The Performance of the Nottingham Prognosis Index and the Adjuvant Online Decision Making Tool for Prognosis in Early-stage Breast Cancer Patients.

BACKGROUND: Prognostic tools are widely used in the practice of Oncology and have been developed to help stratify patients into specific risk-related grouping. We sought to apply of two such tools used for patients with early-stage breast cancer and to correlate them with actual outcomes. METHODS: A retrospective study was designed to include early-stage breast cancer cases seen from 1994 to 2014 at the Seyedoshohada Hospital in Isfahan, Iran. Information was derived from the patients' records, and indices were derived from prognostic tools. Information was analyzed using descriptive statistics and one sample t-test. RESULTS: In 233 patients, the difference between the predicted overall survival (OS) by the Adjuvant Online (AO) prognosis tools (69.28) and the observed OS (71.2) was not statistically significant (P = 0.52), and the AO prognosis tools had predicted the patients' OS correctly. In the Nottingham prognosis index (NPI), this difference in all groups except the very poor prognosis group was not statistically significant. CONCLUSIONS: Adjuvant Online prognosis tools were capable of predicting the 10-year OS rate although not in all of the subgroups. The NPI was capable of distinguishing good, moderate, and poor survival rates, but this ability was not visible in more specific groups with moderate and poor prognosis.

Application of joinpoint regression in determining breast cancer incidence rate change points by age and tumor characteristics in women aged 30-69 (years) and in Isfahan city from 2001 to 2010.

BACKGROUND AND OBJECTIVES: Breast cancer is a major threat to women's health. Evaluation of the changes in trend of the incidence rate provides valuable information for the assessment and planning of development indicators of each country. The aim of the present study was to apply the JoinPoint regression model for determining changes in the trend of the breast cancer incidence rate in Isfahan. MATERIALS AND METHODS: In this cross-sectional study, 3640 women with breast cancer referring to oncology and radiotherapy departments of Seyed-al-Shohada and Milad cancer treatment centers of Isfahan during 2001-2010 were studied and sampling was not done. Joinpoint regression model was used to investigate the pattern of breast cancer incidence rate. Response and independent variables were the natural logarithm of the age-standardized incidence rates and year of diagnosis of breast cancer, respectively, in which various levels of cancer tumor characteristics (P < 0.05) were analyzed. RESULTS: The incidence rates increased annually in the age groups of 40-44 years (6.2%), 45-49 years (5.3%), and 55-59 years (5.3%). The trend of incidence rates in women with tumor size ≤2 cm (18.2%), well (moderately) differentiated tumor grade [8% (10.2%)], positive estrogen (progesterone) hormone receptor status [10.5% (6.9%)], and the proportion of positive lymph node to surgery node ≤25% (nonsignificant) was upward. CONCLUSION: The trend of incidence rates with tumor size ≤2 cm, well-differentiated tumor grade, moderately differentiated tumor grade, and positive estrogen and progesterone hormone receptors was upward. The pattern of breast cancer can help in cancer prevention and prognosis, and in selecting the best type of surgery.

Trends in breast cancer incidence rates by age and tumor characteristics of women in the city of Isfahan for the period 2001-2010: An application of joinpoint analysis.

BACKGROUND: Cancer incidence trends use by health officials in order to program evaluations and development of cancer control strategies. The trends of cancer incidence have used to evaluate programs and develop the cancer control strategies. The aim of this study is to analyze changes of breast cancer incidence trends in Isfahan city using joinpoint regression models. MATERIALS AND METHODS: The study was based on all cases of breast cancer reported among women residing in the city of Isfahan for the period 2001-2010. Age-standardized rates were calculated for each tumor characteristics, using the direct method. Joinpoint regression was used to provide estimated annual percentage change. RESULTS: A plot of the age-specific rates of breast cancer showed an increase in all age groups from 30 to 69 years and sharp increase in the incidence of breast cancer confined to estrogen receptor-positive and progesterone receptor-positive tumors and the significant change (2003) by progesterone receptor(-) tumors. The analysis by tumor size and grade, incidence rates decreased for tumors >5 cm by 10.6% since 2006.7 and for poorly differentiated tumor by 26.1% since 2007.8. No decrease in incidence was observed for group of proportion of positive lymph nodes to lymph node surgery ≥25%. The proportion of positive lymph node to surgery node ≤25% (nonsignificant) was upward. CONCLUSION: The trend of incidence rates with tumor size ≤2, well-differentiated tumor grade, moderately differentiated tumor grade, positive estrogen and progesterone hormone receptors was upward. The pattern of breast cancer can help to cancer prevention and prognosis, selecting the best type of surgery.

Hormonal and reproductive risk factors associated with breast cancer in Isfahan patients.

BACKGROUND: Breast cancer is the most prevalent type of cancer among Iranian females; it is noteworthy that the condition of this type of cancer among Iranian women does not significantly differ from what has been reported from other countries. Considering the importance of this issue, identification of the backgrounds factors and risk factors of the breast cancer risk are highly needed. Therefore, the present study is aimed to compare the risk factors of resident patients of Isfahan province, Iran, with accredited risk factors by other countries and also identify the importance of each factor in the incidence of cancer. MATERIALS AND METHODS: The present work is a case-control study, which was conducted in 2011. In order to conduct the study, 216 women who had been clinically identified with breast cancer were selected from Seiedo-Shohada Hospital, Isfahan, Iran, as the case group. Moreover, 41 healthy women who were the relatives of the selected patients (i.e., sisters and aunts) were selected as the control group. The data and information of the patients from 1999 to 2010 were collected from either assessing the database system of the center for breast cancer research or interviewing the patients through phone. To analyze the data, multiple logistic regression method was applied. RESULTS: The range of age among selected individuals in this study was from 20-75 years old. The determinant factors for odds of breast cancer included in the applied multiple logistic regression model were the use of oral contraceptive pills (OCPs) (odds ratio [OR] =0.18, 95% confidence interval [CI] = 0.04-0.75) as the protective factor, hormone replacement therapy (OR = 10.2, 95% CI = 1.18-88.89) and menopause at old age (OR = 1.26, 95% CI = 1.11-2.12) as the risk factors. Furthermore, there was not seen any significant relationship between age, vocation, and marital status with odds of breast cancer in multiple model. CONCLUSION: Based on the results, use of OCPs as protective factor, hormone replacement therapy, and menopause at old age are identified as the risk factors in developing breast cancer among women. Influencing and modifiable factors should be considered very important in society based interventions and preventive interventions planning.

Investigation of the age trends in patients with breast cancer and different sizes of tumors in Breast Cancer Research Center of Isfahan University of Medical Sciences in 2001-2010.

BACKGROUND: Breast cancer is the most common cause of death in women in the age range of 35-55 years. Each year, one or two cases of breast cancer per 1000 women are diagnosed as new cases. Despite the serious prognosis and high rate of morbidity, mortality, and pathogenicity, in the case of early diagnoses, the prognosis will be better. The aim of this study was to investigate the age trends in breast cancer patients with different sizes of tumors in Breast Cancer Research Center of Isfahan University of Medical Sciences in 2001-2010. MATERIALS AND METHODS: The information in radiotherapy and oncology of Isfahan University of Medical Sciences and Milad Hospital from 2001 to 2010 were coded and analyzed. Frequency of patients' age groups, tumor sizes and the year of cancer diagnosis were calculated. Correlation test was used for data analysis in statistical analysis in social science (SPSS) software version 18. FINDINGS: Among the 3722 patients with breast cancer, the highest relative frequency distribution, respectively was observed in the age of 40-49 years (34.4%), 50-59 years (26.6%), 30-39 years (17.7%), 60-69 years (13.2%), 20-29 years (2.5%), 70 years and older (5.2%) and less than 20 years. Relative frequency distribution of tumor sizes in a variety of 5 cm (T2) was with the frequency of 59.8%, and then 26% at 5 cm (T3), 10.5% at 2 cm (T1), 3.1% at T4 and 0.6 at In-situ, respectively. CONCLUSION: The investigation of age trends showed that diagnosis rate of breast cancer increased from 2001 to 2004. It reached its highest value in 2006 at the age range of 30-39 years. Then, the trend has been downward, and it has continued to decline until 2010, which could be the result of the equipping screening system and recording the malignant cases. 85.8% of the examined tumors in T2 and T3 group were visible and may be disturbing. Comparing the frequency distribution of the infected population showed that the highest incidence of breast cancer diagnosis were in the age range of 40-49 years. It seems that as long as the mass has not reached an obvious palpable state, it has not been diagnosed.

Comparison of satisfactions from mastectomy and Lump Ectome in breast cancer patients.

INTRODUCTION: The prevalence of breast cancer among women in compare to other types of cancers in all over the world and in Iran is high. Mastectomy surgery is one of the common treatments for these patients. Another method, which is less invasive, is Lumpectomy. This study comprised the satisfaction of patients under two types of surgery; Mastectomy and Lumpectomy. MATERIALS AND METHODS: In this cross-sectional study, two types of patients which had either, Mastectomy or Lumpectomy, were studied. RESULTS: From 119 patients which studied here, 80 patients (66.7%) were treated by mastectomy and 39 patients (32.5%) were treated under lumpectomy. Two groups had not significant differences in duration between diagnostic and surgery, the number of lymph nodes involved and the number of lymph nodes removed. Lumpectomy patients had higher pain and numbness in 24 h, 1 week after surgery and at the time of study than the other group. The observed difference was significant (P = 0.043). DISCUSSION: It is implied in previous studies that patients under lumpectomy had more satisfaction than patients under mastectomy. However, no differences were observed in quality-of-life between the two groups in some other studies. The differences between various studies might be for the sake of cultural variety and time interval between surgery and filling questionnaire.

Detection of prognostic factors in metastatic breast cancer.

BACKGROUND: The aim of this study was to detect prognostic factors in recurrent breast cancer metastasis. MATERIALS AND METHODS: This retrospective cohort study employed data from 996 breast cancer patients of Isfahan Seyed-o-Shohada research center from 1998 to 2010. Stratified Cox proportional hazards model, marginal approach, was used to evaluate the prognostic value of estrogen receptor, progesterone receptor, tumor protein 53, human epidermal growth factor receptor type 2, diagnosis age, nodal ratio, tumor size, antigen Ki67, and cathepsin D. Survival curves were plotted using Kaplan-Meier method and log-rank test was carried out to compare survival in two categories of nodal ratio (≤0.25 vs. >0.25). RESULTS: In simple Cox regression model, age (P = 0.037), nodal ratio (P < 0.0001), and Ki67 (P = 0.032) were associated with hazard of distant metastasis. Multiple analysis showed that patients with greater nodal ratio had significantly higher adjusted hazard of recurrent metastasis (Hazard ratio: 2.756, 95% Confidence interval: 1.017-7.467; P = 0.046). Tumor size was not an independent prognostic factor for recurrent metastasis. Comparing survival curves, there was significant difference between two categories of nodal ratio in the first (P < 0.0001), second (P < 0.0001) and third (P = 0.024) metastasis; survival was higher in-patients with nodal ratio <0.25. CONCLUSION: Our findings indicate that tumor size was insignificant; this raises the question about conventional premise of being a major prognostic factor for distant metastasis. Furthermore, nodal ratio is suggested to clinicians as a prognostic variable in follow-up of breast cancer patients; patients with higher nodal ratio have greater hazard of distant metastasis.

The mortality and response rate after FLANG regimen in patients with refractory/relapsed acute leukemia.

BACKGROUND: Oncologists today are greatly concerned about the treatment of relapsed/refractory acute leukemia. FLANG regimen, combination of novantron, cytarabine, fludarabine, and granulocyte-colony stimulating factor, has been used in treatment of refractory/relapsed acute leukemia since 1990s. The present study has evaluated mortality and response rate of this regimen. MATERIALS AND METHODS: In this study, 25 patients with refractory/relapsed acute leukemia aged 15-55 years underwent FLANG regimen at Seyed-Al-Shohada Hospital, Isfahan, Iran during 2008-2009. One month later, bone marrow samples were taken to evaluate the responsiveness to treatment. Participants were followed for a year. The data was analyzed by student-t and chi-square tests, logistic, and Cox regression analysis, and Kaplan-Meier curves in SPSS(19). RESULTS: Out of the 25 patients, 8 patients (32%) had acute lymphoblastic leukemia (5 refractory and 3 relapsed cases) and 17 subjects had acute myeloid leukemia (7 refractory and 10 relapsed cases). According to the bone marrow biopsies taken one month after FLANG regimen, 10 patients (40%) had responded to treatment. Five patients of the 10 responders underwent successful bone marrow transplantation (BMT). On the other hand, 13 patients (52%), who had not entered the CR period, died during the follow-up. Logistic regression analysis did not reveal any significant associations between disease type and responsiveness to treatment. CONCLUSION: This study indicated higher rates of unresponsiveness to treatment while its mortality rate was comparable with other studies. Overall, according to limitations for BMT (as the only chance for cure) in Iran, it seems that FLANG therapy is an acceptable choice for these patients.

Intestinal parasitic infections in renal transplant recipients

The impact of intestinal parasitic infection in renal transplant recipients requires careful consideration in the developing world. However, there have been very few studies addressing this issue in Iran. This study was conducted to determine the prevalence of intestinal parasitic infections in renal transplant recipients in Iran. Stool specimens from renal transplant recipients and control groups were obtained between June 2006 and January 2007. The samples screened for intestinal parasitic infections using direct smear, formalin-ether sedimentation, Sheather's flotation and modified Ziehl-Neelsen staining methods. Out of 150 renal transplant recipients, 33.3 percent (50), and out of 225 control group, 20 percent (45) were infected with one or more type of intestinal parasites. The parasites detected among patients included Entamoeba coli (10.6 percent), Endolimax nana (8.7 percent), Giardia lamblia (7.4 percent), Blastocystis spp. (4.7 percent), Iodamoeba butschlii (0.7 percent), Chilomastix mesnili (0.7 percent) and Ascaris lumbricoides (0.7 percent). Multiple infections were more common among renal transplant recipients group (p < 0.05). This study highlights the importance of testing for intestinal parasites among Iranian renal transplant recipients. Routine examinations of stool samples for parasites would significantly benefit the renal transplant recipients by contributing to reduce severe infections.

Detection of rifampin resistance patterns in Mycobacterium tuberculosis strains isolated in Iran by polymerase chain reaction-single-strand conformation polymorphism and direct sequencing methods

Mutations in the rpoB locus confer conformational changes leading to defective binding of rifampin (RIF) to rpoB and consequently resistance in Mycobacterium tuberculosis. Polymerase chain reaction-single-strand conformation polymorphism (PCR-SSCP) was established as a rapid screening test for the detection of mutations in the rpoB gene, and direct sequencing has been unambiguously applied to characterize mutations. A total of 37 of Iranian isolates of M. tuberculosis, 16 sensitive and 21 resistant to RIF, were used in this study. A 193-bp region of the rpoB gene was amplified and PCR-SSCP patterns were determined by electrophoresis in 10 percent acrylamide gel and silver staining. Also, 21 samples of 193-bp rpoB amplicons with different PCR-SSCP patterns from RIFr and 10 from RIFs were sequenced. Seven distinguishable PCR-SSCP patterns were recognized in the 21 Iranian RIFr strains, while 15 out of 16 RIFs isolates demonstrated PCR-SSCP banding patterns similar to that of sensitive standard strain H37Rv. However one of the sensitive isolates demonstrated a different pattern. There were seen six different mutations in the amplified region of rpoB gene: codon 516(GAC/GTC), 523(GGG/GGT), 526(CAC/TAC), 531(TCG/TTG), 511(CTG/TTG), and 512(AGC/TCG). This study demonstrated the high specificity (93.8 percent) and sensitivity (95.2 percent) of PCR-SSCP method for detection of mutation in rpoB gene; 85.7 percent of RIFr strains showed a single mutation and 14.3 percent had no mutations. Three strains showed mutations caused polymorphism. Our data support the common notion that rifampin resistance genotypes are generally present mutations in codons 531 and 526, most frequently found in M. tuberculosis populations regardless of geographic origin.