Non-metastatic Tumors Research Articles

Mixed adenoneuroendocrine carcinomas of the appendix: Is there a survival advantage to right hemicolectomy over appendectomy?

Backgroundthe surgical treatment and prognostic characteristics of mixed adenoneuroendocrine carcinomas (MANEC) of the appendix are not yet available. In this study, we sought to figure out the choice of surgical approach (right hemicolectomy versus appendectomy), and explore the effect of chemotherapy on appendiceal MANEC. Methodspatients with appendiceal MANEC from the Surveillance, Epidemiology, and End Results database (2000–2020) were stratified by gender, race, age group, tumor grade, and TNM stage. Logistic regression and Kaplan-Meier analyses relating TNM stage, grade, and receipt of right hemicolectomy (abbreviated as colectomy) to overall and cancer-specific survival were performed. Results455 patients with appendiceal MANEC were included, of whom 146(32 %) underwent appendectomy and 309(68 %) underwent colectomy. Patients who underwent colectomy had better cancer-specific survival (HR = 0.68, 95%CI (0.47–0.98), P = 0.041) and overall survival (HR = 0.67, 95%CI (0.48–0.93), P = 0.015) than those who underwent appendectomy alone. However, colectomy did not confer any survival advantage over appendectomy in subgroup analyses, including low-grade or high-grade tumors, T1-2N0M0 group, T3-4N0M0 group, node-positive non-metastatic tumors, and metastatic tumors. On multivariate analysis, lack of chemotherapy and high-stage (node-positive or metastatic) were associated with poorer overall survival; high-grade (grade 3–4) and high-stage were primary predictors of cancer-specific mortality. Furthermore, there was no significant association between colectomy and better survival, either overall survival or cancer specific survival, when accounting for tumor stage and grade. ConclusionsOur study found that colectomy did not provide a survival benefit compared to appendectomy alone. Moreover, tumor stage and grade were independent determinants of cancer specific survival; chemotherapy and tumor stage were independent determinants of overall survival.

COLONOSCOPIC TREATMENT FOR EARLY STAGE RECTUM ADENOCARCINOMA

Colorectal cancer is a malignant neoplasm that arises in the colon or rectum, characterized by the uncontrolled growth of epithelial cells, forming invasive tumors that can metastasize. It is the third most common neoplasm globally, with approximately 1.9 million new cases per year. In Brazil, in 2022, 5,573 deaths from rectal cancer were recorded, with a high incidence among women and a growing concern in younger age groups. Risk factors include type II Diabetes Mellitus, use of anti-inflammatory drugs, smoking and obesity, which is related to chronic inflammation and hormonal changes that favor cancer. Approximately 20% of patients with non-metastatic tumors can develop metastases, often affecting the gastrointestinal tract and organs such as the liver and lungs. The main treatment involves surgery and, in some cases, radiotherapy. Recommended screening for people aged 50 and over includes colonoscopy, with recent suggestions to start screening five years earlier, due to the global increase in the incidence of these conditions.

Germline DNA damage repair variants and prognosis of patients with high-risk or metastatic prostate cancer.

Deleterious germline variants in certain DNA repair genes are risk factors for developing aggressive prostate cancer. The objective was to quantify their prognostic impact after prostate cancer diagnosis. Men with prostate cancer, predominantly of European ancestry, were included from four cohorts with long-term follow-up. Pathogenic or likely pathogenic germline variants in 26 DNA repair genes were assessed in relation to metastasis-free survival in high-risk, localized prostate cancer and to overall survival in metastatic castration-sensitive prostate cancer (mCSPC) and metastatic castration-resistant prostate cancer (mCRPC). Among 3,525 patients initially diagnosed with non-metastatic prostate cancer, 2,594 had high-risk localized prostate cancer, 429 mCSPC, and 502 mCRPC at inclusion. BRCA2 variant carriers did not have worse metastasis-free survival in high-risk localized prostate cancer (hazard ratio [HR] 1.01, 95% confidence interval [CI] 0.69, 1.46) or overall survival in mCSPC (HR 0.46, 95% CI 0.14, 1.45) or mCRPC (HR 0.60, 95% CI 0.31, 1.17) compared to non-carriers of DNA repair variants. Among 868 additional patients with de novo metastatic (M1) prostate cancer, BRCA2 variant carriers tended to have worse overall survival (HR 1.59, 95% CI 1.01, 2.51). BRCA2 prognostic associations were not explained by radiation, PARP inhibitor, or platinum therapy. Results for other genes were limited in precision because variants were less common. Among patients with high-risk or metastatic prostate cancer who were initially diagnosed with and treated for non-metastatic tumors, germline DNA repair variants in BRCA2 do not confer a substantially worse prognosis.

Low SMARCD3 expression is associated with poor prognosis in patients with prostate cancer.

SWI/SNF complexes represent a family of multi-subunit chromatin remodelers that are affected by alterations in >20% of human tumors. While mutations of SWI/SNF genes are relatively uncommon in prostate cancer (PCa), the literature suggests that deregulation of various subunits plays a role in prostate tumorigenesis. To assess SWI/SNF functions in a clinical context, we studied the mutually exclusive, paralogue accessory subunits SMARCD1, SMARCD2, and SMARCD3 that are included in every known complex and are sought to confer specificity. Performing immunohistochemistry (IHC), the protein levels of the SMARCD family members were measured using a tissue microarray (TMA) comprising malignant samples and matching healthy tissue of non-metastatic PCa patients (n = 168). Moreover, IHC was performed in castration-resistant tumors (n = 9) and lymph node metastases (n = 22). To assess their potential role as molecular biomarkers, SMARCD1 and SMARCD3 protein levels were correlated with clinical parameters such as T stage, Gleason score, biochemical recurrence, and progression-free survival. SMARCD1 protein levels in non-metastatic primary tumors, lymph node metastases, and castration-resistant samples were significantly higher than in benign tissues. Likewise, SMARCD3 protein expression was elevated in tumor tissue and especially lymph node metastases compared to benign samples. While SMARCD1 levels in primary tumors did not exhibit significant associations with any of the tested clinical parameters, SMARCD3 exhibited an inverse correlation with pre-operative PSA levels. Moreover, low SMARCD3 expression was associated with progression to metastasis. In congruence with previous literature, our results implicate that both SMARCD1 and SMARCD3 may exhibit relevant functions in the context of prostate tumorigenesis. Moreover, our approach suggests a potential role of SMARCD3 as a novel prognostic marker in clinically non-metastatic PCa.

High-Grade Progression, Sarcomatous Transformation, and/or Metastasis of Pituitary Neuroendocrine Neoplasms (PitNENs): The UCSF Experience.

Pituitary neuroendocrine tumors (PitNET) that metastasize comprise ~ 0.2% of adenohypophyseal tumors are aggressive and are challenging to treat. However, many non-metastatic tumors are also aggressive. Herein, we review 21 specimens from 13 patients at UCSF with metastatic PitNETs (CSF or systemic, N = 7 patients), high-grade pituitary neuroendocrine neoplasms (HG-PitNEN, N = 4 patients), and/or PitNETs with sarcomatous transformation (PitNET-ST, N = 5 patients). We subtyped cases using the World Health Organization (WHO) and International Agency for Research on Cancer (IARC) criteria for neuroendocrine neoplasms (NENs). Lineage subtypes included acidophil stem cell, null cell, thyrotroph, corticotroph, lactotroph, and gonadotroph tumors. The median Ki-67 labeling index was 25% (range 5-70%). Lack of p16 was seen in 3 cases, with overexpression in 2. Strong diffuse p53 immunopositivity was present in 3 specimens from 2 patients. Loss of Rb expression was seen in 2 cases, with ATRX loss in one. Molecular analysis in 4 tumors variably revealed TERT alterations, homozygous CDKN2A deletion, aneuploidy, and mutations in PTEN, TP53, PDGFRB, and/or PIK3CA. Eight patients (62%) died of disease, 4 were alive at the last follow-up, and 1 was lost to the follow-up. All primary tumors had worrisome features, including aggressive lineage subtype, high mitotic count, and/or high Ki-67 indices. Additional evidence of high-grade progression included immunohistochemical loss of neuroendocrine, transcription factor, and/or hormone markers. We conclude that metastatic PitNET is not the only high-grade form of pituitary NEN. If further confirmed, these histopathologic and/or molecular features could provide advanced warning of biological aggressiveness and be applied towards a future grading scheme.

Assessment of the circulating levels of immune system checkpoint selected biomarkers in patients with lung cancer.

Lung cancer is recognized as one of the leading causes of cancer-related deaths globally, with a significant increase in incidence and intricate pathogenic mechanisms. This study examines the expression profiles of Programmed Cell Death Protein 1 (PD-1), PD-1 ligand (PDL-1), β-catenin, CD44, interleukin 6 (IL-6), and interleukin 10 (IL-10), as well as their correlations with the clinic-pathological features and diagnostic significance in lung cancer patients. The research involved lung cancer patients exhibiting various pathological characteristics, alongside demographically matched healthy controls. The expression levels of PD-1, PDL-1, β-catenin, and CD44 were analyzed using Real-Time PCR, while circulating levels of IL-6 and IL-10 were assessed through ELISA assays. This investigation focused on peripheral blood mononuclear cells (PBMC) to evaluate these factors non-invasively. Findings indicated that levels of PD-1, PDL-1, and CD44 were significantly elevated in patients compared to controls, which coincided with a decrease in β-catenin levels. Additionally, a concurrent rise in IL-6 and IL-10, both pro-inflammatory cytokines, was observed in patients, suggesting a potential regulatory role for these cytokines on the PD-1/PDL-1 axis, which may help tumors evade immune system checkpoints. The predictive value of these factors concerning lung tumors and metastasis was significant (Regression analysis). Furthermore, these markers demonstrated diagnostic potential in differentiating between patients and healthy controls, as well as between individuals with metastatic and non-metastatic tumors (ROC curve analysis). This study provides insights into the expression profiles of PD-1/PDL-1 immune system checkpoints and their regulatory factors in lung cancer, potentially paving the way for new therapeutic and diagnostic approaches.

Evaluación tomográfica del mixoma odontogénico en maxilar superior. Reporte de caso y revisión de la literatura

Odontogenic myxoma (OM) is a slow-growing, painless, aggressive and non-metastatic central jaw tumor of mesenchymal origin. Radiographically, it can vary from a unilocular radiolucent lesion to a multilocular lesion with well-defined or diffuse margins. The aim of this paper is to recognize the radiographic and tomographic characteristics of OM in a patient who attended the Dental Clinic of the Faculty of Dentistry of the Universidad Nacional Mayor de San Marcos in Lima-Peru. Case presentation: 86 year old male patient, who in the panoramic radiography indicated for his oral rehabilitation, a unilocular radiolucent image was found in the anterosuperior area with partially defined limits, corticalized edges and oval shape. In the volumetric tomography there was evidence of thinning and erosion of both bone tables, thinning of the floor of the nasal cavity. The radiolucent image seems to havean extension close to the alveolar ridge. In adition, there was an effacement of the cortices of the nasopalatine duct. The lesion was enucleated and an anatomopathological examination was performed. Diagnosis was odontogenic myxoma. The patient was evaluated at one year and six months with satisfactory results. The wide variety of radiographic characteristics of odontogenic myxoma leads us to think of a large number of differential diagnoses, being the histological evaluation together with the imaging analysis the ones that provide a definitive diagnosis. Although the anterosuperior area is the least common for its presentation, radiolucent images in this area should be considered as possible odontogenic myxomas, since this condition is more frequent in latín race.

Simultaneous Detection of Collagen I Alpha II and Cytokeratin 19 mRNA by Multiplex qPCR in Liquid Biopsy in Diagnosis of Patients with Resectable Solid Tumors.

The early detection of tumors is one of the key factors in increasing overall survival in cancer patients. A wide range of cancers still do not have a system of early diagnosis; therefore, the development of new non-invasive tools in this line is essential. Accordingly, the objective of our work was to develop a non-invasive screening method for the early detection of various carcinomas in plasma using a panel that combines two markers using RT-qPCR. A retrospective case-control study was conducted to develop a cancer screening test based on the detection of stromal and epithelial biomarkers (COL1A2 and KRT19) in plasma. The expression of biomarkers was evaluated using multiplex quantitative PCR applied to 47 cases with non-metastatic tumors and 13 control participants. For both biomarkers, a cut-off value was stablished using Youden's J index through ROC curve analysis and areas under the curve (AUC) were calculated. The plasma mRNA expression level of both biomarkers was significantly higher in diseased versus healthy patients. Moreover, ROC curve analysis showed an AUC value of 0.897 for the combined model. This model also resulted in a cutoff value of 0.664, as well as a sensitivity of 83% and a specificity of 84.6%. These results suggest that the plasma expression levels of COL1A2 and KRT19 could a have potential role in detecting various types of cancer at the early stages. The combined analysis of both stromal and epithelial biomarkers would provide a non-invasive screening method that would allow us to differentiate patients with an active neoplastic process.

Extended procedure has no oncological benefits over segmental resection in the treatment of non-metastatic splenic flexure colon cancer, a population-based cohort study and a single center's decade-long experience.

To compare the oncological survival outcome between extended resections (ER) and segmental resection (SR) for non-metastatic splenic flexure tumors. A total of 10,063 splenic flexure colon cancers patients who underwent ER (n = 5546) or SR (n = 4517) from 2010 to 2018 were included from the Surveillance, Epidemiology, and End Results (SEER)-registered database. Additionally, we included 135 patients from our center who underwent ER (n = 54) or SR (n = 81) between 2011 and 2021. Survival rates were compared between groups. To reduce the inherent bias of retrospective studies, propensity score matching (PSM) analysis was performed. In the SEER database, patients in the ER group exhibited higher pT stage, pN stage, larger tumor size, and elevated rates of CEA level, perineural invasion, and tumor deposits compared to those in the SR group (each P < 0.05). The 5-year cancer-specific survival (CSS) rate was slightly lower in the ER group than in the SR group (79.2% vs. 81.6%, P = 0.002), while the 5-year overall survival (OS) rates were comparable between the two groups (66.2% vs. 66.9%, P = 0.513). After performing PSM, both the 5-year CSS and 5-year OS rates were comparable between the ER and SR groups (5-year CSS: 84.9% vs. 83.0%, P = 0.577; 5-year OS: 70.6% vs. 66.0%, P = 0.415). These findings were consistent in the subgroup analysis that included only patients with stage III disease or tumor size ≥ 7cm. Furthermore, although the number of harvested lymph nodes was higher in the ER group compared to the SR group (14.4 vs. 12.7, P < 0.001), the number of invaded lymph nodes remained similar between the two groups (0.5 vs. 0.5, P = 0.90). Similarly, our center's data revealed comparable 3-year OS and 3-year disease-free survival (DFS) rates between the two groups. ER have no significant oncological benefits over SR in the treatment of non-metastatic splenic flexure colon cancer, even for locally advanced cases.

Comparison of Outcomes Between Partial and Radical Laparoscopic Nephrectomy for Localized Renal Tumors Larger Than Four Centimeters: A Systematic Review and Meta-Analysis.

Earlier studies have juxtaposed different laparoscopic methods for treating renal tumors; however, extensive evidence with a particular focus on large kidney tumors remains lacking. The objective of this meta-analysis was to assess the perioperative outcomes, kidney performance, and cancer-related results of laparoscopic partial nephrectomy (LPN) versus laparoscopic radical nephrectomy (LRN) for treating extensive, localized, non-metastatic kidney tumors (cT1b-cT2N0M0). We systematically searched multiple databases from database inception until December 2023 for relevant studies. Selected data were analyzed with the Cochrane Collaboration's Review Manager 5.4 software using a random-effects model. Outcomes were expressed as odds ratios and weighted mean differences with 95% confidence intervals, considering a P value of < 0.05 as significant. Data from nine studies encompassing 1,303 patients (529 LPN, 774 LRN) revealed that LPN was associated with lengthier surgeries and increased blood loss compared to LRN. While LPN exhibited higher postoperative complication rates, the disparity did not reach statistical significance. LPN led to improved postoperative renal function, manifesting as a reduced estimated glomerular filtration rate (eGFR) decline and fewer incidents of new chronic kidney disease cases. Both groups demonstrated comparable tumor recurrence and overall mortality rates, but LPN exhibited significantly lower cancer-specific mortality rates. LPN, despite longer operative times and greater intraoperative blood loss, was found to be superior to LRN in preserving postoperative renal function. Oncologically, LPN and LRN have comparable overall mortality rates, but LPN showed a significant advantage in terms of lower cancer-specific mortality rates.

Surgery Prolongs Five-Year Survival for Nonmetastatic Colon Neuroendocrine Tumors

Abstract Background: While treatment guidelines for colon neuroendocrine tumors recommend surgical intervention when feasible, evidence in the literature is limited for patients with nonmetastatic tumors. Objectives: This study assessed the efficacy of surgery in terms of five year survival for patients with nonmetastatic colon neuroendocrine tumors. Design: This was a retrospective cohort study. Patient and Methods: This study used the National Cancer Database (NCDB) which compiles data from 1500 + facilities accredited to the Commission on Cancer. Data from patients with histologically confirmed colon neuroendocrine tumors from 2007 to 2018 were collected. Other inclusion criteria were age more than 18 years, nonmetastatic, nonpalliative care, known surgery status/type, and chemotherapy status. The five year survival rates were assessed using Kaplan–Meier curves and multivariate adjusted Cox proportional hazards regression to analyze the efficacy of surgery for these tumors. In addition, sensitivity analyses were performed to determine the associations in patients with well differentiated and early stage (stage 1) tumors. Main Outcome Measure: The main outcome was five year overall survival. Sample Size: A total of 3,340 patients met the inclusion criteria from the NCDB. Results: The majority of patients received some form of surgery (95.8%), while fewer patients (4.3%) received nonsurgical treatment. Overall, patients were on average 61.5 ± 13.3 years old, female (54.3%), and majority white (77.7%). Five year survival rates were 65.5% for the no surgery group and 79.5% for the surgery group [Kaplan–Meier log rank, P &lt; .0001]. Moreover, multivariate proportional hazards regression showed prolonged five year survival after surgery [adjusted hazards ratio (aHR) (95% confidence interval): 0.39 (0.28–0.54)]. In addition, all sensitivity analyses revealed prolonged survival of patients who underwent surgery. Conclusion: To our knowledge, this is the first study to assess survival for nonmetastatic colon neuroendocrine tumors using a national database. Limitations: This study was limited by retrospective review, potential selection bias from a registry, and missing data. Conflicts of Interest: None.

Implementing active surveillance for low-risk thyroid carcinoma into clinical practice: collaborative recommendations for Latin America.

The incidence of thyroid cancer is increasing globally, but mortality rates have remained steady. Many patients with thyroid cancer have low-risk, nonmetastatic intrathyroidal tumors smaller than 2 cm. Active surveillance has shown benefits in these patients, but the adoption of this approach remains below standard in Latin America. The purpose of this article is to identify ways to improve the incorporation of active surveillance into clinical practice for patients with low-risk thyroid carcinoma in Latin America, taking into consideration cultural and geographic factors. Current recommendations include three steps involving patient participation. The first step, which consists of the initial clinical examination, has eight factors requiring special attention. Anxiety must be managed while considering individual, disease-related, cognitive, and environmental aspects. Terms like "overdiagnosis", "incidentaloma," and "overtreatment" must be explained to the patient. Implementing precise terminology contributes to adequate disease perception, substantially reducing stress and anxiety. Clarifying the nonprogressive nature of thyroid cancer helps dispel myths surrounding the disease. The second step includes advice about procedures and guidelines for patients who choose active surveillance. Flexible monitoring techniques should be implemented, with regular check-ins scheduled based on patient needs. Reasons for adjusting treatment must be clearly communicated to the patient, and changes in preference regarding active surveillance should be considered in advance. The third step includes assistance during follow-up. Patients must be educated about ultrasound results and receive surgical indications from specialized physicians. The effectiveness of active surveillance can be reinforced by explaining to the patients the dynamics of changes in nodule size using clear and concise visual aids.

Effect of sodium thiosulfate anhydrous on cisplatin-induced ototoxicity in pediatric cancers: Turkish compassionate use treatment protocol—Updated results.

e15075 Background: Cisplatin induced ototoxicity (CIO), with permanent hearing loss is observed in &gt;60% pediatric patients in Turkey. PEDMARK (Sodium Thiosulfate anhydrous) reduced the risk of CIO cases with non-metastatic solid tumors observed in Phase 3 studies (SIOPEL 6 &amp; COG ACCL0431). We aimed to evaluate the investigational product PEDMARK provided for pediatric cases via a National Compassionate Use Treatment Protocol (CUP) in Turkey. Methods: Patients (1 month to &lt;18 years) with a localized, nonmetastatic solid tumor, standard-risk hepatoblastoma (HBB), nasopharyngeal carcinoma (NPC) and medulloblastoma MB whose treatment plans were including cisplatin were eligible. PEDMARK was administered intravenously 6 hours after each cisplatin dose infusion. Adverse events, demography, pre and post- hearing were recorded from 21OCT2019-21SEPT2022. Results: The CUP enrolled 12 patients, 8 HBB, 3 NPC and 1 MB in 3 years, from 6 academic institutions. HBB patients' median age was 1year (3mos-3 yrs). All pts had newly diagnosed HBB PRETEXT 3 (n = 5) with a median baseline AFP OF 54.000. 3 NPC age 13-17 yrs, MB 6yrs of age. All patients had Brock Grade 0 on hearing tests prior to treatment Patients received a median 0f 6 cycles (range 4-6) of cisplatin and PEDMARK. Patients with hearing tests available post-treatment (n=11), all maintained Brock Grade 0. At a median of 0.8mos post-treatment, CR were observed in all patients except one HBB with progressive disease. All CRs wer sustained 18.8 mos. AEs in 2 patients were Grade 1-2 nausea/vomiting, no Grade &gt;3 AEs were reported. Conclusions: PEDMARK was well tolerated, provided via a Turkish CUP to reduce the CIO in pediatric patients with nonmetastatic solid tumors. No hearing loss was observed/ detected post-treatment and the tumor outcomes were consistent with the Phase 3 studies. This is very encouraging.

First- and second-line biomarker utilization in non-small cell lung cancer.

e20564 Background: Targeted therapy has revolutionized the treatment of non-small cell lung cancer (NSCLC) since FDA-approval of the first EGFR-inhibitor in 2003. While number of actionable mutations and FDA-approved therapies has drastically increased, numerous studies have reported lackluster utilization rate of these therapies. Many of these studies take place in the community setting and focus on first line targeted therapy utilization. We aim to investigate the utilization rate of targeted therapies in an academic center, as well as explore utilization rate of newer second line therapies. Methods: The pathology database was queried for all stages of NSCLC cases with molecular testing (including qPCR, FISH, and NGS) from Jan 2016-Jan 2024. Patients with actionable alterations in EGFR, ALK, ROS1, BRAF, MET, RET, NTRK, KRAS, and ERBB2 ( HER2) that were detected six months prior to the first FDA approval for their respective targeted therapy were included. Patients who were lost to follow-up, those with early-stage non-metastatic tumors, or without progression on first line therapy at time of data cutoff (for actionable mutations with approved targeted second-line treatment) were subsequently excluded. Therapy plans and clinical course for the remaining patients were reviewed. Results: 355 NSCLC patients with actionable mutations were identified (210 EGFR, 63 ALK, 15 BRAF, 18 ROS1, 6 RET, 26 MET, 1 NTRK, 17 KRAS, 0 ERBB2). The following patients received an FDA-approved targeted first line therapy: EGFR (non-exon 20 insertion) 194/207 (94%), BRAF 8/15 (53%), ALK 60/63 (95%), ROS116/18 (89%), RET 5/6 (83%), MET 22/26 (85%), and NTRK 1/1 (100%). For FDA-approved second line therapy, KRAS 10/17 (59%) and EGFR (exon20 insertion) 2/3 (67%) patients received targeted therapy. No ERBB2 patients progressed. There was statistically significant difference between treatment rates between BRAF and non- BRAF first line therapies (p &lt; .0002) and between rates of treatment with first and second line therapies (p &lt; .0002). For those that did not receive eligible therapy, 15/37 (41%) received chemotherapy or immunotherapy treatment and 20/37 (54%) were too clinically severe for treatment. Conclusions: Despite most eligible patients receiving the appropriate targeted therapy (89%), there remains distinct subsets with significantly lower treatment rates. In particular, there is a large gap in treatment between the FDA-approved first and second line therapies as well as patients with BRAF mutations compared to other first line therapies. While the overall treatment rate based on molecular findings are higher than those reported from community settings, there remains patient populations which seemingly have their molecular findings overlooked. [Table: see text]

Lower Plasma Selenium Level in Primary Malignant Bone Tumors: A Survey Research

Objective: To compare plasma selenium levels in primary bone tumor patients with clinically healthy Thai subjects. Materials and Methods: A cross-sectional study on plasma selenium of primary bone tumor patients aged above 12 years old was obtained at Siriraj Hospital. The plasma samples were used for selenium assay by Electrothermal Atomic Absorption spectrometry method. The plasma selenium levels were compared with the clinically healthy Thai subjects or within primary bone tumor groups (age: below or above 30 years, gender: male or female, benign or malignant tumor, metastasis or non-metastasis). Results: One hundred and nine primary bone tumor patients were included in this study. Plasma selenium level in clinically healthy Thai subjects aged more than 30 years old was significantly higher than a primary bone tumor group (121.71 ± 19.96 g/L vs 111.88 ± 23.62 g/L, mean difference -9.83, p-value = 0.017). The plasma selenium levels within the primary bone tumor patients did not exhibit significant differences when compared across genders, age groups below and above 30 years old, benign and malignant tumors, or between metastatic and non-metastatic tumor cases. Conclusion: A patient with a history of malignant bone tumors tends to have a lower level of plasma selenium than normal people. However, the study of selenium supplementation for those who have a higher risk of developing malignant bone tumors is needed in the future.

Molecular pathways of common breast cancer metastases and the distinguishing features of triple-negative breast cancer

Breast cancer is the most common type of female cancer in Turkey, and metastasis is the most important cause of death, as in other solid organ cancers. Triple-negative tumors constitute 15-20% of breast cancer patients. Within three years after the development of the primary tumor, the tumor spreads to other organs. Breast cancer tends to spread to distant organs, such as bone, liver, brain, lung, and adrenal gland, either through regional lymph nodes or vascular channels. This condition, defined as the tendency to metastasize to specific organs, is called organotropism. Triple-negative breast cancer is a heterogeneous breast cancer subtype showing organotropism for the brain and the lungs. Identifying the molecular changes that may cause tropism for various regions and organs in non-metastatic tumors at the time of diagnosis is vital to developing targeted therapies and achieving longer overall and disease-free survival. In this review, we aimed to summarize the pathogenesis of breast cancer metastasis, the molecular changes involved in the metastatic process, and organotropism, as well as to emphasize the distinguishing features of triple-negative breast cancer in terms of metastatic organotropism.

Benefits of cardiopulmonary resuscitation in cancer patients.

According to meta-analytic data, the prognosis of a cancer patient post-cardiopulmonary resuscitation (CPR) is relatively similar to the general population. However, preselection of patients, the details of CPR, patient-specific characteristics, and post-CPR care are poorly described. The aim of this study is to identify prognostic factors in order to recognize cancer patient profiles more likely to benefit from CPR. This is a retrospective study on a series of patients with solid or hematological malignancies who received CPR between January 2010 and December 2020 in a cancer institute. Sixty-eight patients were included. The ratio of solid to hematological malignancy was 44/24, of which 32 were metastatic solid tumors. Median age was 61years. Hypoxemia (29%) was the primary factor for cardiac arrest, followed by septic shock (21%). ICU mortality and hospital mortality were 87% and 88% respectively. Younger age, the presence of hematological malignancy, or a metastatic solid tumor were poor predictors for in-hospital mortality. Similarly, cardiac arrest in the ICU, as the final consequence of a pathological process, and a resuscitation time of more than 10min have a negative influence on prognosis. This study shows that CPR is a useful intervention in cancer patients, even in the elderly patient, especially in non-metastatic solid tumors where cardiac arrest is the consequence of an acute event and not a terminal process.

A pure endoscopic full-thickness resection of a large non-metastatic GI stromal tumor >5 cm of the stomach after neoadjuvant imatinib therapy

A pure endoscopic full-thickness resection of a large non-metastatic GI stromal tumor >5 cm of the stomach after neoadjuvant imatinib therapy

Parenchymal obliteration by renal masses: Functional and oncologic implications

ObjectivesMost renal tumors merely displace nephrons while others can obliterate parenchyma in an invasive manner. Substantial parenchymal volume replacement (PVR) by renal cell carcinoma (RCC) may have oncologic implications; however, studies regarding PVR remain limited. Our objective was to evaluate the oncologic implications associated with PVR using improved methodology including more accurate and objective tools. Patients/MethodsA total of 1,222 patients with non-metastatic renal tumors managed with partial nephrectomy (PN) or radical nephrectomy (RN) at Cleveland Clinic (2011-2014) with necessary studies were retrospectively evaluated. Parenchymal volume analysis via semiautomated software was used to estimate split renal function and preoperative parenchymal volumes. Using the contralateral kidney as a control, %PVR was defined: (parenchymal volumecontralateral–parenchymal volumeipsilateral) normalized by parenchymal volumecontralateral x100%. PVR was determined preoperatively and not altered by management. Patients were grouped by degree of PVR: minimal (<5%, N = 566), modest (5%-25%, N = 414), and prominent (≥25%, N = 142). Kaplan-Meier was used to evaluate survival outcomes relative to degree of PVR. Multivariable Cox-regression models evaluated predictors of recurrence-free survival (RFS). ResultsOf 1,122 patients, 801 (71%) were selected for PN and 321 (29%) for RN. Overall, median tumor size was 3.1 cm and 6.8 cm for PN and RN, respectively, and median follow-up was 8.6 years. Median %PVR was 15% (IQR = 6%-29%) for patients selected for RN and negligible for those selected for PN. %PVR correlated inversely with preoperative ipsilateral GFR (r = -0.49, P < 0.01) and directly with advanced pathologic stage, high tumor grade, clear cell histology, and sarcomatoid features (all P < 0.01). PVR≥25% associated with shortened recurrence-free, cancer-specific, and overall survival (all P < 0.01). Male sex, ≥pT3a, tumor grade 4, positive surgical margins, and PVR≥25% independently associated with reduced RFS (all P < 0.02). ConclusionsObliteration of normal parenchyma by RCC substantially impacts preoperative renal function and patient selection. Our data suggests that increased PVR is primarily driven by aggressive tumor characteristics and independently associates with reduced RFS, although further studies will be needed to substantiate our findings.

Clinical application of LARS tumor tube in joint function reconstruction of tumor type artificial hip replacement.

Proximal femur tumor resection often leads to hip joint instability and functional loss. Various methods have been clinically applied to repair hip joint soft tissue function, but deficiencies remain. This study aims to evaluate the advantages and disadvantages of the ligament advanced reinforcement system (LARS) tumor tube in assisting soft tissue function reconstruction in patients undergoing tumor type artificial hip replacement surgery. This study included 85 patients (41 males, 44 females) with proximal femoral tumors treated at the Xiangya Bone Tumor Treatment Center from January 2012 to January 2022, aged 10 to 79 (38.5±18.2) years. Among them, 13 cases had benign aggressive tumors, 45 had primary malignant bone tumors, and 27 had bone metastases. Clinical data, imaging data, and intraoperative photos were collected. Patients were followed up and postoperative functional evaluations were conducted using the Musculoskeletal Tumor Society (MSTS) scoring system and Harris hip joint scoring system to assess limb function and hip joint function. Preoperative pathological fractures were present in 37 cases (43.5%), with a lesion length of (9.4±2.9) cm. Among non-metastatic tumor patients, 7 experienced postoperative recurrence, including 6 cases of osteosarcoma and 1 case of fibrosarcoma. Pulmonary metastases occurred in 9 osteosarcoma patients. Five patients required reoperation due to postoperative complications, including 3 cases of deep vein thrombosis, 1 case of giant cell granuloma, and 1 case of prosthesis infection. Postoperatively, 5 patients exhibited Trendelenburg gait, and 6 had leg length discrepancies. The postoperative MSTS score was 26.7±1.4, and the Harris score was 89.6±5.3. The LARS tumor tube can effectively assist in reconstructing the soft tissue function of the hip joint and greatly reduce postoperative complications, making it an effective technical improvement in joint function reconstruction in tumor type artificial hip replacement surgery.