Clinical Oncology Department Research Articles

Assessment of Quality of Life of Cancer Survivors in Tertiary Care Hospital at Karachi

Background: Cancer is the driving source of deaths and this mortality is quickly expanding day by day. Individuals with tumor experience physical and psychological complications such as anxiety, depression, and emotional distress, which have undesirable impacts on patients’ quality of life. Objectives: This study aimed to observe the quality of life of cancer survivors. Methods: This descriptive cross-sectional study was conducted from 25 February to 25th April 2022 by using a consecutive sampling technique. Data were collected by using the FACT-G questionnaire on 320 admitted and OPD cancer survivors in the Department of Clinical Oncology, JPMC. Data were analyzed through SPSS. Descriptive statistics and the Mann-Whitney test was run for demographic variables with two categories and the Kruskal-Wallis test for a variable with more than two categories. Results: Findings of this study showed that most of the study participants (60.9%) were male and married (73.4%). Most were in the age group of 18-30 years (47.5%) Majority of participants were suffering from terminal stages of liquid and solid cancer and on chemo-radiotherapy. Qualification was significantly associated with all four domains. The FWB, SWB, and PWB had a significant association with gender. The residence and cancer stages were associated with the SWB domain and overall FACT-G. The employment status was significantly associated with SWB, PWB, EWB, and FACT-G scores. Conclusion: The quality of life of cancer survivors was influenced by qualification, gender, residence, cancer stage, and employment status. It is essential to initiate suitable programs for cancer patients to enhance their quality of life.

Analysis of the efficacy and tolerability of FOLFIRINOX chemotherapy treatment in patients over 65 years of age with diagnosis of advanced adenocarcinoma of the pancreas.

Systemic treatment of pancreatic adenocarcinoma in the population of people over 65 years old is a challenge resulting from both the extremely unfavourable prognosis of this cancer and the particularly high sensitivity to the toxicity of chemotherapy in the elderly. This article presents the effectiveness and side effects of first-line chemotherapy according to the FOLFIRINOX regimen in patients over 65 years of age diagnosed with advanced pancreatic adenocarcinoma. The analysis was conducted in a group of 43 patients diagnosed with locally advanced inoperable pancreatic cancer or metastatic pancreatic cancer. Patients were treated between 2017 and 2021 in the Clinical Oncology Department, University Clinical Centre, Katowice, Poland. In the study group, the median overall survival was 9.8 months; the median progression-free survival was 8.8 months. Treatment toxicity occurred in all patients. Adverse events of G3 and G4 severity (common terminology criteria for adverse events 5.0) occurred in 8% of patients. In 2 patients (5%), chemotherapy toxicity was the reason for discontinuation of systemic treatment. Triple-drug chemotherapy in a group of patients aged over 65 years with a diagnosis of advanced pancreatic cancer shows similar effectiveness to the general treated population, and with proper medical supervision the severity of side effects is at an acceptable level.

Clinical and Prognostic Significance of PD-L1, Beclin 1 and Fascin 1 Immunohistochemical Expression in Colorectal Carcinoma

Introduction: Colorectal Cancer (CRC) is a leading cause of death worldwide, and its incidence has been rising. It is important to identify novel markers that could predict the prognosis of the disease. Aim: To identify the impact of Programmed cell death-ligand 1 (PD-L1), Beclin 1, and Fascin 1 immunohistochemical expression on CRC behaviour and disease prognosis. Also, to assess the different surgical options (laparoscopic versus open) in the management of these patients. Materials and Methods: This cohort study included 72 cases of CRC, conducted in the Pathology, General Surgery, Internal Medicine, Clinical Oncology, and Medical Oncology Departments of the Faculty of Medicine, Zagazig University Hospitals, Egypt between June 2018 and June 2022. PD-L1, Beclin 1, and Fascin 1 expression were assessed immunohistochemically, and their prognostic significance were evaluated. Data were analysed using IBM Statistical Package for the Social Sciences (SPSS) 23.0 for Windows (SPSS Inc., Chicago, IL, USA) and NCSS 11 for Windows (NCSS LCC., Kaysville, UT, USA) in the Community Medicine Department, Faculty of Medicine, Zagazig University, Egypt. Results: A significant association was found between PDL1 expression and grading (p-value=0.02), lymphovascular invasion, distant metastasis (p-value=0.001), peritoneal spread (p-value=0.002), tumour budding (p-value=0.005), lymph node metastasis, and American Joint Committee on Cancer (AJCC) stage (p-value<0.001). A significant association was also found between Beclin 1 expression and distant metastasis (p-value=0.001), lymphovascular invasion (p-value=0.004), lymphocytic infiltration (p-value=0.006), perineural invasion (p-value=0.01), peritoneal spread (p-value=0.002), and AJCC stage (p-value=0.007). A highly significant association between Fascin 1 expression and grading, lymphovascular invasion, tumour budding, lymph node metastasis, lymphocytic infiltration, perineural invasion, metastasis, peritoneal spread, and AJCC stage (p-value<0.001) was detected. In patients with negative PD-L1 or high Fascin 1 expression, survival rates were lower. Beclin 1 expression was not associated with a favourable prognosis (p-value>0.05). Conclusion: PD-L1, Beclin 1, and Fascin 1 expression are significantly elevated in CRC tissues and closely associated with adverse prognostic factors. PD-L1 and Fascin 1 expression have important prognostic value and may be of great help in identifying high-risk patients who will benefit the most from treatment.

Concomitant Chemo-Radiotherapy with Oral Capecitabine in Locally Advanced Squamous Cell Carcinoma Cervix

Background: Cervical carcinoma is the fourth most common malignant neoplasm after carcinoma of the breast, lung, colorectal, endometrium and ovary. Aim: To assess the all RECIST responses of concomitant chemo-radiotherapy with capecitabine in locally advanced squamous cell carcinoma cervix in a tertiary healthcare facility at Multan. Methodology: It was a Descriptive case series Conducted at the Department of Clinical Oncology, Nishtar Hospital Multan. Patients (n=60) with locally advanced squamous cell carcinoma cervix received conventional radiation (Total Dose: 45Gy) with 825 mg/m2 twice daily Capecitabine for five days a week for 6 weeks and followed by brachytherapy. Data was evaluated by using SPSS version 23. Post stratification Chi-square test was applied with P-value of 0.05 was considered as significant. Results: Mean age of patient population was 39.5±6.8 (range: 31-52) years. Majority i.e. 30(50%) were between 30 to 40 years of age. The overall response rate was 88%, complete Response Rate was 80%, Partial Response rate was 8.3%, Stable Disease lasting ≥6 months was 5%, Progressive Disease was 6.7% in 60 patients at the end of treatment. Commonly observed performance status was ECOG 0 (n=57, 95.0%) while most of the patients had stage IIB at presentation (n= 35, 58.3%). Practical Implication: Current project helped health providers to evaluate response rate to cervical carcinoma treatment to oral capeccitabine. With other chemo-drugs like Cisplatin, renal toxicity developed even with single low dose as elderly patients are more susceptible. Because renal toxicity of oral capecitabine was low as compared to cisplatin thus it was more effective than cisplatin. Due to low local data regarding oral capecitabine in cervical carcinoma as treatment option so planned present study. Conclusion: It was concluded that patients of cervical carcinoma showed better response rate to concomitant chemo-radiation using Capecitabine with low renal toxicity. Keywords: Cervical Cancer, Oral Capecitabine, Concurrent Chemo-Radiation and Brachytherapy.

Approach to Radical Hysterectomy for Cervical Cancer in Pregnancy: Surgical Pathway and Ethical Considerations.

Cervical cancer is currently the fourth most common cancer in women and in the poorest countries this neoplasia still represents a widespread and potentially lethal disease. We present a rare case of cervical cancer in pregnancy, analyzing the historical changes behind the procedure of radical hysterectomy for cervical cancer and discussing variations in surgical techniques and anatomical definitions that have since been proposed. We present the case of a 33-year-old patient who attended with vaginal bleeding in the second trimester of pregnancy. Examination revealed an abnormal looking cervix, with investigations concluding stage IIb squamous cell carcinoma. Following extensive discussion regarding management options, the patient went on to have a peripartum foetocidal type III nerve sparing radical Wertheim hysterectomy at 18 weeks gestation with conservation and transposition of the ovaries above the level of the pelvic brim. The patient recovered well without significant morbidity and received further input from fertility and psychological medical teams in addition to adjuvant treatment within the department of clinical oncology. This case represents several elements of great interest and learning. Notably, we highlight this both due to the surgical challenges that a gravid uterus presents in the execution of a radical hysterectomy; and regarding the compassionate care demonstrated by the team - not only in supporting the patient and her partner in a period of profound turmoil in terms of the management of their cancer diagnosis and unborn child, but also regarding the uncertainty in consideration of the oncological and fertility related outcomes. This manuscript adds to the growing literature on the appropriate use of radical surgery for cervical cancer, more specifically during pregnancy and in consideration of such ethical dilemma, where management guidelines do not exist to aid clinicians further in their provision of treatment.

Analysis and treatment results of spinal Metastases; ten years experience of Alexandria clinical oncology department

Analysis and treatment results of spinal Metastases; ten years experience of Alexandria clinical oncology department

Impact of COVID-19 pandemic on therapy in cancer patients

Introduction and purpose: The Covid-19 pandemic has spread rapidly across the globe, resulting in more than 6 million deaths worldwide. Oncological patients are considered to be at increased risk of SARS-CoV-2 coronavirus infection and the severe course of the disease. The current understanding of the correlation between COVID-19 and cancer is limited. In this study, we attempted to analyze the course of SARS-CoV-2 infection in cancer patients who were treated at the Department of Clinical Oncology and Chemotherapy SPSK4 in Lublin in the period from November 2020 to March 2022. 
 Material and methods: This retrospective study included patients in the age rage from 36–79 years old. All necessary information were obtained from electronic medical records. Subsequently collected data were submitted to statistical calculations. 
 Results: A varied course of COVID-19 infection in oncology patients has been observed. Preliminary observations showed that, in many cases COVID-19 infection caused a delay in the administration of the next dose of a therapeutic agent during the course of systemic anticancer treatment, but this delay was not observed to have a significant impact on reducing the effectiveness of oncology treatment 
 Conclusions: In the light of our own presented observations, global statistics and reports of other authors, the role of certain individual characteristics of patients is visible, which increase the risk of more severe course of SARS-CoV-2 infection and / or increased mortality . It is necessary to continue the search for an optimal diagnostic regimen that would identify cancer patients with a particular risk of the most severe complications of SARS-CoV-2 infection.

Sleep pattern changes in patients with lung cancer

Background: There are multiple connections between sleep and lung cancer. Both of them impacting each other lung cancer can make it difficult to sleep well due to symptoms and treatment side effects( 20-70% of cancer patients suffer of insomnia) .Also there is possible relationship between lung cancer and nocturnal intermittent hypoxia, apnea and daytime sleepiness, progression of lung cancer considered as risk factor of obstructive sleep apnea severity. Aim of the work: to evaluate sleep pattern changes in patients with lung cancer. Patients and methods: 26 patients with non small cell lung cancer were interviewed for assessment of histopathological subtypes and stages according to TNM classification and treated at Department of Clinical Oncology and Nuclear Medicine (chemotherapy, radiotherapy, targeted therapy and surgical treatment were scheduled), they underwent to sleep questionnaire and Epworth Sleepiness Score (ESS).overnight full polysomnography was done.

Malnutrition among Cancer Patients in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Malnutrition is one of the most frequent disorders among cancer patients. It is seen in 50-90% of cancer patients. This high prevalence of malnutrition is very concerning as it is associated with reduced effective treatment, functional status, quality of life and survival. The aim of the study was to find out the prevalence of malnutrition among cancer patients in a tertiary care centre. A descriptive cross-sectional study was conducted among 95 cancer patients in the Department of Clinical Oncology of a tertiary care centre from 25 January 2022 to 25 July 2022. Ethical approval was obtained from the Institutional Review Committee (Reference number: 1192/2078/79). Convenience sampling was done. Patients were screened using Patient-Generated Subjective Global Assessment for malnutrition. Point estimate and 95% Confidence Interval were calculated. Among 95 cancer patients, 22 (23.15%) (15.10-32.90, 95% Confidence Interval) were malnourished. The prevalence of malnutrition was found to be lower than in other studies done in similar settings. Nutritional assessment and support should be an integral part of care for gastrointestinal cancer. malnourishment; nutritional deficiency; screening.

Patients’ experiences of the COVID-19 pandemic and the change to telephone consultations in cancer care

PurposeDuring the COVID-19 pandemic, teleconsultations have increasingly been used to reduce physical contact and thus risk of infection. This study investigated how patients with cancer experienced the COVID-19 pandemic and how they perceived the change from in-person consultations to telephone consultations in an oncology outpatient clinic. The aim was to provide insights that could optimize the future use of teleconsultations in cancer care.MethodsThis qualitative study included 15 patients with colorectal, breast, gynecological, lung, or prostate cancer treated at the outpatient clinic at the Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Denmark in June or July 2020. Data were collected through semi-structured individual interviews and analyzed by thematic analysis.ResultsPatients with cancer experienced social, psychological, and organizational consequences of the COVID-19 pandemic related to their cancer care. Not all patients were comfortable with telephone consultations. Six themes were identified: (1) double burden as a consequence of simultaneous cancer and the COVID-19 pandemic, (2) parameters for patient satisfaction with telephone consultations, (3) the importance of relatives attending consultations, (4) loss of information and nuances during telephone consultations, (5) the impact of physicians’ language and communicative skills during telephone consultations, and (6) patients’ suggestions for future telephone consultations.ConclusionBeyond the COVID-19 pandemic, it is important that hospitals offering teleconsultations involve patients’ preferences, consider for which patients and consultations the solution is suitable, which technology to use, how to prepare patients and relatives, and how to provide physicians with the necessary communicative skills.

Induction chemotherapy followed by concurrent chemoradiation versus concurrent chemoradiation alone for locally advanced laryngeal & nasopharyngeal cancers: A retrospective study

Background: One of the most common cancers all over the world is Head and Neck cancers, with higher mortality rates among developing countries. Squamous cell carcinomas (SCCs) represent more than 90%. SCCs arise commonly from the mucosal lining of the upper aerodigestive tract.Objective: To Compare between Concurrent Chemoradiation following Neoadjuvant Chemotherapy versus Concurrent Chemoradiation alone in Locally Advanced Larynx & Nasopharynx Cancer (stage III or IVA,B) regarding efficacy, toxicity, progression free survival, disease free survival and organ preservation (in laryngeal cancer).Methods: A Retrospective study was conducted to Compare between Concurrent Chemoradiation following Neoadjuvant Chemotherapy versus Concurrent Chemoradiation alone in Locally Advanced Larynx & Nasopharynx Cancer (stage III or IVA,B) in the Clinical Oncology Department, Suez Canal University Hospital, Ismailia, Egypt between 1/2017 & 12/2018, with follow up 2 years (from 1/2019 to 12/2020).Results: Results of our study show a statistic significance in progression free survival in Concurrent chemoradiation following neoadjuvant chemotherapy compared with concurrent chemoradiation alone.Conclusions: Neoadjuvant chemotherapy by TPF or PF is a wise choice in the locally advanced squamous cell carcinoma of the nasopharynx and larynx (non-metastatic cases). Better results were detected in radiological assessment post radiation therapy in laryngeal cancer cases and progression free survival in both treatment groups.

Incidence of Sleep Bruxism in Different Phenotypes of Obstructive Sleep Apnea.

(1) Background: Sleep bruxism (SB) is a common sleep behavior. Obstructive sleep apnea (OSA) is a prevalent sleep-related breathing disorder with potential long-term major neurocognitive and cardiovascular sequelae. Although the co-occurrence of SB and OSA has been described previously, the exact relationship remains unclear. The present study aimed to evaluate the incidence of SB in different phenotypes of OSA. (2) Methods: The participants of this study were adult patients referred to the Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology at the Wroclaw Medical University. They underwent a single-night video polysomnography in a sleep laboratory. The data related to common OSA phenotypes were analyzed in two separate groups of patients: body position related (n = 94) and rapid eye movement (REM) related (n = 85). (3) Results: The obtained results showed that the incidence of SB and severe SB was higher for body position-related OSA phenotype (p < 0.05 for all comparisons). No statistically significant differences were observed for REM-related OSA phenotype (p > 0.05 for all comparisons). (4) Conclusions: Body position-related OSA phenotype seems to be associated with higher SB and severe SB incidence, but the relationship is not independent. However, in the light of the unclear relationship between SB and sleep-disordered breathing, the topic needs further study.

Clinical observations of generalized and inoperable locally advanced forms of basal cell carcinoma

Background. Basal cell carcinoma (BCC) occupies around 80% of all the cases of diagnosed skin cancer (according to American Cancer Society). In various countries of the world the morbidity rate of BCC differs due to the main predisposing factor of BCC development – ultraviolet radiation. In Ukraine, according to National Cancer Registry, 15882 new cases of non-melanoma skin cancer were registered in 2019–2020. Standardized morbidity rate of this pathology increased by 2,6% compared to 2018. Basal cell cancer commonly recurs (according to different experts, the rate varies from 10% to 80%), at the same time, distant metastases are diagnosed quite rarely. Understanding contribution of Hedgehog (Hh) signaling pathway to carcinogenesis of BCC has become a serious achievement in molecular biology. In spite of relatively benign course of BCC and variety of treatment methods of this disease, there is a high risk of recurrence, and in some patients, lesions may progress to such extent that they become unsuitable for local therapy which makes it urgent to search for alternatives to surgery and radiation therapy.&#x0D; Purpose – to study the peculiarities of course, treatment, development of complications of recurrent, locally advanced, metastatic inoperable BCC by the example of clinical cases. Materials and methods. Clinical observation of female patient K., 73 years old, who was undergoing treatment in the Department of Clinical Oncology and Hematology by reason of multiple BCC lesions (observation time 14 years) and female patient D., 42 years old, who was undergoing treatment in the Department of Radiation Pathology and Palliative Care by reason of aggressive course of locally advanced form of basalioma (observation time 29 years). Observation and treatment were performed in the State Organization «Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine».&#x0D; Results. The clinical cases of observation and different stages of treatment of patients with constantly recurring aggressive BCC over a long period of time, 14 and 29 years, are demonstrated. Metastasing of BCC is confirmed in both cases, local advancement is shown, various methods of treatment were used: surgery, radiation therapy, cryodestruction, chemotherapy. Difficulty of patients' management is shown, especially when all available methods are used up. Treatment of complications of special therapy methods, multistage restoring plastic surgeries using different methods of plastic repair are described.&#x0D; Conclusions. Treating recurrent, metastatic, and locally advanced inoperable forms of BCC when one runs out of possibilities of the main treatment methods – surgery, radiation therapy, chemotherapy is a difficult task which requires further development of modern technology and treatment methods.

Prevention of Adjuvant Treatment Induced Cardiotoxicity in Egyptian Breast Cancer (BC) Patients: A Randomized Prospective Study

Background: Adjuvant Anthracyclines Chemotherapy (ANTC) and trastuzumab have been documented to prolong survival in patients with breast cancer (BC). However, these drugs are also well known to induce left ventricular systolic dysfunction (LVSD). Multiple studies have shown that angiotensin converting enzyme inhibitors (ACEIs) and beta blockers (BBs) can prevent LVSD among women with BC.&#x0D; Objectives: We aimed to prospectively evaluate the efficacy of enalapril (ACEI) and carvedilol (BB) in preventing the ANTC ± trastuzumab induced LVSD, in patients with non-metastatic BC.&#x0D; Patients and Methods: We randomized 126 patients with non-metastatic (M0) BC, who were scheduled to be treated with ANTC ± trastuzumab into the intervention group (group 1; n = 63), which received enalapril and carvedilol or the control group (group 2; n = 63), which did not receive enalapril or carvedilol. To evaluate left ventricular (LV) systolic and diastolic functions the conventional echocardiography (ECHO) and cardiac magnetic resonance imaging (CMR) were performed at baseline, after 3 therapy cycles, and at 1-year follow-up. The secondary endpoint was designed to detect the incidence of a decrease in left ventricular ejection fraction (LVEF) ≥ 10%, heart failure (HF), LVSD (defined as LVEF&lt;45%) or deterioration in LV diastolic function.&#x0D; Results: In the intervention group, 58 patients had 3 cycles ANTC, 6 patients received 6 cycles ANTC, and 12 patients received trastuzumab. In the control group, 47 patients had 3 cycles ANTC, 16 patients were given 6 cycles ANTC and 18 patients received trastuzumab (as per the guidelines issued by breast clinic in the department of clinical oncology, faculty of medicine, Ain Shams University) for adjuvant and neoadjuvant chemotherapy in early breast cancer).&#x0D; After 3 ANTC cycles, LVEF did not change in the intervention group, but decreased by M-mode in the control group (p-value: 0.03), which was associated with statistically significant deterioration of LV diastolic function. At 1 year follow-up, while no change was observed in LVEF in group 1, there was a decrease in LVEF by CMR in group 2 (65.78% at baseline, 61.48% at 1 year; p-value: 0.04 8).&#x0D; Conclusion: Combined prophylaxis with enalapril and carvedilol may prevent LVSD in patients with non-metastatic BC treated with anthracycline-containing chemotherapy ± trastuzumab. However, the clinical relevance of this strategy should be confirmed in the future, large-scale randomized studies.

The Supportive Care Needs of Breast Cancer Patients and Its Related Factors: A Cross-sectional Study

Background: Planning cancer supportive care programs require assessing patients’ supportive needs. Objectives: This study aimed to investigate breast cancer patients’ supportive care needs and their related factors. Methods: This cross-sectional study was conducted this Zahedan, Iran, in 2020. Patients with breast cancer, who referred to the clinical oncology departments of Khatam-Al-Anbia hospital and Ali ibn Abi Talib hospital were selected by the census method. Standard questionnaires were distributed among the participants to obtain information and analyze data in SPSS software version 19.0. Results: This study examined 120 breast cancer patients with a mean age of 47.35 (SD 10.67) years. The patients’ highest and lowest need for help were related to health system/information (63.23 ± 20.80) and sexual needs (6.73 ± 19.66). Spearman’s correlation coefficient analysis indicated that social support and illness adjustment negatively correlated with many supportive care domains. Conclusions: Supportive care services, especially in the information and psychology domain, are needed for breast cancer patients in Zahedan, Iran. Patients can benefit from social support and positive coping strategies to help them cope with their disease.

Analysis of Selected Nutritional Parameters in Patients with HPV-Related and Non-HPV-Related Oropharyngeal Cancer before and after Radiotherapy Alone or Combined with Chemotherapy.

Simple SummaryThe aim of this study was to assess and compare the nutritional status (NS) of patients with HPV-related (HPV+) and non-HPV-related (HPV-) oropharyngeal cancer (OPC) before and after radiotherapy (RT) or chemoradiotherapy (CRT). The analysis included 127 patients with OPC who underwent radiotherapy (RT) alone, or in combination with chemotherapy (CRT). In both groups, a significant decrease in all analyzed nutritional parameters was noted after RT/CRT. Overall survival (OS) and disease-free survival (DFS) were significantly better in patients with a higher BMI in the HPV- group; DFS was significantly better in patients with total lymphocyte count (TLC) >1.28/mm3 in the HPV+ group. Higher NRS 2002 was an independent adverse prognostic factor for OS and DFS in HPV-, but not in the HPV+ group. Regardless of HPV status, patients with OPC can develop malnutrition during RT/CRT. Therefore, nutritional support during RT/CRT is required in patients with HPV- and HPV+ OPC.Background: Radiotherapy plays an essential role in the treatment of oropharyngeal carcinoma (OPC). The aim of this study was to assess and compare the nutritional status (NS) of patients with HPV-related (HPV+) and non-HPV-related (HPV-) OPC before and after radiotherapy (RT) or chemoradiotherapy (CRT). Methods: The analysis included 127 patients with OPC who underwent radiotherapy (RT) alone, or in combination with chemotherapy (CRT), in the I Radiation and Clinical Oncology Department of Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Poland. Patients were divided according to HPV status. Confirmation of HPV etiology was obtained from FFPE (formalin-fixed, paraffin-embedded) tissue material and/or extracellular circulating HPV DNA. Basic anthropometric and biochemical parameters before and after RT/CRT were compared between the HPV- and HPV+ groups. The effect of NS on survival was also analyzed. Results: In both groups, a significant decrease in all analyzed nutritional parameters was noted after RT/CRT (p < 0.01). CRT caused significant weight loss and decreases in BMI, albumin, total lymphocyte count (TLC), and hemoglobin concentration, as well as an increase in the Nutritional Risk Score (NRS) 2002, in HPV- and HPV+ patients. A significant decrease in prealbumin levels after CRT was noted only in HPV+ patients. RT caused a significant decrease in hemoglobin concentration and TLC in HPV- patients. There were no significant differences regarding other nutritional parameters after RT in either group. RT did not have negative impact on body mass index (BMI), weight, NRS, CRP, Alb, Prealb, or PNI. Overall survival (OS) and disease-free survival (DFS) were significantly better in patients with a higher BMI in the HPV- group (OS, p = 0.011; DFS, p = 0.028); DFS was significantly better in patients with C-reactive protein (CRP) < 3.5 g/dL in the HPV- (p = 0.021) and HPV+ (p = 0.018) groups, and with total lymphocyte count (TLC) >1.28/mm3 in the HPV+ group (p = 0.014). Higher NRS 2002 was an independent adverse prognostic factor for OS and DFS in HPV-, but not in the HPV+ group. Kaplan–Meier analysis showed that both OS and DFS were significantly better in HPV- patients with lower NRS 2002 scores. However, this relationship was not observed in the HPV+ group. Conclusions: Regardless of HPV status, patients with OPC can develop malnutrition during RT/CRT. Therefore, nutritional support during RT/CRT is required in patients with HPV- and HPV+ OPC.

Correlation between Neutrophil-to-Lymphocyte Ratio and Pretreatment Magnetic Resonance Imaging and Their Predictive Significance in Cervical Carcinoma Patients Referred for Radiotherapy.

Objective The aim of this study was to determine the correlation between neutrophil-to-lymphocyte ratio (NLR) and various tumor parameters assessed by pretreatment magnetic resonance imaging (MRI) and to evaluate their prognostic significance for cervical carcinoma treated with radiotherapy (RT). Methods The study enrolled 78 patients with biopsy-proven squamous cell carcinoma (SCC) of primary cervical cancer (clinically staged IB2 to IVA) who were treated in the Department of Clinical Oncology of the University of Hong Kong-Shenzhen Hospital between August 2015 and May 2019. A retrospective analysis of patients with SCC was performed. Firstly, we investigated the correlations between NLR and MRI parameters. Then, univariate and multivariate analyses were performed to identify the prognostic factors for overall survival (OS) and progression-free survival (PFS). Kaplan–Meier curves were constructed for OS and PFS. Results Higher NLR showed significant association with larger tumor diameter and parametrial invasion assessed by pretreatment MRI. Univariate analysis indicated that uterine body invasion, parametrial invasion, and NLR were associated with prognosis of cervical cancer. Multivariable analyses demonstrated that parametrial invasion and NLR higher than the cutoff were independently associated with shorter OS and PFS, whereas uterine body invasion showed a significantly unfavorable influence on OS but showed no significant effect on PFS. Using the three risk factors of NLR above cutoff, parametrial invasion, and uterine body invasion, patients were divided into three subgroups. The three-year OS rates of patients with zero risk factors, one risk factor, and two or three of these factors were 96%, 91%, and 42%, respectively (P < 0.001), showing a downward trend. Conclusions Uterine body invasion, parametrial invasion, and NLR were significant prognostic factors for patients with cervical carcinoma treated with RT. These results may supplement FIGO staging to improve prognostic assessment of patients.

Outcome of Patients With Head and Neck Squamous Cell Carcinoma Can be Predicted by Expression of eIF4E and Osteopontin in Free Surgical Margins.

Squamous cell carcinoma of the head and neck (HNSCC) is recognized as the third most common cause of death. Incomplete resection of the primary tumor is the main cause of local recurrence and poor prognosis in HNSCC. Histologic assessment in order to determine "tumor-free" margins could be inadequate because of malignant transformation occurs at the molecular level earlier than the morphologic level. The present study aimed to evaluate the prognostic significance of eukaryotic initiation factor 4E (eIF4E) and Osteopontin in the tumor cells and histologically tumor free surgical margins of HNSCC. This cohort study was performed on 60 cases of HNSCC diagnosed at the Department of Pathology and treated at the Clinical Oncology Department, Faculty of Medicine, Zagazig University. Our enrolled formalin fixed paraffin embedded biopsy specimens with their matched tumor free surgical margins from resected head and neck squamous cell carcinoma were immunostaind for eIF4E and Osteopontin markers. 65% of our HNSCC patients had eIF4 E positive cytoplasmic immunostaining and 70% of them exhibited Osteopontin staining. Two-thirds of the dead patients exhibited high Osteopontin positive staining, whereas the surviving group did not exhibit this high expression. Concerning eIF4E, 85% and 5% of the dead patients showed high and low eIF4E expression, respectively. Disease-free survival (DFS) and overall survival were significantly (P=0.000) different between high and negative expression of Osteopontin, high and negative expression of eIF4E. 84% of patients with eIF4E positive margins and 75% with Osteopontin positive margins had local recurrence. In addition, negative expression of eIF4E is associated with highly significant better DFS and overall survival (P=0.000 and 0.001), respectively, in the margin negative expression status, while negative expression of Osteopontin was significantly associated with better DFS but of no significance in overall survival outcome. Our findings suggest that tumor-free surgical margins in HNSCC may be redefined as histologically Osteopontin and eIF4E negative resection margins. However, multicenter prospective studies are required to further evaluate their clinical utility in the surgical management of primary HNSCC.

Expression of HnRNP A1, ZEB1, and E-cadherin in Hepatocellular carcinoma and their impact on patients' prognosis and survival.

Hepatocellular carcinoma (HCC) is one of the most prevalent malignancies in Egypt. HCCs usually have a poor prognosis because of late diagnosis, aggressive metastasis, and early invasion. Heterogeneous ribonucleoproteins (HnRNPs) are nuclear proteins that play a variety of roles in telomere formation, DNA repair, cell signaling, and gene regulation. Zincfinger Eboxbinding homeoboxes (ZEBs) are transcription factors that have a consistent inverse correlation with Ecadherin in numerous types of cancer and associated with poor prognosis. This study aimed to verify the prognostic expression of HnRNP A1, ZEB1, and E-cadherin in HCC. The retrospective study consisted of 54 formalin-fixed paraffin-embedded tissue blocks of hepatocellular carcinoma. Immunohistochemical staining was performed using antibodies against HnRNP A1, ZEB1, and E-cadherin. The patients were followed at the Clinical Oncology Department from May 2018 to July 2021. SPSS version 20 using the Chi-square test to compare data and the Kaplan-Meier plot for comparing survival. HnRNP A1 high positivity was detected in 59.3% of the cases, whereas negative E-cadherin and ZEB 1 expression presented in 37% and 70.4% of the patients, respectively. A statistically significant relation was present between HnRNP A1, ZEB1, E-cadherin, and various clinicopathological variables. The mean progression-free survival and overall survival in low HnRNP A1 and negative ZEB1 expressions were longer than those exhibited in high HnRNP A1 and positive ZEB1 expressions. HnRNP A1 and ZEB1 expressions are poor prognostic factors of HCC. E-cadherin has an important role in the development of differentiated HCCs and favorable outcome.

Obesity in Terms of BMI and BSA in Egyptian Breast Cancer Patients: Can Tumor Behavior Be Predicted?

Background: Obesity is a major health problem worldwide and is involved in etiology of breast cancer. Egypt is ranked among the highest globally in obesity problem. Body mass index (BMI) is the most widely used tool to define obesity. Body surface area (BSA) is another measure used widely in clinical practice, particularly in calculating doses of chemotherapeutic agents. Both Body Surface Area (BSA) and Body Mass Index (BMI) rely on weight and height and can be used as indicators of obesity. Patients and Methods: This is a cross-sectional observational study that was carried out in the department of clinical oncology, Faculty of medicine, Ain Shams University Hospitals. Medical records of patients scheduled for adjuvant chemotherapy were revised regarding age, comorbidity, side of the tumor, stage, and type of the surgery performed. Immunohistochemistry (IHC) to detect ER, PR, and Her2 and molecular subtypes of the tumors was recorded. BMI and BSA were calculated for all patients. Inclusion Criteria: Female patients with newly diagnosed breast cancer, cases that didn’t start the adjuvant treatment, data for IHC available, weight, and height of the patients recorded in the files. Exclusion Criteria: Male breast cancer cases, bilateral cases, metastatic cases, age above 80 years, cases with multiple primaries. Results: The mean age of patients was 48 ± 11 years and 60% of them were premenopausal. The mean weight in Kgs was 81 ± 13 and the mean height in cm was 156 cm ± 5. Mean BMI was 33.8 ± 6.0 and mean BSA was 1.84 ± 0.15. Comorbidities were present in 10.6% of patients. In the studied group of patients, tumors were more common of right side (55.7%), T2 tumor (40%), N1 (40.9%), and stage III in 57.4%. Regarding the hormonal receptor status, most of the patients were ER+ (76.5%), PR+ (66.1%) and Her2? (73.9%). The molecular subtypes were also estimated with HR+ subtype most common in (60%) and Her2+ subtype least common in (10.4%). Neither BMI nor BSA was different based on menopausal status. Tumor characteristics were compared in relation to BMI and BSA, and none of the studied parameters regarding menopausal status, T staging, N staging, TNM staging, ER, PR, Her2 and molecular subtype were significantly associated with BMI or BSA. Receiver operating characteristic (ROC) curve was done for the poor prognostic variables. It was found that both BMI and BSA were poorly predictive for the prognostic tumor characteristics regarding T stage, N stage, Her2 overexpression and TN disease. Conclusion: Obesity is a major health problem among breast cancer patients in Egypt. Both BSA and BMI (as indicators of obesity) in Egyptian breast cancer patients are higher compared to other parts of the world. Both BMI and BSA were poorly predictive of prognostic parameters in breast cancer patients.