Common Primary Site Research Articles

Factors predicting surgical receipt in extracranial rhabdoid tumors.

e23541 Background: Extracranial rhabdoid tumors (ERTs) are a very rare and aggressive carcinoma that grow in a wide range of tissues, including but not limited to the lungs, kidneys, muscles, skin, and other soft tissues. These tumors most commonly present in infants between 11-18 months old, with an estimated annual incidence of less than 1 per million in the United States. Metastasis is common, and average survival time after diagnosis is approximately 5 years. Though most patients appear to undergo tumor resection at the primary site, a standardized treatment protocol for ERTs has not yet been developed. This study aimed to analyze the factors predicting receipt of this surgery. Methods: The National Cancer Database (NCDB) was used to identify patients diagnosed with SEF from 2004 to 2020 using histology code 8963 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, ANOVA Chi-Square, and Logistic Regression tests were performed, and data were analyzed using SPSS version 29. Statistical significance was set at α = 0.05. Results: 208 patients with extracranial rhabdoid tumors formed the initial sample. Of these patients, 128 patients (61.5%) received surgery at the primary site. 80 patients (38.5%) did not have tumor resection. Median overall survival of surgical patients was significantly higher than nonsurgical patients ( 91.6 months vs. 32.1 months, p < 0.001). Head, neck, and face, were the most common primary tumor sites (25.4%). Wider surgical margins were associated with improved outcomes ( p < 0.05). On nominal regression, stage I, II, and III disease, grade 1 and 2, and younger age were associated with increased likelihood of receiving surgery ( p < 0.05). Metastasis to distant sites was associated with decreased likelihood of receiving surgery ( p < 0.05). Treatment at an academic facility, income status, tumor size, insurance status, and race were not significant predictors of receiving surgery. 77 patients (37%) received adjuvant chemotherapy, 1 patient received adjuvant radiation, and 4 patients received adjuvant chemoradiation. 121 patients (58.2%) did not receive adjuvant therapy. Conclusions: Resection of the primary tumor in ERT is associated with improved overall survival. Younger age, stage I, II, or III disease, and grade 1 or 2 disease are factors predicting a higher likelihood of receiving surgery. Improved outcomes of tumor resection are associated with wider surgical margins. The presence of metastasis decreased likelihood of undergoing surgery. Treatment location, insurance, status, race, income, and tumor size did not affect surgery receipt. Interestingly, the majority of patients sampled did not receive any adjuvant therapies, such as chemotherapy or radiation. Future research should continue delineating what factors predict both receipt of surgery and improved surgical outcomes, as well as better understand what the role of adjuvant therapies is in managing ERT.

Genomic landscape and therapeutic implications in advanced solid cancers: KOSMOS-II (KOrean Precision Medicine Networking Group Study of MOlecular profiling guided therapy based on genomic alterations in advanced Solid tumors, KCSG AL-22-09).

11161 Background: Despite advances in genomic diagnosis and therapeutics, providing precision medicine remains a challenge in the real-world practical application, especially in nations with diverse next-generation sequencing (NGS) cancer panels and a shortage of available targeted agents due to lack of approval or reimbursement. Methods: The KOSMOS-II is an ongoing prospective, nationwide, master observational study with multiple cohorts undergoing molecular-guided treatment (MGT) recommended by a central molecular tumor board based on local NGS cancer panel results for advanced cancer patients (pts) (J Clin Oncol 2023;41:16 suppl TPS 1608). Key genomic features were integrated with clinical data to construct a Clinico-Genomic Database (CGDB). To minimize inter-panel variations, all variant calling format (VCF) data on single nucleotide variants, insertions, and deletions were normalized by lifting over to the same reference genome (hg19). Re-annotation was performed using a consistent pipeline incorporating public databases. This preliminary analysis outlines the genomic landscapes and therapeutic implications in the first half of enrolled patients out of a targeted accrual of 1,000. Results: From September 2022 to December 2023, 489 pts were enrolled with a median age of 60 years (19 - 87), male 56.9%, and a median of 4 lines (1-15) of prior systemic therapy. The most common primary cancer sites were colorectum (n = 96, 19.6%), biliary tract (n = 63, 12.9%), and breast (n=40, 8.2%). CGDB was constructed for 360 pts, employing 20 different panels from 31 participating centers. The most common genomic alterations were TP53 mutation (Mut) (n=183, 50.8%), APC Mut (n=124, 34.4%), and ERBB2 amplification (AMP) (n=90, 25%). MGT was assigned to 59.5% of pts, 45.2% were allocated to investigational drugs targeting genetic alterations approved for other indications (Tier 1), and 12.6 % to clinical trials matching their genetic alterations (Tier 3). The concordance rate between pre-submitted physician choices and the MTB recommendation was 54.6% (Tier 1, 55%; Tier 2 (alternative treatments including palliative care), 46%; Tier 3, 86%). ERBB2 alterations were most frequently led to MGT; trastuzumab emtansine (n = 75, 20.8%; ERBB2 AMP n=36; ERBB2 Mut n=20; ERBB2 AMP & Mut n=17; NA n=2), or trastuzumab plus pertuzumab (n = 17, 7.5%), followed by EGFR gain to bevacizumab plus erlotinib (n = 18, 5%) and high TMB (≥20 mut/Mb) to atezolizumab (n= 46, 12.8%). Response evaluation of Tier 1 treatment was available in 158 patients, with a 16-week clinical benefit rate of 34.8%. Conclusions: The KOSMOS-II study demonstrated the feasibility of a pragmatic, nationwide precision medicine approach using diverse real-world NGS panels and favorable clinical outcomes.

Hodgkin’s lymphoma, lymphocyte-depleted, reticular: An NCDB analysis of demographic and socioeconomic factors of diagnosed patients.

e19033 Background: Lymphocyte-depleted Hodgkin's lymphoma (LDHL) is an aggressive, rare form of Hodgkin’s lymphoma (HL). The LDHL reticular subtype (LDHL-R) is characterized by a scant invasion of lymphocytes without an increase in collagen fibers by fibroblasts. Patient demographics and clinical features of LDHL-R are poorly understood, causing it to frequently be misdiagnosed as other variants of HL. At diagnosis, patients have often already progressed to late disease staging. The demographic and socioeconomic factors of patients diagnosed with LDHL-R within the National Cancer Database (NCDB) were analyzed to better understand its epidemiology. Methods: A retrospective cohort analysis was performed using data from the 2004-2020 NCDB of the 51 cases of LDHL-R (ICD-O-3 9655). Demographic and socioeconomic factors such as age, sex, race, Hispanic status, treatment facility type, Charles-Deyo score, and 90-day mortality were examined using descriptive statistics. Diagnostic trends were quantified through regression analysis. Results: A total of 51 patients were diagnosed with Hodgkin lymphoma, lymphocyte depletion, reticular subtype within the NCDB. The most common primary site of diagnosis was within lymph nodes of multiple regions (41%). The majority of patients were males (65%), White (72%), and non-Hispanic (74%). Patients tended to have residence in metropolitan counties with populations greater than 1 million (71%) and were enrolled in academic/research programs (36%). Most of the patients were privately insured (41%) followed by those insured by Medicare (29%). A higher percentage of patients were in the top quartile of income earners (31%) than those in the second, third, or fourth quartiles. The incidence rate of diagnosis remained constant from 2004 to 2020 (R² = 0.02). The mean age of diagnosis was 51 years (SD=21, Range=14–90). Using the AJCC System, patients tended to be classified as Stage IV (41%) at diagnosis and had a Charlson-Deyo comorbidity score of 0 (71%). Primary treatment methods involved chemotherapy (84%) and radiation therapy (20%). Surgical intervention was given to 14 patients, and post-surgery survival rates were 93% after 90 days. Conclusions: To the best of our knowledge, this is the first NCDB analysis of the demographic factors of patients diagnosed with LDHL-R. Consistent with previous studies about the aggressiveness of this subtype of Hodgkin’s Lymphoma, most patients received a Stage IV diagnosis. Understanding LDHL-R’s epidemiology could result in significantly earlier diagnoses and improved prognosis. Patients tended to be male, White, and non-Hispanic with a residence in metropolitan counties. To improve understanding of the impact of demographic and socioeconomic factors of the diagnosis, treatment, and survival of patients with LDHL-R, more research is recommended.

An NCDB analysis of patient treatment trends in soft tissue angiosarcoma.

e23563 Background: Angiosarcoma is a rare subtype of soft tissue sarcoma associated with a generally poor prognosis and high mortality rate. Median survival of patients with angiosarcoma typically ranges from 15 to 24 months, with a 5-year survival of 12-33%. Angiosarcomas have a high propensity for local recurrence, metastasis, and multiple organ involvement as they originate from vascular endothelial cells. Though surgical excision currently plays a central role in the treatment of angiosarcoma, no significant study has analyzed NCDB for treatment trends in these patients. This study aims to characterize the effect of different treatment modalities on overall survival of angiosarcoma patients. Methods: The National Cancer Database (NCDB) was used to identify patients diagnosed with angiosarcoma from 2004 to 2020 using histology code 9120 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, ANOVA, Chi-Square, Cox Proportional Hazards and Logistic Regression tests were performed, and data were analyzed using SPSS version 29. Statistical significance was set at α = 0.05. Results: 3560 patients with angiosarcoma of the soft tissue were queried. The most common primary site for a tumor was the head, neck, or face (920 patients, 31.3%). Of the initial sample, 1889 ( 53.1%) patients received surgery alone, 450 ( 12.6%) patients received adjuvant chemotherapy, 55 ( 1.54%) received adjuvant radiation, and 30 ( 0.84%) patients received adjuvant chemoradiation. Surgery alone conferred the greatest median survival; no surgery conferred the least ( 31.4 months vs. 7.2 months; p < 0.001). In the crude and adjusted logistic regression models, combined chemoradiation (OR = .210; 95% CI:.100-.400) and surgery alone were associated with the lowest odds of death (OR = .271; 95% CI: .224-.329) relative to no surgical procedure of the primary site. This finding persisted once the model was adjusted for age, stage, and tumor size. Surgery alone conferred the lowest hazard ratio (HR = .352; 95% CI: .323-.384) relative to no surgery. Conclusions: In angiosarcoma patients, surgical excision at the primary site alone was associated with the greatest median survival and the lowest hazard ratio. Additionally, angiosarcoma patients who did not receive surgery had the least median survival. Surgery with adjuvant chemoradiation and surgery alone had the lowest odds of death. These findings affirm that surgical excision at the site of the primary tumor plays a key role in increasing the survival of angiosarcoma patients. Further research is necessary in characterizing treatment trends in angiosarcoma patients to supplement current standardized treatment protocols and improve the mortality of this lethal cancer.

Mixed liposarcoma: A study of socioeconomic and demographic factors.

e23527 Background: Mixed Liposarcoma (LS) is an extremely rare subtype of LS, with characteristics often spanning 2 or more of the other LS subtypes such as myxoid, round cell, or well-differentiated LS. To date, the cytologic features of this uncommon tumor has yet to be described. Analyzing trends in diagnoses may produce valuable information about its epidemiology. The National Cancer Database (NCDB) was analyzed to uncover the demographic factors in patients diagnosed with mixed LS. Methods: A retrospective cohort study from 2004 to 2020 was conducted using the NCDB. 199 patients were found with a histologically confirmed diagnosis of mixed LS (ICD-8855-3). Race, gender, Hispanic origin, type of treatment facility, insurance coverage, and distance from patient residence to treatment facility were analyzed via descriptive statistics, and trends in incidence were interpreted using regression analysis. Results: The majority of patients were white (89%) and non-Hispanic (83%) with a relatively equal split of males (56%) and females (44%). The most common primary site of mixed LS was the retroperitoneum (72%), and the frequency of diagnosis decreased from 2004 to 2020 (R2 = 0.4568). Patients were treated at academic/research programs (45%), comprehensive community cancer programs (25%) and integrated network cancer programs (18%) that were generally located in the Middle Atlantic (19%), South Atlantic (18%), and East North Central (16%). The two primary payers at diagnosis include private insurance/managed care (45%) and Medicare (43%). Most patients were from counties in metro areas with a population of at least 1 million (57%) followed by metro counties with a population of 250,000 to 1 million (18%). The largest median household income quartile was $74,063 or more (38%), followed by $46,227 - $57,856 (22%). Most patients had a Charlson-Deyo Score of 0 (83%) with a NCDB analytic stage of either I (28%), III (26%), or not applicable (21%). Conclusions: To the best of our knowledge this NCDB analysis on mixed LS is the first of its kind and therefore addresses a significant knowledge gap. Most patients tend to be white and non-Hispanic. Mixed LS most commonly is found in the retroperitoneum, which is similar to case reports. We found that mixed LS patients have a relatively high household income, most often live in high populated metro areas, and are most frequently treated at academic/research programs. These findings are significant because these socioeconomic factors have not been noted before in literature. Further examination of these demographic and socioeconomic factors is required to understand how they impact treatment, diagnosis of, and survival of patients with mixed LS.

Analysis of demographic and socioeconomic factors in adamantinoma using data from the National Cancer Database (NCDB).

e23501 Background: Adamantinoma is a rare low-grade primary malignant bone tumor accounting for less than 1% of all malignant bone tumors. It largely presents in the tibia of young adults, is locally aggressive, and can metastasize. Definitive diagnosis is primarily established by histopathological examination. This rare tumor with uncertain histogenesis remains under-studied. Therefore, exploring trends in diagnoses may provide insight into its epidemiology. The National Cancer Database (NCDB) was examined to reveal the demographic factors in patients diagnosed with Adamantinoma. Methods: A retrospective cohort analysis utilizing the 2004–2020 NCDB included 206 patients with a histologically-confirmed diagnosis of adamantinoma (ICD-O-3 Code 9261). Demographic factors such as age, sex, race, Hispanic status, insurance status, facility type, distance from facility, and Charlson-Deyo score were analyzed via descriptive statistics. Trends in incidence were interpreted using regression analysis. Results: A total of 206 patients were identified in the NCDB with a confirmed diagnosis of adamantinoma of long bones between 2004-2020. Incidence remained relatively stable over this time period (R² = 0.009). The most common primary site of diagnosis were the long bones of lower limb and associative joints (97%). Most individuals (88%) had a Charlson-Deyo comorbidity score of 0. The majority of patients (66%) were classified as Stage 1 AJCC staging. Men were more likely to be diagnosed (56%) compared to women (44%). Most patients were White (78%) and non-Hispanic (85%). A higher percentage of patients were privately insured (67%) and lived in metropolitan areas (87%). Treatment facilities primarily were academic programs (74%). Almost all of the patients were treated surgically (92%) with the most common approach being lymph node dissection (61%) more so than local tumor excision or removal of adjacent organs. Following surgery, the patients observed had a very good prognosis, with a 99% ninety-day survival, a 93% five-year survival, and an 89% ten-year survival. Conclusions: Adamantinoma has a risk for recurrent and metastatic disease. This first NCDB analysis on adamantinoma’s demographics addresses a significant knowledge gap on this topic. The primary site of diagnosis were lower extremity long bones, most commonly treated with surgical intervention, and had a high survival rate which is consistent with earlier studies. The majority of patients included in this study tend to be White, non-Hispanic, and privately insured. This may suggest a demographic and socioeconomic factor that plays a part in diagnosis, prognosis, and treatment of individuals with adamantinoma. Future research should focus on the understanding of factors that impact the course of one’s health and the etiology of this rare pathology.

High-grade neuroendocrine head and neck cancer: Case series and review of the literature

BackgroundHigh-grade neuroendocrine cancers (NEC) of the head and neck (HN) are rare and aggressive, accounting for ≤1 % of all HN cancers, with a 5-year overall survival (OS) of ≤20 %. This case series examines clinical characteristics, treatments, and outcomes of patients diagnosed at a regional UK HN cancer centre over the last 23 years. MethodsA retrospective review of medical records was conducted for all patients diagnosed with NEC HN from 1st January 2000 until 1st March 2023 at Velindre Cancer Centre. ResultsDuring the study period, 19 cases of NEC HN were identified, primarily affecting males (n = 15, 79 %). Median age of 67 years (range: 44–86). At diagnosis, 32 % of patients (n = 6) were smokers. The most common primary tumour sites were larynx (n = 5, 26.3 %) and sinonasal (n = 5, 26.3 %). Most patients presented with advanced loco-regional disease or distant metastasis, with stage IVA (n = 6, 32 %) and stage IVC (n = 6, 32 %) being the most common. The key pathology marker was synaptophysin, present in 100 % of the tested patients (n = 15). In the study, of the 12 patients with non-metastatic disease, 10 received a combination of treatments that included radiotherapy (RT). Some of these patients also received chemotherapy (CT) at the same time as their radiotherapy. Surgery alone was used in two patients with stage II disease. Seven subjects had complete responses, and one achieved a partial response. Among the seven metastatic patients, three received CT, and one underwent palliative RT, all achieving a partial response. In all cases, the CT used was carboplatin and etoposide. After a median follow-up of 11 months (range: 1–96), the median OS was 27 months for the overall population, 51 months for those treated radically, and three months for metastatic patients with palliative treatment. The 1-year OS for all patients was 54.3 %, the 2-year OS was 46.5 %, and the 5-year OS was 23.3 %. Among patients treated radically, these rates were 65.3 %, 52.2 %, and 26.1 %, respectively. For patients treated palliatively, the 1-year OS was 33.3 %. ConclusionThis case series contributes preliminary observations on the characteristics and management of non-metastatic NEC HN, suggesting potential benefits from multimodality treatment strategies. Given the small cohort size, these observations should be interpreted cautiously and seen as a foundation for further research.

Comparison of Volumetric Modulated Arc Therapy (VMAT) and Conventional Intensity-Modulated Radiotherapy (IMRT) for Locally Advanced Head and Neck Squamous Cell Carcinoma: A Retrospective Cohort Study.

Purpose This study examines the outcomes of locally advanced head and neck squamous cell carcinoma (HNSCC) following the adoption of conventional intensity-modulated radiotherapy (cIMRT) and volumetric-modulated arc therapy (VMAT) over a decade. The region under study has higher comorbidities associated with increased HNSCC incidence and poorer prognosis. Materials and methods A 10-year retrospective review of electronic medical records included 296 patients with stage III, IVA, and IVB HNSCC (American Joint Committee on Cancer, Seventh edition). Survival outcomes were compared between VMAT and cIMRT using Kaplan-Meier survival curves and adjusted for relevant demographic factors using Cox's proportional hazards model. Analysis was performed using R software(R Foundation, Vienna, Austria). Results The median age of the cohort was 63 years, comprising of 80% males. The oropharynx was the most common primary tumor site. 264 (89%) received 50Gy or higher dose radiation by either cIMRT (22%) or VMAT (67%). At five years, locoregional control (LC) and overall survival (OS) rates were 79.5% and 56.7%, respectively. VMAT showed a significant improvement in five-year OS (63.4% versus 43.8% for cIMRT, p=0.0023)but no significant difference in five-year LC (81% VMAT versus 74.5% cIMRT, p=0.17). Grade 3-4 acute toxicity was observed in 22% of patients. Conclusions VMAT and cIMRT demonstrated excellent LC in locally advanced HNSCCdespite high comorbidity rates. Notably, VMAT was associated with significantly better OS compared to cIMRT. These outcomes surpass historical data, suggesting that VMAT technology may lead to improved patient outcomes. However, larger randomized controlled trials and dosimetric studies are needed to confirm these findings.

Predictive Nomogram and Propensity Score Matching in Neuroendocrine Carcinoma of the Tubular Gastrointestinal Tract: A US Population-Based Clinical Outcome Study.

Background: Neuroendocrine carcinomas (NECs) of the tubular gastrointestinal tract (GI-NECs) are rare and associated with worse clinical outcomes. This population-based study aims to highlight key demographics, clinicopathological factors, and survival outcomes in the US population. Methods: Data from 10,387 patients with GI-NECs were extracted from the Surveillance, Epidemiology, and End Result (SEER) database from 2000 to 2020. Results: Most patients were >40 years old at the time of presentation with a median age of 63 years old, with almost equal ethnic distribution per US population data. The most common primary tumor site was the small intestine (33.6%). The metastatic spread was localized in 34.8%, regional in 27.8%, and distant in 37.3% of cases, and the liver was the most common site of metastasis (19.9%) in known cases of metastases. Most NEC patients underwent surgery, presenting the highest 5-year overall survival of 73.2% with a 95% confidence interval (CI) (95% CI 72.0-74.4%), while chemotherapy alone had the lowest 5-year survival of 8.0% (95% CI 6.4-10.0%). Compared to men, women had a superior 5-year survival rate of 59.0% (95% CI 57.6-60.5%). On multivariate analysis, age > 65 (HR 2.49, 95% CI 2.36-2.54%, p ≤ 0.001), distant metastasis (HR 2.57, 95% CI 2.52-2.62%, p ≤ 0.001), tumor size > 4 mm (HR 1.98, 95%, CI 1.70-2.31%, p ≤ 0.001), esophageal (HR 1.49, 95% CI 0.86-2.58%, p ≤ 0.001), transverse colon (HR 1.95, 95% CI 1.15-3.33%, p ≤ 0.01), descending colon (HR 2.12, 95% CI 1.12, 3.97%, p = 0.02) anorectal sites, and liver or lung metastases were associated with worse survival. Surgical intervention and tumors located in the small intestine or appendix showed a better prognosis. Conclusion: GI-NECs are a group of rare malignancies associated with a poor prognosis. Therefore, epidemiological studies analyzing national databases may be the best alternative to have a more comprehensive understanding of this condition, assess the impact of current practices, and generate prognosis tools.

Safety and Efficacy of 177 Lu-DOTATATE in Children and Young Adult Population : A Single-Center Experience.

This single-center retrospective study explores the safety and efficacy of 177 Lu-DOTATATE in children and young adult population with metastatic/inoperable neuroendocrine tumors (NETs). This study is a retrospective analysis of all children and young adult patients (≤29 years) with advanced inoperable/metastatic epithelial or nonepithelial NETs who were administered a median of 4 cycles of 177 Lu-DOTATATE therapy and low-dose oral capecitabine as a radiosensitizer every 8-12 weeks, except 2 patients who received CAPTEM chemotherapy. The radiological response was assessed using RECIST 1.1 on interim and end-of-treatment 68 Ga-DOTANOC PET/CT. The primary endpoint was objective response rate, whereas disease control rate, toxicity profile, progression-free survival, and overall survival were secondary endpoints. Nineteen biopsy-proven NET patients (median age, 22 ± 10 years) with 8 of them adolescents (10-18 years) and the remaining young adults (19-29 years) were included. Fourteen patients had gastroenteropancreatic neuroendocrine tumor (pancreas being most common primary site), whereas the rest had non-gastroenteropancreatic neuroendocrine tumor. A total of 65 cycles of 177 Lu-DOTATATE (range, 1-6 cycles) were administered with a median cumulative activity of 600 mCi (range, 100-1000 mCi). The objective response rate and disease control rate were 41% and 94%, respectively. Grade 1 and 2 adverse events were observed in 14 (74%) and 5 (26%) of 19 patients, respectively. In a total of 8 events (42%), 4 events each of disease progression and death occurred during a median follow-up of 80.1 months with an estimated 5-year progression-free survival and overall survival of 54% (95% confidence interval, 30-78) and 63% (95% confidence interval, 39-87), respectively. 177 Lu-DOTATATE appears safe and effective in children and young adults with metastatic/inoperable NETs. Large prospective trials are required to validate these results.

The diagnostic utility of cell block as an adjunct to routine cytology

Despite the diagnostic utility of cell block in FNAC and fluid cytology, known for better cellular yield and improved diagnostic accuracy, the technique remains to be underutilized for diagnosing neoplastic lesions.In this paper, a hospital based prospective study of 195 samples was conducted on cytological samples with the aim (a) to evaluate the diagnostic utility of cell block as an adjunct to routine cytological evaluation of aspiration and effusion fluid specimens, (b) To correlate the findings of routine cytology, cell block and routine histopathological examination wherever possible and (c) to explore the possibility of using ancillary techniques such as immunohistochemistry on cell blocks. The study revealed, most of the patients were between 51- 60 years with female preponderance. Among 195 samples, 79 (40.5%) were peritoneal fluids and 85 (43.5%) were lymph node. The diagnosis on conventional smear and cell block showed 71 (36.5%) cases and 68 (35%) cases were negative for malignancy respectively. 6 (3%) cases and 4 (2%) cases were suspicious for malignancy respectively. 118 (60.5%) cases and 123 (63%) cases were positive for malignancy respectively. Amongst the peritoneal effusion the most common primary site was ovary whereas majority of the primary site was unknown in lymph node FNAC. Peritoneal effusion showed 8 additional cases as positive for malignancy in CB preparation which were negative or suspicious for malignancy on CS. In FNAC, two additional positive case was found in CB preparation of lymph node. A Kappa value of 89.5 % for statistical correlation between Conventional smear and cell block preparation was calculated. The use of Cell block technique increases the detection of malignancy when used as an adjunct to conventional smears. Cell block technique is simple, inexpensive and reliable adjuvant to smears and it is recommended for routine cytological diagnosis and for application of immunomarkers and molecular studies.

Utility of metabolic ratios in the diagnosis of tumor Thrombus on F-18 FDG PET/CT

BackgroundThis study aims to predict quantitative parameter in form of metabolic ratios to diagnose tumor thrombus on F-18 FDG PET/CT.MethodsThis is a retrospective study from Nuclear Medicine department at All India Institute of Medical Sciences, Jodhpur, India. Patients with malignancies who underwent F-18 FDG PET/CT in our department or images sent for review from February 2020 till September 2022 were screened for tumor thrombus that comprised study group. Control group had patients with malignancy and no imaging evidence of tumor thrombus. Metabolic activities (SUVmax) of tumor thrombus, liver and descending aorta in study group, and that of IVC, liver and descending aorta in control group were recorded. Metabolic ratios of tumor thrombus to liver (SUR L) and to aorta (SUR A) in study group, and IVC to liver (SUR* L) and to aorta (SUR*A) in control group were compared using receiver operator curves.ResultsOf 2277 studies screened, 12 had tumor thrombus. The most common primary malignant site and vessel involved were lung and IVC respectively. The median (IQR) SUR L, SUR A, SUR* L and SUR* A were 2.5 (3.25), 2.6 (6), 0.67 (0.18) and 1 (0.17) respectively. Area under ROC for SUR L and SUR A were 0.983 [95% CI: 0.955–1.0] and 0.958 [95% CI: 0.90–1.0] respectively. The ideal cut-off for SUR L was 0.953 (sensitivity 92.3%, specificity 98.0%) and for SUR A was 1.42 (sensitivity 84.6%, specificity 98.0%).ConclusionMetabolic ratios of tumor thrombus to liver (SUR L) and aorta (SUR A) have good diagnostic performance and can be useful in studies with non-iodinated contrast CT.

Cutaneous melanoma in adolescents and young adults.

Cutaneous malignant melanoma (CMM) ranks among the five most common cancers in young people in high-income countries and it features peculiar clinicopathological traits. Very few studies have addressed the quality of care and the costs for adolescents and young adults (AYA) population. To provide a comprehensive epidemiological and clinicopathological profile of CMM in AYA. The study also addresses the cost-of-illness and the diagnostic-therapeutic performance indicators by patient age category. This population-based cohort study included 2435 incident CMM (age range 15-65 years; age 15-39 = 394; age 40-65 = 2041), as recorded in 2015, 2017 and 2019 by the Regional Veneto Cancer Registry (Italy). Cramer's-V tested the strength of association between pairs of variables. The Kaplan-Meier method was used to test the association between age and survival rate. The clinical performance indicators were computed using the Clopper-Pearson exact method. In AYA patients (16.2%), CMM incidence rates increased significantly from 1990 to 2019. Low-stage CMM (p = 0.007), radial growth pattern (p = 0.026) and lower Clark levels (p = 0.007) prevailed; males had less advanced malignancies (p = 0.003), with the trunk as the most common primary site (67.5%); the lower limbs (32.6%) were the most common primary site for females (p < 0.001). Overall survival was better in AYA than adults. No significant difference was detected in the clinical management of the two age groups, with the only exception of the margin in wide local excision. The care costs were lower in AYA (€195.99 vs. €258.94, p = 0.004). In AYA patients, the CMM clinicopathological presentation shows a distinctive profile. The present results provide critical information for optimizing primary and secondary prevention strategies and for tailoring diagnostic therapeutic procedures to the peculiar profile of AYA CMM patients.

Metastatic germ cell tumors in serous cavities and cerebrospinal fluid: A single-center experience.

Metastatic germ cell tumors (GCTs) involving body cavity effusions and cerebrospinal fluid (CSF) are rare. Diagnosis is challenging because of limited morphological and clinicopathological information in the literature. A database search of our institution from 1990 to 2024 identified 27 cases of metastatic GCTs, comprising five pediatric and 22 adolescent and adult patients, in serous cavities or the CSF, including peritoneal (15), pleural (nine), CSF (two), and pericardial (one) fluid. The most common primary site was the testis (n=10), followed by the ovaries (n=7), mediastinum (n=4), retroperitoneum (n=3), pineal gland (n=2), and sacrum/coccyx (n=1). The primary tumors in 14 patients were mixed GCTs (six with a seminoma component), followed by immature teratomas (six), yolk sac tumors (three), embryonal carcinomas (two), pure seminomas (one), and postpubertal teratomas (one). The median interval between primary tumor diagnosis and diagnosis of fluid positivity was 7 months (range: 0-134 months). In nine cases, the malignant fluid was diagnosed simultaneously with or within 1 month of the primary tumor. GCT subtyping was performed on 23 of the 27 cytological specimens. Twenty-four patients (89%) also had metastases to other sites. Thirteen patients died of the disease (48%), with a median survival time of 4 months. Metastatic GCTs in serous effusions and CSF are often associated with disseminated disease and poor prognosis. Subtyping can be performed by cytomorphology combined with immunohistochemistry.

Ocular metastases profile in a tertiary hospital in São Paulo, Brazil

ObjectiveOcular metastases are the most common intraocular tumours in adults. Data regarding the occurrence of these tumours in the Brazilian population is scarce. We aimed to investigate the profile of ocular metastases of patients referred to tertiary hospital service in São Paulo, Brazil.DesignRetrospective study.ParticipantsPatients referred to the Ocular Oncology service of the Federal University of São Paulo with initial diagnostic hypothesis of ocular metastasis.MethodsData was retrospectively collected from medical records from June 2017 to June 2023. Age, sex, primary tumour site, previous knowledge of the systemic diagnosis, laterality, initial visual acuity (VA), local or systemic treatment and mean follow-up period were obtained.ResultsA total of 37 cases were referred to the ocular oncology division due to a suspected ocular metastasis, 15 (40.5%) were confirmed. Mean age at diagnosis was 53.47 ± 16.01 years old, the majority (86.7%) of patients already knew the systemic diagnosis. Breast cancer (66.7%) was the most common primary site, followed by Lung cancer (26.7%). Both eyes were affected in 66.67% of the cases, all patients had metastases at the choroid (100.0%), and the mean initial VA was 1.37 ± 1.04 logMAR. Chemotherapy was the main systemic treatment modality (73.3%), and most patients had no ocular treatment (53.3%). The mortality rate along the follow-up period was 30.0%.ConclusionsConsidering the number of new patients absorbed by the Ocular Oncology service over the study period, the frequency of ocular metastases was relatively low. The patients’ characteristics was comparable to data published in the international literature.

Re-irradiation versus systemic therapy for the management of local-regionally recurrent head and neck cancer

PurposeThe optimal management of local-regionally recurrent head and neck cancer that is not amenable to surgical resection is uncertain. We sought to compare outcomes among patients treated with and without re-irradiation in this setting. Methods and MaterialsA review of institutional registries identified 65 patients with local-regionally recurrent squamous cell carcinoma of the head and neck who were ineligible for surgery. Forty patients (62 %) opted for re-irradiation with the remaining 25 patients (38 %) undergoing initial systemic therapy alone. All patients had measurable disease. Forty-three patients (66 %) were male and twenty-two (33 %) were female. The median age at the time of recurrence was 59 years (range, 39–84 years). The most common primary sites of disease were the oropharynx, (n = 25), oral cavity (N = 19), and nasopharynx (n = 11). The median interval from completion of prior radiation to the diagnosis of recurrent disease was 35 months (range, 2–102 months). ResultsRe-irradiation improved 2-year overall survival, (32 % versus 11 %), progression-free survival (31 % versus 7 %), and local–regional control (39 % versus 3 %) compared to systemic therapy alone (p < 0.05, for both). The likelihood of developing any new grade 3+ toxicity was significantly higher among patients treated by re-irradiation compared to those treated by systemic therapy (53 % vs. 28 %, p < 0.001). There were 3 treatment-related fatalities, all of which occurred in the re-irradiation group. The incidence of grade 3+ late toxicity was 48 % and 12 % for patients in the re-irradiation and systemic therapy cohorts, respectively (p < 0.001). ConclusionAlthough re-irradiation improved overall survival compared to systemic therapy for appropriately selected patients with local-regionally recurrent head and neck cancer, the relatively high risk of toxicity must be considered.

Identification of potential C1-binding sites in the immunoglobulin CL domains.

Immunoglobulin G (IgG) molecules that bind antigens on the membrane of target cells spontaneously form hexameric rings, thus recruiting C1 to initiate the complement pathway. However, our previous report indicated that a mouse IgG mutant lacking the Cγ1 domain activates the pathway independently of antigen presence through its monomeric interaction with C1q via the CL domain, as well as Fc. In this study, we investigated the potential interaction between C1q and human CL isoforms. Quantitative single-molecule observations using high-speed atomic force microscopy revealed that human Cκ exhibited comparable C1q binding capabilities with its mouse counterpart, surpassing the Cλ types, which have a higher isoelectric point than the Cκ domains. Nuclear magnetic resonance and mutation experiments indicated that the human and mouse Cκ domains share a common primary binding site for C1q, centred on Glu194, a residue conserved in the Cκ domains but absent in the Cλ domains. Additionally, the Cγ1 domain, with its high isoelectric point, can cause electrostatic repulsion to the C1q head and impede the C1q-interaction adjustability of the Cκ domain in Fab. The removal of the Cγ1 domain is considered to eliminate these factors and thus promote Cκ interaction with C1q with the potential risk of uncontrolled activation of the complement pathway in vivo in the absence of antigen. However, this research underscores the presence of potential subsites in Fab for C1q binding, offering promising targets for antibody engineering to refine therapeutic antibody design.

The Profile of Sinonasal Tumors with Orbital Involvement in Dr. M. Djamil General Hospital, Padang, Indonesia: A 10-Year Overview

Background: Sinonasal tumors are rare tumors, either malignant or benign, that vary greatly based on the origin and primary tumor location in the sinonasal tract. The close anatomical relationship between the sinonasal tract and the orbital cavity makes orbital involvement very common (50%-80%) in sinonasal tumors, and this indicates a negative prognostic factor in sinonasal malignancy. The purpose of this study is to demonstrate the profile of sinonasal tumors with orbital involvement in our center.&#x0D; Methods: Retrospective study from oncology subdivision files and medical records from January 2011 – December 2020. Collected data including age, gender, the clinical manifestations of orbital involvement, primary location, histopathology, and management of sinonasal tumors.&#x0D; Results: There were 35 patients examined by the oncology subdivision either directly came or consulted from the ENT department, consisting of 18 (51.4%) males and 17 (48.6%) females. The age of patients ranged from 11 to 83 years old. with the most common age groups being 41-50 and 51-60 (25.7% in each age group). The majority of the patients (77.1%) had presented with proptosis. Maxillary sinus was the most common (45.7%) primary site of tumors, and squamous cell carcinoma was the most common (51.4%) histopathology found. Most of the patients (37.1%) were treated with a combination of chemotherapy and radiotherapy.&#x0D; Conclusion: Orbital involvement commonly occurs in malignant sinonasal tumors with proptosis as a major clinical presentation. A combination of chemotherapy and radiotherapy was the most common practice management because the tumors were unresectable at the time of presentation.

Favorable clinical efficacy of cytotoxic chemotherapy in patients with progressive desmoid tumors: a retrospective real-world study.

The real-world evidence about the efficacy of cytotoxic chemotherapy in desmoid tumors is still limited. We investigated the efficacy of chemotherapy in the treatment of recurrent or progressive desmoid tumors. The patients with desmoid tumors who had received cytotoxic chemotherapy between November 2007 and June 2020 in two tertiary hospitals in Korea were reviewed. A total of 25 patients were included in the analysis. The most common primary tumor site was the intra-abdominal or pelvic cavity (56%), followed by the trunk and abdominal wall (24%), extremities (16%), and head and neck (4%). Sixty percent of the patients had familial adenomatous polyposis and 76% received doxorubicin plus dacarbazine. The objective response rate and disease control rate was 64% (95% confidence interval [CI]: 40.7-82.8) and 96% (95% CI: 77.2-99.9), respectively. With the median follow-up time of 55months (95% CI: 41.0-68.2), the 3-year PFS rate was 65% (95% CI: 41.1-80.5), and the 3-year OS rate was 89% (95% CI: 63.8-97.3). Grade 3 or 4 hematologic adverse events were reported in 14 patients, all of which were manageable. Our real-world evidence suggests that doxorubicin-based cytotoxic chemotherapy can be an effective treatment option for recurrent and progressive desmoid tumors with respect to favorable clinical outcomes.

Abstract 7658: Artificial intelligence-powered spatial analysis of tumor-infiltrating lymphocytes as a prognostic biomarker for pembrolizumab plus chemotherapy in recurrent or metastatic head and neck squamous cell carcinoma

Abstract Background: Programmed cell death ligand 1 (PD-L1) expression alone has limited predictive value for pembrolizumab plus 5-fluorouracil and platinum (PFP) therapy in recurrent or metastatic head and neck squamous cell carcinoma (HNSCC). An artificial intelligence (AI)-powered spatial tumor-infiltrating lymphocyte (TIL) analyzer may provide independent prognostic information. Methods: This study included 63 patients with locally incurable HNSCC who received first-line PFP at Samsung Medical Center. Patients were classified into inflamed phenotype (IP) or non-inflamed phenotype (NIP) based on the 5% proportion threshold of inflamed 1 mm2-sized grids over total grids within hematoxylin and eosin-stained whole-slide images (WSIs) analyzed using Lunit SCOPE IO. We evaluated the prognostic value of inflamed status and densities of intratumoral TILs (iTILs), stromal TILs (sTILs), and tumor microenvironment TILs (tTILs). Results: Patients were predominantly male (78%). The median age at PFP initiation was 57 years. The most common primary tumor site was oral cavity (49.2%), followed by oropharynx (16%) and hypopharynx (10%). Of the 37 patients with available PD-L1 combined positive score (CPS), 2 (5%), 23 (62%), and 12 (32%) had CPS values of &amp;lt;1, 1-19, and ≥20, respectively. The overall response rate was 54%, with 67% in the CPS ≥20 subgroup and 48% in the CPS &amp;lt;20 subgroup. The median progression-free survival (PFS) was 7.2 months, with 10.8 months for patients with CPS ≥20 and 5.5 months for patients with CPS &amp;lt;20. The median overall survival (OS) was 18.6 months. Among 62 patients with available WSIs, 47 (74%) and 15 (26%) patients were categorized as having an IP and NIP, respectively. Oral cavity cancer was enriched with IP (57.4% of all IP cases vs 26.7% of all NIP cases), while all four paranasal sinus tumors had NIP. The overall response rate was 57% in the IP group and 44% in the NIP group. Patients with IP had significantly longer PFS and OS than patients with NIP, both in unadjusted (hazard ratio [HR] for PFS, 0.4; 95% confidence interval [CI], 0.21-0.78; P = 0.007; HR for OS, 0.43; 95% CI, 0.2-0.95; P = 0.036) and PD-L1 CPS-adjusted analyses (HR for PFS, 0.41; 95% CI, 0.21-0.79; P = 0.008; HR for OS, 0.4; 95% CI, 0.18-0.89; P = 0.025). High densities (≥25th percentile) of iTILs, sTILs, and tTILs were all significantly associated with prolonged PFS after CPS adjustment (P = 0.001, 0.001, and 0.012). High density of iTILs was also significantly associated with improved OS (P = 0.001 after CPS adjustment), while there was no significant association between OS and high density of sTILs or tTILs (0.077 and 0.085, respectively, after CPS adjustment). Conclusion: An AI-driven spatial TIL analyzer might serve as a simple and independent prognostic biomarker in HNSCC patients receiving pembrolizumab plus chemotherapy. Citation Format: Sehhoon Park, Junghoon Shin, Chan-Young Ock, Chang Ho Ahn, Hyun Ae Jung, Se-Hoon Lee, Myung-Ju Ahn. Artificial intelligence-powered spatial analysis of tumor-infiltrating lymphocytes as a prognostic biomarker for pembrolizumab plus chemotherapy in recurrent or metastatic head and neck squamous cell carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 7658.