Diagnosis In Advanced Stages Research Articles

Three-Year Analysis of the Rectal Cancer Care Trajectory after the COVID-19 Pandemic.

The global pandemic period from 2020 to 2022 caused important alterations in oncology care. This study aimed to describe the trends and variations in patient characteristics, comorbidities, and treatment approaches during this time in Romania. We conducted a retrospective database search to identify patients with rectal cancer who underwent surgical intervention between 2020 and 2022 and the year 2019, which served as a pre-pandemic period control. This study included 164 patients, with a yearly increase of approximately 10% in surgical interventions noted from 2020 (1709 interventions) to 2022 (2118 interventions), but an overall 34.4% decrease compared with the pre-pandemic period. Notable shifts were observed in the type of surgeries performed, with laparoscopic procedures doubling from 2020 (25%) to 2022 (47.5%), confirming the decrease in emergency presentations during the last year of the COVID-19 pandemic and a recovery to normality with planned, elective interventions. Elective interventions increased significantly in 2022 (79.7%) compared with the previous years (p = 0.043), with a concurrent rise in neoadjuvant therapy uptake in 2022 (35.6%). However, significant alterations in the TNM staging, from 12.5% stage IV cases in 2020 to 25.4% in 2022 (p = 0.039), indicated an increased diagnosis of advanced stages of rectal cancer as the years progressed. There was a significant difference in albumin levels over the years (p = 0.019) and in the American Society of Anesthesiology (ASA) scores (from 6.2% ASA stage IV in 2020 to 16.9% in 2022), denoting an increase in case complexity (p = 0.043). This study reveals a trend of increasing surgical interventions and the prevalence of more advanced stages of rectal cancer during the pandemic years. Despite the subtle fluctuations in various patient characteristics and treatment approaches, notable shifts were documented in the severity at diagnosis and surgery types, pointing toward more advanced disease presentations and changes in surgical strategies over the period studied. Nevertheless, the trends in ICU admission rates and mortality did not alter significantly during the pandemic period.

Malignant Melanoma of the jaw and oral mucosa - A rare diagnosis to consider when assessing high-grade tumors on small biopsies

Abstract Introduction/Objective Malignant melanoma arises from neural crest-derived cells called melanocytes. These melanocytes migrate to several sites, including the skin and the mucous membranes. Oral melanoma (OM) cases account for <1% of all melanoma cases and <2% of all oral malignancies. Primary malignant melanoma of the jaw is an even rarer entity. Most OM cases arise in the palate and the maxillary alveolar gingivae. Other sites, such as mandibular gingiva and buccal mucosa, are rarely involved. The etiopathogenesis remains unclear, with stimulation of melanoblasts being one of the proposed hypotheses. The incidence is highest in the fifth and sixth decades of life and occurs more commonly in males than females. Clinically, it remains an asymptomatic pigmented growth until it reaches advanced stages. Diagnosis in advanced stages leads to OM having an overall survival (OS) rate of just 15.4% at 10 years with an abysmal prognosis. These neoplasms are highly invasive and metastasize quickly. Of mutations, KIT (14.6%), BRAF (7%) and NRAS (5.6%) were the most frequently encountered in OM cases. Methods/Case Report We searched for “oral melanoma” in our healthcare system for the last 10 years- from 2013 to 2022. 4 cases were selected for this case series, and pertinent information was pulled from CoPath and Epic software. The cases were then analyzed, and the results were reported. Results (if a Case Study enter NA) In our case series, we found the mean age to be 78.5 years, with 75% (3 of 4) of the patients being male and the rest 25% (1 of 4) female. Three cases were diagnosed with melanoma or malignant melanoma, while the 4th case had atypical melanocytic proliferation favoring malignant melanoma as the diagnosis. Regarding the tumour site, 1 case arose in the right anterior maxilla, 2 cases involved the mandible (left mandible and right anterior mandibular vestibule, respectively), and 1 case was present in the buccal mucosa. Microscopic findings and immunohistochemistry results concurred with the diagnoses. Conclusion Herein, we present 3 cases (out of the 4) from rarer sites, such as the mandible and oral mucosa, as opposed to the typical sites- the palate and the maxilla. Discussing rarer cases helps physicians to keep these in the differential while examining similar tumors. Additionally, having rarer cases adds to the literature and focuses attention on entities that require more study and research. Since these neoplasms are highly invasive and metastasize quickly, they necessitate an early diagnosis for effective management.

Factors associated with advanced-stage diagnosis of cervical cancer in Estonia: a population-based study

ObjectivesCervical cancer (CC) remains a crucial public health issue in Estonia, with high incidence and late diagnosis. The aim of this study was to examine time trends of stage-specific CC incidence in Estonia and factors associated with advanced-stage diagnosis of CC. Study designThis was a nationwide population-based retrospective study. MethodsData on CC cases diagnosed in Estonia in 2007–2018 were obtained from the Estonian Cancer Registry, including tumour, nodes, metastases stage at diagnosis. Sociodemographic data were obtained from the Population Registry. To estimate the risk of advanced-stage diagnosis (stages II–IV vs stage I) associated with sociodemographic factors, Poisson regression with robust variance was used to calculate univariate and multivariate prevalence ratios (PR) with 95% confidence intervals (CIs). Time trends of stage-specific CC incidence for 2005–2019 were examined with joinpoint analysis. ResultsIncidence of stage I CC showed a significant decline of 4.9% per year since 2007, whereas no change was seen for other stages. Of the 2046 women diagnosed in 2007–2018, 1137 (55.6%) were diagnosed at an advanced stage; this proportion increased from 51% in 2007–2009 to 58% in 2015–2018 (P = 0.004). Multivariate regression analysis showed that advanced-stage diagnosis was associated with age (PR 2.16, 95% CI 1.87–2.49 for women aged ≥75 years compared with those aged 30–44 years), educational level (PR 1.32, 95% CI 1.15–1.51 for women with basic/primary education compared to university education) and marital status (PR 1.14, 95% CI 1.01–1.29 for single women compared to married/cohabiting women). No associations were observed by region of residence or nationality. ConclusionsTo reduce CC mortality, it is crucial to improve prevention and early diagnosis of CC in Estonia through human papillomavirus vaccination and effective and quality-assured screening particularly targeting high-risk groups as well as encouraging symptom awareness and regular check-ups among older women.

OGC P41 Presentation, Management and Outcomes in Young Patients Diagnosed with Oesophageal Cancer

Abstract Background Oesophageal cancer is a devastating malignancy associated with poor prognosis, primarily affecting older individuals with multiple co-morbidities. However, outcomes of younger patients have been perceived as poor due to late diagnosis and more aggressive disease subtype. This subset of patients poses unique clinical challenges and requires a better understanding of their outcomes. This comprehensive retrospective cohort study aimed to evaluate the patient characteristics, treatment modalities, and survival outcomes of young patients diagnosed with oesophageal cancer, to provide further insights into this understudied population. Methods A retrospective analysis was conducted using electronic medical records from a regional oesophago-gastric cancer service serving 3.5 million people across the North West of England, encompassing a 5-year period between January 2018 and December 2022 inclusive. Young patients were defined as being 50 or younger at the time of diagnosis of oesophageal cancer. Clinical and pathological data, including tumour characteristics, treatment approaches, and survival outcomes, were collected. Survival analysis was performed utilising Kaplan-Meier estimates, and survival rates following oesophagectomy were compared to publicly available outcomes. Results 87/2485 (3.5%) of patients studied were aged 50 or below at the time of diagnosis. Mean age at diagnosis was 44.3 (range = 24-50); 71% were male. Adenocarcinoma and SCC accounted for 73% (33% poorly differentiated, 40% moderately differentiated) and 25% of cases respectively. The majority presented with c-stage III (24%), c-stage IVa (17%) and c-stage IVb (46%) disease. Initial treatment intent was curative in 43%. 1-and 3-year overall survival rates were 49% and 21% respectively - similar to the wider population. 1- and 3-year survival rates after oesophagectomy were 80% and 44.5% (versus 82.5% and 59.5% for wider population). Conclusions Our findings underscore the concerns about the proportion of advanced-stage diagnosis in young patients with oesophageal cancer, and poorer longer-term outcomes after curative resection. This highlights the importance of timely detection and appropriate treatment strategies in this patient group. Future research should focus on understanding the underlying mechanisms in this group, exploring novel therapeutic strategies as well as validating these finding in larger and more diverse patient populations.

AUM302, a novel triple kinase PIM/PI3K/mTOR inhibitor, is a potent in vitro pancreatic cancer growth inhibitor.

Pancreatic cancer is one of the leading causes of cancer deaths, with pancreatic ductal adenocarcinoma (PDAC) being the most common subtype. Advanced stage diagnosis of PDAC is common, causing limited treatment opportunities. Gemcitabine is a frequently used chemotherapeutic agent which can be used as a monotherapy or in combination. However, tumors often develop resistance to gemcitabine. Previous studies show that the proto-oncogene PIM kinases (PIM1 and PIM3) are upregulated in PDAC compared to matched normal tissue and are related to chemoresistance and PDAC cell growth. The PIM kinases are also involved in the PI3K/AKT/mTOR pathway to promote cell survival. In this study, we evaluate the effect of the novel multikinase PIM/PI3K/mTOR inhibitor, AUM302, and commercially available PIM inhibitor, TP-3654. Using five human PDAC cell lines, we found AUM302 to be a potent inhibitor of cell proliferation, cell viability, cell cycle progression, and phosphoprotein expression, while TP-3654 was less effective. Significantly, AUM302 had a strong impact on the viability of gemcitabine-resistant PDAC cells. Taken together, these results demonstrate that AUM302 exhibits antitumor activity in human PDAC cells and thus has the potential to be an effective drug for PDAC therapy.

A CROSS-SECTIONAL STUDY EVALUATING THE ASSOCIATION OF PATIENT LITERACY WITH THE STAGE OF PENILE CARCINOMA

Background: Penile carcinoma is a rare and often late-diagnosed malignancy associated with advanced-stage presentation and poor prognosis. Health literacy, the ability to understand and apply health information, is crucial in healthcare-seeking behavior and early diagnosis. Methods: This cross-sectional study, conducted over 12 months at a tertiary care center, included 150 patients diagnosed with penile carcinoma. Patient literacy was categorized into four levels based on educational background. Data on demographic and clinical variables, such as age, smoking status, circumcision status, HPV infection, and the time to medical consultation, were collected. The TNM classification system was used to determine the disease stage. Results: Lower patient literacy levels were significantly associated with an increased likelihood of advanced-stage penile carcinoma presentation (p < 0.001). Patients with limited literacy, particularly those with "No Education," exhibited longer delays in seeking medical attention, contributing to the advanced stage at diagnosis. Additional factors, such as circumcision status and the time to medical attention, were also linked to disease stage. Discussion: This study underscores the critical role of health literacy, categorized into distinct educational levels, in penile carcinoma presentation. Patients with lower literacy levels face barriers to recognizing symptoms and seeking timely medical attention, ultimately resulting in advanced-stage diagnosis. The findings highlight the need for tailored health education and awareness campaigns, especially in communities with varying educational backgrounds. Conclusion: Patient literacy is associated with advanced-stage penile carcinoma presentation. Addressing disparities in health literacy and promoting awareness of penile carcinoma symptoms may enhance early diagnosis and treatment outcomes. The study emphasizes the multifaceted nature of cancer risk factors, underlining the importance of considering cultural and healthcare-related elements in future research and public health efforts.

Rare breast cancers with seemingly benign features on conventional imaging: Radio-pathological correlation and review of literature

Oval or rounded breast masses with circumscribed margins, absence of microcalcifications, and architectural distortions are usually benign. However, 10-20% of breast cancers may have circumscribed margins, which may be misdiagnosed as benign breast mass or lead to delayed diagnosis in advanced stages of cancer. Most frequently, circumscribed breast cancers are high-grade invasive ductal carcinoma of triple-negative molecular subtype. However, there are many other rare histological subtypes of cancers in the breast with circumscribed margins or less aggressive features on imaging and mimic benign breast lesions. A radiologist needs to be familiar with the imaging features of various atypical malignant breast tumors to avoid delay in diagnosis. These rare malignant breast tumors are mucinous carcinoma, papillary carcinoma, lymphoma, leukemia, myeloma, metastasis from extramammary primaries, adenoid cystic carcinoma, signet-ring carcinoma, malignant phyllodes tumor, mesenchymal sarcoma, Ewing’s sarcoma, and medullary carcinoma. This pictorial review illustrates the clinical, multimodality imaging features of rare malignant breast tumors with less aggressive features on conventional breast imaging with pathological correlation.

Prognosis and Treatment Outcomes of Bone Metastasis in Gallbladder Adenocarcinoma: A SEER-Based Study.

Gallbladder carcinoma (GBC) is a rare, aggressive malignancy comprising 0.5% of gastrointestinal cancers. It has poor survival outcomes due to its insidious onset, lack of standardized screening, and limited therapies. Advanced-stage diagnosis with liver, lymph node, and peritoneal metastasis is common, while bone metastasis is rare. The knowledge on bone metastasis in GBC is limited to case reports and small series, and its clinical significance is largely unexplored. The study extracted the demographic and clinical variables of patients with metastatic (M1) gallbladder adenocarcinoma from the Surveillance, Epidemiology, and End Results (SEER) database between 2011 and 2020. Descriptive statistics were used to analyze the demographic characteristics. The multivariate Cox regression analysis was used to calculate the hazard ratio. The overall survival (OS) was assessed using the Kaplan-Meier method, and the log-rank test was utilized to compare the survival between the groups. A total of 2724 patients were included in the study. A total of 69% of the patients were female, and the median age was 68 (range 24-90+). A total of 7.4% of the patients had bone metastasis on diagnosis. The multivariate Cox analysis identified bone metastasis as an independent mortality risk factor in metastatic GBC (HR 1.50, p < 0.001). The patients were divided into two age groups: a younger age group (18-74 years) and an older age group (75+ years). In the younger group, the median OS with and without bone metastasis was 3 and 5 months, respectively (p < 0.0001). In the older age group, there was no significant difference in the OS between the patients with and without bone metastasis (p = 0.35). In the younger group who were treated with chemotherapy, the patients with bone metastasis had a significantly worse OS (median OS 5 months vs. 8 months, p < 0.0001). In the untreated group, the patients with bone metastasis in the younger age group had a significantly worse OS (median OS 1 month vs. 2 months, p = 0.014). In the patients with bone metastasis, those who did not receive chemotherapy had a significantly worse OS than those who were treated with chemotherapy in both age groups (younger age group: median OS 1 month vs. 5 months, p < 0.0001 and older age group: median OS 1 month vs. 5 months, p = 0.041). Our findings suggest that the presence of bone metastasis in gallbladder adenocarcinoma is an independent prognostic factor associated with unfavorable survival outcomes in the younger age group (18-74 years). However, in the older age group (75+ years), the presence of bone metastasis did not impact the survival. Treatment with chemotherapy was associated with extended survival in all patients. Thus, early detection and aggressive management of bone metastasis, including the consideration of chemotherapy, may be crucial in improving the OS and quality of life for individuals with gallbladder adenocarcinoma.

MicroRNA-495: a therapeutic and diagnostic tumor marker.

Therapeutic and diagnostic progresses have significantly reduced the mortality rate among cancer patients during the last decade. However, there is still a high rate of mortality among cancer patients. One of the important reasons involved in the high mortality rate is the late diagnosis in advanced tumor stages that causes the failure of therapeutic strategies in these patients. Therefore, investigating the molecular mechanisms involved in tumor progression has an important role in introducing the efficient early detection markers. MicroRNAs (miRNAs) as stable factors in body fluids are always considered as non-invasive diagnostic and prognostic markers. In the present review, we investigated the role of miR-495 in tumor progression. It has been reported that miR-495 has mainly a tumor suppressor function through the regulation of transcription factors and tyrosine kinases as well as cellular processes such as multidrug resistance, chromatin remodeling, and signaling pathways. This review can be an effective step towards introducing the miR-495 as a non-invasive diagnostic/prognostic marker as well as a suitable target in tumor therapy.

Determining the clinical utility of a breath test for screening an asbestos-exposed population for pleural mesothelioma: baseline results

Pleural mesothelioma (PM) is an aggressive cancer of the serosal lining of the thoracic cavity, predominantly caused by asbestos exposure. Due to nonspecific symptoms, PM is characterized by an advanced-stage diagnosis, resulting in a dismal prognosis. However, early diagnosis improves patient outcome. Currently, no diagnostic biomarkers or screening tools are available. Therefore, exhaled breath was explored as this can easily be obtained and contains volatile organic compounds, which are considered biomarkers for multiple (patho)physiological processes. A breath test, which differentiates asbestos-exposed (AEx) individuals from PM patients with 87% accuracy, was developed. However, before being implemented as a screening tool, the clinical utility of the test must be determined. Occupational AEx individuals underwent annual breath tests using multicapillary column/ion mobility spectrometry. A baseline breath test was taken and their individual risk of PM was estimated. PM patients were included as controls. In total, 112 AEx individuals and six PM patients were included in the first of four screening rounds. All six PM patients were correctly classified as having mesothelioma (100% sensitivity) and out of 112 AEx individuals 78 were classified by the breath-based model as PM patients (30% specificity). Given the large false positive outcome, the breath test will be repeated annually for three more consecutive years to adhere to the ‘test, re-test’ principle and improve the false positivity rate. A low-dose computed tomography scan in those with two consecutive positive tests will correlate test positives with radiological findings and the possible growth of a pleural tumor. Finally, the evaluation of the clinical value of a breath-based prediction model may lead to the initiation of a screening program for early detection of PM in Aex individuals, which is currently lacking. This clinical study received approval from the Antwerp University Hospital Ethics Committee (B300201837007).

Does Community Affluence Improve Survival of Colorectal Cancer?

Colorectal cancer is the second most common cause of cancer-related death in the U.S. Lower SES and lack of health insurance coverage are 2 known risk factors for lower colorectal cancer survival. The primary objective of this research is to evaluate the survival rates of patients diagnosed with colorectal cancer who reside in an affluent suburb and to examine factors that may impact mortality. Information was collected from the Stony Brook Cancer Center registry for all cases of colorectal cancer diagnosed between 2010 and 2020. The Distressed Community Index, a proxy for SES based on geographic location and data obtained from the U.S. Census, was paired with patient ZIP codes to evaluate the impact of prosperity on survival. Chi-square tests, Kaplan-Meier survival curves, and hazard ratios are presented. Among 946 patients with colorectal cancer, more than half resided in a prosperous (Distressed Community Index ≤ 20) ZIP code. Age and sex were similar between Distressed Community Index groups; however, a significant association was found between Black race and Distressed Community Index score >20 (p<0.01). Patients who were married were more likely to live in a prosperous ZIP code (p<0.01), whereas those with Medicaid health insurance were more likely to reside in a nonprosperous community (p<0.01). More than 75% of cases were diagnosed at Stage 2 or higher, and survival rates at 1 year and 5 years were 84.6% and 59.2%, respectively. Stage at diagnosis and overall survival were not associated with Distressed Community Index status. Older age (≥70 years) (hazard ratio=2.43, 95% CI=1.18, 5.01) and late stage at diagnosis (hazard ratio= 12.24, 95% CI=6.86, 21.81) were found to be associated with increased mortality at 5 years. In this relatively affluent study population from a tertiary care facility registry, improved survival rates among patients with colorectal cancer were not observed compared with national averages. Advanced stage of diagnosis and older age increased mortality in persons with colorectal cancer. Because early detection remains one of the most important tools for improving survival outcomes, efforts to increase screening education and reduce barriers as well as address challenges with screening adherence would likely benefit the population at risk, irrespective of community prosperity.

Pre-diagnosis Symptoms, Attributed Causes, and Healthcare Seeking Assets of Younger Colorectal Cancer Survivors.

Younger onset colorectal cancer (CRC) rates continue to rise. Survivors younger than the requisite age of population-based screening guidelines experience adverse symptoms, longer appraisal delays, and more advanced-stage diagnoses. This secondary analysis of interviews with n=252 recently diagnosed CRC survivors was completed to compare younger and older survivors' symptoms, attributed causes, and healthcare seeking assets. The original transcripts and quantitative data were divided into two survivor classifications, younger (age <50 years) (N=64) and older (N=188). Bivariate analyses assessed differences between younger and older survivors for symptoms, attributed causes, and seeking healthcare assets. Multiple logistic regression models adjusting for race, sex, income, education, and stage of diagnosis were conducted for significant bivariate findings. An α level .05 was used to detect significance. Bleeding (𝛘2=3.8, p =0.05) and loss of appetite/weight differed between survivors (𝛘2=5.3, p=0.02) but not after controlling for sex and race respectively. Younger survivors were more likely to report being too young/healthy to have cancer (𝛘2=7.8, p<0.01) and social support encouragement to seek healthcare (𝛘2=6.4, p=0.01). Having a regular healthcare provider was more common among older survivors (𝛘2=6.4, p=0.01). Logistic regression models also detected age as a significant predictor for all healthcare seeking assets. Clinical and public health practice can benefit from understanding that CRC symptoms may present similarly but assets that facilitate seeking healthcare appraisal differ based upon age. Expanding knowledge of CRC risk factors and symptoms across healthcare professionals and the general public could promote earlier appraisal regardless of age and improve outcomes for younger survivors.

Gene selection with Game Shapley Harris hawks optimizer for cancer classification

Cancer disease has been classified as a perilous disease for humans, being the second leading cause of death globally. Even advanced-stage diagnosis may not be effective in preventing patient mortality. Therefore, it is important to establish a sustainable framework that predicts reliable estimates for an early cancer diagnosis. In this paper, a new two-phase feature (gene) selection approach is presented. In the first phase, the kernel Shapley value (kSV) that is based on the cooperative game-theoretic feature extraction approach is utilized to extract the important feature from the high dimensional gene expression data. In the second phase, Harris hawks optimizer (HHO) algorithm is utilized to further optimize the most effective feature extracted by kSV. Next, to evaluate the effectiveness of our proposed algorithm, we conduct extensive experiments on eight benchmark high-dimensional gene expression datasets, comparing them with other state-of-the-art techniques. We employ three classifiers, namely support vector machines (SVM), Naive Bayes (NB), and K-nearest neighbors (KNN), to assess the selected genes efficacy and their impact on classification accuracy. The experimental results demonstrate that the proposed method, particularly when combined with the SVM classifier, outperforms other gene selection methods. The evaluation metrics, including accuracy, precision, recall, F1-score, ROC-AUC, box plot, and radar plot, consistently indicate the superiority of kSV-HHO across all tested datasets. Moreover, the comparative and statistical analysis reveals that our proposed method excels in identifying the most relevant features for cancer diagnosis compared to other gene selection approaches. This makes our framework a valuable tool for cancer research and clinical practice, potentially enhancing the accuracy of early cancer diagnosis using high-dimensional gene expression biomedical data.

Comparison of the Treatment Response of Drug-Eluting Bead Transarterial Chemoembolization and Conventional Transarterial Chemoembolization in Patients With Hepatocellular Carcinoma.

Introduction Hepatocellular carcinoma (HCC) is a common primary hepatic cancer. Its early diagnosis can aid in its treatment by curative means such as surgery or ablation. Advanced-stage diagnosis limits these treatment options, and such cases can be treated with transarterial chemoembolization (TACE). Conventional transarterial chemoembolization (cTACE) and drug-eluting beadtransarterial chemoembolization (DEB-TACE) are usually used, and follow-up response is evaluated using modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria. This study was done to compare the treatment response of cTACE and DEB-TACE in patients with HCC. Materials and methods A retrospective review of electronic medical records of all patients diagnosed with HCC from January 2021 to August 2022 who underwent cTACE or DEB-TACE was undertaken at the Department of Interventional Radiology, Indus Hospital and Health Network. Both male and female patients aged 18 years or above with Child-Pugh class A and B were included. DEB-TACE or cTACE was performed by a fellowship-trained interventional radiologist, and the response was evaluated at six weeks follow-up using mRECIST criteria. Results A total of 129 patients were included in this study, with a mean age of 54.1 ± 10.8 years. The mean size of HCC was 3.1 ± 1.7 cm. Seventy-eight (60.5%) patients underwent cTACE, and 51 (39.5%) underwent DEB-TACE. Out of the 78patients who underwent cTACE, complete response (CR) was found in 28 (35.9%), partial response (PR)was found in 33 (42.3%), stable disease (SD) was found in 12 (15.4%), and progressive disease (PD) was found in five (6.4%) patients. Of the 51 patients who underwentDEB-TACE, CR was found in 13 (25.5%), PR was found in 20 (39.2%), SD was found in 11 (21.6%), and PD was found in seven (13.7%) patients. Conclusion The response rate of TACE in the form of complete or partial response was higher with a lower frequency of stable or progressive disease. cTACE has a high response rate as compared to DEB-TACE.

Effects of the COVID-19 pandemic on delays in diagnosis-to-treatment initiation for breast cancer in Brazil: a nationwide study.

Short period from diagnosis to breast cancer (BC) treatment initiation remains challenging for the public health system in Brazil, which may have been further affected by the coronavirus disease-2019 (COVID-19) pandemic. This study assessed BC diagnosis-to-treatment intervals (DTi) in Brazil and the possible effects of the COVID-19 outbreak on delays. The Painel de Monitoramento de Tratamento Oncológico database was queried to obtain the number of Brazilian patients with a BC confirmed diagnosis and initiating cancer treatment in the pre-COVID-19 (2013-2019) and during the COVID-19 (2020-2021) periods, adopting a 60-day limit as timely treatment. A p-value of <0.05 was considered significant. A total of 315,951 cases were included (females: 99.3% and males: 0.7%), of which 251,667 and 64,284 records were computed before and during the COVID-19 years, respectively. Most patients failed to perform the first cancer treatment within 60 days (>60: 51.8%). We observed an upward trend in the number of BC treatments provided in the pre-COVID-19 years (r2 = 0.9575; p < 0.05), but the volume of treatments exhibited an average reduction of 24.6% yearly during the COVID-19 pandemic. The average DTi in days was 122.4, 122.5 and 122.3 in the total period studied, before and during the COVID-19 outbreak, respectively. The arrival of COVID-19 in Brazil increased the chances of treatment delay (OR = 1.043; p < 0.05) and inverted the proportion of early/advanced stages at BC diagnosis (55.8%/44.2%-48.4%/51.6%). COVID-19 has imposed changes in BC care in Brazil, reducing the number of treatments provided by the Brazilian public health system, increasing the chances of delayed treatment initiation despite no differences in DTi averages being identified, and raising the proportion of advanced-stage diagnoses.

Association between COPD and Stage of Lung Cancer Diagnosis: A Population-Based Study.

Chronic obstructive pulmonary disease (COPD) is associated with an increased risk of lung cancer; however, the association between COPD and stage of lung cancer diagnosis is unclear. We conducted a population-based cross-sectional analysis of lung cancer patients (2008-2020) in Ontario, Canada. Using estimated propensity scores and inverse probability weighting, logistic regression models were developed to assess the association between COPD and lung cancer stage at diagnosis (early: I/II, advanced: III/IV), accounting for prior chest imaging. We further examined associations in subgroups with previously diagnosed and undiagnosed COPD. Over half (55%) of all lung cancer patients in Ontario had coexisting COPD (previously diagnosed: 45%, undiagnosed at time of cancer diagnosis: 10%). Compared to people without COPD, people with COPD had 30% lower odds of being diagnosed with lung cancer in the advanced stages (OR = 0.70, 95% CI: 0.68 to 0.72). Prior chest imaging only slightly attenuated this association (OR = 0.77, 95% CI: 0.75 to 0.80). The association with lower odds of advanced-stage diagnosis remained, regardless of whether COPD was previously diagnosed (OR = 0.68, 95% CI: 0.66 to 0.70) or undiagnosed (OR = 0.77, 95% CI: 0.73 to 0.82). Although most lung cancers are detected in the advanced stages, underlying COPD was associated with early-stage detection. Lung cancer diagnostics may benefit from enhanced partnership with COPD healthcare providers.

Circular RNAs as the pivotal regulators of epithelial-mesenchymal transition in gastrointestinal tumor cells.

Gastrointestinal (GI) cancers, as the most common human malignancies are always considered one of the most important health challenges in the world. Late diagnosis in advanced tumor stages is one of the main reasons for the high mortality rate and treatment failure in these patients. Therefore, investigating the molecular pathways involved in GI tumor progression is required to introduce the efficient markers for the early tumor diagnosis. Epithelial-mesenchymal transition (EMT) is one of the main cellular mechanisms involved in the GI tumor metastasis. Non-coding RNAs (ncRNAs) are one of the main regulatory factors in EMT process. Circular RNAs (circRNAs) are a group of covalently closed loop ncRNAs that have higher stability in body fluids compared with other ncRNAs. Considering the importance of circRNAs in regulation of EMT process, in the present review we discussed the role of circRNAs in EMT process during GI tumor invasion. It has been reported that circRNAs mainly affect the EMT process through the regulation of EMT-specific transcription factors and signaling pathways such as WNT, PI3K/AKT, TGF-β, and MAPK. This review can be an effective step in introducing a circRNA/EMT based diagnostic panel marker for the early tumor detection among GI cancer patients.

The social determinants associated with the advanced stage diagnosis of breast cancer in Egypt in the previous ten years: a single-center quantitative retrospective cohort study

The social determinants associated with the advanced stage diagnosis of breast cancer in Egypt in the previous ten years: a single-center quantitative retrospective cohort study

Evaluation of the Survival Outcomes of Intestinal Adenosquamous Carcinomas Using the SEER 18 Registry: What Do We Know?

Background: Intestinal adenosquamous carcinoma (ASC) is a rare malignancy. This study evaluated overall survival of this malignancy in the small intestine, colon, and rectum. Methods: Using the Surveillance, Epidemiology, and End Results (SEER) 18 registry, we analyzed cases from 2000 through 2015 by Cox proportional hazards using univariate and multivariate analysis, adjusting for age, primary tumor site, tumor grade, and type of surgery performed to calculate the hazard ratios for overall survival. All analyses were performed on R version 4.0.5. Results: We identified 332 patients with ASC: small intestine ( n = 20, 6.02%), colon ( n = 200, 60.2%) and rectum ( n = 112, 33.7%). Age of diagnosis was significantly different between the groups: 44.5, 40, and 36, for small intestine, colon, and rectum, respectively ( p &lt; 0.05). The 5-year survival for small intestine, colon, and rectum were 5.0%, 24.9% and 42.5%, respectively ( p &lt; 0.001). Based on grade of cancer at diagnosis, overall 5-year survival was 61% for 1, 39.9% for 2, 25.9% for 3/4 tumors, and 24.1% for tumors of unknown grade with significant difference ( p = 0.006). The overall hazard ratio in poorly differentiated grade 3 tumors was 3.17 times that of well-differentiated tumors (95% CI, 1.01–9.96, p &lt; 0.05). The overall hazard ratio for death in patients without any surgical intervention was 3.33 (95% CI, 2.34–4.72, p &lt; 0.001) compared to patients who had surgery. Conclusion: There was high rate of diagnosis in advanced stages of ASC, which was associated with poor survival outcomes. Patients who underwent surgical intervention had better survival outcomes when adjusted for grade and site of tumor.

MP77-02 HIGH AREA DEPRIVATION INDEX IS ASSOCIATED WITH DE NOVO PROSTATE CANCER METASTASIS IN VETERANS

You have accessJournal of UrologyCME1 Apr 2023MP77-02 HIGH AREA DEPRIVATION INDEX IS ASSOCIATED WITH DE NOVO PROSTATE CANCER METASTASIS IN VETERANS Ananta Wadhwa, Lorna Kwan, Michael Lewis, Brent Rose, Jennifer Cullen, Nicholas Nickols, Kara Maxwell, Kosj Yamoah, and Isla Garraway Ananta WadhwaAnanta Wadhwa More articles by this author , Lorna KwanLorna Kwan More articles by this author , Michael LewisMichael Lewis More articles by this author , Brent RoseBrent Rose More articles by this author , Jennifer CullenJennifer Cullen More articles by this author , Nicholas NickolsNicholas Nickols More articles by this author , Kara MaxwellKara Maxwell More articles by this author , Kosj YamoahKosj Yamoah More articles by this author , and Isla GarrawayIsla Garraway More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003351.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Metastatic prostate cancer (PCa) is highly lethal with a 5-year survival rate of 30%. Individuals with specific germline mutations, a family or personal cancer history, and/or identifying as Black/African-American display higher risk of developing PCa, including metastatic PCa. Healthcare barriers, such as lack of insurance and/or lower socioeconomic status, also correlate with advanced stage diagnosis. We sought to determine if the Area Deprivation Index (ADI), a ranking of socioeconomic disadvantage including income, education, employment, and housing quality, was associated with de novo metastases and/or metastatic progression in a racially/ethnically diverse VA PCa cohort. METHODS: Veterans diagnosed and/or treated for PCa from 2000-2013 in the Greater Los Angeles VA Healthcare System were identified in accordance with an institutional review board approved protocol. Clinical, pathological, and demographic data were obtained from the electronic medical record and the Veterans Health Administration Corporate Data Warehouse. State ADI (decile rank of 1-10) was calculated based upon the 9-digit residential zip code. Multivariate analyses identified factors associated with de novo metastasis or metastatic progression. Kaplan-Meier (KM) analysis permitted survival comparison of de novo metastatic (M1) cases, or localized cases with metastatic progression (M0-MP). RESULTS: Of 2152 PCa cases identified, ADI could be determined in 1498 (69.6%). There were 1311 M0, 76 M1, 136 MX cases, and 57 M0 patients who experienced metastatic progression (M0-P). On multivariate analysis, state ADI decile rank ≥7 was significantly associated with de novo metastasis diagnosis (rank 7-8: OR=4.39 (1.26, 15.35); rank 9-10: OR=4.12 (1.05, 16.09)). State ADI rank was not associated with metastatic progression in M0 patients. There were no significant differences in PCa-specific survival by ADI Rank within M1 nor M0-P strata. CONCLUSIONS: Veterans residing in areas of high socioeconomic disadvantage (ADI rank ≥7) were >4 times more likely to be diagnosed with de novo metastasis, while no effects of ADI were observed on PCa-survival in M1 cases or M0-P cases. These results suggest that even in a relatively equal access healthcare system, potential social barriers indicated by high ADI may lead to delayed diagnosis. Future studies linking frequency of healthcare visits and/or screening to ADI may reveal potential strategies to mitigate this disparity in the VA population. Source of Funding: Research support for the investigators include National Institutes of Health K08CA215312, KNM; 5P50CA092131, R01 PAR-20-077, IPG); US Department of Defense (W81XWH211075, IPG; W81XWH-19-1-0435, KY); Prostate Cancer Foundation (PCF17CHAL04, IPG; 20YOUNG02, KNM; 18VALO10, KY, NGN), Burroughs Wellcome Foundation (1017184, KNM); Basser Center for BRCA at the University of Pennsylvania (KNM); Jean Perkins Foundation (IPG), STOP Cancer Foundation (IPG), and VA ORD CSR&D (NGN) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1101 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ananta Wadhwa More articles by this author Lorna Kwan More articles by this author Michael Lewis More articles by this author Brent Rose More articles by this author Jennifer Cullen More articles by this author Nicholas Nickols More articles by this author Kara Maxwell More articles by this author Kosj Yamoah More articles by this author Isla Garraway More articles by this author Expand All Advertisement PDF downloadLoading ...