Long-Noncoding-RNA HOTAIR Upregulation is Associated with Poor Breast Cancer Outcome: A Systematic Review and Meta Analysis.

BACKGROUND: Breast cancer is the most frequent cancer among women worldwide with significant disproportionate mortality rates in developing countries. Although clinical management of breast cancer has been immensely improved, refinement in the prognostic and recurrent markers is still needed. Long non-coding RNAs (lncRNA) HOTAIR has recently been associated with poor outcome and is potentially used as a prognostic marker in breast cancer. METHODS: We comprehensively reviewed studies evaluating lncRNA HOTAIR in association with overall and disease-free survivals in breast cancers. Systematic searches were performed in Pubmed, ProQuest, ScienceDirect, Scopus, Google Scholar, Semantic Scholar, Springer, Nature, Sage Journals, and Wiley databases using combination keywords "long non-coding RNA," "lncRNA," "HOX transcript antisense RNA," "HOTAIR," "breast can-cer," "carcinoma mammae," "prognosis," and "survival." Risk of bias score was used to assess quality of studies, I2 test was conducted to assess heterogeneity. Meta-analysis was performed to compare HOTAIR expression with breast cancer survival rates using STATA v.17 software. RESULTS: Of the total 1,504 screened studies, seven studies were included in the meta-analysis involving 533 patients. High expression of HOTAIR was associated with poor survival rates (pooled HR: 1.69; 95%CI: 1.11-2.59; p=0.015), shorter overall survival (OS) (pooled HR: 1.33; 95%CI: 0.78-2.26; p=0.455), poor disease-free survival (DFS) (pooled HR: 2.40; 95%CI: 1.63-3.53; p<0.001), poor distant metastatic-free survival (MFS) (HR: 1.75; 95%CI: 1.13-2.71; p=0.012). In addition, overexpression of HOTAIR was associated with positive lymph node infiltration (pooled OR: 2.38; 95%CI: 0.53-10.69; p=0.26) and ductal type cancer (pooled OR: 3.27; 95%CI: 1.15-9.30; p=0.03). CONCLUSION: Upregulation of lncRNA HOTAIR is associated with worse DFS aand MFS that can potentially be used as a prognostic marker in breast cancer patients.

Risk Factors, Patterns, and Distribution of Bone Metastases and Skeletal-Related Events in High-Risk Breast Cancer Patients.

BACKGROUND: More than a quarter of breast cancer patients are at risk to develop recurrent metastases to the bone. OBJECTIVE: This study was designed to identify risk factors and predilections of bone metastasis and skeletal-related events (SRE) in a population of breast cancer survivors initially diagnosed in advanced stages and with high-risks of relapse. METHODS: Associated risk factors, distribution, and attainable treatment of bone metastasis and SRE were analyzed in a cohort of 1,329 breast cancer patients. The association with dependent variables was subsequently analyzed using multivariable logistic regression. Sociodemographic and adverse clinical characteristics were included as covariates of progression into bone metastasis and SREs. RESULTS: Of 1329 breast cancer patients, 246 patients (18.5%) were diagnosed as metastatic breast cancer in which 232 of them (94.3%) had bone metastases. Spines were the most common sites of bone metastases (25.6%). In multivariable analysis, advanced stage at diagnosis (OR=1.840, 95%CI:1.198-2.826, P=0.005), luminal subtype (OR=1.788, 95%CI:1.206-2.652, P=0.045), lobular histology (OR=1.795, 95%CI:1.012-3/184, P=0.046), positive axillary lymph node (OR=1.771, 95%CI:1.087-2.886, P=0.022), multiple metabolic comorbidities (OR=2.193, 95%CI:1.371-3.508, P=0.001), early menopause (OR=2.136, 95%CI:1.116-4.464, P=0.046) were significantly associated with risk of recurrent bone metastases. SREs occurred in 89 (68.5%) patients. Several risk factors for SREs were early menopausal age (OR=2.342, P=0.024), advanced stages (OR=1.404, P=0.039), lobular histology (OR=2.279, P=0.007), and having multiple metabolic comorbidities (OR=1.728, P=0.039). CONCLUSION: Bone metastases and SREs are relatively high in breast cancer patients diagnosed in advanced stages. Luminal subtypes, having multiple metabolic comorbidities, and lobular histology are associated with higher risks of recurrent bone metastases. Living in rural areas and advanced stage at diagnosis as a risk factors for bone metastases might represent a social gradient of care delivery.

Extrathyroidal extension and cervical node infiltration are associated with recurrences and shorter recurrence-free survival in differentiated thyroid cancer: a cohort study.

BACKGROUND: Differentiated thyroid cancer has excellent overall survival. However, around 20% of patients experience recurrent diseases after a certain time of follow-up. Therefore, identification of risk factors for recurrence is necessary to adjust treatment and surveillance planning. METHODS: A retrospective study was conducted of 312 patients with differentiated thyroid cancer who received surgery with and without adjuvant treatment. Clinical and pathological risk factors were analyzed for recurrences. RESULTS: After median follow-up of 57 months, 109 of 312 patients (34.9%) developed recurrences. Extrathyroidal extension and positive cervical nodes were significantly associated with recurrences (OR = 2.449, 95%CI:1.260-4.760, P = 0.008 and OR = 3.511, 95%CI:1.860-6.626, P < 0.001; respectively). Lympho-vascular invasion (LVI) and tumor multifocality were also associated with increased risk of recurrence (OR = 2.577, 95%CI:1.380-4.812, P = 0.003 and OR = 1.602, 95%CI:1.001-2.495, P = 0.050; respectively). Using multivariable regression, only older age and tumor infiltration to the lymph nodes were significantly associated with recurrences (OR = 2.227, 95%CI:1.037-4.782, P = 0.040 and OR = 2.966, 95%CI:1.470-5.986, P = 0.002; respectively). In addition, T4, cervical lymph node infiltration, older age, and LVI were associated with shorter recurrence-free survival. CONCLUSION: Recurrence rates in our study population are relatively high. Extrathyroidal extension, positive neck lymph node, and older age were associated with recurrence risks of well differentiated thyroid cancers.

The prioritation and gap of preoperative COVID-19 vaccination in cancer surgery of the breast, head and neck, and skin: A cohort study of 367 patients in an Indonesian hospital.

BACKGROUND: Postoperative infection of Coronavirus Disease 2019 (COVID-19) has been associated with higher risks of mortality and pulmonary complication. Preoperative vaccination could significantly prevent postoperative-related mortality and morbidity particularly for cancer patients. METHODS: Cancer patients who were scheduled for elective major surgery were questioned for status and their willingness to receive COVID-19 vaccination and were prospectively monitored for the presence of postoperative COVID-19 infection and major complications. RESULTS: During the period of April-July 2021, 367 patients with median age of 49 years were scheduled for cancer surgery. Procedures for breast cancer were the most frequently performed (N = 166, 45.2%). Surgery procedures with potential aerosol generating procedures (AGPs) were performed in total of 104 patients (28.3%). Only 6 of 367 patients (1.6%) were fully vaccinated in the day of surgery and 351 patients (95.6%) were willing to receive COVID-19 vaccination. Fully vaccinated patients were significantly higher among those who were living in urban areas (OR = 22.897, 95%CI:4.022-130.357, P = 0.0001). Willingness to get the COVID-19 vaccination was significantly higher among female patients (OR = 4.661, 95%CI:1.685-12.896, P = 0.003). Postoperative COVID-19 infection was confirmed in 17 patients (4.6%) and major surgical complications were observed in 12 patients (3.3%). None of preoperatively vaccinated patients experienced postoperative COVID-19 infection or the related major complications. CONCLUSION: Although prioritizing COVID-19 vaccination in preoperative cancer patients has been recommended to prevent postoperative fatalities, only a small proportion of our patients have been vaccinated. Preoperatively vaccinated patients show advantages in the prevention of postoperative COVID-19 infection and major surgery complications. The slow rollout and disparity in the vaccination progress for patients requiring a major cancer surgery need to be specifically addressed.

Vigilance to misleading information is required to avoid delayed diagnosis: Case series of acral melanomas.

INTRODUCTION: Melanoma is considered a rare cancer among Asians with a wide range of mucocutaneous manifestations. Failure to recognize a lesion as melanoma at first presentation might delay surgery aimed at complete resection. Acral melanoma has been related with the highest rate of misdiagnosis (~30%) causing further delayed diagnosis. Reliability of patient' history taking in melanoma has not yet been systematically reported. PRESENTED CASES: Two patients visited our oncology clinic with pigmented lesions in their soles. A 66-year-old man disclosed it appeared since a year ago after accidently hitting a stone while farming. Physical examination showed a black-brown irregular 100 × 80 mm lesion covering the distal third of the right sole with ulceration in the central lesion. The second patient was a geriatric woman with a black-purple 25 × 27 mm lesion with slight protrusion and ulceration in the central, irregular border, and partial hyperkeratosis. She explained the lesion emerged two years ago after she accidently stepped on a nail. Both patients were then diagnosed with acral melanomas and were treated with wide-excision, closure with skin grafting, and inguinal dissection. DISCUSSION: Both patients reported history of traumas in lesions later confirmed as acral melanomas. Although history taking can provide up to 80% of the information for accurate diagnosis, in ambivalent cases, careful anamnesis, clinical examination, and biopsy are required to confirm diagnosis of acral melanoma. Early disease identification to establish definitive diagnosis of cancer is generally associated with better clinical outcomes. In suspected cases, vigilance toward misleading information in history taking is required.

Complete diaphysis resorption of the femur: A case report in a metastatic papillary thyroid cancer.

INTRODUCTION: Although differentiated thyroid cancers generally have a good prognosis, a small proportion of patients will have recurrent or progressive disease. Bone resorption due to thyroid cancer can cause significant challenges in the clinical management and rehabilitation. PRESENTED CASE: Nearly total femur resorption was found as a first presentation in a patient with thyroid cancer. The patient complained about chronic pain in her left thigh that had progressed into an inability to walk. She was treated by a traditional healer for six years before she was persuaded by a social worker to seek medical help. X-rays showed pathological loss of the right diaphyseal femur. Neck CT-scan showed a left thyroid mass with tracheal deviation, with multiple lytic lesions in the sternum and 5th rib. Needle biopsy of the thyroid mass resulted in an inconclusive follicular neoplasm. Total thyroidectomy and neck dissection revealed a classical type of papillary thyroid carcinoma. After thyroid ablation, she opted for palliative radiotherapy and bisphosphonate treatment for the bone metastases. DISCUSSION: Bone metastases are rarely detected at the time of thyroid cancer diagnosis. In the presence of bone metastasis, median survival of well-differentiated thyroid cancer decreases into only 4 years. Bone metastases are often neglected and less studied than regional lymph node and lung metastases. CONCLUSION: Although well differentiated thyroid cancer is usually indolent, a neglected bone metastasis at an initial diagnosis might adversely affect patient's quality of life and prognosis.

Effects of Omega-3 Supplementation on Ki-67 and VEGF Expression Levels and Clinical Outcomes of Locally Advanced Breast Cancer Patients Treated with Neoadjuvant CAF Chemotherapy: A Randomized Controlled Trial Report

Background: Omega-3 is a polyunsaturated fatty acid with an ability to regulate cell proliferation and apoptosis through interaction with inflammatory mediators. The potential additional beneficial effects of Omega-3 on chemotherapy patients with breast cancer is not yet completely revealed. Methods: A double-blind randomized control trial (RCT) involving a total of 48 locally advanced breast cancer patients was conducted. Ki-67 and VEGF expressions, as well as overall survival of patients receiving neoadjuvant cyclophosphamide-doxorubicin-5'fluorouracyl (CAF) chemotherapy plus Omega-3 (intervention group) or placebo (control group), were compared. Kaplan-Meier curve and Cox-regression tests were used to assess conditional disease-free survival (DFS) and overall survival (OS) between the two groups. Results: Decreased Ki-67 expression was observed in the intervention group compared to control (42.4±4.8 versus 39.2±5.3; T-test p=0.032). Decreased Ki-67 expression was observed in intervention compared to control group (42.4±4.8 versus 39.2±5.3; T-test p=0.032). Decreased VEGF expression was also seen in the intervention group compared to control (32.7±5.2 versus 29.5±5.4; T-test p=0.041). VEGF expression positively correlated with Ki-67 expression (Spearman's test p<0.001, R2=0.541). Overall survival in the intervention group was significantly longer in comparison to the control group (mean survival: 30.9 ± 3.71 versus 25.9 ± 3.6 weeks, Mantel-Cox test p=0.048; HR=0.411, 95%CI: 0.201-0.840). Disease-free survival was significantly longer in the intervention group compared to the control group (mean survival: 28.5 ± 3.3 versus 23.7 ± 3.6, respectively; Mantel-Cox test p=0.044, HR= 0.439, 95%CI: 0.222-0.869). Conclusion: Omega-3 fatty acid supplementation improved overall survival and progression-free survival of locally advanced breast cancer treated with CAF neoadjuvant chemotherapy and mastectomy.