Malignant Tumor Patients Research Articles

Clinical Features and Prognosis of Double Primary Malignant Neoplasms in Patients with Non-Hodgkin Lymphoma

Non-Hodgkin lymphoma (NHL) combined with malignant solid tumors are a unique subtype of double primary malignant neoplasms (DPMNs). With the advancements in diagnostic procedures and the continuous development of new drugs, the overall survival (OS) of patients with malignant tumors has been prolonged,allowing more patients with malignant tumors to survive long enough to develop a second tumor. Most studies on this combination of DPMNs have been case reports and epidemiological investigations, and studies with a large sample size for summarizing the clinical characteristics have been lacking. To investigate the clinical features, survival, and prognostic factors of patients with DPMNs comprising NHL and malignant solid tumors. The clinical data of patients with NHL diagnosed at the First Hospital of Jilin University from July 2011 to July 2021 were reviewed. Of 2337 patients diagnosed as having NHL, 90 (3.85%) patients were diagnosed as DPMNs according to the diagnostic criteria of MPMNs proposed by Warren and Gates. 41 (45.56%) had NHL first (the NHL-first group) and 49 (54.44%) had solid tumor first (the ST-first group). The median age of the patients was 60 (53-66) years at the diagnosis of the first tumor and 63 (56-70) years at the diagnosis of the second tumor. Regarding the distribution of DPMNs, Diffuse large B-cell lymphoma（DLBCL) (43.90%) and chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) (14.63%) were more frequently seen in the NHL-first group; DLBCL (43.94%) and marginal zone lymphoma（MZL) (14.29%) were more common in the ST-first group. In the NHL-first group, the most frequent sites of solid tumors were the digestive system (41.46%) and respiratory system (34.15%), whereas in the ST-first group, the most common sites were the digestive system (30.61%), breast (22.45%), and thyroid (22.45%). Compared with the ST-first group, the median interval between the two tumors was shorter in the NHL-first group (4.5 months vs. 57 months), and more NHLs in early stages and originating from extranodal sites were observed. Moreover, the immunohistochemical results showed a higher rate of the MUM1 protein positivity in the NHL-first group. 51.11% (46/90) of patients with DPMNs did not receive chemotherapy or radiotherapy prior to the diagnosis of the second tumor. The ST-first group had better overall survival than the NHL-first group (P = 0.024). For patients with DPMNs, factors such as female sex, patients age < 65 years at diagnosis of the second tumor, normal β2-MG, and hemoglobin ≥ 110 g/L were associated with better OS (Fig.1). A multivariate Cox proportional hazard regression analysis showed that age ≥ 65 years at diagnosis of the second tumor, hemoglobin < 110 g/L, and NHL diagnosed first were independent risk factors that affected the prognosis of patients with DPMNs. Patients with DPMNs comprising NHL and malignant solid tumors were not unusual. NHL, whether as the first or second primary tumor, is predominantly DLBCL. The digestive system and respiratory system were the most common sites for solid tumors as the second tumor. The most frequent types of solid tumors as first primary tumors were digestive system tumors, thyroid cancer, and breast cancer. In the NHL-first group, the interval between the two tumors was shorter, and more lymphomas originating from extranodal sites were observed. Moreover, the prognosis of these patients with NHL diagnosed first was poor, necessitating close monitoring and follow-up. Radiotherapy and chemotherapy were not always important risk factors for DPMNs comprising NHL and malignant solid tumors. Further germline genetic testing and bidirectional analysis of immune status are warranted to explore the association between the two tumors. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

EPID-25. THE CLINICAL AND MOLECULAR LANDSCAPE OF GLIOMAS IN ADOLESCENTS AND YOUNG ADULTS

Abstract OBJECTIVE Gliomas in adolescents and young adults (AYA) are commonly treated with a standard chemo-radiation approach. Molecular alterations have not been comprehensively described to date. METHODS We compiled a multi-institutional cohort of patients diagnosed with glioma between 15-39.9 years over 20 years. Molecular analysis, therapeutic data and outcome was collected. For specific alterations, analysis included patients aged 0-39.9 years. RESULTS A total of 1900 patients with 876 AYA gliomas were included. Ongoing analysis reveals genetic alterations in 95% of available tumours. IDH p.R132H was found in 49% of tumours, while non-canonical IDH mutations were found in 7%. Paediatric-type mutations were found in 33% of AYA tumours with IDH-WT GBM accounting for the remaining 11%. The most common paediatric alterations in AYAs included BRAF p.V600E (11%) and FGFR alterations (7%) while BRAF fusions, H3 p.K27M and H3.3 p.G34R were rarely observed (4%, 4% and 1% respectively). BRAF fused tumours with non-canonical binding partners were enriched in AYAs. Analysis of BRAF-V600E gliomas between ages 0-40 revealed increased tendency for malignant tumours in patients &amp;gt; 20 years suggesting malignant transformation possibly due to higher rate of secondary hits. This resulted in worse overall-survival for AYA patients with BRAF-V600E glioma when compared to children under 20 years (p=0.0032). Ten-year OS of 100%, 90% and 95% was seen for BRAF fused, BRAF-V600E and FGFR-altered AYA low grade glioma respectively, compared to 14% and 25% for BRAF-V600E and FGFR-altered high grade glioma. In contrast, continuous decline was observed in the IDH-mutant gliomas with 10-year OS of 50% which declined to 29% at 15 years. CONCLUSIONS Gliomas in AYA often have non-canonical alterations that may evade standard molecular analysis. They are enriched for paediatric-type alterations with distinct molecularly-based outcomes. These tumours may respond to targeted inhibitors and would benefit from comprehensive diagnostic and therapeutic approaches.

Quality of life, out-of-pocket expenditures, and indirect costs among patients with the central nervous system tumors in Thailand.

The aim of this study was to investigate out-of-pocket (OOP) expenditures, indirect costs, and health-related quality of life (HRQoL) associated with the central nervous system (CNS) tumors in Thailand. A prospective study of CNS tumor patients who underwent first tumor resection at a tertiary care institution in Thailand was conducted. Patients were interviewed during hospitalization for undergoing first surgery. Within 6 months, they were interviewed once more if the disease continued to progress. Costs collected from a patient perspective and converted to 2019 US dollars. For dealing with these skewed data, a generalized linear model was used to investigate the effects of disease severity (malignancy, progressive disease, Karnofsky performance status score, and histology) and other factors on costs (OOP, informal care, productivity loss, and total costs). P < 0.05 was considered statistical significant for all analysis. Among a total of 123 intracranial CNS tumor patients, there were 83 and 40 patients classified into benign and malignant, respectively. In the first brain surgery, there was no statistical difference in HRQoL between patients with benign and malignant tumors (P = 0.072). However, patients with progressive disease had lower HRQoL mean scores at pre-operative and progressive disease periods were 0.711 (95% confidence interval [CI]: 0.662-0.760) and 0.261 (95% CI: 0.144-0.378), respectively. Indirect expenditures were the primary cost driver, accounting for 73.81% of annual total costs. The total annual costs accounted for 59.81% of the reported patient's income in malignant tumor patients. The progressive disease was the only factor that was significantly increases in all sorts of costs, including the OOP (P = 0.001), the indirect costs (P = 0.013), and the total annual costs (P = 0.001). Although there was no statistical difference in HRQoL and costs between patients with benign and malignant tumor, the total costs accounted for more than half of the reported income in malignant tumor patients. The primary cause of significant increases in all costs categories was disease progression.

Radiation-Induced Heart Disease: Current Status and Challenges

Being one of the major therapeutic measures for malignant tumors, radiation therapy, or radiotherapy, plays a particularly crucial role in the multidisciplinary integrated treatment of thoracic tumors. With the development in radiotherapy technology, the research focus has shifted from improving the overall survival of malignant tumor patients to reducing the incidence of radiation-related injuries. Currently, radiation-induced heart disease (RIHD) has become one of the leading non-cancer causes of death in thoracic tumor patients who have undergone radiotherapy, seriously affecting their quality of life and clinical prognosis. In recent years, there has been growing understanding of the pathogenesis of RIHD, and proposals have been made for some potential measures for the prevention and treatment of RIHD. Based on the clinical manifestations and pathological changes of RIHD that have been reported, we herein reviewed the biological mechanism and potential treatment options for RIHD. We also discussed existing challenges in the prevention and treatment of RIHD, intending to provide references for the prevention and treatment of RIHD.

Construction and validation of a prognostic model for predicting overall survival of primary adrenal malignant tumor patients: A population-based study with 1,080 patients.

Primary adrenal malignant tumor is rare. The factors affecting the prognosis remain poorly defined. This study targeted to construct and corroborate a model for predicting the overall survival of adrenal malignant tumor patients. We investigated the SEER database for patients with primary adrenal malignant tumor. 1,080 patients were divided into a construction cohort (n = 756) and a validation cohort (n = 324), randomly. The prognostic factors for overall survival were evaluated using univariate and multivariate Cox analyses. The nomogram was constructed and then validated with C-index, calibration curve, time-dependent ROC curve, and decision curve analysis in both cohorts. Then we divided the patients into 3 different risk groups according to the total points of the nomogram and analyzed their survival status by Kaplan-Meier curve with log-rank test. The baseline characteristics of these two cohorts were not statistically different (P > 0.05). Using univariate and multivariate Cox analyses, 5 variables, including age, tumor size, histological type, tumor stage, and surgery of primary site, were distinguished as prognostic factors (P < 0.05). Based on these variables, we constructed a nomogram to predict the 3- year, 5- year, and 10-year overall survival. The C-indexes were 0.780 (0.760-0.800) in the construction cohort and 0.780 (0.751-0.809) in the validation cohort. In both cohorts, the AUC reached a fairly high level at all time points. The internal and external calibration curves and ROC analysis showed outstanding accuracy and discrimination. The decision curves indicated excellent clinical usefulness. The best cut-off values for the total points of the nomogram were 165.4 and 243.1, and the prognosis was significantly different for the three different risk groups (P < 0.001). We successfully constructed a model to predict the overall survival of primary adrenal malignant tumor patients. This model was validated to perform brilliantly internally and externally, which can assist us in individualized clinical management.

Preliminary study on the molecular features of mutation in multiple primary oral cancer by whole exome sequencing.

Multiple primary cancers (MPCs) refer to cancers that occur simultaneously or metachronously in the same individual. The incidence of MPC has increased recently, as the survival time of malignant tumor patients has been greatly prolonged. It is difficult to differentiate MPC from primary cancers (PCs) in the same anatomical region from the clinical manifestation alone. However, their biological behaviors appear to be distinct. In this study, we show that the prognosis of multiple primary oral cancers (MP-OCs) is worse than primary oral cancers (P-OCs). To better understand the molecular mechanisms of MP-OC, we used whole exome sequencing (WES) to analyze samples from 9 patients with MP-OC and 21 patients with P-OC. We found more somatic mutations in MP-OC than in P-OC. MP-OC had more complicated mutation signatures, which were associated with age-related and Apolipoprotein B mRNA Editing Catalytic Polypeptide-like (APOBEC) activity-related signatures. Tumor mutational burden (TMB) and mutant-allele tumor heterogeneity (MATH) of MP-OC trended higher compared to P-OC. KEGG and GO analysis showed the differential pathways of MP-OC versus P-OC. In addition, MP-OC took amplification, not loss, as the main pattern of copy number variation (CNV), while P-OC took both. Lastly, we did not find significantly different mutant germline genes, but MSH-6 mutation may be a potential MP-OC driver. In short, our preliminary results show that MP-OC and P-OC have different molecular characteristics.

Prognosis of Human Cytomegalovirus in Cancer Patients Undergoing Chemotherapeutic Treatment in Egypt and an Emergent Prevalence of Glycoprotein B-5

The human cytomegalovirus (HCMV) is a global opportunistic β-herpes virus causing severe diseases in immune-compromised patients, such as malignant tumor patients, especially those undergoing chemotherapeutic treatment. This study aimed to determine the prevalence of HCMV-DNA in chemotherapeutic treatment naive cancer patients, and after chemotherapy, to compare between conventional nested PCR and ELISA techniques for the detection of HCMV, and to detect glycoprotein B genotypes. Plasma and serum samples before and after three chemotherapy cycles were collected from 49 chemotherapy-naive cancer patients. DNA was extracted from plasma samples using QIAamp® DNA Mini kit. HCMV-DNA was detected using a nested PCR technique. Multiplex nested PCR was used for HCMV-glycoprotein B (gB) genotyping. HCMV-IgG and -IgM were detected using ELISA technique. Thirty one (63.3 %) of the 49 plasma samples of the chemotherapy-naïve cancer patients were positive for HCMV-DNA; 21 of which remained positive after chemotherapy. However, 18 samples were negative of which 16 became positive after chemotherapy. gB-5 was the most common glycoprotein genotype detected (80.6 %), followed by gB-1, gB-3, gB-4, and gB-2. HCMV IgG was detected in the 49 serum samples of chemotherapy-naïve patients, and after exposure to chemotherapy. HCMV-DNA is commonly identified in cancer patients. Its detection after chemotherapy exposure may suggest HCMV reactivation. The most common genotype detected in cancer patients in Egypt is gB-5 in contrast to earlier research. IgG was detected in all patients. This indicates that HCMV is endemic in Egypt, necessitating the development of public awareness campaigns about HCMV infection and preventive strategies.

A framework for identification and classification of liver diseases based on machine learning algorithms.

Hepatocellular carcinoma (HCC) is one of the most commonly seen liver disease. Most of HCC patients are diagnosed as Hepatitis B related cirrhosis simultaneously, especially in Asian countries. HCC is the fifth most common cancer and the second most common cause of cancer-related death in the World. HCC incidence rates have been rising in the past 3 decades, and it is expected to be doubled by 2030, if there is no effective means for its early diagnosis and management. The improvement of patient’s care, research, and policy is significantly based on accurate medical diagnosis, especially for malignant tumor patients. However, sometimes it is really difficult to get access to advanced and expensive diagnostic tools such as computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET-CT)., especially for people who resides in poverty-stricken area. Therefore, experts are searching for a framework for predicting of early liver diseases based on basic and simple examinations such as biochemical and routine blood tests, which are easily accessible all around the World. Disease identification and classification has been significantly enhanced by using artificial intelligence (AI) and machine learning (ML) in conjunction with clinical data. The goal of this research is to extract the most significant risk factors or clinical parameters for liver diseases in 525 patients based on clinical experience using machine learning algorithms, such as regularized regression (RR), logistic regression (LR), random forest (RF), decision tree (DT), and extreme gradient boosting (XGBoost). The results showed that RF classier had the best performance (accuracy = 0.762, recall = 0.843, F1-score = 0.775, and AUC = 0.999) among the five ML algorithms. And the important orders of 14 significant risk factors are as follows: Total bilirubin, gamma-glutamyl transferase (GGT), direct bilirubin, hemoglobin, age, platelet, alkaline phosphatase (ALP), aspartate transaminase (AST), creatinine, alanine aminotransferase (ALT), cholesterol, albumin, urea nitrogen, and white blood cells. ML classifiers might aid medical organizations in the early detection and classification of liver disease, which would be beneficial in low-income regions, and the relevance of risk factors would be helpful in the prevention and treatment of liver disease patients.

Metabolic reprogramming enables the auxiliary diagnosis of breast cancer by automated breast volume scanner.

Breast cancer is the leading cause of female cancer-related deaths worldwide. New technologies with enhanced sensitivity and specificity for early diagnosis and monitoring of postoperative recurrence are in critical demand. Automatic breast full volume scanning system (ABVS) is an emerging technology used as an alternative imaging method for breast cancer screening. Despite its improved detection rate of malignant tumors, ABVS cannot accurately stage breast cancer preoperatively in 30–40% of cases. As a major hallmark of breast cancer, the characteristic metabolic reprogramming may provide potential biomarkers as an auxiliary method for ABVS.ObjectiveThe objective of this study was to identify differential metabolomic signatures between benign and malignant breast tumors and among different subtypes of breast cancer patients based on untargeted metabolomics and improve breast cancer detection rate by combining key metabolites and ABVS.MethodsUntargeted metabolomics approach was used to profile serum samples from 70 patients with different subtypes of breast cancer and benign breast tumor to determine specific metabolomic profiles through univariate and multivariate statistical data analysis.ResultsMetabolic profiles correctly distinguished benign and malignant breast tumors patients, and a total of 791 metabolites were identified. There were 54 different metabolites between benign and malignant breast tumors and 17 different metabolites between invasive and non-invasive breast cancer. Notably, the missed diagnosis rate of ABVS could be reduced by differential metabolite analysis. Moreover, the diagnostic performance analyses of combined metabolites (pelargonic acid, N-acetylasparagine, and cysteine-S-sulfate) with ABVS performance gave a ROC area under the curve of 0.967 (95% CI: 0.926, 0.993).ConclusionsOur study identified metabolic features both in benign and malignant breast tumors and in invasive and non-invasive breast cancer. Combined ultrasound ABVS and a panel of differential serum metabolites could further improve the accuracy of preoperative diagnosis of breast cancer and guide surgical therapy.

Malignant skin neoplasms in patients after kidney transplantation

Introduction. The widespread use of modern immunosuppressive therapy schemes has increased the duration of transplanted organ function. However, along with an increase in life expectancy, there is an elevation in malignant neoplasms in patients with a transplanted organ.Objective. To present own clinical experience in the treatment of patients with malignant skin neoplasms after kidney transplantation.Materials and methods. Four patients with malignant skin neoplasms were observed in our clinic from 2010 to 2017. Three of them developed Kaposi's sarcoma between 6 months and 6 years after kidney transplantation, and one was diagnosed with squamous-cell skin cancer 10 years after the operation.Results. After histological verification of Kaposi's sarcoma, excision of neoplasms was performed in two cases, followed by a decrease in the dosage of immunosuppressive drugs. In one case, a complete conversion of immunosuppressive therapy was performed. Stabilization of the oncological process was noted during therapy. However, subsequent deterioration in the function of the transplanted organ was recorded up to a complete loss of function in all patients, which led to the removal of the kidney. A patient with squamous-cell skin cancer underwent surgical treatment with a course of close-focus radiotherapy, but further progression led to a lethal outcome.Conclusion. Kidney transplant recipients receive lifelong immunosuppressive therapy and represent a high-risk group for developing skin malignancies and an increased risk of cancer mortality. Withdrawal of immunosuppressive drugs, i.e. calcineurin inhibitors, is still the main condition for the complete cure of patients with Kaposi's sarcoma but is accompanied by an extremely high probability of loss of function of the transplanted organ.

Changes in survival over time for primary brain and other CNS tumors in the United States, 2004–2017

PurposeDespite advances in cancer diagnosis and clinical care, survival for many primary brain and other central nervous system (CNS) tumors remain poor. This study performs a comprehensive survival analysis on these tumors.MethodsSurvival differences were determined utilizing the National Program of Cancer Registries Survival Analytic file for primary brain and CNS tumors. Overall survival and survival of the 5 most common histopathologies, within specific age groups, were determined. Overall survival was compared for three time periods: 2004–2007, 2008–2012, and 2013–2017. Survival differences were evaluated using Kaplan–Meier and multivariable Cox proportional hazards models. Models were adjusted for sex, race/ethnicity, and treatment. Malignant and non-malignant brain tumors were assessed separately.ResultsAmong malignant brain and CNS tumor patients overall, there were notable differences in survival by time period among all age groups. Similar differences were noted in non-malignant brain and CNS tumor patients, except for adults (aged 40–64 years), where no survival changes were observed. Survival differences varied within specific histopathologies across age groups. There were improvements in survival in 2008–2012 and 2013–2017, when compared to 2004–2007, in children, AYA, and older adults with malignant tumors, and among older adults with non-malignant tumors.ConclusionOverall survival for malignant brain and other CNS tumors improved slightly in 2013–2017 for all age groups as compared to 2004–2007. Significant changes were observed for non-malignant brain and other CNS tumors among older adults. Information regarding survival over time can be utilized to identify population level effects of diagnostic and treatment improvements.

Sulfur hexafluoride microbubbles combined with serology distinguish benign and malignant ovarian tumors

To explore the value of contrast-enhanced ultrasound with Sulfur hexafluoride microbubbles, serum carbohydrate antigen 125, carcinoembryonic antigen and human epididymis protein 4 joint inspection in the differential diagnosis of ovarian tumors. A total of 56 patients with ovarian tumors were chosen as research materials from June 2018 to October 2021. Result show 24 patients of benign tumors and 32 patients of malignant tumors were confirmed by pathological diagnosis. The rise time and time to peak values of malignant tumors were lower than those of benign tumors (p&lt;0.001). However, peak intensity, Time intensity curve -Area under Curve and serum human epididymis protein 4, carcinoembryonic antigen, carbohydrate antigen 125 levels joint inspection in malignant tumors were higher than those in benign tumors (p &lt; 0.001). Rise time, peak intensity and time to peak in benign and malignant ovarian tumors were 0.895 (0.802–0.999, 95% CI), 0.852 (0.804–0.916, 95% CI), 0.907 (0.829–0.925, 95% CI), respectively. Area under Curve were 0.909 (0.846–1.012, 95% CI) and serum carbohydrate antigen 125 and carcinoembryonic antigen and human epididymis protein 4 for diagnosis of benign and malignant ovarian tumors were 0.865 (0.838–0.991, 95% CI), 0.816 (0.702–0.930, 95% CI), 0.903 (0.850–1.007, 95% CI). Contrast-enhanced Ultrasound unite to serum carbohydrate antigen 125 and carcinoembryonic antigen and human epididymis protein 4, the accuracy rate 92.86% (52/56) significantly higher than Contrast-enhanced Ultrasound or serum v diagnosis benign and malignant of ovarian tumor (p&lt;0.01, 92.86% vs. 82.14%, p&lt;0.001, 92.86% vs. 73.21%). Conclusion Contrast-enhanced Ultrasound, carbohydrate antigen 125, carcinoembryonic antigen, human epididymis protein 4 joint inspection can improve the accuracy of early ovarian cancer.

Analysis of Nursing Effect of PICC Catheterization in Chemotherapy of Malignant Tumor Patients with Diabetes Mellitus

Analysis of Nursing Effect of PICC Catheterization in Chemotherapy of Malignant Tumor Patients with Diabetes Mellitus

A randomized controlled trial of WeChat-based cognitive behavioral therapy intervention to improve cancer-related symptoms in gynecological cancer survivors: study protocol

BackgroundGynecological malignant patients often have significant psychological and physical problems. The feasibility and generalizability of traditional intervention method is low due to the high time and labor cost, large number of gynecological malignant tumor patients in China, as well as shortage of health professionals. Therefore, it is necessary to design an alternative, innovative, and easily accessible intervention method. This study aims to evaluate the effect of WeChat-based intervention on anxiety, depression and disease-related symptoms of patients with gynecological malignant tumors during rehabilitation.MethodsA single-blinded, randomized, controlled, parallel-group pre-test and repeated post-test design will be conducted. A total of 76 participants will be randomly divided into the intervention group and control group. Anxiety and depression, disease-related symptoms, coping ability, benefit finding and quality of life will be measured at baseline and repeated immediately after the intervention (test 1), 3 months (test 2) and 6 months (test 3) after the intervention.DiscussionAs the first randomized controlled trial with rigorous research design for patients with gynecological malignant tumors in the rehabilitation stage in China, this study will provide evidences for the effectiveness of the WeChat platform during intervention of patients with gynecological malignant tumors in the rehabilitation stage. The results are helpful to further explore the effect of WeChat-based intervention on improving patients' anxiety and depression, disease-related symptoms, and quality of life.Trial registrationChinese Clinical Trial Registry: ChiCTR2100053450, Registered 21 November 2021,http://www.chictr.org.cn/searchproj.aspx

Effects of the Concept of Fast-Track Surgery Combined with Empathic Nursing on Perioperative Complication Prevention and Postoperative Recovery of Gynecological Malignant Tumor Patients.

Objective This study is aimed at exploring the effects of the concept of fast-track surgery (FTS) combined with empathic nursing on perioperative complication prevention and postoperative recovery of gynecological malignant tumor patients. Methods A total of 180 patients with gynecological malignant tumor treated by surgery in our hospital from September 2018 to October 2021 were randomly divided into three groups: group A, group B, and group C, with 60 patients in each group. Group C was given conventional nursing intervention, group B was given FTS intervention, and group A was given FTS intervention combined with empathic care. Psychological stress state (systolic blood pressure, diastolic blood pressure, and heart rate), postoperative recovery indicators (time of first anal exhaust, time of first defecation, time of getting out of bed, and length of postoperative hospital stay), postoperative complications, and psychological state (Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS)) levels of patients in the three groups were compared. Results Systolic blood pressure, diastolic blood pressure, and heart rate in group A were lower than those in group B, and those in group B were lower than those in group C (all P < 0.05). The time of first anal exhaust, time of first defecation, time of getting out of bed, and postoperative hospital stay in groups A and B were shorter than those in group C (all P < 0.05).The incidence of postoperative complications in groups A and B was 8.33% and 8.33%, respectively, lower than 23.33% in group C (both P < 0.05). SAS and SDS scores of group A were lower than those of groups B and C after intervention (all P < 0.05). Conclusion The concept of FTS combined with empathic nursing is beneficial to reduce the stress response of patients with gynecological malignant tumor before surgery, reduce the risk of postoperative complications, improve patients' mood, and speed up the rehabilitation process of patients.

Readmission risk of malignant brain tumor patients undergoing laser interstitial thermal therapy (LITT) and stereotactic needle biopsy (SNB): a covariate balancing weights analysis of the National Readmissions Database (NRD).

Despite procedural similarities between laser interstitial thermal therapy (LITT) and stereotactic needle biopsy (SNB), LITT induces delayed, pro-inflammatory responses not associated with SNB that may increase the risk of readmission within 30- or 90- days. Here, we explore this hypothesis. We queried the National Readmissions Database (NRD, 2010-18) for malignant brain tumor patients who underwent elective LITT or SNB using International Classification of Diseases codes. Readmissions were defined as non-elective inpatient hospitalizations. Survey regression methods and a weighted analysis were utilized to adjust for demographic and clinical differences between LITT and SNB cohorts. During the study period, an estimated 685 malignant brain patients underwent elective LITT and 15,177 underwent elective SNB. Patients undergoing LITT and SNB exhibited comparable median lengths of hospital stay [IQR; LITT = 2 (1, 3); SNB = 1 (1, 2); p = 0.820]. Likelihood of routine discharge was not significantly different between the two procedures (p = 0.263). No significant differences were observed in the odds of 30- or 90-day unplanned readmission between the LITT and SNB cohorts after multivariable adjustment (all p ≥ 0.177). The covariate balancing weighted analysis confirmed comparable 30 or 90-day readmission risk between LITT and SNB treated patients (all p ≥ 0.201). The likelihood of 30- and 90-day readmission for malignant brain tumor patients who underwent LITT or SNB are comparable, supporting the safety profile of LITT as therapy for malignant brain cancers.

Cannabinoids to Improve Health-Related Quality of Life in Patients with Neurological or Oncological Disease: A Meta-Analysis.

Background: Cannabinoids have been suggested to alleviate frequently experienced symptoms of reduced mental well-being such as anxiety and depression. Mental well-being is an important subdomain of health-related quality of life (HRQoL). Reducing symptoms and maintaining HRQoL are particularly important in malignant primary brain tumor patients, as treatment options are often noncurative and prognosis remains poor. These patients frequently report unprescribed cannabinoid use, presumably for symptom relieve. As studies on brain tumor patients specifically are lacking, we performed a meta-analysis of the current evidence on cannabinoid efficacy on HRQoL and mental well-being in oncological and neurological patients. Methods: We performed a systematic PubMed, PsychINFO, Embase, and Web of Science search according to PRISMA guidelines on August 2 and 3, 2021. We included randomized controlled trials (RCTs) that assessed the effects of tetrahydrocannabinol (THC) or cannabidiol (CBD) on general HRQoL and mental well-being. Pooled effect sizes were calculated using Hedges g. Risk of bias of included studies was assessed using Cochrane's Risk of Bias tool. Results: We included 17 studies: 4 in oncology and 13 in central nervous system (CNS) disease. Meta-analysis showed no effect of cannabinoids on general HRQoL (g=-0.02 confidence interval [95% CI -0.11 to 0.06]; p=0.57) or mental well-being (g=-0.02 [95% CI -0.16 to 0.13]; p=0.81). Conclusions: RCTs in patients with cancer or CNS disease showed no effect of cannabinoids on HRQoL or mental well-being. However, studies were clinically heterogeneous and since many glioma patients currently frequently use cannabinoids, future studies are necessary to evaluate its value in this specific population.

The influence of cross-regional medical treatment on total medical expenses, medical insurance payments, and out-of-pocket expenses of patients with malignant tumors in Chinese low-income areas

BackgroundIn recent years, due to the increasing number of cross-regional medical patients, countries around the world have issued a series of policies or regulations to reduce their out-of-pocket burden. In this context, this study intended to explore the impact of the Spatio-temporal characteristics of cross-regional medical treatment on total medical expenses, medical insurance payments, and out-of-pocket expenses of patients with malignant tumors in low-income areas.MethodsThis study included 54,904 data of cross-provincial medical treatment of malignant tumor patients insured in Heilongjiang Province, China in 2020. Firstly, Microsoft Excel 2019 and ArcGIS 10.2 were applied to conduct a descriptive analysis of the Spatio-temporal characteristics of their cross-provincial medical treatment. Then, binary and multivariate logistic regression models were used to explore the specific impact of economic level and geographical distance of medical regions on total medical expenses, medical insurance payments, and out-of-pocket expenses.ResultsThe number of cross-regional medical patients showed a gradual upward trend from February to December, and fell back in January. They were concentrated in regions with high economic level and short distance from the insured region, where were more likely to form the group with high out-of-pocket expenses (AOR = 3.620, P < 0.001; AOR = 1.882, P < 0.001). While this possibility in middle-distance medical regions were less (AOR = 0.545, P < 0.001). Afterwards, two sensitivity analysis methods showed that the results were robust.ConclusionThe number of cross-regional medical patients with malignant tumors in low-income areas is affected by seasonal factors, meanwhile, their total medical expenses, actual medical insurance payment levels, and out-of-pocket expenses are all affected by the economic level and geographical distance of medical regions. And the middle-distance medical regions may be the best choice for patients with planned cross-regional medical treatment. These provide some evidence for policymakers to improve the fairness and sustainability of medical security for cross-regional medical patients and reduce their direct economic burden of disease.

Semantic Segmentation of the Malignant Breast Imaging Reporting and Data System Lexicon on Breast Ultrasound Images by Using DeepLab v3+

In this study, an advanced semantic segmentation method and deep convolutional neural network was applied to identify the Breast Imaging Reporting and Data System (BI-RADS) lexicon for breast ultrasound images, thereby facilitating image interpretation and diagnosis by providing radiologists an objective second opinion. A total of 684 images (380 benign and 308 malignant tumours) from 343 patients (190 benign and 153 malignant breast tumour patients) were analysed in this study. Six malignancy-related standardised BI-RADS features were selected after analysis. The DeepLab v3+ architecture and four decode networks were used, and their semantic segmentation performance was evaluated and compared. Subsequently, DeepLab v3+ with the ResNet-50 decoder showed the best performance in semantic segmentation, with a mean accuracy and mean intersection over union (IU) of 44.04% and 34.92%, respectively. The weighted IU was 84.36%. For the diagnostic performance, the area under the curve was 83.32%. This study aimed to automate identification of the malignant BI-RADS lexicon on breast ultrasound images to facilitate diagnosis and improve its quality. The evaluation showed that DeepLab v3+ with the ResNet-50 decoder was suitable for solving this problem, offering a better balance of performance and computational resource usage than a fully connected network and other decoders.

Off-Label Drug Use in Oncology

The off-label use of medicines is a routine clinical practice of oncology, especially in malignant-tumour patients with no treatment alternatives left when registered-drug options have been exhausted or standard therapies reveal contraindications. The recent shift from single-gene assays to multigene panels powered by full-exome or -genome sequencing expands the capacity of precision therapy, leading to a wider agnostic off-label use of targeted drugs for detecting a particular molecular genetic disorder. Studies of the off-label drug use in oncology will clarify the feasibility and safety of such prescriptions in patients with rare forms of malignancy when registered therapies have been exhausted or standard treatment reveals contraindications. This article examines the prevalence and landscape of off-label drug use in cancer patients and elaborates on the off-label principle. The paper presents a critical reflection on the off-label use of medicines in oncology.