Machine Learning Approach for the Determination of the Best Cut-Off Points for Ki67 Proliferation Index in Adjuvant and Neo-Adjuvant Therapy Breast Cancer Patients.

BACKGROUND: This study aims to evaluate Ki67 cut-off points for differentiating low and high-risk patients based on survival and recurrence and find the best Ki67 cut-off points in breast cancer patients undergoing adjuvant and neoadjuvant therapy using machine learning methods. PATIENTS AND METHODS: Patients with breast cancer treated at 2 referral hospitals between December 2000 and March 2021 who had invasive breast cancer entered this study. There were 257 patients in the neoadjuvant group and 2139 in the adjuvant group. A decision tree method was used to predict the likelihood of survival and recurrence. The 2-ensemble technique of RUSboost and bagged tree were imposed on the decision tree method to increase the accuracy of the determination. 80 percent of the data was used to train and validate the model, and 20% was used as a test. RESULTS: In adjuvant therapy breast cancer patients with Invasive ductal carcinoma (IDC) and Invasive lobular carcinoma (ILC) the cutoff points for survival were 20 and 10, respectively. For luminal A, luminal B, Her2 neu, and triple-negative adjuvant therapy patients' the cutoff points for survival were 25, 15, 20, and 20, respectively. For neoadjuvant therapy luminal A and luminal B group, survival cutoff points were 25 and 20, respectively. CONCLUSION: Despite variability in measurement and cut-off points, the Ki-67 proliferation index is still helpful in the clinic. Further investigation is needed to determine the best cut-off points for different patients. The sensitivity and specificity of Ki-67 cutoff point prediction models in this study could further prove its significance as a prognostic factor.

Iranian Brief Pain Inventory: Validation and Application in Elderly People With Cancer Pain.

CONTEXT: Cancer is a major health problem in the elderly, and pain is one of the most common symptoms among older patients with cancer. Sufficient pain treatments depend on the accuracy of the pain assessment tool. OBJECTIVES: This study aimed to assess the psychometric properties of the Iranian version of the Brief Pain Inventory (BPI-IR) among elderly individuals with cancer. METHODS: This validation study was conducted with 368 people aged 60+ years old who were undergoing oncology treatments. The BPI-IR was applied to the elderly participants through face-to-face interviews. Reliability of the BPI-IR was evaluated using Cronbach's alpha coefficient and intraclass correlation coefficient between test-retest scores. Criterion validity was determined by calculating the Spearman's correlation coefficient between scores on the BPI-IR and those on the SF-36 physical function, Activities of Daily Living, Instrumental Activities of Daily Living, Center for Epidemiological Studies Depression, Patient Pain Questionnaire, and Symptom Distress Scale. Construct validity of the BPI-IR was evaluated using exploratory factor analyses. RESULTS: Cronbach's alpha coefficient was calculated to be 0.94, and the intraclass correlation coefficient between twice the BPI-IR scores over two weeks obtained was 0.89. There were moderate-to-high correlations between the BPI-IR and the Patient Pain Questionnaire (r = 0.886), Symptom Distress Scale (r = 0.492), SF-36 physical function (r = 0.554), and Center for Epidemiological Studies Depression (r = 0.608). Two factors were extracted in exploratory factor analyses, and they explained 73.86% of total variance. CONCLUSION: The BPI-IR is a reliable and valid tool for assessing pain among older adults with cancer.

Cervical Cancer Screening: Recommendations for Muslim Societies.

BACKGROUND: The overall cervical cancer incidence rate is low in Iran; however, because of a higher risk of death for cervical cancer, a disease that kills women in middle age, a cervical cancer control program is needed. The aim of this study was to provide consensus recommendation for cervical cancer prevention in Iran and other Muslim societies with low incidences of cervical cancer. MATERIALS AND METHODS: Through a practical guideline development cycle, we developed six questions that were relevant to produce the recommendation. We reviewed 190 full text records of cervical cancer in Iran (1971 to 2013) of which 13 articles were related to the data needed to answer the recommendation questions. We also reviewed World Health Organization, IARC, GLOBOCAN report, Iran Ministry of Health cancer registry report and 8 available foreign countries guidelines. Lastly, we also evaluated the Pap smear results of 825 women who participated in the Iranian HPV survey, of whom 328 were followed-up after a 5-year interval. RESULTS: The obtained data highlighted the burden of HPV and cervical cancer situation in Iran. Experts emphasized the necessity of a cervical cancer screening program for Iranian women, and recommended an organized screening program with a cytological evaluation (Pap smear) that would start at the age of 30 years, repeated every 5 years, and end at the age of 69 years. Meanwhile, there is no need for screening among women with a hysterectomy, and screening should be postponed to post-partum among pregnant women. CONCLUSIONS: An organized cervical cancer screening is a necessity for Iran as more than 500-900 women in middle age diagnosed with an invasive cervical cancer every year cannot be ignored. This recommendation should be taken into account by the National Health System of Iran and Muslim countries with shared culture and behavior patterns. CUBA HPV test could be consideration in countries Muslim country with appropriate budget, resources and facility.

Attitude of cancer patients toward diagnosis disclosure and their preference for clinical decision-making: a national survey.

OBJECTIVES: There is still contradictory evidence on disclosure preferences regarding cancer diagnosis. The aim of this study was to evaluate the preference of cancer patients for knowing the truth about their disease, as well as the factors that might have an impact on these preferences. METHOD: This study was conducted in 11 cancer centers in Iran. A questionnaire was used to collect data, and all patients above 15 years of age who were willing to participate were included in the study. The patients were asked if they were aware of the malignant nature of their disease, and if they came to know about their disease at the time of initial diagnosis, or later. The patients were then asked about the way they looked upon their disease. In the final part of the questionnaire, the participants were asked the level of involvement they prefer to have in making treatment decisions. RESULTS: In total, 1226 patients were enrolled in this study, only 565 (46.7%) of whom were aware of their disease at the time of diagnosis, and 878 (72.7%) at the time of interview, while 980 (85.2%) were willing to receive information about their disease. Patients' awareness was significantly associated with age under 50 years, female gender, having breast, skin or head and neck cancer, and having medical care in Shiraz or Hamadan while it was not associated with the stage or accompanying illness. CONCLUSION: While the majority of Iranian cancer patients prefer to be aware of the nature of their disease and have an active role in treatment decision making, they do not receive this information.

Frequency of Human Papillumavirus among Women with High-Grade Squamous Intraepithelial Lesions and Invasive Cervical Cancer Attending Shahid Beheshti University of Medical Sciences Clinics, Tehran, Iran.

BACKGROUND: The previous studies reported some information about prevalence release of high-risk HPV types in HSIL or cervical cancer globally and in Iran, however, this information is not enough for final judgment about vaccination against HPV or any screening program. The aim of the present study was to assess the HPV type distribution in HSIL and ICC specimens of women attending Shahid Beheshti University of Medical Sciences teaching hospitals, Tehran, Iran for treatment during 10 years. METHODS: This retrospective- descriptive study evaluated the HPV type distribution of pathologic specimens of Iranian women with invasive cervical cancer (ICC) and high-grade squamous cell intraepithelial lesions (HSIL). Formalin-fixed tumor biopsies that were retrieved from women presenting with histological confirmation for ICC and 17 pathologic confirmation for HSIL specimens. RESULTS: The most frequently identified HPV type 16 among both groups, women with invasive cervical cancer (4-2.18%) and women with High Grade Squamous Intraepithelial Lesion (29.41%), followed by HPV18, HPV31 and 26. HPV16 and / or 18 accounted for 82.2% of all infected samples. CONCLUSION: The dominance of HPV16 over other high-risk types might be even higher than in a region with low HPV exposure. However, there was no strong evidence for any judgment that show to the policy makers; which one is cost-effectiveness and feasibility for cervical cancer prevention in Iran, vaccination, screening or both? More population based study and national meta-analysis needed for better understanding of HPV prevalence and HPV DNA patterns in Iran.