Non-metastatic Malignancies Research Articles

Patients with metastatic cancer have worse short-term coronary artery bypass grafting outcomes: A population-based study of National Inpatient Sample from 2015 to 2020

BackgroundMetastasis is a hallmark for cancer progression. While patients with metastatic cancer (MC) have higher risk profiles, outcomes of coronary artery bypass grafting (CABG) in these patients have not been established, likely due to their smaller representation in the CABG patient population. This study aimed to examine the short-term outcomes of patients with MC who underwent CABG. MethodsPatients who underwent CABG were identified in National Inpatient Sample from Q4 2015–2020. Exclusion criteria included age <18 years, concomitant procedures, and non-metastatic malignancies. A 1:3 propensity-score matching was used to address differences in demographics, socioeconomic status, primary payer status, hospital characteristics, comorbidities, and transfer/admission status between MC and non-MCC patients. In-hospital post-CABG outcomes were evaluated. ResultsThere were 379 (0.23 %) patients with MC who underwent CABG. All MC patients were matched to 1161 out of 164,351 non-MC patients who underwent CABG during the same period. Patients with MC had higher risks of mortality (4.76 % vs 2.58 %, p = 0.04), pacemaker implantation (2.91 % vs 1.12 %, p = 0.03), venous thromboembolism (1.85 % vs 0.43 %, p = 0.01), and hemorrhage/hematoma (61.11 % vs 55.04 %, p = 0.04). In addition, MC patients had a longer time from admission to operation (3.35 ± 4.19 vs 2.82 ± 3.54 days, p = 0.03) and longer hospital length of stay (11.86 ± 8.17 vs 10.65 ± 8.08 days, p = 0.01). ConclusionPatients with MC had higher short-term mortality and morbidities after CABG. These findings can help provide insights for clinicians in the management of patients with concurrent coronary artery disease and MC, particularly in terms of preoperative risk stratification and therapeutic decision-making.

The Charlson comorbidity index and short-term readmission in patients with heart failure: A retrospective cohort study.

The relationship between the Charlson comorbidity index (CCI) and short-term readmission is as yet unknown. Therefore, we aimed to investigate whether the CCI was independently related to short-term readmission in patients with heart failure (HF) after adjusting for other covariates. From December 2016 to June 2019, 2008 patients who underwent HF were enrolled in the study to determine the relationship between CCI and short-term readmission. Patients with HF were divided into 2 categories based on the predefined CCI (low < 3 and high > =3). The relationships between CCI and short-term readmission were analyzed in multivariable logistic regression models and a 2-piece linear regression model. In the high CCI group, the risk of short-term readmission was higher than that in the low CCI group. A curvilinear association was found between CCI and short-term readmission, with a saturation effect predicted at 2.97. In patients with HF who had CCI scores above 2.97, the risk of short-term readmission increased significantly (OR, 2.66; 95% confidence interval, 1.566-4.537). A high CCI was associated with increased short-term readmission in patients with HF, indicating that the CCI could be useful in estimating the readmission rate and has significant predictive value for clinical outcomes in patients with HF.

Paraneoplastic Cerebellar Degeneration Presented as Acute Vertigo

Paraneoplastic cerebellar degeneration is a rare neurological manifestation of nonmetastatic malignancy. Its usual manifestation is subacute to chronic dizziness, gait ataxia, and dysarthria. There have been only a few cases of paraneoplastic cerebellar degeneration with acute presentation. This study describes a patient with paraneoplastic cerebellar degeneration, who presented acute vestibular syndrome and then episodically developed horizontal gaze-evoked nystagmus and gait ataxia.

Oncofertility and Reproductive Counseling in Patients with Breast Cancer: A Retrospective Study.

Introduction. Improving the prognosis of breast cancer patients is of utmost importance in terms of increasing survival rates. Modern medicine has therefore prioritized better quality of life for patients, even after the disease, through a better management of the potential long-term side effects induced by anticancer treatments. Fertility preservation and family planning are therefore crucial issues to be addressed in all cancer patients of reproductive age. Along those lines, a new branch of medicine with distinct multidisciplinary characteristics has developed over the years: oncofertility. Although both national and international guidelines value reproductive counseling as an essential aspect of the diagnostic-therapeutic pathway, part and parcel of the informed consent process, it is not included within the protocols adopted by the operating units for the care and management of neoplastic diseases. Objective. This study aimed to evaluate the activity of the Breast Unit of the Policlinico Umberto I Hospital, Rome, Italy, and the degree of compliance with guidelines. By knowing the strengths and weaknesses of such approaches, the standards of care offered to breast cancer patients can be improved. Materials and methods. A retrospective study based on a review of medical records was conducted between 2014 and 2021. Patients under 40 years of age diagnosed with non-metastatic malignancies were included who received chemotherapy treatment, namely neoadjuvant, adjuvant or adjuvant hormone therapy. Results. The data were extracted from the medical records of 51 patients who met the inclusion criteria, 41% of whom received reproductive counseling, and of these, 43% decided to undertake a path of fertility preservation. Factors such as the absence of children and young age reportedly favored both the interest in counseling proposals by the medical staff and the decision to undertake a path of fertility preservation. Conclusions. The study shows that there has been growing interest in the topic of oncofertility, especially in light of law 219/2017. Therefore, since 2018, multiple proposals for reproductive counseling have been set forth, but there was not an equally growing demand for fertility preservation practices, which can be explained by the invasive nature of such practices, the patients’ concern about their own state of health, and poor or inadequate information. Such impediments highlight the importance of standardized counseling and the need for a multidisciplinary medical team to support the patient in the decision-making process. The study also revealed a drop in the number of patients receiving counseling due to the COVID-19 pandemic, contrary to the positive trend that was recorded prior to the pandemic.

Postavení miniinvazivní a robotické chirurgie v léčbě nádorů jícnu a žaludku

Summary: Esophagectomy and gastrectomy are essential curative methods in the treatment of non-metastatic malignancies of the esophagus and stomach. Video-assisted minimally invasive resections of the esophagus and stomach have demonstrated surgical and oncological safety and can be used as part of multimodal treatment strategy. Robot-assisted surgical operations are a new technology in the field of mini-invasive upper gastrointestinal surgery. The technical advantages of robotic systems combining minimally invasive surgical approaches with the possibility of multi-element articulation of robotic instruments in the operating field lead to a worldwide expansion of robotic centers. Further technological development can be expected to enhance support and facilitation of minimally invasive surgery and to further reduction of the surgical stress while adhering to the criteria of radical oncosurgery. Key words: minimally invasive surgery – laparoscopy – robotic surgery – esophagectomy – gastrectomy

MO165CANCER, KIDNEY AND DIET: THE NUTRITIONAL MANAGEMENT IN ONCO-NEPHROLOGICAL PATIENTS. A SINGLE CENTER EXPERIENCE

Abstract Background and Aims Controlled low-normal protein (LNP) diet in CKD patient is effective in controlling the progression of renal impairment. Oncological guidelines explain how a high protein level should be always required in patients (pts) affected by malignancies in order to compensate the cancer derived metabolism and avoid catabolism. But what about the onco-nephrological pts? Aim of our study is to investigate the metabolic impact of a low-normal protein diet in a consecutive cohort of 103 nephrological pts affected or not by urological non-metastatic malignancies. Method A consecutive cohort of 103 pts was enrolled in the Urological Department at San Raffaele Scientific Institute between 2018-2020. Inclusion criteria were: Age (&amp;gt;18 years old), eGFR (&amp;lt; 90 ml/min/1.73), Malnutritional Screening Tool (MTS&amp;lt;2), Urological Cancer aggressiveness (no metastatic process), Informed consent (signed). We divided the total cohort in 2 matched subgroups; case (CS: onco-nephrological pts with urological malignancies) and control (CT: nephrological pts) with a 2.1 ratio. Each patient underwent an initial nephrological and nutritional evaluation and was subsequently subjected to a conventional CKD LNP-diet (0,7-1 g/Kg/die: calories: 30-35 kcal per kg body weight/die) for a period of 6 months (+/- 2 moths). The diet was based on the estimated Glomerular Filtration Rate (CKD-EPI 2012 formula), comorbidities, nutritional status and hypermetabolic conditions. LNP-diets were integrated with aproteic food to maintain a relevant amount of high–biological value proteins, especially for oncological and advanced CKD pts. MTS, Body Mass Index (BMI), Phase Angle (PA), Fat Mass percentage (FM%), Fat-Free Mass Index (FFMI), body cell mass index (BCMI), extracellular:intracellular water ratio (ECW/ICW), waist circumference (WC), lab test exams and clinical variables were examined at baseline and after 6 months. Statistical analysis: Kruskal-Wallis rank sum test; Data analysis: R programming language and RStudio integrated development environment. Results Population divided as follows: average age: 69.8 (+/- 10.3); ♂ : ♀ ratio: 2.4; Hypertension: 57.28%; Diabetes: 19,41%; CKD classification: 3,88% stage 2, 87,37% above stage 3. At time zero no pts were underweight and 51 % were overweight or obese with difference condition of FM percentage (FM % average: 24.3 % ♀ and 18.1 % ♂for CS pts vs 31.6 % ♀ and 18.2 % ♂for CT pts). Only 2.1% of pts had a PA of less than 4°, considered a negative prognostic index (PA average: 5.6° for CS pts vs 5.5° for CT pts) and 6.3 % of pts had a value of cell mass less than 8 kg/m2 indicative of reduced lean mass (BCMI average: 10.4 kg / m2 for CS pts vs 11 kg / m2 for CT pts). An increase in ECW/ICW ratio greater than 1 was more present in CT pts in respect to CS pts (41.6 % vs 22.8 % and ECW/ICW average: 1.01 for CT pts vs 0.93 for CS pts) as well as WC measurement associated with increased cardiovascular risk (WC average: 87 cm ♀ and 99 cm ♂ for CS pts vs 97 cm ♀ and 104 cm ♂ for CT pts). After 6 months of diet, we observed a similar behavior between the CS and the CT cohorts in terms of renal metabolites and eGFR profile. In fact, the 65% of onco-nephrological and the 55% of nephrological pts displayed a significative decrease in urea plasmatic levels (- 27,76 mg/dl) and eGFR improvement (+ 6,27 ml/min/1,73). The nutritional status, as assessed by the MST, was preserved in both groups during the study. In addition, all pts had an improvement in BMI (CS: 2.8 kg/m2; CT :1.3 kg/m2) PA (CS: 2.8°; CT: 1.3°), BCMI (CS: 1.31 kg / m2; CT :0.38 kg / m2) and FFMI (CS; 0.1 ♀ and 0.1 ♂; CT; 2.9 ♀ and 1.1 ♂) and a decrease of WC (CS: - 1.3 cm; CT– 1,65), FM percentage (CS: 0 %; CT – 2.7) and ECW/ICW (CS: 0.02; CT 0.03). Conclusion Our study suggests that LNP high calorie diet ameliorates the nephrological scenarios, the metabolic complications, and the nutritional perspective in uro-oncological pts with stage 2-5 CKD. A larger prospective study to validate these results is on-going.

The Impact of Comorbidity on Survival in Patients With Head and Neck Squamous Cell Carcinoma: A Nationwide Case-Control Study Spanning 35 Years

BackgroundComorbidity is presumed to impact survival of head and neck squamous cell cancer (HNSCC) patients. However, the prevalence and prognostic impact of comorbidity in these patients is not yet well established. The aim of this study is to outline the comorbidity burden of HNSCC patients and investigate the relation to overall survival and cancer-specific mortality.MethodsThe comorbidity burden of patients registered with HNSCC in the Danish Cancer Registry between 1980 and 2014 was evaluated based on the Charlson Comorbidity Index (CCI). Patients’ risks of comorbid conditions compared to age- and gender-matched controls were estimated by odds ratios (OR). The impact of comorbidity on overall survival and cancer-specific mortality was evaluated by Cox regression and Kaplan-Meier survival analysis.ResultsA total of 25,388 HNSCC patients were included (72.5% male; mean age 63.2 years at diagnosis; median follow-up 3.0 years). CCI at diagnosis was significantly higher in patients compared to controls (p < 0.001). The most common comorbid conditions among the patients were additional non-metastatic malignancy (10.9%) and cerebrovascular disease (7.7%). Compared to controls, patients had higher odds of metastatic malignancy (OR: 4.65; 95% CI: 4.21–5.15; p < 0.001), mild liver disease (OR: 6.95; 95% CI: 6.42–7.53; p < 0.001), and moderate-severe liver disease (OR: 7.28; 95% CI: 6.14–8.65; p < 0.001). The multivariate Cox analysis revealed increasing hazard ratios with increasing CCI and in coherence the Kaplan-Meier curves showed poorer overall survival and increased cancer-specific mortality in patients with higher CCI.ConclusionHNSCC patients’ comorbidity burden was significantly greater compared to the general population and increased comorbidity was correlated with increased cancer-related mortality.

Fully integrated [18F]FDG PET/MR in large vessel vasculitis.

The aim of this study is to evaluate the usefulness of [18F] fluorodeoxyglucose (FDG) positron emission tomography (PET)/magnetic resonance (MR) in large vessels vasculitis (LVV) patients. We performed an observational retrospective study based on our records. Images were acquired on a PET/MR scanner using [18F]FDG-PET whole body imaging. For each PET scan, a qualitative analysis and a semi-quantitative measure using the maximum of the standardized uptake value (SUV<inf>max</inf>) were performed. SUV<inf>max</inf> measurements normalized to the liver uptake were categorized using a grading scale. Vessel's wall thickness (WT) was measured at five fixed points (inferior margin of T5, T9, T12, L3, thickest area [max WT]). Twenty-three LVV patients were included, 56.5% giant cells arteritis, 34.8% Takayasu's arteritis and 8.7% isolated aortitis, all Caucasian, mostly females (82%). We considered 32 PET scans for the LVV group (from a minimum of one to a maximum of three scans per patient) mainly during follow-up (29/32 scans), and 23 PET scans from a control group of non-metastatic malignancies patients. We found higher SUV<inf>max</inf> compared to controls, in all sites, irrespective of clinical disease activity. Mean WT resulted higher in patients than in controls but was not correlated to SUV<inf>max</inf>. Mean WT positively correlated with age in both cohorts, inversely correlated to disease duration, while no correlation with SUV<inf>max</inf> was observed. The concordance between clinically active disease and PET hypermetabolism was poor (Cohen' κ=0.33). PET/MR is a safe imaging technique capable of detecting inflammation in aortic wall. Low radiological exposure of PET/MR should be considered especially in young women receiving follow-up studies.

Macrophages Mediate a Switch between Canonical and Non-Canonical Wnt Pathways in Canine Mammary Tumors

ObjectiveAccording to the current hypothesis, tumor-associated macrophages (TAMs) are “corrupted” by cancer cells and subsequently facilitate, rather than inhibit, tumor metastasis. Because the molecular mechanisms of cancer cell–TAM interactions are complicated and controversial we aimed to better define this phenomenon.Methods and ResultsUsing microRNA microarrays, Real-time qPCR and Western blot we showed that co-culture of canine mammary tumor cells with TAMs or treatment with macrophage-conditioned medium inhibited the canonical Wnt pathway and activated the non-canonical Wnt pathway in tumor cells. We also showed that co-culture of TAMs with tumor cells increased expression of canonical Wnt inhibitors in TAMs. Subsequently, we demonstrated macrophage-induced invasive growth patterns and epithelial–mesenchymal transition of tumor cells. Validation of these results in canine mammary carcinoma tissues (n = 50) and xenograft tumors indicated the activation of non-canonical and canonical Wnt pathways in metastatic tumors and non-metastatic malignancies, respectively. Activation of non-canonical Wnt pathway correlated with number of TAMs.ConclusionsWe demonstrated that TAMs mediate a “switch” between canonical and non-canonical Wnt signaling pathways in canine mammary tumors, leading to increased tumor invasion and metastasis.Interestingly, similar changes in neoplastic cells were observed in the presence of macrophage-conditioned medium or live macrophages. These observations indicate that rather than being “corrupted” by cancer cells, TAMs constitutively secrete canonical Wnt inhibitors that decrease tumor proliferation and development, but as a side effect, they induce the non-canonical Wnt pathway, which leads to tumor metastasis.These data challenge the conventional understanding of TAM–cancer cell interactions.

Phase I trial of a PSMA DNA vaccine for patients(pts) with good risk renal cell carcinoma(RCC)

16073 Background: Prostate Specific Membrane Antigen (PSMA) is a self antigen first identified as a marker for epithelial cells in the prostate but is expressed on the vascular endothelium of metastatic RCC. PSMA mRNA transcripts and protein expression have been seen in the endothelium of tumor-associated neovasculature of non-metastatic malignancies. No PSMA mRNA or protein expression has been found in vascular endothelial cells of corresponding benign tissues. The clinical importance of PSMA expression is supported by the observation that PSMA RNA detected by RT-PCR in the circulation of RCC pts correlates with disease progression. A phase I trial was designed using a xenogeneic murine versus human PSMA DNA vaccine to evaluate safety in pts with RCC. Eighteen pts with clear cell RCC status post nephrectomy, cytokine therapy, or post metastastectomy with high risk of recurrent disease were enrolled. Good risk pts were defined as having a KPS of >80%, prior nephrectomy, normal calcium and hemoglobin levels. Methods: Six pts each were assigned to dose levels (500, 1500 and 3000μg) and were randomized to receive 3 murine or 3 human PSMA DNA vaccines im every 3 weeks. After the third vaccine, pts were crossed-over to the other species for an additional 3 vaccines. If pts remained disease-free or had clinically responding disease, booster immunizations were administered bimonthly for up to 4 additional booster vaccinations at weeks 24, 32, 40 and 48. Results: Ten of 15 treated pts were evaluable. The vaccine was well-tolerated. One pt from the 500μg dose level who received the murine vaccine first, and 2 pts from the 1500μg dose and 1 pt from the 3000μg dose who received the human PSMA DNA vaccine first, remain on study at 167, 114, 125 and 68 weeks, respectively. FACS analysis of pts’ sera against 3T3 fibroblasts genetically transduced to secrete PSMA showed no reactivity at the 500μg dose level; 1 of 2 pts at 1500μg and 1 pt at the 3000μg dose showed reactivity against PSMA, respectively. Minimal activity was seen by ELISA. Conclusions: The vaccine was safe at all dose levels without autoimmunity. The 2 pts at the 1500μg dose level have stable lung lesions. Studies are ongoing to examine other parameters of immune responsiveness. Supported by the Byrne Foundation No significant financial relationships to disclose.

A Prognostic Model for 1-Year Mortality in Older Adults after Hospital Discharge

Purpose To develop and validate a prognostic index for 1-year mortality of hospitalized older adults using standard administrative data readily available after discharge. Subjects and methods The prognostic index was developed and validated retrospectively in 6382 older adults discharged from general medicine services at an urban teaching hospital over a 4-year period. Potential risk factors for 1-year mortality were obtained from administrative data and examined using logistic regression models. Each risk factor associated independently with mortality was assigned a weight based on the odds ratios, and risk scores were calculated for each patient by adding the points of each independent risk factor present. Patients in the development cohort were divided into quartiles of risk based on their final risk score. A similar analysis was performed on the validation cohort to confirm the original results. Results Risk factors independently associated with 1-year mortality included: aged 70 to 74 years (1 point); aged 75 years and greater (2 points); length of stay at least 5 days (1 point); discharge to nursing home (1 point); metastatic cancer (2 points); and other comorbidities (congestive heart failure, peripheral vascular disease, renal disease, hematologic or solid, nonmetastatic malignancy, and dementia, each 1 point). In the derivation cohort, 1-year mortality was 11% in the lowest-risk group (0 or 1 point) and 48% in the highest-risk group (4 or greater points). Similarly, in the validation cohort, 1-year mortality was 11% in the lowest risk group and 45% in the highest-risk group. The area under the receiver operating characteristic curve was 0.70 for the derivation cohort and 0.68 for the validation cohort. Conclusion Reasonable prognostic information for 1-year mortality in older patients discharged from general medicine services can be derived from administrative data to identify high-risk groups of persons.

Long-term treatment with dalteparin low-molecular-weight heparin (LMWH) may improve survival in patients with non-metastatic malignancy and venous thromboembolism (VTE)

Long-term treatment with dalteparin low-molecular-weight heparin (LMWH) may improve survival in patients with non-metastatic malignancy and venous thromboembolism (VTE)

Renal Handling of Calcium and Sodium in Metastatic and Non-Metastatic Malignancy

No AccessJournal of UrologyOncology and Chemotherapy1 Sep 1986Renal Handling of Calcium and Sodium in Metastatic and Non-Metastatic Malignancy S.R. Heller, and D.J. Hosking S.R. HellerS.R. Heller More articles by this author , and D.J. HoskingD.J. Hosking More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)45052-XAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Renal Handling of Calcium and Sodium in Metastatic and Non-Metastatic Malignancy." The Journal of Urology, 136(3), p. 752 © 1986 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 136Issue 3September 1986Page: 752 Advertisement Copyright & Permissions© 1986 by The American Urological Association Education and Research, Inc.MetricsAuthor Information S.R. Heller More articles by this author D.J. Hosking More articles by this author Expand All Advertisement Loading ...

Renal handling of calcium and sodium in metastatic and non-metastatic malignancy.

Investigation of the renal handling of calcium and sodium in rehydrated patients with hypercalcaemia associated with malignancy showed enhanced reabsorption of calcium in most cases. This was a feature of both metastatic and non-metastatic malignancy, and in this respect the patients were indistinguishable from patients with primary hyperparathyroidism. As the increased calcium reabsorption was inversely correlated with the rate of excretion of sodium modest salt loading can be used to inhibit this process. This is an important practical aspect of the treatment of patients with this type of hypercalcaemia.

Leukocyte alkaline phosphatase in cancer patient.

Leukocyte alkaline phosphatase (LAP) activity in peripheral blood was determined in 113 patients with non-metastatic malignancies, 36 patients with metastatic spread, and 22 individuals who served as controls. The LAP score of the non-metastatic cancer patients was significantly higher (p less than 0.001) than the controls, and the score of the metastatic group was further increased significantly as compared to both control (p less than 0.001) and non-metastatic groups (p less than 0.001). The results of this survey suggest that the level of LAP score in peripheral blood might be used to differentiate between non-metastatic and metastatic disease and might serve as an aid in prognosis of the patients.

Living Cytology—Revisited. In Vitro Demonstration of Intraabdominal Adenocarcinomatosis

An in vitro culture technique, "living cytology", was used in a single-blind study to study 36 paracentesis and 7 intracystic fluid specimens for possible adenocarcinomatosis. Islets of epithelial cells were demonstrated only in the 20 patients who were ultimately shown to have intraabdominal adenocarcinomatosis. Ten patients with nonmalignant conditions and 6 patients with nonmetastatic malignancies did not exhibit a comparable pattern. One of the 7 intracystic fluid specimens grew out epithelial islets similar to those observed in patients with intraabdominal adenocarcinomatosis.

Intermittent Cholestatic Jaundice and Nonmetastatic Prostatic Carcinoma

Hepatomegaly and abnormal liver function can occur in nonmetastatic malignancies. A patient with metastatic prostatic adenocarcinoma that had spared the liver and extrahepatic biliary tree is described. He had puzzling episodes of jaundice for a period of 2 1/2 years. The results of appropriate investigations and an exploratory laparotomy performed dlring the patient's four antemortem hospitalizations were indicative of "recurrent intrahepatic cholestasis," the cause of which remained an enigma even after exploratory laparotomy. At autopsy, no evidence of hepatic metastases or extrahepatic biliary obstruction was found. Alcohol, hepatotoxic drugs, toxins, viral and chronic active hepatitis, hemolysis, and extrahepatic biliary obstruction were eliminated as causes of the jaundice. We believe that the intermittent intrahepatic cholestasis is one of the nonmetastatic manifestations (nonmetastatic hepatopathy of malignancy) of the prostatic adenocarcinoma.