Common Site Of Metastasis Research Articles

Establishment and Validation of Diagnostic and Prognostic Prediction Models for Liver Metastasis in Patients with Rectal Cancer: A SEER-based Study

Background: Rectal cancer is one of the most common gastrointestinal tumors, among which the liver is the most common site of distant metastasis and liver metastasis that leads to poor prognosis. This study aimed to develop and validate a diagnostic nomogram to predict the occurrence of rectal cancer with liver metastasis (RCLM) and a prognostic nomogram to predict cancer-specific survival (CSS) in RCML patients. Methods: Data on patients with rectal cancer diagnosed between 2010 and 2013 were collected from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate logistic regression and multivariate logistic regression were used to determine the independent risk factors of RCLM. Univariate Cox proportional hazards regression and multivariate Cox proportional hazards regression were used to identify independent prognostic factors for RCLM. This study then developed two novel nomograms, and the results were evaluated by receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Results: A total of 29367 patients with rectal cancer were included. Among them, 3403 patients (11.59%) had liver metastases at the time of diagnosis. The independent risk factors of RCLM included sex, race, tumor grade, AJCC N, CEA, marital status, tumor size, total number of primary tumors, and histological type. Age, chemotherapy, total number of primary tumors, surgery sites, and histological type were independent prognostic factors of patients with RCLM. The results of ROC curves, calibration curves, and DCA in the development, validation, and testing sets confirmed that the diagnostic nomogram can precisely predict the occurrence of RCLM. The results of ROC curves, calibration curves, DCA, C-indexes, and Kaplan–Meier (K-M) survival curves in the development, validation, and testing sets confirmed that the prognostic nomogram could precisely predict the prognosis of RCLM. Conclusion: The two nomograms are expected to be effective tools for predicting the risk of liver metastasis for patients with rectal cancer and personalized prognosis prediction for patients with RCLM, which may benefit clinical decision-making.

Navigating the Diagnostic Maze: A Case Report of Uncommon Cardiac Metastasis in Childhood Ewing Sarcoma

AbstractEwing sarcoma is a bone cancer affecting children and young adult males. It usually presents as a single bone tumor, but it can also occur in multiple locations. Nevertheless, Ewing sarcoma is an extremely aggressive tumor capable of metastasizing to other parts of the body, such as the lungs, bones, liver, and lymph nodes. Cardiac metastases are rare, indicating a poor prognosis, as they suggest that the cancer has become more advanced and challenging to treat.This case report describes a 9-year-old boy who presented with complaints of fever and multiple swellings in the calvaria, periorbital region, clavicle, and left thigh. Laboratory investigations revealed a high erythrocyte sedimentation rate, elevated absolute neutrophil count, high phosphate and calcium levels, and low magnesium levels. Computed tomography imaging revealed the presence of multifocal osseous expansile lytic lesions, multiple pulmonary metastases, and extensive soft tissue involvement of the heart. Based on these findings, possible differential diagnoses of Langerhans cell histiocytosis, lymphoma, and Ewing sarcoma were considered. Further histopathological examination and immunohistochemistry confirmed a final diagnosis of metastatic Ewing sarcoma.The most common metastasis sites for Ewing sarcoma are the lungs, with rare occurrences in the central nervous system, and metastasis to the heart is uncommon. We present here a rare undiagnosed Ewing sarcoma with cardiac metastasis, in addition to pulmonary and multifocal osseous metastasis. This case is unique because multifocal osseous involvement is rare and further lung and heart involvement is even rarer in Ewing sarcoma.

Clinical and Genomic Phenotype of Brain Metastasis in Nasopharyngeal Carcinoma.

Brain metastasis in nasopharyngeal carcinoma is a rare but poor prognosis clinical problem. This study aims to investigate the clinical characteristics and identify the genomic profiling of nasopharyngeal carcinoma brain metastasis. Patients with a diagnosis of nasopharyngeal carcinoma who visited at the Fifth Affiliated Hospital of Sun Yat-sen University since January 2013 to December 2023 were retrospectively collected. Clinical data of patients diagnosed with nasopharyngeal carcinoma brain metastasis were extracted. Paraffin blocks of NPC brain metastases were acquired for immunohistochemistry and genetic testing. High-throughput second generation sequencing was performed for genomic analysis. The mutation landscape was further analyzed. Of the 2378 NPC patients from our database, only six were clinically diagnosed with nasopharyngeal carcinoma brain metastasis. Three were pathologically diagnosed with nasopharyngeal carcinoma brain metastasis. The time interval from the first diagnosis of nasopharyngeal carcinoma to brain metastasis was 15-56 months. The common sites of brain metastasis were frontal lobe and cerebellum, and could be single or multiple, cystic or solid lesions. The OS ranged from 7 to 48 months. Single nucleotide variants were found in 32 genes, such as PTEN, TP53, NFKBIA, KMT2C, and NOTCH1. Copy number variation occurred in five genes, including PTEN, CCDN1, FGF19, FGF3 and FGF4. PTEN and fibroblast growth factors might be involved in the molecular regulation of brain metastasis in nasopharyngeal carcinoma.

Abstract IA020: Deciphering the mechanisms of neutrophil immune response in bone metastatic prostate cancer

Abstract Metastatic disease of prostate cancer (PCa) is currently incurable. Bone is the most common tissue site for prostate cancer metastasis and progression in bone is largely dictated by tumor-stromal interactions in the bone microenvironment. We showed previously that bone marrow neutrophils inhibit bone metastatic PCa growth, however metastatic PCa becomes resistant to neutrophil response and progresses within the bone compartment. It is unclear how these findings translate to a clinical setting. Further, the mechanisms associated with tumor resistance to neutrophil immune response remain unknown and presents a new avenue for therapeutic intervention. Thus, the goals of this study were: 1) to define the impact of metastatic PCa on neutrophil function throughout prostate cancer progression and 2) to determine the potential of neutrophils as predictive biomarkers of PCa disease progression. To do this, peripheral blood polymorphonuclear neutrophils (PMNs) were collected from 4 patient cohorts (localized PCa, metastatic hormone-sensitive PCa (mHSPC), metastatic castration-resistant (mCRPC) and healthy men) and PMN molecular and functional properties assessed, including: cancer cell cytotoxicity and cell surface markers. There was a significant decrease with disease progression in PMN expression of CD10, a marker for differentiation, while in tandem, there was an increase in pro-inflammatory marker, CD88 (complement receptor) in mCRPC men compared to mHSPC. PMNs from all disease stages were equally cytotoxic to human PCa cell lines (LNCaP, C42B, and PC3). However, second generation androgen deprivation therapy (ADT) suppressed patient PMN cytotoxicity against mCRPC cells (C42B, PC3). This suppression was due to androgen receptor (AR)-mediated regulation of the pleotropic and immune suppressant cytokine, transforming growth factor beta receptor I (TβRI). PMNs from mCRPC patients who received 2nd generation ADT, expressed significantly more TβRI than patients who only received 1st line ADT. Further, we found that PMNs in CRPC patient bone metastases express more TβRI than PMNs in matched liver metastases, which express little to no TβRI. Treatment of mouse bone marrow neutrophils with enzalutamide, increased neutrophil TβRI expression in a dose dependent manner and blocked cytotoxicity against PCa cells. Exogenous testosterone treatment in vivo, pharmacologic inhibition (using Repsox, a small molecule kinase inhibitor of TβRI) or genetic deletion (using conditional TβRI knockout mice) rescued enzalutamide-mediated neutrophil suppression and restored neutrophil cytotoxicity. These data collectively suggest that AR inhibition suppresses anti-tumor neutrophil responses via TβRI however, this study highlights the ability to leverage standard-care ADT to generate neutrophil anti-tumor responses against bone metastatic PCa. Citation Format: Leah M Cook. Deciphering the mechanisms of neutrophil immune response in bone metastatic prostate cancer [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor-body Interactions: The Roles of Micro- and Macroenvironment in Cancer; 2024 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(22_Suppl):Abstract nr IA020.

Abstract C033: Identifying and targeting prostate cancer therapy resistance mechanisms driven by the tumor microenvironment

Abstract Background: Prostate cancer is a prevalent malignancy in men, with treatment resistance posing a significant challenge to successful cure. Acquired Resistance to Therapy (ART) arises from two main components: (1) Tumor Microenvironment (TME) and (2) mutations or epigenetic changes at gene level within the tumor cells themselves. While most cancer therapies target the intrinsic biology of cancer cells, growing evidence indicates that these treatments can also harm the stromal cells within TME, potentially driving ART. The biology of ART may vary based on the types of treatments, cell types, and organ locations. Thus, this study aims to dissect ART components driven by TME-mediated cellular processes in a comprehensive manner. Hypothesis: We propose that cancer therapies induce stress responses in non-cancerous cells within the TME. These stress responses involve the secretion of cytokines, mediators, and growth factors, which we term Stress Response Secretory Programs (SRSPs). We further hypothesize that targeting SRSPs could overcome ART that helps to improve treatment specificity and efficacy. Materials and Methods: We employed comprehensive single-cell profiling of common metastatic sites included liver, prostate, lung, bone, lymph node and spleen in preclinical models to identify secreted proteins and dysregulated pathways caused by genotoxic therapies. In vitro, we evaluated treatment resistance in murine prostate epithelial cell lines (Myc-CAP) by exposing them to conditioned media (CM) from irradiated murine fibroblasts (F4M2), using cell growth assays. Results: Single-cell RNA sequencing of organ samples revealed significant expressions of SRSPs and increased inflammatory responses in liver and prostate fibroblasts as well as other stromal cells treated with carboplatin. In vitro, CM from irradiated F4M2 cells enhanced cell proliferation and survival of Myc-CAP cells in response to docetaxel treatment. Conclusion: Our findings highlight the crucial role of SRSPs in mediating ART through interactions within the TME, which alter tumor cell phenotypes. Targeting these SRSPs holds potential for overcoming treatment resistance and improving therapeutic outcomes, underscoring the need to consider TME complexity in cancer treatment strategies. Citation Format: Tony Lok Heng Chu, Armand Bankhead, Ilsa Coleman, Sander Frank, Peter S. Nelson, Tarana Arman. Identifying and targeting prostate cancer therapy resistance mechanisms driven by the tumor microenvironment [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor-body Interactions: The Roles of Micro- and Macroenvironment in Cancer; 2024 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(22_Suppl):Abstract nr C033.

Expression of HECTD2 predicts peritoneal metastasis of gastric cancer and reconstructs immune microenvironment

Peritoneal metastasis (PM) is a common metastasis site and death cause of gastric cancer, which is a complex biological process, but there is currently a lack of effective prediction and treatment targets. In this study, we first analyzed the differential gene expression of gastric cancer patients with or without peritoneal metastasis, and identified the HECT domain E3 ubiquitin protein ligase 2 (HECTD2) as the core gene of PM in gastric cancer. The current study shows that the role of HECTD2 in tumor is contradictory. In this study, our results show that the low expression of HECTD2 indicates that the survival rate of overall survival (OS), progression-free survival (PFS), disease-specific survival (DSS), and disease-free survival (DFS) are better, and can be used as an important component of prognostic indicators. In addition, through pathway enrichment analysis, we found that HECTD2 was mainly involved in metastasis related pathways such as extracellular matrix remodeling and cell adhesion in gastric cancer, and high expression of HECTD2 could activate epithelial-mesenchymal transition (EMT) metastasis related pathways in gastric cancer. In regulating the metastasis of gastric cancer cells, HECTD2 can also change the surrounding microenvironment, induce the enrichment of interstitial components and build an immune microenvironment conducive to tumor progression, while patients with low expression of HECTD2 may be more likely to benefit from immunotherapy. In conclusion, HECTD2 may be a novel biomarker for the diagnosis and prognosis of peritoneal metastasis of gastric cancer, providing basis for the mechanism of peritoneal metastasis of cancer and clinical medication.

A Rare Case of Pancreatic Metastasis of Synovial Sarcoma

Synovial sarcoma is a rare mesenchymal tumor of soft tissue and has high metastatic potential. The most common sites of metastases are the lungs, lymph nodes and bones. The pancreatic location of a synovial sarcoma is very rare. Histological and immunohistochemical examinations are essential to confirm the diagnosis. We report the case of a 57-year-old patient treated for (SS) of pulmonary localization 2 years ago and who currently presents with pancreatic localization.

Retinoic acid receptor responder 2 and lipid metabolic reprogramming: A new insight into brain metastasis.

The brain is a common metastatic site for carcinoma, and metabolic reprogramming is crucial for organ-tropic metastatic formation. Li et al. found RARRES2 deficiency affected lipid metabolic reprogramming through PTEN-mTOR-SREBP1 pathway and promoted BCBrM. Other studies revealed that lipid metabolic reprogramming is part of metabolic adaptation to central nervous system. Overall, there is an intricate connection between lipid metabolism and brain metastases, and disrupting this connection may be a potential therapeutic target for BCBrM treatment.

The clinical outcome, pathologic spectrum, and genomic landscape for 454 cases of salivary mucoepidermoid carcinoma

Mucoepidermoid carcinoma (MEC) is the most common malignant salivary tumor. A complete understanding of the high heterogeneity of MEC in histology and genetics would help in accurate diagnosis and treatment. Therefore, We evaluated the clinical features, treatment outcomes, and pathological parameters of 454 MECs and analyzed their genomic features using whole-exome sequencing and whole-transcriptome sequencing. We found that MECs predominantly occurred in females and those in their 4th–5th decades. The parotid gland was the most frequently affected site. All patients underwent complete mass resection with lobectomy; 414 patients were alive without relapse at follow-up, after an average period of 62 months (1–116 months). The disease progressed after initial treatment in 40 patients. The lungs were the most common site of distant metastasis. For classical MECs, histologic gradings of the AFIP, modified Healey, and MSK systems were significantly associated with recurrence and lymph nodal metastasis; these gradings were significantly related to lymph nodal metastasis for the subtypes. Older age, minor salivary gland involvement, clinical symptoms, high TNM stage, high-grade tumor, and improper surgical modality were the main prognostic factors. BAP1 was the most frequently mutated gene in MEC. Mutations in CDKN2A, MET, and TP53 were more frequently found in aggressive tumor phenotypes. MAML2 rearrangement was observed in 42% of patients, and EWSR1 rearrangement in 8%. Specific genetic events (in TP53 and FBXW7) with CRTC1::MAML2 fusion superimposed might be associated with unfavorable prognosis. This study provides new insights into precision therapeutic strategies for MEC.

Histone deacetylase upregulation of neuropilin-1 in osteosarcoma is essential for pulmonary metastasis

The lungs represent the most common site of metastasis for osteosarcoma (OS). Despite our advances in developing targeted therapies for treating solid malignancies, broad acting chemotherapies remain the first line treatment for OS. In assaying the efficacy of approved therapeutics for non-OS malignancies, we previously identified the histone deacetylase 1 and 2 (HDAC1 and 2) inhibitor, romidepsin, as effective for the treatment of established lung metastatic OS. Yet, romidepsin has noted toxicities in humans and so here we aimed to define the primary mechanisms through which HDAC1/2 mediate OS progression to identify more selective druggable targets/pathways. Microarray and proteomics analyses of romidepsin treated OS cells revealed a significant suppression of neuropilin-1 (NRP1), a known regulator of cancer cell migration and invasion. Silencing of NRP1 significantly reduced OS proliferation, migration, invasion and adhesion in vitro. More strikingly, in vivo, reduced NRP1 expression significantly mitigated the lung metastatic potential of OS in two independent models (K7M2 and SAOS-LM7). Mechanistically, our data point to NRP1 mediating this effect via the down regulation of migration machinery, namely SRC, FAK and ROCK1 expression/activity, that is in part, related to NRP1 interaction with integrin beta 1 (ITGB1). In summary, our data indicate that romidepsin down regulation of NRP1 significantly mitigates the ability of OS cells to seed the lung and establish metastases, and that targeting NRP1 or its effectors with selective inhibitors may be a viable means with which to prevent this deadly aspect of the disease.

Discordance of human epidermal growth factor receptor 2-low status between breast primary and distant metastases with clinical-pathological correlation.

Breast cancer with human epidermal growth factor receptor 2 (HER2) immunohistochemistry (IHC) 1+ or 2+ with negative in-situ hybridisation (ISH) (HER2-low) can now be targeted by HER2 antibody drug conjugates. We set out to compare HER2 status between matched primary invasive breast carcinoma (IBC) and distant metastases (DM) with clinical-pathological correlation, with specific interest in HER2-low. Biomarker studies and clinical-pathological features of primary IBC with matched DM diagnosed between 2021 and 2022 were retrospectively analysed. HER2 status was assessed per 2023 American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) guidelines for IHC (4B5) and ISH (IQFISH pharmDX). Bilateral breast primaries were excluded. HER2 IHC 0 to 1+ were reassessed. One hundred and forty-seven cases of primary IBC with matched DM were identified. Biomarkers were performed on core biopsy (n = 74) and resection (n = 73). One hundred and twenty-six (86%) were initially classified as 'HER2-negative'; of these, 67 (46%) were reclassified as HER2-low. Patients with HER2-positive primaries were younger (P = 0.01) and had an increased incidence of micropapillary carcinoma (P = 0.02). HER2-low primaries also had an increased incidence of micropapillary carcinoma (P = 0.02) and oestrogen receptor (ER) positivity (P = 0.02) compared to HER2 0. One hundred and sixty-nine matched DM cases excluding bone metastasis were identified (range = one to seven metastases per IBC). The most common sites of metastases were liver (50 of 169, 30%), lung (36 of 169; 21%), distant lymph node (26 of 169, 15%); 138 DM cases (82%) were previously classified as 'HER2-negative', and 62 (37%) were reclassified as HER2-low. Like HER2-low primaries, HER2-low metastases were frequently ER-positive (52 of 62; 84%) (P = 0.02). Brain metastases were more frequently HER2-positive (five of 32; 16%) (P = 0.04). Comparing HER2 status in matched primaries and DM, HER2 status was discordant in 62 cases (37%). Most changes occurred from HER2-low to HER2 0 (33 of 169, 20%), HER2 0 to HER2-low (17 of 169, 10%) and HER2-low to positive (10 of 169, 6%). All HER2-low to HER2 0 changes were HER2 1+ to 0. In 30 patients with multiple DM sites (47 cases), HER2 status among different DM samples was discordant in 16 patients (53%), mainly from HER2-low to HER2 0 (16 of 47, 34%). A significant proportion of previous 'HER2-negative' primaries and DM cases were reclassified as HER2-low. Discordant HER2 status between IBC primary and metastasis and between different DM sites demonstrated tumour heterogeneity and highlights the need for HER2 retesting in distant metastasis.

Identification Of Risk Factors Of Bone Metastasis Among Iraqi Breast Cancer Women

Background: The most common site of metastases in people with breast cancer is bone metastasis. Patients with advanced phases of cancer are associated with an increased prevalence of several types of metastases, one of which is bone metastasis. Object: Assessment of the risk factors for bone metastases in patients with breast cancer. Patients and Methods: This is a retrospective study of 316 patients with breast cancer who either had bone metastases at the time of diagnosis or developed it later on. The study was carried out between January 2013 and April 2018. Three hundred and sixteen patients were assigned into two groups. In the case group, 100 patients with breast cancer had been diagnosed with bone metastasis by CT, MRI, bone scan, and PET scan; in the control group, there were 216 cases in are control group with breast cancer metastasis to sites other than bone. The questionnaire was created to record all factors (with the exception of demographic information), such as age, histopathological reading for invasive lobular carcinoma, invasive ductal carcinoma, or another type of cancer, ER status, PR status, Her2neu status, lymph node status and stage, and menopausal status. Results: The majority were 45 years of age or younger, and 96.5% of them had invasive ductal carcinoma in terms of hormonal status. Positive ER and PR status is found in 67.7% and 67.1% of the cases, respectively; 40.5% of the cases had amplified Her2neu receptors, 78.5% of the cases had positive lymph nodes, and 41.9% of the cases had (N1) stage. The highest proportion of bone metastasis was associated with negative ER and PR receptors (46.2% and 49%, respectively), while no significant statistical association (P= 0.65). Conclusion: negative ER, PR status, and Her2neu receptors not amplified, lymph node involvement, age 45 and less, infiltrating lobular carcinoma (ILC) histological type, and menopausal state are significant risk factors for bone metastasis in breast cancer.

Metastatic organotropism in small cell lung cancer.

Metastasis is the leading cause of cancer-related deaths, yet its regulatory mechanisms are not fully understood. Small-cell lung cancer (SCLC) is the most metastatic form of lung cancer, with most patients presenting with widespread disease, making it an ideal model for studying metastasis. However, the lack of suitable preclinical models has limited such studies. We utilized well-annotated rapid autopsy-derived tumors to develop xenograft models that mimic key features of SCLC, including histopathology, rapid and widespread development of metastasis to the liver, brain, adrenal, bone marrow, and kidneys within weeks, and response to chemotherapy. By integrating in vivo lineage selection with comprehensive transcriptomic and epigenomic analyses, we identified critical cellular programs driving metastatic organotropism to the liver and brain, the most common sites of SCLC metastasis. Our findings reveal the key role of nuclear-cytoskeletal interactions in SCLC liver metastasis. Specifically, the loss of the nuclear envelope protein lamin A/C, encoded by the LMNA gene, increased nuclear deformability and significantly increased the incidence of liver metastasis. Human liver metastases exhibited reduced LMNA expression compared to other metastatic sites, correlating with poorer patient outcomes and increased mortality. This study introduces novel preclinical models for SCLC metastasis and highlights pathways critical for organ-specific metastasis, offering new avenues for the development of targeted therapies to prevent or treat metastatic disease.

Is pancreatic adenosquamous carcinoma (PASC) a surgical disease? A large healthcare system review

IntroductionPancreatic cancer represents an increasing cause of cancer-related deaths. Pancreatic adenosquamous carcinoma (PASC) is a rare subtype of pancreas cancer. Optimal treatment is not well-defined. This review aims to provide a detailed analysis of the natural history, management, and outcomes of the patients with PASC within a single large healthcare system. Materials and methodsA large healthcare database was used to retrospectively identify all patients with histological diagnosis of PASC from 2010 to 2020. The cohort was evaluated as a whole and according to the following management modalities: operative, non-metastatic non-operative, and patients with metastatic disease. Abstracted data included patient characteristics, oncologic characteristics at presentation, and details of surgical and non-surgical treatment. ResultsIn total, 60 patients with PASC were identified. All patients had confirmed histopathological diagnosis of PASC. Mean age at the time of diagnosis was 70.9 years, and 28 patients were male (46.7 %). Most patients presented with pancreas head tumors (60 %). Thirty-four patients presented with non-metastatic disease (56.6 %). The operative group consisted of 17 patients (28.3 %). Most patients received adjuvant systemic therapy (70.6 %). Majority of patients experienced recurrence (76.5 %), with median time to recurrence at 6.5 months. Median overall survival in the operative group was 19.1 months. Seventeen patients with non-metastatic disease (28.3 %) did not undergo resection. Median overall survival of this cohort was 3.3 months. Systemic chemotherapy was used in 8 patients. Approximately half of patients with non-metastatic disease (9/17) did not receive any treatment due to rapid physical deterioration or poor functional status at baseline. Median survival for the non-treatment group was 1.7 months. At presentation, 26 patients (43.3 %) had metastatic disease. Most common site of metastasis was the liver. Median survival for patients with metastatic disease was 3.1 months. DiscussionPASC is a distinct entity from glandular PDAC, and it appears to be a more aggressive disease process. Complete resection confers survival benefit but is not curative. Furthermore, few patients undergo surgery, even with seemingly resectable disease. Systemic therapy administration is limited in many patients due to physiologic decline. Dismal clinical course and poor survival is universal among all patients who do not undergo any treatment modality, regardless of metastatic status. Globally grim prognosis appears to be due early systemic effects, disease progression and lack of effective systemic therapy. ConclusionsPASC remains a poorly understood cancer and portends particularly poor prognosis. It is associated with a rapid clinical decline, poor response to systemic therapy, early recurrence, and poor overall survival. However, ability to treat with surgery and chemotherapy may best prolong survival. SynopsisPancreatic adenosquamous carcinoma (PASC) is a rare subtype of pancreatic cancer. In this study, we evaluated 60 patients with PASC. PASC is a systemic disease characterized by rapid clinical decline, poor response to systemic therapy, early recurrence, and poor survival. Despite resection or systemic therapy, patients succumb rapidly.

Correlation between Clinicopathological Features of Soft Tissue Sarcoma and Clinical Outcomes; A Retrospective Study

Abstract Background Sarcoma is a rare and diverse mesenchymal cancer that accounts for fewer than 1% of all adult cancers and 10% of paediatric tumours. Around 11,000 new cases are diagnosed each year in the United States, accounting for <1% of all cancers. Approximately 80% of sarcoma originate from soft tissue, and the rest originate from bone. Most sarcomas (about 55%) affect mainly the extremities, mostly the legs, and about 15% affect the head and neck area or trunk, the rest are retroperitoneal or intraperitoneal. Objective The primary objective is to determine the clinicopathological features and treatment strategies of soft tissue sarcoma and its correlation to clinical outcomes in the form of Overall survival, Disease free survival and Progression free survival in the period from January 2017 to December 2021. Methods This study is a retrospective study that included 151 patients diagnosed with soft tissue sarcoma attending the sarcoma unit at the Clinical Oncology Department, Ain Shams University, in the period between the start of January 2017 to the end of December 2021 Results 151 patients were eligible for overall survival evaluation in which median OS was 80 months. Disease free survival was calculated in 133 patients in our study with median DFS 36 months. Patients presented with metastasis from the start represented 10.5% of the population. Meanwhile 23% of the studied population developed metastasis later on, with median PFS 17 months. The most common site of metastasis was lung in 36.5%. Metastasis at initial presentation had a negative impact on overall survival with p value < 0.001. Resection margin had high impact on overall survival outcomes and recurrence with p value <0.001 and <0.018, respectively. Other clinicopathological factors that had a statistical significance on OS and DFS and local recurrence were; Age, ECOG, tumor size, stage and resection margin. Conclusion STS represents a heterogenous group of malignancies that require multidisciplinary team and referral to experienced tertiary centers. Treatment patterns for STS have evolved with increased utilization of neoadjuvant radiation therapy for patients diagnosed with resectable disease aiming for less toxicity with lower dose and smaller treatment volume, limb sparing surgery with free resection margins and better quality of life. We concluded that the most significant predictors of survival and prognostic factors are; stage at initial presentation, type of surgery and margin status.

Case Series Analysis of Diagnosis and Treatment of Gastrointestinal Metastasis in Lung Cancer Patients.

This study was designed to investigate the clinical, pathological, endoscopic, and imaging characteristics of gastrointestinal metastasis in patients with lung cancer. The clinical data of 20 patients with primary lung cancer with gastrointestinal metastasis. This study included sixteen men and four women, ranging in age from 31 to 75 years. The time interval from the diagnosis of lung cancer to the detection of gastrointestinal metastasis ranged from 13 to 142 months. The most common sites of metastasis were the small intestine (eight cases), colon (four cases), and upper gastrointestinal tract (eight cases). The major symptoms included obstruction, perforation, abdominal pain, abdominal distension, anorexia, and anemia. The predominant pathological type was poorly differentiated adenocarcinoma (seventeen cases). A single ulcer was mostly seen on endoscopy, and some cases showed a slight depression of the intestinal wall. The CT and PET-CT scan revealed bowel wall thickening, intraluminal polypoid masses, and intestinal perforation. Gastrointestinal metastasis of lung cancer is mainly observed in the small intestine, colon, and stomach, and is often detected when severe complications such as gastrointestinal obstruction and perforation occurred. Regular evaluation of gastrointestinal conditions during lung cancer diagnosis and treatment is recommended to improve the diagnostic accuracy and prevent misdiagnosis.

Overview and management of sacral tumors

Sacral tumors can range from benign to malignant. The sacrum is a common site of metastases however surgical intervention is not common for sacral metastases unless there is neurological compromise. Benign aggressive tumors such giant cell tumors, osteoblastomas and aneurysmal bone cysts (ABC) can be found in the sacrum. Malignant primary tumors including chordoma, chondrosarcomas and osteosarcomas can affect the sacrum. Management depends on the tumor histology including debulking and stabilization for metastatic spine lesions. For benign tumors such as ABCs, intralesional resection is an option. For primary spine tumors partial or total sacrectomies are an option and morbidity is dependent on the level of sacral resection.

Metastasis patterns and prognosis in patients with gastric cancer: a Surveillance, Epidemiology, and End Results-based analysis.

Gastric cancer is one of the most commonly diagnosed malignancies, and a majority of patients with gastric cancer are diagnosed at an advanced stage. However, the association between metastatic patterns and survival outcomes in patients with advanced gastric cancer has not been fully explored. In the present study, we aimed to investigate the metastatic patterns and their association with prognosis in patients with gastric cancer. We collected and reviewed data of patients with metastatic gastric cancer from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2015. The Kaplan-Meier method was used to create survival curves, and the Cox proportional regression model was applied to analyze the association between metastatic pattern and prognosis. A total of 10,262 patients were enrolled in the present study. Among them, 4,699 (45.79%) had single-site metastasis, including 3,358 (32.72%) with liver-only metastasis, 699 (6.81%) with bone-only metastasis, 560 (5.46%) with lung-only metastasis, and 82 (0.80%) with brain-only metastasis. Moreover, 1,308 (12.75%) patients had multisite metastases, and 4,255 (41.46%) patients had distant metastases but no other detailed information. The median overall survival for patients with single-site and multisite metastases was 4 and 3 months, respectively. The multivariate Cox regression analysis showed that compared with bone-only metastasis, liver-only metastasis (P<0.001) and lung-only metastasis (P=0.001) were associated with better prognosis. The liver is the most common metastatic site in patients with gastric cancer. N stage, chemotherapy, surgery, and metastatic pattern are independent risk factors associated with prognosis.

Contrast-Enhanced Ultrasound-Based Radiomics for the Prediction of Axillary Lymph Nodes Status in Breast Cancer.

Breast cancer is the leading cause of cancer-related deaths in the female population. Axillary lymph nodes (ALN) are a group of the most common metastatic sites of breast cancer. Timely assessment of ALN status is of paramount clinical importance for medical decision making. To utilize contrast-enhanced ultrasound (CEUS)-based radiomics models for noninvasive pretreatment prediction of ALN status. Clinical data and pretreatment CEUS images of primary breast tumors were retrospectively studied to build radiomics signatures for pretreatment prediction of nodal status between May 2015 and July 2021. The cases were divided into the training cohorts and test cohorts in a 9:1 ratio. The mRMR approach and stepwise forward logistic regression technique were used for feature selection, followed by the multivariate logistic regression technique for building radiomics signatures in the training cohort. The confusion matrix and receiver operating characteristic (ROC) analysis were used for accessing the prediction efficacy of the radiomics models. The radiomics models, which consist of six features, achieved predictive accuracy with the area under the ROC curve (AUC) of 0.713 in the test set for predicting lymph node metastasis. The CEUS-based radiomics is promising to be developed as a reliable noninvasive tool for predicting ALN status.

Outcome of radiotherapy for metastatic neuroblastoma

Background. Neuroblastoma (NB) is a prevalent solid extracranial tumor that primarily affects children. It is the third most common type of cancer in children, following leukemia and brain tumors. Aim. The study aimed to discuss the clinical outcomes after adjuvant radiotherapy to the primary site in case of metastatic NB after good response to chemotherapy. Methods. A retrospective clinical-dosimetric study of 25 patients metastatic NB treated with radiotherapy at Baghdad Radiotherapy and Nuclear Medicine Center, at Baghdad Medical City Complex, Baghdad, Iraq. Data collection begin from December 2023 and March 2024. Data were collected retrospectively with review of records. The following variables were studied: sex, age, date of diagnosis, site of primary tumor, site of metastasis, chemotherapy, surgery, RT, RT sites, doses of RT, fractions of RT, recurrence sites, date of relapse and survival outcome for each patient. Follow-up period include look up to metastasis, site of metastasis, recurrence, site of recurrence and survival rates. Results. In relation to sex, males (14, 56%) were more than females (11, 44%). The mean age of NB cases was 45.64±17.6 months. In NB, suprarenal masses were the most common site of primary in 21 (84%) of patients. The most common site of metastasis of NB was bone marrow in 12 (48). The multi sites of recurrence was the commonest presentation in 48%. The relapse-free survival (RFS) was 22.38 months. 5 out of 25 patients were alive whereas 20 (80%) of cases were dead. The median follow-up time was 6 years, and the OS of NB in this study after optimal treatment was 2.46 years (95%CI= 1.705-3.21) for survivors. The MS was 4.84 years. The OS was 6 yrs for those diagnosed at 2017, 2 yrs for those diagnosed at 2018, 1.5 yrs for those diagnosed at 2019, 1.75 yrs for those diagnosed at 2020, 3 yrs for those diagnosed at 2021 and 1.5 yrs for those diagnosed at 2022. There was a significant difference among doses (Log Rank (Mantel-Cox)= 11.425, p=0.044). Conclusions. This study is the first study in Iraq that examines the clinical results of radiotherapy on the primary site in cases of metastatic neuroblastoma following induction chemotherapy. The suprarenal masses of neuroblastoma are the most often occurring main site. The primary sites of metastases for neuroblastoma (NB) are the bone marrow and bones. Timely detection and proactive treatment of NB can improve overall results. Reoccurrence of skeletal issues and the infiltration of bone marrow are frequently observed. There were no significant differences observed in terms of relapse-free survival and overall survival based on factors such as sex, age, location of the main tumor, chemotherapy, radiation treatment, surgery, and radiation therapy dosages.