Cost, Cost-effectiveness and Survival Impact Assessment for A Better Management of Colorectal Cancer Patients: A Single Centre Comprehensive Analysis.

BACKGROUND AND AIMS: The world healthcare systems are currently challenged by the accumulating burden of colorectal cancer (CRC), and cancer registries represent an important segment for prevention and developing management plans, being useful in providing data regarding incidence, mortality, survival, exposure to carcinogens, lifestyle. Retrospective data from CRC patients in Romania was used to assess survival impact, costs, and cost-effectiveness considering three crucial aspects: pharmacology, chemo-/radio-therapy, and hospitalization for care and management of these patients. METHODS: 423 CRC patients from the Institutional Cancer Registry of the Prof. Dr. Ion Chiricuta Institute of Oncology in Cluj-Napoca, Romania were included in the cost analysis. For the assessment of cost efficiency of the primary treatment strategy, we collected data regarding direct medical costs associated with surgery, radiotherapy and medication, as well as the afferent day or continuous hospitalization, for each patient. For the cost-effectiveness analysis we used the method of estimation of incremental cost-effectiveness ratio. RESULTS: No compelling differences regarding survival time were observed in different therapeutic options per CRC stage. Substantial differences in cost effectiveness among therapeutic options in the same stage of several thousand Euros in stages I-III, while for stage IV, the ICER was more than 100,000 Euros per life saved. CONCLUSIONS: Systematic evaluation of costs, cost-effectiveness, and survival impact, helps healthcare systems can make informed decisions to improve the management of colorectal cancer patients, optimizing outcomes while minimizing financial burden.

3D laparoscopic salvage radical prostatectomy: mini-series report and review of the literature.

PURPOSE: Salvage therapy represents a rescue therapy, given after the first line of treatment had failed.The purpose of this study was to review the outcomes of patients who underwent salvage laparoscopic radical prostatectomy (sLRP) in our department and to review current published studies. METHODS: Our mini-series consisted of 6 patients with recurrent prostate cancer(PCa) after non-surgical primary treatment. All interventions were performed by a single surgeon from the Oncological Institute "Prof. Dr. Ion Chiricuta" Cluj Napoca, Romania.A literature review was carried out in June 2020 using the PubMed and MEDLINE databases to identify relevant studies published in the literature between 2000 and 2020. Six papers were selected for our review.We reviewed the oncological and functional outcomes of patients that underwent sLRP. RESULTS: Extraperitoneal sLRP was performed in 6 patients. Biochemical failure after primary treatment developed between one and five years. Mean operative time was 135.5 min, mean blood loss was 328 ml. No intraoperative complications occurred and no conversions to open surgery. R0 was achieved in 5 out of the 6 patients (83.5%). Out of the 6 patients 2 are incontinent. CONCLUSIONS: SLRP remains an underused procedure and a missed therapeutic opportunity for selected patients. From published data and personal experience, we conclude that in experienced hands sLRP for localized prostate cancer is a feasible, safe and efficient method to treat recurrent PCa. Short-term oncological outcomes are optimistic but further studies need to be made to observe the long-term outcomes.

The value of tumor infiltrating lymphocytes as prognostic factor for lymph node status and survival amongst patients with cutaneous malignant melanoma.

PURPOSE: Tumor infiltrating lymphocytes (TILs) in cutaneous malignant melanoma are classified as brisk, non-brisk or absent. Numerous studies suggest the presence of TILs, especially brisk, are associated with a lower rate of lymph node metastasis and with an improved overall survival (OS). Our purpose was to assess the value of TILs as a prognostic factor for the lymph node metastasis and survival in completely resected pT3 stage malignant melanoma patients. METHODS: We included a number of 114 patients with pathological pT3 cutaneous malignant melanoma, treated exclusively in our institution, between 2000-2015. Correlations of clinical and pathological factors with lymph node status and OS were analyzed. RESULTS: A brisk infiltrate was present in 60% of the patients, whereas 40% presented a non-brisk infiltrate or absent TILs. In univariate analysis, the presence of ulceration was correlated with a non-brisk infiltrate, whereas in multivariate analysis, lymph node invasion and a non-brisk infiltrate were associated with a higher risk of death. CONCLUSIONS: TILs density grade represents an independent prognostic factor for the OS. Therefore, we conclude that an accurate prognosis may be provided by TILs status in patients with pT3 malignant melanoma.

The role of inhibitor of DNA-binding 1 (ID-1) protein and angiogenesis in serous ovarian cancer.

BACKGROUND: Overexpression of Inhibitor of DNA-binding 1 protein (ID-1) is correlated with poor prognosis in some malignancies and few studies have assessed its role in ovarian cancer. This led us to investigate its association with the microvessel density (MVD) in patients with ovarian cancer. MATERIALS AND METHODS: Fifty-six patients with epithelial serous ovarian cancer were selected. The early-stage group consisted of 14 patients and the advanced-stage group comprised 42 patients. ID-1 expression and MVD were evaluated by immunohistochemistry. RESULTS AND CONCLUSION: The histoscore for ID-1 and MVD were significantly higher in advanced-stage cancer (p<0.05). The MVD was significantly higher in the high ID-1 expression group compared to the low ID-1 expression group (p<0.001). The mean follow-up time was 52 months. The survival period in patients with high ID-1 expression was not significantly shorter than for those with low ID-1 expression (p=0.62). The role of ID-1 protein requires further investigation.