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1.
S Afr J Surg ; 62(2): 8-12, 2024 May.
Article in English | MEDLINE | ID: mdl-38838112

ABSTRACT

Primary liver cancer was the third most common cause of death due to cancer worldwide in 2020. As the predominant type, hepatocellular carcinoma (HCC) represents the overwhelming majority of newly diagnosed primary liver tumours. Liver transplantation remains the treatment of choice for a cure in otherwise unresectable HCC. For nearly thirty years, the Milan and Barcelona Clinic Liver Cancer (BCLC) criteria have guided physicians' clinical decision-making for selection of liver transplant candidates in the treatment of HCC. More recently, studies have demonstrated survival benefit for patients transplanted beyond Milan criteria. This remains an area of active research and includes advancements in local-regional therapies and their role in downstaging tumours to within transplant criteria as a bridge to transplant. Other advancements on the horizon include the identification of tumour biomarkers that may lead to earlier diagnosis and more accurate prediction of prognosis and risk of recurrence, as well as new neoadjuvant therapies and post-transplant immunosuppression regimens that may allow for further expansion of transplant eligibility criteria. Additionally, several recent studies have investigated the potential survival benefit of combination therapy using local-regional intervention with systemic immunotherapy to downstage otherwise unresectable disease that is beyond Milan criteria. Liver transplantation will continue to play an important role in the treatment of HCC for the foreseeable future and based on currently available evidence, both local-regional therapies and immunomodulation in combination are poised to change the landscape of liver transplantation for HCC as we currently know it.


Subject(s)
Carcinoma, Hepatocellular , Liver Neoplasms , Liver Transplantation , Humans , Carcinoma, Hepatocellular/surgery , Carcinoma, Hepatocellular/therapy , Liver Neoplasms/surgery , Liver Neoplasms/pathology , Patient Selection , Neoadjuvant Therapy , Neoplasm Staging
2.
Arch Dermatol Res ; 316(6): 337, 2024 Jun 06.
Article in English | MEDLINE | ID: mdl-38844623

ABSTRACT

BACKGROUND: The PROspective Cutaneous Lymphoma International Prognostic Index (PROCLIPI) study is aprospective analysis of an international database. Here we examine front-line treatments and quality of life (QoL) inpatients with newly diagnosed mycosis fungoides (MF). OBJECTIVES: To identify (i) differences in first-line approaches according to tumour-nodes-metastasis-blood (TNMB)staging; (ii) parameters related to a first-line systemic approach and (iii) response rates and QoL measures. METHODS: In total, 395 newly diagnosed patients with early-stage MF (stage IA-IIA) were recruited from 41 centresin 17 countries between 1 January 2015 and 31 December 2018 following central clinicopathological review. RESULTS: The most common first-line therapy was skin-directed therapy (SDT) (322 cases, 81·5%), while a smallerpercentage (44 cases, 11·1%) received systemic therapy. Expectant observation was used in 7·3%. In univariateanalysis, the use of systemic therapy was significantly associated with higher clinical stage (IA, 6%; IB, 14%; IIA,20%; IA-IB vs. IIA, P < 0·001), presence of plaques (T1a/T2a, 5%; T1b/T2b, 17%; P < 0·001), higher modified Severity Weighted Assessment Tool (> 10, 15%; ≤ 10, 7%; P = 0·01) and folliculotropic MF (FMF) (24% vs. 12%, P = 0·001). Multivariate analysis demonstrated significant associations with the presence of plaques (T1b/T2b vs.T1a/T2a, odds ratio 3·07) and FMF (odds ratio 2·83). The overall response rate (ORR) to first-line SDT was 73%,while the ORR to first-line systemic treatments was lower (57%) (P = 0·027). Health-related QoL improvedsignificantly both in patients with responsive disease and in those with stable disease. CONCLUSIONS: Disease characteristics such as presence of plaques and FMF influence physician treatment choices,and SDT was superior to systemic therapy even in patients with such disease characteristics. Consequently, futuretreatment guidelines for early-stage MF need to address these issues.


Subject(s)
Mycosis Fungoides , Neoplasm Staging , Quality of Life , Skin Neoplasms , Humans , Mycosis Fungoides/pathology , Mycosis Fungoides/drug therapy , Mycosis Fungoides/diagnosis , Mycosis Fungoides/therapy , Male , Female , Middle Aged , Skin Neoplasms/pathology , Skin Neoplasms/drug therapy , Skin Neoplasms/therapy , Skin Neoplasms/diagnosis , Aged , Adult , Prospective Studies , Aged, 80 and over , Treatment Outcome , Prognosis
3.
J Robot Surg ; 18(1): 244, 2024 Jun 07.
Article in English | MEDLINE | ID: mdl-38847899

ABSTRACT

Robotic partial nephrectomy (RPN) is a gold standard treatment for focal kidney tumors. Off-clamp RPN avoids prolonged ischemia times. We sought to evaluate the safety and efficacy of off-clamp RPN in patients with renal tumors > 4 centimeters (cm). From 2007 to 2021, we examined patients who underwent RPN for cT1b-T2N0M0 renal tumors. Preoperative, intraoperative, and postoperative outcomes were examined for patients who underwent on or off-clamp RPN. Patients with cT1b tumors (4-7 cm) who underwent either approach were retrospectively propensity-matched based on renal function and tumor size. Of 225 patients, on-clamp RPN was employed in 147 patients, while 78 patients underwent an off-clamp approach. Preoperative estimated glomerular filtration rate (eGFR) was significantly lower in the off-clamp group (p = 0.026). Mean nephrometry scores and mean tumor sizes were similar between cohorts. Average estimated blood loss (EBL) and operative times were similar. Major complication risk was 4.4% lower in the off-clamp group. Blood transfusion rate was 5.6% lower in the off-clamp group. Patients in the off-clamp cohort experienced a < 2% higher risk of positive margins. Postoperative eGFR was more favorable for off-clamp RPN following surgery at 1 year. The propensity-matched analysis demonstrated similar intraoperative outcomes. Blood transfusion rate was significantly lower at 1.5% for patients who underwent off-clamp RPN (p = 0.03). Risk of a major complication was 6.1% lower in the off-clamp RPN cohort, while postoperative eGFR and positive margin rates were similar between off and on-clamp groups. A non-inferior approach for patients with cT1b-T2N0M0 and moderately complex localized renal masses is off-clamp RPN.


Subject(s)
Glomerular Filtration Rate , Kidney Neoplasms , Nephrectomy , Robotic Surgical Procedures , Humans , Nephrectomy/methods , Robotic Surgical Procedures/methods , Kidney Neoplasms/surgery , Male , Female , Middle Aged , Treatment Outcome , Aged , Retrospective Studies , Operative Time , Postoperative Complications/etiology , Postoperative Complications/epidemiology , Neoplasm Staging , Propensity Score , Blood Loss, Surgical/statistics & numerical data , Margins of Excision
4.
World J Gastroenterol ; 30(20): 2731-2733, 2024 May 28.
Article in English | MEDLINE | ID: mdl-38855157

ABSTRACT

A significant number of patients with hepatocellular carcinoma (HCC) are usually diagnosed in advanced stages, that leads to inability to achieve cure. Palliative options are focusing on downstaging a locally advanced disease. It is well-supported in the literature that patients with HCC who undergo successful conversion therapy followed by curative-intent surgery may achieve a significant survival benefit compared to those who receive chemotherapy alone or those who are successfully downstaged with conversion therapy but not treated with surgery. Hepatic artery infusion chemotherapy can be a potential downstaging strategy, since recent studies have demonstrated excellent outcomes in patients with colorectal liver metastatic disease as well as primary liver malignancies.


Subject(s)
Carcinoma, Hepatocellular , Infusions, Intra-Arterial , Liver Neoplasms , Neoplasm Staging , Humans , Liver Neoplasms/pathology , Liver Neoplasms/therapy , Carcinoma, Hepatocellular/pathology , Carcinoma, Hepatocellular/therapy , Carcinoma, Hepatocellular/mortality , Treatment Outcome , Hepatic Artery , Hepatectomy , Palliative Care/methods
5.
J Dtsch Dermatol Ges ; 22(6): 783-791, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38857075

ABSTRACT

BACKGROUND: The introduction of tyrosine kinase inhibitors (TKI) has greatly improved the management of metastatic melanoma. Recent studies have uncovered a relationship between the body mass index (BMI) and outcome of patients with metastatic melanoma. However, conflicting results have challenged the relevance of this finding. In the current work, we aim to dissect body composition features of melanoma patients treated with TKI to evaluate their value as biomarkers. PATIENTS AND METHODS: We analyze body composition features via CT scans in a retrospective cohort of 57 patients with non-resectable stage III/IV melanoma receiving first-line treatment with TKI in our department, focusing on the impact of body composition on treatment efficacy and occurrence of adverse events. RESULTS: In uni- and multivariate analyses, we identify an association between the visceral adipose tissue gauge index (VATGI) and survival. We furthermore profile additional body composition features including sarcopenia, which was also associated with a shorter overall survival. Finally, we detected an enrichment of cases with fatigue in patients with low VATGI. CONCLUSIONS: Our study represents the first exploratory study evaluating the suitability of body composition measurements as biomarkers for melanoma patients treated with TKI. Our data suggest a putative use of VATGI as a biomarker predicting patient outcome.


Subject(s)
Body Composition , Melanoma , Protein Kinase Inhibitors , Skin Neoplasms , Humans , Melanoma/drug therapy , Melanoma/pathology , Body Composition/drug effects , Male , Female , Middle Aged , Protein Kinase Inhibitors/therapeutic use , Protein Kinase Inhibitors/adverse effects , Retrospective Studies , Skin Neoplasms/drug therapy , Skin Neoplasms/pathology , Aged , Body Mass Index , Adult , Treatment Outcome , Tomography, X-Ray Computed , Neoplasm Staging , Intra-Abdominal Fat/diagnostic imaging , Intra-Abdominal Fat/drug effects
6.
Article in Chinese | MEDLINE | ID: mdl-38858110

ABSTRACT

Objective:To investigate the differences in the therapeutic effects of endoscopic surgery combined with chemotherapy and endoscopic surgery combined with radiotherapy in the treatment of early nasopharyngeal carcinoma, and to select individualized treatment strategy for early nasopharyngeal carcinoma. Methods:The clinical data of 68 patients with early nasopharyngeal carcinoma(T1-2N0M0) who received surgical treatment in a high-incidence area were retrospectively analyzed. According to different treatment methods, they were divided into the surgery + chemotherapy group(n=34, treated with endoscopic surgery combined with chemotherapy) and the surgery + radiotherapy group(n=34, treated with endoscopic surgery combined with radiotherapy). Propensity score matching was used to match the patient data between the two groups at a 1∶1 ratio. Patients were followed up, and the survival rates and hematological toxicities were compared between the two groups. Results:Twenty-four cases in the surgery + chemotherapy group and 24 cases in the surgery + radiotherapy group were successfully matched. After matching, there was no statistically significant difference in T stage, and clinical stage between the two groups(all P>0.05). The 3-year OS and DFS in the surgery + chemotherapy group were 100.0% and 95.8%, respectively, while the 3-year OS and DFS in the surgery + radiotherapy group were 100.0% and 100.0%, respectively, with no significant difference in survival rates between the two groups(both P>0.05). After treatment, there was no statistically significant difference in bone marrow suppression between the surgery + chemotherapy group and the surgery + radiotherapy group (all P> 0.05) Conclusion:Endoscopic surgery combined with chemotherapy and surgery combined with radiotherapy have comparable clinical efficacy in the treatment of early nasopharyngeal carcinoma, but without radiotherapy-related complications, which is worth further investigation.


Subject(s)
Carcinoma , Endoscopy , Nasopharyngeal Carcinoma , Nasopharyngeal Neoplasms , Humans , Nasopharyngeal Neoplasms/therapy , Nasopharyngeal Neoplasms/radiotherapy , Nasopharyngeal Carcinoma/therapy , Nasopharyngeal Carcinoma/radiotherapy , Retrospective Studies , Male , Prognosis , Female , Combined Modality Therapy , Carcinoma/therapy , Survival Rate , Middle Aged , Neoplasm Staging , Incidence , Treatment Outcome , Adult
7.
BMC Cancer ; 24(1): 699, 2024 Jun 07.
Article in English | MEDLINE | ID: mdl-38849741

ABSTRACT

BACKGROUND: [18F]Fluorodeoxyglucose ([18F]FDG) positron emission tomography (PET) is recommended during diagnostic work-up for ovarian cancer; however, [18F]FDG PET has several inherent limitations. The novel oncologic PET-tracer fibroblast activation protein inhibitor (FAPI) has demonstrated promising results in multiple cancer types, including ovarian cancer, and could overcome the limitations of [18F]FDG PET; however, high-quality clinical studies are lacking. The primary objective of the present study is to compare the diagnostic accuracy of [68Ga]Ga-FAPI-46 PET/CT and [18F]FDG PET/CT in ovarian cancer patients and to investigate how this potential difference impacts staging and patient management. METHODS AND DESIGN: Fifty consecutive ovarian cancer patients will be recruited from Aalborg University Hospital, Denmark. This study will be a single-center, prospective, exploratory clinical trial that adheres to the standards for reporting diagnostic accuracy studies (STARD). This study will be conducted under continuous Good Clinical Practice monitoring. The eligibility criteria for patients are as follows: (1) biopsy verified newly diagnosed ovarian cancer or a high risk of ovarian cancer and referred for primary staging with [18F]FDG PET/CT; and (2) resectable disease, i.e., candidate for primary debulking surgery or neoadjuvant chemotherapy followed by interval debulking surgery. All recruited study subjects will undergo [68Ga]Ga-FAPI-46 PET/CT at primary staging, before primary debulking surgery or neoadjuvant chemotherapy (Group A + B), in addition to conventional imaging (including [18F]FDG PET/CT). Study subjects in Group B will undergo an additional [68Ga]Ga-FAPI-46 PET/CT following neoadjuvant chemotherapy prior to interval debulking surgery. The results of the study-related [68Ga]Ga-FAPI-46 PET/CTs will be blinded, and treatment allocation will be based on common clinical practice in accordance with current guidelines. The histopathology of surgical specimens will serve as a reference standard. A recruitment period of 2 years is estimated; the trial is currently recruiting. DISCUSSION: To our knowledge, this trial represents the largest, most extensive, and most meticulous prospective FAPI PET study conducted in patients with ovarian cancer thus far. This study aims to obtain a reliable estimation of the diagnostic accuracy of [68Ga]Ga-FAPI-46 PET/CT, shed light on the clinical importance of [68Ga]Ga-FAPI-46 PET/CT, and examine the potential applicability of [68Ga]Ga-FAPI-46 PET/CT for evaluating chemotherapy response. TRIAL REGISTRATION: clinicaltrials.gov: NCT05903807, 2nd June 2023; and euclinicaltrials.eu EU CT Number: 2023-505938-98-00, authorized 11th September 2023.


Subject(s)
Fluorodeoxyglucose F18 , Gallium Radioisotopes , Neoplasm Staging , Ovarian Neoplasms , Positron Emission Tomography Computed Tomography , Humans , Female , Positron Emission Tomography Computed Tomography/methods , Ovarian Neoplasms/diagnostic imaging , Ovarian Neoplasms/pathology , Ovarian Neoplasms/drug therapy , Prospective Studies , Radiopharmaceuticals , Middle Aged , Adult , Aged , Quinolines
8.
BMC Cancer ; 24(1): 704, 2024 Jun 07.
Article in English | MEDLINE | ID: mdl-38849770

ABSTRACT

BACKGROUND: The axillary lymph-node metastatic burden is closely associated with treatment decisions and prognosis in breast cancer patients. This study aimed to explore the value of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT)-based radiomics in combination with ultrasound and clinical pathological features for predicting axillary lymph-node metastatic burden in breast cancer. METHODS: A retrospective analysis was conducted and involved 124 patients with pathologically confirmed early-stage breast cancer who had undergone 18F-FDG PET/CT examination. The ultrasound, PET/CT, and clinical pathological features of all patients were analysed, and radiomic features from PET images were extracted to establish a multi-parameter predictive model. RESULTS: The ultrasound lymph-node positivity rate and PET lymph-node positivity rate in the high nodal burden group were significantly higher than those in the low nodal burden group (χ2 = 19.867, p < 0.001; χ2 = 33.025, p < 0.001). There was a statistically significant difference in the PET-based radiomics score (RS) for predicting axillary lymph-node burden between the high and low lymph-node burden groups. (-1.04 ± 0.41 vs. -1.47 ± 0.41, t = -4.775, p < 0.001). The ultrasound lymph-node positivity (US_LNM) (odds ratio [OR] = 3.264, 95% confidence interval [CI] = 1.022-10.423), PET lymph-node positivity (PET_LNM) (OR = 14.242, 95% CI = 2.960-68.524), and RS (OR = 5.244, 95% CI = 3.16-20.896) are all independent factors associated with high lymph-node burden (p < 0.05). The area under the curve (AUC) of the multi-parameter (MultiP) model was 0.895, which was superior to those of US_LNM, PET_LNM, and RS models (AUC = 0.703, 0.814, 0.773, respectively), with statistically significant differences (Z = 2.888, 3.208, 3.804, respectively; p = 0.004, 0.002, < 0.001, respectively). Decision curve analysis indicated that the MultiP model provided a higher net benefit for all patients. CONCLUSION: A MultiP model based on PET-based radiomics was able to effectively predict axillary lymph-node metastatic burden in breast cancer. TRIAL REGISTRATION: This study was registered with ClinicalTrials.gov (registration number: NCT05826197) on May 7, 2023.


Subject(s)
Axilla , Breast Neoplasms , Fluorodeoxyglucose F18 , Lymph Nodes , Lymphatic Metastasis , Positron Emission Tomography Computed Tomography , Humans , Female , Breast Neoplasms/pathology , Breast Neoplasms/diagnostic imaging , Positron Emission Tomography Computed Tomography/methods , Middle Aged , Lymphatic Metastasis/diagnostic imaging , Retrospective Studies , Adult , Aged , Lymph Nodes/pathology , Lymph Nodes/diagnostic imaging , Radiopharmaceuticals , Prognosis , Neoplasm Staging , Radiomics
9.
World J Surg Oncol ; 22(1): 151, 2024 Jun 07.
Article in English | MEDLINE | ID: mdl-38849854

ABSTRACT

BACKGROUND: Small bowel adenocarcinoma (SBA) is a rare gastrointestinal malignancy forwhich survival is hampered by late diagnosis, complex responses to treatment, and poor prognosis. Accurate prognostic tools are crucial for optimizing treatment strategies and improving patient outcomes. This study aimed to develop and validate a nomogram based on the Surveillance, Epidemiology, and End Results (SEER) database to predict cancer-specific survival (CSS) in patients with SBA and compare it to traditional American Joint Committee on Cancer (AJCC) staging. METHODS: We analyzed data from 2,064 patients diagnosed with SBA between 2010 and 2020 from the SEER database. Patients were randomly assigned to training and validation cohorts (7:3 ratio). Kaplan‒Meier survival analysis, Cox multivariate regression, and nomograms were constructed for analysis of 3-year and 5-year CSS. The performance of the nomograms was evaluated using Harrell's concordance index (C-index), the area under the receiver operating characteristic (ROC) curve, calibration curves, decision curve analysis (DCA), net reclassification improvement (NRI), and integrated discrimination improvement (IDI). RESULTS: Multivariate Cox regression identified sex, age at diagnosis, marital status, tumor site, pathological grade, T stage, N stage, M stage, surgery, retrieval of regional lymph nodes (RORLN), and chemotherapy as independent covariates associated with CSS. In both the training and validation cohorts, the developed nomograms demonstrated superior performance to that of the AJCC staging system, with C-indices of 0.764 and 0.759, respectively. The area under the curve (AUC) values obtained by ROC analysis for 3-year and 5-year CSS prediction significantly surpassed those of the AJCC model. The nomograms were validated using calibration and decision curves, confirming their clinical utility and superior predictive accuracy. The NRI and IDI indicated the enhanced predictive capability of the nomogram model. CONCLUSION: The SEER-based nomogram offers a significantly superior ability to predict CSS in SBA patients, supporting its potential application in clinical decision-making and personalized approaches to managing SBA to improve survival outcomes.


Subject(s)
Adenocarcinoma , Intestinal Neoplasms , Nomograms , SEER Program , Humans , Male , Female , SEER Program/statistics & numerical data , Adenocarcinoma/mortality , Adenocarcinoma/pathology , Adenocarcinoma/therapy , Middle Aged , Survival Rate , Aged , Intestinal Neoplasms/mortality , Intestinal Neoplasms/pathology , Intestinal Neoplasms/therapy , Intestinal Neoplasms/diagnosis , Prognosis , Follow-Up Studies , Neoplasm Staging , Intestine, Small/pathology , ROC Curve , Adult , Retrospective Studies
10.
J Dermatolog Treat ; 35(1): 2360568, 2024 Dec.
Article in English | MEDLINE | ID: mdl-38852942

ABSTRACT

BACKGROUND: Response rates of approved systemic therapies for cutaneous T-cell lymphoma (CTCL) hover near 30%, suggesting unmet need. This study describes real-world treatment patterns and response rates of extracorporeal photopheresis (ECP) in CTCL patients. METHODS: A chart review was conducted in the United States of adults with CTCL who initiated ECP between January 1, 2017, and February 28, 2019, and received at least three months of ECP treatment as monotherapy or concomitant therapy. Clinical outcomes were collected quarterly for up to 18 months. RESULTS: The 52 patients were predominantly Caucasian. Half were male; median age was 69 years. Most patients had Sézary syndrome (50%) or mycosis fungoides (36.5%). Nearly 40% of patients had stage IV disease; 33% had lymph node involvement. Nineteen patients (36.5%) achieved response (>50% reduction in BSA affected); median time to response was 6.5 months. The percentage of patients rated as at least minimally improved was 59.5% at 6 months (N = 22), 75.0% at 9 months (N = 24), and 60.0% at 12 months (N = 15) after ECP initiation. CONCLUSIONS: Despite the ECP treated population in this study being older and having more advanced-stage disease than recent trials, response rates were comparable. These real-world findings support ECP as an effective treatment option for CTCL patients.


Subject(s)
Lymphoma, T-Cell, Cutaneous , Photopheresis , Skin Neoplasms , Humans , Male , Female , Aged , Middle Aged , Lymphoma, T-Cell, Cutaneous/therapy , Lymphoma, T-Cell, Cutaneous/pathology , Skin Neoplasms/therapy , Skin Neoplasms/pathology , United States , Treatment Outcome , Retrospective Studies , Adult , Aged, 80 and over , Sezary Syndrome/therapy , Sezary Syndrome/pathology , Mycosis Fungoides/therapy , Mycosis Fungoides/pathology , Neoplasm Staging
11.
J Egypt Natl Canc Inst ; 36(1): 20, 2024 Jun 10.
Article in English | MEDLINE | ID: mdl-38853190

ABSTRACT

BACKGROUND: The goal is to use three different machine learning models to predict the recurrence of breast cancer across a very heterogeneous sample of patients with varying disease kinds and stages. METHODS: A heterogeneous group of patients with varying cancer kinds and stages, including both triple-negative breast cancer (TNBC) and non-triple-negative breast cancer (non-TNBC), was examined. Three distinct models were created using the following five machine learning techniques: Adaptive Boosting (AdaBoost), Random Under-sampling Boosting (RUSBoost), Extreme Gradient Boosting (XGBoost), support vector machines (SVM), and Logistic Regression. The clinical model used both clinical and pathology data in conjunction with the machine learning algorithms. The machine learning algorithms were combined with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) imaging characteristics in the radiomic model, and the merged model combined the two types of data. Each technique was evaluated using several criteria, including the receiver operating characteristic (ROC) curve, precision, recall, and F1 score. RESULTS: The results suggest that the integration of clinical and radiomic data improves the predictive accuracy in identifying instances of breast cancer recurrence. The XGBoost algorithm is widely recognized as the most effective algorithm in terms of performance. CONCLUSION: The findings presented in this study offer significant contributions to the field of breast cancer research, particularly in relation to the prediction of cancer recurrence. These insights hold great potential for informing future investigations and clinical interventions that seek to enhance the accuracy and effectiveness of recurrence prediction in breast cancer patients.


Subject(s)
Breast Neoplasms , Machine Learning , Magnetic Resonance Imaging , Neoplasm Recurrence, Local , Humans , Female , Neoplasm Recurrence, Local/diagnostic imaging , Neoplasm Recurrence, Local/pathology , Magnetic Resonance Imaging/methods , Retrospective Studies , Middle Aged , Breast Neoplasms/diagnostic imaging , Breast Neoplasms/pathology , Adult , Algorithms , ROC Curve , Aged , Support Vector Machine , Prognosis , Triple Negative Breast Neoplasms/diagnostic imaging , Triple Negative Breast Neoplasms/pathology , Neoplasm Staging , Radiomics
12.
Ann Saudi Med ; 44(3): 153-160, 2024.
Article in English | MEDLINE | ID: mdl-38853474

ABSTRACT

BACKGROUND: Nasopharyngeal carcinoma (NPC) is a rare disease worldwide; To the best of our knowledge, there is no established standard of care specifically tailored for the adolescent population. The majority of existing research relies on retrospective data analysis. OBJECTIVE: Evaluate clinical features, treatment results, prognostic factors and late toxicities of locally advanced NPC patients treated with tomotherapy. DESIGN: Retrospective. SETTINGS: Tertiary care hospital. PATIENTS AND METHODS: Between January 2007 and January 2020, we treated patients with NPC, aged between 14 and 21 years, with concomitant chemoradiotherapy using tomotherapy at our institution. We prospectively collected details of clinical characteristics, treatment modalities, outcomes and prognostic factors of these patients and then analysed them retrospectively. MAIN OUTCOME MEASURES: 3-5 years overall survival (OS), 3-5 years locoregional control rate, 3-5 years disease-free survival (DFS), prognostic factors. SAMPLE SIZE: 51 patients. RESULTS: There were 26 male and 25 female patients included in our study. The mean age was 16.5 years, 5 (9.8%) patients with stage III, and 46 (90.2%) with stage IVa according to the American Joint Committee on Cancer, 8th edition staging system. Most patients (98%) received two or more cycles of induction chemotherapy. All patients received concomitant chemoradiotherapy. The median total dose of radiotherapy delivered was 6600 cGy (range 4800-7000). With a median follow-up of 73 months (range 9-168 months), a 5-year locoregional control rate, 5-year OS and 5-year DFS rates were 100%, 86.8% and 71.7%, respectively. Five years later, disease control was 71.7%. Ten (19.6%) patients had disease recurrence in the form of distant metastases during the follow up. CONCLUSIONS: Helical tomotherapy has an excellent late toxicity profile without compromising clinical outcome for patients with NPC. Radiotherapy remains the mainstay of treatment of nasopharyngeal carcinoma to achieve remarkable local control rates. LIMITATIONS: Single institution experience, small number of patients, and retrospective design.


Subject(s)
Chemoradiotherapy , Nasopharyngeal Carcinoma , Nasopharyngeal Neoplasms , Neoplasm Staging , Radiotherapy, Intensity-Modulated , Humans , Female , Male , Adolescent , Nasopharyngeal Carcinoma/therapy , Nasopharyngeal Carcinoma/radiotherapy , Nasopharyngeal Carcinoma/mortality , Nasopharyngeal Carcinoma/pathology , Nasopharyngeal Neoplasms/therapy , Nasopharyngeal Neoplasms/radiotherapy , Nasopharyngeal Neoplasms/pathology , Retrospective Studies , Radiotherapy, Intensity-Modulated/methods , Radiotherapy, Intensity-Modulated/adverse effects , Young Adult , Chemoradiotherapy/methods , Disease-Free Survival , Saudi Arabia , Prognosis , Treatment Outcome , Survival Rate , Induction Chemotherapy/methods
13.
J Cardiothorac Surg ; 19(1): 307, 2024 May 31.
Article in English | MEDLINE | ID: mdl-38822379

ABSTRACT

BACKGROUND: Accurate prediction of visceral pleural invasion (VPI) in lung adenocarcinoma before operation can provide guidance and help for surgical operation and postoperative treatment. We investigate the value of intratumoral and peritumoral radiomics nomograms for preoperatively predicting the status of VPI in patients diagnosed with clinical stage IA lung adenocarcinoma. METHODS: A total of 404 patients from our hospital were randomly assigned to a training set (n = 283) and an internal validation set (n = 121) using a 7:3 ratio, while 81 patients from two other hospitals constituted the external validation set. We extracted 1218 CT-based radiomics features from the gross tumor volume (GTV) as well as the gross peritumoral tumor volume (GPTV5, 10, 15), respectively, and constructed radiomic models. Additionally, we developed a nomogram based on relevant CT features and the radscore derived from the optimal radiomics model. RESULTS: The GPTV10 radiomics model exhibited superior predictive performance compared to GTV, GPTV5, and GPTV15, with area under the curve (AUC) values of 0.855, 0.842, and 0.842 in the three respective sets. In the clinical model, the solid component size, pleural indentation, solid attachment, and vascular convergence sign were identified as independent risk factors among the CT features. The predictive performance of the nomogram, which incorporated relevant CT features and the GPTV10-radscore, outperformed both the radiomics model and clinical model alone, with AUC values of 0.894, 0.828, and 0.876 in the three respective sets. CONCLUSIONS: The nomogram, integrating radiomics features and CT morphological features, exhibits good performance in predicting VPI status in lung adenocarcinoma.


Subject(s)
Adenocarcinoma of Lung , Lung Neoplasms , Neoplasm Invasiveness , Neoplasm Staging , Nomograms , Tomography, X-Ray Computed , Humans , Male , Female , Lung Neoplasms/pathology , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/surgery , Middle Aged , Tomography, X-Ray Computed/methods , Adenocarcinoma of Lung/surgery , Adenocarcinoma of Lung/diagnostic imaging , Adenocarcinoma of Lung/pathology , Neoplasm Staging/methods , Aged , Retrospective Studies , Pleura/diagnostic imaging , Pleura/pathology , Pleural Neoplasms/diagnostic imaging , Pleural Neoplasms/surgery , Pleural Neoplasms/pathology , Radiomics
14.
J Manag Care Spec Pharm ; 30(6): 572-580, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38824631

ABSTRACT

BACKGROUND: New cancer diagnoses are associated with employment decrease, workplace absenteeism, and attributable costs to employers. OBJECTIVE: To estimate the workplace productivity loss in the year following a new diagnosis of early-, intermediate-, or advanced-stage hepatocellular carcinoma (HCC) in commercially insured US adults. METHODS: We conducted a retrospective cohort study using Merative MarketScan commercial claims to identify incident HCC diagnoses from 2010 to 2020. Patients were stratified into early-, intermediate-, or advanced-stage cohorts based on presence of secondary malignancy codes or first treatment received. Mean workdays lost and attributable cost in the year following a new diagnosis were calculated using the Kaplan-Meier sample averages to account for censoring. An exploratory analysis was conducted on subgroups in the early and advanced cohorts to assess productivity loss in patients with and without treatment. RESULTS: Mean workdays lost in the year following a new HCC diagnosis among the early, intermediate, and advanced cohorts was 22.6 days (95% CI = 16.0-29.8), 17.4 days (95% CI = 11.9-23.2), and 19.5 days (95% CI = 15.6-23.6), respectively. Corresponding indirect costs were $6,031(95% CI = $4,270-$7,953), $4,644 (95% CI = $3,176-$6,192), and $5,204 (95% CI = $4,163-$6,298). Early-stage patients without a liver transplant and advanced-stage patients who received systemic therapy had 19.7 (95% CI = 12.7-27.4) and 22.0 (95% CI = 16.6-27.7) mean workdays lost, respectively. CONCLUSIONS: Productivity loss varies by stage and appears to be higher in early-stage patients who receive more intensive treatments in the first year following a new HCC diagnosis.


Subject(s)
Carcinoma, Hepatocellular , Databases, Factual , Efficiency , Liver Neoplasms , Neoplasm Staging , Humans , Carcinoma, Hepatocellular/economics , Carcinoma, Hepatocellular/diagnosis , Carcinoma, Hepatocellular/epidemiology , Carcinoma, Hepatocellular/therapy , Liver Neoplasms/economics , Liver Neoplasms/epidemiology , Liver Neoplasms/therapy , Male , Female , Retrospective Studies , Middle Aged , Adult , United States , Absenteeism , Aged , Cohort Studies , Insurance Claim Review , Young Adult , Cost of Illness
15.
Yakugaku Zasshi ; 144(6): 685-690, 2024.
Article in English | MEDLINE | ID: mdl-38825477

ABSTRACT

Docetaxel (DTX) is a key drug used in perioperative chemotherapy for breast cancer. Edema is a known adverse effect of DTX, but its effect on health-related QOL (HRQOL) is unclear. In this study, we evaluated the effects of edema caused by administration of DTX on HRQOL in patients with early-stage breast cancer. We prospectively investigated patients diagnosed with early-stage breast cancer (stage I-III) who received 4 cycles of DTX as preoperative or postoperative chemotherapy between September 2021 and December 2022 at Yamanashi Prefectural Central Hospital. The circumference of each extremity was measured at each administration of DTX, and limb edema was evaluated by Common Terminology Criteria for Adverse Events version 5.0. HRQOL was evaluated using SF-12 version 2, which has a range of 0-100 (national standard, 50), and compared between the presence and absence of grade 2 or higher edema and between before and after administration of DTX. Twenty patients met the eligibility criteria and were included in the study. There was no difference in the HRQOL score according to whether grade 2 limb edema was present. The median HRQOL summary scores before and after administration of DTX were 51.1 and 50.8 (p=0.763), respectively, for mental health, 52.6 and 49.4 (p=0.005) for physical health, and 38.9 and 37.5 (p=1.000) for role/social health. We found no direct effect of DTX-induced limb edema on HRQOL in patients with early-stage breast cancer. However, HRQOL summary scores indicated that administration of DTX reduced physical health in these patients.


Subject(s)
Breast Neoplasms , Docetaxel , Edema , Quality of Life , Humans , Docetaxel/adverse effects , Docetaxel/administration & dosage , Breast Neoplasms/drug therapy , Female , Prospective Studies , Middle Aged , Edema/chemically induced , Edema/etiology , Aged , Neoplasm Staging , Adult , Extremities , Antineoplastic Agents/adverse effects , Perioperative Care
16.
BMC Cancer ; 24(1): 671, 2024 Jun 01.
Article in English | MEDLINE | ID: mdl-38824581

ABSTRACT

BACKGROUND: The role of novel circular RNAs (circRNAs) in colorectal cancer (CRC) remains to be determined. This study aimed to identify a novel circRNA involved in CRC pathogenesis, assess its diagnostic value, and construct a regulatory network. METHODS: Differential expression analysis was conducted using circRNA datasets to screen for differentially expressed circRNAs. The expression of selected circRNAs was validated in external datasets and clinical samples. Diagnostic value of plasma circRNA levels in CRC was assessed. A competing endogenous RNA (ceRNA) network was constructed for the circRNA using TCGA dataset. RESULTS: Analysis of datasets revealed that hsa_circ_101303 was significantly overexpressed in CRC tissues compared to normal tissues. The upregulation of hsa_circ_101303 in CRC tissues was further confirmed through the GSE138589 dataset and clinical samples. High expression of hsa_circ_101303 was associated with advanced N stage, M stage, and tumor stage in CRC. Plasma levels of hsa_circ_101303 were markedly elevated in CRC patients and exhibited moderate diagnostic ability for CRC (AUC = 0.738). The host gene of hsa_circ_101303 was also found to be related to the TNM stage of CRC. Nine miRNAs were identified as target miRNAs for hsa_circ_101303, and 27 genes were identified as targets of these miRNAs. Subsequently, a ceRNA network for hsa_circ_101303 was constructed to illustrate the interactions between the nine miRNAs and 27 genes. CONCLUSIONS: The study identifies hsa_circ_101303 as a highly expressed circRNA in CRC, which is associated with the progression of the disease. Plasma levels of hsa_circ_101303 show promising diagnostic potential for CRC. The ceRNA network for hsa_circ_101303 provides valuable insights into the regulatory mechanisms underlying CRC.


Subject(s)
Biomarkers, Tumor , Colorectal Neoplasms , Gene Expression Regulation, Neoplastic , Gene Regulatory Networks , MicroRNAs , RNA, Circular , Humans , Colorectal Neoplasms/genetics , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/blood , Colorectal Neoplasms/pathology , RNA, Circular/genetics , RNA, Circular/blood , Biomarkers, Tumor/genetics , Biomarkers, Tumor/blood , Male , Female , MicroRNAs/genetics , MicroRNAs/blood , Middle Aged , Gene Expression Profiling , Neoplasm Staging
17.
J Cancer Res Clin Oncol ; 150(6): 298, 2024 Jun 08.
Article in English | MEDLINE | ID: mdl-38850403

ABSTRACT

OBJECTIVE: The International Union for Cancer Control/American Joint Committee on Cancer (UICC/AJCC) rT staging is not clinically practical for recurrent nasopharyngeal carcinoma (rNPC). The aim of this study was to establish a new rT staging to guide the treatment of rNPC. METHODS: We conducted a retrospective analysis of 175 patients diagnosed with rNPC between January 2012 and December 2020, using ROC curve analysis to evaluate its effectiveness. RESULTS: We analyzed the overall survival (OS) and progression-free survival(PFS) of patients diagnosed with rNPC according to the 8th (UICC/AJCC) rT staging, and found that the overall survival of rT1 and rT2 patients (OS; 29.98% vs. 27.09%, p = 0.8059) and progression-free survival (PFS; 28.48% vs. 26.12%, p = 0.4045) had no significant difference. In rT1 and rT2 patients of this study, overall survival(OS; 30.44% vs. 24.91%, p = 0.0229) and progression-free survival(PFS 29.12% vs. 24.03%, p = 0.0459) had a significant difference. Smoking, family history, and time interval of initial recurrence were independent prognostic factors for OS and PFS. CONCLUSION: The new rT staging of this study has a better predictive value for survival of rNPC patients than the 8th (UICC/AJCC) rT staging.


Subject(s)
Nasopharyngeal Carcinoma , Nasopharyngeal Neoplasms , Neoplasm Recurrence, Local , Neoplasm Staging , Humans , Male , Female , Nasopharyngeal Carcinoma/pathology , Nasopharyngeal Carcinoma/mortality , Nasopharyngeal Carcinoma/therapy , Middle Aged , Retrospective Studies , Neoplasm Recurrence, Local/pathology , Nasopharyngeal Neoplasms/pathology , Nasopharyngeal Neoplasms/mortality , Nasopharyngeal Neoplasms/therapy , Adult , Aged , Young Adult , Prognosis , Survival Rate
18.
J Nucl Med Technol ; 52(2): 173-174, 2024 Jun 05.
Article in English | MEDLINE | ID: mdl-38839116

ABSTRACT

In a 32-y-old man with neurofibromatosis type 1, 18F-FDG PET/CT incidentally revealed a vesicourachal diverticulum, a rare anatomic variant. The PET/CT, performed for staging a malignant peripheral nerve sheath tumor, highlighted a distinctive 18F-FDG-avid pattern crucial for accurate diagnosis. Recognizing such features enhances disease assessment and clarifies distinctions between benign urogenital anomalies and malignancies in 18F-FDG PET/CT staging.


Subject(s)
Diverticulum , Fluorodeoxyglucose F18 , Incidental Findings , Positron Emission Tomography Computed Tomography , Humans , Male , Adult , Diverticulum/diagnostic imaging , Cell Transformation, Neoplastic , Neoplasm Staging , Neurofibromatosis 1/diagnostic imaging , Urinary Bladder/diagnostic imaging , Urinary Bladder/pathology , Urinary Bladder/abnormalities
19.
J Am Coll Radiol ; 21(6S): S168-S202, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38823943

ABSTRACT

As the proportion of women diagnosed with invasive breast cancer increases, the role of imaging for staging and surveillance purposes should be determined based on evidence-based guidelines. It is important to understand the indications for extent of disease evaluation and staging, as unnecessary imaging can delay care and even result in adverse outcomes. In asymptomatic patients that received treatment for curative intent, there is no role for imaging to screen for distant recurrence. Routine surveillance with an annual 2-D mammogram and/or tomosynthesis is recommended to detect an in-breast recurrence or a new primary breast cancer in women with a history of breast cancer, and MRI is increasingly used as an additional screening tool in this population, especially in women with dense breasts. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.


Subject(s)
Breast Neoplasms , Evidence-Based Medicine , Neoplasm Invasiveness , Societies, Medical , Breast Neoplasms/diagnostic imaging , Breast Neoplasms/pathology , Humans , Female , United States , Neoplasm Invasiveness/diagnostic imaging , Neoplasm Staging , Mammography/standards , Magnetic Resonance Imaging/methods
20.
J Am Coll Radiol ; 21(6S): S249-S267, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38823948

ABSTRACT

Cervical cancer is a common gynecological malignancy worldwide. Cervical cancer is staged based on the International Federation of Gynecology and Obstetrics (FIGO) classification system, which was revised in 2018 to incorporate radiologic and pathologic data. Imaging plays an important role in pretreatment assessment including initial staging and treatment response assessment of cervical cancer. Accurate determination of tumor size, local extension, and nodal and distant metastases is important for treatment selection and for prognostication. Although local recurrence can be diagnosed by physical examination, imaging plays a critical role in detection and follow-up of local and distant recurrence and subsequent treatment selection. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.


Subject(s)
Societies, Medical , Uterine Cervical Neoplasms , Humans , Female , Uterine Cervical Neoplasms/diagnostic imaging , Uterine Cervical Neoplasms/pathology , United States , Neoplasm Invasiveness , Neoplasm Staging , Evidence-Based Medicine
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