The Impact on Survival of Neoadjuvant Treatment Interruptions in Locally Advanced Rectal Cancer Patients.

The standard oncologic treatment of locally advanced rectal cancer is long-course radio-chemotherapy followed by surgery and adjuvant chemotherapy. This can result in a lengthy total treatment duration, sometimes up to one year from the diagnosis. Interruptions to neoadjuvant treatment can occur for a variety of reasons, forced or unforced. The main purpose of this study is to analyze the survival data of locally advanced rectal cancer patients who received neoadjuvant treatment and to find a cut-off point showing exactly how many days of interruption of neoadjuvant treatment the risk of death or disease relapse increases. We conducted a retrospective study on 299 patients with locally advanced rectal cancer using survival analysis (Kaplan-Meier curve and Cox regression) to determine survival probabilities for overall survival, local control, and disease-free survival. Patients with 0 to 3 days of neoadjuvant therapy interruption had a higher overall survival probability compared to patients with 4 or more days (90.2% compared to 57.9%, p-value < 0.001), hazard ratio 5.89 (p < 0.001). Local control and disease-free survival had a higher probability in patients with 0-2 days of interruption compared to people with 3 or more days (94% vs. 75.4%, and 82.2% vs. 50.5%, respectively, both p-values < 0.001). Patients with tumoral or nodal downstaging experienced fewer days of interruption than patients with no downstage. These findings reinforce the need for radiation oncologists to be well-organized when starting neoadjuvant treatment for rectal cancer, in order to anticipate and prevent potential treatment interruptions and achieve the best therapeutic results.

Prediction of Subclinical and Clinical Multiple Organ Failure Dysfunction in Breast Cancer Patients-A Review Using AI Tools.

This review explores the interconnection between precursor lesions of breast cancer (typical ductal hyperplasia, atypical ductal/lobular hyperplasia) and the subclinical of multiple organ failure syndrome, both representing early stages marked by alterations preceding clinical symptoms, undetectable through conventional diagnostic methods. Addressing the question "Why patients with breast cancer exhibit a tendency to deteriorate", this study investigates the biological progression from a subclinical multiple organ failure syndrome, characterized by insidious but indisputable lesions, to an acute (clinical) state resembling a cascade akin to a waterfall or domino effect, often culminating in the patient's demise. A comprehensive literature search was conducted using PubMed, Google Scholar, and Scopus databases in October 2023, employing keywords such as "MODS", "SIRS", "sepsis", "pathophysiology of MODS", "MODS in cancer patients", "multiple organ failure", "risk factors", "cancer", "ICU", "quality of life", and "breast cancer". Supplementary references were extracted from the retrieved articles. This study emphasizes the importance of early identification and prevention of the multiple organ failure cascade at the inception of the malignant state, aiming to enhance the quality of life and extend survival. This pursuit contributes to a deeper understanding of risk factors and viable therapeutic options. Despite the existence of the subclinical multiple organ failure syndrome, current diagnostic methodologies remain inadequate, prompting consideration of AI as an increasingly crucial tool for early identification in the diagnostic process.

Abberant Immunohistochemical Expression of OCT3/4 and EMT Related Markers, Vimentin and E-cadherin, is Correlated with Adverse Histopathological Features in Colorectal Adenocarcinoma.

Background: Although clinical management for colorectal cancer has been markedly improved, it is faced with a growing incidence among the young and among those in developing nations. Furthermore, diagnosis occurs mostly in advanced stages, when the therapeutic resources are limited. Therefore we need new biomarkers for diagnostics and therapeutic targets. The key event that leads to invasion and metastasis is the epithelial to mesenchymal transition (EMT), which can be studied with IHC markers. We aimed to corelate the expression of EMT related markers (Vimentin and E-cadherin) and a stem cell marker (OCT 3/4) with the clinicopathological parameters of the tumors. Material and Methods: Surgical resection specimens from 30 treatment-naive colon cancer patients, hospitalized from 2018 to 2021 were assessed. Immunohistochemical tests were performed to investigate the expression of EMT related markers and OCT 3/4 in tumor cells. Results: Vimentin, OCT3/4 positivity and loss of E-cadherin were significantly associated with tumor grade, tumor budding, invasive tumor front, and lymph node metastasis. Conclusions: Vimentin, E-cadherin and OCT 3/4 might serve as a panel of biomarkers that can aid in the prognostication of patients, with the added potential of being oncotargets.