Advanced Stage Research Articles

Mortality rate and predictors of colorectal cancer patients in Ethiopia: a systematic review and meta-analysis

IntroductionThe incidence of colorectal cancer (CRC) has been increasing in Sub-Saharan countries, including Ethiopia. However, the real mortality rate for CRC patients in Ethiopia has not been established. Therefore, this systematic review and meta-analysis aimed to determine the overall mortality rate and identify predictors among CRC patients in Ethiopia.MethodsPubMed, EMBASE, Web of Science, Scopus, Science Direct, and Google Scholar were searched to identify relevant articles. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) were followed. The quality of the included studies was assessed using the Newcastle-Ottawa Scale Critical Appraisal checklist. A random effect model was used to estimate the pooled mortality rate and adjusted hazard ratio (AHR). Publication bias was assessed using funnel plots and Egger’s regression test, while heterogeneity was evaluated through the Cochran Q test and I2 statistics.ResultsAfter reviewing 74 articles, only 7 studies met the criteria and were included in the analysis. The analysis revealed that the overall mortality rate among CRC patients in Ethiopia was 40.5% (95% confidence interval [CI]: 32.05, 48.87) while the survival rates at 1 year, 3 years, and 5 years were 82.3% (95% CI: 73.33, 91.31), 48.8% (95% CI: 43.35, 54.32), and 26.6% (95% CI: 21.26, 31.91) respectively. Subgroup analysis indicated that studies conducted after 2017 had higher mortality rates compared to those studied earlier (43.0% vs. 38.2%). Older age (AHR: 1.89, 95% CI: 1.27, 2.82); being married (AHR: 2.53, 95% CI: 1.79, 3.57); having comorbidities (AHR: 1.84, 95% CI: 1.45, 2.35); having high CEA levels (AHR: 2.06, CI: 1.35, 3.13); being in stage II (AHR: 4.13, 95% CI: 1.85, 9.22), III (AHR: 8.62, 95% CI: 3.88, 19.15), and IV (AHR: 8.06, CI: 2.89, 22.49) were the most important predictors.ConclusionIn Ethiopia, the mortality rate among individuals diagnosed with CRC is high, with two out of five patients dying from this disease. Age, marital status, CEA level, comorbidities, and cancer stage were identified as predictors of mortality in CRC patients. Therefore, early detection and screening should be prioritized, particularly for older patients, those who are married, have comorbidities, elevated CEA levels, and advanced cancer stages.

Impact of COVID-19 Epidemic on Morbidity and Mortality of Cancer Patients in the Ryazan Region

INTRODUCTION: In 2020, humanity faced a pandemic of a new infection a Severe Acute Respiratory Syndrome-related Corona Virus 2 (SARS-CoV-2) that had a significant impact on the economic, social, including medical, aspects of our life. Against the background of these changes, oncological diseases, like many other comorbid pathologies, seemed to fade into insignificance. But, as we understand, they have not lost their relevance, but only ‘retreated to the shadow’ for a while. Study of the basic statistical indicators used for evaluating the prevalence of cancer pathology and the results of the work of oncological service, helps analyze and understand the processes occurring in conditions of reorientation of medical measures for combating the pandemic. AIM: To study changes in the main indicators of the oncology service of the Ryazan region during the COronaVIrus Disease 2019 (COVID-2019) epidemic. MATERIALS AND METHODS: The main statistical indicators of morbidity, detestability and mortality from malignant neoplasms (MNs) in the Ryazan region were analyzed on the basis of statistical forms of federal statistical observation No. 7 (Form No. 7) ‘Record of MNs’, reports and data of cancer registry for 2012–2022. The most relevant statistical indicators were analyzed, data on most common and relevant tumor localizations were separately considered. RESULTS: At the height of COVID-19 pandemics in 2020–2021, a sharp reduction of the total number of identified MN cases was observed a seeming decline of ‘mortality’. At the same time, there was an increase in the proportion of patients with advanced IV stage pathology of lungs, stomach, and colorectal cancer, which, in turn, led in some cases to increase in one-year mortality, and to general increase in mortality among cancer patients. To note, despite a complicated situation associated with non-observance of the terms of the periodic medical examinations, reprofiling of a number of medical organizations and increased load on the primary medical care organizations, the oncology service of the Ryazan region showed a not that catastrophic impairment of the main statistical indicators, and of some of them a proportion of detection of early stages, results of treatment of tumors of visual localization even a positive dynamics. In 2022, officially registered cancer incidence rates in our region returned to previous values comparable to 2019. CONCLUSION: The experience of recent years should help in developing measures to prevent both the spread of similar epidemiological diseases and measures to prevent a decline of the quality of specialized medical care, in particular, in the field of oncology.

Tomato leaf disease detection and management using VARMAx-CNN-GAN integration

In contemporary agriculture, farmers confront substantial challenges in maintaining crop yields and mitigating agricultural losses attributable to diseases. The existing methods for diagnosing and managing tomato leaf diseases often exhibit deficiencies in terms of accuracy, robustness, and interpretability. Typically, these methods are reactive, addressing symptoms after the disease has already impacted the plants, resulting in delayed and often ineffective interventions. The precision of disease localization and severity estimation plays a crucial role in efficient disease treatment; regrettably, existing post-processing techniques frequently fall short in this regard. While these methods have their flaws, our proposed method uses the best parts of deep learning and vector autoregressive moving average processes with eXogenous regressors (VARMAx processes) to quickly and accurately find tomato leaf diseases. Our approach represents an innovative solution to the challenges currently confronting the agriculture sector, thanks to its proactive attributes, improved categorization capabilities, and advanced post-processing stages. Convolutional neural networks (CNNs) and generative adversarial networks (GANs), built upon the “VARMAx-CNN-GAN Integration” framework, form the core of our method. In this integrated model, convolutional neural networks serve the purpose of extracting features and performing early disease classification, whereas generative adversarial networks come into play for generating synthetic images, expanding the dataset, and enhancing the model’s ability to generalize. The “VARMAx-CNN-GAN Integration” model improves disease classification and decision-making for farmers and agronomists by providing insights into critical leaf images. Compared to traditional methods, it improves precision, accuracy, recall, AUC, and delay in identifying tomato diseases. The approach also shows potential for disease prevention, revolutionizing tomato leaf disease identification and management.

ENO2, a Glycolytic Enzyme, Contributes to Prostate Cancer Metastasis: A Systematic Review of Literature

Prostate cancer (PCa) is the second leading cause of male cancer deaths in the UK and the fifth worldwide. The presence of distant PCa metastasis can reduce the 5-year survival rate from 100% to approximately 30%. Enolase 2 (ENO2), a crucial glycolytic enzyme in cancer metabolism, is associated with the metastasis of multiple cancers and is also used as a marker for neuroendocrine tumours. However, its role in PCa metastasis remains unclear. In this study, we systematically reviewed the current literature to determine the association between ENO2 and metastatic PCa. Medline, Web of Science, and PubMed were searched for eligible studies. The search yielded five studies assessing ENO2 expression in PCa patients or cell lines. The three human studies suggested that ENO2 expression is correlated with late-stage, aggressive PCa, including castrate-resistant PCa (CRPC), metastatic CRPC, and neuroendocrine PCa (NEPC). This was further supported by two in vitro studies indicating that ENO2 expression can be regulated by the tumour microenvironment, such as androgen deprived conditions and the presence of bone-forming osteoblasts. Therefore, ENO2 may functionally contribute to PCa metastasis, possibly due to the unique metabolic features of PCa, which are glycolysis dependent only at the advanced metastatic stage.

Rare histological prostate cancer subtypes: Cancer-specific and other-cause mortality.

To assess cancer-specific mortality (CSM) and other-cause mortality (OCM) rates in patients with rare histological prostate cancer subtypes. Using the Surveillance, Epidemiology, and End Results database (2004-2020), we applied smoothed cumulative incidence plots and competing risks regression (CRR) models. Of 827,549 patients, 1510 (0.18%) harbored ductal, 952 (0.12%) neuroendocrine, 462 (0.06%) mucinous, and 95 (0.01%) signet ring cell carcinoma. In the localized stage, five-year CSM vs. OCM rates ranged from 2 vs. 10% in acinar and 3 vs. 8% in mucinous, to 55 vs. 19% in neuroendocrine carcinoma patients. In the locally advanced stage, five-year CSM vs. OCM rates ranged from 5 vs. 6% in acinar, to 14 vs. 16% in ductal, and to 71 vs. 15% in neuroendocrine carcinoma patients. In the metastatic stage, five-year CSM vs. OCM rates ranged from 49 vs. 15% in signet ring cell and 56 vs. 16% in mucinous, to 63 vs. 9% in ductal and 85 vs. 12% in neuroendocrine carcinoma. In multivariable CRR, localized neuroendocrine (HR 3.09), locally advanced neuroendocrine (HR 9.66), locally advanced ductal (HR 2.26), and finally metastatic neuroendocrine carcinoma patients (HR 3.57; all p < 0.001) exhibited higher CSM rates relative to acinar adenocarcinoma patients. Compared to acinar adenocarcinoma, patients with neuroendocrine carcinoma of all stages and locally advanced ductal carcinoma exhibit higher CSM rates. Conversely, CSM rates of mucinous and signet ring cell adenocarcinoma do not differ from those of acinar adenocarcinoma.

Rare histological prostate cancer subtypes: Cancer-specific and other-cause mortality.

To assess cancer-specific mortality (CSM) and other-cause mortality (OCM) rates in patients with rare histological prostate cancer subtypes. Using the Surveillance, Epidemiology, and End Results database (2004-2020), we applied smoothed cumulative incidence plots and competing risks regression (CRR) models. Of 827,549 patients, 1510 (0.18%) harbored ductal, 952 (0.12%) neuroendocrine, 462 (0.06%) mucinous, and 95 (0.01%) signet ring cell carcinoma. In the localized stage, five-year CSM vs. OCM rates ranged from 2 vs. 10% in acinar and 3 vs. 8% in mucinous, to 55 vs. 19% in neuroendocrine carcinoma patients. In the locally advanced stage, five-year CSM vs. OCM rates ranged from 5 vs. 6% in acinar, to 14 vs. 16% in ductal, and to 71 vs. 15% in neuroendocrine carcinoma patients. In the metastatic stage, five-year CSM vs. OCM rates ranged from 49 vs. 15% in signet ring cell and 56 vs. 16% in mucinous, to 63 vs. 9% in ductal and 85 vs. 12% in neuroendocrine carcinoma. In multivariable CRR, localized neuroendocrine (HR 3.09), locally advanced neuroendocrine (HR 9.66), locally advanced ductal (HR 2.26), and finally metastatic neuroendocrine carcinoma patients (HR 3.57; all p < 0.001) exhibited higher CSM rates relative to acinar adenocarcinoma patients. Compared to acinar adenocarcinoma, patients with neuroendocrine carcinoma of all stages and locally advanced ductal carcinoma exhibit higher CSM rates. Conversely, CSM rates of mucinous and signet ring cell adenocarcinoma do not differ from those of acinar adenocarcinoma.

The Influence of Inflammatory and Nutritional Status on the Long-Term Outcomes in Advanced Stage Ovarian Cancer

Background: Despite improving surgical techniques and achieving more often complete debulking procedures, certain patients with advanced-stage ovarian cancer still have a very poor prognosis. The aim of the current paper is to investigate whether inflammatory and nutritional status can predict the long-term outcomes of ovarian cancer patients. Methods: A retrospective analysis of 57 cases diagnosed with advanced-stage ovarian cancer submitted to surgery as first intent therapy was carried out. In all cases, the preoperative status was determined by calculating the CRP/albumin ratio, as well as the Glasgow score, the modified Glasgow score and the prognostic nutritional index. Results: Patients presenting higher values of the CRP/albumin ratio, with a higher Glasgow score, modified Glasgow score and prognostic nutritional index (PNI), were more frequently associated with incomplete debulking surgery, a higher peritoneal carcinomatosis index and poorer overall survival (20 months versus 9 months for the CRP/albumin ratio p = 0.011, 42 versus 27 versus 12 months for the Glasgow score p = 0.042, 50 versus 19 versus 12 months for the modified Glasgow score, p = 0.001, and 54 months versus 21 months, p = 0.011 for the prognostic nutritional index). Conclusions: A strong relationship between the nutritional and inflammatory status in advanced-stage ovarian cancer seems to exist.

The Influence of Inflammatory and Nutritional Status on the Long-Term Outcomes in Advanced Stage Ovarian Cancer

The Influence of Inflammatory and Nutritional Status on the Long-Term Outcomes in Advanced Stage Ovarian Cancer

Investigating the Determinants of Mortality before CD4 Count Recovery in a Cohort of Patients Initiated on Antiretroviral Therapy in South Africa Using a Fine and Gray Competing Risks Model

CD4 count recovery is the main goal for an HIV patient who initiated ART. Early ART initiation in HIV patients can help restore immune function more effectively, even when they have reached an advanced stage. Some patients may respond positively to ART and attain CD4 count recovery. Meanwhile, other patients failing to recover their CD4 count due to non-adherence, treatment resistance and virological failure might lead to HIV-related complications and death. The purpose of this study was to find the determinants of death in patients who failed to recover their CD4 count after initiating antiretroviral therapy. The data used in this study was obtained from KwaZulu-Natal, South Africa, where 2528 HIV-infected patients with a baseline CD4 count of &lt;200 cells/mm3 were initiated on ART. We used a Fine–Gray sub-distribution hazard and cumulative incidence function to estimate potential confounding factors of death, where CD4 count recovery was a competing event for failure due to death. Patients who had no tuberculosis were 1.33 times at risk of dying before attaining CD4 count recovery [aSHR 1.33; 95% CI (0.96–1.85)] compared to those who had tuberculosis. Rural patients had a higher risk of not recovering and leading to death [aSHR 1.97; 95% CI (1.57–2.47)] than those from urban areas. The patient’s tuberculosis status, viral load, regimen, baseline CD4 count, and location were significant contributors to death before CD4 count recovery. Intervention programs targeting HIV testing in rural areas for early ART initiation and promoting treatment adherence are recommended.

Short- and long-term outcomes of mechanical thrombectomy in acute ischemic stroke patients with chronic kidney disease.

Chronic kidney disease (CKD) is a risk factor of acute ischemic stroke (AIS). Outcomes of treatment with mechanical thrombectomy (MT) in patients with CKD seem to be poorer than in the general population. Long-term follow-up studies are lacking. Assessing short- and long-term outcomes (up to 365 days after stroke) in MT-treated AIS patients with concomitant CKD. The study included all AIS patients treated with MT in a Comprehensive Stroke Center from 2019 to 2021. The subjects were divided into CKD group (best glomerular filtration rate during hospitalization <60 ml/min/1.73 m2 or CKD diagnosed in patient's medical history) and controls. In-hospital, 90-day and 365-day mortality and rate of good functional outcomes (defined as modified Rankin Scale ≤2) were compared between CKD patients and controls as well as between patients with CKD stages 1-3 (GFR ≥30ml/min/1.73m2) and 4-5 (GFR <30ml/min/1.73m2). Factors associated with abovementioned outcomes were identified using univariable logistic regression analyses and then added to multivariable analyses. CKD patients had higher 90- and 365-day mortality and lower 90- and 365-day good functional outcome rates than controls. Patients with CKD stage 4-5 had significantly higher in-hospital, 90-day and 365-day mortality than patients with CKD stage 1-3. Neither CKD nor its late stages (4-5) were independently associated with short- and long-term mortality and functional outcomes of MT. Outcomes of MT-treatment in CKD patients are worse, especially in advanced stages of the disease, but CKD is not independently associated with bad prognosis. CKD alone should not be a contraindication for MT in otherwise eligible patients, although patients with impaired kidney function require more careful postprocedural monitoring.

Urinary neutrophil gelatinase-associated lipocalin as early biomarker for renal disease in dogs with leishmaniosis

Canine leishmaniosis (CanL), caused by Leishmania sp., presents a wide array of symptoms; renal dysfunction is frequently observed in these dogs and is associated with a poor prognosis and increased mortality. The traditional biomarkers namely urea and creatinine can detect renal damage but only in advanced stages of the disease. However, it has been shown that the symmetric dimethylarginine assay (SDMA) or the protein/creatinine ratio (UPC) and are early biomarkers of renal dysfunction. Their elevation occurs earlier than that of creatinine, but other novel biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL) are currently under investigation. Our objective was to determine whether the urine NGAL-creatinine ratio (uNGAL/c) can provide very early diagnosis of kidney disease in CanL. In total, 68 dogs were included in the study: 15 healthy dogs and 53 dogs with CanL who were classified according to International Renal Interest Society (IRIS) classification: IRIS 1 (N= 34), IRIS 2 (N= 9) and IRIS 3/4 (N= 10). IRIS 1 was subdivided according to proteinuria in IRIS 1NP (13 dogs with UPC < 0.2), IRIS 1BL (8 dogs with UPC = 0.2–0.5) and IRIS 1 P (13 dogs with UPC > 0.5). Blood samples were collected for complete hematological and biochemistry analysis including plasma NGAL. Urinalysis included specific gravity, UPC, CysC and NGAL expressed as a ratio with creatinine. The mean concentrations of pCysC and SDMA in CanL, show a statistically significant increase from IRIS 1NP, not being statistically significant for pCysC in the IRIS 1BL group. The UPC show a statistically significant increase from IRIS 1NP. In all groups with CanL for uCysC/c and uNGAL/c was observed a statistically significant increase. The uNGAL/c in the group proteinuric animals, presents a positive correlation with all renal biomarkers studied. In the group of non-proteinuric animals, the uNGAL/c presents a positive correlation with SDMA and UPC. The uNGAL/c can be considered a reliable indicator of renal disease in dogs diagnosed with CanL who are non-azotemic and non-proteinuric.

Associations between Microglia and Astrocytic Proteins and Tau Biomarkers across the Continuum of Alzheimer’s Disease

Recent investigations implicate neuroinflammatory changes, including astrocyte and microglia activation, as crucial in the progression of Alzheimer’s disease (AD) Thus, we compared selected proteins reflecting neuroinflammatory processes to establish their connection to AD pathologies. Our study, encompassing 80 subjects with (n = 42) AD, (n = 18) mild cognitive impairment (MCI) and (n = 20) non-demented controls compares the clinical potential of tested molecules. Using antibody-based methods, we assessed concentrations of NGAL, CXCL-11, sTREM1, and sTREM2 in cerebrospinal fluid (CSF). Proinflammatory proteins, NGAL, and CXCL-11 reached a peak in the early stage of the disease and allowed for the identification of patients with MCI. Furthermore, the concentration of the anti-inflammatory molecule sTREM2 was highest in the more advanced stage of the disease and permitted differentiation between AD and non-demented controls. Additionally, sTREM2 was biochemically linked to tau and pTau in the AD group. Notably, NGAL demonstrated superior diagnostic performance compared to classical AD biomarkers in discriminating MCI patients from controls. These findings suggest that proteins secreted mainly through microglia dysfunction might play not only a detrimental but also a protective role in the development of AD pathology.

Costs and healthcare use of patients with chronic kidney disease in the Northern Territory, Australia

BackgroundThe burden of chronic kidney disease (CKD) is high in the Northern Territory (NT), Australia. This study aims to describe the healthcare use and associated costs of people at risk of CKD (e.g. acute kidney injury, diabetes, hypertension, and cardiovascular disease) or living with CKD in the NT, from a healthcare funder perspective.MethodsWe included a retrospective cohort of patients at risk of, or living with CKD, on 1 January 2017. Patients on kidney replacement therapy were excluded from the study. Data from the Territory Kidney Care database, encompassing patients from public hospitals and primary health care services across the NT was used to conduct costing. Annual healthcare costs, including hospital, primary health care, medication, and investigation costs were described over a one-year follow-up period. Factors associated with high total annual healthcare costs were identified with a cost prediction model.ResultsAmong 37,398 patients included in this study, 23,419 had a risk factor for CKD while 13,979 had CKD (stages 1 to 5, not on kidney replacement therapy). The overall mean (± SD) age was 45 years (± 17), and a large proportion of the study cohort were First Nations people (68%). Common comorbidities in the overall cohort included diabetes (36%), hypertension (32%), and coronary artery disease (11%). Annual healthcare cost was lowest in those at risk of CKD (AUD$7,958 per person) and highest in those with CKD stage 5 (AUD$67,117 per person). Inpatient care contributed to the majority (76%) of all healthcare costs. Predictors of increased total annual healthcare cost included more advanced stages of CKD, and the presence of comorbidities. In CKD stage 5, the additional cost per person per year was + $53,634 (95%CI 32,769 to 89,482, p < 0.001) compared to people in the at risk group without CKD.ConclusionThe total healthcare costs in advanced stages of CKD is high, even when patients are not on dialysis. There remains a need for effective primary prevention and early intervention strategies targeting CKD and related chronic conditions.

Development and Competition of Three Parasitoid Wasps, Brachymeria podagrica, Dirhinus himalayanus, and Nasonia vitripennis, in Their Host, Sarcophaga dux, in Single and Mixed Infections

Laboratory trials were carried out to investigate the development of three entomophagous parasitoid wasps in preimaginal stages of Sarcophaga dux in monoinfections and mixed infections. Laboratory-raised postfeeding S. dux third-stage larvae were exposed to Brachymeria podagrica. After pupation, 50 of these fly puparia were brought in contact with pupal parasitoid Dirhinus himalayanus and 50 with Nasonia vitripennis, and the remaining 50 puparia were left as Brachymeria monoinfection. In three further trials, each set of 50 freshly pupated host puparia from the same source was exposed to N. vitripennis and D. himalayanus, as monoinfections and mixed infections, respectively. The uninfected control group consisted of 50 S. dux larvae that were kept separately under the same conditions. The percentages of successfully developed B. podagrica and D. himalayanus in monoinfections were 56 and 86%, respectively, and progeny of N. vitripennis hatched from 88% of the exposed host puparia. In mixed infections, N. vitripennis dominated over B. podagrica and D. himalayanus with rates of successfully infected hosts of 50 and 94%, respectively. The number of Nasonia progeny in these groups ranged from 4 to 49 and 5 to 43, respectively. Dirhinus himalayanus did not develop in the simultaneous infection with N. vitripennis. Not a single S. dux eclosed in the six experimental groups, while in the uninfected control group, 46 (92%) adult flies eclosed 11 to 14 days after the start of pupation. Since the three parasitoids emerge from flesh fly pupae, these insects can become important in criminal forensic investigations when corpses are in an advanced stage of decay. More data on their preimaginal development at different temperatures are necessary.

Clinical Presentation of Sudanese Patients with Breast Cancer

Background: Breast cancer with advanced stages at a young age is a significant new challenge in Sudan. The purpose of this study was to determine the most common presentations of breast cancer patients in western Sudan. Methodology: For this retrospective descriptive investigation, materials for 183 breast cancer patients were obtained from two histopathology centers (Kordofan histopathology center and El-Obeid International Hospital). A full coverage sample was collected, spanning from January 2019 to May 2024. All data pertaining to the patient's essential identifying, clinical, and histological data were gathered. Results: This study looked at 183 breast cancer patients (177 (96.7%) women and 6 (3.3%) men). Their ages ranged from 20 to 90, with a mean ± standard deviation of 50.78 ± 13.6 years. The majority of participants were aged 41-50 years, followed by ≥61 and 51-60 years, with 50/183 (27%), 43 (23%), and 35 (19%), respectively. For clinical appearance, the most common skin change was unremarkable, followed by ulcerated skin change, which accounted for 127/183 (69%) and 48 (26%) respectively. Conclusion: Breast cancer with advanced stages upon presentation is common in Sudan. The majority of patients presented at a younger age and had distinct initial manifestations.

Cytotoxic T-lymphocyte-associated 4 protein expression is associated with a high international prognostic score in advanced-stage classical Hodgkin lymphoma

ObjectiveTwenty percent of all classical Hodgkin lymphoma (CHL) cases relapse and recur, especially in advanced stages with a high International Prognostic Score (IPS). Cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) is a regulatory molecule that can inhibit the immune response and is related to tumor aggressiveness. This study aimed to determine the relationship between CTLA-4 expression in advanced-stage CHL and IPS, identifying it as a potential therapy target.ResultsIn advanced-stage CHL, the group with a high IPS exhibited significantly higher mean CTLA-4 expression compared to the group with a low IPS (p = 0.003).The group with Hb level < 10.5 g/dl, leukocyte count > 15,000/µL, lymphocyte count < 8%, albumin level < 4 g/dl, and stage 4 exhibited higher CTLA-4 expression than the other group, although only leukocyte count and stage showed statistical significance (p = 0.004 and p = 0.020). Mean CTLA-4 expression was 239.84 ± 76.36 for nodular sclerosis, 293.95 ± 147.94 for mixed cellularity, 271.4 ± 23.56 for lymphocyte depleted, and 225.2 for lymphocyte-rich subtypes. The results suggest that CTLA-4 expression is associated with adverse prognostic factors in the IPS for advanced-stage CHL, supporting the notion that immune checkpoints play a role in cancer progression.

Using a machine learning algorithm and clinical data to predict the risk factors of disease recurrence after adjuvant treatment of advanced-stage oral cavity cancer

ABSTRACT Objectives: Head-and-neck cancer is a major cancer in Taiwan. Most patients are in the advanced stage at initial diagnosis. In addition to primary surgery, adjuvant therapy, including chemotherapy and radiotherapy, is also necessary to treat these patients. We used a machine learning tool to determine the factors that may be associated with and predict treatment outcome. Materials and Methods: We retrospectively reviewed 187 patients diagnosed with advanced-stage head-and-neck cancer who received surgery and adjuvant radiotherapy with or without chemotherapy. We used eXtreme Gradient Boosting (XGBoost) – a gradient tree-based model – to analyze data. The features were extracted from the entries we recorded from the electronic health-care system and paper medical record. The patient data were categorized into training and testing datasets, with labeling according to their recurrence status within the 5-year follow-up. The primary endpoint was to predict whether the patients had recurrent disease. The risk factors were identified by analyzing the feature importance in the model. For comparison, we also used regression to perform the variate analysis to identify the risk factors. Results: The accuracy, sensitivity, and positive predictive value of the model were 57.89%, 57.14%, and 44.44%, respectively. Pathological lymph node status was the most important feature, followed by whether the patient was receiving chemotherapy. Fraction size, early termination, and interruption were the important factors related to radiotherapy and might affect treatment outcome. The area under the curve of the receiver operating characteristic curve was 0.58. The risk factors identified by XGBoost were consistent with those found by regression. Conclusion: We found that several factors were associated with treatment outcome in advanced-stage head-and-neck cancer. In future, we hope to collect the data according to the features introduced in this study and to construct a stronger model to explain and predict outcomes.

Cytotoxic T-lymphocyte-associated 4 protein expression is associated with a high international prognostic score in advanced-stage classical Hodgkin lymphoma.

Twenty percent of all classical Hodgkin lymphoma (CHL) cases relapse and recur, especially in advanced stages with a high International Prognostic Score (IPS). Cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) is a regulatory molecule that can inhibit the immune response and is related to tumor aggressiveness. This study aimed to determine the relationship between CTLA-4 expression in advanced-stage CHL and IPS, identifying it as a potential therapy target. In advanced-stage CHL, the group with a high IPS exhibited significantly higher mean CTLA-4 expression compared to the group with a low IPS (p = 0.003).The group with Hb level < 10.5g/dl, leukocyte count > 15,000/µL, lymphocyte count < 8%, albumin level < 4g/dl, and stage 4 exhibited higher CTLA-4 expression than the other group, although only leukocyte count and stage showed statistical significance (p = 0.004 and p = 0.020). Mean CTLA-4 expression was 239.84 ± 76.36 for nodular sclerosis, 293.95 ± 147.94 for mixed cellularity, 271.4 ± 23.56 for lymphocyte depleted, and 225.2 for lymphocyte-rich subtypes. The results suggest that CTLA-4 expression is associated with adverse prognostic factors in the IPS for advanced-stage CHL, supporting the notion that immune checkpoints play a role in cancer progression.

Time to Diagnosis and Treatment for Ovarian Cancer and Associations with Outcomes: A Systematic Review.

Background: Ovarian cancer is commonly diagnosed symptomatically at an advanced stage. Better survival for early disease suggests improving diagnostic pathways may increase survival. This study examines literature assessing diagnostic intervals and their association with clinical and psychological outcomes. Methods: Medline, EMBASE, and EmCare databases were searched for studies including quantitative measures of at least one interval, published between January 1, 2000 and August 9, 2022. Interval measures and associations (interval, outcomes, analytic strategy) were synthesized. Risk of bias of association studies was assessed using the Aarhus Checklist and ROBINS-E tool. Results: In total, 65 papers (20 association studies) were included and 26 unique intervals were identified. Interval estimates varied widely and were impacted by summary statistic used (mean or median) and group focused on. Of Aarhus-defined intervals, patient (symptom to presentation, n = 23; range [median]: 7-168 days) and diagnostic (presentation to diagnosis, n = 22; range [median]: 7-270 days) were most common. Nineteen association studies examined survival or stage outcomes with most, including five low risk-of-bias studies, finding no association. Conclusions: Studies reporting intervals for ovarian cancer diagnosis are limited by inconsistent definitions and reporting. Greater utilization of the Aarhus statement to define intervals and appropriate analytic methods is needed to strengthen findings from future studies.

Long-Term Outcomes of Thymoma Treated at a Single Institute

Introduction Thymomas are uncommon tumors that originate from epithelial cells of thymus and may have varying clinical course. Materials and Methods A retrospective review of medical records of thymoma patients treated between January 2012 and April 2022 at our institute was conducted. Results There were a total of 23 patients (12 males and 11 females) with median age of 52 years (range, 33–77 years). Eleven patients (47.8%) had associated paraneoplastic syndromes of which 10 (43.5%) had myasthenia gravis and 1 (4.3%) had pure red cell aplasia. Average maximal tumor diameter was 62 mm (28–160 mm). Masaoka-Koga stage distribution was as follows: stage I (n = 2, 8.7%), IIA (n = 4, 17.4%), IIB (n = 1, 4.3%), IIIA (n = 2, 8.7%), IIIB (n = 4, 17.4%), IVA (n = 7, 30.4%), and IVB (n = 3, 13.1%). The World Health Organization type B2 was the commonest histology (n = 12, 52.17%), followed by B3 (n =7, 30.4%), B1 (n = 2, 8.7%), AB (n = 1,4.3%), and A (n = 1, 4.3%). Six patients received neoadjuvant chemotherapy with cyclophosphamide regimen, 22 (95.6%) underwent surgery, and 1 patient received adjuvant chemotherapy. R0 resection was attained in 20 (91%) patients, R1 resection in 1 (4.5%) patient, and R2 in 1 (4.5%) patient. All operated patients underwent postoperative radiotherapy (45–60 Gy in 25–30 fractions). Four patients relapsed at a median duration of 14 months (2–26 months). At a median follow-up of 6 years, 5-year overall survival was 67.1% and 5-year progression-free survival was 66.6%. Local control at 5 years was 86.6%. Conclusion Despite majority of our patients presenting at an advanced stage, the local control rates are encouraging and reinforce multimodality approach.