Major Primary Sites Research Articles

Association of quality of life (QoL) with mortality in patients with adenoid cystic carcinoma using an internationally validated QoL questionnaire (EQ-5D-5L): A new baseline.

6097 Background: An evaluation of impact on quality of life (QoL) is required for regulatory approval and reimbursement of new drug therapies. Almost all studies of new therapies in adenoid cystic carcinoma (ACC) are non-randomised with no comparator QoL measure. To support Health Technology Assessments and the evaluation of the clinical utility of these therapies, we sought to determine the QoL measures in a cohort of ACC patients and to assess for change over time and associations with clinical or prognostic factors. Methods: An internationally validated QoL questionnaire (EQ-5D-5L) was completed by ACC patients referred to an experimental medicine centre between 2019 and 2024, who provided written informed consent to analysis. EQ-5D value scores (EQV) were calculated from each questionnaire using the EuroQol England value set. A Cox proportional hazards model was built with EQV as a time dependent variable, with a variant using penalised smoothing splines to assess linearity. A base non-linear mixed effects (nlme) model was constructed between time and EQV. The relationship between EQV and other predictors (NOTCH1 alteration status, age at diagnosis, sex, local and/or metastatic recurrence, and primary site of disease) were tested against the base model using variant models built for each predictor. Both analyses used R Statistical Software (v4.3.2) with survival and nlme packages in Rstudio (v2023.12.0.0). Results: Between 2019 and 2023, 563 EQ-5D-5L questionnaires were completed by 161 patients with ACC (median 2 responses/patient, range 1 to 20). NOTCH1 alteration was seen in 8% (13/161), median age at diagnosis 49 years (range 17 to 81), 40% male, 36% (58/161) had a major salivary gland as primary site, and 14% had local recurrence, 46% metastatic recurrence and 26% both for 86% total with recurrent disease (139/161). For all 161 patients, median EQV was 0.81 (range -0.22 to 1.0); an EQV of 1 is ideal QoL and 0 is QoL as bad as death. The median EQV for the clinical subgroups were 0.83 (NOTCH1, IQR 0.74-0.87), 0.84 (no recurrence, IQR 0.75-0.92), 0.80 (local recurrence only, IQR 0.70-0.86), 0.81 (distant metastasis only, IQR 0.70-0.92), 0.83 (distant and local, IQR 0.75-0.92), 0.84 (major primary site, IQR 0.75-0.92), 0.81 (other primary site, IQR 0.70-0.89), and no statistical differences were identified between these groups. However, a decrease in EQV from 1 to 0 was associated with an eightfold increase in risk of death in the total population (HR= 0.118, 95% CI 0.057 to 0.244, p= <0.001). There was a significant non-linear relationship between EQV and survival over time (p=0.011), with a greater marginal effect on survival for EQVs >0.81. Conclusions: For patients with ACC, a worse QoL as measured by EQ-5D-5L was associated with a significantly increased risk of death. NOTCH1 and disease recurrence were not associated with a worse QoL.

Metastatic Sites in Rare Genitourinary Malignancies and Primary Cancer Sites in Genitourinary Organ Metastases: A Secondary Analysis Using the Japanese Pathological Autopsy Registry Database

BackgroundThe epidemiology of metastases from rare genitourinary cancer and metastases to genitourinary organs from other primary neoplasms remains poorly understood. ObjectiveTo investigate the epidemiology of rare genitourinary metastases from rare genitourinary organ–type cancer and to genitourinary organs using data from a large national autopsy registry in Japan. Design, setting, and participantsA secondary analysis of the data reported in the Annual of the Pathological Autopsy Cases in Japan and the Japanese Mortality Database from 1993 to 2020 was performed. Outcome measurements and statistical analysisVia a retrospective epidemiologic analysis, we evaluated the frequency (probability of occurrence [number per person]) and proportion (percentage) of metastases from upper urinary tract, adrenal, testicular, urethral, and penile cancers. Moreover, the sites of primary tumors metastasizing to genitourinary organs were examined. Results and limitationsIn Japan, the mortality rate of upper urinary tract cancer is increasing rapidly. In the integrated database with 365 099 autopsies and 835 959 metastatic organs, the major metastatic sites (range of frequency ratios) of rare genitourinary organ–type cancers were the lungs (0.38–0.47), liver (0.21–0.56), bone (0.16–0.33), adrenal gland (0.10–0.20), peritoneum (0.0–0.16), and kidneys (0.07–0.22). The major primary sites (range of proportions) of genitourinary organ metastases were the respiratory tract (5.6–34.0%), stomach (4.7–27.0%), hematologic site (0.9–24.9%), lymphoid (2.4–22.2%), bladder (0.8–20.0%), prostate (0.7–14.1%), rectal (2.0–11.7%), and pancreas (2.6–11.0%). The cancers with a high likelihood of genitourinary metastasis were respiratory and stomach cancers. However, the study lacked individual-level information, and there might be a concomitant selection bias in this autopsy study. ConclusionsThis large-scale autopsy database analysis identified the epidemiology of metastasis from rare genitourinary organ–type cancer and the origins of metastasis to genitourinary organs. Patient summaryThis study provides valuable metastatic epidemiologic data and clinical information that are fundamental to the mechanisms of genitourinary metastasis.

PB2116: CLINICAL PRESENTATION AND TREATMENT OUTCOME OF CHILDREN WITH B-CELL LYMPHOMA; 3-YEAR STUDY AT CHILDREN’S WELFARE TEACHING HOSPITAL (2016-2018)

Background: Lymphoma is an aggressive tumor with promising survival rate; indeed, it needs supportive care to reach this goal which is not available in developing countries that make survival much lower compared with the developed countries. Aims: To study the clinico-pathological presentation of B-cell non-Hodgkin’s lymphoma and whether the outcome has been changed in comparison with previous studies done at the same hospital. Methods: A descriptive analytic study on 92 children less than 14 years of age with B-cell non-Hodgkin’s lymphoma who were admitted to Oncology Unit/ Children Welfare Teaching Hospital /Medical City campus from January 2016 to December 2018. They were managed according to the modified FAB LMB 96 protocol. Duration of data collections was from January 2021 to January 2022. Results: Fifty-two (56.5%) patients were below 5 years, male to female ratio was 2.28:1 and 72.8% had duration of symptoms less than 60 days. The abdomen represents the major primary site seen in 68 (73.9%) patients, advanced stages (III&IV) form 95%. Tissue diagnosis seen in 40.2% while cytology in 59.7% of cases, Burkitt’s lymphoma was the commonest type seen in 44 (47.8%). Management was carried out by modified FAB LMB 96 protocols; 7 patients were not eligible for outcome analysis. From 85 patients received COP-reduction phase, response was poor in 9 (10.6%) patients, 9 (10.6%) died, 57 patients assigned for group B and 19 for group C. Three-year Event Free Survival was and Overall Survival were equal (62%) and the most common cause of deaths were presumptive sepsis followed by tumor lysis syndrome. Variables that contribute to survival were LDH level and PS score before starting treatment and response to COP phase after treatment ensued. Summary/Conclusion: Therapy related mortality remained high and EFS and OS has a trend for improvement compared with previous published papers from the same centre. Proper risk stratification and staging with Reduction of the intensity of chemotherapy to accommodate the lack of supportive care in resource-limited settings is appreciated.

Apixaban in Japanese patients with cancer-associated venous thromboembolism: a multi-center phase II trial

Recent pivotal phase III trials involving direct oral anticoagulant (DOAC) versus low molecular weight heparin have demonstrated the utility of DOACs in Western patients with cancer-associated venous thromboembolism (VTE). However, these trials did not include Japanese patients. This phase II trial evaluated the safety and efficacy of apixaban in Japanese patients with cancer-associated VTE (UMIN000028447). Apixaban was initiated at 10mg twice daily for 7days, followed by 5mg twice daily for 23weeks. The primary endpoint was the incidence of major or clinically relevant non-major (CRNM) bleeding events during the treatment period. The study was terminated due to safety concerns after enrolling 27 patients. Median age was 71years; median body weight was 51.3kg; and major primary tumor sites were the gastrointestinal tract (26%) and lung (19%). During the median follow-up period of 5.4months, major or CRNM bleeding occurred in in 26% of patients (major, n = 5; CRNM, n = 2; 95% confidence interval, 11-46%). No recurrent VTE or VTE-related death occurred. Estimated overall survival at 6months was 68%. This study demonstrated the excessive bleeding risk of apixaban at the standard dose in Japanese patients with cancer-associated VTE.

Multi-Institutional Retrospective Analysis of the Outcomes of Proton Beam Therapy for Patients With 1 to 3 Pulmonary Oligometastases From Various Primary Cancers

PurposeOur purpose was to evaluate the efficacy of proton beam therapy (PBT) in patients with 1 to 3 pulmonary oligometastases from various primary cancers in Japan. Methods and MaterialsThis multi-institutional retrospective survey included 118 patients with 141 metastatic lung tumors from miscellaneous primary cancers, across 6 Japanese institutions, and involved the analyses of local progression-free rate (LPF), distant progression-free rate, progression-free survival rate, cause-specific survival rate, and overall survival rate (OS). Treatment-induced adverse effects of grade ≥2 were evaluated according to the Common Terminology Criteria for Adverse Events (version 4.0). Cox proportional hazards regression models were used in univariable analysis and multivariable analysis (MVA) for the identification of the prognostic factors of LPF and OS. ResultsThe median follow-up duration from the time of PBT was 25.5 months. The major primary disease sites included colorectal cancer (42.4%), lung cancer (11.9%), head and neck cancer (8.5%), and kidney cancer (8.5%). For years 1, 2, and 3, LPFs were 92.2%, 86.3%, and 78.4%; distant progression-free rates were 59.1%, 44.1%, and 34.0%; progression-free survival rates were 49.6%, 31.7%, and 24.2%; cause-specific survival rates were 83.4%, 72.5%, and 64.8%; and OS rates were 79.0%, 67.8%, and 59.6%, respectively. Eight patients developed acute adverse effects (grade ≥2). Ten patients developed radiation pneumonitis (grade 2) as a late adverse effect. None of the patients developed severe late toxicity (grade ≥3). Colorectal cancer as the primary disease was the only prognostic factor associated with LPF that remained independently significant in the MVAs performed using 3 sets of parameters (hazard ratio [HR], 3.31-4.76 in 3 MVA sets). In the MVA, the significant prognostic factors for OS were performance status (HR, 2.78; 95% confidence interval, 1.01-7.67) and total tumor volume (HR, 1.01; 95% confidence interval, 1.00-1.02). ConclusionsPBT provides promising outcomes for pulmonary oligometastasis with acceptable toxicities.

Place of death for patients treated at a tertiary cancer center in Jordan.

Home death is considered to be a marker of good death. Little is known about the place of death and its determinants in patients with cancer in Jordan. A retrospective analysis of regularly collected data of cancer patients who had a palliative care consultation at King Hussein Cancer Center and died between 2011 and 2012. Variables analyzed were related to the patient, disease, and palliative care services. Patient-related factors included age at death, gender, place of residence, and code status; disease-related variables were cancer type (solid vs hematological), major primary site, and time from cancer diagnosis to death; palliative care service-related variables included time of consultation for palliative care services to death, location of first palliative encounter (outpatient clinic vs hospital floor), multidisciplinary palliative home care teams involvement, and the number of home care visits before death. We examined the association between each variable and place of death using Pearson's chi-square and the Mann-Whitney tests. Factors with statistical significance of P value < 0.1 were entered into multivariate logistic regression model. Among 630 patients, 80 (12.7%) died at home. Univariate analysis showed the following to be significantly associated with dying at home: male gender, age more than 65years old, earlier palliative care involvement, and involvement of home care services (P value < 0.05). Independent predictors for dying at home were male gender, age more than 65years old, and involvement of home care services. Hospital death is more prevalent than home death in cancer patients in Jordan. Involvement of home care services can help achieve the goal of dying at home.

Clinical characteristics and prognostic factors of male yolk sac tumor: a Surveillance, Epidemiology, and End Results program study.

Yolk sac tumor (YST) is a rare malignant germ cell tumor, which usually affects young males. Because of the low incidence, few studies on YST have been published. In our study, we aim to investigate the clinical characteristics, survival and risk factors of male YST patients based on the Surveillance, Epidemiology, and End Results (SEER) program. We identified 569 male YST patients from the SEER-18 database with additional treatment fields. Clinical characteristics, survival and prognostic factors were described in the study. Chi-square tests were applied to analyze categorical and continuous variables between different groups. Univariate and multivariate Cox proportional hazard model were performed to assess the relative impacts of risk factors on cancer-specific survival (CSS) in YST patients. Kaplan-Meier method and the log-rank test were used to analyze differences in survival that were significant. The major primary sites of YST were testis (74.69%), mediastinum (15.47%), retroperitoneum (2.64%) and central nervous system (1.24%). The 3-year and 5-year CSS was 70.0%, 56.5% vs. 97.2%, 96.0% for the mediastinal and testicular YST patients, respectively (p < 0.001). Primary site of mediastinum, distant SEER Summary stage were independent factors of poor prognosis (hazard ratio (HR) = 2.010 (1.094-3.695), p = 0.025; HR = 6.501 (2.294-18.424), p < 0.001, respectively). Receiving surgery was a good prognosis factor for all patients (HR = 0.495 (0.260-0.940), p = 0.032) and for the mediastinal group (p = 0.0019). Being treated with chemotherapy indicated poor outcome in all patients (HR = 3.624 (1.050-12.507), p = 0.042) and in the localized testicular YST patients (p = 0.0077). For the first time, our study revealed the primary site distribution of male YST, and summarized the clinical characteristics, survival and prognostic factors based on the SEER database, which provided important epidemiological evidence for clinical practice.

Single community-based institutional series of stereotactic body radiation therapy (SBRT) for treatment of liver metastases.

Stereotactic body radiation therapy (SBRT) is a safe and effective option for treatment of liver metastases. However, existing data are mostly reported by high-volume centers. There have been reports that advanced radiotherapy techniques performed at low-volume centers result in inferior outcomes. Our goal was to assess the implementation of SBRT for the treatment of liver metastases at a low-volume center by studying the efficacy and toxicity of this technology through retrospective database review at a single, community-based institution. We performed an IRB approved patient registry study. Patients had a median age of 65, KPS of at least 70 (median 90) and primary tumor controlled. All patients underwent fiducial marker placement under CT-guidance 1-2 weeks prior to planning scans. Gross tumor volume (GTV) was delineated using contrast enhanced CT scans, as well as fusion with PET and/or MRI scans. GTV was expanded by 5 mm to create the planning target volume (PTV). Treatment was delivered by image guided stereotactic robotic radiosurgery with respiratory motion tracking. Lesions were treated with 3 fractions to a median total dose of 54 Gy. Overall survival, progression-free survival (PFS) and local failure-free survival were estimated using the Kaplan-Meier method. Log-rank statistic was used to compare local control based on GTV volume. Between 2006 and 2016, 42 consecutively treated patients with 81 metastatic liver lesions were treated with SBRT. Median follow-up was 25 months. Major primary tumor sites were colon (n=18) and lung (n=7). Synchronous extrahepatic disease was present in 15% of the treated lesions and 46% had prior local treatment of liver metastases. The number of lesions treated concurrently ranged from 1 to 4. Lesions had a median maximum diameter of 2.5 cm (range, 0.5-9.5 cm), and a mean volume of 53 cc (range, 0.5-363.0 cc). Kaplan-Meier estimated 1- and 2-year overall survival was 72% and 62%. Estimated 1- and 2-year progression free survival was 32% and 23%. Estimated 1- and 2-year local control was 86% and 80%. Two-year local control was worse for lesions >50 cc compared to lesions ≤50 cc (62% vs. 84%, P=0.04). Toxicity occurred in 26% of treatment courses and included grade 1 (n=12) and grade 2 toxicity (n=3). These results are comparable to available published data regarding the safety and efficacy of liver metastasis SBRT on trial at high volume institutions. Our findings, therefore, demonstrate the successful implementation of a liver metastasis SBRT program in the low-volume, community-hospital setting. These findings suggest that low-volume and high-volume centers are both options for liver metastasis SBRT.

The Incidences and Characteristics of Various Cancers in Patients on Dialysis: a Korean Nationwide Study.

BackgroundThe numbers of patients on dialysis and their life expectancies are increasing. Reduced renal function is associated with an increased risk of cancer, but the cancer incidence and sites in dialysis patients compared with those of the general population require further investigation. We investigated the incidences of various cancers in dialysis patients in Korea and used national health insurance data to identify cancers that should be screened in dialysis clinics.MethodsWe accessed the Korean National Health Insurance Database and excerpted data using the International Classification of Disease codes for dialysis and malignancies. We included all patients who commenced dialysis between 2004 and 2013 and selected the same number of controls via propensity score matching.ResultsA total of 48,315 dialysis patients and controls were evaluated; of these, 2,504 (5.2%) dialysis patients and 2,201 (4.6%) controls developed cancer. The overall cancer risk was 1.54-fold higher in dialysis patients than in controls (adjusted hazard ratio, 1.71; 95% confidence interval, 1.61–1.81). The cancer incidence rate (incidence rate ratio [IRR], 3.27) was especially high in younger dialysis patients (aged 0–29 years). The most common malignancy of end-stage renal disease patients and controls was colorectal cancer. The major primary cancer sites in dialysis patients were liver and stomach, followed by the lung, kidney, and urinary tract. Kidney cancer exhibited the highest IRR (6.75), followed by upper urinary tract (4.00) and skin cancer (3.38). The rates of prostate cancer (0.54) and oropharyngeal cancer (0.72) were lower than those in the general population.ConclusionDialysis patients exhibited a higher incidence of malignancy than controls. Dialysis patients should be screened in terms of colorectal, liver, lung, kidney and urinary tract malignancies in dialysis clinics.

Metastatic non-small cell lung carcinoma a mimic of primary breast carcinoma-case series and literature review.

Metastatic tumors to the breast are rare but constitute a major diagnostic dilemma. Of these, non-mammary carcinomatous metastases to the breast are particularly challenging and, without a clinical history, may be extremely difficult to distinguish from primary breast carcinoma (PBC). We specifically studied metastatic tumors of pulmonary origin, as the lung is one of the major primary sites for carcinomatous metastasis to breast. Sixteen metastatic lung tumors to the breast were identified in our archives between 1996 and 2017 including 12 non-small cell lung carcinomas (NSCLC), one large-cell neuroendocrine, one atypical carcinoid, and two small-cell carcinomas. Adenocarcinoma was the most frequent amongst the NSCLCs (11/14). We retrieved the clinical information of these cases and reviewed the pathological characteristics to provide practical tools for pathologists to aid in their identification. Even in the absence of a clinical history of lung cancer, metastatic pulmonary adenocarcinoma to the breast should be considered in at least one of the following scenarios: (1) single or multiple well-circumscribed lesions of the breast that lack an in situ component and that are accompanied by distant metastases but negative axillary lymph nodes, (2) breast tumors that are triple negative yet not high-grade, or (3) breast tumors presenting as stage 4 disease and/or having an unusually aggressive clinical course on standard breast therapy. Accurate and timely diagnosis of these tumors is mandatory because of treatment and prognostic implications.

Immunohistochemical Characterization of the Origins of Metastatic Well-differentiated Neuroendocrine Tumors to the Liver.

Metastatic neoplasms of unknown primary site pose a major challenge to patient management. As targeted therapies are now being tailored to neuroendocrine tumors (NETs) of different primary sites, identifying the origin of metastatic NETs has become increasingly important. Compared with more extensive efforts on metastatic adenocarcinomas of unknown primary, the literature on metastatic NETs (often to the liver) is relatively sparse and most studies are based on primary tumors. We sought to study metastatic well-differentiated NETs to the liver to identify markers that predict the site of origin. Eighty-five metastatic NETs to the liver were retrieved from the pathology archive. The primary sites were determined based on either pathologic review of the primary tumors (in most cases) or radiologic/clinical findings. Immunohistochemical labeling for TTF1, CDX2, ISL1, NKX2.2, and PDX1 was performed on either tissue microarrays or whole sections. The primary sites of the NETs in the study cohort included: pancreas (35%), small intestine (32%), rectum (8%), stomach (2%), bile duct (1%), lung (9%), and unknown primary (12%). We found predominant expression of TTF1 in lung carcinoid (63%), CDX2 in small intestinal (89%) and ISL1 in pancreatic NETs (77%), respectively. NKX2.2 was mainly expressed in NETs of the digestive organs. PDX1 was detected in a small percentage of pancreatic, small intestinal and the single bile duct NET. There was no statistically significant association between tumor grade (World Health Organization G1 vs. G2) and the expression of any of the above markers. The 3-marker panel (TTF1, CDX2, and ISL1) had sensitivities of 81%, 89%, and 63%, specificities of 100%, 94%, and 100%, positive predictive values of 100%, 89%, and 100%, and negative predictive values of 84%, 94%, and 96% in separating metastatic NETs into 3 major primary sites: pancreas/rectum, small intestine, and lung, respectively, with an overall accuracy of 82%. Furthermore, this panel predicted a primary site for 6 of the 10 NETs of unknown primary, which reduced the NETs of unknown primary from 12% to 5%. Thus, through immunohistochemical study of a large series of metastatic NETs to the liver, we have demonstrated the utility of a 3-marker panel for the identification of one or more potential primary sites of most metastatic NETs, which could provide practical guidance in patient management.

Stereotactic body radiotherapy (SBRT) in the management of extracranial oligometastatic (OM) disease.

A review of stereotactic body radiotherapy (SBRT) for oligometastases defined as three or fewer sites of isolated metastatic disease. The aim was to identify local control, overall survival (OS) and progression-free survival (PFS) of patients receiving SBRT for oligometastatic (OM) disease. Data were analysed for SBRT delivered between 01 September 2010 and 31 March 2014. End points included local control, PFS, OS and toxicity. 76 patients received SBRT. The median age was 60 years (31-89 years). 44 were male. Median follow-up was 12.3 months (0.2-36.9 months). Major primary tumour sites included colorectal (38%), the breast (18%) and the prostate (12%). The treatment sites included lymph nodes (42%), the bone and spine (29%) and soft tissue (29%). 42% were previously treated with conventional radiotherapy. 45% were disease free after SBRT. 4% had local relapse, 45% had distant relapse, and 6% had local and distant relapse. Local control was 89%. The OS was 84.4% at 1 year and 63.2% at 2 years. PFS was 49.1% at 1 year and 26.2% at 2 years. Toxicities included duodenal ulcer and biliary stricture formation. SBRT can achieve durable control of OM lesions and results in minimal radiation-induced morbidity. This cohort is one of the largest reported to date and contributes to the field of SBRT in oligometastases that is emerging as an important research area. It is the only study reported from the UK and uses a uniform technique throughout. The efficacy and low toxicity with durable control of local disease with this approach is shown, setting the foundations for future randomized studies.

The time trends of gallbladder cancer and cholangiocarcinoma in 1,047 patients.

376 Background: Gallbladder cancer (Gb ca) and cholangiocarcinoma (CC ca) are major primary sites in biliary tract cancer. Progresses of diagnosis and anti-cancer therapy for Gb and CC ca lead to the changes of patients’ characteristics and overall survival time, but is not fully understood. This study aimed to identify the time trends in patients with Gb and CC ca. Methods: The inclusive criteria in this study was the patients receiving initial treatment including surgery (Op), chemotherapy (Chemo), radiotherapy (RT), or best supportive care (BSC) for Gb or CC ca in our institution, and 1047 patients were reviewed. Patient who received initial treatment at 1992-2005 were in 54.1 % of the study subjects and was defined as Group 1. Patients with initial treatment at 2006-2012 were categorized to Group 2 and were in 45.9% of all patients. The differences between two groups were evaluated, and the features of Group 2 were identified. Results: Age more than 60 years (Odd ratio [OR]: 2.37), the absence of distant metastasis (OR: 2.13), and ECOG performance status score (PS) = 0 (OR: 1.70) were identified as the independent features of Group 2. The rates of Op, Chemo, RT, and BSC were 38.5, 24.7, 14.9, and 21.7% in Group 1, and 40.8, 49.9, 1.5, and 6.0% in Group 2. The rate of Chemo in Group 2 was higher than that in Group 1 (P &lt; 0.01). The median times of overall survival (OS) in Op, Chemo, RT, and BSC were 21.1, 5.2, 6.9, and 2.4 months in Group 1 and 60.6, 9.2, 10.5, 2.8 months in Group 2. The OS in Op or Chemo of Group 2 was longer than that in Group 1 (P &lt; 0.01, P &lt; 0.01). The independent poor prognostic factors were distant metastasis (HR: 3.91), Group 1 (1.81), and PS &gt; 0 (1.72) in all patients, distant metastasis (HR: 3.56), Group 1 (2.12), biliary drainage (1.75) in Op, and PS&gt;0 (HR: 1.97), Group 1 (1.74), and distant metastasis (1.64) in Chemo. Conclusions: The recent trends in patients with Gb and CC ca were aging, low rates of distant metastasis, good PS, increased cases with chemotherapy, and the prolonged survival times in surgery and chemotherapy. The presence of distant metastasis, the worsened PS, and the previous treatment group were the independent poor prognostic factors.

The Epidemiology of Neuroendocrine Tumors in Taiwan: A Nation-Wide Cancer Registry-Based Study

BackgroundThe epidemiology of neuroendocrine tumors (NETs) is not well illustrated, particularly for Asian countries.MethodsThe age-standardized incidence rates and observed survival rates of NETs diagnosed in Taiwan from January 1, 1996 to December 31, 2008 were calculated using data of the Taiwan Cancer Registry (TCR) and compared to those of the Norwegian Registry of Cancer (NRC) and the US Surveillance, Epidemiology, and End Results (SEER) program.ResultsDuring the study period, a total of 2,187 NET cases were diagnosed in Taiwan, with 62% males and a mean age of 57.9 years-old. The age-standardized incidence rate of NETs increased from 0.30 per 100,000 in 1996 to 1.51 per 100,000 in 2008. The most common primary sites were rectum (25.4%), lung and bronchus (20%) and stomach (7.4%). The 5-year observed survival was 50.4% for all NETs (43.4% for men and 61.8% for women, P<0.0001). The best 5-year observed survivals for NETs by sites were rectum (80.9%), appendix (75.7%), and breast (64.8%).ConclusionsCompared to the data of Norway and the US, the age-standardized incidence rate of NETs in Taiwan is lower and the major primary sites are different, whereas the long-term outcome is similar. More studies on the pathogenesis of NETs are warranted to devise preventive strategies and improve treatment outcomes for NETs.

Worldwide Relative Burden of Cancer Death in 2008 Extrapolated from the WHO Mortality Database

In order to compare the burden of cancer mortality worldwide, we abstracted the crude mortality rate in 2008 from the WHO mortality database. We used a crude mortality rate by cancer sites in Japan, the Philippines, the USA, Brazil, the UK, Poland and Australia. However, the most recent published mortality rate in Australia is from 2006. We selected five cancer sites with the highest mortality rates in each country and compared the difference between the sites and the distribution of cancer burden. Figure 1 shows the burden of cancer mortality ranking highest for males and Figure 2 shows these data for females. For males, the burden of cancer death at five major primary sites accounted for more than half of all cancer mortalities in all countries except the USA and Australia. In the seven countries, lung cancer was the most frequent cancer in varying proportions (14.8% in Brazil, to 32.3% in Poland). In all the countries except Japan and the Philippines, prostate cancer was placed second; it was third in the Philippines and fifth in Japan. Stomach cancer was the second most common cancer reported for Japan and liver cancer for the Philippines. Colon cancer was also a common form of cancer except in Brazil. It was the third most common cancer in the USA, the UK, Poland and Australia, and the fourth most frequent in Japan and the Philippines. In Japan, liver cancer was the third most frequent. For females, the burden of cancer death at five major primary sites accounted for 60.8% of all cancer mortalities in the USA and for nearly half in other countries. Lung, breast and colon cancer were the common forms of cancer in all the countries. In most of the countries, lung cancer was placed first, except for the Philippines and Brazil where it was second. Breast cancer was also common in most countries; the most frequent in the Philippines (24.1%) and Brazil (15.5%), and the second most frequent in the USA (15.0%), the UK (16.1%), Poland (13.1%) and Australia (15.5%). In contrast, it was the fifth most frequent in Japan (8.6%). In Japan, stomach cancer was the second most frequent in females (the same as for males), and it accounted for 5.9% in Brazil. Liver cancer was reported as the third most common for the Philippines, and cancer of the cervix uteri was reported as the third most common in Brazil. Pancreas cancer was placed fourth or fifth, except for the Philippines and Brazil. The distribution of burden of cancer death showed great variety; however, in ranking of the burden of cancer mortality, the USA was similar to Australia, and the UK was similar to Poland.

Metastatic colorectal adenocarcinoma of the jaw – a case report

AbstractMetastatic tumours of the oral region are far less frequent than the primary tumours. The major primary sites of carcinoma metastasising to the oral cavity are the lungs and breast, but there are several reported cases of other primary sites. To our knowledge, oral metastases from a primary colorectal malignancy are a very rare occurrence. We present a case of metastatic adenocarcinoma of the oral region from a colorectal primary malignancy.We discuss the clinical and histopathological aspects of this rare condition and the management of this patient.

Subclassification of Recursive Partitioning Analysis Class II Patients With Brain Metastases Treated Radiosurgically

Although the recursive partitioning analysis (RPA) class is generally used for predicting survival periods of patients with brain metastases (METs), the majority of such patients are Class II and clinical factors vary quite widely within this category. This prompted us to divide RPA Class II patients into three subclasses. This was a two-institution, institutional review board-approved, retrospective cohort study using two databases: the Mito series (2,000 consecutive patients, comprising 787 women and 1,213 men; mean age, 65 years [range, 19-96 years]) and the Chiba series (1,753 patients, comprising 673 female and 1,080 male patients; mean age, 65 years [range, 7-94 years]). Both patient series underwent Gamma Knife radiosurgery alone, without whole-brain radiotherapy, for brain METs during the same 10-year period, July 1998 through June 2008. The Cox proportional hazard model with a step-wise selection procedure was used for multivariate analysis. In the Mito series, four factors were identified as favoring longer survival: Karnofsky Performance Status (90% to 100% vs. 70% to 80%), tumor numbers (solitary vs. multiple), primary tumor status (controlled vs. not controlled), and non-brain METs (no vs. yes). This new index is the sum of scores (0 and 1) of these four factors: RPA Class II-a, score of 0 or 1; RPA Class II-b, score of 2; and RPA Class II-c, score of 3 or 4. Next, using the Chiba series, we tested whether our index is valid for a different patient group. This new system showed highly statistically significant differences among subclasses in both the Mito series and the Chiba series (p < 0.001 for all subclasses). In addition, this new index was confirmed to be applicable to Class II patients with four major primary tumor sites, that is, lung, breast, alimentary tract, and urogenital organs. Our new grading system should be considered when designing future clinical trials involving brain MET patients.

Assembly and Initial Characterization of a Panel of 85 Genomically Validated Cell Lines from Diverse Head and Neck Tumor Sites

Human cell lines are useful for studying cancer biology and preclinically modeling cancer therapy, but can be misidentified and cross-contamination is unfortunately common. The purpose of this study was to develop a panel of validated head and neck cell lines representing the spectrum of tissue sites and histologies that could be used for studying the molecular, genetic, and phenotypic diversity of head and neck cancer. A panel of 122 clinically and phenotypically diverse head and neck cell lines from head and neck squamous cell carcinoma, thyroid cancer, cutaneous squamous cell carcinoma, adenoid cystic carcinoma, oral leukoplakia, immortalized primary keratinocytes, and normal epithelium was assembled from the collections of several individuals and institutions. Authenticity was verified by carrying out short tandem repeat analysis. Human papillomavirus (HPV) status and cell morphology were also determined. Eighty-five of the 122 cell lines had unique genetic profiles. HPV-16 DNA was detected in 2 cell lines. These 85 cell lines included cell lines from the major head and neck primary tumor sites, and close examination shows a wide range of in vitro phenotypes. This panel of 85 genomically validated head and neck cell lines represents a valuable resource for the head and neck cancer research community that can help advance understanding of the disease by providing a standard reference for cell lines that can be used for biological as well as preclinical studies.

Clinical features of Bacteroides bacteremia and their association with colorectal carcinoma

We investigated the clinical features of Bacteroides bacteremia for 5 years to determine the risk factors for mortality and to ascertain whether bacteremia due to Bacteroides spp. is associated with colorectal carcinoma. This study comprised a review of all patients with Bacteroides bacteremia at a teaching hospital in Tokyo from April 2003 to March 2008. We also conducted a case-control study between Bacteroides bacteremia and bacteremia due to other pathogens. During the study period, 25 cases of bacteremia were due to Bacteroides spp. Bacteroides bacteremia was associated with a high mortality rate (24%). Malignancy (76%) was the major comorbidity, followed by a history of surgery (40%). Colorectal carcinoma was the most frequent (n = 8, 32%) of the comorbid malignancies and was recognized as the primary infection site in six cases. Prevalence of colorectal carcinoma as comorbidity was significantly higher in Bacteroides bacteremia than in other bacteremia. In the Bacteroides bacteremia cases of this study, colorectal carcinoma was the major comorbidity and primary infection site. Colorectal carcinoma screening in Bacteroides bacteremia patients is potentially an important diagnostic marker for the early detection of this infection in the future.

Extrapulmonary neuroendocrine tumors: An institutional experience of 337 patients at the National Cancer Center Hospital in Japan.

293 Background: Extrapulmonary neuroendocrine tumors (EPNET) are a rare and heterogeneous disease entity, and little information regarding these tumors is available. The aim of the present study was to clarify the clinical behavior, treatment strategy, and outcome of EPNET arising from various primary sites. Methods: We retrospectively reviewed the medical records of 337 patients with pathologically confirmed NET arising from extrapulmonary site between January 2000 and December 2008 at the National Cancer Center Hospital of Japan. Results: The major primary tumor site was the rectum followed by the pancreas and stomach. Among the gastrointestinal tract tumors, 113 patients had NET from the foregut, 92 patients from the hindgut, and only 4 patients from the midgut. The median patient age was 60 years, and 57% of the patients were male. The histologic grade was as follows: 39% were well-differentiated neuroendocrine tumors (WDNET); 20% were well-differentiated neuroendcrine carcinomas (WDNEC); 33% were poorly differentiated neuroendocrine carcinomas (PDNEC); and 8% were mixed exocrine-endocrine tumors (Mixed). Most NETs from the rectum or duodenum are WDNET, whereas the ratio of PDNEC was high among NET from the genital organs or esophagus. The treatment strategy was associated with the clinical stage or the primary organ; in particular, 94% of the localized rectal NET were resected endoscopically. The 2-year survival rate for all the patients were 70%. A multivariate analysis demonstrated that distant disease of clinical stage and PDNEC of histological grade had a stronger impact on a poor outcome than the primary tumor site. The 2-year survival rate among the patients with WDNET, WDNEC and PDNEC were 97%, 80% and 36%, respectively, and 94%, 72%, and 32% of the patients had localized, regional, and distant disease, respectively. Conclusions: Japanese patients with EPNET have different clinicopathological features such as the primary organ or treatment procedure compared with previous reports in Western countries. Identifying the precise clinical stage and histological grade of patients with NET is essential because these factors influence the patient outcome. No significant financial relationships to disclose.