Oncological Status Research Articles

Oatmeal and wheat flour as the sources of thyroid peroxidase and proinflammatory enzymes modulators in the prevention of thyroid diseases

Polyphenolic plant compounds possess nutritional and pro-healthy potential, reducing the risk of auto-inflammatory and neoplastic diseases. However, their interference with the progression of thyroid gland dysfunctions has remained largely unaddressed. For this purpose, we combined the analyses of phenolic content and antioxidative activity with the thyroid peroxidase (TPO), lipoxygenase (LOX), xanthine oxidase (XO) and cyclooxygenase-2 (COX-2) activity assays, isobolographic approach and the estimation of thyroid cancer cells’ proliferation and motility in vitro. Bioaccessible oatmeal (OM) and wheat flour (WF) compounds activated TPO while inhibiting LOX and XO’s in vitro activity. OM extracts also inhibited COX-2 activity. Isobolographic and combination index studies revealed cooperation of compounds from OM and WF. However, the relatively strong inhibitory activity of bioaccessible OM compounds on LOX activity correlated with their mildly cytostatic and relatively distinct pro-invasive effects in the thyroid cancer model in vitro. Collectively, the application of OM and WF products for the prophylactics of inflammatory thyroid diseases should be considered with care, especially in the context of the oncological status of the patient.

Current status of precision oncology in adult glioblastoma.

The concept of precision oncology, the application of targeted drugs based on comprehensive molecular profiling, has revolutionized treatment strategies in oncology. This review summarizes the current status of precision oncology in glioblastoma (GBM), the most common and aggressive primary brain tumor inadults with a median survival below 2 years. Targeted treatments without prior target verification have consistently failed. Patients with BRAF V600E-mutated GBM benefit from BRAF/MEK-inhibition, whereas targeting EGFR alterations was unsuccessful due to poor tumor penetration, tumor cell heterogeneity, and pathway redundancies. Systematic screening for actionable molecular alterations resulted in low rates (< 10%) of targeted treatments. Efficacy was observed in one-third and currently appears to be limited to BRAF-, VEGFR-, and mTOR-directed treatments. Advancing precision oncology for GBM requires consideration of pathways instead of single alterations, new trial concepts enabling rapid and adaptive drug evaluation, a focus on drugs with sufficient bioavailability in the CNS, and the extension of target discovery and validation to the tumor microenvironment, tumor cell networks, and their interaction with immune cells and neurons.

A multisite initiative to assess the immunization status of medical oncology patients.

289 Background: The Swedish Cancer Institute (SCI) is committed to holistic care and recognizes immunizations are an essential component to quality outcomes. In 2022 the SCI was selected to participate in the Specialty Societies Advancing Adult Immunization (SSAAI) project supported by the Centers for Disease Control and Prevention (CDC) with a goal of incorporating the CDC Standards for Adult Immunization Practice into medical oncology clinical care. The CDC Standards for Adult Immunization Practice are assess, recommend, administer or refer, and document. Recognizing immunization status is not routinely assessed, this quality initiative aimed to increase assessment of immunization status in medical oncology across 7 network clinics on 4 campuses to above 50 % by the end of 2023. Methods: All team members completed the ASCO Quality Training Program. The Plan Do Study Act (PDSA) framework was selected. Assessment was defined as having completed the Immunization Activity Record within the Epic Medical Record system, which includes reconciliation with the Washington state immunization registry. Data was initially abstracted manually to determine the baseline assessment rate until an automated method was developed. A Fishbone diagram determined the top barrier was the lack of awareness about this functionality and lack of training around the task. A workflow diagram and standard operating procedure were implemented. Clinic staff were trained on the new workflow when rooming patients. A small pilot with one clinic of solid tumor medical oncology clinics was completed. Patients included were on active treatment and seen face to face within the clinic. The standardized process and tools were refined, and problem areas addressed. The work was then expanded to all seven of the SCI network medical oncology clinics including hematology as the final PDSA cycle using the same training, process and tools. Results: The Epic Immunization Activity Record completion rate went from less than 1% of solid tumor patients with an active systemic treatment plan to 61% in the pilot project. After two additional PDSA cycles to refine the steps and target problem areas, the rate improved to 67% over a 3-month period. The PDSA cycle was expanded to bring the refined process to all 7 network clinics with a baseline assessment rate of 6% which increased to 45% after interventions within a 3-month period and concluding the 2023 year. Conclusions: Developing tools and implementing a new workflow for immunization assessment yielded a significant improvement in assessment rates thereby setting a foundation of assessment utilizing the CDC Standards for Immunization Practice. The use of concrete written tools improves the sustainability of the changes. Additional tools and refinement of existing tools will be studied to improve the current rate and sustain the gains. Reference: Standards for Adult Immunization Practices | CDC .

Posterior aggressive debulking versus minimal decompression surgery in patients with metastatic spinal cord compression: propensity-score-matching analysis from a multicenter study cohort.

The goal of this study was to evaluate the comparative outcomes of aggressive debulking (AD) and minimal decompression (MD) surgeries for metastatic spinal cord compression based on surgical burden, functional improvement, and symptomatic local recurrence (SLR). In this retrospective analysis from 2 tertiary hospitals, the authors assessed patients with metastatic spinal cord compression treated via AD and MD surgeries between 2010 and 2022. The evaluation included patient demographics, Eastern Cooperative Oncology Group performance status (ECOG-PS), primary tumor type, modified Tokuhashi scores, surgical burden, and SLR. Propensity-score matching (1:1 ratio) was conducted based on oncological status for intergroup comparisons. Survival analysis and logistic regression analyses were conducted. A total of 264 patients were included in the study. After 1:1 propensity-score matching, a total of 156 matched patients were analyzed (78 patients each in the AD and MD groups). Operation time, estimated blood loss, transfused red blood cell units, and inpatient medical complications were significantly higher in the AD group compared to the MD group (p = 0.001, p = 0.002, p = 0.006, and p = 0.035, respectively). There was no significant difference in distribution of postoperative ECOG-PS between the AD and MD groups (OR 1.461, 95% CI 0.821-2.599, p = 0.197). In initially nonambulatory patients (ECOG-PS of grade 3 or 4), the AD group showed a higher proportion of patients regaining ambulatory function compared to the MD group (56.5% vs 36.2%; OR 2.294, p = 0.049). In cases with a preoperative ECOG-PS of grade 3, the difference in ambulation recovery between AD and MD was not statistically significant (60.0% vs 53.3%, p = 0.577). However, for severely impaired patients (ECOG-PS of grade 4), the AD group showed a higher proportion of patients regaining ambulatory function compared to the MD group (33.3% vs 5.9%, p = 0.086). Symptomatic SLR-free survival showed no significant differences at final follow-up (p = 0.095). Multivariate analysis identified the modified Tokuhashi score as the sole predictor of SLR (OR 1.871, p = 0.001). This study found that MD surgery significantly reduced surgical burden compared to AD. AD surgery led to slightly better functional recovery showing greater rescue ratios, especially in patients with a preoperative ECOG-PS of grade 4. However, no difference in rescue ratio was observed in patients with a preoperative ECOG-PS of grade 3. There was no significant difference in SLR rates between the AD and MD groups.

Newly established borderline resectable 1 (BR1)category is one of the favorable candidates for selecting the use of multidisciplinary combination therapy in patients with advanced hepatocellular carcinoma treated with systemic therapy.

The aim of this study was to evaluate the newly established oncological criteria of resectability of hepatocellular carcinoma (HCC) for selecting suitable candidates for systemic and combination therapy. The data of 156 consecutive HCC patients with intrahepatic target nodules who had initially received systemic therapy (lenvatinib and atezolizumab plus bevacizumab) were reviewed. The patients were classified into three groups according to the novel oncological criteria for resectability (R, resectable; BR1, borderline resectable 1; and BR2, borderline resectable 2). The prognostic ability and clinical utility for selecting this population to receive combined use of multiple systemic sequential and locoregional therapy was then evaluated. Combined use of systemic sequential therapy with more than two agents and locoregional treatment was defined as multidisciplinary combination therapy (MCT), while systemic sequential therapy only and repeated locoregional treatment was defined as a single treatment procedure (STP). Patients classified as R and BR1 had significantly better overall survival (OS) compared with BR2 (R vs. BR2, p=0.012; BR1 vs. BR2, p=0.004). However, there was no significant difference between R and BR1 (p=1.000), in spite of significantly worse oncological status in the BR1 patients. Following a R0 resection and MCT, the BR1 patients had significantly better OS compared with those receiving STP or no additional treatment (median OS, not reached vs. 25.2months and 20.1 vs. 11.3months, respectively; p=0.034). In patients with advanced HCC with intrahepatic target nodules the BR1 category is one of the favorable candidates for selecting those to be treated with MCT strategies.

Rab3B Proteins: Cellular Functions, Regulatory Mechanisms, and Potential as a Cancer Therapy Target.

RAB3 proteins, a pivotal subgroup within the Rab protein family, are known to be highly expressed in brain and endocrine gland tissues, with detectable levels also observed in exocrine glands, adipose tissue, and other peripheral tissues. They play an indispensable role in the trafficking of cellular products from the endoplasmic reticulum (ER) to the Golgi apparatus and ultimately to secretory vesicles, participating in vesicle transport, mediating cell membrane adhesion, and facilitating membrane fusion during exocytosis. Among these, Rab3B, a specific subtype of RAB3, is a low-molecular-weight (approximately 25 kD) GTP-binding protein (GTPase) characterized by its typical GTPase fold, composed of seven β-strands (six parallel and one antiparallel) surrounded by six α-helices. Previous studies have proved the significant roles of Rab3B in vesicle transport and hormone trafficking. However, its involvement in cancer remains largely unexplored. This review aims to dig into the potential mechanisms of Rab3B in various cancers, including hepatocellular cancer, lung adenocarcinoma, pancreatic cancer, breast cancer, prostate cancer, neuroblastoma and cervical cancer. Given its pivotal functions and underexplored status in oncology, Rab3B stands out as a promising target for both diagnosis and therapy in cancer treatment, with investigations into its biological mechanisms in tumorigenesis offering significant potential to advance future diagnostic and therapeutic strategies across various malignancies.

Current status and perspectives in environmental oncology.

Cancer stands as a leading global cause of death, with its etiology characterized by complexity and multifaceted factors. Growing research indicates a strong correlation between environmental factors and cancer incidence, underscoring the critical importance of intervening in environmental risk factors to mitigate cancer occurrence. Despite this, specialized research institutions focusing on the intersection of environment and cancer remain scarce, with global investment in cancer prevention significantly trailing behind efforts in diagnosis and treatment. Against the backdrop of rapid global climate change, industrialization, urbanization, aging populations, and the globalization of lifestyles, we proposed the concept of Environmental Oncology (EO) to address these challenges. We discussed the rationale and necessity of developing EO and presented a comprehensive research framework focusing on cancer prevention and treatment. Future EO research will aim to identify cancer causes and implement early prevention strategies using advanced scientific technologies and methods. By emphasizing multidisciplinary collaboration and integrating molecular biology at the micro level, EO will explore the relationship between external and internal environments and cancer. EO will identify potential therapeutic targets by studying the pathways through which environmental exposures lead to carcinogenesis. EO will develop early warning systems and disseminate research findings by collecting big data, employing robust statistical models, and establishing research centers.

Preliminary results from the phase 2 study of AFM24 in combination with atezolizumab in patients with EGFR wild-type (EGFR-WT) non-small cell lung cancer (NSCLC).

2522 Background: Immunotherapy combinations could be a promising strategy to overcome resistance to existing therapies. AFM24, a first in class, bispecific, tetravalent innate cell engager, binds CD16A on innate effector cells (NK cells and macrophages) and EGFR on solid tumors, redirecting and enhancing the innate and possibly the adaptive immune response towards tumors. Atezolizumab, a PD-L1 inhibitor, abrogates activation of the PD-1 immune checkpoint, potentiating the adaptive immune response. This Phase 1/2a study (NCT05109442) is evaluating if combining AFM24 with atezolizumab synergistically enhances both innate and adaptive immunity to effectively target EGFR+ solid tumors. Here we report initial results of the EGFR-WT NSCLC expansion cohort. Methods: The recommended Phase 2 dose of 480 mg AFM24 is given intravenously (IV) weekly in combination with 840 mg atezolizumab IV fortnightly, in patients with advanced or metastatic EGFR-WT NSCLC who progressed on ≥1 prior line of therapy including at least a platinum doublet and a checkpoint inhibitor (CPI). The primary endpoint is overall response rate by RECIST v1.1 by Investigator assessment. Secondary endpoints include safety, pharmacokinetics, and immunogenicity. Treatment is given in four-week cycles until disease progression, intolerable toxicity, investigator discretion, or patient withdrawal of consent. Tumor assessments are performed at screening, cycles 2, 4, 6, 8, 10, 12; and every three cycles thereafter. Results: As of January 2024, 17 patients in the EGFR-WT NSCLC cohort received AFM24 and atezolizumab for a mean (range) duration of 14.4 (1–33) weeks. Median (range) age is 66 (45–75) years; 82.4% male; European Cooperative Oncology Status Performance Score 0–1; median (range) number of prior lines is 2 (1–5). The combination was well tolerated with no new or unexpected toxicities observed compared to each single agent. The most common AFM24-related adverse events were infusion-related reactions (10 Grade 1–2, two Grade 3). Of the 15 response-evaluable patients, one complete response and three PRs were confirmed; two showed shrinkage of ≥50% in target lesions from baseline. All responders were resistant to prior CPI. Seven patients achieved stable disease as BOR. After a median follow-up time of 5.5 (95% CI 3.45; 5.55) months, 8 patients are still on treatment including all responders. Conclusions: AFM24 with atezolizumab shows remarkable signs of clinical efficacy, even in patients with resistance to prior CPI, and a well-tolerated and manageable safety profile in patients with EGFR-WT NSCLC. The study is ongoing and up to 40 patients will be enrolled into this cohort. Clinical trial information: NCT05109442 .

Clinical status of established MRONJ in oncology patients continuing bone-modifying agents.

The continuation of bone-modifying agents (BMAs) in patients with established medication-related osteonecrosis of the jaw (MRONJ) is a common concern among dentists and oncologists. There is little evidence supporting or refuting the continued use of BMAs or drug holidays and their impact on established MRONJ. This paper evaluates the outcome of continued BMAs use on the patient's MRONJ status. A retrospective review of 29 oncology patients undergoing active cancer care for either metastatic disease or multiple myeloma was conducted. Data on demographics, oncological status, BMA history and MRONJ status were collected. In total, 90% of patients were judged to have healed or stable MRONJ while continuing BMAs. Most patients (69%) continued the same BMA regime (three- or four-weekly) that they were on before developing MRONJ. The average number of BMAs doses received after an MRONJ diagnosis was 12 (range 1-48). Three patients (10.3%) were found to have MRONJ progression, with two patients developing new sites of necrosis. This real-world dataset suggests that the majority of MRONJ cases remain stable and will not worsen with the continuation of BMAs.

Long COVID in Children, Adults, and Vulnerable Populations: A Comprehensive Overview for an Integrated Approach.

Long COVID affects both children and adults, including subjects who experienced severe, mild, or even asymptomatic SARS-CoV-2 infection. We have provided a comprehensive overview of the incidence, clinical characteristics, risk factors, and outcomes of persistent COVID-19 symptoms in both children and adults, encompassing vulnerable populations, such as pregnant women and oncological patients. Our objective is to emphasize the critical significance of adopting an integrated approach for the early detection and appropriate management of long COVID. The incidence and severity of long COVID symptoms can have a significant impact on the quality of life of patients and the course of disease in the case of pre-existing pathologies. Particularly, in fragile and vulnerable patients, the presence of PASC is related to significantly worse survival, independent from pre-existing vulnerabilities and treatment. It is important try to achieve an early recognition and management. Various mechanisms are implicated, resulting in a wide range of clinical presentations. Understanding the specific mechanisms and risk factors involved in long COVID is crucial for tailoring effective interventions and support strategies. Management approaches involve comprehensive biopsychosocial assessments and treatment of symptoms and comorbidities, such as autonomic dysfunction, as well as multidisciplinary rehabilitation. The overall course of long COVID is one of gradual improvement, with recovery observed in the majority, though not all, of patients. As the research on long-COVID continues to evolve, ongoing studies are likely to shed more light on the intricate relationship between chronic diseases, such as oncological status, cardiovascular diseases, psychiatric disorders, and the persistent effects of SARS-CoV-2 infection. This information could guide healthcare providers, researchers, and policymakers in developing targeted interventions.

Analyzing the Efficacy of Metronidazole as Additional Surgical Site Infection Prophylaxis in Patients Undergoing Hysterectomy [ID 2683482

INTRODUCTION: The American College of Obstetricians and Gynecologists recommends cefazolin for antibiotic surgical prophylaxis for hysterectomy procedures. In 2018, hysterectomy surgical site infection (SSI) data at John Peter Smith Hospital demonstrated a higher proportion of anaerobic growth identified on cultures. The addition of metronidazole with cefazolin became surgical prophylaxis protocol at our institution. The purpose of the study is to compare rates of non-superficial SSI before and after the addition of metronidazole in hysterectomy procedures. METHODS: This was a retrospective cohort study of patients who underwent hysterectomy of any surgical approach from January 2015 to July 2023. The primary exposure of interest was administration of metronidazole with additional covariates including age, body mass index, diabetes, oncology status, and wound class. The association between metronidazole administration and non-superficial SSI was examined using a logistic regression model. Appropriate waiver was received from the institutional IRB. RESULTS: Two thousand five hundred thirty-four hysterectomies were included in our cohort. 1,207 (44%) cases had metronidazole administration, with 98% of those cases occurring after the antibiotic was incorporated into the protocol. Of the patients who did not receive metronidazole, 49 (3.7%) patients had a non-superficial SSI compared to 14 (1.2%) patients that had a non-superficial SSI with metronidazole administration. After adjusting for age and oncology status, patients who did not receive metronidazole had higher odds of having a SSI compared those who did (adjusted odds ratio [aOR]: 3.6; 95% CI: 1.97, 6.3; P≤.0001). CONCLUSION: The results demonstrate potential infection prevention benefit with metronidazole to patients undergoing hysterectomy, supporting the institutional prophylaxis protocol. The findings could have further implications across hospitals with similar patient populations.

Primary Results of Patients with Genitourinary Malignancies Presented at a Molecular Tumor Board

Introduction: Personalized medicine poses great opportunities and challenges. While the therapeutic landscape markedly expands, descriptions about status, clinical implementation and real-world benefits of precision oncology and molecular tumor boards (MTB) remain sparse, particularly in the field of genitourinary (GU) cancer. Hence, this study characterized urological MTB cases to better understand the potential role of MTB in uro-oncology. Methods: We analyzed patients with complete data sets being reviewed at an MTB from January 2019 to October 2022, focusing on results of molecular analysis and treatment recommendations. Results: We evaluated 102 patients with GU cancer with a mean patient age of 61.7 years. Prostate cancer (PCa) was the most frequent entity with 52.9% (54/102), followed by bladder cancer (18.6%, 19/102) and renal cell carcinoma (14.7%, 15/102). On average, case presentation at MTB took place 54.9 months after initial diagnosis and after 2.7 previous lines of therapy. During the study period, 49.0% (50/102) of patients deceased. Additional MTB-based treatment recommendations were achieved in a majority of 68.6% (70/102) of patients, with a recommendation for targeted therapy in 64.3% (45/70) of these patients. Only 6.7% (3/45) of patients – due to different reasons – received the recommended MTB-based therapy though, with 33% (1/3) of patients reaching disease control. Throughout the MTB study period, GU cancer case presentations and treatment recommendations increased, while the time interval between initial presentation and final therapy recommendation were decreasing over time. Conclusion: Presentation of uro-oncological patients at the MTB is a highly valuable measure for clinical decision-making. Prospectively, earlier presentation of patients at the MTB and changing legislative issues regarding comprehensive molecular testing and targeted treatment approval might further improve patients’ benefits from comprehensive molecular diagnostics.

Impact of surgical proximal and distal margins on the recurrence of resectable colon cancer: a single-center observational cohort study.

Few studies have investigated the impact of the surgical proximal and distal margins on colon cancer recurrence. We conducted this study to investigate the effect of resection margins on the prognosis of resectable colon cancer. We analyzed data on 1458 patients who underwent colorectal resection in our institute between January, 2004 and March, 2020, including 579 patients with resectable colon cancer. The association between the resection margin and recurrence for each oncological status was assessed and the value of the resection length that influenced recurrence was analyzed. Patients who had pT4 colon cancer with margins of more than 7cm had a trend of fewer recurrences and longer relapse-free survival (RFS) than those with colon cancer of other stages (P = 0.033; hazard ratio [HR], 0.42; 95% confidence interval [CI], 0.20-0.89). Multivariate analysis identified a margin of < 7cm as an independent risk factor for RFS in patients with pT4 colon cancer (P = 0.023; HR, 2.65; 95% CI 1.013-6.17). No correlation was found between resection margins and recurrence, depending on the extent of lymph node metastasis and tumor location. A resection margin of at least 7cm should be maintained for patients with pT4 colon cancer.

Envisioning Academic Global Oncologists: Proposed Competencies for Global Oncology Training From ASCO.

Recognizing the rising incidence, prevalence, and mortality of cancer in low- and middle-resource settings, as well as the increasingly international profile of its membership, ASCO has committed to expanding its engagement at a global level. In 2017, the ASCO Academic Global Oncology Task Force sought to define the potential role for ASCO in supporting global oncology as an academic field. A set of recommendations to advance the status of global oncology as an academic discipline were created through a consensus-based process involving participation by a diverse group of global oncology and global health practitioners; these recommendations were then published. The recommendations included developing a set of global oncology competencies for trainees and faculty interested in a career in academic global oncology. Here, we describe the global oncology competencies developed by this task force. These competencies consist of knowledge and skills needed in general global health as well as cancer-specific care and research, including understanding global cancer health disparities, defining unique resources and needs in low- and middle-resource settings, and promoting international collaboration. Although the competencies were originally developed for US training programs, they are intended to be widely applicable globally. By formalizing the training of oncologists and supporting career pathways in the field of global oncology, we can make progress in achieving global equity in cancer care and control.

Breaking Bad Proteins-Discovery Approaches and the Road to Clinic for Degraders.

Proteolysis-targeting chimeras (PROTACs) describe compounds that bind to and induce degradation of a target by simultaneously binding to a ubiquitin ligase. More generally referred to as bifunctional degraders, PROTACs have led the way in the field of targeted protein degradation (TPD), with several compounds currently undergoing clinical testing. Alongside bifunctional degraders, single-moiety compounds, or molecular glue degraders (MGDs), are increasingly being considered as a viable approach for development of therapeutics, driven by advances in rational discovery approaches. This review focuses on drug discovery with respect to bifunctional and molecular glue degraders within the ubiquitin proteasome system, including analysis of mechanistic concepts and discovery approaches, with an overview of current clinical and pre-clinical degrader status in oncology, neurodegenerative and inflammatory disease.

The impact of perioperative risk factors on long-term survival after radical cystectomy: a prospective, high-volume cohort study

IntroductionRadical cystectomy (RC) is the gold standard for muscle-invasive bladder cancer. Nevertheless, RC is associated with substantial perioperative morbidity and mortality. We aimed to evaluate the role of important perioperative risk factors in predicting long-term survival after RC.MethodsAn analysis of the prospective cohort of patients undergoing open RC from 2004 to 2023 at our center was performed. Patients who died within one month after RC were excluded from the study. A univariate and multivariable Cox regression analysis was performed to assess the role of sex, age, urinary diversion, preoperative values of creatinine and hemoglobin, first-day postoperative values of CRP, leucocytes, and thrombocytes, perioperative Clavien-Dindo complications, perioperative chemotherapy, admission to the intensive or intermediate care unit, as well as type of histology, pathologic T-stage, positive lymph nodes, and positive surgical margins on predicting the long-term overall survival after RC. For all analyses hazard ratios (HRs) with the corresponding 95% confidence intervals (CIs) were estimated.ResultsA total of 1,750 patients with a median age of 70 years (IQR: 62–76) were included. Of them, 1,069 (61%) received ileal conduit and 650 (37%) neobladder. Overall, 1,016 (58%) perioperative complications occurred. At a median follow-up of 31 months (IQR: 12–71), 884 (51%) deaths were recorded. In the multivariable Cox regression analysis, increasing age (HR: 1.03, 95%CI: 1.02–1.04, p < 0.001), higher preoperative creatinine values (HR: 1.27, 95%CI: 1.12–1.44, p < 0.001), lower preoperative hemoglobin values (HR: 0.93, 95%CI: 0.89–0.97, p = 0.002), higher postoperative thrombocyte values (HR: 1.01, 95%CI: 1.01–1.02, p = 0.02), Clavien-Dindo 1–2 complications (HR: 1.26, 95%CI: 1.03–1.53, p = 0.02), Clavien-Dindo 3–4 complications (HR: 1.55, 95%CI: 1.22–1.96, p < 0.001), locally advanced bladder cancer (HR: 1.29, 95%CI: 1.06–1.55, p = 0.009), positive lymph nodes (HR: 1.74, 95%CI: 1.45–2.11, p < 0.001), and positive surgical margins (HR: 1.61, 95%CI: 1.29–2.01, p < 0.001) negatively affected long-term survival.ConclusionBeside increased age and worse oncological status, impaired renal function, lower preoperative hemoglobin values, higher postoperative thrombocyte values, and perioperative complications are independent risk factors for mortality in the long term in patients undergoing open RC.

(204) Reliability of a Recalled IIEF-5 Score Collected 3 Months Post-Operatively in Assessing Pre-Operative Erectile Function in Patients Undergoing Radical Prostatectomy

Abstract Introduction Erectile function (EF) is a major concern for the patients after radical prostatectomy (RP). The precise evaluation of EF before RP is one of the crucial prognostic factors for its recovery after surgery. Due mainly to time constraints, most urologists routinely just ask vaguely a question about EF before surgery. Also, most patients need firstly to have a clear view of their oncologic status and no incontinence before visiting a sexual medicine specialist, usually after three months. So, three months after surgery, are they reliable to report their pre-operative EF? In the literature, there are evaluations one month or six months after surgery with mixed results concerning the reliability, but there is no evaluation of the recalled EF three months after RP. Objective To examine if the recalled pre-operative EF three months after surgery is in agreement with the real-time pre-operative EF collected just before surgery. Methods We recruited consecutive patients who underwent RP and consequently visited our Sexual Rehabilitation after RP Clinic. All patients completed the IIEF-5 questionnaire (the real-time IIEF-5 score), the day before the operation. Three months after RP, they were also asked to recall their preoperative baseline erectile function, completing a second IIEF-5 score (the recalled IIEF-5 score). In both questionnaires, the target period was the last 6 months before surgery. We excluded from the study patients with major psychiatric disorders and drug or alcohol abuse. The collection of the real-time and the recalled IIEF-5 score was conducted from two different investigators. Concerning the severity of erectile dysfunction, patients were divided into five categories according to their IIEF-5 scores: severe (1–7), moderate (8–11), mild to moderate (12–16), mild (17–21), and no ED (22–25). An interrator agreement analysis in distribution was performed using the kappa statistic to determine the degree of agreement between the IIEF-5 scores. Results We collected data from 55 men. The mean (± standard deviation) age and PSA was 67.5 (± 5.8) years and 9.96 (± 7.24) ng/ml. The real-time pre-operative IIEF-5 mean score and the recalled pre-operative IIEF-5 mean score and standard deviation (three months after the operation) was 17.8 (± 6.3). Concerning the different categories of erectile dysfunction, most patients (60%) were classified to no or mild erectile dysfunction for the real-time IIEF-5 score and similar percentage of patients (61.8%) were classified for no or mild erectile dysfunction for the recalled IIEF-5 score. The correlation of real-time and recalled IIEF-5 score was high, as the Pearson correlation co-efficient was 0.885 (p&amp;lt;0.001). Similar correlations were noted in the different questions of IIEF-5, too. The scatterplot created for the real-time IIEF-5 score and the recalled IIEF-5 score depicts nicely the correlation (Figure 1). In addition, the agreement between the categories of erectile dysfunction severity between the two different IIEF-5 questionnaires was substantial (kappa=0.613, p&amp;lt;0.001), as shown vividly in Table 1. Conclusions Patients reliably report their pre-operative EF even three months after radical prostatectomy. This finding may make clinicians use the IIEF-5 questionnaire to evaluate the EF before surgery and therefore, guide treatment appropriately. Disclosure No.

Harnessing the potential of reverse-phase protein array technology: Advancing precision oncology strategies.

The last few decades have seen remarkable strides in the field of cancer therapy. Precision oncology coupled with comprehensive genomic profiling has become routine clinical practice for solid tumors, the advent of immune checkpoint inhibitors has transformed the landscape of oncology treatment, and the number of cancer drug approvals has continued to increase. Nevertheless, the application of genomics-driven precision oncology has thus far benefited only 10%-20% of cancer patients, leaving the majority without matched treatment options. This limitation underscores the need to explore alternative avenues with regard to selecting patients for targeted therapies. In contrast with genomics-based approaches, proteomics-based strategies offer a more precise understanding of the intricate biological processes driving cancer pathogenesis. This perspective underscores the importance of integrating complementary proteomic analyses into the next phase of precision oncology to establish robust biomarker-drug associations and surmount challenges related to drug resistance. One promising technology in this regard is the reverse-phase protein array (RPPA), which excels in quantitatively detecting protein modifications, even with limited amounts of sample. Its cost-effectiveness and rapid turnaround time further bolster its appeal for application in clinical settings. Here, we review the current status of genomics-driven precision oncology, as well as its limitations, with an emphasis on drug resistance. Subsequently, we explore the application of RPPA technology as a catalyst for advancing precision oncology. Through illustrative examples drawn from clinical trials, we demonstrate its utility for unraveling the molecular mechanisms underlying drug responses and resistance.

Community-Based Oncology Nursing: Current Status and Prospects – A Secondary Publication

Objective: Currently, it is difficult to determine whether a comprehensive and systematic community-based cancer care project is properly implemented. The purpose of this article is to present the current status and prospects of community-based oncology nursing by reviewing related literature. Methods: A new cancer care model was established through the analysis of existing models and a literature review of community-based cancer prevention, cancer screening, cancer survivor care, and cancer patient hospice care. Results: The Comprehensive Cancer Care Model (CCCM) was established. The CCCM organizes the stages of cancer treatment and the cancer journey on the horizontal axis. On the vertical axis, public health centers, oncology hospitals, cancer convalescent hospitals, primary care physicians, and prayer centers were involved. The levels of participation of human resources among institutions and the degree of interconnection between organizations was observed. Conclusion: It is expected that CCCM will be used for holistic, sustainable, and cost-effective cancer management. In community-based oncology nursing, the team of health promotion nurses in public health centers is in charge of population-based cancer prevention and early detection programs, while the visiting health management team of nurses is in charge of individual-based cancer survivor and hospice programs.

Comprehensive geriatric assessment as an essential tool to register or update DNR codes in a tertiary care hospital.

To investigate the prevalence of Do not Resuscitate (DNR) code registration in patients with a geriatric profile admitted to Antwerp University Hospital, a tertiary care hospital in Flanders, Belgium, and the impact of comprehensive geriatric assessment (CGA) on DNR code registration. Retrospective analysis of a population of 543 geriatric patients (mean age 82.4 ± 5.19years, 46.4% males) admitted to Antwerp University Hospital from 2018 to 2020 who underwent a CGA during admission. An association between DNR code registration status before and at hospital admission and age, gender, ethnicity, type of residence, clinical frailty score (CFS), cognitive and oncological status, hospital ward and stay on intensive care was studied. Admissions before and during the first wave of the pandemic were compared. At the time of hospital admission, a DNR code had been registered for 66.3% (360/543) of patients. Patients with a DNR code at hospital admission were older (82.7 ± 5.5 vs. 81.7 ± 4.6years, p = 0.031), more frail (CFS 5.11 ± 1.63 vs. 4.70 ± 1.61, p = 0.006) and less likely to be admitted to intensive care. During the hospital stay, the proportion of patients with a DNR code increased to 77% before and to 85.3% after CGA (p < 0.0001). Patients were consulted about and agreed with the registered DNR code in 55.8% and 52.1% of cases, respectively. The proportion of patients with DNR codes at the time of admission or registered after CGA did not differ significantly before and after the start of the COVID-19 pandemic. After CGA, a significant increase in DNR registration was observed in hospitalized patients with a geriatric profile.