Classification Of Malignant Tumors Research Articles

Expression of p53 and ki-67 in Breast Carcinomas and Their Association with Histopathological Type, Grade, and Stage

Background & objective: Recently many laboratories are evaluating the usefulness of determining p53, and Ki67 proliferation activities using immunohistochemical techniques in cancer. Although the available studies suggest that these factors might help make treatment decisions in cancer patients, their clinical usefulness is still controversial. The present study was undertaken to see the expression of p53 and Ki-67 in breast carcinoma and their associations with histopathological variables. Methods: This cross-sectional analytical study was conducted in the Department of Pathology, in collaboration with the Department of Surgery, Rajshahi Medical College Hospital and the Department of Pathology, Bangobandhu Sheikh Mujib Medical University (BSMMU), Dhaka over a period of one and a half year from July 2018 to December 2019. Resected specimens of breast tissue, histopathologically confirmed as breast carcinoma, were the study population. Histological grading of breast carcinoma was done according to Nottingham modification of the Bloom-Richardson system, while staging was done using Tumor-Node-Metastasis (TNM) classification of malignant tumors, as recommended by the Union for International Cancer Control (UICC). The Ki67 and p53 expressions were assessed by immunohistochemistry. Based on the Ki67 labeling index (Ki67-LI), the patients were divided into two groups – Ki 67 > 30% (considered as over-expressed) and ≤ 30% (considered as less expressed). Likewise, p53 immuno-expression was grouped as over-expressed (score ≤ 8) and low-expressed (score > 8). The histological grade, type, and stage were then compared between patients with tumours of high and low proliferating activities to find the associations of Ki67 and p53 with tumor grade, type, and stage. Result: In the present study, almost three-quarters (74%) of the specimen of the breast had high Ki67-LI and 26% intermediate and low Ki67-LI. The p53 was found to be highly expressed in the majority (86%) of the cases. Analyses of the association of biomarkers with histological grade, stage, and type revealed that advanced-stage breast cancers (Stage-IIIA) were more likely to be associated with high Ki67-LI than the early-stage breast cancers (Stage-IIA and Stage-IIB) (p = 0.023). Poorly differentiated (G3) carcinoma also more often tends to be associated with high Ki67-LI than with low and intermediate Ki67-LI (p = 0.066). Likewise, stage IIIA tumors and poorly differentiated carcinoma were also considerably higher in the p53 over-expressed group (23.3%) than in the low p53 expression group (14.3%) (p = 0.023). Conclusion: The study concluded that a substantial proportion of breast carcinomas demonstrates high Ki67-LI. The p53 overexpression is also found in the majority (86%) of the breast carcinoma cases. Both Ki67 and p53 proliferation activities show their significant presence in high-grade and advanced-stage tumours. Ibrahim Card Med J 2023; 13 (1&2): 11-18

New Insight of Oncology: Cancer Concept without Tumor

This article presents an analysis of current trends in the field of oncology, as an industry that was influenced by both scientific discoveries and the very order of civilization development as a whole. The key technological breakthroughs that have had an impact on oncology in the medium and long term perspective, as well as changes in the structure and approaches to the treatment of oncological diseases, which, in their turn, can determine the foresight of oncology development for the coming decades, are outlined. The TNM (tumor, lymph node, and metastasis) Classification of Malignant Tumors has been critically reassessed through the prism of the achievements in modern molecular biology. In this context, we are inevitably moving towards a new paradigm of oncological science "cancer without a tumor", where the tumor itself becomes a symptom of a systemic "oncological disease". The concept of "cancer without a tumor" has been proposed for the first time. This article is intended to engage professional communities in the oncology field in a discussion of understanding the transformation of the modern concept of oncological diseases.

Soluble NKG2DLs Are Elevated in Breast Cancer Patients and Associate with Disease Outcome.

Ligands of the natural killer group 2D (NKG2DL) family are expressed on malignant cells and are usually absent from healthy tissues. Recognition of NKG2DLs such as MICA/B and ULBP1-3 by the activating immunoreceptor NKG2D, expressed by NK and cytotoxic T cells, stimulates anti-tumor immunity in breast cancer. Upregulation of membrane-bound NKG2DLs in breast cancer has been demonstrated by immunohistochemistry. Tumor cells release NKG2DLs via proteolytic cleavage as soluble (s)NKG2DLs, which allows for effective immune escape and is associated with poor prognosis. In this study, we collected serum from 140 breast cancer (BC) and 20 ductal carcinoma in situ (DCIS) patients at the time of initial diagnosis and 20 healthy volunteers (HVs). Serum levels of sNKG2DLs were quantified through the use of ELISA and correlated with clinical data. The analyzed sNKG2DLs were low to absent in HVs and significantly higher in BC patients. For some of the ligands analyzed, higher sNKG2DLs serum levels were associated with the classification of malignant tumor (TNM) stage and grading. Low sMICA serum levels were associated with significantly longer progression-free (PFS) and overall survival (OS). In conclusion, we provide the first insights into sNKG2DLs in BC patients and suggest their potential role in tumor immune escape in breast cancer. Furthermore, our observations suggest that serum sMICA levels may serve as a prognostic parameter in the patients analyzed in this study.

Clinical and biological significance of microRNA-127 and microRNA-138 expression in women with breast cancer: response to treatment and survival impact

Background and ObjectiveGenetic and epigenetic changes characterize the multi-step process of breast carcinogenesis. It is believed that abnormal microRNA (miRNA) expression has a role in the onset and progression of breast cancer. This study aimed to examine the link between miRNA-127 and miRNA-138 and metastasis, tumor invasion, and apoptosis in Egyptian women with breast cancer, as well as their correlation with its molecular types.MethodologyA total of 150 participants were included in this study, including 75 women with breast cancer and 75 supposedly healthy women who were age and gender-matched. Every patient underwent a thorough physical examination, a general clinical examination, a mammogram, and lab tests, such as the determination of the levels of miRNA-127 and miRNA-138 expression by real-time PCR and the measurement of blood carcinoembryonic antigen (CEA) and carcinoma antigen 15–3 (CA15-3) and CA15-3 and CEA levels.ResultsThere was a significant low expression of miRNA-127 in favor of high TNM stage (Classification of Malignant Tumors), left-sided tumor, metastasis, high-grade disease, increased axillary nodal involvement, absence of estrogen and progesterone receptors, and low antigen Kiel 67 (Ki67) expression. Also, a significant expression of miRNA 127 in triple-negative breast cancer was found, followed by human epidermal growth factor receptor 2 (HER2/neu) overexpression, then luminal B, and the highest expression was with the Luminal A molecular subtype. A significant negative correlation existed between miRNA 127 and miRNA 138 with CEA and CA15.3 levels.ConclusionThe miRNA-127 and miRNA-138 suppression may promote metastasis. Consequently, the restoration of miRNA-127 and miRNA-138 in breast cancer may have therapeutic potential; so, the miRNA-127 and miRNA-138 may play a role in breast cancer development.

Comparison of Palliative Fractionated Radiotherapy to Thorax in Non-small Cell Lung Carcinoma: A Prospective Comparative Study

Background: Most patients of lung carcinoma come into the OPD with advance disease and with moderate to severe symptoms. Palliative Radiotherapy to chest can relieve symptoms arising due to intrathoracic pathology. Timing and fractionation schedule is very important for symptomatic relief and response. Time to come the effect of RT is 3 months. The aim of this study is to investigate survival after PTR and evaluate symptomatic relief and adverse effects of RT. Methods: Patients with non-small-cell lung cancer (NSCLC) planned for PTR in the period of January 2022 to October 2022 at ATRCTRI Bikaner (Rajasthan). We noted pathology, tumor, node, and metastasis (TNM) classification of malignant tumors, stage, indication, starting date, schedule for PTR, completed yes/no, performance status (PS) and time of death. Results: Out of total 86 patients 12 patients did not complete RT. Rest 74 patients who received PTR included in the study, 30 patients (40%) died within 30 days and 15 patients died within 3 months of treatment. Only 20 patients remained alive at 6 months. More Symptomatic relief seen with 20 Gy in 5 fractions. More Survival seen with PS 1-2 and 30Gy/10fraction. Dyspnea, hemoptysis, and SVC syndrome were the most frequent indications for PTR in our study. Almost every patient noted for >1 indication. Fractionated schedule 30Gy/10F used more frequently in good PS patients.Conclusions: Our study shows that a significant number of patients who received PTR died before they could achieve optimal effect of the treatment. PS and histology were significant prognostic factors favoring PS 1-2 and squamous cell carcinoma. Based on our study, we suggest that patients with PS 1-2 should be considered for fractionated PTR whereas patients with PS ≥ 2 should be considered for comparatively shorter fractionation size or best supportive palliative care.

Da-resbigru -brain tumor classification using Dual attention residual bi directional gated recurrent unit using MRI images

Brain tumors are a major health issue that causes enormous problems for people’s health. Detection is a very complicated process of classifying tumor types, where early detection can fix the problem as soon as possible. Manual diagnosis and detection pose a risk to human life. In addition, the classification of malignant tumors and gliomas is difficult due to the asymmetric or uneven boundary of the skull. For resolving the classification issues, the Dual Attention method based on the Resnet-50 with bidirectional gated recurrent unit (DA_ResBiGRU) model is proposed. Firstly, MRI images are pre-processed using Advanced Median Filter (AMF), and then the pre-processed data is transferred to the feature extraction phase. Significant features are extracted using Convolutional Neural Network (CNN), Haralick Texture Features and Speed-up Robust Features (SURF). Using the extracted features, optimized features are retrieved further by the Enhanced Fennec Fox Optimization (IFFO) algorithm. Here, brain tumor classification datasets and Figshare datasets are used for experimental analysis. Performance metrics like accuracy, F1 score, recall, precision, etc., are used to study the model performance. The proposed model achieves 98.53% accuracy, 97.7% precision, 97% recall, and 98% F1 score in brain tumor classification datasets, and 99.3% accuracy, 98.8% precision, 98.8% recall and 98.7% at F1 score are achieved in Figshare dataset. The values ​​obtained show that the proposed model overtakes other models.

TNM classification of malignant tumors: Eighth edition for retroperitoneal liposarcoma. Ways to improve.

This study was aimed at assessing the prognostic significance of the "TNM: Classification of Malignant Tumors" eighth edition (TNM8) in the most common retroperitoneal tumors - liposarcoma. The study included 192 patients with retroperitoneal liposarcoma (RLPS). The distribution of patients by stages and survival in accordance with the TNM8 were studied. In the TNM8, only the degree of malignancy of the tumor has a prognostic value. The T-category does not reflect the actual size of the RLPS and is considered as T4 in 93%, which leads to inadequate staging. During the 15-year period, there were no cases with stages II and IIIA, and the survival rate was estimated only in patients with stages I and IIIB. The tumor node metastasis (TNM) classification with new values of the T-category was proposed by us, which demonstrated a more adequate distribution of patients by stages and the reliability of intergroup differences in the survival rate. It is advisable to create a special TNM classification for RLPS, which makes up more than half of all retroperitoneal sarcomas. The TNM8 does not accurately reflect the prevalence of the tumor and the prognosis in RLPS. Revision of the T-staging is necessary to improve the accuracy of the prognosis in RLPS. The modified by us TNM classification demonstrated a more adequate distribution of patients by stages.

LOT and HOT … or not. The proliferation of clinically insignificant and poorly characterised types of renal neoplasia

The classification of malignant tumours is influenced by both immunohistochemical and molecular genetic findings. This is highlighted in the latest World Health Organization classification of renal neoplasia, which has a tumour category of 'tumours that are molecularly defined'. This implies that the defining molecular features are integral to tumourigenesis, which may not necessarily be the case. Renal oncocytoma is recognised as a benign tumour with variable morphology and immunoexpression. A variant of these tumours is hybrid oncocytic chromophobe tumour, which has features of both oncocytoma and chromophobe renal cell carcinoma and may, on rare occasions, show malignant behaviour. Recent reports have proposed two further entities with eosinophilic cytoplasm and varying nuclear pleomorphism, designated low grade oncocytic tumour (LOT) and eosinophilic vacuolated tumour (EVT), formally known as high grade oncocytic tumour (HOT). The diagnosis of these apparently benign tumours was made on the basis of morphological and immunohistochemical features. More recently it has been claimed that the mutations in the mTOR pathway are also a diagnostic feature and it is further suggested that these mutations are key to the pathogenesis of these tumours. As is seen in oncocytoma, immunohistochemical expression of tumours included in series of LOT and EVT is variable. The mutations in the mTOR pathway, where detected, were not constant, with any combination of mTOR, TSC1 and/or TSC2 being involved. A major issue is that in many of the studies full comparative genomic hybridisation results are not presented. In addition it is well recognised that mTOR mutations are seen in a variety of renal tumours. In view of these conflicting results, the rarity of these tumours and their apparent benign nature, raises questions as to why these tumours should be considered specific entities.

A case of radical resection for brain metastases of pancreatic cancer after curative chemotherapy for para-aortic lymph node metastases

BackgroundThe incidence of brain metastasis of pancreatic cancer has been reported to be approximately 0.3%. The blood–brain barrier of the central nervous system restricts the transfer of substances, including chemotherapeutic agents, from the bloodstream. It is hypothesized that brain metastasis may occur despite successful chemotherapy for the primary tumor. Herein, we report a case of brain metastases of pancreatic cancer that occurred after chemotherapy and discuss relevant literature.Case presentationA 64-year-old man underwent distal pancreatectomy with D2 lymph node dissection for resectable pancreatic tail cancer. Invasive ductal carcinoma of pancreas, pT3N2M0 pStageIII (TNM Classification of Malignant Tumors, UICC 8th edition) was diagnosed. S-1 adjuvant chemotherapy was initiated. Three months postoperatively, CA19-9 had increased to 619 U/mL. Additionally, contrast-enhanced computed tomography (CT) and fluorodeoxyglucose-positron emission tomography (FDG-PET)/CT revealed local recurrence in the para-aortic lymph nodes. Chemotherapy was revised to a combined regimen of gemcitabine and nab-paclitaxel. After 4 cycles, tumor markers were normalized. After 5 cycles, recurrence could not be identified on contrast-enhanced CT; therefore, the patient was adjudged to be in complete remission. However, after 29 cycles of chemotherapy, the patient had symptoms of raised intracranial pressure. Magnetic resonance imaging showed two metastatic lesions of 20 mm and 32 mm in the left frontal lobe and cerebellum, respectively. Quasi-emergency resection of the metastatic brain tumors was performed. Pathological examination revealed that the resected specimens originated from primary pancreatic cancer. The patient was discharged on postoperative day 12, without any complications. Postoperatively, a total of 53 Gy of local brain radiation therapy was added. On postoperative day 30, blood carcinoembryonic antigen level had decreased to 5.4 ng/dl and all other tumor markers were negative. Additionally, tumor markers of the cerebrospinal fluid were markedly reduced and the cytology was negative for tumor cells. These results suggested complete resection of the metastatic brain tumors.ConclusionsAggressive resection and salvage stereotactic radiotherapy for metastatic brain tumors may lead to complete cure and a good long-term prognosis.

Outcomes of pleurectomy decortication in patients with biphasic mesothelioma

ObjectiveThere are limited small, single-institution observational studies on the role of surgery in patients with biphasic mesothelioma. Herein we report a series of 147 consecutive patients with biphasic mesothelioma treated over 11 years in a high-volume single institution with intended pleurectomy decortication (PDC). MethodsAll patients with biphasic mesothelioma from 2007 to 2017 who underwent PDC in our institution were included and clinical, pathologic, and surgical information was retrieved. Kaplan–Meier estimators and log rank test were used to compare the overall survival, and Cox regression models were used to analyzed prognostic factors. ResultsThere were 117 men (80%), 99 right-sided operations (67%), and median age was 70 (range, 36-86) years. Neoadjuvant therapy was given to 36 (24.5%) and 108 (73.5%) received intraoperative heated chemotherapy. Macroscopic complete resection was achieved in 126 (86%). Tumors were assigned to stages IA (23; 18.8%), IB (60; 47.5%) II (15; 11.5%), IIIA (17; 13.1%), and IIIB (11; 9%) according to the eighth edition of the tumor-node-metastasis classification of malignant tumors. The 30- and 90-day mortality were 1.3% and 6.1%, respectively. The median overall survival in the macroscopic complete resection group was 16.7 months and 24 months in patients younger than 70 years. In a univariate analysis, factors that were associated with patient overall survival included age (P = .001), preoperative percentage forced expiratory volume in 1 second (P = .019), and adjuvant therapy (P < .001). No correlation was found between sex, neoadjuvant therapy, and nodal status to overall survival. ConclusionsIn selected patients with biphasic mesothelioma and good prognostic factors prolonged survival after PDC is expected.

Citric Acid as a Potential Prostate Cancer Biomarker Determined in Various Biological Samples.

Despite numerous studies, the molecular mechanism of prostate cancer development is still unknown. Recent investigations indicated that citric acid and lipids—with a special emphasis on fatty acids, steroids and hormones (ex. prolactin)—play a significant role in prostate cancer development and progression. However, citric acid is assumed to be a potential biomarker of prostate cancer, due to which, the diagnosis at an early stage of the disease could be possible. For this reason, the main goal of this study is to determine the citric acid concentration in three different matrices. To the best of our knowledge, this is the first time for citric acid to be determined in three different matrices (tissue, urine and blood). Samples were collected from patients diagnosed with prostate cancer and from a selected control group (individuals with benign prostatic hyperplasia). The analyses were performed using the rapid fluorometric test. The obtained results were correlated with both the histopathological data (the Gleason scale as well as the Classification of Malignant Tumors (pTNM) staging scale) and the biochemical data (the values of the following factors: prostate specific antigen, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglyceride, total cholesterol, creatinine and prolactin) using chemometric methods. For tissue samples, the results indicated a decreased level of citric acid in the case of prostate cancer. The analyte average concentrations in serum and urine appeared to be corresponding and superior in the positive cohort. This trend was statistically significant in the case of urinary citric acid. Moreover, a significant negative correlation was demonstrated between the concentration of citric acid and the tumor stage. A negative correlation between the total cholesterol and high-density lipoprotein and prolactin was particularly prominent in cancer cases. Conversely, a negative association between low-density lipoprotein and prolactin levels was observed solely in the control group. On the basis of the results, one may assume the influence of hormones, particularly prolactin, on the development of prostate cancer. The present research allowed us to verify the possibility of using citric acid as a potential biomarker for prostate cancer.

Classification of malignant tumors by a non-sequential recurrent ensemble of deep neural network model.

Many significant efforts have so far been made to classify malignant tumors by using various machine learning methods. Most of the studies have considered a particular tumor genre categorized according to its originating organ. This has enriched the domain-specific knowledge of malignant tumor prediction, we are devoid of an efficient model that may predict the stages of tumors irrespective of their origin. Thus, there is ample opportunity to study if a heterogeneous collection of tumor images can be classified according to their respective stages. The present research work has prepared a heterogeneous tumor dataset comprising eight different datasets from The Cancer Imaging Archives and classified them according to their respective stages, as suggested by the American Joint Committee on Cancer. The proposed model has been used for classifying 717 subjects comprising different imaging modalities and varied Tumor-Node-Metastasis stages. A new non-sequential deep hybrid model ensemble has been developed by exploiting branched and re-injected layers, followed by bidirectional recurrent layers to classify tumor images. Results have been compared with standard sequential deep learning models and notable recent studies. The training and validation accuracy along with the ROC-AUC scores have been found satisfactory over the existing models. No model or method in the literature could ever classify such a diversified mix of tumor images with such high accuracy. The proposed model may help radiologists by acting as an auxiliary decision support system and speed up the tumor diagnosis process.

Discrepancies between UICC and AJCC TNM classifications for oral cavity tumors in the 8th editions and following versions.

To underline discrepancies between the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC) Tumor-Node-Metastasis (TNM) classifications in oral cavity cancer. Comparison between the UICC and AJCC TNM classifications of oral cavity cancer in their 8th editions and following versions. The most important update was the introduction of the depth of infiltration (DOI), which reflects the proximity of the tumor to the underlying lymphovascular tissues and was associated to the presence of nodal metastases. Since the first publication of the 8th edition of the AJCC Cancer Staging Manual on March 30, 2017, two further versions have been published, while the UICC TNM classification was left unchanged until a document containing modifications to the 8th edition of the UICC TNM Classification of Malignant Tumours was published online on October 6, 2020. Different versions of the TNM classification can be confounding for the scientific community. Citing the 8th edition of the UICC TNM Classification of Malignant Tumours or the AJCC Cancer Staging Manual without specifying the precise version used for classification may be insufficient. Clinicians and researchers are invited to always refer to the latest update of each classification.

Notch Signaling Pathway in Pancreatobiliary Tumors.

Background and Objectives: The Notch signaling pathway plays an important role both in the development of the ductal systems of the pancreas and the bile ducts as well as in cancer development and progression. The aim of this study was to examine the expression of central proteins of the Notch signaling pathway in pancreatobiliary tumors and its influence on patient survival. Materials and Methods: We compared the receptors (Notch1, Notch4), activating splicing factors (ADAM17), and target genes (HES1) of the Notch pathway and progenitor cell markers with relevance for the Notch signaling pathway (CD44, MSI1) between pancreatic adenocarcinomas (PDAC, n = 14), intrahepatic cholangiocarcinoma (iCC, n = 24), and extrahepatic cholangiocarcinoma (eCC, n = 22) cholangiocarcinomas via immunohistochemistry and ImageJ software-assisted analysis. An Immunohistochemistry (IHC)-score was determined by the percentage and intensity of stained (positive) cells (scale 0–7) and normal and malignant tissue was compared. In the IHC results, patients’ (gender, age) and tumor (TNM Classification of Malignant Tumors, Union Internationale contre le Cancer (UICC) stages, grading, and lymphangitic carcinomatosa) characteristics were correlated to patient survival. Results: For eCC, the expression of CD44 (p = 0.043, IHC-score 3.94 vs. 3.54) and for iCC, the expression of CD44 (p = 0.026, IHC-score 4.04 vs. 3.48) and Notch1 (p < 0.001, IHC-score 2.87 vs. 1.78) was significantly higher in the tumor compared to non-malignant tissue. For PDAC, the expression of ADAM17 (p = 0.008, IHC-score 3.43 vs. 1.73), CD44 (p = 0.012, IHC-score 3.64 vs. 2.27), Notch1 (p = 0.012, IHC-score 2.21 vs. 0.64), and Notch4 (p = 0.008, IHC-score 2.86 vs. 0.91) was significantly higher in the tumor tissue. However, none of the analyzed Notch-signaling related components showed an association to patient survival. Conclusion: A significant overexpression of almost all studied components of the Notch signaling pathway can be found in the tumor tissue, however, without a significant influence on patient survival. Therefore, further studies are warranted to draw conclusions on Notch pathway’s relevance for patient survival.

Classification of malignant tumours in breast ultrasound using unsupervised machine learning approaches

Traditional computer-aided diagnosis (CAD) processes include feature extraction, selection, and classification. Effective feature extraction in CAD is important in improving the classification’s performance. We introduce a machine-learning method and have designed an analysis procedure of benign and malignant breast tumour classification in ultrasound (US) images without a need for a priori tumour region-selection processing, thereby decreasing clinical diagnosis efforts while maintaining high classification performance. Our dataset constituted 677 US images (benign: 312, malignant: 365). Regarding two-dimensional US images, the oriented gradient descriptors’ histogram pyramid was extracted and utilised to obtain feature vectors. The correlation-based feature selection method was used to evaluate and select significant feature sets for further classification. Sequential minimal optimisation—combining local weight learning—was utilised for classification and performance enhancement. The image dataset’s classification performance showed an 81.64% sensitivity and 87.76% specificity for malignant images (area under the curve = 0.847). The positive and negative predictive values were 84.1 and 85.8%, respectively. Here, a new workflow, utilising machine learning to recognise malignant US images was proposed. Comparison of physician diagnoses and the automatic classifications made using machine learning yielded similar outcomes. This indicates the potential applicability of machine learning in clinical diagnoses.

Classification of malignant tumors in breast ultrasound using a pretrained deep residual network model and support vector machine

In this study, a transfer learning method was utilized to recognize and classify benign and malignant breast tumors, using two-dimensional breast ultrasound (US) images, to decrease the effort expended by physicians and improve the quality of clinical diagnosis. The pretrained deep residual network model was utilized for image feature extraction from the convolutional layer of the trained network; whereas, the linear support vector machine (SVM), with a sequential minimal optimization solver, was used to classify the extracted feature. We used an image dataset with 2099 unlabeled two-dimensional breast US images, collected from 543 patients (benign: 302, malignant: 241). The classification performance yielded a sensitivity of 94.34 % and a specificity of 93.22 % for malignant images (Area under curve = 0.938). The positive and negative predictive values were 92.6 and 94.8, respectively. A comparison between the diagnosis made by the physician and the automated classification by a trained classifier, showed that the latter had significantly better outcomes. This indicates the potential applicability of the proposed approach that incorporates both the pretrained deep learning network and a well-trained classifier, to improve the quality and efficacy of clinical diagnosis.

An endoscopic dilation method using the rendezvous approach for the treatment of severe anastomotic stenosis after rectal cancer surgery: a case report

BackgroundPostoperative anastomotic stenosis is a common complication in colorectal cancer patients (3–30%). Complete anastomotic stenosis is rare; however, when it occurs, almost all cases require surgical treatment. We herein report a case in which endoscopic dilation was effective for treating complete anastomotic stenosis after high anterior resection in a rectal cancer patient.Case presentationThe patient was a 67-year-old man who underwent laparoscopic high anterior resection for rectal cancer (RS, T4a, N0, M0, Stage IIB (TNM Classification of Malignant Tumors)) in May 2018. The postoperative course was good and the patient was discharged on the 12th postoperative day. Subsequently adjuvant chemotherapy was initiated with oral uracil and tegafur plus leucovorin (UFT/LV); however, he complained of frequent defecation and melena after completion of the first course of chemotherapy. Thus, colonoscopy was performed, which revealed anastomotic stenosis. Endoscopic dilation was initially attempted, but failed. Thus, low anterior resection was performed with diverting colostomy. Four additional courses of chemotherapy were administered for 1 month after surgery. At 6 months after the second surgery, colonoscopy was performed, and complete anastomotic stenosis was pointed out again. The patient was successfully treated by endoscopic dilation using the rendezvous method. After this treatment, the lumen of the anastomotic site was observed to have narrowed again and endoscopic dilatation to treat anastomotic stenosis was repeated. In addition, he received local injection of steroids in anastomotic stenosis site. The lumen of anastomotic stenosis remained after the local injection of steroids and closure of colostomy was performed 9 months after the second operation.ConclusionsEndoscopic dilation using the rendezvous method was effective for treating anastomotic stenosis after colorectal surgery.

Reduction of Serum Concentrations and Synergy between Retinol, β-Carotene, and Zinc According to Cancer Staging and Different Treatment Modalities Prior to Radiation Therapy in Women with Breast Cancer

The procedures used for breast cancer treatment are able to increase the level of oxidative stress and cause depletion of antioxidants. Objectives: To investigate the relationship between serum concentrations of retinol, β-carotene, and zinc, according to breast cancer staging, considering different treatment modalities prior to radiation therapy and the synergistic action between these micronutrients. Methods: This is a cross-sectional observational study comprising a cohort of patients with breast cancer which was carried out prior to radiation therapy. Patients were divided into 3 groups: G1 comprised women who had undergone breast-conserving surgery, G2 comprised those who had undergone chemotherapy, and G3 those who had undergone breast-conserving surgery and chemotherapy. Serum concentrations of retinol, β-carotene, and zinc were quantified. Breast cancer staging was based on the TNM (Tumor, Node, Metastasis) classification of malignant tumors, a type of staging tool for different cancers. Results: A total of 230 patients were assessed. A decrease of the serum concentrations of the micronutrients assessed as the staging level of the disease increased was observed. Surgery alone had a greater negative impact on serum concentrations of retinol. Considering the treatments prior to radiotherapy, patients undergoing surgery alone and chemotherapy associated with surgery had higher percentages of deficiency of β-carotene and retinol. There was a positive correlation between the concentrations of zinc, retinol, and β-carotene, showing a synergy between these micronutrients. Conclusion: A significant reduction in the serum concentrations of the assessed micronutrients was observed, according to the increase in breast cancer staging. The synergy between the micronutrients must be considered in order to maximize the benefits and minimize the adverse effects of irradiation to normal cells.

Abstract 3153: Prostatic acid phosphatase (PAP) predictive effect for prostate cancer in a population-based study: The renewal of PAP

Abstract Objective: Use prostatic specific acid phosphatase (PAP) to characterize the disease progression and median survivals of patients with prostate cancer (PCa) based on the analysis in a population-based study from Surveillance, Epidemiology, and End Results (SEER) database. Materials and Methods: PCa patients with completed PAP results were selected from the SEER database of the National Cancer Institute. Mann-Whitney Sum test was utilized to compare the statistical significance for measurement data and ranked data, which were stratified by age, race, TNM Classification of Malignant Tumors (TNM), pathological grades, number of tumors, PAP and survival duration. Logistic analysis was performed to identify predictors of the presence of invasion and metastases. Cox regression was utilized to analyze the factors associated with all-cause mortality and prostate-cancer specific mortality. Moreover, survival curve was also present. Results: In total, there are 5184 PAP+ patients and 3161 PAP- patients involved in this study. The Mann-Whitney Sum test showed that slightly greater tumor size(p=0.03), elevated lymphatic (p=0.005) and distant (p&amp;lt;0.001) metastases rate, higher pathologic grade(p&amp;lt;0.001), localized tumor number (p&amp;lt;0.001), shortened survival months (p&amp;lt;0.001) were observed in the PAP+ group compared with the PAP- group. In the Multivariable Logistic Regression, invasion and metastases Hazard Ratio (HR) were elevated significantly (p&amp;lt;0.001) in the PAP+ individuals. In the survival analysis, PAP- patients experience the prolonged median survival. In the post-surgical patients, the survival months were still longer in PAP+ patients compared with the negative ones (p&amp;lt;0.001), though surgery prolonged the survival months of both groups. Survival months stratified by localized, invasion and metastases situations were analyzed. In the three stratified sub-groups, survival duration is significantly decreased in the PAP+ individuals in the localized PCa group (P&amp;lt;0.001**) and the metastases group (P=0.013). Conclusions: The findings of this study provide population-based estimates of the PCa progress and prognosis for patients with different PAP results, which may suggest a renewed period for the PAP. Citation Format: Fubo Wang, Huan Xu, Yinghao Sun. Prostatic acid phosphatase (PAP) predictive effect for prostate cancer in a population-based study: The renewal of PAP [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3153.

A LINK BETWEEN AUTOPHAGY REGULATORY PROTEINS M-TOR AND BECLIN-1 AND PARAMETERS OF LYMPHOGENIC METASTASIS IN COLORECTAL CANCER

Currently the impact of autophagy on carcinogenesis remains understudied. On the one hand, autophagy acts as a tumor suppressor, as it activates degradation of oncoproteins, toxic proteins, and damaged cell organelles, that may be aggressive and lead to DNA damage. On the other hand, autophagy may promote tumor cell survival under hypoxia and in the presence of reactive oxygen species, which occurs primarily due to blocking of apoptosis mechanisms, raising the chances for maintaining tumor clone dynamics. Autophagy regulation is a complicated and multi-stage process. The main regulator here is a signaling pathway that activates serine/threonine protein kinase m-TOR (the mammalian target of rapamycin). Data on the impact of autophagic proteins ATG5, LC3A, LC3B, and Beclin-1 on malignant cell survival as well as on tumor growth and progression have been reported in literature. However, studies aimed at seeking possible relationships between autophagy and pathogenetic mechanisms of carcinogenesis are of great interest.Theaimof the study is to investigate a relationship between the expression parameters of autophagy regulatory proteins m-TOR and Beclin-1 and the features of lymphogenic metastasis in colorectal cancer.Materials and methods. The study included 105 patients with T1-4N0-3M0 colorectal cancer treated in the Thoracic and Abdominal Department of Cancer Research Institute of Tomsk Research Medical Center from 2012 to 2015. The average age of patients was 59.7±4.3 years. Morphological verification of the diagnosis was performed on the biopsy samples of primary tumor tissue. Staging of colorectal cancer was determined according to the TNM classification of malignant tumors (2002).Results.Analysis of the frequency of lymphogenic metastasis depending on the presence or absence of m-Tor and Beclin-1 expression in tumor cell cytoplasm revealed a statistically significant link between these variables.Conclusion.The obtained findings clearly exhibit that deceleration or loss of autophagic activity in the tumor is accompanied by implementation of lymphogenic dissemination, which is a predictor of an unfavorable outcome of the disease.