Role Of Chemotherapy Research Articles

RNA modification writers pattern in relation to tumor microenvironment and prognosis in prostate cancer.

Background: RNA modifications are important in the study of epigenetic regulatory mechanisms in immune responses and tumorigenesis. When RNA writers are mutated or disrupted in expression, the genes associated with the pathways they modify are also disrupted and can activate or repress related pathways, affecting tumorigenesis and progression. However, the potential role of RNA writers in prostate cancer is unclear. Methods: Based on data from three datasets, we describe 26 RNA writers that mediate gene expression and genetic mutation in prostate cancer and assess their expression patterns in 948 prostate cancer samples. Using principal component analysis algorithms, the RM Score was developed to quantify the RNA modification patterns of specific tumors. Results: Two different categories were determined by unsupervised clustering methods, and survival analysis showed significant differences in OS prognosis between these two categories. Differentially expressed genes between the different categories were detected and the RNA writers-mediated scoring model RM_Score were constructed based on this. Also, the RM_Score was analyzed in relation to clinical characteristics, immune infiltration level, drug response, and efficacy of chemotherapy and immunotherapy. Those results confirm that multilayer alterations in epitope-modified RNA writers are associated with patient prognosis and with immune cell infiltration characteristics. Finally, we examined differentially expressed mRNA, lncRNA and miRNA between high and low RM_Score groups, based on which a ceRNA regulatory network was constructed. Conclusion: This work is a comprehensive analysis of modified writers in prostate cancer and identified them to have a role in chemotherapy and immunotherapy.

Role of addition of chemotherapy to palliative radiotherapy protocol: A review of literature and experience from a tertiary cancer center of India

Unresectable head-and-neck cancers (HNCs) pose a significant challenge to clinical oncologists. Radiotherapy (RT) has a pivotal role in palliation of symptoms in advanced unresectable stage. Palliative RT protocols generally employ hypofractionated regimes in an attempt to reduce the overall treatment time and acute toxicities. Concurrent chemoradiotherapy (CCRT) may improve local control facilitating faster palliation of symptoms. Yet the role of chemotherapy with hypofractionated schedules is unclear in palliative settings due to the fear of increased toxicities. The literature review was hence conducted to validate the tolerability and efficacy of CCRT in the palliative setting. The literature search was performed on electronic databases using appropriate keywords. Studies evaluating untreated patients, treated recurrent cancers, second primaries localized in the head and neck or metastatic HNC were all chosen. Five studies were selected which met our selection criteria. Palliation of symptoms, response rates, and toxicities of these studies was evaluated. Role of such concurrent regimes at other sites have also been discussed. All the evaluated studies demonstrated good rates of symptom palliation and response rates with tolerable adverse effects. In addition, our literature review has identified a paucity of evidence that warrants large-scale longitudinal studies to derive conclusive remarks on the use of palliative CCRT.

Comprehensive Analysis of DMRT3 as a Potential Biomarker Associated with the Immune Infiltration in a Pan-Cancer Analysis and Validation in Lung Adenocarcinoma.

Doublesex and Mab-3 related Transcription Factor 3 (DMRT3) is associated with the prognosis of some tumors. It is possible to explore the role of DMRT3 in the cancer process using bioinformatic approaches and experimental validation. We comprehensively explored the clinical and immunological characteristics of DMRT3. The DMRT3 expression is abnormal in human cancers and correlates with clinical staging. A high DMRT3 expression is significantly associated with poor overall survival (OS) in KIRC, KIRP, LUAD, and UCEC. Amplification was the greatest frequency of the DMRT3 alterations in pan-cancer. The OS was significantly lower in the DMRT3 altered group than in the DMRT3 unaltered group (P = 0.0276). The DMRT3 expression was significantly associated with MSI in three cancer types and TMB in six cancer types. The DMRT3 expression was significantly correlated with the level of the immune cell infiltration and the immune checkpoint genes. The DMRT3 was involved in some pathways in pan-cancer. DMRT3 may play a role in chemotherapy and may be associated with chemoresistance. A ceRNA network of KCNQ1OT1/miR-335-5p/DMRT3 was constructed in LUAD. DMRT3 was significantly upregulated in the LUAD cell lines. DMRT3 was aberrantly expressed in pan-cancer and may promote tumorigenesis and progression via different mechanisms. DMRT3 can be used as a therapeutic target to treat cancer in humans.

Ph+ ALL in 2022: is there an optimal approach?

Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL) carried a very poor prognosis prior to the advent of tyrosine kinase inhibitors (TKIs) that block the activity of the BCR-ABL1 oncoprotein. With improvements in TKI efficacy and allogeneic hematopoietic cell transplantation (HCT), survival has improved over the past 3 decades, and the role of chemotherapy and allogeneic HCT is now changing. Better risk stratification, the application of the third-generation TKI ponatinib, and the use of immunotherapy with the CD19-CD3 bifunctional T-cell engaging antibody blinatumomab in place of chemotherapy has made therapy for Ph+ ALL more tolerable and arguably more efficacious, especially for older patients who comprise most patients with Ph+ ALL.

Prevention and management of anthracycline induced cardiotoxicity: A review

Anthracycline drugs such as doxorubicin, epirubicin, idarubicin play a highly significant role in chemotherapy. These agents have been in use for about six decades now and have proven to be greatly effective. However, progressive cardiotoxicity has been outlined to be the greatest concern of these drugs during the treatment, especially with first time users. Although it is usually noticed in recent users, research has shown that it can occur after a longer duration due to the cumulation of the dose which is less studied as compared to the early onset studies. Despite the vast effort in terms of research that has been conducted to ensure safety, a specific treatment regimen is yet to be drafted due to divergent ideologies within the field.

Primary cutaneous extraskeletal osteosarcoma: a series of 16 cases

Extraskeletal osteosarcoma (EOS) is a high grade soft tissue tumour characterised by the production of malignant osteoid, without attachment/involvement of underlying bone/periosteum. Rarely, EOS presents as a cutaneous tumour. The clinical behaviour of primary cutaneous EOS (PC-EOS) remains incompletely characterised. Herein we present the largest case series of PC-EOS reported to date. Sixteen PC-EOS cases from the archives/consultation files were retrieved (male:female 1:1; age 31-96 years, mean age 66 years). The tumours measured 1-10 cm (mean 3.2 cm) and were located on the lower extremity (7), head (6), upper extremity (2), and trunk (1). They consisted of pleomorphic, spindled-to-epithelioid cells, with fascicular, nodular, or sheet-like growth patterns and foci of malignant osteoid. Immunohistochemistry did not reveal specific lines of differentiation, and there was no evidence of other tumour types. A literature review was conducted to identify all well characterised cases of PC-EOS. A combined analysis of present and past cases was performed to determine overall trends in clinical characteristics and outcomes. The mean follow-up period was 23.9 months, during which 67.5% of patients experienced progression-free survival and 18% of patients died of disease. Rates of local recurrence and metastasis were 10% and 25%, respectively, approximately double past estimates. These data suggest that the prognosis of PC-EOS is less favourable than previously thought. The differential diagnosis includes benign entities (e.g., ossifying pyogenic granuloma) and malignant neoplasms with heterologous osteosarcomatous differentiation (e.g., carcinosarcoma, transdifferentiated melanoma). Wide excision remains the standard of care, and the role of chemotherapy and radiation remains inconclusive. Recognition of this rare entity can facilitate prompt diagnosis and appropriate treatment.

Induction of immunogenic cell death by novel platinum-based anticancer agents

Traditional platinum-based anticancer drugs, led by cisplatin, play an important role in chemotherapy. However, the development of platinum compounds is limited due to serious toxicity and side effects. In recent years, studies have showed that immunogenic cell death (ICD) may be one of the potential action mechanisms of classical platinum drugs, such as oxaliplatin. This strategy combining chemotherapy and immunotherapy can effectively utilize the body's immune system to help platinum compounds to fight against tumors, and the dose can be appropriately reduced to limit toxic side effects. The induction of ICD by platinum compounds has become a research hotspot and one of the future development directions of metal drugs. Here, the progress of platinum compounds were collected and comprehensively summarized, their capacity of ICD induction and mechanism of action are exposed, providing reference for the design and synthesis of new anticancer platinum ICD inducers.

The effect of chemotherapy in sarcomatoid bladder cancer patients treated with radical cystectomy.

Data about the role of chemotherapy in sarcomatoid bladder cancer (SBC) are limited. We addressed the effect of chemotherapy in non-metastatic SBC patients treated with radical cystectomy (RC). Using the Surveillance, Epidemiology, and End Results database (2001-2018), we identified 331 patients with non-metastatic muscle-invasive or higher SBC (T2-4N0-3M0). Kaplan-Meier plots and Cox regression models tested cancer-specific mortality (CSM ). Sample size and power analyses tested for power limitations. Of 331 SBC patients, 129 (38.9%) were exposed to chemotherapy. The rate of organ-confined stage (T2N0M0) was 33% in both chemotherapy-exposed and chemotherapy-naive patients. In the overall cohort, median CSM-free survival was 84 months (interquartile range [IQR] 21-NA) vs. 26 months (IQR 17-84) in chemotherapy exposed vs. chemotherapy-naive patients, respectively. In multivariable Cox regression models, chemotherapy was associated with lower CSM, without reaching statistical significance (hazard ratio [HR ] 0.72, confidence interval [CI] 0.51-1.01, p=0.054). In subgroup analyses, chemotherapy exposure in organ-confined (n=110) vs. non-organ-confined (n=221) patients resulted in a HR of 0.51 (p=0.12) vs. 0.77 (p=0.17), respectively. Power analyses, based on two-sided α=0.05, revealed values of 52%, 14%, and 43% in the entire population, organ-confined, and nonorgan-confined subgroups, respectively. In non-metastatic SBC treated with RC, the association between chemotherapy and lower CSM is particularly strong in organ-confined stage. A substantially larger cohort would be required to confirm the statistical significance of the recorded protective effect of chemotherapy.

Review of 20 years of Adult Medulloblastoma Treatment at a High-Volume Center – Chemotherapy Prescription Trends and Survival

<h3>Purpose/Objective(s)</h3> Medulloblastomas are WHO grade 4 tumors and represent less than 1% of adult brain malignancies. Standard of care is maximal safe resection follow by craniospinal and primary site radiation – the role for chemotherapy has been unclear. The objective of this study was to review 20-year chemotherapy prescribing trends in adult medulloblastoma patients at a high-volume center, with secondary objectives assessing overall and progression free-survival. We hypothesized that primary chemotherapy (concurrent or adjuvant) would be associated with prolonged survival and that patients treated in the most recent decade would have received chemotherapy more often. <h3>Materials/Methods</h3> A retrospective review was performed of adult medulloblastoma patients at a high-volume center from 1999-01-01–2020-12-31. Eligible patients were 18 years and older with a pathologic diagnosis of medulloblastoma – those with supratentorial primitive neuroectodermal tumors were excluded. Descriptive statistics were used to present population data and Kaplan–Meier estimators for survival analysis. <h3>Results</h3> Forty-nine patients were eligible; median age was 30 and male: female ratio was 2:1. Desmoplastic and classical histologies were the most common. Molecular subgroup was available for 6 patients, with SHH predominating. Of all patients, 47% (23/49 were classified as high risk – most commonly due to large cell/anaplastic histology or large residual. Only 10 (20%) received primary chemotherapy, 70% of which had high risk disease. Of the patients who received primary chemotherapy, 30% went on to receive chemotherapy for recurrence or metastases; of the entire population, this was only 39%. Primary regimens were mainly cisplatin/lomustine/vincristine, while recurrence regimens were often cisplatin/etoposide. The majority who received primary chemotherapy were treated from 2010–2020. Median overall survival was 7.8 years (95% CI 5.7–∞), with 1-, 5-, and 10-year survival 95.8%, 67.5% and 42.2% respectively. Overall survival was marginally better for those who did not receive primary chemotherapy (8.5 years) vs those who did (7.4 years) <i>but this was non-significant</i>. The main chemotherapy toxicity was hematologic and neuropathy - 90% of primary chemotherapy patients experienced toxicity <h3>Conclusion</h3> This study reviewed 20 years of treatment trends for a group of adult medulloblastoma patients at a high-volume center. We found only a small proportion of patients received chemotherapy as their primary treatment with surgery and radiation. Patients who received primary chemotherapy had marginally worse overall survival, but this was non-significant – perhaps due to baseline worse clinical status not captured by the definition of high vs. intermediate risk disease. Despite calls for adjuvant chemotherapy for all adult medulloblastoma patients, there is clinical equipoise and future randomized trials are needed.

The emerging role of cancer nanotechnology in the panorama of sarcoma.

In the field of nanomedicine a multitude of nanovectors have been developed for cancer application. In this regard, a less exploited target is represented by connective tissue. Sarcoma lesions encompass a wide range of rare entities of mesenchymal origin affecting connective tissues. The extraordinary diversity and rarity of these mesenchymal tumors is reflected in their classification, grading and management which are still challenging. Although they include more than 70 histologic subtypes, the first line-treatment for advanced and metastatic sarcoma has remained unchanged in the last fifty years, excluding specific histotypes in which targeted therapy has emerged. The role of chemotherapy has not been completely elucidated and the outcomes are still very limited. At the beginning of the century, nano-sized particles clinically approved for other solid lesions were tested in these neoplasms but the results were anecdotal and the clinical benefit was not substantial. Recently, a new nanosystem formulation NBTXR3 for the treatment of sarcoma has landed in a phase 2-3 trial. The preliminary results are encouraging and could open new avenues for research in nanotechnology. This review provides an update on the recent advancements in the field of nanomedicine for sarcoma. In this regard, preclinical evidence especially focusing on the development of smart materials and drug delivery systems will be summarized. Moreover, the sarcoma patient management exploiting nanotechnology products will be summed up. Finally, an overlook on future perspectives will be provided.

Adult medulloblastoma: a case report

BackgroundMedulloblastoma is a malignant brain tumor that is common in children but very uncommon in adults, especially those older than 40 years, accounting for less than 1% of all primary brain tumors in adults. Although surgery and radiotherapy play an important role treatment of adult medulloblastoma, the use of chemotherapy is controversial. This is the first instance of adult medulloblastoma at the Ocean Road Cancer Institute in Tanzania.Case descriptionWe report the case of a 51-year-old female of African ethnicity who was diagnosed with high-risk hemispheric posterior cranial fossa medulloblastoma of classic type with World Health Organization central nervous system grade 4 and Chang stage M0. Immunohistochemistry, reticulin stain, and molecular subtyping could not be done because they were not available. She was treated by subtotal posterior cranial fossa tumor resection followed by adjuvant concurrent chemo-craniospinal radiation and adjuvant chemotherapy.ConclusionEven in adults over 50 years old, medulloblastoma should be included in the differential diagnosis of posterior fossa tumor. Adult medulloblastoma is a very rare and very heterogeneous tumor, but it has a good prognosis. Immunohistochemistry and molecular subclustering are difficult to implement in low-income countries such as Tanzania owing to cost. Treatment of adult medulloblastoma is highly heterogeneous among (and even within) facilities. There is no evidence that the extent of resection enhances survival. While craniospinal radiation therapy improves survival, there is controversy about the role of chemotherapy in managing adult MB.

Outcomes with chemotherapy in carcinoma penis: Experience from a tertiary cancer center.

Carcinoma penis is more common in India compared to the West. The role of chemotherapy in carcinoma penis is ambiguous. We analyzed the profile and outcomes of patients with carcinoma penis treated with chemotherapy. We analyzed the details of all patients with carcinoma penis treated at our institute between 2012 and 2015. We collected particulars regarding demography, clinical presentation, treatment details, toxicities, and outcomes of these patients. Event-free and overall (OS) survival were calculated from the time of diagnosis until documentation of disease relapse/progression or death for the patients with advanced carcinoma penis who were eligible for chemotherapy. There were 171 patients with carcinoma penis treated at our institute during the study period including 54 (31.6%) patients with stage I, 49 (28.7%) patients with stage II, 24 (14.0%) patients with stage III, 25 (14.6%) patients with stage IV, and 19 (11.1%) patients with recurrent disease at presentation. The present study included 68 patients with advanced carcinoma penis (stages III and IV) who were eligible for chemotherapy, with a median age of 55 years (range: 27-79 years). Sixteen patients received paclitaxel and carboplatin (PC) and 26 patients cisplatin and 5-FluoroUracil (CF). Neoadjuvant chemotherapy (NACT) was given to four patients with stage III and nine patients with stage IV disease. Of the 13 patients given NACT, we observed a partial response in five (38.5%), stable disease in two (15.4%), and progressive disease in five (38.5%) evaluable patients. Six (46%) patients underwent surgery after NACT. Only 28/54 (52%) patients received adjuvant chemotherapy. After a median follow-up of 17.2 months, the 2-year OS rates were 95.8, 89, 62.7, 51.9, and 28.6% for stages I, II, III, IV, and recurrent disease, respectively. The 2-year OS of patients who were given chemotherapy versus those who were not given chemotherapy were 52.7 and 63.2%, respectively (P = 0.762). We report the real-world outcomes of two chemotherapeutic regimens used in consecutive patients with advanced carcinoma penis. Both PC and CF seemed effective and safe. However, approximately half of patients with advanced carcinoma penis do not receive the planned/indicated chemotherapy. We need further prospective trials regarding the sequencing, protocols and indications of chemotherapy in this malignancy.

A rare case study of myxoid chondrosarcoma in 4th metacarpal hand

Background: myxoid chondrosarcoma (MC) is a rare soft tissue tumor that typically affects the lower limbs of men between the ages of 50 and 60. EMC of the Metacarpals is rare of rarest with a high risk of local recurrence and distant metastasis. A planned surgical excision in sarcoma referral centers (SRCs) is mandatory to obtain the best outcome. The role of chemotherapy (CHT) and Radiotherapy (RT) on soft tissue chondrosarcoma is still under study. Case presentation: A 53-year-old male patient presented to our hospital with a history of swelling in the left hand for 6 months. Radiological and histological study reveals diagnosis of extra skeletal chondrosarcoma. Wide surgical excision was done using cryotherapy in form of liquid nitrogen. Biopsy was taken from the site and sent to immunohistochemistry which proved the diagnosis. A Kirschner wire embedded with polymethylmethacrylate cement was placed in defect site and checked for movements. imaging exams did not reveal distant metastasis or residual disease. Local radiotherapy was administered with a total dose of 50 Gy and adjuvant chemotherapy was given. No relapse occurred in a 12-months post-operative follow up. Conclusions: The case here described suggests the importance of patient’s management in SRCs.

Rare case study of myxoid chondrosarcoma in 4th metacarpal hand

Background:myxoid chondrosarcoma (MC) is a rare soft tissue tumor that typically affects the lower limbs of men between the ages of 50 and 60. EMC of the Metacarpals is rare of rarest with a high risk of local recurrence and distant metastasis. A planned surgical excision in sarcoma referral centers (SRCs) is mandatory to obtain the best outcome. The role of chemotherapy (CHT) and Radiotherapy (RT) on soft tissue chondrosarcoma is still under study. Case presentation: A 53-year-old male patient presented to our hospital with a history of swelling in the left hand for 6 months .Radiologicaland histological study reveals diagnosis of extra skeletal chondrosarcoma .Wide surgical excision was done using cryotherapy in form of liquid nitrogen. Biopsy was taken from the site and sent to immunohistochemistry which proved the diagnosis. A Kirschner wire embedded with polymethylmethacrylate cement was placed in defect site and checked for movements. imaging exams did not reveal distant metastasis or residual disease. Local radiotherapy was administered with a total dose of 50 Gy and adjuvant chemotherapy was given. No relapse occurred in a 12-months post-operative follow up.

INTRA-ABDOMINAL DESMOID TUMOUR- A RARE CASE REPORT WITH REVIEW OF LITERATURE.

Introduction: Desmoid tumours (DTs) are benign, slowly growing deep seated monoclonal myo-fibroblastic neoplasms. It arises from musculoaponeurotic stromal elements. The incidence in the general population is 2-4 cases per million people per year. DTs are typically sporadic; and can occur anywhere in the body. A 30 year male patient presented with a giant intraabdominal DT is discussed here with review of available literature. DTs areDiscussion: benign, deep-seated slowly growing monoclonal myo-fibroblastic neoplasms arise from musculoaponeurotic stromal elements. Diagnosis may be confirmed with biopsy and immunohistochemistry. Preoperative assessment with MRI, CT with angiogram are imperative for definitive surgical resection. There are roles of chemotherapy and radiation therapy in management of primary and recurrent lesions. The surgical resection remains the mainstay of its management. Conclusions: The management of DT is challenging. Surgical resection is the cornerstone of its management. Chemotherapy and radiation therapy in management of primary and recurrent lesions may be considered.

The potential role of prebiotics, probiotics, and synbiotics in adjuvant cancer therapy especially colorectal cancer.

Cancer is a global health issue that is rising swiftly with younger people and an increased number of patients. The role of human microbiota in the pathophysiology of tumors has been paid more and more attention. Microecologics including prebiotics, probiotics, and synbiotics are among the best validated/proven resources for the application of microbiological prophylaxis and therapy. There is strong evidence that microecologics have anti-cancer activity and their potential association with cancer is significant. In this review, we will focus on the role of prebiotics, probiotics, and synbiotics in tumor suppression in maintaining the colon barrier, metabolism, immune regulation, inhibition of host tumor cell proliferation, and epidemiological-based recommendations. Besides, other signs illuminate the role of microecological agents to adjunct the cancer treatment and counter the toxic side effects of cancer drugs. In addition, we will explore their role in chemotherapy, where these probiotics can be used as an adjunct to chemotherapy, counteracting the toxic side effects of chemotherapy drugs to minimize or optimize the therapeutic effect. In the treatment of cancer, we can see the role of prebiotics, probiotics, synbiotics, and their application in cancer patients, and the effectiveness effect can be considered as a clinical benefit. PRACTICAL APPLICATIONS: A large number of studies have shown that microecologics including prebiotics, probiotics, and synbiotics play an important role in regulating intestinal microecology and contribute to the prevention and treatment of cancer, indicating that prebiotics, probiotics, and synbiotics have the potential to be used as microecological modulators in the adjuvant therapy of cancer. However, it is not clear what is the anti-tumor mechanism of these microecologics and how they antagonize the side effects of cancer chemotherapy and protect normal cells. This paper reviews the role of prebiotics, probiotics, and synbiotics in tumor suppression in maintaining the colon barrier, metabolism, immune regulation, and prevention of rapid growth of host cells, as well as their potential role in cancer chemotherapy. This review helps to better understand the relationship between prebiotics, probiotics, and synbiotics with immune regulation, intestinal microecology, metabolic regulation, and cell proliferation and provides strong evidence for their potential application as microecologics in cancer adjuvant therapy.

Primary squamous cell carcinoma of the colon: A rare case report.

Introduction and importanceSquamous cell carcinoma (SCC) of the colon is an extremely rare pathologic entity, accounting for less than 1 % of all colorectal cancer cases. They tend to be very aggressive with poor outcomes and treatment strategies are still controversial due to the paucity of data available to guide management.Case presentationA case of a cecal mass with metastatic liver lesions. Initially diagnosed as an adenocarcinoma, the patient underwent resection with metastasectomy. Despite achieving negative surgical margins and undergoing adjuvant chemotherapy, the patient relapsed and presented with a new mass in the descending colon. The patient underwent resection with subsequent follow-up revealing distant metastasis. The patient passed away soon after.Clinical discussionPrimary colorectal SCC has similar presentation to adenocarcinoma of the colon. Unfortunately, it usually presents at a late stage. Diagnosis of colorectal SCC requires histologic confirmation of SCC plus exclusion of possible causes. Management is predominantly definitive radical resection followed by adjuvant chemotherapy and radiotherapy. Surgical margins should be at least 5 cm, preferably 10 cm. Lymph node yield greater than 20 was associated with improved survival. Studies assessing the prognosis of primary colorectal SCC following chemo-radiotherapy have not been done.ConclusionSurgery remains the most vital important step in the management of colonic SCC. The role of chemotherapy and/or radiation remains questionable. Depending on the aggressiveness of this disease the need for further frequent.

A rare case report: Giant cell tumor of the presacral space and it’s management

Giant Cell Tumor (GCT) is a rare primary skeletal lesion accounting for approximately 5% of all primary bone tumors in adults. GCT has been described histologically as a benign neoplastic lesion. It clinically presents as painless, firm, well defined mass without any fixity to underling structures. Although it is benign in nature but rarely GCT may exhibit a much more aggressive phenotype, and the role of chemotherapy in metastatic GCT or residual tumor is not well defined in the literatures.

Prognostic impact of Lymph node resection in stage II colon cancer: a prospective study from a tertiary hospital center

Background. The treatment of stage II colon cancer has been a subject of debate for a long time. In the last years, a few risk factors have been proposed in order to guide any treatment decision more accurately. One of these risk factors is the number of resected lymph nodes, and according to the latest guidelines, it is recommended that at least 12 lymph nodes should be resected for optimal staging. The aim of this study is to evaluate the role of lymph node resection, in stage II colon cancer and the implication of suboptimal lymph node resection on disease free survival and overall survival. Patients and methods. This was a prospective study that included 130 patients with stage II colon cancer who were monitored between October 2014 and October 2016. The relation between patients’ tumour characteristics that include number of lymph node resection and the use of adjuvant chemotherapy using Chi test and multiple logistic regression was analyzed. The disease-free survival and overall survival were estimated with the Kaplan-Meier method and compared with the log-rank test. Results. 130 patients with stage II colon cancer were recruited. 56 patients were treated with surgery alone and 74 patients received fluorouracil- based chemotherapy after surgery. Patients' age varied from 37 years to 81 years. According to the number of resected lymph nodes, patients were divided into two groups - with less than 12 lymph nodes resected and at least 12 lymph nodes resected. The number of resected lymph nodes varied from 2 to 32 lymph nodes. Median follow up was 36 months. Suboptimal resections of lymph nodes confirmed to be a negative prognostic factor for survival without disease recurrence. Conclusion. Data results confirmed the importance of lymph node resection as a prognostic factor for stage II colon cancer and the role of chemotherapy for patients with suboptimal lymph node resection.

Abstract 2021: Wilms tumor and pure erythroid leukemia arising from the same clone in an adolescent

Abstract Wilms tumor and pure erythroid leukemia (PEL) are distinct malignancies arising from different tissues. Here we describe a case of an adolescent with a constitutional pathogenic BRCA2 variant who was diagnosed with a Wilms tumor and developed PEL while undergoing treatment. We provide evidence that both malignancies are distinct and arose from the same clone. A 16-year-old boy presented with a diffusely anaplastic Wilms tumor metastatic to liver. He was treated with radical nephrectomy, partial hepatectomy, radiation, and multiagent chemotherapy. Six months into treatment he developed new lung and liver lesions along with cytopenias. A bone marrow aspirate confirmed a diagnosis of PEL. His disease progressed after one cycle of myeloid leukemia-directed chemotherapy and he died of disease shortly after. Samples from his initial renal tumor, blood at Wilms tumor diagnosis, and diagnostic bone marrow for PEL were characterized by whole genome sequencing and RNA sequencing. Two sequence variants were shared in both tumors but were not found in the constitutional tissue (blood at first presentation): a promoter variant in TERT (c.-124C&amp;gt;T) and a missense variant in PDE4DIP (p.Gln1045His). Although neither variant has been reported in Wilms tumor or PEL, the TERT variant has been well described in other tumor types and is associated with decreased survival in some carcinomas. Both tumors also had pathogenic TP53 variants albeit a different one in each tumor (p.Arg175His in the Wilms tumor, p.Asp228* in PEL). Loss of heterozygosity at TP53 was present in both malignancies via copy number loss of 17p with a shared breakpoint. Furthermore, while both malignancies had complex and distinct karyotypes, 7p loss and 22q loss with identical breakpoints were present in both. None of these variants or copy number variants were present in constitutional tissue. RNA sequencing data confirmed the histologic finding that these were distinct malignancies as the expression patterns for each malignancy were consistent with previously published expression data for Wilms tumors and myeloid leukemias respectively. Although the patient had a constitutional pathogenic BRCA2 variant, loss of heterozygosity at that locus was not found in either tumor. Chromosome fragility testing for Fanconi anemia was uninterpretable due to the concomitant use of chemotherapeutic agents at the time of testing, however the patient had no phenotypic features to support this diagnosis. In this case there are multiple lines of evidence suggesting that a Wilms tumor and PEL arose from the same clone including shared TERT variants and copy number variant breakpoints. Kidney and hematopoietic tissue both arise from the embryonic mesoderm suggesting that the earliest alterations occurred in this tissue. The contribution of each shared pathogenic variant (TERT, BRCA2, 17p loss) to tumorigenesis and the role of chemotherapy in PEL development are still under investigation. Citation Format: Anita Villani, Winnie Lo, Yisu Li, Mohamed Abdelhaleem, Mary Shago, Federico Comitani, My Linh Thibodeau, Sarah Alexander, Uri Tabori, David Malkin, Adam Shlien, Jack Brzezinski. Wilms tumor and pure erythroid leukemia arising from the same clone in an adolescent [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2021.