Increased colorectal cancer incidence in Iran: a systematic review and meta-analysis.

BACKGROUND: Colorectal cancer is the third most common cancer in Iran. The increasing trend of colorectal cancer incidence in Iran and the close relationship with the geographical location are the underlying reasons for this study. DATA SOURCE: Eleven databases, including MEDLINE, EMBASE, SCOPUS, and four other databases, for articles in Persian were searched from April 2014 to October 2014. Additional data were obtained from an online survey of the Central Library of Tabriz Faculty of Medicine. STUDY ELIGIBILITY CRITERIA: In this systematic review and meta-analysis, we included studies reporting different measures of incidence, age-standardized incidence rates, and crude incidence rates. All rates (per 100,000 person-years) were standardized to the world standard population. STUDY APPRAISAL AND SYNTHESIS METHODS: A preliminary review of the title and abstracts of these articles was used to exclude any that were clearly irrelevant. The full text review determined whether the article was relevant to our topic. All the potentially relevant manuscripts were reviewed by two other investigators (S.D., M.G.). A total of 39 studies (10 Persian and 29 English articles) from different provinces and diverse areas of Iran, were analyzed in this study using comprehensive meta-analysis software. For accuracy studies, we used estimated rates for males and females with 95 % confidence intervals. RESULTS: Age-standardized incidence rates were obtained based on the random effects model and were 8.16 (95 % CI: 6.64 to 9.68) and 6.17 (95 % CI: 5.01 to 7.32) for males and females, respectively. The random crude rates were 5.58 (95 % CI: 4.22 to 6.94) for males and 4.01 (95 % CI: 3.06 to 4.97) for females. CONCLUSIONS: Colorectal cancer incidence rates rise due to individual and environmental risk factors as well as improvement in the registry system and increase in access to health services. A more executed organized and structured system for collecting cancer data, in all cities and rural areas of the country, is an essential priority.

Chronic lymphocytic leukemia in the recent 10 years and treatment effects of Fludarabin.

OBJECTIVE: CLL (Chronic Lymphocytic Leukemia) is the most common form of leukemia in the western world and because of prolonged survival of patients, the prevalence is high. Chemotherapy is usually not indicated in early and stable disease and using Chlorambucil with or without steroids has been the drug of choice in the treatment of CLL for many years . Clinical studies have shown that using Fludarabin can cause a complete response in significant number of untreated and/or previously treated CLL patients. The aim of this study is evaluating of CLL patients and determining the effects of treatment with Fludarabin. METHODS: A retrospective (descriptive/cross sectional) study of CLL patients who admitted to Hematology and Oncology Research Center of Tabriz university of Medical Sciences, between 1995-2005 was made and 126 patients enrolled. Collection of data was carried out according to special questionnaire and response to Fludarabin was analyzed by SPSS 11 software. RESULTS: The patients mean age of diagnosis was 63.7 years (SD=8.9), 69.8% were males. Illness and fatigue were the commonest presenting symptoms in 54% and lymphadenopathy was the most common clinical sign in 88.9%. Most of the patients were in stage C in Binet system (52.4%) and/or stage IV in Rai system (44.4%). Chemotherapy with chlorambucil and Prednisolone was the most common regimen used (60.3%) and 49.2% of patients were in partial remission with this treatment. Forty two patients treated with Fludarabin and 50% were in partial remission, 35% in static disease, 10% in progressive disease and 5% in complete remission (P=0.053). CONCLUSION: The median survival with Fludarabin was 43.9 months (SD=27.2) and in the case of Chlorambucil+Prednisolone and CVP or Chop it was 45 months (SD=26.5) and 50 months (SD=32.2), respectively (P>0.05). P value in the relationship with survival and response to Fludarabin was more than 0.05. Above all, Fludarabin is the choice treatment as first and second line therapy, as well as for patients who have failed therapy with standard regimens.

A novel KRAS gene mutation report in sporadic colorectal cancer, from Northwest of Iran.

While the role of KRAS gene mutations has been widely accepted for predicting responses to anti-EGFR therapy in patients with colorectal cancer, although this study was based on observation of a single case it gives hope that some KRAS gene mutation may have favorable prognosis. More studies are required on patients with similar mutation to validate this finding.

Other Side of Breast Cancer: Factors Associated with Caregiver Burden.

PURPOSE: This study aimed to determine factors associated with caregiver burden among primary caregivers of women with breast cancer in Iran. METHODS: This was a descriptive correlation study conducted in 2012 on 150 main caregivers of patients with breast cancer who came to the oncology clinic of Shahid Ghazi hospital in Tabriz, Iran. A questionnaire which included caregiving-related factors and the Zarit Burden Interview was used for data collection after its validity and reliability were determined. Data was analyzed using SPSS 13.0 software with descriptive and analytic statistics. The association between significant variables and the dependent variable with an observation of the effects of other variables was assessed using the multiple linear regression model. RESULTS: The mean age of caregivers was 39.60 ± 13.80 years old, and 77 (51.3%) of them were men. The mean score of the Zarit Burden Interview was 30.55 ± 19.18. In the regression model, the mean score of activities of daily living, level of education, gender, and financial status were identified as the determining factors of the burden of caregivers. CONCLUSIONS: Primary caregivers need to be financially supported by the relevant organizations. Care skills training and providing palliative care seem helpful in reducing the pain and the burden of family caregivers for patients with breast cancer.

Variation of tumor markers in 277 breast cancer cases.

INTRODUCTION AND PURPOSE: Breast cancer is the most frequently diagnosed cancer in women in the world, Advances in paraclinical methods have resulted in dramatic changes in determining the survival of patients. Serial evaluation of serum levels of tumor markers is one of these methods. METHODS: During 1993-2002, 277 cases with breast cancer after mastectomy were included in this cross sectional study. Data were extracted from the patients records. Characteristics of the patients associated with serum levels of tumor markers like CEA,CA15-3 and receptor markers like ER,PR with P53,Cathepsin-D and HER-2 were evaluated. RESULTS: The most common involved age was in the 4th decade, accounting for 43.3%of the total. Most of the cases (54.3%) had stage II disease; Ductal carcinoma with frequency of 83.3% was the most common pathology involved and bone metastasis with 59% was prominent. There were elevated serum levels of CEA and CA15-3 in 50.6% and 41.7%, respectively. There was no statistical relation between serum levels of these markers with disease stage (CEA: pearson chi-square = 0.133 CAl5-3: Pearson chi-square = 0.064). There was a great increase in serum level of tumor markers during relapse (CEA P = 0.000 CA15-3 P = 0.000). DISCUSSION AND CONCLUSIONS: Because diagnosis of breast cancer is generally at advanced stage in our country, serum levels of tumor markers demonstrate great differences from those published for the Western world. It seems, however, that serum levels of tumor markers might be reliable for predicting relapses.

Delayed hemolytic transfusion reaction with multiple alloantibody (Anti S, N, K) and a monospecific autoanti-JK(b) in intermediate ß-thalassemia patient in Tabriz.

It appears that delayed hemolytic transfusion reactions may occur several days after the administration of donor red cells is true even though they have been shown to be compatible in cross match tests by the antiglobulin technique. A specific case was observed in our center, which confirms the fact. The patient was a 37-year-old male suffering from intermediate ß-thalassemia. He had a history of two previous transfusions, with unknown transfusion reaction. In the last transfusion, laboratory data showed: Hb 7.8 g/dL and Hematocrit (Hct) 24.2%. The patient received two units of cross matched, compatible concentrated red blood cells (RBCs). After eight days a severe reaction was observed with clinical evidence of tachycardia, fatigue, fever, back pain, chest discomfort, jaundice, nausea and anorexia. Accordingly delayed hemolytic transfusion reaction was suspected, and anti-RBC antibodies were tested. Laboratory tests revealed the presence of three alloantibodies: Anti-N, anti-S, anti-K, and a monospecific autoanti-JK(b).

Association of serum level of 25 hydroxy-vitamin D with prognostic factors for breast cancer.

BACKGROUND AND AIM: In recent years, there has been considerable interest in whether vitamin D inhibits breast cancer development. Experimental studies have shown that vitamin D promotes cell differentiation and retards or terminates proliferation of breast cancer cells. However, there is little evidence supporting the association of vitamin D and prognosis of breast cancer. METHODS AND MATERIALS: In this analytic-descriptive study, 119 female patients with histological proven breast cancer were recruited in Tabriz oncology clinics in a 15-month period of time. History of chemotherapy, radiotherapy or receiving vitamin D/Ca supplements and presence of other malignancies were exclusion criteria. Serum level of 25 hydroxy vitamin D (25(OH)D) was measured in all patients. RESULTS: One hundred and nineteen patients with a mean age of 50.4∓12.6 (26-76) years were enrolled in the study. Metastasis was present in 21.8% of the cases. Stage of tumor was I, II, III and IV in 11, 56, 26 and 26 patients, respectively. The Tumor grade was low in 37 cases, intermediate in 46 cases, and high in 36 cases. The P53, Ki-67, HER2, ER and PR were positive in 30.3%, 49.6%, 17.6%, 61.2% and 55.5% of the patients, respectively. The mean serum level of 25(OH)D was 15.7∓17.8 (4-122) ng/ml, deficient in 66 cases, insufficient in 36 cases and normal level in 17 cases. The median level of 25(OH)D was lower in the P53+ group in a borderline trend (17.3 vs. 13.6 ng/ml; p=0.07). The median level of 25(OH)D was significantly higher in the patients with metastasis, as well (27.7 vs. 12.0 ng/ml; p=0.03). There was no significant association between the serum level of 25(OH)D and other studied parameters. CONCLUSION: Based on our findings, there may be an association between the serum level of 25(OH)D and prognosis of breast cancer.