Asymptomatic Cancer Patients Research Articles

Increased incidence of interstitial pneumonia detected on [18F]-FDG-PET/CT in asymptomatic cancer patients during COVID-19 pandemic in Lombardy: a casualty or COVID-19 infection?

PurposeThe study aimed to compare the incidence of interstitial pneumonia on [18F]-FDG PET/CT scans between two 6-month periods: (a) the COVID-19 pandemic peak and (b) control period. Secondly, we compared the incidence of interstitial pneumonia on [18F]-FDG PET/CT and epidemiological data from the regional registry of COVID-19 cases. Additionally, imaging findings and the intensity of [18F]-FDG PET/CT uptake in terms of maximum standardized uptake value (SUVmax) were compared.MethodsWe retrospectively analyzed [18F]-FDG PET/CT scans performed in cancer patients referred to nuclear medicine of Humanitas Gavazzeni in Bergamo from December 2019 to May 2020 and from December 2018 to May 2019. The per month incidence of interstitial pneumonia at imaging and the epidemiological data were assessed. To evaluate the differences between the two symmetric groups (period of COVID-19 pandemic and control), the stratified Cochran–Mantel–Haenszel test was used. Chi-square test or Fisher’s exact test and t test or Wilcoxon test were performed to compare the distributions of categorical and continuous variables, respectively.ResultsOverall, 1298 patients were included in the study. The two cohorts—COVID-19 pandemic (n = 575) and control (n = 723)—did not statistically differ in terms of age, disease, or scan indication (p > 0.05). Signs of interstitial pneumonia were observed in 24 (4.2%) and 14 patients (1.9%) in the COVID-19 period and the control period, respectively, with a statistically significant difference (p = 0.013). The level of statistical significance improved further when the period from January to May was considered, with a peak in March (7/83 patients, 8.4% vs 3/134 patients, 2.2%, p = 0.001). The curve of interstitial pneumonia diagnosis overlapped with the COVID-19 incidence in the area of Lombardy (Spearman correlation index was equal to 1). Imaging data did not differ among the two cohorts.ConclusionsSignificant increase of interstitial lung alterations at [18F]-FDG PET/CT has been demonstrated during the COVID-19 pandemic. Additionally, the incidence curve of imaging abnormalities resulted in resembling the epidemiological data of the general population. These data support the rationale to adopt [18F]-FDG PET/CT as sentinel modality to identify suspicious COVID-19 cases to be referred for additional confirmatory testing. Nuclear medicine physicians and staff should continue active surveillance of interstitial pneumonia findings, especially when new infection peak is expected.

Assessment of extra-parenchymal lung involvement in asymptomatic cancer patients with COVID-19 pneumonia detected on 18F-FDG PET-CT studies.

BackgroundLung involvement in patients with coronavirus disease 2019 (COVID-19) undergoing PET-CT has been previously reported. However, FDG uptake outside lung parenchyma was poorly characterized in detail. We evaluated the extra-parenchymal lung involvement in asymptomatic cancer patients with COVID-19 pneumonia through 18F-FDG PET-CT.MethodsA total of 1079 oncologic 18F-FDG PET-CT were performed between February 2 and May 18, 2020. Confirmed COVID-19 pneumonia was defined as characteristic ground-glass bilateral CT infiltrates and positive genetic/serologic tests. Nonmetastatic extra-parenchymal lung PET-CT findings were evaluated through qualitative (visual), quantitative (measurements on CT), and semiquantitative (maximum standardized uptake value: SUVmax on PET) interpretation. Clinical data, blood tests, and PET-CT results were compared between patients with and without COVID-19 pneumonia.ResultsA total of 23 18F-FDG PET-CT scans with pulmonary infiltrates suggestive of COVID-19 and available laboratory data were included: 14 positive (cases) and 9 negative (controls) for COVID-19 infection, representing a low prevalence of COVID-19 pneumonia (1.3%). Serum lactate dehydrogenase and D-dimers tended to be increased in COVID-19 cases. Extra-parenchymal lung findings were found in 42.9% of patients with COVID-19, most frequently as mediastinal and hilar nodes with 18F-FDG uptake (35.7%), followed by incidental pulmonary embolism in two patients (14.3%). In the control group, extra-pulmonary findings were observed in a single patient (11.1%) with 18F-FDG uptake located to mediastinal, hilar, and cervical nodes. Nasopharyngeal and hepatic SUVmax were similar in both groups.ConclusionIn cancer patients with asymptomatic COVID-19 pneumonia, 18F-FDG PET-CT findings are more frequently limited to thoracic structures, suggesting that an early and silent distant involvement is very rare. Pulmonary embolism is a frequent and potentially severe finding raising special concern. PET-CT can provide new pathogenic insights about this novel disease.

Mandatory preoperative COVID-19 testing for cancer patients-Is it justified?

BackgroundSevere acute respiratory syndrome coronavirus 2 has caused substantial disruptions in routine clinical care. Emerging data show that surgery in coronavirus disease (COVID)‐positive cases can be associated with worsening of clinical outcomes and increased postoperative mortality. Hence, preoperative COVID‐19 testing for all patients before elective surgery was implemented in our institution.Materials and MethodsTwo hundred and sixty‐two asymptomatic cancer patients were preoperatively tested for COVID‐19 using reverse‐transcription polymerase chain reaction technique with nasopharyngeal and oropharyngeal swabbing. All negative patients were operated within 72 hours, and positive patients were quarantined for a minimum 14 days before re‐swabbing.ResultsIn our cohort, 21 of 262 (8.0%) asymptomatic preoperative patients, who were otherwise fit for surgery, tested positive. After adequate quarantine and a negative follow‐up test report, 12 of 21 (57%) had an operation. No major postoperative morbidity due to COVID‐19 was noted during the immediate postoperative period before discharge from the hospital.ConclusionRoutine preoperative COVID‐19 testing was successful in identifying asymptomatic viral carriers. There was no incidence of symptomatic COVID‐19 disease in the postoperative period, and there was no incidence of morbidity attributable to COVID‐19. These data suggested a beneficial role for mandatory preoperative COVID‐19 testing.

Molecular identification and subtypes distribution of Blastocystis sp. isolated from children and adolescent with cancer in Iran: evaluation of possible risk factors and clinical features.

This study aimed to determine the molecular characterization and subtype distribution of Blastocystis sp. isolated from cancer children and adolescents in Shiraz, Fars province, southwestern Iran. Overall, 200 fecal samples obtained from cancer children and adolescents under 18years old (107 males and 93 females) and checked by microscopy, culture, and molecular methods (PCR). Possible etiological factors and clinical characteristics of Blastocystis infection were also evaluated and compared between Blastocystis infected and non-infected patients. Thirteen of 200 (6.5%) stool samples were positive for Blastocystis by microscopy. While 21 of 200 (10.5%) were positive by culture, and 24 of 200 (12%) were positive by PCR. Out of 24 positive samples tested by PCR and sequencing, ST3 was reported as the most common subtype (nine samples, 37.5%), followed by ST2 (eight samples, 33.3%), ST1 (five samples, 20.9%), and ST7 (two samples, 8.3%). The prevalence of Blastocystis infection in males was significantly higher than females (p = 0.024). Also, Blastocystis was more prevalent in patients who had received at least eight chemotherapy cycles than fewer (p = 0.002). However, no associations were found between Blastocystis-positive rate and age, residence, type of cancers, or contact with animals. Also, there was no significant difference between frequency of Blastocystis subtypes in symptomatic and asymptomatic cancer patients. Various controlled epidemiologic and topographic studies need to confirm or reject these possible associations with Blastocystis infection. The data from this study are an invaluable addition to the growing body of research studies on Blastocystis infection in cancer patients.

Oral Cancer Surgery and COVID 19 Pandemic: Our Experience

The COVID 19 pandemic limited the clinical practice of Surgical Oncologists all over the world to performing emergency procedures and surgeries. During this initial period of two to three weeks we realised that further delay in the treatment of curable oral cancers would have serious adverse prognostic implications. So we started the process to formulate our own institutional guidelines to screen and test all preoperative asymptomatic oral cancer patients for COVID 19. All preoperative oral cancer patients were tested for Reverse Transcriptase Polymerase Chain Reaction (RT PCR) and a negative COVID RT PCR report was followed by HRCT Chest. We share our prospectively collected data of Oral Cancer Surgery patients from 14th April to 31st May 2020 with details of sub site, stage, operative procedure and type of reconstruction offered. Our institutional protocol to test all preoperative patients by the highly sensitive HRCT Chest combined with the gold standard RT PCR assay ensured the safety of our patients, attendants and the hospital staff.

A Snapshot of The Tumor Microenvironment in Colorectal Cancer: The Liquid Biopsy.

The molecular profile of liquid biopsies is emerging as an alternative to tissue biopsies in the clinical management of malignant diseases. In colorectal cancer, significant liquid biopsy-based biomarkers have demonstrated an ability to discriminate between asymptomatic cancer patients and healthy controls. Furthermore, this non-invasive approach appears to provide relevant information regarding the stratification of tumors with different prognoses and the monitoring of treatment responses. This review focuses on the tumor microenvironment components which are detected in blood samples of colorectal cancer patients and might represent potential biomarkers. Exosomes released by tumor and stromal cells play a major role in the modulation of cancer progression in the primary tumor microenvironment and in the formation of an inflammatory pre-metastatic niche. Stromal cells-derived exosomes are involved in driving mechanisms that promote tumor growth, migration, metastasis, and drug resistance, therefore representing substantial signaling mediators in the tumor-stroma interaction. Besides, recent findings of specifically packaged exosome cargo in Cancer-Associated Fibroblasts of colorectal cancer patients identify novel exosomal biomarkers with potential clinical applicability. Furthermore, additional different signals emitted from the tumor microenvironment and also detectable in the blood, such as soluble factors and non-tumoral circulating cells, arise as novel promising biomarkers for cancer diagnosis, prognosis, and treatment response prediction. The therapeutic potential of these factors is still limited, and studies are in their infancy. However, innovative strategies aiming at the inhibition of tumor progression by systemic exosome depletion, exosome-mediated circulating tumor cell capturing, and exosome-drug delivery systems are currently being studied and may provide considerable advantages in the near future.

134P - Identification, development and validation of a circulating miRNA-based diagnostic signature for early detection of gastric cancer

BackgroundAlthough endoscopic surveillance remains the gold standard for diagnosing asymptomatic gastric cancer (GC) patients, associated costs and its invasive nature render it inadequate as a screening approach. Development of less invasive tests is needed for surveillance of early stage GCs. Over the last decade, tumor-derived miRNAs in peripheral blood are emerging as promising disease biomarkers. Herein we have conducted a comprehensive miRNA expression profiling, followed by bioinformatic analysis to establish a novel serum-based miRNA signature for the diagnosis of patients with GC. MethodsWe analyzed tissue miRNA expression profiles in three patient cohorts (n = 602) in an in-silico discovery step, during which the robustness of candidate biomarkers was tested and validated. The performance of this miRNA signature was evaluated in a serum training cohort (n = 327). Using a logistic regression model, the panel was further refined, and this circulating miRNA signature was validated in two prospective cohorts (n = 174, 175). ResultsGenome-wide analysis of miRNA expression data resulted in identification of 10-miRNAs that distinguished cancer tissues from normal mucosa in three independent datasets (AUC = 0.984, 0.939 and 1.000). Using a serum training cohort, the miRNA candidates were further refined to six-circulating-miRNA signature. This miRNA signature demonstrated a robust diagnostic value in the training cohort. Subsequently we demonstrated robustness of the signature in two prospective cohorts (AUC = 0.87, 0.86). Remarkably, the 6-circulating-miRNA signature was able to detect early stage GC patients robustly (AUC = 0.855). Furthermore, the signature was significantly superior at identifying patients with GC to conventional tumor markers, CEA (P = 0.0001) and CA19-9 (P = 0.0001). ConclusionsUsing a comprehensive data analysis followed by substantial clinical validations, involving over 1600 GC tissue and serum specimens across 7 independent cohorts, we developed a novel 6-circulating-miRNA signature, which demonstrated an unprecedented diagnostic value and a great promise for early non-invasive detection of GC. Legal entity responsible for the studyDaisuke Izumi. FundingNIH. DisclosureAll authors have declared no conflicts of interest.

Phase II randomized clinical trial of endosonography and PET/CT versus clinical assessment only for follow-up after surgery for upper gastrointestinal cancer (EUFURO study)

Upper gastrointestinal malignancies have a poor prognosis. There is no consensus on how patients should be followed after surgery. The authors hypothesized that a structured follow-up programme including endoscopic ultrasonography (EUS) and [18 F]fluorodeoxyglucose (FDG) PET/CT would detect cancer recurrences, leading to more patients being eligible for therapy. After surgery with curative intent for adenocarcinomas in the gastro-oesophageal junction, stomach or pancreas, patients were randomized 1 : 1 to standard clinical assessment in the outpatient clinic at 3, 6, 9, 12, 18 and 24 months after operation, or clinical assessment plus imaging including [18 F]FDG PET/CT and EUS. The primary endpoint was number of patients receiving oncological treatment for recurrence. Secondary endpoints were overall and progression-free survival, survival after recurrence detection of isolated locoregional recurrences and risk factors affecting survival. In total, 183 patients were enrolled, including 93 who underwent standard follow-up and 90 who had follow-up plus imaging. A recurrence was detected in 84 patients within 2 years after surgery (42 in each group), including 33 of 42 patients in the imaging group who were asymptomatic. Some 25 of 42 patients in the imaging group and 14 of 42 in the standard group received chemotherapy (P = 0·028). Although survival after detection of recurrence in asymptomatic patients was significantly longer than that for symptomatic patients (P < 0·001), overall survival from date of surgery in the two treatment groups was comparable. Follow-up after surgery for upper gastrointestinal cancer with EUS and PET/CT leads to detection of more asymptomatic cancer recurrences and patients referred for treatment without prolonging overall survival. Registration number: NCT02209415 ( http://www.clinicaltrials.gov).

Development of a blood-based cancer screening assay with a novel multivariate cancer risk score (MCRS) model by integrating shallow WGS data and plasma protein markers.

45 Background: Despite the increase of our knowledge about carcinogenesis and recent successful development of innovative cancer drugs, cancer mortality has only slightly decreased in the past decades. Cancer early detection is probably the most cost-effective means to reduce cancer mortality as prognosis is much better when cancer is detected and treated at the early stage. Recently studies have demonstrated that blood-based mutation detection approaches may be effective to identify asymptomatic cancer patients from general population. Methods: Here we reported a novel multivariate cancer risk score (MCRS) model that interrogates shallow whole genome sequencing (WGS) data from cell-free DNA (cfDNA) and protein markers results in a single blood draw. Results: In a prospective clinical study consisting of 76 stage I-IV cancer patients and 152 normal individuals, the MCRS model demonstrated 60% sensitivity at 98.5% specificity. In order to validate clinical utility of the MCRS model in detection of cancer patients, we collated the data from a previous study of occult maternal malignancies from 1.93 million pregnant women undergoing NIPT test between 2016 and 2017. 466 out of the 639 pregnant women who tested positive for multiple chromosomal aneuploidies (MCAs) in the initial NIPTs (i.e. 0.06 - 0.1x WGS), have also underwent the protein markers test. Out of the 466 subjects, 39 maternal malignant cancer cases were diagnosed with a median follow-up of 399 days (IR, 303 - 487 days) by imaging and histology. The cancer patients presented a wide spectrum of cancer types, the most frequent being breast cancer (10 cases), liver cancer (8) and lymphoma (8), at stage II to IV. This subgroup of 466 subjects was selected as an independent validation cohort for our study. Through our new method, we analyzed shallow WGS and proteins data. The MCRS model allowed 28 of the 39 (71.8%) cancer cases to be identified with a positive predictive value of 73.7% and specificity of 97.7%. Conclusions: Taken together, these data demonstrate the MCRS model holds promise for detecting cancer in asymptomatic individuals, particularly in the populations at high risk of cancer.

An international survey of healthcare providers\u2019 knowledge of cardiac complications of cancer treatments

BackgroundCardio-oncology is a young sub-specialty that addresses the needs of cancer patients at risk of, or who have experienced cancer therapy related cardiac dysfunction (CTRCD). This study assessed clinicians’ understanding of cardio-oncology, opinions towards current practice, and approach to diagnosing and managing CTRCD.MethodsA 45-question survey was administered online via Survey Monkey and WeChat to health care providers (HCPs) comprising of cardiologists, oncologists, and others from September 2017 to March 2018. Implementation of the survey followed a modified Dillman’s Total Design Method.ResultsIn total, 160 responses were collected from 22 countries; majority were from cardiologists (53.8%) and oncologists (32.5%). The remaining 13.7% identified themselves as “others,” including general internists, cardio-oncologists, pediatric oncologists, radiation oncologists, cardiac rehabilitation therapists, nurse practitioners, research students, and pharmacists. In the setting of metastatic cancer, there was a difference in risk tolerance for cardiotoxicity between subspecialties. In this case, more cardiologists (36.7%) accepted a 5–10% risk of cardiotoxicity compared to oncologists (20.0%). Majority of cardiologists felt that cardiotoxicity should be monitored, even in asymptomatic cancer patients (55.8%). Only 12% of oncologists selected this response. In contrast, 50.0% of oncologists reported that cardiologists should be involved only when patients develop cardiotoxicity. In comparison, 6.5% of cardiologists selected this response. Majority of cardiologists stated that cardio-oncology clinics would significantly improve cancer patients’ prognosis (88.3%); only 45.8% of oncologists shared this opinion. Of all respondents, 66.9% stated they were familiar with a variety of international guidelines for managing cardiotoxicity. Of all oncologists, 65.3% indicated that they referred to these guidelines for clinical decision making.ConclusionsDespite the growth of cardio-oncology clinics, there are significant knowledge gaps regarding prevention and treatment strategies for CTRCD among health care providers. Knowledge translation from guidelines and collaboration between cardiologists and oncologists are needed to improve cardiovascular outcomes of cancer patients.

Is There a Survival Advantage in Diagnosing Endometrial Cancer in Asymptomatic Patients? A Systemic Review and Meta-analysis.

Data supporting a survival advantage of endometrial cancer diagnosed before the onset of postmenopausal bleeding are lacking. This study sought to compare overall survival and disease recurrence between women who were asymptomatic at diagnosis and women who were symptomatic at diagnosis. A systemic search was conducted in databases using the terms: "asymptomatic," "ultrasound," "screening," and "endometrial cancer." Only original research studies that compared characteristics of tumour advancement and survival measures were included. The six articles included in the meta-analysis comprised 2961 patients. Data were collected on study design and period, number and characteristics of participants, and outcomes in terms of tumour histology and survival measures. Higher rates of stage I tumours were shown among asymptomatic patients (relative risk 1.19). The proportion of high-grade histology did not differ between the two groups (relative risk 0.92). The crude pooled estimate for overall survival did not yield statistical significance, nor did recurrence-free survival (which was reported by three studies). In conclusion, endometrial cancer diagnosed in asymptomatic women is not associated with higher survival than in symptomatic women. Invasive procedures in asymptomatic women with incidental ultrasonographic findings should be carefully weighed because no survival advantage is expected.

The role of PET/CT with 18F-fluorodeoxyglucose in detecting the progression of colorectal cancer in asymptomatic patients with elevated level of сarcinoembryonic antigen (literature review)

Positron emission tomography-computed tomography (PET/CT) with 18 F-fluorodeoxyglucose in colorectal cancer is a highly sensitive imaging technique that detects malignant foci characterized by increased glucose metabolism. Currently, an increasing number of studies indicate the added value of PET/CT for the diagnosis and preoperative restaging of recurrent colorectal cancer. A special problem is a group of patients suffering from colorectal cancer, with negative or ambiguous results of radiology methods, but with an elevated level of с arcinoembryonic antigen. Many studies confirm the opinion that early use of PET/CT with 18 F- fluorodeoxyglucose may have predictive value in the treatment of such patients.

LBA-09 DAROLUTAMIDE DELAYS PROSTATE-SPECIFIC ANTIGEN PROGRESSION AND TIME TO NEXT ANTICANCER THERAPIES IN PATIENTS WITH NONMETASTATIC CASTRATION-RESISTANT PROSTATE CANCER

INTRODUCTION AND OBJECTIVES:Asymptomatic nonmetastatic castrate-resistant prostate cancer (nmCRPC) patients (pts) would benefit from treatments (Tx) that delay disease progression with minimal Tx-r...

The Risks and Benefits of Immune Checkpoint Blockade in Anti-AChR Antibody-Seropositive Non-Small Cell Lung Cancer Patients.

Background: Anti-programmed cell death 1 (PD-1) monoclonal antibodies (Abs) unleash an immune response to cancer. However, a disruption of the immune checkpoint function by blocking PD-1/PD-ligand 1(PD-L1) signaling may trigger myasthenia gravis (MG) as a life-threatening immune-related adverse event. MG is a neuromuscular disease and is closely associated with being positive for anti-acetylcholine receptor (anti-AChR) Abs, which are high specific and diagnostic Abs for MG. Methods: A 72-year-old man was diagnosed with chemotherapy-refractory lung squamous cell carcinoma and nivolumab was selected as the third-line regimen. We describe the first report of an anti-AChR Ab-seropositive lung cancer patient achieving a durable complete response (CR) to an anti-PD-1 antibody therapy. To further explore this case, we performed multiplex immunofluorescence analysis on a pretreatment tumor. Results: The patient achieved a durable CR without developing MG. However, the levels of anti-AChR Abs were elevated during two years of anti-PD-1 antibody therapy. The tumor of the subclinical MG patient had high PD-L1 expression and an infiltrated–inflamed tumor immune microenvironment. Conclusions: This study suggests that immune checkpoint inhibitors can be safely used and provide the benefits for advanced cancer patients with immunologically ‘hot’ tumor even if anti-AChR Abs are positive. Although careful monitoring clinical manifestation in consultation with neurologist is needed, immune checkpoint inhibitors should be considered as a treatment option for asymptomatic anti-AChR Ab-seropositive cancer patients.

Performance of whole-body 18F-FDG PET/CT as a posttreatment surveillance tool for sinonasal malignancies.

To determine the diagnostic utility of posttreatment surveillance whole-body 18F-FDG PET/CT in detecting local tumor recurrence (R), regional lymph-node metastasis (LM), and distant metastasis (DM) in asymptomatic sinonasal cancer patients. Eighty consecutive patients (53 men, 27 women; mean age, 60years; range, 28-92years) who had undergone 197 posttreatment whole-body 18F-FDG PET/CT examinations for sinonasal malignancies between January 2009 and August 2017 were retrospectively reviewed. 18F-FDG PET/CT findings were categorized as positive or negative for R, LM, and DM, separately. Outcomes of 18F-FDG PET/CT scans were compared with the final diagnosis confirmed by histological analysis or follow-up period for a minimum 12months. The diagnostic accuracy of scans was calculated for each site using contingency tables. Impact on the management of 18F-FDG PET/CT examinations was additionally evaluated. 18F-FDG PET/CT scans identified 37/44 of local recurrences, 21/23 of LMs, and 30/37 of DMs. For local recurrence, sensitivity, specificity, positive predictive value, and negative predictive value were 84% (68-97%), 95% (80-100%), 84% (68-97%), and 95% (80-100%), respectively. For LM, the respective values were 91% (75-100%), 99% (83-100%), 91% (75-100%), and 99% (83-100%). For DM, the values were 81% (64-97%), 99% (85-100%), 97% (81-100%), and 96% (81-100%), respectively. 18F-FDG PET/CT accounted for a change in management of 85% patients with recurrences. Whole-body 18F-FDG PET/CT is a suitable surveillance tool for sinonasal malignancies in detecting locoregional and distant recurrences in asymptomatic patients without any evidence of recurrence on regular follow-up and endoscopy during the posttreatment period.

Clinicopathological Characteristics of Asymptomatic Young Patients with Gastric Cancer Detected during a Health Checkup.

The Korean National Cancer Screening Program recommends biennial gastric cancer screening for patients aged ≥40 years. This study compared the characteristics of asymptomatic young gastric cancer patients aged <40 years, whose cancer was detected during a health checkup (screening group), with those whose disease was detected because of symptoms (diagnostic group). Data were collected retrospectively from 84 subjects who underwent a gastroduodenoscopy before the age of 40 years and who were diagnosed with gastric cancer from January 2006 to February 2017 in three tertiary centers in Korea. The clinicopathological characteristics, including age, sex, stage, location, pathology, and survival, were compared according to the purpose of endoscopy (screening group, n=23 vs. diagnostic group, n=61). The median age of the screening group was higher than that of the diagnostic group (37 vs. 35 years, p=0.027), as was the proportion of early gastric cancer cases (78.3% vs. 29.5%, p<0.01), curative endoscopic treatment or operation rate (95.7% vs. 52.5%, p<0.01), and the overall survival (p<0.01). Poorly differentiated or signet ring cell carcinoma was less common in the screening group than in the diagnostic group (56.5% vs. 83.6%, p=0.006). The sex ratio, smoking status, family history of gastric cancer, Helicobacter pylori infection status, and tumor location were similar in the two groups. Screening gastroduodenoscopy may enable the early detection of gastric cancer and prolong survival in patients <40 years of age.

The survival benefit of palliative gastrectomy and/or metastasectomy in gastric cancer patients with synchronous metastasis: a population-based study using propensity score matching and coarsened exact matching.

Introduction: Palliative surgeries were controversial for asymptomatic metastatic gastric cancer (mGC) patients. This study was aimed to evaluate survival benefit of palliative surgeries to gastric and/or metastatic tumors in mGC patients based on U.S population.Materials and Methods: A total of 8345 gastric cancer patients diagnosed with synchronous distal metastasis between 2004 to 2013 from the Surveillance, Epidemiology, and End Results Program (SEER) database were divided into four groups according to surgery strategies: surgeries to both primary and metastatic tumors (SPM), gastrectomy only (GO), metastasectomy only (MO) and no surgery performed (NS). Their clinicopathological characteristics and overall survival (OS) were analyzed before and after propensity score matching (PSM) and coarsened exact matching (CEM).Results: The median OS of SPM and GO patients was both significantly higher than NS patients (11 months vs. 8 months vs. 5 months; P<0.001, respectively) while that of MO was not (6 months vs. 5 months; P= 0.286). In comparisons between surgery strategies, survival benefit was similar between SPM and GO groups (P=0.389) and both showed significantly better survival than MO patients (P<0.001). All surgery strategies were proved to be favorable prognostic factors over non-surgical treatment (Hazard ratio (HR) for SPM: 0.60, P<0.001; HR for GO: 0.62, P<0.001; HR for MO: 0.91, P=0.046). Similar results were obtained after matching by PSM and CEM except that prognostic impact of MO deteriorated.Conclusions: Gastrectomy plus metastasectomy or gastrectomy alone could be adopted as a choice of improving survival in the U.S population. Metastasectomy alone is not generally recommended.

Pathological features of total gastrectomy specimens from asymptomatic hereditary diffuse gastric cancer patients and implications for clinical management.

Hereditary diffuse gastric cancer (HDGC) is an autosomal dominant syndrome characterised by multigenerational diffuse gastric cancer, and is mainly caused by germline alterations in the CDH1 gene. Currently, endoscopy has limited diagnostic accuracy, and total gastrectomy (TG) is the treatment of choice for asymptomatic CDH1 carriers. In this study, we aimed to obtain a better understanding of HDGC syndrome by exploring the histopathological findings of TG specimens from asymptomatic HDGC patients. A comprehensive literature review was carried out, searching for TGs performed in asymptomatic HDGC patients. Fourteen unpublished cases, analysed in our institution, were also included. The series encompassed 174 CDH1 carriers. Preoperative endoscopic biopsies were positive in 28.3%. A macroscopic lesion was apparent in 11.7% of TGs. Histopathological analysis revealed intraepithelial lesions and/or intramucosal signet ring cell carcinoma in 87.9% of TGs. When we explored the type of protocol used for handling the specimens, we found that microscopic cancer foci were detected in 95.3% of TGs when a total-embedding protocol (assessment of the totality of gastric mucosa) was applied, and only in 62.5% when no specific protocol was used (P<0.001). Helicobacter pylori infection was found in 23.4% cases. In conclusion, a thorough histopathological examination of gastric mucosa remains the gold standard for detection of cancer foci in HDGC gastrectomy specimens, requiring experienced pathologists for an accurate diagnosis. A better understanding of the natural history of HDGC will enable better clinical management of HDGC patients, particularly regarding the optimal timing for the performance of TG.

Urine cultures at the onset of febrile neutropenia rarely impact antibiotic management in asymptomatic adult cancer patients.

There is a paucity of data regarding the utility of routine urine cultures in adults with febrile neutropenia (FN) without urinary symptoms receiving protocolised antibiotics. This is reflected by inconsistent recommendations in international and regional FN guidelines. We addressed this issue by retrospectively reviewing the impact of routine urine cultures on antibiotic management in haematology cancer inpatients at a tertiary hospital. All haematology inpatients over a 5-year period (2011-2015) were retrospectively reviewed for episodes of FN (neutrophil count < 0.5 × 109/L and fever > 37.5°C). For each episode, demographic data, urinary tract symptoms and signs (absence of which was termed 'asymptomatic'), urinalysis and urine culture results, antibiotic therapy and duration, and patient outcomes were collected. A urine culture was considered positive if > 105 colony forming units (CFU)/L were detected. Empiric antibiotic therapy for FN consisted of intravenous piperacillin/tazobactam in stable patients, with the addition of vancomycin and a single dose of gentamicin if systemically compromised. Four hundred and thirty-three episodes of FN were identified in 317 patients. Urine cultures were performed in 362 (84%) episodes. Cultures were positive in 9 of 48 (19%) symptomatic episodes versus 8 of 314 (2.5%) asymptomatic episodes (RR = 7.4, p < 0.0001). A change in antibiotic management due a positive urine culture occurred in only 5 episodes (1.4%): 3 of 48 (6.3%) symptomatic and 2 of 314 (0.6%) asymptomatic episodes respectively (RR = 9.8, p = 0.01). Routine urine cultures in FN patients without urinary symptoms who are already receiving protocolised broad spectrum antibiotics rarely impact subsequent antibiotic management.

Frequency and Site of Skeletal Metastatic Lesion Detected by Bone Scintigraphy in Newly Diagnosed Asymptomatic Cancer Patients

&lt;p&gt;&lt;strong&gt;Objectives:&lt;/strong&gt; Bone is one of the most common organ for metastasis. Bone scintigraphy is widely used for staging of cancer patients before initiation of chemotherapy and adjuvant therapy and it can detect both symptomatic and asymptomatic bone metastases. The purpose of this study was to determine the frequency and site of metastatic bone lesion detected by bone scintigraphy in newly diagnosed asymptomatic cancer patients who werwe referred to National Institute of Nuclear Medicine &amp;amp; Allied Sciences (NINMAS) for bone scintigraphy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients and Methods:&lt;/strong&gt; This cross sectional observational type of study was carried out in NINMAS from July 2015 to June 2016. A total of 116 newly diagnosed asymptomatic cancer patients referred for the first time bone scintigraphy were included in this study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Of the total 116 patients (57 male and 59 female; mean age: 54.8 ± 14.0 years), 46 (39.7%) patients had carcinoma breast, 30 (25.9%) patients had carcinoma prostate, 12(10.3%) patients had carcinoma lung, 8(6.9%) patients had carcinoma urinary bladder, 4(3.4%) patients had renal cell carcinoma and 16(13.8%) patients had other cancer. Bone scan was found positive for metastatic disease in 44.8% patients. Most common sites of bone metastases in different types of cancer in newly diagnosed asymptomatic cancer patients were rib, then hip bone, vertebral column (lumbar vertebra, thoracic vertebra respectively), sternum and skull.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; In this study, it was revealed that newly diagnosed asymptomatic cancer patients are frequently associated with metastatic bone disease, those can be detected by bone scintigraphy.&lt;/p&gt;&lt;p&gt;Bangladesh J. Nuclear Med. 20(1): 14-18, January 2017&lt;/p&gt;