A deep learning model for accurately predicting cancer-specific survival in patients with primary bone sarcoma of the extremity: a population-based study

Purpose Primary bone and joint sarcomas of the long bone are relatively rare neoplasms with poor prognosis. An efficient clinical tool that can accurately predict patient prognosis is not available. The current study aimed to use deep learning algorithms to develop a prediction model for the prognosis of patients with long bone sarcoma. Methods Data of patients with long bone sarcoma in the extremities was collected from the Surveillance, Epidemiology, and End Results Program database from 2004 to 2014. Univariate and multivariate analyses were performed to select possible prediction features. DeepSurv, a deep learning model, was constructed for predicting cancer-specific survival rates. In addition, the classical cox proportional hazards model was established for comparison. The predictive accuracy of our models was assessed using the C-index, Integrated Brier Score, receiver operating characteristic curve, and calibration curve. Results Age, tumor extension, histological grade, tumor size, surgery, and distant metastasis were associated with cancer-specific survival in patients with long bone sarcoma. According to loss function values, our models converged successfully and effectively learned the survival data of the training cohort. Based on the C-index, area under the curve, calibration curve, and Integrated Brier Score, the deep learning model was more accurate and flexible in predicting survival rates than the cox proportional hazards model. Conclusion A deep learning model for predicting the survival probability of patients with long bone sarcoma was constructed and validated. It is more accurate and flexible in predicting prognosis than the classical CoxPH model (AU)

Tumor protein expression of the DNA repair gene BRCA1 and lethal prostate cancer.

DNA repair genes are commonly altered in metastatic prostate cancer, but BRCA1 mutations are rare. Preliminary studies suggest that higher tumor expression of the BRCA1 protein may be associated with worse prognosis. We undertook a prospective study among men with prostate cancer in the Health Professionals Follow-up Study and evaluated BRCA1 via immunohistochemical staining on tissue microarrays. BRCA1 was expressed in 60 of 589 tumors. Prevalence of BRCA1 positivity was 43% in the 14 men with metastases at diagnosis compared with 9% in non-metastatic tumors [difference, 33 percentage points; 95% confidence interval (CI), 7-59]. BRCA1-positive tumors had 2.16-fold higher Ki-67 proliferative indices (95% CI, 1.18-3.95), higher tumor aneuploidy as predicted from whole-transcriptome profiling, and higher Gleason scores. Among the 575 patients with non-metastatic disease at diagnosis, we evaluated the association between BRCA1 expression and development of lethal disease (metastasis or cancer-specific death, 69 events) during long-term follow-up (median, 18.3 years). A potential weak association of BRCA1 positivity with lethal disease (hazard ratio, 1.61; 95% CI, 0.82-3.15) was attenuated when adjusting for age, Gleason score and clinical stage (hazard ratio, 1.11; 95% CI, 0.54-2.29). In summary, BRCA1 protein expression is a feature of more proliferative and more aneuploid prostate tumors and is more common in metastatic disease. While not well suited as a prognostic biomarker in primary prostate cancer, BRCA1 protein expression may be most relevant in advanced disease.

Manifestaciones paraneoplásicas a propósito de un caso con sarcoma de partes blandas y metástasis ósea / Paraneoplastic manifestations regarding a case with soft tissue sarcoma and bone metastases

Introducción: El sarcoma de tejidos blandos (STB) constituye un grupo variado de más de 60 neoplasias que solo suponen 1 por ciento del total de los tumores. Objetivo: Describir el caso de un paciente con sarcoma de partes blandas con metástasis ósea y manifestaciones paraneoplásicas. Caso clínico: Se presenta el caso de un paciente masculino de 55 años de edad con antecedentes de diabetes mellitus tipo 2 e hipertensión arterial que refiere que hace 50 días inició con decaimiento marcado, luego de permanecer 1 mes con este síntoma inició con dolor en la columna en la parte más baja de la espalda, conjuntamente iniciando con un cuadro febril. Además, tuvo pérdida de la fuerza principalmente en las piernas, y hablaba cosas incoherentes sin sentido, gran inapetencia, con pérdida de peso de 50 lb en 20 días. Ante cuadro de pérdida de la conciencia y de la fuerza principalmente en las piernas se decidió su remisión hacia el Hospital Clínico Quirúrgico Lucía Íñiguez Landín de Holguín donde se concluyó como sarcoma de partes blandas con manifestaciones paraneoplásicas y metástasis ósea. Conclusiones: El caso presentado de sarcoma de partes blandas pretende aportar información sobre esta enfermedad tan infrecuente en nuestro medio(AU)

Introduction: Soft tissue sarcoma (STB) constitutes a varied group of more than 60 malignancies that only accounts for 1% of all tumors. Objective: To report a case of a patient with soft tissue sarcoma with bone metastases and paraneoplastic manifestations. Clinical case report: We report the case of a 55-year-old male patient with a history of type 2 diabetes mellitus and hypertension, who stated that 50 days ago he began to feel markedly listless. And after a month he began to suffer pain in the spine, in the lower back, and have a fever. In addition he had loss of strength mainly in the legs, and spoke inconsistently, nonsense, great loss of appetite, with weight loss of 50 lbs in 20 days. Given the condition of loss of consciousness and strength, mainly in the legs, it was decided to refer him to Lucía Iñiguez Landín Surgical Clinical Hospital in Holguín, where a soft tissue sarcoma with paraneoplastic manifestations and bone metastases was diagnosed. Conclusions: The report of this case of soft tissue sarcoma aims to provide information about this disease, which is so rare in our setting(AU)

Metástasis de carcinoma de esófago en falange. Presentación de un caso y revisión de la literatura / Metastatic carcinoma of the esophagus in phalanx. A case report and review of the literature

Las metástasis acrales en huesos o partes blandas de manos o pies son localizaciones poco comunes de la diseminación a distancia de una enfermedad oncológica. El propósito de este trabajo es presentar el caso de un paciente con cáncer de esófago con metástasis acral en mano izquierda y una revisión de trabajos acerca de esta rara entidad.

Acral metastases in bone or soft parts of the hands or feet are rare entities of distant dissemination of an oncological disease. The purpose of this paper work is to present a patient case with esophageal cancer with metastases acral in his left hand and to revie the literature about the pathology.

Metástasis de carcinoma de esófago en falange. Presentación de un caso y revisión de la literatura / Metastatic carcinoma of the esophagus in phalanx. A case report and review of the literature

Las metástasis acrales en huesos o partes blandas de manos o pies son localizaciones poco comunes de la diseminación a distancia de una enfermedad oncológica. El propósito de este trabajo es presentar el caso de un paciente con cáncer de esófago con metástasis acral en mano izquierda y una revisión de trabajos acerca de esta rara entidad. (AU)

Acral metastases in bone or soft parts of the hands or feet are rare entities of distant dissemination of an oncological disease. The purpose of this paper work is to present a patient case with esophageal cancer with metastases acral in his left hand and to revie the literature about the pathology. (AU)

¿Olvidar¿ una patología en la anamnesis ¿puede acortar la vida del paciente? / Can ¿overlooking¿ a disease in the anamnesis shorten the patient¿s life?

La realización adecuada y exhaustiva de la anamnesis es de suma importancia para el médico de Atención Primaria. Presentamos un varón de 61 años que consulta por sobrepeso, dolores articulares y fiebre compatibles con brucelosis. El paciente presenta una mala evolución y sufre una tumoración en hombro izquierdo, que acaba diagnosticándose de metástasis de melanoma. El diagnóstico de melanoma ya era conocido por el paciente, pero fue ¿inconscientemente¿ olvidado por éste en la anamnesis sin motivo aparente. Hubo un retraso de 4 meses en el diagnóstico de las metástasis. Si se hubiese informado de los antecedentes de melanoma se hubiera orientado mejor el diagnóstico, y el tratamiento de dichas metástasis hubiese sido más precoz y probablemente hubiera mejorado su expectativa de vida (AU)

Making a suitable and complete anamnesis is extremely important for the Primary Care physician. We present the caseof a 61-year old male patient who consulted due to overweight,joint pain and fever consistent with brucellosis. Thepatient’s evolution was poor, with a tumor in left shoulder,that was finally diagnosed as melanoma metastasis. The patientwas already aware of the melanoma diagnosis but “unconsciously”forgot to mention it in the anamnesis for no apparentreason.There was a 4-month delay in the diagnosis of the metastasis.If the patient had reported the melanoma background,the diagnosis would have been better oriented, with the consequentearlier treatment of the metastasis as well as improvedlife expectancy (AU)

Angiography-proven liver metastases explain low efficacy of lymph node dissections in medullary thyroid cancer patients.

AIM: To report the role of liver angiography in the staging of medullary thyroid cancer (MTC) patients. MATERIAL AND METHODS: Sixty MTC patients with persistent or recurrent hypercalcitonemia (n=49), a characteristic general symptom (diarrhea, n=4) or a normal basal calcitonin level without general symptoms (n=7) were investigated by dynamic liver CT, MRI and angiography between 06/1998 and 06/2002. RESULTS: Dual-phase CT and MRI investigations identified hepatic metastases with relatively low frequency (8/58 on MRI, and 7/60 on CT). Angiography indicated liver involvement in 54/60 cases. The hepatic metastases were typically multiple, hypervascular, small foci (only 13 foci measured >/=10 mm). With one exception significant disease progression was not observed over 5 years of follow-up. CONCLUSIONS: Liver angiography is a powerful tool to reveal hepatic metastases in MTC patients. Frequent, inoperable liver metastases in hypercalcitoninemic MTC patients demonstrate that secondary lymph node dissection is an inefficient technique for restoration of a normal calcitonin level.

Punción biopsia ósea percutánea guiada bajo TC / TC guided percutaneous biopsy of the bone lesions

Se evaluaron los beneficios de la biopsia percutánea por TC en distintas lesiones óseas. Las indicaciones se establecieron por protocolos de acuerdo a si la lesión era inflamatoria, benigna o maligna, respetando las contraindicaciones del método. Del total de biopsias realizadas entre enero de 1995 y septiembre de 1996, se extrajeron 76 por disponerse del estudio por TC y del resultado anatomopatológico. Las muestras extraídas correspondieron a: vértebra, 33; fémur, 17; tibia, 6; costillas, 6; ilíaco, 4; esternón, 4; sacro, 2; rama isquiopubiana, 2; cuboides, 1 y escafoides, 1. Se concluye que la biopsia percutánea guiada bajo TC es la técnica de elección para determinar la etiología de las lesiones del sistema musculoesquelético, cuando está indicada una biopsia guiada por imágenes. El método tiene muy baja morbilidad y es bien tolerado por el paciente

Punción biopsia ósea percutánea guiada bajo TC / TC guided percutaneous biopsy of the bone lesions

Se evaluaron los beneficios de la biopsia percutánea por TC en distintas lesiones óseas. Las indicaciones se establecieron por protocolos de acuerdo a si la lesión era inflamatoria, benigna o maligna, respetando las contraindicaciones del método. Del total de biopsias realizadas entre enero de 1995 y septiembre de 1996, se extrajeron 76 por disponerse del estudio por TC y del resultado anatomopatológico. Las muestras extraídas correspondieron a: vértebra, 33; fémur, 17; tibia, 6; costillas, 6; ilíaco, 4; esternón, 4; sacro, 2; rama isquiopubiana, 2; cuboides, 1 y escafoides, 1. Se concluye que la biopsia percutánea guiada bajo TC es la técnica de elección para determinar la etiología de las lesiones del sistema musculoesquelético, cuando está indicada una biopsia guiada por imágenes. El método tiene muy baja morbilidad y es bien tolerado por el paciente (AU)