Extracapsular Invasion Research Articles

Higher microRNA-221 and lower microRNA-451 expression are associated with poor prognosis in patients with thyroid papillary carcinoma.

To analyze the relationship between serum microRNA-221 and microRNA-451 expression and the pathological features and prognosis of patients with thyroid papillary carcinoma. Cross-sectional study that included 120 patients with papillary thyroid cancer treated at the hospital and 120 healthy volunteers selected as the control group who underwent physical examination. The relative expression levels of microRNA-221 and microRNA-451 were compared between the thyroid papillary carcinoma group (prior to treatment) and the control group. Additionally, microRNA-221 and microRNA-451 expression levels were analyzed in patients with papillary thyroid carcinoma across different pathological characteristics. Serum microRNA-221 relative levels were significantly higher (p<0.001) in the papillary carcinoma group compared to the control group, while microRNA-451 levels were higher in the control group (p<0.001). In the papillary carcinoma group, microRNA-221 expression was significantly higher in patients with extracapsular invasion (p<0.001), lymphatic metastasis (p=0.003), and poor prognosis (p<0.001). Conversely, microRNA-451 expression was significantly lower (p<0.001) in patients with extracapsular invasion, lymphatic metastasis and poor prognosis. In the multivariate logistic regression analysis, morphological features suggestive of an aggressive clinical behavior (extracapsular invasion and lymphatic metastasis) were related to high expression of microRNA-221 and low expression of microRNA-451 in patients with thyroid papillary carcinoma (p<0.001). Serum microRNA-221 and microRNA-451 expression levels are significantly higher and lower, respectively, in patients with papillary thyroid carcinoma, particularly in patients with morphological features suggestive of an aggressive clinical behavior (extracapsular invasion and lymphatic metastasis) and, therefore, of a poor prognosis.

The value of 68Ga-PSMA PET/CT in the diagnosis of intracapsular prostate cancer with a poor prognosis

ObjectiveTo evaluate the diagnostic value of 68Ga-prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) for intracapsular prostate cancer with a poor prognosis (PPC) and no extracapsular invasion or distant metastasis.MethodsThe PET/CT images and clinical data of 221 patients were retrospectively analyzed. These patients all had clear pathological results. The maximum standard uptake value (SUVmax) of the main lesions was measured at the postprocessing workstation and was tested for correlation with the pathological score. The diagnostic accuracy was calculated using the receiver operating characteristic (ROC) curve, and the best diagnostic threshold was calculated. The correlation between SUVmax and the International Society of Urological Pathology Grade Group (GG) was also analyzed.ResultsThe pathological results of the 221 patients were 48 benign lesions and 173 malignant lesions, including 81 PPC. Low-, intermediate-, and high-risk prostate cancers made up 21.97% (38/173), 54.33% (94/173), and 23.70% (41/173) of the malignant lesions, respectively. SUVmax and GG were positively correlated (r = 0.54, P < 0.01). The best SUVmax thresholds for 68Ga-PSMA PET/CT for the diagnosis of intracapsular PC and PPC were 7.95 and 13.94, respectively; the specificities were 0.83 and 0.85, the negative predictive values were 0.55 and 0.87, and the areas under the ROC curves were 0.88 and 0.88, respectively.Conclusion68Ga-PSMA PET/CT has high specificity and NPV in the diagnosis of intracapsular PPC, but the sensitivity for the diagnosis of intracapsular low-risk PC is low, which may cause some cases to be undetected.

Endometrial cancer with positive sentinel lymph nodes: pathologic characteristics of metastases as predictors of extent of lymphatic dissemination and prognosis

ObjectivesTo assess predictors of extensive lymph node dissemination and non-vaginal recurrence in patients with endometrial cancer with positive sentinel lymph nodes (SLNs).MethodsPatients with endometrial cancer who underwent primary surgery with...

Presacral Schwannoma Resembling Lymph Node Metastasis in a Patient with Locally Advanced Prostate Cancer

Introduction: SSchwannomas originating in the pelvic region are rare and present diagnostic challenges when they coexist with malignancies. Case Presentation: A 58-year-old man with urinary frequency and an elevated prostate-specific antigen level underwent preoperative imaging. T2-weighted magnetic resonance imaging (MRI) of the prostate identified an irregular hypointense lesion with extracapsular invasion, as well as a presacral nodule resembling lymph node metastasis. The presacral nodule exhibited an intermediate signal intensity on the apparent diffusion coefficient map that was derived from diffusion-weighted images. Dynamic contrast-enhanced MRI revealed persistent enhancement in the presacral node, while the prostate tumor exhibited strong early enhancement followed by washout. Pathological and laparoscopic findings confirmed the coexistence of locally advanced prostate cancer and pelvic schwannoma. Conclusions: MRI is useful not only in detecting prostate cancer but also in differentiating lymph node metastases from schwannoma.

Correlations between the average Young's modulus and histopathological characteristics of papillary thyroid carcinoma

Objective: To explore the histopathological factors affecting the stiffness of papillary thyroid carcinoma (PTC). Methods: Ninety-six patients with PTC confirmed by surgery and pathology in Shanxi Bethune Hospital from January 2019 to December 2020 were selected, including 101 nodules. Two-dimensional ultrasound and shear-wave elastography (SWE) were performed before surgery and the average Young's modulus (Emean) of PTC nodules were measured. Histopathological examinations on the nodules were conducted after surgery to decide the lesion size, number of lesions, calcification type, presence or absence of capsular and extracapsular invasion, degree of fibrosis, microvessel density, and number of tumor cells. The correlations between the lesion size, degree of fibrosis, microvessel density, and number of tumor cells and the Emean were analyzed. The Emeans of nodules with different numbers of lesions, presence or absence of capsular and extracapsular invasion, and different pathological calcification types were compared. The multiple linear regression analysis was used to evaluate the histopathological factors influencing the Emean. Results: The ranges of the lesion sizes, degrees of fibrosis, microvascular density, numbers of tumor cells, and the Emeans of the 101 investigated PTC nodules were (1.29±0.95) cm, (30.64±18.37)%, (101.64±30.7) vessels per high power field, (373.52±149.87) cells per high power field, and (36.47±19.62) kPa, respectively. Correlation analysis showed that the lesion size of PTC and the degree of fibrosis were positively correlated with the Emean (r=0.660, P＜0.001; r=0.789, P＜0.001), while the microvessel density was negatively correlated with the Emean (r=-0.198, P=0.047). The Emean of the group with capsular and extracapsular invasion was higher than that of the group without (P=0.014). There were statistical differences in the Emeans among different types of pathological calcification (P＜0.001). The multiple linear regression analysis showed that the lesion size (β=0.325, P＜0.001), degree of fibrosis (β=0.563, P＜0.001), psammoma bodies (β=0.177, P=0.001), stromal calcification (β=0.164, P=0.003), and mixed calcification of both psammoma bodies and stroma (β=0.163, P=0.003) were independent influencing factors for the Emean. The degree of fibrosis had the greatest impact on the Emean. Conclusions: The Emean of PTC lesions was correlated with the histopathological characteristics of PTC. The lesion size, degree of fibrosis, and calcification had significant impact on the Emean, among which the degree of fibrosis had the greatest impact.

Effects of hormone receptor status on patient clinic and survival in HER2 positive breast cancer.

In the current study, the effect of hormone receptor (HR) status on clinical and survival in early-stage human epidermal growth factor receptor 2 (HER2)-positive breast cancer was investigated. Two hundred ninety-one patients with HER2- positive were examined in two categories as HR-positive and HR-negative. Of these, 197 (68%) were HR-positive and 94 (32%) were HR-negative with a mean follow-up period of 68±2.7months. The groups were found to be similar in terms of age, menopausal status, comorbidity, pathologic type, stage, T stage, N stage, lymphovascular invasion, presence and percentage of intraductal component, multicentricity/focality and extracapsular invasion. Family history (P=0.038), stage 2 tumor rate (P<0.001), and perineural invasion (P=0.005) were significantly higher in the HR-positive group. In the HR-negative group, mean Ki-67 value (P =0.014), stage 3 tumor rate (P<0.001), tumor necrosis (P=0.004) and strong (3+) HER2 staining on immunohistochemical staining (P=0.003) were higher. The incidence of relapse and metastasis, and the localization of metastasis were similar in both patient groups. The rate of locoregional relapse during the first 2years was higher in the HR-negative patients than in the HR-positive patients (P=0.023). Overall survival (OS) and disease-free survival (DFS) did not differ between the groups in univariate analysis. However, HR status was determined as an independent prognostic factor (HR: 2.11, 95% CI: 1.17-3.79; P=0.012) for OS was not found to be significant for DFS in multivariate analysis. Both clinicopathologic features and OS outcomes of HR-negative patients were worse than those of HR-positive patients.

Impact of cervical lymph node metastasis on transoral surgery for hypopharyngeal squamous cell carcinoma: A retrospective multicenter study.

Hypopharyngeal carcinoma is likely to spread to the lymph nodes, but there is no established strategy for management in transoral surgery. We compared oncologic and functional outcomes in a retrospective multicenter study of patients who underwent transoral surgery for hypopharyngeal carcinoma between 2015 and 2021. Two-hundred and thirty-two patients were included. Comparing patients with and without adjuvant radiotherapy, 3-year regional recurrence-free survival (RRFS) was not significantly different in pN2b and pN2c, but was significantly worse in pN3b without adjuvant radiotherapy. In patients without neck dissection, the 3-year RRFS was 85.6%, 76.8%, and 70.0% for T1, T2, and T3 primary lesions, respectively, and was significantly worse for T2 or higher (p = 0.035). In the absence of extracapsular invasion, regional control did not deteriorate without adjuvant therapy. If prophylactic neck dissection is not performed, careful follow-up is necessary if the primary lesion is T2 or greater.

Bi-Parametric Magnetic Resonance Imaging Analysis of Biochemical Recurrence of Prostate Cancer after Radical Surgery and Its Predictive Value: A Retrospective Study.

This study aimed to analyse the characteristics of biochemical recurrence after radical prostatectomy via bi-parametric magnetic resonance imaging. A total of 200 patients with radical prostatectomy admitted to our hospital from January 2016 to January 2021 were retrospectively enrolled as observation objects. According to whether there was biochemical recurrence after surgery, the patients were divided into the abnormal group (n = 62) and normal group (n = 138). Clinical data, encapsulation infiltration, seminal vesicle infiltration and prostate imaging report and data system (PI-RADS) were collected and compared between the two groups. Propensity score matching (PSM) was used to balance the baseline data of the two groups. Student's t-test and Chi-square test were used to analyse the data. PSM was performed in a 1:1 ratio, and a total of 72 patients were included in the abnormal and normal groups. The baseline data of the patients in each group were not statistically significant. The incidence of extraperitoneal invasion and seminal vesicle invasion was higher in the abnormal group than in the normal group, and we observed a significant difference in PI-RADS scores between the two groups (p < 0.05). Extracapsular invasion, seminal vesicle invasion, PI-RADS score and biochemical recurrence were significantly correlated (p < 0.05). The PI-RADS score has a high value for predicting biochemical recurrence, with an area under the curve value of 0.824, sensitivity of 0.667, specificity of 0.861 and Youden index of 0.528. Bi-parametric magnetic resonance imaging has a high predictive value in biochemical recurrence after radical prostatectomy, which can provide reference for early intervention measures.

Correlations Between Preoperative Indicators and Postoperative Histopathological Outcomes in Prostate Cancer Patients

Objective: Prostate cancer continues to pose a significant health challenge, with diverse prognoses influenced by preoperative and postoperative assessments. This study aims to elucidate the correlation between preoperative clinical indicators and postoperative histopathological outcomes to enhance prognostic models. The primary objective of this study is to investigate the predictive value of preoperative factors, such as age, Prostate-Specific Antigen (PSA) level, prostate volume (PV), and tumor volume (TV), on postoperative outcomes, specifically focusing on extracapsular invasion (ECI), seminal vesicle invasion (SVI), and positive surgical margins (PSM). Materials and Methods: We retrospectively analyzed the data of 63 patients with prostate cancer who underwent radical prostatectomy. Preoperative clinical data, including age, PSA level, PV, and TV, were collected. Postoperative histopathological data were gathered for ECI, SVI, and PSM. Statistical analyses, including correlation coefficients and median comparisons, were employed to identify significant predictors of postoperative outcomes. Results: The cohort had a mean age of 64.1 years, with PSA levels ranging from 3.65 to 112 ng/ml. Patients with ECI had a median PSA of 14.9 ng/ml, whereas those without had 8.2 ng/ml (p=0.001). Median PV and TV were significantly higher in patients with ECI (PV: 55 cc, TV: 8.07 cc) than in those without ECI (PV: 49 cc, TV: 4.25 cc, p=0.001). Similar significant differences were noted for SVI and PSM, with higher PSA, PV, and TV values in patients with these features (p≤0.042). Age did not significantly affect the outcomes. Conclusion: Preoperative PSA level, prostate volume, and tumor volume were significant predictors of adverse postoperative histopathological features in patients with prostate cancer. These findings highlight the need for a multifactorial approach in preoperative evaluation and advocate the development of enhanced predictive models for improved clinical decision-making and patient management.

Subcentimetric Papillary Thyroid Carcinoma: Does the Diagnosis Kind Impact Prognosis?

Subcentimetric papillary thyroid carcinoma (SPTC) (papillary thyroid carcinoma with less than 10 mm in size) usually presents an excellent prognosis, with few aggressive reported cases. Given the globally increased incidenceof SPTC, physicians are struggling with the need to identify prognostic factors to stratify SPTC. The aim was to compare clinicopathological variables and prognosis between clinically and incidentally diagnosed SPTC. Materials and methodsː This is a retrospective observational study on patients with SPTC who underwent thyroidectomy between 2002 and 2015. Two groups were considered: G1 (n=60 (61.9%)), clinical diagnosis (Bethesda III-VI cytology in the thyroid tumor/in cervical lymphadenopathies) and G2 (n=37 (38.1%)), incidental diagnosis (thyroidectomy for benign thyroid pathology). The histological material was reviewed, and molecular analysis of the BRAF, RAS, and TERTpromoter (TERTp) genes was performed. Resultsː Ninety-seven individuals were included, 60 (61.9%) of which were from G1, with a predominance of female sex (n=83 (85.6%)). Individuals of G1 were younger (53.0±14.2 versus 59.3±13.9 years; p=0.035), were more frequently treated with 131-iodine (39.2% versus 13.4%; p=0.007), had the largest diameter (8(p25-p75: 7-9) versus 5(p25-p75: 4-6.5) mm; p<0.001), and higher frequency of minimal extracapsular invasion (45% versus 24.3%; p=0.041). Increased tumor size was the only independent predictor of a clinical diagnosis (p<0.001). Conclusionsː Clinically and incidentally diagnosed SPTC showed excellent medium- to long-term prognosis. A larger SPTC was more likely a driver of clinical detection than a marker of tumor aggressiveness, but caution should be taken as contradictory data persists.

FRI270 A Rare Case Of Giant Benign Pheochromocytoma

Abstract Disclosure: M.S. Hossain: None. B. Gautam: None. K. Mandal: None. H. Liao: None. D.S. Rosenthal: None. S.C. Kumar: None. Background: Pheochromocytomas are Catecholamine-secreting tumors that arise from the adrenal medulla. These tumors are rare however giant pheochromocytomas (&amp;gt;7 cm) are even rarer entities, which are thought to be more aggressive and malignant. Here we present a case of incidentally found giant but benign pheochromocytoma. Case Report: A 40-year-old female with no PMH presented to the hospital with fever &amp; cough for 1 month which was associated with weight loss (10lb). Patient was started on antibiotics and CT revealed right-sided adrenal incidentaloma while searching for sources of infection. CT &amp; MRI abdomen were done for better characterization, showed a round circumscribed right adrenal mass measuring 11.3 x 11.4 x 12.8 cm. Mass had irregular central necrosis, peripheral enhancement &amp; neovascularization. Patient denied headache, sweating &amp; palpitation; no personal or family history of pheochromocytoma. On physical examination BP: 103/70, HR: 98, Temp: 98F, BMI:25.9, unremarkable for cushingoid features, virilization &amp; hirsutism. Hormonal workup showed elevated free normetanephrine 185 (&amp;lt;148pg/ml) &amp; chromogranin A 801 (&amp;lt;311ng/ml), but normal free metanephrine &amp;lt;25 (&amp;lt;57pg/ml) &amp; total metanephrines 185 (&amp;lt;205pg/ml). 24hr Urine study: elevated total metanephrines 1661 (182-739mcg/24h) &amp; normetanephrine 1482 (88-649mcg/24h) but normal metanephrine 179(58-203mcg/24h), urine volume 2360ml/24h, urine creatinine 0.87(0.50-2.15g/24h). Patient Cortisol, ACTH, Aldosterone, Renin activity, DHEA-S, Androstenedione was normal. Patient was started on alpha-blockers. Patient underwent successful right-sided adrenalectomy &amp; nephrectomy with IVC resection. Pathology reported pheochromocytoma stage II T2Nx, Ki 67 &amp;lt;5%. No vascular and extracapsular invasion &amp; no mitosis. Post operative outpatient follow up showed elevated plasma free normetanephrine 199(&amp;lt;148pg/ml) &amp; normal free metanephrine &amp;lt;25 (&amp;lt;57pg/ml) &amp; total metanephrine 199 (&amp;lt;205pg/ml). 24hr urine study: normal metanephrine 61 (58-203mcg/24h), Normetanephrine 268 (88-649mcg/24h) &amp; total metanephrines 329 (182-739mcg/24h). Patient was advised for Ga68 DOTATE/PET scan, genetic counseling &amp; lifelong follow-up with endocrinology for surveillance. Discussion: Pheochromocytoma symptoms may vary regardless of tumor size. Giant pheochromocytoma may not have high secretory potential due to central necrosis resulting in reduced chromaffin cells or catecholamines that are restricted to capsular mass which may release into the bloodstream intraoperatively1. Therefore, initiating alpha-blockers before surgery in these cases may prevent perioperative complications.1. Minei S, Yamashita H, Koh H, Satoh T, Kobayashi S, Furuhata M, et al. Giant cystic pheochromocytoma A case report. Hinyokika Kiyo. 2001;47:561-3. Presentation: Friday, June 16, 2023

Disease Characteristics, Treatment and Survival for Oropharyngeal Squamous Cell Carcinoma of Elderly

Incidence of oropharyngeal cancers (OP) has been increasing over the past few decades, mainly driven by human papilloma virus (HPV) associated cancers in younger men. However, a large number of OP patients in recent years are ≥65 years of age. We wanted to determine if there is a difference in outcomes in elderly patients with OP as compared to younger patients. We queried our institutional prospectively maintained head and neck cancer database for patients with non-metastatic OP treated between 1/2009-6/2020. We excluded patients who did not receive any definitive treatment. We analyzed clinicopathological and treatment characteristics for elderly (age at diagnosis ≥65 years) compared to young (<65 years) across HPV subtypes. We also studied survival endpoints among age groups using Kaplan-Meier curves and log-rank test. Independent predictors were estimated using multivariate (MVA) Cox regression models for each HPV subtype. We identified 340 patients who met our inclusion criteria: elderly 123 (36%) and young 213 (64%). The proportion of elderly HPV+ve patients showed an increasing trend over the years studied. Median age was 70 years (range 65-91) in elderly and 56 years (38-64) in young (p<0.001); and HPV+ve/-ve were 73.2/26.8% vs 74.6/25.3% for both age groups respectively (p = 0.86). Elderly patients had higher Charlson Comorbidity Index (CCI) and included more divorcees (p<0.05). There were more elderly current/former smokers (97% vs 82%; p = 0.007) within HPV-ve cases. Definitive radiotherapy (RT) +/- systemic therapy (CRT) was utilized in 73.2% (n = 249), while the remainder had surgery +/- adjuvant RT/CRT. There was no difference with age for OP subsite, 8th edition AJCC stage and treatment received except for more use of cetuximab (22.5% vs 10.2%; p<0.001) and weekly cisplatin (32.4% vs 25.8%; p<0.001) among elderly patients. After a median follow up of 5.24 years (IQR: 3.53), 3-year overall (OS) (HPV+ve: 85 vs 81%; HPV-ve: 39 vs 52%), locoregional free (LRFS) (HPV+ve: 86 vs 90%; HPV-ve: 67 vs 69%) and distant metastasis free (DMFS) survival (HPV+ve: 91 vs 90%; HPV-ve: 79 vs 81%) were all non-significant for elderly vs young respectively. On MVA, CCI and AJCC stage for HPV+ve; and smoking, T-stage and lymphovascular space invasion for HPV- were associated with OS. For HPV+ve, AJCC stage, adjuvant vs definitive RT and treatment in later years were predictive of better LRFS, whereas smoking index and extracapsular space invasion were deterministic for DMFS. Interestingly, outcomes among those who received cetuximab was similar to those who received concurrent cisplatin for all endpoints. We did not note any significant difference in outcomes among elderly patients treated for OP when compared to the younger patients when multi-disciplinary head and neck cancer care is provided. This was noted even though a significantly larger proportion of elderly patients received cetuximab concurrent with RT as opposed to standard of care cisplatin.

Evaluation of the diagnostic accuracy of preoperative ultrasound for axillary lymph nodes in breast cancer patients

Background Breast cancer is the most prevalent cancer and the second leading cause of death among women is breast cancer. The likelihood of survival rises with early breast cancer diagnosis, which lowers death rates. For the treatment of breast cancer, axillary lymph nodes (ALNs) must be correctly staged and managed. The main goals of ALNs staging are to gather prognostic data and information that might influence management decisions. Objective To evaluate the accuracy of the preoperative ultrasound in detection of malignant ALNs in breast cancer patients. Methods The records of breast cancer patients at the breast surgery unit of Kasr Alainy Hospital, between 2017 and 2020, were reviewed. Patients with an axillary ultrasound report who underwent a sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND) were enrolled in the present study. Demographic and clinicopathologic characteristics including age, family history, body mass index (BMI), primary tumor size, histological and biological grade, Lymphovascular invasion (LVI), extracapsular invasion (ECE), were evaluated. Results Out of the 348 Breast Cancer patients who were managed in our department, the age range was 28–89 years (median age 52 years). The histopathology results of the tumor were 96% with invasive duct carcinoma (IDC) 2.3% invasive lobular carcinoma (ILC) and 1.7% were mixed ductal/lobular. Cortical thickness greater than 3 mm had a significant difference for positive nodal status, effacement of hilum had a sensitivity 56.2% in detecting positive lymph nodes (LNs), round LNs shape had a sensitivity of 82.3% in detecting true positive LNs. Pathological LNs by ultrasound had a sensitivity of 93% and specificity of 77% in detecting true positive LNS, BMI was not significant in ultrasound detection of pathological LNs. Conclusion The data shows that axillary ultrasound by its assessment has revealed to be useful in detection of malignant LNs with a sensitivity of 93.1% and specificity 77% in detecting true malignant LNs.

Imaging evaluation of para-aortic lymph nodes in cervical cancer.

In recent years, much literature has reported the diagnostic value of computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET)-CT in para-aortic lymph node metastasis of cervical cancer. To compare and analyze the para-aortic lymph node presentations found in cervical cancer on different images in order to determine the best precise imaging method for identifying metastatic lymph nodes. PubMed, Web of Science, MEDLINE, and other databases were searched for the non-invasive detection of metastatic lymph nodes for a comprehensive comparison. Positive lymph nodes on CT are significantly related to the following factors: short axis ≥10 mm; and round or central necrosis. Positive lymph nodes on MRI are significantly related to the following factors: short axis ≥8 mm; inhomogeneous signal intensity; morphology: round, irregular edge, extracapsular invasion, central necrosis, loss of lymph node structure, burrs, or lobes; and ADC value decreases, combined with local actuality. On PET-CT examination, when the short axis of the lymph node is >5 mm, the SUV is >2.5, or the FDG uptake is greater than that of the surrounding tissue, it is a metastatic lymph node. In conclusion, different imaging techniques show metastatic lymph nodes in different ways. Combining the patient's medical history with the symptoms of the aforementioned lymph nodes, together with one or more imaging techniques, is important to diagnose para-aortic lymph nodes in cervical cancer.

Neoadjuvant tislelizumab combined with APF for patients with locally advanced head and neck squamous cell carcinoma: A prospective single-arm clinical trial.

6080 Background: Seeking out a more effective and less-toxic regimen is necessary for patients with locally advanced head and neck squamous cell carcinoma (HNSCC). The aim of this study is to evaluate the efficacy and safety of neoadjuvant anti-programmed cell death-1 antibody tislelizumab combined with APF (albumin-bound paclitaxel, platinum and fluorouracil) followed by surgery or concurrent chemoradiotherapy. Methods: In this prospective, single-center, single-arm clinical study, previously untreated patients with locally advanced HNSCC, aged 18-75 years without severe comorbidities and contraindications to immunotherapy are enrolled. Eligible patients received A (200 mg/m2 d1) P (60 mg/m2 d1- d2) F (600 mg/m2 CIV120h) induction chemotherapy along with tislelizumab (200 mg d1) every 3 weeks. The curative effect is evaluated (RECIST 1.1) after 3 cycles and a multidisciplinary team discuss whether to perform surgery. For patients undergoing surgery, treatment is completed if there is no residual and extra-capsular lymph node invasion; in case of positive surgical margin, or extracapsular lymph node invasion, or residual lymph nodes, patient will receive concurrent chemoradiotherapy (tumor bed and neck lymph drainage area 66 Gy~70 Gy, P 60 mg/m2). Those not suitable for surgery will receive radical concurrent chemoradiotherapy (GTV 66Gy~70Gy, PTV 50Gy, P 60 mg/m2) within 3 weeks after neoadjuvant treatment. The primary endpoint of efficacy evaluation is the pathological complete response (pCR) rate. Safety evaluation indicators include vital signs, laboratory indicators and adverse events (NCI CTC AE4.0). Results: From Apr 2022 to Jan 2023, 12 patients are screened and enrolled. For the 7 patients who complete 3 cycles of neoadjuvant therapy, 3 patients (42.8%) successfully undergo surgery, with 2 patients (28.5%) achieving pCR and 1 patient (14.3%) achieving major pathological response (MPR). For the other 4 patients, 1 patient (14.3%) achieve pCR by multipoint biopsy of the primary lesion and 2 patients (28.5%) obtain radiologic partial response (PR) by MRI. 1 patient’ lymph nodes tend to increase during radiotherapy and that patient withdraw from clinical trial and undergo salvage surgery. The objective response rate (ORR) of neoadjuvant treatment is 85.7% and pCR rate is 42.9%. Grade 2 or higher AEs during neoadjuvant therapy include grade 2 liver function damage (n = 1, 8.3%), grade 3 myelosuppression (n = 1, 8.3%). 1 (8.3%) patient developed radiation-related oral mucositis (RTOG 2). No other obvious adverse reactions of radiotherapy, chemotherapy or immunotherapy are observed. Conclusions: Combining Tislelizumab with APF followed by surgery or radical concurrent chemoradiotherapy is feasible and effective in patients with locally advanced HNSCC, and further studies are needed to verify its effectiveness and safety.

Malignancy risk factors and prognostic variables of pancreatic mucinous cystic neoplasms in Chinese patients.

Pancreatic mucinous cystic neoplasms (MCNs) represent one of the precursor lesions of pancreatic ductal adenocarcinoma, and their detection has been facilitated by advances in preoperative imaging. Due primarily to the rarity of MCNs, however, there is limited knowledge regarding the prognostic variables and high-risk factors for malignant transformation. A more comprehensive and nuanced approach is necessary to fill this gap and provide a basis for improved treatment decisions and patient outcomes. To investigate the high-risk factors associated with malignant MCNs and to explore the prognostic factors of MCN with associated invasive carcinoma (MCN-AIC). All cases of resected MCNs from a single high-volume institution between January 2012 and January 2022 were retrospectively reviewed. Only cases with ovarian-type stroma verified by progesterone receptor staining were included. Preoperative features, histological findings and postoperative course were documented. Multivariate logistic regression was employed to investigate variables related to malignancy. Survival analysis was performed using the Kaplan-Meier curve, and the prognostic factors were assessed to evaluate the postoperative course of patients with MCN-AIC. Among the 48 patients, 36 had benign MCNs, and 12 had malignant MCNs (1 high-grade atypical hyperplasia and 11 MCN-AIC). Age, tumour size, presence of solid components or mural nodules and pancreatic duct dilatation were identified as independent risk factors associated with malignancy. The follow-up period ranged from 12 mo to 120 mo, with a median overall survival of 58.2 mo. Only three patients with MCN-AIC died, and the 5-year survival rate was 70.1%. All 11 cases of MCN-AIC were stage I, and extracapsular invasion was identified as a prognostic factor for poorer outcomes. The risk factors independently associated with malignant transformation of MCNs included age, tumour size, presence of solid components or mural nodules, and pancreatic duct dilatation. Our study also revealed that encapsulated invasion was a favourable prognostic factor in MCN-AIC patients.

Triple Negatif Meme Kanseri Hastalarında Neoadjuvan Kemoterapiye Tam Yanıtı Etkileyen Faktörler

AIM: The triple negative breast cancer is a very aggressive type of breast cancer which constituting approximately 10-15% of all cases. Despite the administration of adjuvant chemotherapy, 5-year disease-free survival rates are lower than other types. Response to treatment may indicate patients' long-term outcome. Several studies are associated with pathological complete response , improved disease-free survival and overall survival . Residual disease after neoadjuvant chemotherapy shows the tumor resistance to treatment. The aim of this study is to explore the relationship between pathological complete response and tumor characteristics.&#x0D; MATERIAL AND METHOD: Data of 53 triple negative breast cancer patients who were operated at one center after neoadjuvant chemotherapy between 2015-2022 were retrospectively analyzed. The data analyzed with descriptive and inferential statistics using SPSS IBM version 25.&#x0D; RESULTS: In the evaluation of 53 patients between the ages of 28 and 81 (mean: 50.7), pathological complete response was obtained in 21 of the patients (39.6 %), while 32 (60.4 %) were found to have an incomplete response or no response. Absence of axillary lymph node metastasis before neoadjuvant chemotherapy, high Ki-67 proliferation index and absence of extracapsular invasion in metastatic LN were associated with pathological complete response; Other clinicopathologic parameters were found to have no effect on the results.&#x0D; DISCUSSION: Patients with a high Ki-67 proliferation index and no axillary involvement are more likely to have a pathological complete response after neoadjuvant chemotherapy.&#x0D; CONCLUSION: It can be predicted that the prognosis may be better in patients with high Ki-67 proliferastion index and no axillary involvement .

Impact of smoking on urologic cancers: a snapshot of current evidence

PurposeThe purpose of this paper is to present evidence regarding the associations between smoking and the following urologic cancers: prostate, bladder, renal, and upper tract urothelial cancer (UTUC).MethodsThis is a narrative review. PubMed was queried for evidence-based analyses and trials regarding the associations between smoking and prostate, bladder, renal, and UTUC tumors from inception to September 1, 2022. Emphasis was placed on articles referenced in national guidelines and protocols.ResultsProstate—multiple studies associate smoking with higher Gleason score, higher tumor stage, and extracapsular invasion. Though smoking has not yet been linked to tumorigenesis, there is evidence that it plays a role in biochemical recurrence and cancer-specific mortality. Bladder—smoking is strongly associated with bladder cancer, likely due to DNA damage from the release of carcinogenic compounds. Additionally, smoking has been linked to increased cancer-specific mortality and higher risk of tumor recurrence. Renal—smoking tobacco has been associated with tumorigenesis, higher tumor grade and stage, poorer mortality rates, and a greater risk of tumor recurrence. UTUC—tumorigenesis has been associated with smoking tobacco. Additionally, more advanced disease, higher stage, lymph node metastases, poorer survival outcomes, and tumor recurrence have been linked to smoking.ConclusionSmoking has been shown to significantly affect most urologic cancers and has been associated with more aggressive disease, poorer outcomes, and tumor recurrence. The role of smoking cessation is still unclear, but appears to provide some protective effect. Urologists have an opportunity to engage in primary prevention by encouraging cessation practices.

Unusual papillary thyroid carcinoma with hyalinizing trabecular tumor-like feature in a young female patient: a case report

BackgroundHyalinizing trabecular tumor is a rare follicular cell-derived thyroid neoplasm that is considered to be a borderline tumor with malignant potential rather than a benign tumor. The detection of RET/PTC rearrangements and nuclear cytologic features suggests a relationship between hyalinizing trabecular tumor and papillary thyroid carcinoma. Some recent observations of pathogenic genetic alterations in hyalinizing trabecular tumor have indicated that hyalinizing trabecular tumor is not related to papillary thyroid carcinoma, and should be considered an independent entity. Here we present a case of papillary thyroid carcinoma with hyalinizing trabecular tumor-like features and discuss its interesting aspects and diagnostic issues from a histopathological perspective.Case presentationA 19-year-old Japanese woman with an enlarged thyroid gland was admitted to our hospital. Based on fine-needle aspiration cytology, the enlarged nodule was suspected to be a follicular lesion or follicular tumor. A nodular lesion approximately 3 cm in diameter was detected in the left lobe of the thyroid gland. Histological analysis revealed that the tumor cells were mainly arranged in follicles. Solid nests with occasional trabecular arrangements and papillary structures were intermingled, and the tumor cells showed ground-glass nuclei and occasional nuclear grooving. Petaloid and block-like periodic-acid-Schiff and periodic-acid-methenamine-positive basement membrane components were observed in the interstitium of the solid portions of the tumor. Incomplete membranous immunoreactivity of MIB-1 (Ki-67 (cell prolferation marker)) was also observed in the cells within the solid areas. Moreover, this tumor displayed extracapsular invasion and metastasis to the perithyroidal lymph nodes, suggesting that it may be a malignant tumor. However, BRAFV600E mutation, RET/PTC rearrangements, and PAX8/GLIS 1 and PAX8/GLIS 3 rearrangements were not detected.ConclusionWe diagnosed the tumor as a papillary thyroid carcinoma with characteristic features of hyalinizing trabecular tumor. Importantly, this case may indicate a possible relationship between papillary thyroid carcinoma and hyalinizing trabecular tumor, although specific genetic alterations could not be detected. We also discuss the preoperative diagnostic difficulties with fine-needle aspiration cytology and the unusual pathological findings in this case.

Study to Evaluate the Pattern of Nodal Distribution in Papillary Thyroid Cancer.

Among the thyroid cancers, papillary thyroid cancer (PTC) is the most common with lymphatic metastasis. It has the propensity to spread to the level II-VI lymph nodes in a predictable manner. We evaluated the pattern of nodal distribution at different levels of neck in papillary thyroid cancer in this Observational Prospective study. Total 41 patients of PTC (Papillary thyroid cancer) were included in the study. 36 out of them were diagnosed as PTC by FNAC and underwent total thyroidectomy and central neck dissection, while 5 patients were histologically confirmed cases of PTC on previous hemithyroidectomy and underwent completion thyroidectomy and central neck dissection .Patients with T3/T4 stage or N1 underwent lateral neck dissection also. Clinicopathological factors such as age, sex, tumor stage, nodal metastasis and extracapsular invasion, were evaluated. Lymph node metastasis was noted in 21 patients (51.2%) and all these patients had central (level VI) lymph node involvement. Among 21 patients, pathological ipsilateral lateral neck metastasis was noted in 6 patients (28.57%) at level II, 10 patients (47.62%) at level III and 8 patients (38.10%) at level IV. Only 5 patients (23.81%) had metastasis at level V. Extracapsular invasion was observed in 10 (24.4%) patients. We concluded that patients with PTC show higher rates of metastasis at central neck (level VI) and are not easily detected on clinical examination or by USG due to low sensitivity but are sensitive and specific for lateral neck nodes in late stages . Thus, ipsilateral selective neck dissection should be considered with total thyroidectomy and central neck dissection in presence of clinically or radiologically evident lateral lymph nodes (preoperatively) and in T3, T4 stage (late stages) tumors.