Tumor Histological Type Research Articles

Biomedical applications of terahertz spectra in clinical and molecular pathology of human glioma

Gliomas are the most common type of primary tumor originating in the central nervous system of adults. Tumor histological type, pathological grade, and molecular pathology are significant prognosis and predictive factors. In this study, we were aiming to predict histological type and molecular pathological features based on terahertz time-domain spectroscopy technology. Nine gliomas with different grades, one meningioma, and one lymphoma were enrolled. There were significant differences in terahertz absorption coefficient between normal brain tissue, tumoral-periphery, and tumoral-center tissue in specific frequency bands (0.2–1.4 THz). Histological type, pathological grade, and glioma-specific biomarkers were closely related to the terahertz absorption coefficient in both tumoral-periphery and tumoral-center tissues. Interestingly, tumoral-periphery showed more obvious differences than tumoral-center tissues in almost all aspects. All the results show that the terahertz technology has potential application value in the intraoperative real-time glioma recognition and diagnosis of glioma histological and molecular pathological features.

256. LOCAL CONTROL OF HEPATIC/PULMONARY OLIGOMETASTASIS IS EFFECTIVE IN EGJ ADENOCARCINOMA

Abstract This study investigated the clinicopathological features of distant metastasis of esophagogastric junction (EGJ) adenocarcinoma. Survival benefit of local management was also examined in the patients with hepatic or pulmonary oligometastasis. Among a total of 449 cases of Siewert type I-II surgically resected EGJ adenocarcinoma (2005–2020), 166 cases with distant metastasis were eligible. Examining 22 cases with liver metastasis alone who treated in our hospital, liver-resected cases (N = 13) experienced better outcomes (mOS; 48 M for resection, vs. 8.1 M for those without resection, P = 0.0002). More favorable outcome was observed in the patients with 1–3 nodules (N = 11, P = 0.0023). Regarding lung metastasis alone, systemic chemotherapy was applied to bilateral multiple nodules, otherwise, local control including resection or stereotactic irradiation was selected. The mOS in the patients who underwent local control was significantly longer than that of chemotherapy (44 M for resection vs. 17 M for chemotherapy, P = 0.035). Tumor location or histological type of the primary tumor was associated with organ sites of distant metastasis. Local management conferred survival benefit in the patients with oligometastasis in liver or lung alone.

Completeness and Consistency of Epidemiological Variables from Hospital-Based Cancer Registries in a Brazilian State.

Objective: To evaluate the completeness and consistency of data from hospital-based cancer registries (HCRs) in a Brazilian state. Methods: This retrospective descriptive study was based on secondary data from an HCR in the state of Espírito Santo (ES) between 2010 and 2017. The data were collected between August and November 2020 by the ES State Health Department (SESA/ES). Cancer data were obtained from the HCR of ES using the tumor registration form of the Brazilian Hospital Cancer Registry Integrator and complete databases within the SESA/ES. The incompleteness of the data was classified as excellent (<5%), good (between 5% and 10%), regular (between 10% and 20%), poor (between 20% and 50%), and very poor (>50%), according to the percentage of the absence of information. Descriptive statistical analyses were performed using Statistical Package for the Social Sciences (SPSS® Inc., Chicago, IL, USA) version 20.0. Results: Complete data were observed for the variables of sex, date of the first hospital visit, and histological type of the primary tumor; that is, there were no missing data. Most epidemiological variables, including age, origin, date of first tumor diagnosis, previous diagnosis and treatment, location of the primary tumor, first treatment received at the hospital, date of death of the patient, and probable location of the primary tumor, were classified as having excellent completeness throughout the study period. However, the variables schooling, smoking, alcohol consumption, occupation, family history of cancer, and clinical staging of the tumor were classified as poor. Conclusion: Most epidemiological variables from the HCR in the state of ES, Brazil, showed excellent completeness. It is essential to elucidate the sociodemographic and clinical variables of epidemiological importance for a better understanding of the health-disease process.

When Histological Tumor Type Diagnosed on Core Biopsy Changes Its Face after Surgery: Report of a Deceptive Case of Breast Carcinoma

The presence of stromal osteoclast-like giant cells is a distinctive feature of some rare breast tumors, accounting for less than 1% of all breast cancer cases. Although the presence of stromal osteoclast-like giant cells may be encountered in different breast tumors, some authors still describe them as a specific tumor type. Usually, a histological diagnosis of breast carcinoma is made by a pathologist through a biopsy, which is then confirmed through a surgical specimen: it is rare for the two to differ, particularly when there are pathognomonic morphological markers, such as osteoclast-like giant cells. Herein, we report a case of a 45-year-old pre-menopausal woman, who was found to have a single solid mass in her right breast on screening mammogram. She underwent a core biopsy, which showed a malignant epithelial lesion arranged in tubules, glands, and papillae, intermingled with numerous stromal osteoclast-like giant cells. Therefore, a diagnosis of breast cancer with osteoclast-like giant cells was rendered. Curiously, these cells were no longer detectable in the surgical specimen.

Major features of the 2021 WHO Classification of Tumors of the Central Nervous System: clinician’s view

Advances in the understanding of the molecular biology of central nervous system (CNS) tumors have prompted a new WHO classification of brain and spinal cord tumors in 2021 and integration it in routine clinical practice. Nowadays accurate diagnosis verification consists not only of the histological tumor type, but also includes its molecular-genetic characteristics. Differences in the genetic features of a tumor, even within the same histological type, will determine differences in the prognosis of the disease, and in the tactics of anticancer therapy. The introduced changes necessitate a comprehensive diagnosis of CNS tumors, thereby placing the responsibility for formulating the final diagnosis not only on pathologists. New approaches to classification make it possible to personalize anticancer treatment, as well as including new methods of targeted and immunotherapy, which today seems to be a key aspect of improving the survival of this category of patients.

Serum FSH as a Useful Marker for the Differential Diagnosis of Ovarian Granulosa Cell Tumors.

Simple SummaryThis study aimed to evaluate whether serum gonadotropin and sex steroid hormone measurement is useful in the differential diagnosis of granulosa cell tumors (GCTs). Serum hormone levels were measured preoperatively in patients who underwent surgery for ovarian tumors (n = 471) and compared in two groups, a GCT group (n = 13) and a group with other histological types of ovarian tumor (non-GCT) (n = 458). Univariate analysis showed that the GCT group had significantly lower serum gonadotropin levels and significantly higher serum sex steroid hormone levels than the non-GCT group. Multivariate analysis revealed that the serum follicle-stimulating hormone (FSH) level was significantly associated with GCT (p = 0.004). Receiver-operating characteristic curve analysis for the diagnosis of GCTs showed that the area under the curve of the serum FSH level was 0.99, with a sensitivity of 100% and a specificity of 98%. Preoperative serum FSH levels are an extremely useful marker for differentiating GCTs from all ovarian tumors.Background: We evaluated whether the serum hormone levels are useful in the differential diagnosis of granulosa cell tumors (GCTs), regardless of menopausal status. Methods: Serum levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone, estradiol, and progesterone were measured preoperatively in all patients (n = 471) who underwent surgery for ovarian tumors at Chiba University Hospital between 2009 and 2021. These were compared in two groups, a GCT group (n = 13) and a group with other histological types (non-GCT) (n = 458). Results: The GCT group had significantly lower serum LH and FSH (p = 0.03 and p < 0.001, respectively) and significantly higher testosterone, estradiol, and progesterone (p < 0.001, p < 0.001, and p = 0.045, respectively) than the non-GCT group. Multivariate analysis revealed that serum FSH and estradiol were significantly associated with GCT (FSH, odds ratio (OR) = 0.0046, 95% confidence interval (CI) = 0.0026–0.22, p = 0.004; estradiol, OR = 0.98, 95% CI = 0.96–0.998, p = 0.046). Receiver-operating characteristic curve analysis for GCTs showed that the area under the curve of serum FSH was 0.99, with a sensitivity of 100% and a specificity of 98%, when the cutoff level was set at 2.0 IU/L. Conclusions: Preoperative serum FSH level is an extremely useful marker for differentiating GCTs from all ovarian tumors.

Diagnostic accuracy and adequacy of peripheral pulmonary nodules samples obtained by transthoracic needle aspiration.

To examine the adequacy of samples and accuracy of transthoracic needle aspiration (TTNA) in patients with peripheral pulmonary nodule (PPN) diagnosis. This retrospective study included 248 patients who underwent TTNA of PPN and subsequent diagnostic and therapeutic surgical procedures during a 5-year period at the Institute for Pulmonary Diseases of Vojvodina. The following were analysed: adequacy of cytological samples for diagnosis and molecular testing, tumour localisation and dimensions, and cytological and histopathological characteristics. The adequacy of the cytological samples was 93.15%. The proportion of adequate-diagnostic samples was higher in patients in whom the largest diameter of the lesion was >4cm, and this difference showed statistical significance. Tumour localisation was not statistically significant for the adequacy of samples for cytological analysis. Cytological samples of lung adenocarcinoma had high projected adequacy for EGFR analyses of 91.55%, not dependent on the size and location of the lesion. The most commonly diagnosed lung tumour was adenocarcinoma (45.51%). Patients with a cytological diagnosis of non-small cell carcinoma not otherwise specified, after histopathological analyses, had adenocarcinoma in most cases (53.85%). The overall accuracy of TTNA in the diagnosis of PPN was 71%. The method's accuracy was 75.24% for malignant tumours, while it was 28.57% for benign tumours. The accuracy of cytological analysis for the histological type of tumour was 84.18%. Transthoracic needle aspiration with cytological analysis is an effective and highly sensitive method in determining the aetiology of PPN.

MRI findings of benign tumors and tumor-like diseases of the tonguewith radiologic-pathologic correlation.

Benign tumors or tumor-like lesions of the tongue are uncommon lesions that comprise a heterogeneous group of neoplasms. Although there are a variety of benign tumors or tumor-like lesions, the imaging appearance of these diseases is not well defined because of a paucity of scientific literature on this topic. Most benign tongue tumors usually appear as submucosal bulges located in the deep portion of the tongue. Their true features and extent may only be identified on cross-sectional images such as CT and MRI. Thus, CT and MRI play an important role in the diagnosis of these unusual lesions. It is important that radiologists be able to identify the characteristic CT and MR imaging features that can be used to narrow the differential diagnosis with increased diagnostic confidence, suggest specific histologic tumor types. In this pictorial essay, we provide insights into the MRI presentations of benign tongue tumors and tumor-like diseases and their radiologic-pathologic correlation. Benign tumors or tumor-like lesions of the tongue described herein include papilloma, lipoma, hemangioma, venous malformations, schwannoma, neurofibroma, epidermoid cyst, and dermoid cyst.

Relationship between onco-immunological and morphologic characteristics of lymphoepithelioma-like carcinoma and lymphocyte subtypes of peripheral blood

Objective: To study the relationship between the onco-immunological and morphologic characteristics of lymphoepithelioma-like carcinoma (LELC) and peripheral blood lymphocyte subtypes and its clinical significance. Methods: The pathologic and clinical data of 117 LELC patients who were admitted to the Tumor Hospital of the University of Chinese Academy of Sciences from 2006 to 2018 were collected. The histological classification was based on previously reported morphological classification method. The onco-immunological and morphologic characteristics of the tumors such as lymphoid follicle formation and interstitial fibrous hyperplasia, patient's peripheral blood lymphocyte subtypes and prognosis data were collected. The relationship between various factors and their impact on prognosis were analyzed. Results: There were 117 patients, including 61 females and 56 males. The male to female ratio was 0.9∶1.0. The age of onset was 24-89 years (median 52 years). Primary sites included head and neck (68 cases), lungs (26 cases), stomach (15 cases), and others (eight cases). Morphologically, 54 cases were type Ⅰ, 62 cases were type Ⅱ, and one case could not be classified. The onco-immunological and morphologic features of the LELC tumors showed a continuous spectrum. Interstitial TILs were noted from focally to diffuse, and the interstitial fibrous tissues were from hardly visible to obvious sclerotic. Formation of lymphoid follicles was seen in 42 patients; obvious fibrosis was seen in 31 cases. Data of peripheral blood lymphocyte subtyping by flow cytometry were available in 73 cases. These data included CD3+total T cells, CD3+CD4+helper T cells, CD3+CD8+cytotoxic T cells, CD3-CD56+natural killer (NK) cells, CD3-CD19+B cells, CD4+CD45RA-T helper induction subgroup, CD4+CD45RA+ T suppression induction subgroup, CD4+CD45RO+memory T cell subgroup, CD45RA+CD45RO+activated T cell subgroup, CD8+CD38+activated cytotoxic T cell, and CD25+lymphocytes and CD44+lymphocyte. The proportion of lymphocytes of each subtype was normal in most patients, but the proportion of CD44+lymphocytes in 61 cases (83.6%) was increased; the proportion of T cell suppression induced subgroups was decreased in 53 cases (72.6%). Correlation analysis found a significant correlation between clinical stage and NK cells (P=0.023); tumor histologic type and cytotoxic T cells were significantly positively correlated (P=0.012); while tumor cell morphologic differentiation was significantly related to total T cells (P=0.003) and NK cells (P=0.026); Formation of interstitial lymphoid follicles was positively correlated with memory T cell subsets (P=0.025); Tumor interstitial fibrosis was significantly positively correlated with T suppression-induced subpopulations (P=0.004), and was significantly negatively correlated with total T cells (P=0.023) and with the expression of CD44 adhesion molecules (P=0.003). Survival analysis found that lymphoid follicle formation was a favorable prognostic factor for LELC (P=0.001). Conclusions: The onco-immunological and morphologic features in LELC show a continuous spectrum; the tumor clinicopathological characteristics and onco-immunological morphology are closely related to peripheral blood T lymphocyte subtypes, and the formation of interstitial lymphoid follicles is a favorable prognostic factor for LELC.

Prognostic Significance of Intramural and Extramural Lymphovascular Invasion in Colorectal Carcinoma

ABSTRACT Introduction: Evaluation of lymphovascular invasion (LVI) in Colorectal Carcinoma (CRC) may help to predict the metastatic potential and identify patients with aggressive tumor. Such patients may benefit from adjuvant therapy, hence improving their survival and disease-free outcome. Aims and Objectives: To identify LVI in cases of CRC and classify them as intramural and extramural and find its correlation with parameters such as tumor volume, location, growth pattern, histological type, grade, tumor budding, stage, and nodal metastasis. Materials and Methods: A prospective study was conducted from November 2018 to April 2020 at a tertiary care hospital, New Delhi, which included 27 cases of CRC. Demographic and perioperative data were collected. LVI identified on H and E, further differentiated into intramural and extramural and correlated with clinicopathological data. Observation and Results: About 70.3% of cases showed the presence of LVI. A statistically significant association between intramural and extramural LVI and nodal metastasis was identified. A statistically significant association was also noted between extramural LVI and staging. Conclusion: LVI is an independent predictor of recurrence and silent metastasis in many cancers, especially colorectal cancer. It is a cost-effective and simple method. The result of the present study adds on to the growing literature on the significance of LVI in CRC. However, more work needs to be done with a large sample size to fulfill the limitations.

Circular-stapled esophagogastrostomy using the keyhole procedure after radical esophagectomy for esophageal cancer.

Anastomotic leakage of cervical esophagogastrostomy following radical esophagectomy for esophageal cancer has reduced over time; however, postoperative anastomotic stricture still occurs at a considerably high rate. We developed a novel method of circular-stapled esophagogastrostomy by employing the keyhole procedure, which uses a linear stapler to enlarge the anastomotic opening made with a circular stapler (CS). We retrospectively reviewed 70 patients with esophageal cancer who underwent transthoracic esophagectomy and reconstruction via cervical CS-mediated anastomosis with or without the keyhole procedure between 2018 and 2020. The primary outcome was postoperative anastomotic stricture incidence within 180days after surgery. Among 70 patients, 22 underwent the keyhole procedure (CS + K group) and the remaining did not (CS group). No differences were observed in patients' age, sex, body mass index, performance status, American Society of Anesthesiologists physical status, Charlson's comorbidity index, tumor histological type, tumor location, clinical stage, or preoperative treatment. A smaller stapler was used in the CS + K group (p < 0.001). Incidence of anastomotic stricture was significantly different (CS vs. CS + K, 18.8 vs. 0%, p = 0.049), especially when a 21 or 23mm CS was used (CS vs. CS + K, 50.0 vs. 0%, p = 0.005). Univariate analysis confirmed that CS ≤ 23 without keyhole was a significant risk factor (p = 0.001). The keyhole procedure could be a simple and useful alternative technique that reduces the risk of stricture formation in cervical esophagogastric anastomosis, especially when using the smaller-sized CS.

Prognostic role of hydronephrosis in the treatment of patients with locally advanced cervical cancer: a retrospective cohort

BackgroundObstructive uropathy is present in almost 50% of patients with advanced cervical cancer and is associated with worse outcomes.ObjectiveTo estimate the prognostic role of hydronephrosis and the impact of ureteral...

Histopathological Evaluation and Molecular Diagnostic Tests for Peritoneal Metastases with Unknown Primary Site-a Review.

Cancer of unknown primary (CUP) is a well-studied entity with guidelines available for the management of patients with CUP. The peritoneum represents one of the metastatic sites in CUP, and peritoneal metastases (PM) could present as CUP. PM of unknown origin remains a poorly studied clinical entity. There is only one series of 15 cases, one population-based study, and few other case reports on this subject. Studies on CUP, in general, cover some common tumour histological types like adenocarcinomas and squamous carcinomas. Some of these tumours may have a good prognosis though majority have high-grade disease with a poor long-term outcome. Some of the histological tumour types commonly seen in the clinical scenario of PM like mucinous carcinoma have not been studied. In this review, we divide PM into five histological types-adenocarcinomas, serous carcinomas, mucinous carcinomas, sarcomas and other rare varieties. We provide algorithms to identify the primary tumour site using immunohistochemistry when imaging, and endoscopy fails to establish the primary tumour site. The role of molecular diagnostic tests for PM or unknown origin is also discussed. Current literature on site-specific systemic therapy based on gene expression profiling does not show a clear benefit of this approach over empirical systemic therapies.

FBXL7 Body Hypomethylation Is Frequent in Tumors from the Digestive and Respiratory Tracts and Is Associated with Risk-Factor Exposure.

Squamous cell carcinoma is the main histological tumor type in the upper aerodigestive tract (UADT), including the esophagus (ESCC) and the head and neck sites, as well as the oral cavity (OCSCC), larynx (LSCC) and oropharynx (OPSCC). These tumors are induced by alcohol and tobacco exposure, with the exception of a subgroup of OPSCC linked to human papillomavirus (HPV) infection. Few genes are frequently mutated in UADT tumors, pointing to other molecular mechanisms being involved during carcinogenesis. The F-box and leucine-rich repeat protein 7 (FBXL7) is a potential tumor-suppressing gene, one that is frequently hypermethylated in pancreatic cancer and where the encoded protein promotes the degradation of AURKA, BIRC5 and c-SRC. Thus, the aim of this study was to evaluate the methylation and expression profile of FBXL7 in the UADT and the gene’s association with the clinical, etiological and pathological characteristics of patients, as well as the expression of its degradation targets. Here we show that the FBXL7 gene’s body is hypomethylated in the UADT, independently of histology, but not in virus-associated tumors. FBXL7 body methylation and gene expression levels were correlated in the ESCC, LSCC, OCSCC and OPSCC. Immunohistochemistry analysis showed that FBXL7 protein levels are not correlated with the levels of its degradation targets, AURKA and BIRC5, in the UADT. The high discriminatory potential of FBXL7 body hypomethylation between non-tumor and tumor tissues makes it a promising biomarker.

The use of individual instruments in the surgical treatment of malignant bone tumors created by 3D printing

Introduction. Computer modeling and additive technologies are increasingly used in medicine. Oncoorthopedics is no exception. Careful preoperative planning and the creation of individual instruments make it possible to perform radical operations, which allows maximum preservation of healthy tissues and leads to an increase in the functional potential of patients in the postoperative period.Objective – to improve the results of surgical treatment of patients with malignant bone tumors of complex anatomical localizations using computer modeling and additive technologies.Materials and methods. This study included 44 patients (26 men and 18 women) with malignant bone tumors. The mean age of the patients was 39 ± 15.57 years (range 14 to 66 years). In 39 cases, the anatomical location of PSI application was the pelvis, in four cases it was the distal femur, and in one case the femoral shaft. The most common histological type of tumor was chondrosarcoma (47.7 %).Results. In the case of primary resection of the pelvic bone tumor (26 patients), according to the histological examination, radical resection margins (R0) were observed in 25 cases. In one case, after removal of the tumor, a discrepancy between the preoperative histological conclusion (G2 chondrosarcoma) and postoperative (dedifferentiated G3 chondrosarcoma) was revealed. During operations to remove tumors of the distal segment of the femur and resection of the tumor of the diaphysis of the femur, in all cases, the radicality was R0.Conclusion. Individual navigation devices have proven themselves in clinical practice. The results obtained in our study demonstrate their effectiveness in the treatment of malignant bone tumors.

Elucidation of HER2/neu and Wilms’ tumor 1 immunohistochemical expression in endometrial carcinomas regarding the diagnostic and prognostic significance

Objective To confirm HER2 neu and Wilms’ tumor 1 (WT1) immunohistochemical expression in endometrial cancer and illustrate its possible diagnostic and prognostic significance in various clinicopathological parameters that both physicians and pathologists may find therapeutically valuable. Materials and methods A total of 50 formalin-fixed and paraffin-embedded tissue specimens were acquired and prepared for this investigation from the archival pathology files of Al-Hussein and Al-Zahraa University Hospitals between 2017 and 2020, after obtaining the informed consent and approval of the local ethical committee. The patient’s medical records and histopathologic data such as tumor size, myometrial invasion depth, lymph node invasion, histologic type of tumor, clinical presentation, and International Federation of Gynecology and Obstetrics stage were assessed using hematoxylin-eosin for all sections that were re-evaluated by HER2/neu and WT1 antibodies immunohistochemically. Results Positive HER2/neu and WT1 expressions were frequently associated with a worsening condition in patients with endometrial carcinomas (ECs) with a higher grade, stage, and nonendometrioid carcinoma type, reflecting the prognostic relevance of HER2/neu and WT1 expressions, especially in aggressive EC forms. Follow-up and more genetic concordance between EC subtypes could improve the predictive value of HER2/neu and WT1 expression in EC. For advanced endometrial malignancies, tailored chemotherapy may be valuable. Conclusions HER2/neu-positive and WT1-positive immunohistochemical staining results are generally coupled to ECs in their advanced forms, which have a higher grade, stage, and nonendometrioid carcinoma type, reflecting their prognostic implications, especially in aggressive EC types. However, additional validation is required before enrolling this panel in clinical settings, which could improve the value of prediction of HER2/neu and WT1 immunohistochemical markers in ECs. Moreover, targeted chemotherapy for aggressive endometrial cancers can be beneficial.

Anaplasia and multinucleation in metastases of oropharyngeal squamous cell carcinoma is associated with poorer outcomes.

The presence of tumor cell anaplasia and multinucleation (A/M) in oropharyngeal squamous cell carcinoma (OPSCC) has recently been found to be associated with increased disease recurrence and poorer disease-specific survival, regardless of human papillomavirus status. We studied the detection of A/M in cytology specimens. We performed a comprehensive data search for all patients with OPSCC diagnosed and treated at Northwestern Memorial Hospital between January 2013 and April 2020. All cytology and histopathologic slides were reviewed for the presence of A/M in patients with both surgical resection or biopsy specimens and fine needle aspiration cytology of a metastatic site. A total of 87 patients were identified with both surgical and cytology specimens available for review. A/M was identified in 21 cytology specimens and 14 surgical specimens. Cytologic A/M was seen in 11 of the 14 patients (78.5%) with corresponding histologic A/M and in 10 of the 73 patients (13.7%) without histologic A/M. Disease-specific survival was significantly worse for the patients with cytologic A/M regardless of the presence of histologic A/M (P = 0.0064) and for the patients with cytologic A/M only (P = 0.0271). In patients with p16-positive/human papillomavirus-associated carcinoma, disease-specific survival was significantly worse for the patients with both histologic and cytologic A/M (P=0.0305). A/M can be reliably identified in cytology specimens among all the various stains and preparations, irrespective of the primary tumor histologic type. Identification of A/M on cytology specimens could indicate more aggressive clinical behavior and help guide patient management.

IMP3 Expression in Thyroid Cancers and its Relationship with Prognostic Parameters

To determine the expression of IMP3 (Insulin-like growth factor-II mRNA binding protein 3), which has been reported to be associated with poor prognosis in many organ malignancies, in thyroid malignant tumors and to determine its relationship with prognostic factors such as age, gender, tumor size, and histological type of tumor.

РЕКОНСТРУКТИВНЫЕ И СТАБИЛИЗИРУЮЩИЕ ВМЕШАТЕЛЬСТВА В КОМПЛЕКСНОЙ ТЕРАПИИ ПАЦИЕНТОВ С СОЛИТАРНЫМИ МЕТАСТАЗАМИ ПОЗВОНОЧНИКА

Abstract. Introduction: The problem of diagnosis and treatment of patients with oncological pathology of the spine is relevant due to treatment complexity and the increasing number of patients’ morbidity. Secondary neoplastic processes are common in spine because of its anatomy, physiological features, complex biomechanics and enhanced vascularization. The main clinical manifestations of metastatic lesions of the spine are pain and neurological deficit. The development of spinal cord compression and pain syndrome leads to a sharp deterioration in the quality of life in patients with metastatic lesions of the spine. Despite the progress made in modern surgery of patients with oncological diseases with metastasis to the spine, mortality rates after surgery reaches 6.3% and complications appear in 23% of cases. Aim: Improving the results of treatment of patients with solitary spinal metastases and spinal cord compression. Methods and materials: Between 2010 and 2018, patients with spinal neoformations (N=240) received surgical treatment at Traumatology Unit of North-Western State Medical University named after I.I. Mechnikov. All patients were put into the categories according to their sex, age, histologic type and location of tumors. We assessed patients’ pain severity (BAIII), neurologic status (Frankel scale) and life span (by Kaplan-Meier method). Results: The study presents the analysis of the results of complex therapy of 183 patients with solitary metastases of the spine, who underwent the surgical stage of treatment. For these patients the epidemiological structure and the main clinical and radiological characteristics of solitary metastatic lesions of the spine were determined, a comparative assessment of the effectiveness of various options for surgical interventions in the complex treatment was carried out. To do so, all patients of the primary cohort were divided into 2 groups depending on the volume of surgery. The first group included 54 patients who underwent a radical resection of the affected vertebra in a single block with prosthetics of the anterior support column and posterior instrumental fixation. The second group included 129 patients after palliative decompressive and stabilizing operations from the posterior approach. Conclusion: There were no statistically significant differences between the two studied methods of surgical treatment in terms of the dynamics of the level of pain syndrome, regression of neurological deficit and life expectancy. When choosing the tactics of surgical treatment of patients with solitary spinal metastases, the main method is decompressive and stabilizing interventions, which helps to reduce the risk of surgical complications, improve the quality of life of the patient and continue the complex treatment of the underlying disease.

Time to death from cervical cancer and predictors among cervical cancer patients in Felege Hiwot Comprehensive Specialized Hospital, North West Ethiopia: Facility-based retrospective follow-up study.

A sexually transmitted virus called the Human Papillomavirus is responsible for more than 99% of cervical cancer cases and its precursors. In 2019, the median survival time of cervical cancer patients at 5 years was 37 months. The survival time and predictors of death from cervical cancer vary in different study settings. This study was aimed to assess the time to death and to identify the major predictors of death of cervical cancer patients in Felege Hiwot Comprehensive Specialized Hospital. A facility-based retrospective follow-up study was conducted among 422 randomly selected cervical cancer patients in Felege Hiwot Comprehensive Specialized Hospital from 25th June 2017 to 31st March 2021. Data were extracted from the sampled patient charts by using a structured checklist which was prepared in an English version. Data were coded and then entered, edited, and cleaned using EPI-data 3.1 and exported to STATA14.2 statistical software for analysis. Frequencies and proportions were used to describe the study population with relevant variables and were presented using tables, pie charts, and graphs. Kaplan Meier and life table were used to describe the restricted mean survival time and the overall survival rates. Differences in survival among different variables were compared using the log-rank test. The assumption of proportional hazard was checked using Schoenfeld residual test. Variables having a P-value > 0.05 were considered as fulfilling the assumption. Variables with a significance level below 0.2 in the bivariable Cox regression model were included in a multivariable Cox regression model analysis, where Variables with a p-value < 0.05 were considered to be statistically significant at a 95% confidence interval. Model fitness was checked by Cox-Snell residual. The mean follow up time of this cohort was 27.66 (CI: 26.96, 28.36) months, and the restricted mean survival time of cervical cancer patients in this study was 40.21 (95% CI: 38.95, 41.47) months. Being FIGO stage IV [AHR = 6.10, 95% CI: 2.18, 16.90)], having adenocarcinoma [AHR = 3.12, 95% CI: 1.34, 7.28)], having co-morbidity [AHR = 2.57, 95% CI: 1.29, 5.11)], and being initiated with radiotherapy [AHR = 4.57, 95% CI: 1.60, 13.06)] were a significant predictors of death from cervical cancer. The restricted mean survival time of cervical cancer patients in this study was 40.21 months. Marital status, type of tumor histology, stage of disease, type of treatment initiated, and presence of co-morbidity were significant predictors of death for cervical cancer. Treatment of comorbidities in the early stage of cervical cancer plays a key role in maximizing the survival time of cervical cancer patients.