Tumor Characteristics Research Articles

Cancer incidence and stage at diagnosis in children and adolescents in the Community of Madrid, 2015-2018.

Cancer is the leading cause of death in children aged 1-14 and the second in 15-19-year-old adolescents in Spain. The Paediatric Population-Based Cancer Registry of the Community of Madrid was created to monitor its incidence and survival. This study presents the incidence of childhood and adolescent cancer (0-19 years) in Madrid at a population level by sex, age group, type of tumour and stage at diagnosis. This study was a retrospective analysis of the total number of cases registered in the Paediatric Population-Based Cancer Registry of the Community of Madrid. The registry employs passive and active case finding: by cross-referencing hospital discharge data, primary healthcare data, mortality data and administrative information; and by validation of all potential incident cases through a review of electronic medical charts. All new diagnoses of malignant neoplasms, non-malignant neoplasms of the Central Nervous System, and uncertain and insitu neoplasms of the bladder, identified in 2015-2018 in individuals under age 20 residing in Madrid, were included. Patient information was collected along with tumour characteristics, including stage at diagnosis according to the Toronto Childhood Cancer Stage Guidelines. Age-specific and age-standardised incidence rates were computed with 95% confidence intervals (CI). A total of 1002 tumours were registered in 5,269,524 person-years, yielding an age-standardised rate of 192.7 (95% CI 184.3, 201.4) cases per million person-years. Male/female rate ratio was 1.1. The most common cancers across all ages comprised CNS tumours, leukaemias and lymphomas (primarily Hodgkin): 45.5 (95% CI 39.9, 51.7), 41.1 (95% CI 35.7, 47.1) and 35.8 (95% CI 30.9, 41.3) cases per million person-years, respectively. The proportion of metastatic tumours at diagnosis was similar for ages 0-14 (18.6%) and 15-19 (18.7%). This study provides a comprehensive understanding of childhood and adolescent cancer incidence in Madrid. The registry provides high-quality data and consolidates epidemiological surveillance of cancer in the region.

Prophylactic central lymph node dissection for low-risk papillary thyroid cancer-Impact on subsequent therapy.

For small papillary thyroid cancers (PTCs) with no lateral nodal involvement, American Thyroid Association guidelines recommend performing prophylactic central lymph node dissection (pCLND) if it influences further management. Our cohort study explored to what extent performing pCLND for small PTCs can de-escalate subsequent therapy including completion thyroidectomy and adjuvant radioactive iodine (RAI) ablation. Adults with T1, T2, and cN0 PTCs were identified from 42 centers across the prospectively maintained Australian and New Zealand Thyroid Cancer Registry (ANZTCR) between 2017 and 2023. Patients were excluded if they had clinical nodal involvement or distant metastases. Subsequent therapy and complication rates were compared between patients with and without pCLND. Out of 1290 patients with T1, T2, and cN0 PTCs (78% female and median age 53years), 660 (51%) received a total thyroidectomy and 630 (49%) received a hemithyroidectomy. Prophylactic CLND was performed for 477 patients (37%) and 36% uncovered occult lymph node metastases. After adjusting for differences in age, sex, and tumor characteristics, absence of lymph node metastasis after pCLND was independently associated with fewer completion thyroidectomies (adjusted relative risk [aRR]=0.65 and p=0.008) and reduced RAI ablation (aRR 0.55 and p<0.001). Additionally, pCLND was not associated with higher risks of recurrent laryngeal nerve injury (p=0.33), temporary hypocalcemia (p=0.21), or permanent hypoparathyroidism (p=0.48). In specialized settings across Australia and New Zealand, identifying negative lymph nodes from pCLND is associated with reduced completion thyroidectomies and RAI ablation amongst low risk cN0 PTCs. There were no additional complications rates when performed by experienced thyroid surgeons.

Predictive value of 18F-fluorodeoxyglucose uptake for axillary lymph node metastasis in operable breast cancer: impact of molecular subtypes.

To evaluate the predictive value of standardized uptake value (SUV) in both primary tumors and axillary lymph nodes (ALNs) using FDG PET/CT for lymph node metastasis in breast cancer patients, and to assess the influence of molecular subtypes on this predictive performance. This retrospective study included 287 patients with invasive ductal carcinoma (IDC) who underwent FDG PET/CT prior to surgery between September 2016 and December 2019. The maximum standardized uptake value (SUVmax)of primary tumors (SUV-B) and ALNs (SUV-LN) were analyzed. Molecular subtypes were classified as hormone receptor-positive, HER2-positive, and triple-negative breast cancer (TNBC). Receiver operating characteristic (ROC) curve analysis was performed to assess and compare the diagnostic performance of SUV-B and SUV-LN for predicting ALN metastasis. Among the 287 patients, 62 (21.6%) had confirmed ALN metastasis. The median SUV-LN was significantly higher in patients with metastasis compared to those without metastasis(1.5 vs. 0.9; P < 0.001). SUV-LN demonstrated good discriminative performance for ALN metastasis (AUC: 0.796), whereas SUV-B did not show significant predictive value (AUC: 0.536). The SUV_LN demonstrated significantly lower predictive performance for ALN metastasis in the hormone-positive group (AUC: 0.796) compared to the excellent discriminative performance in the HER2-positive (AUC: 0.923, P = 0.018) and TNBC (AUC: 0.940, P = 0.004) groups. Hormone receptor-positive tumors also exhibited lower FDG uptake in metastatic lymph nodes compared to HER2-positive and TNBC subtypes (P = 0.031). FDG PET/CT SUV-LN effectively predicts ALN metastasis in HER2-positive and TNBC subtypes. Hormone receptor-positive breast cancers show lower FDG uptake in metastatic ALNs, reducing diagnostic accuracy. This finding may aid in selecting the most appropriate diagnostic modality based on tumor characteristics in the era of personalized medicine.

METTL3-Induced m6A Modification Enhances Hsa_Circ_0136959 Expression to Impair the Tumor Characteristics of Papillary Thyroid Carcinoma via Accelerating Ferroptosis.

The number of cases of papillary thyroid cancer (PTC) has gone up significantly in recent years, with high recurrence. Numerous reports have highlighted the participation of circular RNAs (circRNAs) in regulating the advancement of cancers, including PTC. Furthermore, recent studies suggest that N6-methyladenosine (m6A) modified circRNAs play pivotal roles in cancer progression. Hence, we studied the potential role of a novel circRNA, hsa_circ_0136959, and its regulatory mechanism on m6A modification by methyltransferase-like 3 (METTL3) in the tumor characteristics of PTC. The expressions of hsa_circ_0136959 and METTL3 were evaluated in PTC samples and cell lines via quantitative real-time polymerase chain reaction. The effect of hsa_circ_0136959 on the malignant properties of PTC was analyzed by performing Cell Counting Kit-8, colony formation, and transwell assays. In addition, its effects on the levels of markers related to ferroptosis (reactive oxygen species, Fe2+, and iron) in PTC cells were also assessed. Bioinformatics analysis was done to determine the hsa_circ_0136959 expression and m6A modification sites on it in PTC. The m6A level of hsa_circ_0136959 was analyzed through methylated (m6A) RNA immunoprecipitation. The hsa_circ_0136959 was observed to be downregulated in both PTC samples and cells. In vitro experiments showed that its overexpression impeded the malignant properties of PTC cells. Moreover, hsa_circ_0136959 overexpression increased the levels of ferroptosis-related markers in PTC cells. We also found that METTL3 was notably reduced in PTC samples and was positively correlated with hsa_circ_0136959. Mechanistically, METTL3 enhanced hsa_circ_0136959 expression through m6A modification. Our results demonstrate that METTL3-mediated m6A modification elevated hsa_circ_0136959 expression and subsequently restricted the tumor characteristics of PTC by accelerating ferroptosis.

Delayed Facial Nerve Dysfunction Following CyberKnife® Radiosurgery for Vestibular Schwannoma.

The incidence and risk factors for facial nerve dysfunction (FND) following CyberKnife® therapy for vestibular schwannoma (VS) remain poorly understood. This study investigates whether differential radiation doses to vulnerable segments of the facial nerve may be associated with FND outcomes. Patients were identified who underwent CyberKnife® radiosurgery for VS at a single institution. Basic demographics, tumor characteristics, and facial nerve function were collected. Total radiation doses to tumor, internal auditory canal (IAC), and labyrinthine segment of facial nerve (LSFN) were evaluated. Six out of 64 patients experienced FND following CyberKnife® treatment for VS (9.38%, 6/64). Patients with FND were compared to those without FND (control). Of the 64 patients, complete radiation records were obtained for 30 patients (6 FND vs. 24 control). There were no significant differences in demographic or tumor characteristics between control and FND cohorts. More severe FND (HB ≥ 4) had significantly larger tumors (3.74 vs. 1.27 cm3, p = 0.037) with directionally decreased time to FND (3.50 vs. 33.5 months, p = 0.106) than patients with HB < 4, respectively. There were directionally, nonsignificant differences between maximum radiation doses to the LSFN (2492.4 vs. 2557.0 cGy, p = 0.121) and IAC (2877.3 vs. 2895.5 cGy, p = 0.824) between the control and FND cohorts, respectively. FND may represent an underrecognized sequelae of CyberKnife® radiosurgery for VS that can occur many months following treatment. Further studies are needed to elucidate the effect of differential radiation exposure to the facial nerve with FND following treatment. 3 (Retrospective Cohort Study) Laryngoscope, 134:5080-5086, 2024.

Lymph Node Evolution in Eyelid and Orbit Squamous Cell Carcinomas.

To describe a large cohort of eyelid and periorbital SCCs, to compare the location of the tumor and of the pathological lymph nodes, and to analyze the risk factors for lymph node involvement among tumor characteristics. All patients managed inside our institution for an eyelid and periorbital SCCs were included. Tumor characteristics, imaging setup, excision margins, lymph node evolution features, local, regional, and distant recurrences rates, and global survival were reported. The risk for lymph node involvement and location of pathological lymph nodes were analyzed through univariate and multivariate analyses. Between January 2012 and August 2022, 115 patients were included, and 18 presented a lymph node evolution (15.7%), involving the parotid gland in 16 cases (88.9%), the submental and submandibular areas in seven cases (38%), and the jugular and carotid areas in four cases (22%). Tumor size above 20 mm, infiltration of the external canthus and periorbital structures, the presence of perineural invasion or vascular embolism, the depth of infiltration, and the presence of a local recurrence were significantly associated with the risk of lymph node evolution. Periorbital and eyelid SCCs present a true potential for lymph node evolution especially through the parotid gland. Extension setup including the parotid gland and neck should be mandatory, and lymph node dissection should be associated in case of parotidectomy for lymph node involvement. 4 Laryngoscope, 134:4956-4963, 2024.

Retrospective analysis of the clinical outcomes of paraspinal soft-tissue sarcoma

Background ContextDue to the rarity and heterogeneity, paraspinal soft-tissue sarcomas represent a unique and challenging clinical entity for musculoskeletal oncologist. Reports on the treatment of paraspinal soft-tissue sarcoma are limited and the best treatment modality for this rare sarcoma type has not yet been well defined. PurposeTo introduce a modified classification of paraspinal sarcoma, review the outcome of patients treating in our center and determine the effective treatment for paraspinal soft-tissue sarcoma. Study Design/SettingRetrospective review of prospectively collected data. Patient SampleThe study included patients with paraspinal soft-tissue sarcomas in our center. Outcome MeasuresClinical outcomes, complications and survival. MethodsTwenty-five patients with paraspinal soft-tissue sarcomas treating at our center from April 2017 to December 2023 were retrieved from the hospital database. The treatment of these patients included surgery, chemotherapy, radiation, targeted therapy and immunological therapy according to respective tumor type. Patient demographics, tumor characteristics, treatment history, clinical outcomes and survival were collected from electronical medical records. ResultsAccording to the modified classification of paraspinal sarcoma, Type 1 tumors were diagnosed in 15 cases, Type 2 in 4, Type 3 in 5 and Type 4 in 1. All the patients received surgery. No patients in the study received intralesional resection, wide or marginal margins were achieved. Eleven patients received post-operative radiotherapy. The median follow-up duration in this study was 27 months (range 8-67 months). Three patients suffered from wound infection post-operatively and were successfully treated by debridement and antibiotics. Three patients had muscular weakness after surgery and gained improved muscular strength with rehabilitation. There was no implant failure complication. Three recurrence cases were recorded. Four patients died of brain or lung metastasis. Five patients survived with the disease and the remaining 16 patients were alive with disease free. ConclusionsCorrect pathological diagnosis before treatment is vital, and the modified classification can guide the surgical strategy for paraspinal soft-tissue sarcoma. Paraspinal soft-tissue sarcoma is best treated by comprehensive treatment approach with surgery as the main method, which can yield good outcomes.

Vulvar squamous cell carcinoma: The role of p53 and p16 immunohistochemistry

Vulvar squamous cell carcinomas (SCC) represent a heterogeneous group of patients with implications for prognosis and response to treatment. Human papillomavirus (HPV)-associated SCC is characterised by p16 positivity, whereas non-HPV SCC often shows aberrant p53 expression. We conducted a retrospective analysis involving 148 patients with vulvar SCC from two Gynecologic Oncology units from Sydney, Australia. Patients’ demographics, tumor characteristics, types of treatment and survival were analyzed and compared to p16 and p53 immunohistochemistry status. The p16-positive group was younger and included a higher prevalence of smokers, while the p53-positive group demonstrated greater comorbidity indices and was associated with tumor features that are independently related to poor prognosis. Compared to p16-positive patients our study has shown significantly higher recurrence rates and lower overall survival in the p53-positive group. Our findings support existing literature, emphasizing the prognostic significance of p16 and p53 in vulvar SCC. Despite the retrospective nature and variations in immunohistochemistry reporting, our study provides valuable insights into patient outcomes, particularly in a demographically diverse population. Future research, like the STRIVE trial, may determine if implementation of p16 and p53 stratified management algorithm will improve outcomes for women with vulvar SCC (McAlpine, 2024).

Tumor characteristics in immunosuppressed and renal dysfunction populations

PurposeRenal transplantation and end-stage renal disease are increasingly common. Renal dysfunction and immunosuppression are two risk factors in the development of renal cell carcinoma. Carcinomas in these patients are thought to be more indolent, however data are limited and mixed. Our objective was to describe the histology of resected tumors from the transplant and renal dysfunction population and compare them to a control population. Materials and MethodsThis was a single-center retrospective cohort study of all patients who had a nephrectomy for a renal mass from 2009 to 2019. All transplant status and end-stage renal disease diagnoses were identified by diagnostic or procedural coding and confirmed by chart review. Our primary endpoint was the pathology for each patient's tumor. Tumors were classified into aggressive or nonaggressive categories based on their histology and grade. ResultsWe identified 1,150 radical and partial nephrectomies, of which 1,057 met inclusion criteria. Of these, 68 patients (6.4%) had renal dysfunction or a kidney transplant on immunosuppression at time of nephrectomy. After pathologic review, 270 (25%) tumors were classified as aggressive, and 673 (64%) tumors were pT1a or pT1b. On multivariable logistic regression controlling for age and gender, renal dysfunction was not associated with having an aggressive tumor (OR 1.24, 95%CI 0.72–2.15; P = 0.44). ConclusionsWe did not observe a relationship between renal dysfunction status and aggressive pathology. These data suggest that renal dysfunction and transplant patients are at similar risk for aggressive pathology as the general population and should be managed according to the same clinical guidelines.

Immunohistochemical Expression of Cyclin D1 and p16 in Invasive Breast Carcinoma and Its Association with Clinicopathological Parameters.

Invasive breast cancer (IBC) is a significant health concern globally, contributing to substantial morbidity and mortality among women. Dysregulated cellular proliferation, a hallmark of malignancy, involves molecular pathways modulated by proteins such as cyclin D1 and p16. Understanding their roles in IBC pathogenesis and their association with prognostic parameters is crucial for refining treatment strategies. This retrospective study included 50 female IBC patients who underwent modified radical mastectomy. Histopathological evaluation and immunohistochemical staining for cyclin D1 and p16 were conducted. Associations between protein expression and clinicopathological parameters were analyzed using statistical tests. Cyclin D1 was expressed in 76% of cases, significantly associated with lower tumor grade and lower Ki-67 proliferation index. It also correlated with luminal A/B molecular subtypes. p16 expression was observed in 48% of cases, significantly associated with higher tumor grade, higher Ki-67 index, and triple-negative/Her-2 neu-enriched subtypes. Co-expression of cyclin D1 and p16 was noted in 60% of cases. No significant association was found between protein expression and other parameters. Cyclin D1 and p16 exhibit potential as prognostic markers in IBC. Cyclin D1 expression correlates with less aggressive tumor features and luminal subtypes, suggesting a favorable prognosis and potential predictive value for CDK4/6 inhibitor therapy. Conversely, p16 expression associated with aggressive phenotypes, indicating poor prognosis. Further studies are warranted to validate these findings and explore their clinical implications. Integrating these biomarkers into clinical practice may enhance risk stratification and treatment decisions, ultimately improving outcomes for IBC patients.

AI-Driven Web-Based System for Accurate Brain Tumor Detection, Staging, and Visualization Using CNNs and MRI Scans

Abstract: Brain tumors can be attributed as severe problems in the current system of health because of their life endangering complications and equally challenge some diagnostic methods. This work describes a web-based system using deep learning labeled convolutional neural networks for brain tumor detection and staging as well as for image visualization. Scans like MRI scans are uploaded through users control and the system reads these and gives details like tumor size, tumor shape and even tumor stage. High diagnostic accuracy is achieved due to the development of CNN architectures and segmentation methods, tumor characteristics are visualized in the form that is convenient for clinical decision-making. To prevent the system from undergoing a limited learning process and produce highly accurate performance for different patients and tumor types, the system utilizes multiple MRI dataset that include various types of tumors and their stages. Through disease diagnosis, the solution attains a classification accuracy of 98.82%, combining artificial intelligence in medical image analysis with actual care implementation solution, standardized, fast, and efficient. By decreasing radiologists’ load and improving patient care, this system evidences the values of applying AI in diagnostics.

Nanotechnology-Based Drug Delivery Systems for Chemotherapy: A Review of Current Approaches and Future Prospects

Nanotechnology-based drug delivery systems have developed as a novel approach to cancer treatment, notably chemotherapy, with higher precision, efficacy, and less side effects than traditional approaches. Chemotherapy, while successful in targeting rapidly dividing cancer cells, frequently encounters considerable hurdles such as systemic toxicity, non-targeted drug distribution, and resistance. Nanotechnology offers a promising alternative for targeted delivery, controlled release, and overcoming multidrug resistance (MDR). Various nanocarriers, such as liposomes, polymeric nanoparticles, dendrimers, and metallic nanoparticles, have been developed to improve drug delivery by leveraging the increased permeability and retention (EPR) effect for tumour targeting. The design of these nanocarriers, which includes size, surface qualities, and functionality, provides longer circulation time, increased tumour formation, and fewer side effects on healthy tissues. Despite multiple clinical achievements, such as the FDA's clearance of nanomedicines like Doxil and Abraxane, there are still obstacles in translating these technologies from laboratory research to clinical practice. Nanoparticle stability, scalability, regulatory barriers, and cytotoxicity are all important considerations. This study examines the current state of nanotechnology-based drug delivery systems, emphasizing clinical accomplishments, problems, and upcoming technologies such as stimuli-responsive and AI-assisted drug delivery systems. The future of cancer treatment is in the creation of smart nanocarriers that can combine chemotherapy with other therapeutic modalities such as immunotherapy, gene therapy, and photodynamic therapy. Hence, personalized nanomedicine, which tailors drug delivery systems to individual patients' genetic profiles and tumour features, is a promising future direction. Overall, this review seeks to investigate the most recent developments and future prospects in nanotechnology-driven chemotherapy.

Novel Therapies in the Perioperative Management of Localized Gastric Cancer: Current Perspectives and Future Directions

The management of localized gastric cancer has evolved considerably with the advent of novel perioperative treatment strategies with chemotherapy, significantly impacting patient outcomes. Traditionally, surgery has been the cornerstone of treatment, but recurrence rates remained high, necessitating the exploration of additional therapies to enhance long-term survival. The interplay between chemotherapy and radiotherapy is being meticulously studied to define the optimal sequencing and combination that maximizes tumor control while minimizing toxicity. Furthermore, the integration of targeted therapies and immunotherapy into the perioperative setting is gaining momentum with agents targeting HER2, VEGF, and PD-1/PD-L1, pathways have shown promise in advanced gastric cancer and are now being tested in the neoadjuvant and adjuvant settings. Preliminary results from trials investigating these agents, such as pembrolizumab and trastuzumab-deruxtecan, suggest potential survival benefits and warrant further exploration in combination with chemotherapy in the perioperative context. Additionally, the heterogeneity of gastric cancer across different populations and geographic regions necessitates tailored approaches that consider genetic and molecular characteristics of tumors, as well as patient comorbidities. This Comment provides a comprehensive overview of the latest therapeutic advancements in the perioperative setting for localized gastric cancer, emphasizing the critical role of multimodal treatment approaches.

A Trifecta-Based Evaluation of Patients Treated with Percutaneous Thermal Ablation of Small Renal Masses.

Background: Scoring metrics are important to compare outcomes of different percutaneous treatments for small renal masses (RMs). The concept of trifecta (no complications, kidney function preservation, and absence of local recurrence) has been recently introduced in percutaneous thermal ablation of RM. In this context, previous studies have shown that cryoablation (CA) and microwave ablation (MWA) have similar outcomes. We aimed to validate the trifecta in CA and MWA and factors associated with treatment success. Materials and Methods: A retrospective comparative analysis of two cohorts was carried out on 190 consecutive patients with RMs treated using percutaneous CA or MWA. Nephrometry scores described RM complexity. Postoperative complications were categorized according to the Clavien-Dindo system. Glomerular filtration rate (GFR) at the last follow-up was calculated through the chronic kidney disease-epidemiology collaboration (EPI) formula, whereas detection of contrast enhancement during follow-up defined local recurrence. Last, trifecta was defined by the combination of no major (Clavien >2) complications, estimation of GFR (eGFR) decline <10%, and absence of local recurrence. Descriptive statistics and logistic regression models tested the association between predictors and trifecta achievement. Factors associated with recurrence were compared by the log-rank test. Results: Of 175 patients, 121 (69.1%) and 54 (30.8%) patients underwent CA and MWA, respectively. Median (interquartile range [IQR]) age and RM diameter were 75 years (66-80) and 2.4 cm (1.8-3.0). The CA group had a lower preoperative GFR but also had a lower rate of comorbidities (both p = 0.01). Other demographics and tumor characteristics were comparable between groups. In the CA and MWA groups, major complications occurred after 1.6% and 4.8% of procedures (p = 0.33), whereas an eGFR decline >10% was found in 31.5% and 38.8% of cases (p = 0.40), respectively. Similarly, in the CA and MWA groups, at a median follow-up of 21 (8-39) and 24 (9.5-36) months, local recurrence was observed after 10 (8.3%) and 5 (9.3%) cases (p = 0.78), trifecta was accomplished after 72 (59.5%) and 32 (59.3%; p = 1.00) procedures, respectively. Of note, recurrence-free survival (RFS) was comparable among groups (p = 0.57). Moreover, trifecta achievement was comparable when stratifying for demographics and tumor characteristics in the whole cohort and in the CA group (p > 0.05). Conversely, logistic regression showed a lower odds ratio (OR) of trifecta for lesions close to renal collecting system treated by MWA, even when accounting for maximum diameter and preoperative GFR (OR 0.21, confidence interval 0.60-0.72, p = 0.010). Of note, this factor was also associated with a significantly lower RFS (log-rank p = 0.002). Conclusions: Both percutaneous CA and MWA of RM can safely accomplish good oncological outcomes while preserving renal function. Approximately 6 out of 10 patients achieved trifecta after each procedure. Patient selection should account for tumor proximity to the collecting system, as this factor seems to impact the outcomes of MWA.

Prostate cancer in people with HIV

Purpose of review Prostate cancer burden has been rising among people with HIV (PWH), yet it remains understudied in the context of HIV infection. The objective of this review article is to summarize contemporary information on the burden, risk, and outcomes of prostate cancer for people living with HIV. Recent findings Despite a lower apparent incidence of prostate cancer in early studies for PWH compared to uninfected persons, this malignancy is now likely to be the most common tumor for US PWH. Tumor characteristics and stage appear to have limited differences by HIV status. The optimal approach to early detection of prostate cancer remains controversial, and there are little HIV-specific data surrounding screening. Prostate cancer outcomes may have been worse for PWH in the early antiretroviral era but may have improved in more recent years. Summary Prostate cancer is an increasingly common clinical issue for PWH. Lower than expected incidence rates in the early ART-era may be increasing, and oncologic outcomes may also be improving. Treatment tolerability is still a key question for this patient group. Given the clinical and biological complexity of chronic HIV infection, strategies for both early detection and treatment will need continued evaluation specifically in the setting of HIV.

Multimodal imaging of mixed epithelial and stromal tumor of the kidney: Case series.

To investigate the clinical features, imaging manifestations, and pathological characteristics of mixed epithelial stromal tumor of the kidney (MESTK) to improve the understanding of MESTK and the accuracy of preoperative imaging diagnosis. The clinical, imaging, and pathological data of 3 patients with MESTK confirmed by postoperative pathology were retrospectively analyzed. Three patients with MESTK were middle-aged women with no obvious clinical symptoms. The main image representation showed a multilocular cystic or solid-cystic mass, with the larger masses protruding from the kidney contour, with multiple separations, which could be of unequal thickness. The cystic component showed no enhancement on enhancement scans, whereas the segregations and solid components showed gradual and obvious enhancement. Microscopic pathology was characterized by the biphasic differentiation of mesenchymal and epithelial components. MESTK is a rare, mostly benign tumor that appears as a multilocular cystic or cystic solid, with progressive marked enhancement of the septal and solid components on enhanced scans. This imaging feature is helpful for the diagnosis of MESTK.

Identification of HER2-positive breast cancer molecular subtypes with potential clinical implications in the ALTTO clinical trial

In HER2-positive breast cancer, clinical outcome and sensitivity to HER2-targeted therapies are influenced by both tumor and microenvironment features. However, we are currently unable to depict the molecular heterogeneity of this disease with sufficient granularity. Here, by performing gene expression profiling in HER2-positive breast cancers from patients receiving adjuvant trastuzumab in the ALTTO clinical trial (NCT00490139), we identify and characterize five molecular subtypes associated with the risk of distant recurrence: immune-enriched, proliferative/metabolic-enriched, mesenchymal/stroma-enriched, luminal, and ERBB2-dependent. Additionally, we validate the biological profiles of the subtypes and explore their prognostic/predictive value in external cohorts, namely the NeoALTTO trial (NCT00553358), SCAN-B (NCT02306096), I-SPY2 (NCT01042379), METABRIC and TCGA. Immune-enriched tumors present better survival outcomes, in contrast to mesenchymal/stroma-enriched and proliferative/metabolic-enriched tumors, while luminal and ERBB2-dependent tumors are characterized by low and high rates of pathological complete response, respectively. Of note, these molecular subtypes provide the rationale for treatment approaches leveraging the heterogeneous biology of HER2-positive breast cancer.

Correlation between CT spectral quantitative parameters and expression levels of HIF-1α and ALX1 in non-small cell lung cancer.

To detect the expression levels of hypoxia inducible factor-1alpha (HIF-1α) and aristaless-like homeobox 1 (ALX1) in non-small cell lung cancer and analyze the relationship between CT spectral quantitative parameters and immunohistochemical markers, in order to evaluate the biological characteristics of lung cancer by spectral CT. Spectral CT data and paraffin masses of 50 adult patients with lung cancer were collected. CT quantitative parameters including the slope of spectral curve, effective atomic number and iodine concentration in enhanced phases were acquired. Expression levels of HIF-1α and ALX1 were detected by immunohistochemical tests, and compared between different pathological types and differentiation grades of tumor cells. CT quantitative parameters at different expression levels of HIF-1α and ALX1 were compared, respectively. The relationship between CT quantitative parameters and expression levels of HIF-1α and ALX1 were analyzed. There was no significant difference of expression levels of HIF-1α and ALX1 between adenocarcinoma and squamous cell carcinoma. Expression levels of HIF-1α among different differentiation grades of tumor cells had significant difference (χ2 = 27.100, P < .001), while without significant difference in ALX1 expression. CT spectral parameters had significant difference among expression levels of HIF-1α and ALX1 (P < .01). There was a positive correlation between each CT spectral parameter and the expression level of immunohistochemical markers. CT spectral quantitative parameters are significantly different among expression levels of immunohistochemical markers. The positive correlation between CT quantitative parameter and expression level of immunohistochemical markers suggests CT spectral imaging could predict biological characteristics of tumors.

Prolonged ischaemia during partial nephrectomy: impact of warm vs cold.

To evaluate the impact of prolonged ischaemia during partial nephrectomy (PN), which remains understudied despite its potential clinical relevance. Of 1371 patients managed with on-clamp PN (2011-2014), 759 (55%) had imaging and assessment of serum creatinine levels before and after PN within the appropriate timeframes necessary for inclusion. This timeframe was chosen to allow for a robust analysis of both warm and cold ischaemia. Recovery from ischaemia (Recischaemia) was defined as ipsilateral glomerular filtration rate (GFR) preserved, normalized by percentage ofparenchymal volume preserved (PPVP), and would be 100% if all nephrons recovered completely from ischaemia. Pearson correlation and multivariable linear regression models were used to assess associations between Recischaemia and ischaemia type and duration. Of 759 patients, 525 (69%) were managed with warm ischaemia. The median warm/cold ischaemia times were 22 and 30 min, respectively. Overall, the median percent ipsilateral GFR preserved, PPVP and Recischaemia were 79%, 83% and 96%, respectively. Segmented regression analysis demonstrated substantially greater decline in Recischaemia, beginning at approximately 30 min for warm ischaemia, which was not observed for hypothermia. Prolonged ischaemia (defined as >30 min) occurred in 197 patients (26%; 88 warm/109 cold). For limited ischaemia (≤30 min), hypothermia was often used for tumours with increased tumour size and complexity (P < 0.01), while for prolonged ischaemia, the warm/cold subgroups had similar patient and tumour characteristics. For limited ischaemia and prolonged hypothermia, median Recischaemia remained >95%, independent of ischaemia time. Differences in Recischaemia between the warm and cold cohorts became significant only after 30 min (P < 0.05). On multivariable analysis, prolonged warm ischaemia was associated with reduced Recischaemia (P = 0.02), which fell 3.9% for every additional 10 min beyond 30 min. Our data suggest that Recischaemia begins to decline significantly after 30 min during PN, although hypothermia was protective. Avoidance of prolonged warm ischaemia should be prioritized in patients with solitary kidneys and/or significant pre-existing chronic kidney disease.

Therapeutic Outcomes in 691 Angiosarcomas of the Head and Neck-A Retrospective SEER Study.

Angiosarcomas (AS) are an aggressive subtype of head and neck tumors. Current outcome research is limited to single-surgeon and/or single-institution data. This study analyzes the Surveillance, Epidemiology, and End Results program (SEER) database data to improve outcomes of head and neck AS. In this study, the authors accessed the SEER database from 2000 to 2020 to identify patients who underwent surgical and/or nonsurgical treatment of head and neck AS. Data included demographics, diagnostic workup, tumor characteristics, treatment pathways, and therapy outcomes. The study included 691 patients (210 females, 481 males) with AS of the head and neck. The median tumor size was 40mm. Most patients (63%) underwent surgery, with surgery followed by radiation being the most common treatment combination (50%). Median survival was 16 months. Patients treated with surgery showed significantly longer survival (18mo) compared with nonsurgery cases (12mo, P<0.001). Neoadjuvant treatment significantly improved survival (28mo) compared with non-neoadjuvant cases (15mo, P=0.023). Adjuvant treatment also improved overall survival (19mo) versus nonadjuvant treatment (14mo, P<0.001). There was no significant difference between neoadjuvant and adjuvant treatment outcomes (P=0.270). Bottom of Form This study compares the outcomes of multimodal treatments, especially surgery and radiotherapy, for head and neck AS, emphasizing tailored approaches to optimize patient outcomes and extend survival. Future research should refine these strategies.