Biliotórax: una entidad rara para un diagnóstico frecuente. Un reporte de caso / Bilothorax: a Rare Entity for a Frequent Diagnosis. A Case Report

Introducción: El biliotórax es una condición infrecuente definida por la presencia de bilis en el espacio pleural. Actualmente, hay alrededor de 70 casos descritos en la litera-tura. Sigue siendo relativamente desconocido, por lo tanto, poco sospechado. Esta entidad suele ser el resultado de una lesión iatrogénica, a menudo secundaria a cirugías o traumatismos del tracto biliar, que conduce a la formación de una fístula pleurobiliar.

Introduction: Bilothorax is a rare condition defined by the presence of bile in the pleural space. Currently, there are around 70 cases described in the literature. It remains relatively unknown and, therefore, little suspected. This entity is usually the result of an iatrogenic injury, often secondary to surgery or trauma to the biliary tract, leading to the formation of a pleurobiliary fistula

Differential Diagnosis of Oral Metastases / Diagnóstico Diferencial de las Metástasis Orales

Metastatic lesions in the mouth can resemble common inflammatory lesions. Therefore, we set out to investigate oral metastases whose clinical and imaging characteristics mimicked those of harmless lesions, confusing and delaying the diagnosis. For this, a systematic review was carried out from case reports, case series, and cross-sectional studies in the PubMed/Medline, Scopus, Embase-via Elsevier, Virtual Health Library, Web of Science, and gray literature, using PICO strategy without period restriction. We assessed the quality of studies using the Joanna Briggs Institute assessment tool. A narrative synthesis of the data was carried out. Association analyses using chi-square and Fisher's exact tests were performed, with statistical significance at p<0.05. Most of the lesions came from the lung, breast, kidneys, liver, and thyroid. They affected mainly the mandibles of men, between the fifth and seventh decades of life, causing osteolysis. In soft tissue, there were firm swellings, associated with bleeding. Limitations regarding the heterogeneity of the included studies and the absence of clinic pathological descriptions of the tumors substantially reduced the chance of statistical analysis of the data. Knowing the different possibilities of clinical presentation of oral and maxillofacial metastases is important for the diagnost ic suspicion to occur and diagnostic errors to be avoided. Thus, treatment is instituted and survival can be extended. Protocol registration: PROSPERO CRD42020200696.

Las lesiones metastásicas en la cavidad oral pueden parecer similares a lesiones inflamatorias comunes. Por ello, nos propusimos investigar metástasis orales cuyas características clínicas e imagenológicas simularan las de lesiones inofensivas, confundiendo y retrasando el diagnóstico. Para ello, se realizó una revisión sistemática a partir de reportes de casos, series de casos y estudios transversales en PubMed/Medline, Scopus, Embase-vía Elsevier, Virtual Health Library, Web of Science y literatura gris, utilizando la estrategia PICO sin restricción de periodo. La calidad de los estudios se evaluó mediante la herramienta de evaluación del Instituto Joanna Briggs. Se realizó una síntesis narrativa de los datos. Se realizaron análisis de asociación mediante chi-cuadrado y prueba exacta de Fisher, con significancia estadística en p<0,05. La mayoría de las lesiones procedían de pulmón, mama, riñones, hígado y tiroides. Afectan principalmente a las mandíbulas de los hombres, entre la quinta y la séptima década de la vida, provocando osteólisis. En los tejidos blandos, había hinchazones firmes, asociadas con sangrado. Las limitaciones con respecto a la heterogeneidad de los estudios incluidos y la ausencia de descripciones clinicopatológicas de los tumores redujeron sustancialmente la posibilidad de realizar un análisis estadístico de los datos. Conocer las diferentes posibilidades de presentación clínica de las metástasis orales y maxilofaciales es importante para que se produzca la sospecha diagnóstica y se eviten errores diagnósticos. Por lo tanto, se instituye el tratamiento y se puede prolongar la supervivencia. Registro de protocolo: PROSPERO CRD42020200696.

The evolution of non-small cell lung cancer metastases in TRACERx.

Metastatic disease is responsible for the majority of cancer-related deaths1. We report the longitudinal evolutionary analysis of 126 non-small cell lung cancer (NSCLC) tumours from 421 prospectively recruited patients in TRACERx who developed metastatic disease, compared with a control cohort of 144 non-metastatic tumours. In 25% of cases, metastases diverged early, before the last clonal sweep in the primary tumour, and early divergence was enriched for patients who were smokers at the time of initial diagnosis. Simulations suggested that early metastatic divergence more frequently occurred at smaller tumour diameters (less than 8 mm). Single-region primary tumour sampling resulted in 83% of late divergence cases being misclassified as early, highlighting the importance of extensive primary tumour sampling. Polyclonal dissemination, which was associated with extrathoracic disease recurrence, was found in 32% of cases. Primary lymph node disease contributed to metastatic relapse in less than 20% of cases, representing a hallmark of metastatic potential rather than a route to subsequent recurrences/disease progression. Metastasis-seeding subclones exhibited subclonal expansions within primary tumours, probably reflecting positive selection. Our findings highlight the importance of selection in metastatic clone evolution within untreated primary tumours, the distinction between monoclonal versus polyclonal seeding in dictating site of recurrence, the limitations of current radiological screening approaches for early diverging tumours and the need to develop strategies to target metastasis-seeding subclones before relapse.

Tracking early lung cancer metastatic dissemination in TRACERx using ctDNA.

Circulating tumour DNA (ctDNA) can be used to detect and profile residual tumour cells persisting after curative intent therapy1. The study of large patient cohorts incorporating longitudinal plasma sampling and extended follow-up is required to determine the role of ctDNA as a phylogenetic biomarker of relapse in early-stage non-small-cell lung cancer (NSCLC). Here we developed ctDNA methods tracking a median of 200 mutations identified in resected NSCLC tissue across 1,069 plasma samples collected from 197 patients enrolled in the TRACERx study2. A lack of preoperative ctDNA detection distinguished biologically indolent lung adenocarcinoma with good clinical outcome. Postoperative plasma analyses were interpreted within the context of standard-of-care radiological surveillance and administration of cytotoxic adjuvant therapy. Landmark analyses of plasma samples collected within 120 days after surgery revealed ctDNA detection in 25% of patients, including 49% of all patients who experienced clinical relapse; 3 to 6 monthly ctDNA surveillance identified impending disease relapse in an additional 20% of landmark-negative patients. We developed a bioinformatic tool (ECLIPSE) for non-invasive tracking of subclonal architecture at low ctDNA levels. ECLIPSE identified patients with polyclonal metastatic dissemination, which was associated with a poor clinical outcome. By measuring subclone cancer cell fractions in preoperative plasma, we found that subclones seeding future metastases were significantly more expanded compared with non-metastatic subclones. Our findings will support (neo)adjuvant trial advances and provide insights into the process of metastatic dissemination using low-ctDNA-level liquid biopsy.

Recent trends of characteristics and treatments in adults with newly diagnosed brain metastases.

OBJECTIVE: We aimed to evaluate recent trends in characteristics and treatments among patients with brain metastases in clinical practice. METHODS: All newly diagnosed patients with brain metastases during 2016-2021 at a single cancer center were enrolled. We collected the detailed features of each patient and estimated the number of candidates considered to meet the following criteria used in common clinical trials: Karnofsky performance status ≥ 70 and mutated non-small cell lung cancer, breast cancer or melanoma. The brain metastases treatments were classified as follows: (i) stereotactic radiosurgery, (ii) stereotactic radiosurgery and systemic therapy, (iii) whole-brain radiotherapy, (iv) whole-brain radiotherapy and systemic therapy, (v) surgery, (vi) immune checkpoint inhibitor or targeted therapy, (vii) cytotoxic agents and (ix) palliative care. Overall survival and intracranial progression-free survival were estimated from brain metastases diagnosis to death or intracranial progression. RESULTS: A total of 800 brain metastases patients were analyzed; 597 (74.6%) underwent radiotherapy, and 422 (52.7%) underwent systemic therapy. In addition, 250 (31.3%) patients were considered candidates for common clinical trials. Compared to 2016, the later years tended to shift from whole-brain radiotherapy to stereotactic radiosurgery (whole-brain radiotherapy: 35.7-29.1% and stereotactic radiosurgery: 33.4-42.8%) and from cytotoxic agents to immune checkpoint inhibitor/targeted therapy (cytotoxic agents: 10.1-5.0 and immune checkpoint inhibitor/targeted therapy: 7.8-10.9%). There was also an increase in the proportion of systemic therapy combined with radiation therapy (from 26.4 to 36.5%). The median overall survival and progression-free survival were 12.7 and 5.3 months, respectively. CONCLUSIONS: This study revealed the diversity of brain metastases patient characteristics, recent changes in treatment selection and the percentage of candidates in clinical trials.

Análisis de supervivencia e identificación de factores pronósticos de metástasis hepáticas de cáncer colorrectal tras resección hepática / Survival analysis and identification of prognostic factors in colorectal liver metastasis after liver resection

Introducción: El único tratamiento curativo para las metástasis hepáticas de cáncer colorrectal es la cirugía. La identificación de factores pronósticos nos permite individualizar el tratamiento de estos pacientes, mejorando sus resultados oncológicos a largo plazo. El objetivo de nuestro estudio es identificar la supervivencia y los factores pronósticos de pacientes sometidos a tratamiento quirúrgico de metástasis hepáticas de cáncer colorrectal. Métodos: Se trata de un estudio retrospectivo de todos los casos de hepatectomías por metástasis hepáticas de cáncer colorrectal, operadas en un hospital de tercer nivel en España, entre los años 2010 y 2018. Se realizó análisis de supervivencia univariante con las curvas de supervivencia Kaplan-Meier. Mediante el modelo multivariante regresión de Cox se determinaron los factores pronósticos asociados a la supervivencia global. Resultados: La supervivencia global y supervivencia libre de enfermedad de nuestra serie, a los 5 años fue del 43% y del 33%, respectivamente. En el análisis de supervivencia, las características de las metástasis hepáticas (números, tamaño mayor, distribución bilobar y enfermedad extrahepática) y postoperatorias (transfusión sanguínea, complicaciones graves y margen afecto), así como el KRAS no mutado resultaron estadísticamente significativos. No obstante, después de aplicar la regresión de Cox, solo se identificaron 5 factores de riesgo independientes: mutación del KRAS, metástasis hepáticas >4cm, transfusión intraoperatoria, complicaciones graves y margen afecto. Conclusiones: En nuestro grupo de pacientes hemos observado que el tamaño>4cm de la metástasis hepáticas, la transfusión intraoperatoria, las complicaciones posquirúrgicas graves y el margen afecto se mantienen como factores pronósticos tradicionales vigentes. Mientras que el biomarcador KRAS cobra un valor predictivo importante como factor pronóstico de supervivencia. (AU)

Introduction: Liver resection is the only curative treatment for colorectal liver metastasis. The identification of predictive factors leads to personalize patient management to enhance their long-term outcomes. This population-based study aimed to characterize factors associated with, and survival impact of patients who received hepatectomy for colorectal liver metastasis. Methods: A retrospective cohort study of all the hepatectomies for colorectal liver metastasis performed at third-level hospital of Spain (2010–2018) was conducted. The Kaplan–Meier method was used for survival analyses. Multivariable Cox and regression models were used to determine prognostic factors associated with overall survival. Results: The 5-year overall survival and disease-free survival were 42 and 33%, respectively. Survival analysis showed that metastasis features (number, largest size, distribution, and extrahepatic disease) and postsurgical factors (transfusion, major complications, and positive margin resection), as well as non-mutated KRAS, showed a significant association with survival. Otherwise, on multivariate analysis, only 5 independent risk factors were identified: major size metastasis>4cm, RAS mutation, positive margin resection, intraoperative transfusion, and major complications. Conclusions: According to our findings, major size metastasis>4cm, intraoperative transfusion, and major postoperative complications continue to be traditional prognostic factors. Meanwhile, the KRAS biomarker has a powerful impact as a survival prognostic factor. (AU)

Metastasis prevention: How to catch metastatic seeds.

Despite considerable advances in the evolution of anticancer therapies, metastasis still remains the main cause of cancer mortality. Therefore, current strategies for cancer cure should be redirected towards prevention of metastasis. Targeting metastatic pathways represents a promising therapeutic opportunity aimed at obstructing tumor cell dissemination and metastatic colonization. In this review, we focus on preclinical studies and clinical trials over the last five years that showed high efficacy in suppressing metastasis through targeting lymph node dissemination, tumor cell extravasation, reactive oxygen species, pre-metastatic niche, exosome machinery, and dormancy.

Effects of Chitosan Nanoparticles with Long Synthetic siRNAs Targeting VEGF in Triple-Negative Breast Cancer Cells

Abstract Vascular endothelial growth factor (VEGF) is an essential angiogenic factor in breast cancer development and metastasis. Small interfering RNAs (siRNAs) can specifically silence genes via the RNA interference pathway, therefore were investigated as cancer therapeutics. In this study, we investigated the effects of siRNAs longer than 30 base pairs (bp) loaded into chitosan nanoparticles in triple-negative breast cancer cells, compared with conventional siRNAs. 35 bp long synthetic siRNAs inhibited VEGF gene expression by 51.2% and increased apoptosis level by 1.75-fold in MDA-MB-231 cell lines. Furthermore, blank and siRNA-loaded chitosan nanoparticles induced expression of IFN-γ in breast cancer cells. These results suggest that long synthetic siRNAs can be as effective as conventional siRNAs, when introduced into cells with chitosan nanoparticles

Relato de caso: Carcinoma indiferenciado de sítio primário oculto com metástases para pericárdio e Púrpura trombocitopênica trombótica paraneoplásica / Case report: Undifferentiated carcinoma of occult primary site with metastases to the pericardium and paraneoplastic thrombotic thrombocytopenic purpura

A associação entre neoplasia de sítio primário oculto e manifestações paraneoplásicas é um desafio diagnóstico e terapêutico. Este relato de caso descreve uma paciente com púrpura trombocitopênica trombótica (PTT) paraneoplásica como manifestação de um câncer primário oculto atendida pelo setor de Oncologia Clínica do Hospital do Servidor Público Municipal. A paciente apresentou queda importante da funcionalidade em pouco tempo devido a descompensação da neoplasia de base, evoluindo à óbito em poucos meses sem conseguir realizar qualquer tipo de tratamento. Este relato enfatiza a importância da avaliação clínica precisa e abrangente, além da abordagem multidisciplinar nos pacientes oncológicos que tanto sofrem com o estigma dessa doença. Palavras-chave: Neoplasia de Sítio Primário Oculto. Púrpura Trombocitopênica Trombótica Paraneoplásica. Metástases Cardíacas. Oncologia.

Diagnostic utility of PELP1 and GATA3 in primary and metastatic triple negative breast cancer / Utilidad diagnóstica de PELP1 y GATA3 en cáncer de mama triple negativo primario y metastásico

Introduction: Metastasis from Triple-negative breast cancer (TNBC) is a significant cause of morbidity and death and also presents a diagnostic challenge. There are significant therapeutic implications for making a correct and timely diagnosis of metastatic TNBC because the tumors may respond to chemotherapy. PELP1 expression has been reported recently in BC but is poorly studied in the diagnosis of primary and metastasis of TNBC.ObjectivesThe aim of the present study is to assess the diagnostic utility of PELP1and compare it with GATA3, the most commonly used in our practice for breast cancer.MethodsPELP1 and GATA3 were assessed by immunohistochemistry in formalin fixed paraffin embedded tissue blocks of 30 cases of primary TNBC and 15 cases of metastatic TNBC at the Pathology department, Zagazig University, Egypt.ResultsThe immunohistochemical expression of PELP1 revealed a higher frequency of expression than GATA3 in both primary and metastatic TNBC. PELP1 revealed a (96.67%) positive expression rate in primary TNBC and a (86.67%) positive in metastatic TNBC. In comparison to GATA3, revealed (53.33%) positive expression rate in primary TNBC and (60%) positive in metastatic TNBC. Furthermore, the majority of the PELP1 positive cases showed diffuse strong staining, making observation of the staining easy and suggested that PELP1 may be a molecular target for TNBC therapy. We predict that this analysis will shed light on PELP1's significance in TNBC.ConclusionIn comparison to GATA3, PELP1 protein expression is substantially higher in diagnosis of primary and metastatic TNBC. (AU)

Introducción: La metástasis del cáncer de mama triple negativo (TNBC) es una causa importante de morbilidad y muerte y también presenta un desafío diagnóstico. Existen importantes implicaciones terapéuticas para hacer un diagnóstico correcto y oportuno de TNBC metastásico porque los tumores pueden responder a la quimioterapia. La expresión de PELP1 se ha informado recientemente en BC, pero está poco estudiada en el diagnóstico de metástasis primaria y de TNBC.ObjetivosEl objetivo del presente estudio es evaluar la utilidad diagnóstica de PELP1 y compararlo con GATA3, el más utilizado en nuestra práctica para el cáncer de mama.MétodosPELP1 y GATA3 se evaluaron mediante inmunohistoquímica en bloques de tejido embebidos en parafina fijados con formalina de 30 casos de TNBC primario y 15 casos de TNBC metastásico en el departamento de Patología de la Universidad de Zagazig, Egipto.ResultadosLa expresión inmunohistoquímica de PELP1 reveló una mayor frecuencia de expresión que GATA3 en TNBC tanto primaria como metastásica. PELP1 reveló una tasa de expresión positiva (96,67%) en TNBC primario y un (86,67%) positivo en TNBC metastásico. En comparación con GATA3, reveló (53,33%) tasa de expresión positiva en TNBC primaria y (60%) positiva en TNBC metastásica. Además, la mayoría de los casos positivos de PELP1 mostraron una tinción fuerte difusa, lo que facilitó la observación de la tinción y sugirió que PELP1 puede ser un objetivo molecular para la terapia de TNBC. Predecimos que este análisis arrojará luz sobre la importancia de PELP1 en TNBC.ConclusiónEn comparación con GATA3, la expresión de la proteína PELP1 es sustancialmente mayor en TNBC primaria y metastásica. (AU)

Effect of Electronic Symptom Monitoring on Patient-Reported Outcomes Among Patients With Metastatic Cancer: A Randomized Clinical Trial.

Importance: Electronic systems that facilitate patient-reported outcome (PRO) surveys for patients with cancer may detect symptoms early and prompt clinicians to intervene. Objective: To evaluate whether electronic symptom monitoring during cancer treatment confers benefits on quality-of-life outcomes. Design, Setting, and Participants: Report of secondary outcomes from the PRO-TECT (Alliance AFT-39) cluster randomized trial in 52 US community oncology practices randomized to electronic symptom monitoring with PRO surveys or usual care. Between October 2017 and March 2020, 1191 adults being treated for metastatic cancer were enrolled, with last follow-up on May 17, 2021. Interventions: In the PRO group, participants (n = 593) were asked to complete weekly surveys via an internet-based or automated telephone system for up to 1 year. Severe or worsening symptoms triggered care team alerts. The control group (n = 598) received usual care. Main Outcomes and Measures: The 3 prespecified secondary outcomes were physical function, symptom control, and health-related quality of life (HRQOL) at 3 months, measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30; range, 0-100 points; minimum clinically important difference [MCID], 2-7 for physical function; no MCID defined for symptom control or HRQOL). Results on the primary outcome, overall survival, are not yet available. Results: Among 52 practices, 1191 patients were included (mean age, 62.2 years; 694 [58.3%] women); 1066 (89.5%) completed 3-month follow-up. Compared with usual care, mean changes on the QLQ-C30 from baseline to 3 months were significantly improved in the PRO group for physical function (PRO, from 74.27 to 75.81 points; control, from 73.54 to 72.61 points; mean difference, 2.47 [95% CI, 0.41-4.53]; P = .02), symptom control (PRO, from 77.67 to 80.03 points; control, from 76.75 to 76.55 points; mean difference, 2.56 [95% CI, 0.95-4.17]; P = .002), and HRQOL (PRO, from 78.11 to 80.03 points; control, from 77.00 to 76.50 points; mean difference, 2.43 [95% CI, 0.90-3.96]; P = .002). Patients in the PRO group had significantly greater odds of experiencing clinically meaningful benefits vs usual care for physical function (7.7% more with improvements of ≥5 points and 6.1% fewer with worsening of ≥5 points; odds ratio [OR], 1.35 [95% CI, 1.08-1.70]; P = .009), symptom control (8.6% and 7.5%, respectively; OR, 1.50 [95% CI, 1.15-1.95]; P = .003), and HRQOL (8.5% and 4.9%, respectively; OR, 1.41 [95% CI, 1.10-1.81]; P = .006). Conclusions and Relevance: In this report of secondary outcomes from a randomized clinical trial of adults receiving cancer treatment, use of weekly electronic PRO surveys to monitor symptoms, compared with usual care, resulted in statistically significant improvements in physical function, symptom control, and HRQOL at 3 months, with mean improvements of approximately 2.5 points on a 0- to 100-point scale. These findings should be interpreted provisionally pending results of the primary outcome of overall survival. Trial Registration: ClinicalTrials.gov Identifier: NCT03249090.

Resultados del tratamiento a pacientes con cáncer anal en el Hospital Universitario Clínico Quirúrgico "Comandante Manuel Fajardo" / Results of Treating Of Anal Cancer Patients at Comandante Manuel Fajardo Surgical Clinical University Hospital

Introducción: El cáncer anal es el de menor incidencia del tubo digestivo, pero en los últimos años ha presentado un discreto incremento. Objetivo: Identificar los resultados del tratamiento empleado para el cáncer anal en el Servicio de Coloproctología del Hospital Universitario Clínico Quirúrgico "Comandante Manuel Fajardo". Métodos: Se realizó un estudio descriptivo y observacional con pacientes diagnosticados y tratados por cáncer anal en el período 2014-2019. Se estudiaron variables como antecedentes patológicos, factores de riesgo, síntomas, estadio de la enfermedad, tratamientos, entre otras. Resultados: La media de edad fue 58,4±14,7 años y el 75,3 por ciento fueron mujeres. El 52,1 por ciento presentaban antecedentes patológicos y el factor de riesgo más frecuente fue la edad (> 50 años: 80,8 por ciento). La localización más usual fue en el conducto anal y los estadios II y III. El sangrado se manifestó en el 58,9 por ciento de los pacientes. Se aplicó como tratamiento quimiorradioterapia (87,7 por ciento), exéresis local (17,8 por ciento) y cirugía abdominoperineal (8,2 por ciento). Se realizó colostomía al 14 por ciento de los individuos y el 72,6 por ciento estuvieron libres de colostomía más de un año. El tiempo libre de colostomía fue de 87,5 por ciento, con tratamiento de 5 años y más. De los pacientes fallecidos (24,7 por ciento), en el 55,6 por ciento la causa fue progresión de la enfermedad y la metástasis más frecuente fue la hepática. Conclusiones: La quimiorradioterapia fue el principal tratamiento con el que se obtuvo una aceptable tasa de sobrevida en los pacientes con cáncer anal(AU)

Introduction: Anal cancer is the one with the lowest incidence of the digestive tract, but in recent years it has slightly increased. Objective: To identify the results of the treatment used for anal cancer in the Coloproctology Service of Comandante Manuel Fajardo Surgical Clinical University Hospital. Methods: A descriptive and observational study was carried out with patients diagnosed and treated for anal cancer in the 2014-2019 period. Variables such as pathological history, risk factors, symptoms, stage of the disease, treatments, among others, were studied. Results: The mean age was 58.4 ± 14.7 years and 75.3 percent were women. 52.1 percent had pathological antecedents and the most frequent risk factor was age (> 50 years: 80.8 percent). The most usual location was in the anal canal and stages II and III. Bleeding appeared in 58.9 percent of the patients. Chemoradiation therapy (87.7 percent), local exeresis (17.8 percent) and abdominoperineal surgery (8.2 percent) were applied. Colostomy was performed in 14 percent of individuals; 72.6 percent were free of colostomy for more than one year. The colostomy-free time was 87.5 percent, with treatment of 5 years and more. 24.7 percent died, the disease progression was the cause of death in 55.6 percent of the diseased subjects, while the most frequent cause was liver metastasis. Conclusions: Chemoradiotherapy was the main treatment with which an acceptable survival rate was obtained in patients with anal cancer(AU)

Epidemiological Profile of 96 Intracranial Tumors Treated in a Single Reference Center

Objectives The present study aims to categorize the prevalence of intracranial tumors surgically treated at the neurosurgery service of Hospital Universitário Evangélico Mackenzie (HUEM) between 2016 and 2018. Material and Methods This survey included patients surgically treated due to primary or metastatic intracranial neoplasia between 2016 and 2018 at a referral center in the city of Curitiba. These patients were analyzed for epidemiological, histopathological, and topographic data, and they underwent an assessment of the outcome at the time of hospital discharge. Results Atotal of 96patientsmet the inclusion criteria. Themost prevalent tumorwas the glioma, with 39.6% of the sample, with glioblastoma being themost prevalent histological type. Brainmetastases andmeningiomas represented, respectively, 21.9%and 18.8%of the total. There was a predominance of supratentorial and intra-axial tumors in our sample. Conclusion Glioma was the most commonly found tumor, directly associated with high morbidity and mortality. The development of new and more effective drugs with action directed at themolecular level of intracranial tumorsmay be the path to a longer survival and improvement in the quality of life of these patients.

Intraoperative Molecular Analysis of Total Tumor Load in Sentinel Lymph Node: A Predictor of Axillary Status in Early Breast Cancer.

BACKGROUND: Axillary lymph node dissection (ALND) remains the standard of care in breast cancer patients with positive sentinel lymph node (SLN). However, approximately 40-60% of patients with positive SLNs have not developed to non-SLN metastasis and ALND seems to be an overtreatment. The purpose of this study was to analyze predictors and define a specific cut-off of total tumor load (TTL) of CK19 that can be used as a predictive factor of non-SLN metastasis in early breast cancer patients. MATERIALS AND METHODS: The records of 238 patients with cT1-3N0 breast cancer who had an intraoperative SLN evaluation performed through One-Step nucleic acid (OSNA) assay at Songklanagarind Hospital between 1 January 2015 and 31 December 2019 were examined. Univariate and Multivariate analysis was used to identify clinicopathologic features in SLN-positive patients that predict metastasis to non-SLNs. Finally, receiver operative characteristics (ROC) curves were used to choose an optimal TTL cut-off value. RESULTS: Of a total of 110 patients who had a positive SLN, only 48 (43.64%) were found to have positive nodes in non-SLN. Multivariate analysis revealed that lymphovascular invasion, type of SLN metastasis and SLN TTL (copies/µL) were independent predictors of positive non-SLNs.  TTL cut-off value was 19,000 copies/µL, with an AUC of 0.838 with 72.7% sensitivity and 84.7% specificity to predict non-SLN metastasis. CONCLUSIONS: The likelihood of positive non-SLNs in patients who showed a positive SLN correlates with lymphovascular invasion, type of SLN metastasis and SLN TTL (copies/µL). Our result revealed that the patients with a SLN TTL ≥19,000 copies/µl continue to attract the recommendation to proceed with ALND. This cut-off value can then help clinicians to assess which patients would benefit from ALND.

Pretreatment Neutrophil Count and Platelet-lymphocyte Ratio as Predictors of Metastasis in Patients With Osteosarcoma.

BACKGROUND/AIM: Systemic inflammation responses have been associated with cancer development, progression and metastasis. Little is known about the risk of metastasis based on inflammatory-based scores in patients with osteosarcoma. PATIENTS AND METHODS: A total of 65 osteosarcoma patients without metastasis at presentation were enrolled in this retrospective study. All had been diagnosed histologically, and their laboratory data at the first visit were collected from medical records. The inflammation-based scores, tumor size, location, staging, pathological fracture, treatment methods, follow-up periods, and metastasis-free duration were evaluated. RESULTS: A multivariate Cox regression analysis revealed that a high platelet-lymphocyte ratio (PLR) >116 [hazard ratio (HR)=3.8, 95% confidence interval =1.5-9.3; p<0.01], and neutrophil count (NC) ≤4,030/µl (HR=4.5, 95%CI=1.7-12.3; p<0.01), were independent risk factors significantly associated with metastasis of osteosarcoma patients. CONCLUSION: The combination of a high PLR >116 and NC ≤4,030/µl before treatment was a useful inflammatory-based prognostic indicator for metastasis in patients with osteosarcoma.

Overall and progression-free survival of Afro-Caribbean men with metastatic castration-resistant prostate cancer (mCRPC).

INTRODUCTION: Several studies in the Caucasian population have shown the benefit of using docetaxel, abiraterone, or enzalutamide for patients with metastatic prostate cancer at the castration-resistant stage (mCRPC). However, there are no strong data for men of African ancestry. The objective of this study was to estimate the overall and progression-free survival of patients according to these treatments at the mCRPC stage. PATIENTS AND METHODS: This was a monocentric retrospective study that consecutively included 211 men with mCRPC between June 1, 2009 and August 31, 2020. The primary end point was overall survival (OS). The secondary end point was progression-free survival. Kaplan-Meier survival and Cox proportional hazard analyses were performed. RESULTS: The present study included 180 patients for analyses. There was no difference in OS (log-rank test = 0.73), with a median follow-up of 20.7 months, regardless of the treatment administered in the first line. Men with mCRPC who received hormonotherapy (abiraterone or enzalutamide) showed better progression-free survival than those who received docetaxel (log-rank test = 0.004), with a particular interest for abiraterone hazard ratio (HR) = 0.51 (95% confidence interval: 0.39-0.67). The patient characteristics were similar, except for bone lesions, irrespective of the treatment administered in the first line. After univariate then multivariate analysis, only World Health Organization status and metastases at diagnosis were significantly associated with progression. CONCLUSION: Our results suggest the use of hormonotherapy (abiraterone or enzalutamide) with a tendency for abiraterone in first line for men with African ancestry at the mCRPC stage.