Presence Of Metastases Research Articles

CT predictors of sub-centimeter occult lymph node metastases in oral cavity squamous cell carcinoma: A case-control study.

For patients with oral cavity squamous cell carcinoma (OCSCC) without evidence of nodal metastasis (cN0) on pre-operative evaluation, there are no clear guidelines who should undergo elective neck dissection (END) versus clinical surveillance. To identify CT imaging characteristics of sub-centimeter lymph nodes that would help predict the likelihood of nodal metastases on pathology. Retrospective review of cN0 OCSCC patients at a tertiary academic medical center was performed. Inclusion criteria included elective neck dissection, pre-operative CT imaging and presence of metastatic disease within lymph nodes. Control group consisted of patients without nodal metastases on pathology. CT features that were evaluated included asymmetric size, disrupted fatty hilum, asymmetric number, presence of cortical nodule, cortical nodule size, and round/oval shape. We evaluated the associations between CT LN features and the presence of metastases using multi-level mixed-effects logistic regression models. Model evaluation was performed using 5-fold cross-validation. The positive predictive value (PPV) and negative predictive value (NPV) were calculated. 26 patients in each study and control groups were included. Three-level mixed-effects logistic regression models indicated round/oval shape (OR = 1.39, p = .01), asymmetric number (OR = 7.20, p = .005), and disrupted fatty hilum (OR = 3.31, p = .04) to be independently predictive in a 3-variable model with sensitivity = 38.0%, specificity = 92.0%, and PPV = 93.8%. In cN0 OCSCC patients undergoing END, round/oval shape, asymmetric number, and disrupted fatty hilum of lymph nodes on pre-operative CT imaging are novel and highly predictive of occult nodal disease.

Обструкция мочеточника при раке поджелудочной железы.

Introduction. Treatment of patients with pancreatic adenocarcinoma who have metastases in the ureter with subsequent hydroureteronephrosis is extremely rare in clinical practice. Only eight similar cases are on record in the scientific literature. No recent review exists on this topic. This encouraged us to present our review of cases of adenocarcinoma of the pancreas with ureteral metastasis, have been reported earlier. Aim. To systematize the existing knowledge and summarize the clinical experience in the diagnosis and treatment of ureteral obstruction in pancreatic cancer. Materials and methods. The results of the search in the scientific databases PubMed, on the scientific electronic library eLibrary.ru were analyzed for the following keyword queries: «ureter» (ureter), metastasis (metastasis), ureteral metastasis, pancreatic cancer (pancreatic adenocarcinoma), hydronephrosis (hydronephrosis). 59 relevant publications were selected, which were included in the literature review. Results. Metastatic tumors of the ureter are rare and are one of the rarest causes of ureteral obstruction. Most cases of metastatic ureteral cancer are asymptomatic and are a diagnostic finding at autopsy or in the presence of metastatic lesions of other organs. Metastases to the ureters are very rare, but they must be taken into account in the differential diagnosis when a patient with a malignant disease has X-ray signs of ureteral obstruction. The presence of metastases in the ureters may indicate the progression of, for example, pancreatic cancer. Morphological specificity of the ureters, namely: well-developed vascularization of the adventitial membrane and periureteral fiber, contributes to the most frequent primary metastatic lesion of these areas of the ureter. Conclusion. Although the prognosis in these cases is usually unfavorable, but at the same time, an earlier thorough examination followed by organ-specific treatment and resolution of ureteral obstruction can preserve kidney function and increase the chances of survival.

Programmed Cell Death-Ligand 1 (PD-L1) Immunohistochemical Expression in Equine Melanocytic Tumors.

Currently available treatments for equine melanocytic tumors have limitations, mainly due to mass localization and dimension, or the presence of metastases. Therefore, a search for new therapies is necessary. Programmed cell death-ligand 1 (PD-L1) is expressed by several tumors, blocking T cell-mediated elimination of the tumor cells by binding to programmed cell death protein 1 (PD-1). A novel therapeutic approach using PD-1/PD-L1 blockade in human melanoma resulted in tumor regression and prolonged tumor-free survival. This study aimed to evaluate the immunohistochemical expression of PD-L1 in equine melanocytic tumors. A total of 77 melanocytic tumors were classified as benign or malignant and evaluated by extension of labeling. A total of 59.7% of the tumors showed >50% of immunolabeled cells. Regarding malignant tumors, 24/38 tumors presented >50% of labeled cells, 13 tumors presented between 25-50% and one tumor presented <10%. Regarding benign tumors, 22/39 tumors presented >50% of labeled cells, nine tumors presented 25-50%, three tumors presented 10-25%, two tumors presented <10% and three tumors did not present expression. Our results suggest that PD-L1 blockade may be a potential target for immunotherapy in equine melanocytic tumors and that future clinical research trials into the clinical efficacy of the anti-PD-L1 antibody are necessary.

Family clinical case of thyroid cancer in the Republic of Dagestan

A case of familial thyroid cancer in the Republic of Dagestan is presented. Papillary thyroid cancer was diagnosed in a sister and a brother at a young age. The disease was characterized by small size of nodes in the thyroid gland, a multi-focal lesion and the presence of metastases in the regional lymph nodes.

Actualisation des indications chirurgicales et des indicateurs de qualité et sécurité des soins dans la prise en charge des carcinomes mammaires invasifs

ObjectivesBreast surgery is the cornerstone of breast cancer treatment. Its indications and procedures are constantly evolving. To update best practices, four questions were submitted to the Senology Commission (SC) of the Collège national des gynécologues et obstétriciens français (CNGOF), covering the indications and modalities of tumor surgery: (1) initially, (2) following neoadjuvant systemic treatment, (3) in case of local recurrence, and (4) the quality and safety of care indicators applicable to this surgery. MethodsThe CNGOF SC essentially based its responses on the clinical practice recommendations and guidelines of the French Cancer Institute concerning invasive carcinomas of the breast. Exclusion criteria were carcinoma in situ, sarcoma and axillary surgery. ResultsTo define the type of breast surgery, knowledge of four parameters is essential: the patient's level of risk, the presence of metastases, the size of the breast tumor and its focality (assessed by the clinical/mammography/ultrasound tripod). (1) In the case of initial management, the 6 indications for mastectomy are patient choice (particularly in case of high risk), contraindication to radiotherapy, inflammatory cancer (T4d), surgery with positive margins (after several surgical intervention), surgery that cannot be performed as a monobloc in the case of tumors with multiple foci, and poor expected aesthetic results. All other situations should be treated conservatively. (2) The same criteria apply after neoadjuvant systemic treatment, with conservative treatment still possible whatever the size (excluding carcinomatous mastitis) and focality of the initial tumor. (3) In case of local recurrence, total mastectomy is the reference treatment, with a second conservative treatment reserved for patients with no risk factors for a second recurrence, and no poor prognostic factors, after validation in a multidisciplinary meeting. (4) Four quality and safety indicators apply to breast surgery: it must be performed after obtaining a histological diagnosis, within less than 6 weeks of mammography, in a single surgery in over 80% of cases, and followed by local radiotherapy in the case of conservative treatment. ConclusionThe indications and modalities of breast surgery are evolving rapidly. To improve aesthetic results, oncoplastic techniques, immediate breast reconstruction, and preservation of the skin or nipple-areolar complex need to be further developed and evaluated in the long-term. These developments must necessarily be accompanied in France by a training policy for breast surgeons.

Primary squamous cell carcinoma of the pancreas: an update on a rare neoplasm from the SEER database.

Pancreatic squamous cell carcinoma is a rare type of pancreatic cancer of ductal origin, composing an estimated 0.5 - 5% of pancreatic ductal malignancies. As a result, epidemiology, treatment options, and associated outcomes are poorly understood and understudied. Our aim was two-fold: to evaluate demographic trends and analyze overall survival (OS) associated with different treatment modalities for this rare malignancy. Patients with pancreatic squamous cell carcinoma diagnosed between 1992 and 2019 were eligible and reviewed utilizing the Surveillance, Epidemiology, and End Results Registry (SEER) database. Data was analyzed using SPSS and python packages lifelines and pandas. Variables of interest included stage at diagnosis as well as the receipt of surgery, radiotherapy, and/or chemotherapy. Five-year OS curves were analyzed using Kaplan-Meier probability stratified by treatment modality. Of 342 cases of pancreatic squamous cell carcinoma, 170 (49.7%) were females and 172 (50.3%) were males. 72 (21.1%) of patients received radiotherapy, 123 (35.9%) patients received chemotherapy, and 47 (13.7%) received surgery. Patients who were diagnosed under the age of 50 had prolonged survival time compared to those diagnosed over the age of 50 (12 vs 8 months, respectively, p < 0.001). This trend was evident despite the lack of a significant association between age at diagnosis and presence of metastases (p = 0.524). The median OS was 3 months for the entire cohort and there was a significant difference in median survival time noted across treatment modalities: OS was prolonged in those receiving surgery compared to those receiving chemotherapy or radiotherapy alone (30 vs 2 months, respectively, (p<0.001)). Receipt of radiotherapy was not associated with a significant difference in OS compared to those who did not receive radiotherapy. Pancreatic squamous cell carcinoma is a rare subtype of pancreatic cancer and typically portends a poor prognosis. As demonstrated by our study, surgery offers prolonged overall survival compared to other treatment modalities. Age at diagnosis and presence of metastatic disease are also important prognostic factors likely related to patients' ability to tolerate surgery or physician willingness to offer surgery. Given the importance of surgery on outcomes, it may be reasonable to offer it in the oligometastatic setting in patients who are otherwise a good candidate. Future research on larger cohorts is warranted to investigate the role that modality selection plays in overall survival rates in this understudied malignancy.

Characteristics and treatment options of glucagonomas: a national study from the French Group of Endocrine Tumors and ENDOCAN-RENATEN network.

Glucagonoma is a very rare functional pancreatic neuroendocrine tumor (PanNET). We aimed to provide data on the diagnosis, prognosis, and management of patients with glucagonoma. In this retrospective national cohort, we included all patients with glucagonoma, defined by at least one major criterion (necrolytic migratory erythema (NME) and/or recent-onset diabetes and/or weight loss ≥ 5 kg) associated with either glucagonemia >2xULN or positive glucagon immunostaining. Antisecretory efficacy was defined as partial/complete resolution of glucagonoma symptoms. Antitumor efficacy was assessed according to the time to next treatment (TTNT). Thirty-eight patients were included with median age 58.7 yo, primary PanNET located in the tail (68.4%), synchronous metastases (63.2%). Median Ki-67 index was 3%. Most frequent glucagonomas symptoms at diagnosis were NME (86.8%), weight loss (68.4%) and diabetes (50%). Surgery of the primary PanNET was performed in 76.3% of cases, mainly with curative intent (61.5%). After surgery, complete resolution of NME was seen in 93.8% (n = 15/16). The secretory response rates were 85.7%, 85.7%, 75% and 60% with surgery of metastases (n = 6/7), chemotherapy (n = 6/7), liver-directed therapy (n = 6/8) and somatostatin analogues (n = 6/10), respectively. All lines combined, longer TTNT was reported with chemotherapy (20.2 months). Median overall survival was 17.3 years. The Ki-67 index >3% was associated with shorter OS (HR 5.27, 95%CI [1.11-24.96], p = 0.036). Patients with glucagonoma had prolonged survival, even in the presence of metastases at diagnosis. Curative-intent surgery should always be considered. Chemotherapy, PRRT or liver-directed therapy seem to provide both substantial antitumor and antisecretory efficacy.

Metastatic Melanoma of Unknown Primary

Metastatic melanoma without a primary is a rare form of skin cancer. Unlike typical melanomas, where the primary tumor is present, metastatic melanoma without a primary is characterized by the presence of metastases without the presence of an identifiable primary tumor. Treatment options depend on the location and extent of metastasis, and advances have been made in the development of targeted therapies. It is important that individuals with risk factors for this disease undergo regular testing for early signs of the disease and that healthcare professionals are aware of this rare disease when diagnosing metastases without a primary. However, the prognosis remains poor due to the difficulty in diagnosing the disease at an early stage. In this article, we will discuss the causes, symptoms, diagnostic methods, and treatment options for this disease.

Prognostic value of mitotic count in leiomyosarcoma: A comprehensive monocentric retrospective study

BackgroundLeiomyosarcomas (LMSs) include heterogeneous entities with different clinical courses not entirely predicted by known prognostic factors. In particular, the value of mitotic count as independent prognostic factor in LMS has been poorly investigated. MethodsWe retrospectively analyzed all patients with a diagnosis of LMS who accessed to our Institution from June 1999 to May 2022 for which mitotic count was numerically expressed within the pathology report. Univariate and multivariate analyses were conducted to explore the prognostic value of mitotic count along with other clinical and histological variables. ResultsWe identified 121 eligible patients, with a median follow-up of 91.03 months (range 0.62–275.2 months). Median progression-free survival (mPFS) was 16.7 months, and median overall survival (mOS) was 105.6 months. In univariate analysis, mitotic count showed a significant impact on PFS and OS, with an hazard ratio per mitotic unit of 1.03 (1.01–1.04, p < 0.001) and 1.03 (1.01–1.04, p = 0.007), respectively. Similar results were found for locally advanced and metastatic patients, separately. Other significant prognostic factors for PFS were stage at diagnosis, performance status, tumor size and Ki-67, while differentiation, necrosis, grade, stage at diagnosis, tumor size, performance status and age at diagnosis were identified for OS. In multivariate analysis, the only significant factors were mitotic count and the presence of metastases at diagnosis for PFS, whereas the same two factors plus age at diagnosis were identified for OS. ConclusionMitotic count represented the most important histological prognostic factor for OS and PFS in localized and metastatic LMS.

OGC P69 Omentectomy as part of radical surgery for gastric cancer: results of a multicenter prospective cohort study

Abstract Background Omentectomy is routinely performed in patients with gastric cancer as part of sub(total) gastrectomy with modified D2 lymphadenectomy. However, there is little evidence for a survival benefit of omentectomy. This study investigated both the prevalence of metastases in the greater omentum and the survival prognosis for patients afflicted with such omental involvement. Methods This was a multicenter prospective cohort study (OMEGA study) of consecutive patients with gastric cancer undergoing (sub)total gastrectomy with complete en bloc omentectomy and modified D2 lymphadenectomy. After resection, the omentum was separated from the gastrectomy specimen distal to the gastroepiploic vessels and sent separately for pathological examination. The main endpoints were the presence of metastases in the greater omentum and the 5-year overall survival of patients with omental metastases. Pathological factors associated with locoregional recurrence and/or metastases were tested with multivariable regression analysis. Results Of 100 included patients, five had metastases in the greater omentum. All five patients had advanced tumors and microscopically non radical resection (R1). Metastases in the greater omentum correlated significantly with a microscopically non-radical resection, tumour expansion in the oesophagus or duodenum, linitis plastica or a proximal gastric tumour with diameter of at least 5 cm, stage III-IV disease and (y)pM1 category. Five-year overall survival was 0.0% in patients with omental metastases and 44.2% in patients without omental metastases (p=0.001). Median overall survival was seven months in patients with omental metastases and 53 months in patients without omental metastases. Conclusions The incidence of metastases in the greater omentum is low, and when present, it is associated with advanced and unresectable disease with impaired overall survival. Omentectomy as part of radical gastrectomy for gastric cancer may not contribute to survival benefit in cases of undetected omental metastases and may therefore be omitted. Our forthcoming randomized controlled trial aims to investigate the non-inferiority of omentum preservation as compared to omentectomy in terms of 3-year overall survival.

Uptake of doublet therapy for de novo metastatic castration sensitive prostate cancer: a population-based drug utilisation study in Sweden.

Randomised controlled trials have demonstrated prolonged survival with new upfront treatments in addition to standard androgen deprivation therapy (ADT) in men with de novo metastatic castration-sensitive prostate cancer. We describe patient characteristics, time trends and regional differences in uptake of these new treatment strategies in clinical practice. This descriptive study consisted of men registered in the National Prostate Cancer Register of Sweden from 1 January 2018 to 31 March 2022 with de novo metastatic castration-sensitive prostate cancer defined by the presence of metastases on imaging at the time of diagnosis. Life expectancy was calculated based on age, Charlson Comorbidity Index and a Drug Comorbidity Index. Within 6 months from diagnosis, 57% (1,677/2,959) of men with de novo metastatic castration-sensitive prostate cancer and more than 3 years of life expectancy had received docetaxel, abiraterone, enzalutamide, apalutamide and/or radiotherapy. Over time, there was a 2-fold increase in uptake of any added treatment, mainly driven by a 6-fold increase in use of abiraterone, enzalutamide or apalutamide, with little change in use of other treatments. Slightly more than half of men diagnosed with de novo metastatic castration-sensitive prostate cancer and a life expectancy of at least 3 years received additions to standard ADT as recommended bynational guidelines in 2019-2022 in Sweden. There was a 2-fold increase in use of these treatments during the study period; however, efforts to further increase adherence to guidelines are warranted.

Our data on detailing metastasis localization and subtype characteristics in metastatic colorectal cancer patients treated with Bevacizumab

Aims: Our aim in this study was to determine the relationship between metastasis types and mutation subtypes in patients who were followed up in our center and received bevacizumab treatment, to determine the survival rates according to metastasis types, and to contribute to the literature on this subject.&#x0D; Methods: In our study, we retrospectively evaluated 42 consecutive metastatic colorectal cancer patients who were admitted to our hospital and diagnosed with colorectal cancer, thorax-abdominal CT scans were performed in our clinic to detect possible metastases, and the presence of metastases in one or more localizations was detected and treated with Bevacizumab.&#x0D; Results: The majority of colorectal cancers included in our study had the histopathological subtype of adenocarcinoma (90.5%). Genetic analyses revealed that 47.6% (20 patients) had mutant KRAS gene types, while 52.4% (22 patients) had wild type. The distribution of metastases was as follows; 31 (73.8%) cases with liver involvement, 12 (28.6%) with peritoneal involvement and 24 (57.1%) with lung involvement. In our study, median overall survival was 19 months and median disease-free survival was 7 months.&#x0D; Conclusion: The results of studies to date will be useful to help predict prognosis and to select appropriate regimens for treatment. We aimed to contribute to this process by presenting our own data in our own study. However, the true role of RAS genes as prognostic markers continues to be questioned, and multicenter studies are needed on the predictive and prognostic factors of colorectal cancers.

Гостро кровоточивий рак шлунка, ускладнений перфорацією

покращення та оптимізація діагностики та лікування ускладнень раку шлунка.Було проліковано 56 пацієнтів із ускладненим раком шлунка. Середній вік хворих становив56 років. З них жінок було 13 (або 23,21%), а чоловіків – 43 (або 76,79%). Під час всебічногодіагностично-лікувального моніторингу було виявлено, що 15 пацієнтів (або 26,79%) страждаливід шлунково-кишкової кровотечі, 12 пацієнтів (або 21,43%) мали стеноз шлунка різного ступеняважкості, а у решти 29 пацієнтів (або 51,79%) рак шлунка ускладнився перфорацією шлунка,при цьому у 21 пацієнта перфорація виливалася в кровотечу. Досліджували також вік, стать,передопераційну діагностику, місцезнаходження перфорації, глибину інвазії стінки шлунка,наявність метастазів у лімфатичних вузлах, вид операції, рівень лімфатичної диссекції, стадіюта інші ускладнення. Відсоток ускладнення у вигляді перфорації серед раку шлунка становив51,79%. Захворювання частіше зустрічалося на III/IV стадії (70%). Проведені операції:гастректомія у 16 хворих та атипова резекція зони ураження шлунка з відновленням дефектуу 10 пацієнтів. Смерть, пов’язана з хірургічним втручанням, спостерігалася у 4 пацієнтів.Було виконано 10 субтотальних гастректомій і 6 тотальних гастректомій. У 15 пацієнтівспостерігалася клінічно виражена шлунково-кишкова кровотеча, яка проявлялася у виглядімелени, гематемезису або у вигляді мелени та гематемезису одночасно (2,5%). Середнійвік становив 68 ± 12 (діапазон 47–87). Ускладнення у вигляді стенозу шлунка було виявлено у12 пацієнтів (21,43%). Під час дослідження у 5 пацієнтів було виявлено субкомпенсованийстеноз пілоричного відділу шлунка, у решти пацієнтів – декомпенсований стеноз. Вибір методуоперативного втручання проводився індивідуально, залежно від стану хворого, ступеня стенозуі характеру патоморфологічних змін, стану секреторної та моторної функції шлунка, наявностісупупровідньої патології та стадії раку шлунка. Перевагу надавали субтотальній резекціїшлунка. У цій групі пацієнтів наявний 1 випадок летальності, який був обумовлений ІV стадієюраку шлунка та декомпенсованим стенозом з вираженими розладами водно-електролітногобалансу і кислотно-лужної рівноваги.

Interleukin-6 as a biomarker of hypersensitivity reactions in chemotherapeutics and monoclonal antibodies.

In recent years, a new type of immediate hypersensitivity reaction known as cytokine release began to emerge, and within this phenotype of reactions, interleukin-6 is the most frequently associated with the presence during drug administration. Chemotherapeutic agents (QT) and monoclonal antibodies. Determine interleukin-6 levels in hypersensitivity reactions to QT and monoclonal antibodies. Observational and prospective study that was carried out from March 1, 2021 to March 1, 2022 in a university hospital in northeastern Mexico. Symptoms, severity, interleukin-6 levels, and skin tests of hypersensitivity reaction were evaluated at QT and monoclonal antibodies. A total of 41 patients with oncological disease were included, the most frequent being ovarian cancer. Symptoms as initial hypersensitivity reaction were neuromuscular in taxanes and cutaneous in Platinums.41.5% presented elevation of interleukin-6, and it was found more frequently in presence of metastases. Positive skin tests were found more frequently in the carboplatin and doxorubicin groups. The most frequently presented phenotype was type I in paclitaxel, carboplatin, and doxorubicin, and mixed-reaction (type I and cytokine release) in oxaliplatin. With the increasing prevalence of hypersensitivity reactions to biologic and antineoplastic therapies, interleukin-6 should be recognized as a biomarker in immediate hypersensitivity reactions to QT and monoclonal antibodies.

Metastatic risk factors in pheochromocytoma/paraganglioma

Currently, all pheochromocytoma/paraganglioma (PPGLs) are considered malignant due to metastatic potential. Consequently, PPGLs are divided into «metastatic» and «non-metastatic». Metastatic PPGLs can be with synchronous metastasis (metastases appear simultaneously with the identified primary tumor) or metachronous (metastases develop after removal of the primary tumor). The term metastatic PPGLs is not used in the presence of tumor invasion into surrounding organs and tissues, without the presence of distant metastases of lymphogenic or hematogenic origin. It is generally believed that about 10% of pheochromocytomas and about 40% of sympathetic paragangliomas have metastatic potential. On average, the prevalence of PPGLs with the presence of metastases is 15-20%. Risk factors for metastatic PPGLs are widely discussed in the literature, the most significant of which are groups of clinical, morphological and genetic characteristics. The review presents a discussion of such risk factors for metastatic PPGLs as age, localization and type of hormonal secretion of the tumor, the size and growth pattern of the adrenal lesion, the presence of necrosis and invasion into the vessels, the tumor capsule surrounding adipose tissue, high cellular and mitotic activity, Ki-67 index, expression of chromogranin B and S100 protein, the presence of genetic mutations of three main clusters (pseudohypoxia, kinase signaling and Wnt signaling).Over the past two decades, a number of authors have proposed various predictor factors and scales for assessing a probability of metastatic PPGLs. The review contains detailed description and comparison of sensitivity and specificity of such predictor scales as PASS, GAPP, M-GAPP, ASES and COPPS.

A Machine Learning Framework Integrating Electronic Health Records for Survival Prognostication in Cervix Cancer

Recent advances in Machine learning (ML) have led to promising clinical applications in oncology, such as improved detection on imaging, predicting emergency department visits, and predicting survival. The hypothesis of this study is a machine learning model using features extracted from electronic health records can be created to improve individual prognostication in patients with cervix cancer managed with radiotherapy in a binary higher and lower risk group model. This study used a single-institution retrospective dataset. Electronic records of patients treated for cervix cancer with definitive radiotherapy from 2003-2014 were queried. Features were selected for model building were based on relevant clinical variables and ease of abstraction from records: age, race, smoking status, parity, self-reported unintentional weight loss, histology, revised 2018 Fédération Internationale de Gynécologie et d'Obstétrique (FIGO) staging, tumor size, number of enlarged lymph nodes, involved node location, presence of metastases, radiotherapy duration, and concurrent chemotherapy. The dataset was split into training and testing cohorts, with multivariable Cox regression with Lasso regularization performed to predict hazard ratios (HR), and internal 5-fold cross-validation (training set) to determine the regularization parameter. For each patient, a partial HR using all variables was predicted. A cut-off value maximally splitting the training dataset into higher and lower risk cohorts was calculated in the training dataset using Kaplan-Meier estimates and log-rank tests, and this predicted cut-off value was evaluated in the test dataset. A total of 226 patients were included in study, with a median follow-up of 55.1 months; 226 patients in training cohort, and 57 in testing cohort. Feature concordance indices of 0.74 and 0.75 were obtained in the testing and training datasets, respectively, with minimal over-fitting. The three variables that contributed most to the model (with Log HR, 95% CI, p-value) were FIGO stage (0.38, 0.1-0.66, p = 0.01), presence of metastases (0.26, -0.02-0.53, p = 0.07), and unintentional weight loss (-0.34, -0.54-0.14, p<0.01), and FIGO IIB maximally divided the cohort into higher and lower risk stage groupings. A partial HR of 1.15 threshold using all features predicted the largest survival separation between higher and lower risk patients, more so than stage alone (p = 1.18 × 10-3 separated by stage alone vs p = 8.97 × 10-7 separated by partial hazard). A machine learning approach was able to improve prognostication of survival in cervix cancer using additional features from electronic health records. Future work should explore prognostication using large scale datasets and pre-treatment variables for potential incorporation into patient discussions and shared decision making.

Metastasis of tongue cancer locatedunilaterally, not crossing the midline,to the lymph nodes of the neck.

&lt;br&gt;&lt;b&gt;Introduction:&lt;/b&gt; In recent years, there has been a steady increase in the incidence of tongue cancer. Rapid asymptomatic growth, early metastases, and crossing lymphatic drainage of the tongue reduce the chances of successful therapy. The presence of metastases in cervical lymph nodes is also an important prognostic factor.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Aim:&lt;/b&gt; The aim of the study is a retrospective analysis of the incidence of unilateral and bilateral metastases within the cervical lymphatic system in patients with unilateral tongue cancer that does not cross the midline.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Materials and methods:&lt;/b&gt; A retrospective study of a group of patients hospitalized and treated for malignant tongue cancers at the Clinical Ward of Cranio-Maxillo-Facial Surgery of the Department of Otolaryngology and Laryngological Oncology of the Military Institute of Medicine-National Research Institute in Warsaw in 2012-2023. As many as 106 patients treated for unilateral tongue cancer that has not crossed the midline were selected, who also underwent unilateral or bilateral cervical lymphadenectomy, apart from primary tumor resection and reconstruction. The analysis was based on the medical records of the patients, results of imaging and histopathological examinations, and surgical procedure protocols.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Results:&lt;/b&gt; In a group of 106 patients with unilateral tongue cancer, in whom the cancer did not cross the midline, 47 patients underwent unilateral lymphadenectomy, of which 16 had lymph node metastases. Bilateral lymph node removal was performed in 59 patients. In 26 cases metastases were detected only in ipsilateral lymph nodes, and in 13 cases metastases were found in contralateral lymph nodes. Among 106 patients, occult metastases were detected in 21 patients.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Conclusions:&lt;/b&gt; Due to the crossing of the lymphatic drainage of the tongue, which allows for the possibility of contralateral metastases, and the impact of the operation on oncological efficacy, it is reasonable to perform bilateral cervical lymphadenectomy.&lt;/br&gt.

Identification of genomic alterations with clinical impact in canine splenic hemangiosarcoma.

Canine hemangiosarcoma (HSA) is an aggressive cancer of endothelial cells with short survival times. Understanding the genomic landscape of HSA may aid in developing therapeutic strategies for dogs and may also inform therapies for the rare and aggressive human cancer angiosarcoma. The objectives of this study were to build a framework for leveraging real-world genomic and clinical data that could provide the foundation for precision medicine in veterinary oncology,andto determine the relationships between genomic and clinical features in canine splenic HSA. One hundred and nine dogs with primary splenic HSA treated by splenectomy that had tumour sequencing via the FidoCure® Precision Medicine Platform targeted sequencing panel were enrolled. Patient signalment, weight, metastasis at diagnosis and overall survival time were retrospectively evaluated. The incidence of genomic alterations in individual genes and their relationship to patient variables including outcome were assessed. Somatic mutations in TP53 (n = 44), NRAS (n = 20) and PIK3CA (n = 19) were most common. Survival was associated with presence of metastases at diagnosis and germline variants in SETD2 and NOTCH1. Age at diagnosis was associated with somatic NRAS mutations and breed. TP53 and PIK3CA somatic mutations were found in larger dogs, while germline SETD2 variants were found in smaller dogs. We identified both somatic mutations and germline variants associated with clinical variables including age, breed and overall survival. These genetic changes may be useful prognostic factors and provide insight into the genomic landscape of hemangiosarcoma.

Real-world effectiveness and safety of stereotactic body radiotherapy for liver metastases with different respiratory motion management techniques.

Stereotactic body radiotherapy (SBRT) has been firmly established as atreatment choice for patients with oligometastases, as it has demonstrated both safety and efficacy by consistently achieving high rates of local control. Moreover, it offers potential survival benefits for carefully selected patients in real-world clinical settings. Between January 2008 and May 2020, atotal of 149 patients (with 414 liver metastases) received treatment. The Active Breathing Coordinator device was used for 68 patients, while respiratory gating was used for 65 and abdominal compression was used for 16patients. The most common histological finding was colorectal adenocarcinoma, with 37.6% of patients having three or more metastases, and 18% having two metastases. The prescribed dose ranged from 36 to 60 Gy, delivered in 3-5fractions. Local control rates at 2 and 3years were 76.1% and 61.2%, respectively, with no instances of local recurrence after 3years. Factors negatively impacting local control included colorectal histology, lower prescribed dose, and the occurrence of new liver metastases. The median overall survival from SBRT was 32months, with the presence of metastases outside the liver and the development of new liver metastases after SBRT affecting survival. The median disease-free survival was 10months. No substantial differences in both local control and survival were observed between the respiratory motion control techniques employed. Treatment tolerance was excellent, with only one patient experiencing acute gradeIV thrombocytopenia and two patients suffering from ≥ gradeII chronic toxicity. For radical management of single or multiple liver metastases, SBRT is an effective and well-tolerated treatment option. Regardless of the technology employed, experienced physicians can achieve similarly positive outcomes. However, additional studies are required to elucidate prognostic factors that can facilitate improved patient selection.

Volumetric Modulated Arc Therapy for Radiosurgery of Brain Metastases: A Single-Center Study

Whole-brain radiation therapy and stereotactic radiosurgery are two treatment modalities commonly utilized to treat brain metastases (BMs). The aim of this study is to retrospectively analyze the main radio-oncologic and clinical-demographic aspects of a cohort of BM patients treated with Volumetric Modulated Arc Therapy for radiosurgery (VMAT-RS). This is a cross-sectional observational design study with a retrospective review of the medical records of patients with brain metastases treated with VMAT-RS between 2012 and 2018. Clinical and demographic data, with special attention to sex, age, primary tumor, brain tumor-related epilepsy (BTRE), number and brain location of BMs, Karnofsky Performance Status (KPS), the updated DS-GPA prognostic index, and the survival estimated according to the Kaplan–Meier model from the date of radiosurgery, were analyzed. One hundred and twenty-one patients with 229 BMs were treated with VMAT-RS. Patients presented 1–4 BMs, which were treated with five non-coplanar VMAT arcs. Sixty-eight percent of the patients had lung cancer, and 35% of the BMs were in the frontal lobe. The proportion of local control was 88.5%. BTRE prevalence was 30.6%. The median survival time (MST) was 7.7 months. In the multivariate analysis of the Cox regression model, KPS ≥ 70 (HRKPS &lt; 70 = 2.59; p = 0.001) and higher DS-GPA (HRDS-GPAII = 0.55, p = 0.022; HRDS-GPAIII-IV = 0.38, p = 0.006) were associated with improved survival. In the univariate analysis, primary tumor, age, and the presence of metastases in the posterior fossa (PFBMs) were also significant. In conclusion, the VMAT-RS is a technique with an overall survival rate comparable to other radiosurgery techniques. The median survival is significantly longer for those with higher KPS and DS-GPA. Other variables, such as the type of primary tumor, age, and PFBMs, could also influence survival, although further studies are needed.