Presence Of Distant Metastases Research Articles

Triple Negative Breast Cancer: Experience of the Obstetrics and Gynecology Department 2 Over A Period of 3 Years about 105 Cases at the Hassan II University Hospital in Fes

Introduction: Breast cancer is the second leading cause of death worldwide and the leading cancer in women. It is both the most common and the leading cause of death in women from cancer, thus posing a real public health problem. It presents tumor heterogeneity on the histological and molecular levels, explaining the diversity of presentations, responses to treatments, and prognosis. Triple-negative breast cancer is defined by the absence of expression of hormone receptors: estrogen receptors (ER), progesterone receptors (PR) and by the absence of overexpression or amplification of genes encoding HER2 receptors (Human epidermal growth factor receptor 2) and representing only a minority of breast cancers (10-20%). The therapeutic choices for this type of breast cancer are limited because patients do not benefit from hormonal therapy or targeted therapies, which poses a real problem in therapeutic management. Our objective is to describe the epidemiological, clinical, anatomo-pathological characteristics, as well as the evolutionary profile after adequate management of triple-negative breast cancer through the analysis of a series of cases of triple-negative breast cancer collected at the gynecology-obstetrics department 2 at the Hassan II University Hospital in Fez. Method: This is a retrospective study of a series of triple negative breast cancer cases collected in the gynecology-obstetrics department II at the Hassan II University Hospital in Fez during the period between January 2020 and December 2023. Inclusion criteria: Histologically confirmed triple negative infiltrating breast cancer treated in the gynecology-obstetrics department 2 of the Hassan II University Hospital in Fez. IHC = ER = 0% RP = 0% HER2 negative Exclusion criteria: male sex and presence of distant metastases. Results: On the epidemio-clinical level: a peak in frequency between 31 and 42 years old, and 45.7% of patients still in genital activity. On the anatomo-pathological level: ...

Association between tumour-infiltrating lymphocyte-T CD8+ and programmed death-ligand 1 protein with the occurrence of metastasis in colorectal cancer patients: An observational study

Background: Tumour-infiltrating lymphocytes CD8+ (TILs CD8+) as an anticancer immune response and Programmed Death-Ligand 1 (PD-L1) as an immune checkpoint molecule expression are important in colorectal cancer (CRC) as their expression correlates with the immune status and the progression of cancer. The primary objective of this study is to examine the relationship between TILs CD8+ and PD-L1 expression levels and CRC metastasis to provide insights into the immune microenvironment’s role in CRC progression and metastasis, potentially improving patient outcomes and treatment response. Methods: This study was an observational study involving colorectal cancer patients who were treated at a tertiary hospital in Bandung, West Java, Indonesia. There were 40 patients included in the study. Tumour tissue samples were collected from patients, and immunohistochemical staining was performed to evaluate TILs CD8+ infiltration and PD-L1 expression levels. Clinical data, including metastasis occurrences, were collected from the cancer registry. Results: Analysis of TILs CD8+ and PD-L1 expression levels in CRC patients revealed significant findings regarding metastasis occurrence and cancer staging. There was a notable positive correlation between PD-L1 expression and TILs-CD8+ infiltration in the presence of distant metastasis and advanced cancer stage (p < 0.05). However, no significant association was observed between TILs CD8 and PD-L1 expression levels and lymphatic metastasis. Conclusion: This study highlights the potential prognostic value of TILs CD8+ and PD-L1 expression levels in predicting CRC progression and metastasis. However, the lack of a significant correlation with lymphatic metastasis suggests the need for further investigation into the underlying mechanisms. Understanding the roles of PD-L1 and TILs-CD8+ expression in CRC metastasis may facilitate the development of targeted therapeutic strategies to improve patient outcomes.

The importance of MRI in determining the stage of cervical cancer

Cervical cancer is one of the most common malignant tumours in women. The treatment of early and locally advanced stages of this cancer typically involves surgery, chemotherapy, and radiotherapy. However, there is no standardised therapy for metastatic cervical cancer due to the diverse manifestations of the disease. Therefore, timely diagnosis and staging of the carcinoma are crucial for maintaining the quality of life of patients. Imaging during the initial diagnostic evaluation is essential for accurately assessing the extent of the tumour and metastases, and for selecting the optimal therapy, with the FIGO system further emphasising this role. Compared to other imaging techniques, MRI provides detailed information on the location and size of the tumour, invasion into surrounding tissues, and the presence of distant metastases. This allows MRI to facilitate a tailored approach in therapy selection, taking into account the specific characteristics of the tumour. The integration of MRI into the diagnostic and therapeutic process improves clinical outcomes for patients with cervical cancer, enabling effective care. MRI is used alongside other imaging modalities in the diagnosis and treatment planning, and without it, precise staging of the disease and establishing a final diagnosis would not be possible.

Predictors of thyroid cancer survival in Saudi Arabia: A retrospective 10-year analysis.

Thyroid cancer (TC) is becoming more prevalent in Saudi Arabia, currently ranking among the top three cancers affecting women. Despite its rising prevalence, there has been limited assessment of the factors influencing the survival rate (SR) among the Saudi population over an extended period. Therefore, this study aims to address this critical gap in knowledge by identifying the factors affecting the SR of TC, comparing the SR with previous studies, and exploring potential areas for improving the SR of patients. A retrospective study analyzed secondary data from patients diagnosed with TC, as recorded in the King Abdulaziz Medical City Cancer Registry in Riyadh, Saudi Arabia, over 10 years from 2009 to 2018. Of the total 665 TC cases, the mean age at diagnosis was 46.2 years (±SD 16), and most patients were women (78.5%), with the majority being under 50 years old. The most common type of cancer was papillary thyroid carcinoma, comprising 88.6% of all TCs. Over half of the cases were localized to one of the lobes of the thyroid gland, with almost equal frequency between the two lobes. The 5-year SR of localized papillary thyroid carcinoma reached 96.5%, in contrast to the extremely low SR of anaplastic thyroid carcinoma, where most patients died within a few months of the diagnosis. Factors such as morphology, tumor extension, male gender, and age at diagnosis significantly impacted patient survival, as analyzed by the Kaplan-Meier test (p < 0.001). Compared to other types of cancer, those with anaplastic thyroid carcinoma had a lower SR. The SR of TC patients is predicted by factors such as their age, morphological type, and the presence of distant metastasis.

7161 Similar Progression-Free Survival in Familial Non-medullary Thyroid Cancer and Sporadic Differentiated Thyroid Cancer Patients

Abstract Disclosure: E. Chuki: None. N. Behairy: None. S. Auh: None. A. Makarewicz: None. N. Uttarkar Vikram: None. P. Padmasree: None. C. Cochran: None. S. Gubbi: None. J. Klubo-Gwiezdzinska: None. Background: There is conflicting data on the disease aggressiveness in patients with Familial Non-medullary Thyroid Cancer (FNMTC) as compared with sporadic differentiated thyroid cancer (sDTC). Moreover, limited evidence exists comparing FNMTC and sDTC responsiveness to treatment. Therefore, the goal of this study was to compare response to standard therapy, defined as progression-free survival (PFS), in patients with FNMTC and sDTC. Methods: This was a single-center Institutional Review Board-approved cohort study, including patients diagnosed with FNMTC or sDTC, subjected to standard therapy with a median follow-up of 4.8 years (range 2.1-10 years). Patients with FNMTC were matched to patients with sDTC in a 1:2 ratio using the Ccoptimalmatch package in R based on age, sex, and American Thyroid Association (ATA) risk stratification at presentation. PFS was defined from the date of initial thyroid surgery to the first evidence of progression, assessed by RECIST 1.1 criteria. Demographics, cancer characteristics, and treatment modalities were collected and compared. Kaplan-Meier curves and log-rank tests were employed to assess differences in PFS. SAS 9.4 software was used for analyses, with a p-value set at 0.05. Results: The study consisted of 198 subjects, with 66 patients affected by FNMTC and 132 sDTC cases, aged 43.1±14.3, 69.7% female, 47% low, 45.5% intermediate and 7.6% high ATA risk for recurrence. Within the FNMTC cohort 26 (39.4%) cancer cases were detected by screening. There were no differences in age, sex and ATA risk stratification between the study groups due to exact matching (±1 year for age). No significant differences were observed in histology type (p = 0.49), multifocality (p = 0.59), gross extrathyroidal extension (p = 0.76), or presence of distant metastases (p = 0.09). FNMTC exhibited smaller tumor size at diagnosis (mean 1.2±0.96 vs 1.8±1.5 cm, p &amp;lt; 0.01), and fewer positive lymph nodes (p = 0.02). Initial surgery extent favored more total thyroidectomies in the FNMTC group (p &amp;lt; 0.01), and there was a higher prevalence of repeat neck surgeries in the sDTC group (p = 0.045). There was no difference in utilization of RAI therapy between the groups (p = 0.68). During follow up 15.2% of FNMTC and 12.9% of sDTC patients presented with disease progression. PFS probabilities at 5, 10, 15, 20, and 25 years were similar between both groups (0.8 and 0.85 at 5 years, 0.8 and 0.78 for subsequent years) (p = 0.99). Conclusions: The initial surgical treatment for FNMTC tends to be more extensive than applied in sDTC, despite a smaller tumor size and lower number of metastatic lymph nodes at diagnosis. This strategy could lead to a lower need for repeat neck surgeries. The smaller tumor size at diagnosis of FNMTC might be a result of an active screening of affected families. The similar PFS in patients with FNMTC and sDTC suggests a comparable tumor biology and similar responsiveness to standard therapy. Presentation: 6/3/2024

12214 Metastatic Functional Thyroid Carcinoma As An Unusual Cause Of Hyperthyroidism

Abstract Disclosure: S. Jimenez Salazar: None. N. Aristizabal Henao: None. C. Aguilar Londoño: None. N. Buitrago Gómez: None. S. Saldarriaga Betancur: None. D.L. Beltran: None. J.L. Torres: None. Background: Differentiated thyroid carcinoma (DTC) represents the most prevalent endocrine neoplasm. Less than 10% present distant metastases, with the lung (50%), and skeleton (25%) being the most frequently affected sites. The location of bone metastases predominates in the spine and pelvis; usually as osteolytic lesions, being more frequent in follicular thyroid cancer (FTC) (7-28%) than in patients with papillary thyroid cancer (PTC) (1.4-7%). In rare cases this metastasis can be functional and trigger a thyrotoxicosis syndrome with or without recombinant human TSH injections prior to therapy with 131-I. Clinical case: 59-year-old woman with a history of bone metastatic follicular thyroid cancer (FTC) presented with 1 month of palpitations, 4 kg weight loss, non-dysenteric diarrhea and progressive dyspnea. Her FTC had been diagnosed 8 years prior her consultation. In that time iodine refractoriness was considered due to the progression of bone lesions, and Sorafenib 800 mg per day was initiated, which was not tolerated due to severe dermatological manifestations, and the patient decided not to continue with TKI therapy. Since then, she has been treated with zoledronic acid and local radiotherapy as part of palliative care. On physical examination, she was tachycardic (150 bpm), and hypertensive (BP 160/100 mmHg). A suppressed TSH (&amp;lt;0.01 uUI/mL, n: 0.4-4 uUI/mL) with elevation of thyroid hormones (free T4 3.99 ng/dL, n: 0.8-2 ng/dL and total T3 480 ng/dL, n: 45-140 ng/dL) was documented, associated with a patient who had required a dose adjustment of levothyroxine from 700 mcg to 350 mcg weekly 2 months prior to admission. Additionally, she had a significantly elevated thyroglobulin (&amp;gt;5000 ng/mL, n: 0.1-64.1 ng/mL) with undetectable antithyroglobulin antibodies (1.09 UI/mL, n: 0-4.11 UI/mL). Considering the history of total thyroidectomy and the high tumor burden, secondary thyrotoxicosis due to functioning bone metastases of DTC was considered. Levothyroxine was discontinued, and propranolol was initiated for the control of adrenergic symptoms, along with methimazole, cholestyramine, and systemic steroids to control thyroid hormone production. 3 days after therapy adjustment dyspnea, palpitations, and thyroid function tests improved significantly (free T4 1.43 ng/dL, n: 0.8-2 ng/dL and total T3 178 ng/dL, n: 45-140 ng/dL). A new administration of therapy with 131-I 200 mCi was indicated. Antithyroid therapy and beta-blockers were continued with sustained biochemical control. Conclusion: Functional bone metastases of FTC can lead to high morbidity and mortality. Treatment consists of surgical cytoreduction of any large accessible metastatic lesion, therapy with 131-I, and high-dose antithyroid drugs to control hyperthyroidism. It is important to avoid the use of recombinant human TSH due to the risk of secondary thyrotoxicosis following its administration. Presentation: 6/2/2024

Catching the Silent Culprits: TERT Promoter Mutation Screening of Minimally Invasive Follicular and Oncocytic Thyroid Carcinoma in Clinical Practice.

De-escalation of thyroid cancer treatment is crucial to prevent overtreatment of indolent disease, but it remains important to identify clinically aggressive cases. TERT promoter mutations are molecular events frequently associated with high-risk thyroid tumors with poor outcomes and may identify cases at risk of dissemination. In various international guidelines, small minimally invasive follicular thyroid carcinoma and oncocytic thyroid carcinoma (miFTC/miOTC) are classified as low-risk lesions and are not recommended adjuvant treatment. Our study aimed to explore the association between size-based risk assessment and TERT promoter mutations. Between 2019 and May 2024, 84 miFTCs/miOTCs diagnosed at our department underwent digital droplet PCR analysis targeting TERT promoter mutational hotspots C228T and C250T in clinical routine. TERT promoter mutations were found in 10 out of 84 cases (11.9%). Mutated cases were pT1 (n = 1), pT2 (n = 3), or pT3 (n = 6). Patients with mutated tumors were older compared to patients with wild-type tumors (median age of 71years vs. 57years, p = 0.041). There were no significant differences regarding patient sex, tumor size, Ki-67 labeling index, or the presence of distant metastases. Notably, 30% of mutations displayed variant allele frequencies < 10%, possibly suggesting subclonal events. To conclude, TERT promoter mutations in miFTCs and miOTCs were associated with higher patient age and were often suspected to be subclonal. However, they did not affect clinical outcomes, possibly due to short follow-up. Reflex testing for this genetic alteration in miFTCs and miOTCs could be justified regardless of tumor size, though the clinical benefit remains uncertain.

DIAGNOSTIC ACCURACY OF MULTISPIRAL COMPUTED TOMOGRAPHY IN DETECTING AND STAGING OF ESOPHAGEAL AND GASTRIC CANCER

Background. The sensitivity and specificity of multislice computed tomography is of great importance in the detection of gastric and esophageal cancer, and also expands the possibilities of preoperative staging using computed tomography. Materials and methods. A retrospective study at the A.N. Syzganov National Scientific Center of Surgery from 2022 to 2024, included 121 patients: 48 females (39.6%), 73 males (60.3%), with an average age of 60 years. Sensitivity, specificity were calculated to assess diagnostic accuracy. Esophageal and gastric cancer staging via computed tomography was done using the TNM classification and compared with esophagogastroduodenoscopy, pathohistological examination results. Results. The sensitivity of computed tomography was 96.49%, the specificity was 85.71%. Esophagogastroduodenoscopy showed a sensitivity of 79.75%, specificity of 95.24%. Conclusion. Computed tomography is highly informative, sensitive in detecting esophageal and gastric cancer, with superior diagnostic accuracy compared to esophagogastroduodenoscopy. Given the detection of esophageal and gastric cancer at T2 and T3 stages, along with the presence of distant metastases in some patients, implementing protocols for early diagnosis is advisable.

Imaging of Osteosarcoma: Presenting Findings, Metastatic Patterns, and Features Related to Prognosis

Background: Osteosarcomas are rare malignancies (&lt;1% of all cancers) that produce an osteoid matrix. Osteosarcomas are the second most frequent type of primary bone tumor after multiple myeloma and the most prevalent primary bone tumor in children. The spectrum of imaging findings of these malignancies varies significantly, reflecting different histological subtypes. For instance, conventional osteosarcoma typically presents with a mixed radiological pattern (lytic and bone mineralization) or with a completely eburneous one; aggressive periosteal reactions such as sunburst, Codman triangle, and soft-tissue components are frequently displayed. On the other hand, telangiectatic osteosarcoma usually presents as a purely lytic lesion with multiple fluid–fluid levels on MRI fluid-sensitive sequences. Other typical and atypical radiological patterns of presentation in other subtypes of osteosarcomas are described in this review. In addition to the characteristics associated with osteosarcoma subtyping, this review article also focuses on imaging features that have been associated with patient outcomes, namely response to chemotherapy and event-free and overall survivals. This includes simple semantic radiological features (such as tumor dimensions, anatomical location with difficulty of radical surgery, occurrence of pathological fractures, and presence of distant metastases), but also quantitative imaging parameters from diffusion-weighted imaging, dynamic contrast-enhanced MRI, and 18F-FDG positron emission tomography and radiomics approaches. Other particular features are described in the text. Overall, this comprehensive literature review aims to be a practical tool for oncologists, pathologists, surgeons, and radiologists involved in these patients’ care.

Factors Predicting Treatment Adherence in Outpatients with Cancer-Related Edema: Decision Tree Analysis.

This study aimed to determine the combination of factors associated with continuity of care in outpatients with cancer-related edema six months after the initial visit. A total of 101 outpatients were divided into two groups: continuation (n=65) and non-continuation (n=36) groups. Details regarding age, body mass index, sex, affected extremities (upper or lower), site of edema (unilateral or bilateral), International Society of Lymphology (ISL) classification, presence of distant metastasis, and overall score on the lymphedema quality of life questionnaire (LYMQOL) were obtained before initial lymphedema care. In this study, we performed a decision tree analysis using a classification and regression tree (CART) to detect the combination of factors associated with the continuity of edema care for cancer-related edema. Significant differences were observed in the site of edema (unilateral or bilateral) and distant metastasis between the two groups. In the decision tree using CART analysis, the factors selected to influence the possibility of continuation were the side of edema as the first layer, and body mass index of 23.0 and distant metastasis (with/without) as the second layer. Outpatients with unilateral edema and a body mass index higher than 23.0 were most likely to be able to continue care. In contrast, outpatients with bilateral edema and distant metastasis had greater difficulty in continuing care. In this study, factors that were suggested to influence the continuity of cancer-related edema care were the side with edema, body mass index higher than 23.0, and distant metastasis. This information may be helpful for developing care strategies and improving patient adherence.

Circulating Bacterial DNA in Colorectal Cancer Patients: The Potential Role of Fusobacterium nucleatum.

Intestinal dysbiosis is a major contributor to colorectal cancer (CRC) development, leading to bacterial translocation into the bloodstream. This study aimed to evaluate the presence of circulated bacterial DNA (cbDNA) in CRC patients (n = 75) and healthy individuals (n = 25). DNA extracted from peripheral blood was analyzed using PCR, with specific primers targeting 16S rRNA, Escherichia coli (E. coli), and Fusobacterium nucleatum (F. nucleatum). High 16S rRNA and E. coli detections were observed in all patients and controls. Only the detection of F. nucleatum was significantly higher in metastatic non-excised CRC, compared to controls (p < 0.001), non-metastatic excised CRC (p = 0.023), and metastatic excised CRC (p = 0.023). This effect was mainly attributed to the presence of the primary tumor (p = 0.006) but not the presence of distant metastases (p = 0.217). The association of cbDNA with other clinical parameters or co-morbidities was also evaluated, revealing a higher detection of E. coli in CRC patients with diabetes (p = 0.004). These results highlighted the importance of bacterial translocation in CRC patients and the potential role of F. nucleatum as an intratumoral oncomicrobe in CRC.

Prevalence and Analysis of Risk Factors for RAI-Refractory Thyroid Cancer Patients: A 5-Year Retrospective Analysis from a Single Institution in Indonesia

Background: Radioactive iodine (RAI) therapy is a cornerstone in the management of differentiated thyroid cancer (DTC). However, a subset of patients develops RAI-refractory disease, characterized by the inability to concentrate radioiodine, leading to limited treatment options and a poorer prognosis. This study aimed to investigate the prevalence and identify potential risk factors associated with RAI-refractory DTC in an Indonesian population. Methods: A retrospective analysis was conducted on patients diagnosed with DTC and treated with RAI at a single tertiary care center in Indonesia between 2019 and 2023. Data on demographics, clinical characteristics, tumor features, and treatment outcomes were collected. RAI-refractoriness was defined as the absence of iodine uptake on diagnostic whole-body scans after cumulative RAI activity of 600 mCi or more. Bivariate and multivariate analyses were performed to identify risk factors for RAI-refractoriness. Results: A total of 194 patients with DTC were included in the study. The prevalence of RAI-refractoriness was 90%. The median age at diagnosis was 55 years (range 18-82), and 72% were female. Papillary thyroid carcinoma was the most common histological subtype (92%). In bivariate analysis, older age at diagnosis (p=0.02), male gender (p=0.04), and the presence of distant metastases at diagnosis (p&lt;0.001) were significantly associated with RAI-refractoriness. In multivariate analysis, only the presence of distant metastases remained an independent predictor of RAI-refractoriness (odds ratio 3.8, 95% confidence interval 1.5-9.2, p=0.003). Conclusion: RAI-refractoriness is a significant clinical challenge in the management of DTC, with a high prevalence observed in this Indonesian cohort. The presence of distant metastases at diagnosis emerged as a strong predictor of RAI-refractoriness. Further research is needed to elucidate the underlying mechanisms of RAI-refractoriness and develop novel therapeutic strategies for this patient population.

Incorporation of Biologic Variables Into the Staging for Canine Cutaneous and Subcutaneous Mast Cell Tumours: Proposal of the UBo pTNM System.

Canine cutaneous mast cell tumours (MCTs) are currently staged based on the World Health Organization (WHO) classification, which has remained unchanged since its initial formulation. Our study aimed to assess the reliability of a novel pTNM staging system, which incorporates tumour extent (T), lymph node involvement (N), presence of distant metastases (M) and the two-tier histologic grade. We analysed medical records of dogs with one or more cutaneous/subcutaneous completely staged MCT, undergoing tumour excision with lymphadenectomy, unless distant metastases were present, in which cases, medical therapy was administered. Dogs were categorized into three stages: I (T1-2N0M0), II (T1-2N1M0) and III (distant metastases). Stages I and II were further divided based on histologic grade into 'low' and 'high'. Substage b was defined as the presence of tumour diameter of ≥3 cm and/or ulceration. Of 226 dogs, 87 (38.5%) were in Stage I (I-low, n = 75; I-high, n = 12), 107 (47.3%) in Stage II (II-low, n = 59; II-high, n = 48), and 32 (14.2%) in Stage III. The newly proposed staging system was able to significantly stratify the population for both time to progression and tumour-specific survival. Compared to Stage I-low, the risk of progression increased significantly for Stage I-high (18.3 times), Stage II-low (8.5 times), Stage II-high (41.5 times) and Stage III (110.3 times). The staging system was highly prognostic for both cutaneous and subcutaneous MCTs. Prospective validation studies are essential to compare this new system with the current WHO staging and further validate its accuracy and clinical utility.

Immunotherapy and PD-L1 Tumor Expression in Moroccan Non-Small Cell Lung Cancer Patients with Various Metastasis.

The question of whether tumor expression of PD-L1 and the presence of distant metastasis could influence the efficacy of immunotherapy represents a major challenge and needs to be further elucidated. The aim of this study is to evaluate the predictive significance of tumor expression of PD-L1 as well as the number and site of metastasis in non-small cell lung cancer (NSCLC) among Moroccan patients treated with immunotherapy. Between January 2019 and February 2023, we recruited Moroccan patients with metastatic NSCLC. All were treated with immunotherapy, either as monotherapy or in combination with chemotherapy. Immunohistochemistry was used to assess PD-L1 (clone 22C3) and ALK (clone D5F3) status. EGFR status was established by qPCR. Tumor PD-L1 expression was classified into 2 levels: TPS <1% (negative expression) and TPS ≥1% (positive expression). Statistical analysis was performed using SPSS Statistics V.21 software. The median age of patients (N=40) was 67 years (39- 92 years) and the sex ratio was 9. Disease dissemination revealed that 22.5% (N=9) of patients had a metastatic burden ≥ 3 (MB≥3). As for the sites of metastasis, the results showed that 20% (N=8), 10% (N=4), 42.5% (N=17), 22.5% (N=9), 27.5% (N=11), 45% (N=18) and 27.5% (N=11) of patients had developed lymph node, liver, bone, brain, pleural, contralateral lung and adrenal metastasis respectively. Positive PD-L1 expression was significantly associated with shorter overall survival (OS = 17.19 vs. 28.85 months, p=0.01). High metastatic burden (MB ≥ 3) was associated with lower objective response rate (ORR), shorter progression-free survival (PFS), and reduced OS, respectively (ORR = 0 vs. 58.06%, p=0.002; PFS = 10.23 vs. 25.27 months, p=0.001; and OS = 11.60 vs. 27.91 months, p=0.003). Only the presence of osseous metastasis was significantly associated with lower ORR, shorter PFS, and OS compared to other metastatic locations (ORR = 5.88 vs. 73.9%, p=0.000; PFS = 10.72 vs. 31.33 months, p=0.000; and OS = 11.39 vs. 36.17 months, p=0.000). Finally, the presence of hepatic metastasis was significantly associated with shorter PFS (10.75 months) compared to those without hepatic metastasis (22.53 months) (p=0.046). Finally, the results of the multivariate analysis revealed that the presence of bone metastasis was strongly correlated with a significant decrease in progression-free survival (p=0.001) as well as overall survival (p=0.002). Our results suggest that tumor expression of PD-L1 and metastatic burden should play a significant role in predicting the response to immunotherapy. Furthermore, it is important to note that the presence of osseous and hepatic metastasis could negatively influence the clinical outcomes of immunotherapy.

Predictive value of serum magnesium levels for prognosis in patients with non-small cell lung cancer undergoing EGFR-TKI therapy.

The aim of this study is to assess the impact of serum magnesium (Mg) levels on prognostic outcomes in patients with non-small cell lung cancer (NSCLC) undergoing treatment with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKI). A cohort comprising 91 patients with NSCLC with epidermal growth factor receptor mutations received EGFR-TKI therapy. Assessments of liver and kidney function and electrolyte levels were conducted before treatment initiation and after completing two cycles of EGFR-TKI therapy. Data on variables such as age, gender, presence of distant metastasis, smoking history, other therapeutic interventions, and the specific TKI used were collected for analysis. Cox regression analysis revealed that patients with higher Mg levels prior to EGFR-TKI therapy had significantly longer progression-free survival (PFS) and overall survival (OS). Elevated Mg levels remained predictive of PFS and OS after two cycles of EGFR-TKI therapy. Multiple regression analysis confirmed these findings. Additionally, it was observed that smokers might represent a unique population, demonstrating a correlation between OS and Mg levels. Our findings indicate that serum Mg level is a prognostic factor in patients with NSCLC undergoing EGFR-TKI therapy. This may provide new insights into the underlying mechanisms of EGFR-TKI therapy related to electrolyte balance.

Immunohistochemical Expression of CD47 and CD68 in Breast Carcinoma and Their Prognostic Value.

Cluster of differentiation 47 (CD47) has been identified as a new immune checkpoint. The exact role of CD47 in prognosis of breast cancer remains unclear. This study aims to evaluate immunohistochemical (IHC) expression of CD47 in breast cancer, and to measure the density of tumor associated macrophages (TAMs) infiltration by CD68 IHC staining. Furthermore, assessing the relations of CD47 and CD68 expression to different clinicopathological variables and evaluating the prognostic role of CD47 and CD68 in breast cancer cases. This retrospective cohort study included 200 diagnosed primary breast cancer cases who underwent surgical resection at the Oncology Center of Mansoura University (OCMU), Faculty of Medicine, Egypt. Clinicopathological and survival data were collected. IHC for CD47 and CD68 was performed. Among 200 breast cancer cases, high CD47 expression was detected in 89 cases (44.5%). CD47 high expression was significantly associated with presence of distant metastasis (P=0.04), advanced TNM stage (P=0.02), ER & PR negativity (P=0.04 & 0.004 respectively), and molecular subtype (P=0.03). Their was a statistically significant association between CD47 and CD68 expression (P=0.002). CD47 high expression was found to predict poor overall survival, but it is not considered alone as independent poor prognostic factor by multivariate analysis. Multivariate analysis spotted combined high expression of CD47 and CD68 as an independent prognostic predictor for shorter OS in breast cancer patients (P=0.002). CD47 high expression is related to poor prognosis in breast cancer patients especially when associated with high CD68+TAMs infiltration. Therefore, CD47 is a promising prognostic and therapeutic target in breast carcinoma that may direct selection of patients for immunotherapy.

Obstructing colorectal cancer: a population-based review of colonic stenting in Queensland, Australia.

Stenting is a useful treatment option for malignant colonic obstruction, but its role remains unclear. This study was designed to establish how stents have been used in Queensland, Australia, and to review outcomes. Patients diagnosed with colorectal cancer in Queensland from January 1, 2008, to December 31, 2014, who underwent colonic stent insertion were reviewed. Primary outcomes of 5-year survival, 30-day mortality, and overall length of survival were calculated. The secondary outcomes included patient and tumor factors, and stoma rates. In total, 319 patients were included, and distant metastases were identified in 183 patients (57.4%). The 30-day mortality rate was 6.6% (n=21), and the 5-year survival was 11.9% (n=38). Median survival was 11 months (interquartile range, 4-27 months). A further operation (hazard ratio [HR], 0.19; P<0.001) and chemotherapy and/or radiotherapy (HR, 0.718; P=0.046) reduced the risk of 5-year mortality. The presence of distant metastases (HR, 2.052; P<0.001) and a comorbidity score of 3 or more (HR, 1.572; P=0.20) increased mortality. Surgery was associated with a reduced risk of mortality even in patients with metastatic disease (HR, 0.14; P<0.001). Twenty-two patients (6.9%) ended the study period with a stoma. Colorectal stenting was used in Queensland in several diverse scenarios, in both localized and metastatic disease. Surgery had a survival advantage, even in patients with metastatic disease. There was no survival difference according to whether patients were socioeconomically disadvantaged, diagnosed in a major city or not, or treated at private or public hospitals. Stenting proved a valid treatment option with low stoma rates.

Analysis of the Peripheral Blood Helper T-Cell 17-Cell Level and Monocyte/Lymphocyte Ratio for Colorectal Cancer Prognosis Prediction

Objective: To investigate the value of peripheral blood helper T cell 17 cell level and monocyte/lymphocyte ratio to predict the prognosis of colorectal cancer patients. Methods: 74 colorectal cancer patients who attended Hospital 960 from January 2021 to January 2022 were retrospectively analyzed. Clinical data of the patients were collected, including gender, age, and histologic type. Immunohistochemical indexes such as Th17 cell level and monocyte/lymphocyte ratio in the peripheral blood of patients were also collected. The prognosis of patients after treatment, as well as peripheral blood Th17 and MLR levels, were observed and analyzed. Results: After follow-up after treatment, in the final 74 patients, the prognosis was good in 32 patients, accounting for 43.24%, and the prognosis was bad in 42 patients, accounting for 56.76%. There were no significant differences between the average age and tumor diameters of the good prognosis and poor prognosis groups (P &gt; 0.05). However, the TNM staging, intervention taken, differentiation degree, presence of distant metastasis, presence of lymph node metastasis, Th17 level, and MLR level are significantly different between the two groups (P &lt; 0.05). Conclusion: Peripheral blood Th17 and MLR have predictive value for the prognosis of colorectal cancer patients, and high levels of peripheral blood Th17 and MLR imply poor prognosis. The detection of peripheral blood Th17 and MLR levels is simple and convenient and can be used as indicators to provide a reference for the prognostic assessment of colorectal cancer patients.

Frequency of Distant Metastasis of Differentiated Thyroid Carcinoma- A Descriptive Analysis

Introduction: The presence of distant metastases is one of the important predictive factors of poor outcomes in patients with thyroid carcinoma. It is rarely observed at early presentation of differentiated thyroid carcinoma (DTC). This study aimed to analyze the frequency of distant metastasis in differentiated carcinoma of the thyroid. Methods: This cross-sectional observational study was conducted at the Department of Otolaryngology, Rajshahi Medical College Hospital, Rajshahi, and Department of Otolaryngology Bangabandhu Sheikh Mujib Medical University (BSMMU), from July 2011 to Jun 2012. A total of 40 patients were selected as study subjects by simple random sampling technique. A descriptive analysis of data was carried out by using a statistical package for social science (SPSS) 22.0 for Windows. Result: In this study, a majority (35, 87.5%) of the patients suffered from papillary carcinoma, followed by (5,12.5%) follicular carcinoma. Considering the distant metastasis, 2 (5.71%) patients had metastasis to the lung among the patients with papillary carcinoma (n=35). 1 patient had lung metastasis and another 1 patient had bony metastasis among the follicular carcinoma patients. In terms of distant metastasis, 50% of the patients had distant metastasis from each papillary and follicular carcinoma. Conclusion: This study concludes that metastasis in differentiated thyroid carcinoma is not uncommon. Distant metastasis is more common in follicular thyroid carcinoma than papillary carcinoma. Lung and bone metastasis are common regarding the site of metastasis.

Concurrent hyperthermic intraperitoneal chemotherapy and intraoperative radiotherapy with cytoreductive surgery in patients with rectal cancer with peritoneal carcinomatosis.

e15571 Background: Rectal cancer (RC) is often associated with peritoneal carcinomatosis (PC). Hyperthermic intraperitoneal chemotherapy (HIPEC) and intraoperative radiotherapy (IORT) have been shows to reduce recurrence and effectively treat PC across several cancers. However, little evidence is available regarding the concurrent use of HIPEC and IORT alongside cytoreductive surgery (CRS) in the literature. Methods: We retrospectively reviewed the medical records of RC patients with PC who received HIPEC plus IORT during CRS at the King Faisal Specialist Hospital and Research Centre. Demographic data, PC index (PCI), completeness of cytoreduction (CC), and tumor staging were collected. Overall survival (OS) was calculated from the time of surgery until death or last follow-up. Recurrence-free survival (RFS) was calculated from the time of surgery until recurrence or last follow-up. Unadjusted hazard ratios (HR) were used to determine the impact of parameters on OS or RFS. Results: 17 patients were included in our analysis. Basic demographic data can be found in Table 1. The most common operation performed was rectosigmoid resection in 7 (41.2%) patients, followed by low anterior resection in 6 (35.3%). The pT stage was T0 in 1 (5.9%), T4a in 7 (41.2%), and T4b in 9 (52.9%). The pN stage was N0 in 11 (64.7%), N1a in 1 (5.9%), N1b in 2 (11.8%), N1c in 2 (11.8%), and N2b in 1 (5.9%). There was positive resection margin in 2 patients. The PCI was ≤6 in 15 (88.2%), and the CC score was 0-1 in all patients. No patients had intraoperative complications. 12 (70.6%) received mitomycin C, 4 (23.5%) received cisplatin and mitomycin C, and one patient received a reduced dose of mitomycin C due to old age. 2 (11.8%) patients received two doses of IORT. 11 (64.7%) patients had postoperative complications, of which all were Clavein-Dindo grades 1-3b. Recurrence occurred in 11 (64.7%). The median OS was not reached, and the median RFS was 12 months. There were no parameters associated with OS. Male gender (HR: 7.7, 95% CI: 1.4-57.3), pM1 (HR: 4.5, 95% CI; 1.2-18.1), and perineural invasion (HR: 6.5, 95% CI: 1.2-49.3) were associated with poor RFS in univariate analysis. Conclusions: Incorporating HIPEC and IORT into CRS may be an effective treatment strategy for RC patients. Presence of distant metastasis and perineural invasion can be predictors of rapid recurrence. [Table: see text]