Is Survival with Conservative Breast Therapy Becoming Superior to That with Modified Radical Mastectomy Alone for the Treatment of Early Breast Cancer in This Era?

This study aims to assess survival rates in early breast cancer patients treated by conservative breast therapy (CBT), including radiotherapy, compared with those treated by modified radical mastectomy (MRM) alone. The South Egypt Cancer Institute and the Assiut University Oncology Department patients' records, from January 2010 to December 2017, were searched for T1-2N0-1M0 breast cancer patients treated by CBT or MRM. Patients who did not receive chemotherapy were excluded to reduce the treatment variation. The 5-year locoregional disease-free survival (LRDFS) was 97.3% for the CBT patients was and 98.0% for the MRM patients (P = .675). The 5-year distant disease-free survival (DDFS) was 93.6% for CBS and 85.7% for MRM (P = 0.033). The DFS was 91.9% for the BCT patients and 85.3% for the MRM patients (P = 0.045). The 5-year OS was 98.2% for the CBT patients and 94.3% for the MRM patients, (P = 0.02). By Cox regression analysis, the CBT resulted in significantly better OS, (P = 0.018) and the HR = 0.350, 95% CI 0.146-0.837. The adjusted OS, estimated by the propensity score-based weights, remained superior in CBT than in MRM patients (P < 0.001). CBT resulted in better DDFS, DFS, and OS than MRM. Future randomized trials are needed to confirm these findings and determine the cause.

Prognostic Role of Monocytic Myeloid-Derived Suppressor Cells in Advanced Non-Small-Cell Lung Cancer: Relation to Different Hematologic Indices.

METHODS: We recruited 40 cases of advanced NSCLC, stages III and IV, aged > 18-<70 years old, and eligible to receive chemotherapy with or without radiotherapy, along with 20 healthy controls of comparable age and sex; after diagnosis and staging of patients, blood samples were collected for flow cytometric detection of Mo-MDSCs. RESULTS: Significant accumulation of Mo-MDSCs in patients compared to their controls (p < 0.0001). Furthermore, these cells accumulated significantly in stage IV compared to stage III (p = 0.006) and correlated negatively with overall survival (r = -0.471, p = 0.002), lymphocyte to monocyte ratio (r = -0.446, p = 0.004), and mean platelet volume to platelet count ratio (MPV/PC) (r = -0.464, p = 0.003), patients with Mo-MDSCs < 13% had significantly better survival than those with Mo-MDSCs ≥ 13% (p = 0.041). CONCLUSION: Mo-MDSCs represent one of the key mechanisms in the immunosuppressive tumor microenvironment (TME) to play major roles not only in the carcinogenesis of lung cancer but also in disease progression and prognosis and, in addition, predict the efficacy of immune checkpoint inhibitors; our results provided some support to target Mo-MDSCs and needed to be augmented by further studies.

Bladder preservation versus radical cystectomy in transitional cell carcinoma and squamous cell carcinoma muscle invasive bladder cancer.

BACKGROUND: Randomizing patients to bladder preservation or radical cystectomy (RC) for the treatment of bladder cancer has not been practical, due to patient and physician preferences. Therefore, continually comparing the 2 treatment modalities is needed, in order to make the proper choice for each patient. PATIENTS AND METHODS: The records of T1-4N0M0 bladder cancer patients, who presented to the South Egypt Cancer Institute between 2007 and 2017 and were treated by either bladder preservation or RC were reviewed. RESULTS: Out of the 166 included patients, 81 (48.8%) patients were treated by bladder preservation and 85 (51.2%) patients had RC. For the patients treated by bladder preservation and the patients treated by RC, the 5-year overall survival (OS) was 56% and 60% (p = 0.67), the 5-year local recurrence-free survival was 69% and 73% (p = 0.69), and the 5-year disease-free survival was 45% and 53% (p = 0.16), respectively. After propensity matching analysis, the mean 5-year OS was 58% for the bladder preservation patients and 61% for the RC patients (p = 0.51). It is notable that among the bladder preservation group, 8 patients (10%) had squamous cell carcinoma (SCC) pathology and refused RC. Their OS was 56% compared to 53% for the SCC patients treated by RC (p = 0.6). CONCLUSION: Bladder preservation is a safe alternative to cystectomy in transitional cell carcinoma stages T1-4aN0M0, and its use in SCC bladder cancer should be further studied, as it could be feasible to spare them from initial cystectomy.

Laparoscopic versus Open Complete Mesocolic Excision for Right Colon Cancer.

RESULTS: The mean operative time was significantly longer in the LCME group than that in the OCME group with less mean intraoperative blood loss. Conversion was required in 4 patients (8.3%) in the LCME group. The use of laparoscopy increased the number of harvested lymph nodes compared to the open approach (39.81 ± 16.74 vs. 32.65 ± 12.28, respectively, P=0.010). The laparoscopic approach was associated with a shorter time interval to first flatus as well as shorter time interval to liquid and normal diet after surgery. The postoperative hospital stay was significantly shorter in the LCME group. The complication rate was slightly lower in the LCME (14.7%) than in the OCME group (27.2%) (P=0.252). The 3-year OS in the LCME group was similar to that in OCME (78.2% vs. 63.2%, respectively, P value = 0.423). The three-year DFS in the laparoscopic group was higher (74.5%) than the open group (60.0%), but did not reach statistical significance (P value = 0.266). CONCLUSIONS: In conclusion, laparoscopic CME right hemicolectomy is a technically feasible and safe procedure if surgeon expertise is present. LCME has long-term oncologic outcomes (recurrence and survival) comparable to open surgery for management of patients with stage II or III colon cancer.

Prognostic Significance of Circulating CD28 Negative Suppressor T Cells and Memory B Cells in Patients with Breast Cancer.

BACKGROUND: It has been suggested that routine assessment and quantification of different lymphocyte subsets can provide clinically meaningful prognostic information in breast cancer (BC). OBJECTIVE: To determine the relationship between peripheral blood lymphocyte subsets and pathological parameters and response to therapy in patients with BC. METHODS: Thirty patients with operable breast cancer treated surgically with either modified radical mastectomy or breast conservative surgery, and 20 healthy controls were included. For detection of lymphocyte subsets in peripheral blood; Fluorochrome-labeled monoclonal antibodies were used andcells were analyzed by flow cytometry. Patients were treated with chemotherapy, radiotherapy and hormonal treatment, and followed up to determine relapse and recurrence-free survival (RFS). RESULTS: Significant differences were found in the frequencies of B, T, NK, NKT, and CD28‒T cells between patients with BC and controls. Moreover, a significant difference was found in the percentage of CD8+CD28‒ T cells between patients with different pathologic subtypes of BC and negative correlations were observed between the frequency of CD8+CD28‒T cells and memory B cells, and RFS. Also, a significant difference in the frequency of naïve B cells was found in patients with different tumor grades and a negative correlation was found between the frequencies of B cells and NKT cells. CONCLUSION: NK, NKT, lymphocytes, and CD28‒ T cells significantly differed between healthy controls and BC patients. Also, memory B cells were associated with good response to treatment while CD28‒ T cells were associated with shorter RFS.

The Frequency and clinical Implications of Lymphocyte Subsets and Circulating Plasma Cells in Newly Diagnosed Multiple Myeloma Patients.

Multiple myeloma (MM) is characterized by clonal proliferation of plasma cells (PCs) in the bone marrow (BM) leading to end organ damage. Recent interests are increasingly focusing on the quantitative and functional profiles of T-cell subsets, natural killer cells (NK) and natural killer T-cells (NK T), due to their importance in the development of MM. Herein we tried to evaluate the frequency of different lymphocyte subsets and cPCs in newly diagnosed MM patients and their impact on survival. This prospective case-control study included 40 newly diagnosed MM patients presented to South Egypt Cancer Institute (SECI), Assiut University and 20 apparently healthy controls. Flow cytometry was used for evaluation of CD4+ T helper cells, CD8+ T cytotoxic cells, natural NK cells, NK T cells and cPCs. CD4+ T helper cells were significantly decreased in MM patients while, cytotoxic CD8+ T cells were significantly increased in comparison to the controls leading to a significant decrease in the CD4+/CD8+ ratio in MM patients. In addition, MM patients had deficiency in NK cells and NK-T cells. The median number of cPCs was 8 (range: 0 - 477) per 50,000 cells in the MM patients. The median OS for those with < 8 cPCs was 22.5 months compared with 18 months for patients with ≥8 cPCs. In conclusion, alterations in the immune cells homeostasis in MM patients could play a role in the development of MM and may be associated with the release of plasma cells in the peripheral blood. Also, the quantitative estimation of cPCs in patients with newly diagnosed MM may be used as a predictor of survival.