analysis showed that age, PSA, positive DRE, prostate volume (p < 0.001), diastolic blood pressure, CRP and MetS were the only independent parameters associated with a higher risk of cancer on biopsy (p < 0.05). Conclusions: Our findings show that MetS is associated with PCa diagnosed on biopsy but not with the Gleason score and the number of cancer-positive cores. However, these results should be confirmed by larger, multicenter and prospective studies (AU)

Systemic Immune Inflammation Index and T-Staging Predict Prognosis in Patients with Muscle-Invasive Bladder Cancer

Objective: To explore the effect of combining the preoperative systemic immune inflammation index (SII) and T-staging to predict the prognosis of patients with muscle-invasive bladder cancer (MIBC). Methods: The clinical data of 94 MIBC patients who met the inclusion criteria of our hospital from September 01, 2012, to August 31, 2022, were collected. Data included sex, age, smoking history, tumour size, tumour number, pathology, P-grading, T-staging, SII, and overall survival (OS). The optimal cut-off of SII (863.62) was selected by obtaining the receiver operating characteristic (ROC) curve. Then, the samples were divided into the low-SII group (SII <863.62, 51 cases) and the high-SII group (SII ≥863.62, 43 cases). T-staging could be divided into T2 (61 cases) and T3 and higher stages (33 cases) according to the findings on depth of tumour invasion. Furthermore, the role of combined SII and T-staging for prognosis prediction was evaluated by performing Kaplan–Meier survival analysis and Cox proportional hazards modelling in the OS analysis. Results: MIBC patients with higher SII (≥863.62) were associated with shorter OS (p = 0.00005). Patients with more advanced T-stages had shorter OS than those with early T-stages (p = 0.00006). Furthermore, patients who had both higher SII and more advanced T-stages had markedly shorter OS (p = 0.00001). Conclusions: In patients with MIBC, a higher SII and increasing T-stage indicate a worse prognosis and shorter OS. Therefore, the combined SII and T staging approach is a reliable prognostic predictor for patients with MIBC (AU)

Clinical Efficacy of Bushen Yiqi Fuzheng Decoction Combined with Sunitinib in the Treatment of Postoperative Patients with Renal Cell Carcinoma and Its Influence on Their Immune Function

Background: This study aimed to investigate the effect of Bushen Yiqi Fuzheng decoction combined with sunitinib on the prognosis, clinical efficacy and immune function of patients with renal cell carcinoma (RCC) after surgery. Methods: A total of 120 patients who experienced RCC after surgery were randomly divided into the observation and control groups in this prospective study, with 60 cases in each group. The therapeutic effect, improvement of clinical symptoms, changes of immune function-related indicators and adverse reactions during medication were recorded. The changes in immune cell population, midkine (MK), interleukin 35 (IL-35), hypoxia-inducible factor 2alpha (HIF-2α), matrix metalloproteinase-9 (MMP-9), tissue inhibitor of metalloproteinase-1 (TIMP-1), carcinoembryonic antigen (CEA), osteopontin (OPN), ferritin (FERR) and beta2-microglobulin (β2-MG) levels were measured. The Karnofsky performance status (KPS) score of patients was recorded. Results: The total effective rate of the observation group (95%) was better than that of the control group (85%, p < 0.05). After treatment, the changes of immune function indexes in the control group were not obvious. The indexes related to immune function in the observation group significantly decreased. Significant differences were observed in the cluster of differentiation 3+ (CD3+), cluster of differentiation 4+ (CD4+), cluster of differentiation 8+ (CD8+) and CD4+/CD8+ between the two groups after treatment. The incidence of adverse reactions in the observation group was lower than that of the control group. The KPS of the observation group was higher than that of the control group (AU)

SEOM-GEICAM-SOLTI clinical guidelines for early-stage breast cancer (2022)

Breast cancer is the leading cause of cancer in women in Spain and its annual incidence is rapidly increasing. Thanks to the screening programs in place, nearly 90% of breast cancer cases are detected in early and potentially curable stages, despite the COVID-19 pandemic possibly having impacted these numbers (not yet quantified). In recent years, locoregional and systemic therapies are increasingly being directed by new diagnostic tools that have improved the balance between toxicity and clinical benefit. New therapeutic strategies, such as immunotherapy, targeted drugs, and antibody–drug conjugates have also improved outcomes in some patient subgroups. This clinical practice guideline is based on a systematic review of relevant studies and on the consensus of experts from GEICAM, SOLTI, and SEOM (AU)

SEOM–GEICAM–SOLTI clinical guidelines in advanced breast cancer (2022)

Advanced breast cancer represents a challenge for patients and for physicians due its dynamic genomic changes yielding to a resistance to treatments. The main goal is to improve quality of live and survival of the patients through the most appropriate subsequent therapies based on the knowledge of the natural history of the disease. In these guidelines, we summarize current evidence and available therapies for the medical management of advanced breast cancer (AU)