Serum Tumor Marker Levels Research Articles

Systemic Sarcoidosis Induced by Chemotherapy, Mimicking Metastatic Testicular Carcinoma with 18F-FDG PET/CT

A 34-year-old male patient who had left orchiectomy and received three cycles of chemotherapy for testicular mix germ cell carcinoma was referred for 18fluorine-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) for complaints of weight loss and fever. PET/CT showed multiple and progressive 18F-FDG uptakes in supra and infra diaphragmatic lymphatic regions, and multiple abnormal 18F-FDG uptakes were noted in the lytic formed skeletal lesions. Clinicians remain in doubt regarding the multiple metastatic lesions without elevated serum tumor marker levels (alpha-fetoprotein, beta-human chorionic gonadotrophin, CA19-9, and carcinoembryonic antigen).Biopsy of the lytic lesion in the iliac bone revealed granulomatous inflammation suggestive of sarcoidosis. Systemic prednisone at 20-40 mg/daily was started. 18F-FDG PET/CT images showed complete metabolic response to prednisone 8 months following the start of treatment.

Clinical value of color Doppler ultrasound combined with serum tumor markers for the diagnosis of medullary thyroid carcinoma.

The present study aimed to explore the clinical value of color Doppler ultrasound combined with serum tumor markers, including calcitonin (CT) and carcinoembryonic antigen (CEA), for the diagnosis of medullary thyroid carcinoma (MTC). A total of 39 patients with MTC (MTC group), 50 patients with papillary thyroid carcinoma (PTC) (PTC group) and 30 patients with thyroid adenoma (benign control group) were enrolled in the present study. The patients were hospitalized at the Affiliated Hospital of Qingdao University from January 2012 to December 2018 and were diagnosed through surgical procedures and pathology laboratory results. The ultrasound results, as well as serum CT and CEA results, were collected and analyzed. A significant difference was observed between the MTC and PTC groups in regards to morphology, margin, aspect ratio, calcification, internal blood flow and lymph node metastasis (all P<0.01). There was also a significant difference between the MTC and benign control group in regards to internal echo, calcification, internal blood flow and lymph node metastasis (all P<0.01). In addition, the levels of serum CT and CEA in the MTC group were significantly higher than those in the PTC and the benign control groups (both P<0.01). For patients with MTC, the levels of serum CT and CEA were significantly associated with maximum tumor diameter, lymph node metastasis and the patient state after treatment (all P<0.01). Furthermore, the sensitivities of ultrasound, serum CT and CEA for the diagnosis of MTC were 76.92, 74.36 and 68.23%, respectively. The value for the combination of the three markers (94.87%) was significantly higher compared with the sensitivity value of each separate marker (all P<0.05). In conclusion, color Doppler ultrasound combined with detecting the levels of serum tumor markers (CT and CEA) significantly improved the diagnostic efficiency for MTC, which could be useful for the clinical diagnosis and treatment of MTC.

Seminomatous and non-seminomatous mediastinal germ cell tumors (MGCT): A real-world analysis from two tertiary care centers in India.

e18726 Background: Mediastinal germ cell tumor (MGCT) is a rare entity and comprises 10-15% of all mediastinal tumors. We describe the real-world treatment patterns and outcomes of MGCT treated at two tertiary care centres in India. Methods: Patients diagnosed with GCT (any site) at two large tertiary care centres from January 2010 to December 2020 in India were identified using the ICD-09 code (C-62) from prospectively kept databases. From these databases, a manual search was performed to identify MGCT patients. A chart review was done to retrieve demographic, tumor-related (serum tumor marker levels as per International germ cell cancer consensus (IGCCC)) and treatment details. Relapse free survival (RFS) and overall survival (OS) were estimated and compared for seminomatous and non-seminomatous MGCT. Results: A total of 54 patients were identified and all were males with a median age of 25 years (interquartile range, 18-45). Common presenting symptoms included cough (81.4%) shortness of breath (64.8%), chest pain (25.9%), superior vena cava obstruction (20.3%), pleural effusion (18.5%) and pericardial effusion (5.6%). Approximately one-thirds (n = 17) were seminomatous, while two-thirds were non-seminomatous (n = 37). Serum tumors markers levels were S0 (7.4%),S1 (42.6%),S2 (29.6%) and S3 (20.4%). Treatment was primarily by multiagent chemotherapy [ Bleomycin/Etoposide/cisplatin(BEP) 63.0%, EP (Etoposide/Cisplatin) 18.5%, VIP (etoposide/ifosfamide/cisplatin) 13.0%). Median number of cycles administered was 3 (Range 1-6). Three patients did not receive chemotherapy (all seminoma) and were treated with upfront surgery. In total, 11 patients (20.4%) underwent surgery, and eight (14.8%) received radiation. Three patients were not evaluable for response, 33.3% achieved complete response (CR),44.4% achieved partial response (PR), 9.3% had SD (stable disease) and 7.4% progressed on first line chemotherapy. Median follow up was 14.4 months (95% confidence interval [CI] 9.03 -26.16). Three year relapse free survival was 64.0% in overall population, and 100% in seminoma vs 41.5% in non-seminoma (P &lt; 0.001). Three year OS was 80.2% in all patients and 94.1% for seminoma versus 70.0% in non-seminoma (P = 0.178). Conclusions: In this largest real-world analysis of MGCT, we found excellent long-term survival rates for patients with seminomatous MGCT, while further optimization of treatment is needed for those with non-seminomatous MGCT.

Prognostic Models for Nonmetastatic Triple-Negative Breast Cancer Based on the Pretreatment Serum Tumor Markers with Machine Learning.

Purpose Triple-negative breast cancer (TNBC) is a heterogeneous and aggressive disease with poorer prognosis than other subtypes. We aimed to investigate the prognostic efficacy of multiple tumor markers and constructed a prognostic model for stage I-III TNBC patients. Patients and Methods. We included stage I-III TNBC patients whose serum tumor markers levels were measured prior to the treatment. The optimal cut-off value of each tumor marker was determined by X-tile. Then, we adopted two survival models (lasso Cox model and random survival forest model) to build the prognostic model and AUC values of the time-dependent receiver operating characteristic (ROC) were calculated. The Kaplan-Meier method was used to plot the survival curves and the log-rank test was used to test whether there was a significant difference between the predicted high-risk and low-risk groups. We used univariable and multivariable Cox analysis to identify independent prognostic factors and did subgroup analysis further for the lasso Cox model. Results We included 258 stage I-III TNBC patients. CEA, CA125, and CA211 showed independent prognostic value for DFS when using the optimal cut-off values; their HRs and 95% CI were as follows: 1.787 (1.056–3.226), 2.684 (1.200–3.931), and 2.513 (1.567–4.877). AUC values of lasso Cox model and random survival forest model were 0.740 and 0.663 for DFS at 60 months, respectively. Both the lasso Cox model and random survival forest model demonstrated excellent prognostic value. According to tumor marker risk scores (TMRS) computed by the lasso Cox model, the high TMRS group had worse DFS (HR = 3.138, 95% CI: 1.711–5.033, p < 0.0001) and OS (3.983, 1.637–7.214, p=0.0011) than low TMRS group. Furthermore, subgroup analysis of N0-N1 patients in the lasso Cox model indicated that TMRS still had a significant prognostic effect on DFS (2.278, 1.189–4.346) and OS (2.982, 1.110–7.519). Conclusions Our study indicated that pretreatment levels of serum CEA, CA125, and CA211 had independent prognostic significance for TNBC patients. Both lasso Cox model and random survival forest model that we constructed based on tumor markers could strongly predict the survival risk. Higher TMRS was associated with worse DFS and OS both in stage I-III and N0-N1 TNBC patients.

Study on the expression of microRNA-1825 in serum of pre-operative and post-operative patients with breast cancer

By measuring the relative expression level of miR-1825 in serum of pre-operative and post-operative patients with breast cancer and healthy subjects, the clincal value of miR-1825 for pre-operative and post-operative breast cancer patients was evaluated.The serum of pre-operative breast cancer patients(n=92), post-operative breast cancer patients(n=64) and healthy subjects(n=60) were collected from General Hospital of Southern Theatre Command of PLA from October 2018 to March 2021. Real-time quantitative PCR was used to detect the relative expression of miR-1825 in the serum of breast cancer patients and healthy controls. The clinicopathological data were used to analyze the correlation between the expression level of miR-1825 and serum tumor markers level. The receiver operating characteristic curve (ROC) was used to evaluate the diagnosis value of breast cancer with miR-1825, CA15-3. Mann-Whitney U test was used for comparisons between two groups,and Kruskal-Wallis H test was used for multiple group comparisons. The correlation between miR-1825 and CEA, CA15-3, CA-125 expression were analyzed using Spearman correlation test.The relative expression level of miR-1825 in serum of pre-operative patients with breast cancer 1.290(0.705, 1.793) was significantly higher than that of healthy controls 0.18(-0.876, 0.725), but decreased after surgery and chemotherapy -0.080(-0474, 0.405). The analysis of clinicopathological characteristics found that the expression level of miR-1825 was higher in patients with stage Ⅲ-Ⅳ, low degree of tissue differentiation, and tumor larger than 2 cm[stageⅠ-Ⅱ:0.975(0.458, 1.380), stageⅢ-Ⅳ: 1.955(1.663, 2.535), U=98.000, P<0.001;low degree of tissue differentiation:1.685(1.448, 2.143), high/medium degree of tissue differentiation:0.700(0.395, 0.898), U=15.500, P<0.001; tumor smaller than 2 cm:0.935(0.438, 1.370), tumor larger than 2 cm:1.915(1.580, 2.288), U=215.500, P<0.001].Spearman analysis result showed that the expression of serum miR-1825 in breast cancer patients was linearly correlated with the expression of CEA (r=0.274, P=0.008) and CA15-3 (r=0.587, P<0.001); ROC curve result showed that miR-1825 was able to distinguish preoperative breast cancer patients from healthy people and postoperative patients. When using one biomarker to discriminate pre-operation and post-operation patients,miR-1825 had the best diagnostic efficiency,with an area under the ROC curve(AUC) of 0.914(95%CI: 0.872-0.956). miR-1825 may become a potential serum marker for the diagnosis of breast cancer and monitoring of therapeutic efficacy.

Effects of Apatinib Combined with TP Regimen Chemotherapy on the Tumor Markers, MMP-9 and MMP-2 Levels in Patients with Non-small Cell Lung Cancer

Objective . To explore the effects of Apatinib combined with TP regimen chemotherapy on the tumor markers, MMP-9 and MMP-2 levels in patients with non-small cell lung cancer. Methods. A total of 86 patients with non-small cell lung cancer were divided into control group and observation group according to the random number table method, with 43 cases in each group. The control group was given TP regimen chemotherapy, and the observation group was given Apatinib on the basis of the control group. The clinical effects of the two groups were compared. Results The total effective rate of treatment in the observation group was higher than that in the control group (P<0.05). After treatment, the levels of CA125, CEA, CA199, MMP-9, MMP-2 and VEGF in the two groups decreased, and those in the observation group were lower than the control group (P<0.05). Conclusion . The Apatinib combined with TP regimen chemotherapy in the treatment of non-small cell lung cancer has significant clinical effect, it can reduce the level of serum tumor markers, and down regulate the expression of serum MMP-9 and MMP-2.

Clinical Study on Xiaoaiping Oral Liquid Combined with Bevacizumab in Treatment of Advanced Non-small Cell Lung Cancer

Objective. To study the clinical efficacy of Xiaoaiping Oral Liquid combined with Bevacizumab Injection in treatment of advanced non-small cell lung cancer. Methods. Patients (128 cases) with advanced non-small cell lung cancer in the First Affiliated Hospital of Henan University from January 2016 to January 2019 were randomly divided into control and treatment groups, and each group had 64 cases. Patients were treated with TC regimen (carboplatin + paclitaxel). Patients in the control group were iv administered with Bevacizumab Injection at the first day, 7.5 mg/kg. Patients in the treatment group were po administered with Xiaoaiping Oral Liquid on the basis of the control group, 10 mL/time, three times daily. A course had 21 days, and patients in two groups were treated for 4 courses. After treatment, the clinical efficacies were evaluated, and serum levels of CEA, NSE, and CA125, KPS score, progression-free survival time (PFS), total survival time (OS), and adverse reactions were compared between two groups. Results. After treatment, DCR (78.12% vs 67.19%) and ORR (64.06% vs 51.56%) in the treatment group were significantly higher than those in the control group ( P < 0.05). After treatment, the serum levels of CEA, NSE and CA125 in the two groups were significantly reduced ( P < 0.05). And the tumor markers in the treatment group were significantly lower than those in the control group ( P < 0.05). After treatment, KPS scores in two groups were significantly decreased ( P < 0.05), and the KPS score in the treatment group was significantly lower than that in the control group ( P < 0.05). After treatment, PFS and OS in the treatment group were significantly higher than those in the control group ( P < 0.05). The incidence of gastrointestinal reaction, thrombocytopenia, leukopenia and liver dysfunction in the treatment group was significantly lower than that in the control group ( P < 0.05). Conclusion. Xiaoaiping Oral Liquid combined with Bevacizumab Injection has clinical curative effect in treatment of advanced non-small cell lung cancer, can improve the quality of life of patients and reduce the serum levels of tumor markers, which is worthy of clinical application.

Analysis of Clinical Efficacy of Bevacizumab Combined with SOX Chemotherapy in the Treatment of Patients with Stage III to IV Gastric Cancer

Objective . To investigate the clinical efficacy of bevacizumab combined with tigeo combined with oxaliplatin (SOX regimen) in the treatment of stage Ⅲ ～ Ⅳ gastric cancer, and to analyze the effects on serum tumor markers and quality of life. Methods. A total of 44 patients with stage Ⅲ ～ Ⅳ gastric cancer admitted to our hospital from January 2018 to December 2018 were selected and divided into control group and observation group with 22 cases in each according to different treatment regimens. Control group adopts the SOX chemotherapy treatment, observation group in the control group given on the basis of bevacizumab treatment compared two groups of curative effect, observe two groups before and after treatment serum tumor markers: sugar chain antigen (CA19-9, CA242), carcinoembryonic antigen (CEA), as well as the core of quality of life scale (QLQ-C30) score results observation group treatment the total effective rate was 77.27%, 40.91% higher than that of control group, the difference was statistically significant (P ＜ 0.05); After treatment, the levels of serum CEA CA19-9 CA242 in the observation group were lower than those in the control group, and the differences were statistically significant (P ＜ 0.05). After treatment, QLQ-C30 scores in both groups were higher than before treatment, and observation group was higher than control group, the difference was statistically significant (P ＜ 0.05). Conclusion Bevacizumab combined with SOX has a significant effect on patients with stage Ⅲ ～ Ⅳ gastric cancer, which can reduce the level of serum tumor markers and improve the quality of life.

Examination of clinical data and semen analysis results of patients undergoing orchiectomy for testicular tumor.

Testicular tumor constitutes 1% of male neoplasms. Infertility can be determined in patients with testicular tumors before orchiectomy due to the deterioration of spermatogenesis. The aim of this study was to show the clinical, radiological, and pathological characteristics and spermiogram results of patients with testicular tumor and their relationship with each other. The data of patients who underwent orchiectomy due to testicular tumor between 2016 and 2019 were reviewed retrospectively. These data included sociodemographic data of the patients, pretreatment spermiogram characteristics, level of serum tumor markers, characteristics of the ultrasonography, type of orchiectomy, and histopathological examination. This study included 53 male patients, with a mean age of 33.51±12.86 years. The mean levels of all tumor markers were above the reference levels. The mean tumor size was 34.68±23.32 mm. Multiple localizations and microlithiasis were detected in 11.3 and 13.2% of the tumors, respectively. The most common masses were hypoechoic (n=37; 69.8%) and hypervascular (n=47; 81%). Spermiogram and cryopreservation were performed in 29 (54.7%) of 53 patients preoperatively. The mean sperm concentration before orchiectomy was 24.21×106 /mL and group A sperm motility 0.79%, group B sperm motility 39.10%, group C sperm motility 9.83%, and group D sperm motility 22.69% in testicular tumors. Spermatogenesis adversely affected before the treatment due to local and systemic effects of testicular cancer. Fertility expectations can be increased in the subsequent years by semen analysis and referral to cryopreservation.

Effect of irinotecan-assisted FOLFOX chemotherapy regimen on serum levels of tumor markers, miR-200a, and miR-190 in patients with colorectal cancer

Effect of irinotecan-assisted FOLFOX chemotherapy regimen on serum levels of tumor markers, miR-200a, and miR-190 in patients with colorectal cancer

Significantly higher serum tumor marker levels in patients with oral submucous fibrosis

Background/purposeOur previous study showed that carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC–Ag), and ferritin are significantly higher in patients with oral potentially malignant disorders (OPMDs including oral leukoplakia, oral erythroleukoplakia, and oral verrucous hyperplasia) than in healthy controls (HCs). Oral submucous fibrosis (OSF) is also recognized as an OPMD. This study evaluated whether these three serum tumor marker levels were also significantly higher in OSF patients than in HCs.Materials and methodsThe serum CEA, SCC-Ag, and ferritin levels in 41 OSF patients and 164 HCs were measured and compared. Patients with serum CEA level ≥3 ng/mL, SCC-Ag level ≥2 ng/mL, and ferritin level ≥250 ng/mL were scored as serum positive for CEA, SCC-Ag, and ferritin, respectively.ResultsWe found significantly higher mean serum CEA, SCC-Ag, and ferritin levels in 41 OSF patients than in 164 HCs (all P-values < 0.05). Moreover, 41 OSF patients had significantly higher serum positive rates of CEA (39.0%), SCC-Ag (19.5%), and ferritin (53.7%) than 164 HCs (all P-values < 0.05). Of the 41 OSF patients, 26 (63.4%), 7 (17.1%), and 2 (4.9%) had serum positivities of one, two, or three tumor markers including CEA, SCC-Ag, and ferritin, respectively.ConclusionThere are significantly higher mean serum CEA, SCC-Ag, and ferritin levels and significantly higher serum positive rates of CEA, SCC-Ag, and ferritin in OSF patients than in HCs. The serum CEA, SCC-Ag, and ferritin levels may be served as tumor markers for evaluation of malignant potential of OSF lesions.

Clinical observational study of Nimotuzumab combined with concurrent chemoradiotherapy in the treatment of locally advanced cervical cancer

Objective: To investigate the clinical efficacy and safety of Nimotuzumab combined with concurrent chemoradiotherapy in the treatment of locally advanced cervical cancer. Methods: A total of 65 patients with locally advanced cervical cancer treated with Nimotuzumab combined with concurrent chemoradiotherapy in Tianjin Medical University Cancer Institute and Hospital were selected from January 2015 to November 2018. Intensity-modulated radiotherapy and intracavitary post-packaging were used for radiation therapy. Platinum and paclitaxel were used for chemotherapy. Nimotuzumab were 400 mg/week. The clinical efficacy, the changes of serum tumor markers and the occurrence of adverse events were observed for 2 years, and the evaluation was performed once for every 3 months. Results: Sixty-one cases could be evaluated by imaging during the follow-up. The best curative effect evaluation showed that complete remission (CR) was 43 (70.5%), partial remission (PR) was 9 (14.8%), stable disease (SD) was 6 (9.8%) and objective response rate (CR+PR) was 85.3%, disease control rate (CR+PR+SD) was 95.1%. Survival analysis showed that one-year overall survival rate was 93.9% and two-year overall survival rate was 79.6%. After 3 months of treatment, the serum tumor markers SCC, CA125, CEA, and HE4 were significantly lower than those before treatment (P<0.05). Safety assessments showed that the main adverse events were hematochezia, abdominal pain, diarrhea, fever and dizziness, and 37 cases of them were grades Ⅰ-Ⅱ. Conclusion: Nimotuzumab combined with concurrent chemoradiotherapy has a good clinical effect in the treatment of locally advanced cervical cancer, significantly reduces serum tumor marker levels after treatment, and is safe and tolerable in clinical use.

Preventive and therapeutic effect of intraportal oridonin on BALb/c nude mice hemispleen model of colon cancer liver metastasis.

BackgroundThis study is to investigate the preventive and therapeutic effect of intraportal oridonin on colorectal cancer liver metastasis (CRCLM).MethodsThe inhibitory effect of oridonin on HT29 cells was determined by CCK-8 and MTT assays. The preventive and therapeutic effect of intraportal oridonin on CRCLM were investigated by establishing BALb/c nude mice hemispleen models of colon cancer liver metastasis. The microscopic characteristics of tumor tissues were observed by hematoxylin-eosin staining, immunohistochemistry and TUNEL staining. On the other hand, liver function enzymes, such as alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP), were detected to evaluate the hepatotoxicity of intraportal oridonin. The serum levels of tumor markers, including carcinoembryonic antigen (CEA) and α-fetoprotein (AFP), were used to investigate the intervention effect of intraportal oridonin on CRCLM.ResultsOridonin exerted an inhibitory effect on the proliferation of HT29 cells in vitro. Intraportal oridonin was found to effectively prevent the occurrence and formation of CRCLM, whilst intraportal oridonin can also exert a therapeutic effect on CRCLM. Additionally, liver enzymes testing indicated that intraportal oridonin possesses non-hepatotoxicity, instead can effectively alleviate liver injury caused by tumor. Furthermore, intraportal oridonin was also revealed to decrease the serum levels of AFP and CEA.ConclusionsIntraportal oridonin can effectively inhibit the formation of liver metastatic tumor and exert a certain degree of preventive and therapeutic effect on CRCLM. These findings indicate intraportal oridonin to be a promising anti-metastasis agent for CRCLM.

Pre-orchiectomy serum tumor markers as a predictor of recurrence in stage I germ cell tumors.

389 Background: Organ confined (stage IA/IB) testicular cancer has a high cure rate regardless of initial treatment modality, making it important to weigh the toxicities of treatment against potential benefits. While many clinicians routinely obtain serum tumor markers (STMs) prior to radical orchiectomy, their role in predicting recurrence in stage IA and IB testicular cancer has not been studied. Methods: A multi-institutional database of stage I testicular cancer patients diagnosed between 2006 and 2018 was created. Univariate and multivariate regression models were created to understand which factors predict recurrence. Recurrence analyses using Kaplan-Meier curves for elevated and normal pre-orchiectomy STMs were also generated. Results: 150 patients met the study criteria, of whom 16 (11%) relapsed (Table). 9 (56%) patients with recurrence had elevated pre-orchiectomy STMs, and 7 (44%) had normal pre-orchiectomy STMs. Similarly, 75 patients (56%) without relapse had elevated pre-orchiectomy STMs. Of 9 patients with elevated pre-orchiectomy STMs, 6 (67%) had normal STMs at recurrence; of 7 with normal pre-orchiectomy STMs, 4 patients (57%) had elevated STMs at recurrence. On Kaplan-Meier analysis, no association between level of pre-orchiectomy STMs and recurrence free survival was observed. Conclusions: Pre-orchiectomy STMs were not independently associated with recurrence in stage I testis cancer. Interestingly, there was also no association between positivity of pre-orchiectomy STMs and whether or not STMs were elevated at recurrence. These findings support the continued use of standard-of-care imaging and STMs in surveillance of stage IA/IB testicular cancer patients regardless of pre-orchiectomy STMs. [Table: see text]

Predictive factors of tumor sink effect: Insights from 177Lu-Prostate-specific membrane antigen therapy.

Tumor sink effect (TSE) has been defined as; decreased uptake in healthy tissue with increased tumor sequestration of the radiopharmaceuticals. It enables us to give high tumoral radiation doses while resulting in lower absorbed radiation to critical organs. However, the factors which influence this effect are yet to be defined. In this study, we have investigated the predictive factors of the tumor sink effect in a group of patients who received 177Lu-Prostate-specific membrane antigen (PSMA) therapy due to progressive metastatic castration-resistant prostate cancer (mCRPC). We have retrospectively analyzed the pre-therapy 68Ga-PSMA positron-emission tomography (PET)-computed tomography (CT) and post-therapy planar whole-body scans of 65 patients who received at least two cycles of 7.4GBq of 177Lu-PSMA therapy. All patients with mCRPC were referred to our department after multiple treatment lines. Age, previous therapies, International Society of Urological Pathology (ISUP) score, and pre-therapy serum tumor marker levels were recorded. Post 177Lu-PSMA therapy images were analyzed for TSE. 68Ga-PSMA PET-CT images were used for the calculation of SUVmax in malignant and healthy tissues as well as metabolic tumor volume (MTV) and total lesion PSMA index (TLPI). Based on the post-therapy scans, TSE was seen in 17/65 (26.2%) patients. In univariate analysis, patients with TSE had higher pre-therapy PSA, PSA velocity, and ALP (p < 0.0001). In relation to PET parameters, patients with TSE had higher 68Ga-PSMA MTV, 68Ga-PSMA TLPI and lower pretherapy renal SUVmax (p < 0.0001)), pretherapy liver SUVmax (p:0.012), pretherapy parotid gland SUVmax (p:0.032), and pretherapy parotid gland SUVmean (p:0.038). In the multivariant analysis, 68Ga-PSMA TLPI, pre-therapy PSA, and PSA velocity were found to be statistically significant. When analyzed according to Youden index, pretherapy PSA level of 133ng/ml (sensitivity 0.765 and 0.875), PSA velocity of 246ng/ml/year (sensitivity 0.765 and 0.833), and 68Ga-PSMA TLPI of 2969g (sensitivity 0.765 and 0.875) was found to be the best cut-off points to predict TSE. The tumor sink effect was seen in 26.2% of patients. 68Ga- PSMA TLPI, pre-therapy PSA, and PSA velocity was found to be the predictors of TSE. Accurate prediction of TSE may lead to increased tumoral doses while sparing healthy organs. Clinical trials that consider this effect as a part of a dose algorithm may further increase therapeutic efficacy.

Serum levels and positive rates of tumor biomarkers in oral precancer patients

Several previous studies have reported higher serum tumor marker levels in patients with oral or head and neck squamous cell carcinomas. This study evaluated whether 232 patients with oral precancerous lesions (oral precancer patients) had significantly higher serum carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC-Ag), and ferritin levels than healthy control subjects. The serum CEA, SCC-Ag, and ferritin levels in 232 oral precancer patients and 187 healthy control subjects were measured and compared. Patients with serum CEA level ≥3ng/mL, SCC-Ag level ≥2ng/mL, and ferritin level ≥250ng/mL were scored as serum positive for CEA, SCC-Ag, and ferritin, respectively. We found significantly higher mean serum CEA, SCC-Ag, and ferritin levels in 232 oral precancer patients than in 187 healthy control subjects (all P-values<0.05). Moreover, 232 oral precancer patients had significantly higher serum positive rates of CEA (47.4%), SCC-Ag (13.8%), and ferritin (52.2%) than 187 healthy control subjects (all P-values<0.05). Of the 232 oral precancer patients, 121 (52.1%), 56 (24.1%), and 10 (4.3%) had serum positivities of one, two, or three tumor markers including CEA, SCC-Ag, and ferritin, respectively. There are significantly higher mean serum CEA, SCC-Ag, and ferritin levels and significantly higher serum positive rates of CEA, SCC-Ag, and ferritin in oral precancer patients than in healthy control subjects. The serum CEA, SCC-Ag, and ferritin levels are of diagnostic value and may be potential tumor markers for the screening of oral precancer patients.

Analysis of clinical utility of abdominopelvic computer tomography in the follow up of Stage I Seminoma. A single center evaluation.

Background Abdominopelvic computer tomography (CT) is widely used in the follow up of seminoma patients after radical orchidectomy. The aim of this study is to evaluate the clinical utility of abdominopelvic computer tomography in the follow-up of patients with Stage I seminoma. Methods The pathological reports of all patients that have undergone radical orchidectomy in our tertiary referral center between January 2002 and January 2018 have been retrospectively reviewed. All patients with Stage I seminoma and negative serum tumor markers after radical orchidectomy were included. Patients with follow-up shorter than 12 months were excluded. Surveillance records of every patient were reviewed with particular regard to abdominopelvic imaging. Results Of the 133 patients who have undergone radical orchidectomy in our center, 55 had stage I pure seminoma with normal levels of serum tumor markers after surgery. Two patients were excluded as the follow-up was inadequate. Mean follow-up was 63,2 months (IQR: 30-73). The results of 211 abdominopelvic CTs performed as part of the follow up were reviewed. Two (3,7%) patients developed recurrence; one consisted of a scrotal lump and was diagnosed with ultrasonography (US) while the second appeared as paraaortic nodal metastasis and was diagnosed with abdominopelvic CT. The recurrence was successfully treated in both patients. A single abdominopelvic CT was useful for the detection of recurrent disease in our entire study population. No cancer specific death has been reported in the study population. CONCLUSIONSː Follow-up schedules for stage I seminoma exposes patients to potential risks of radiation- induced tumors, emotional distress and represent a significant burden for the healthcare system. The current series suggests that a better risk adapted patient-tailored follow-up program is needed in order to avoid unnecessary investigations.

Pancreatic Mass Mimicking Neuroendocrine Tumor

A 68-year-old man presented to our hospital for the evaluation of an incidentally detected pancreatic mass. Serum tumor marker levels were within normal limits. On delayed-phase computed tomography, a homogeneous enhancing 1.8 cm-sized hypervascular mass was detected in the pancreatic head (Figure 1). As the radiologic impression was that of a neuroendocrine tumor, the patient underwent pylorus-preserving pancreatoduodectomy. Microscopically, the tumor exhibited typical features of pancreatic solid hamartoma (Figure 2). Pancreatic solid hamartoma is an extremely rare entity that shows components that are present in the normal pancreas with distorted architecture and are considered as malformative lesions. Preoperative diagnosis is difficult because the clinicopathological features of solid hamartoma have not yet been fully clarified. The radiologic findings in this mass were similar to those of a neuroendocrine tumor. All patients with pancreatic hamartomas present with a benign clinical course. Recognition of this entity is desirable to avoid unnecessary extended surgical resection.

Metachronous primary colon and periampullary duodenal cancer

Rationale:Primary periampullary duodenal cancer accounts for 3% to 17% of periampullary cancers. There are no previous reports of metachronous primary colon and periampullary duodenal cancer.Patient concerns:We present a case of primary periampullary duodenal cancer that occurred metachronously after colon cancer.Diagnoses:Imaging and endoscopic examinations, serum tumor marker levels, and pathology confirmed metachronous colon and periampullary duodenal cancer, with 14-month interval between the diagnoses of the 2 malignancies.Intervention:The patient received right hemicolectomy combined with mFOLFOX6 chemotherapy for colon cancer and pancreatoduodenectomy for periampullary duodenal cancer.Outcomes:The patient has been followed up for 6 years since the pancreatoduodenectomy and shows no signs of recurrence or metastasis.Lessons:The risk of developing a second malignancy may be associated with the site of the first tumor. Patients with right colon cancer may have particularly high risk of developing small intestinal cancer, including duodenal cancer. Early detection and active surgical treatments can improve prognosis. Long-term regular follow-up is necessary to detect new malignancies occurring after the diagnosis colon cancer.

Correlations Between Staging and Chemotheraphy Response with Testicular Carcinoma Non-Seminoma at Dr. Soetomo Hospital, Surabaya, Indonesia

The purpose of this study to describe patientscharacteristics, correlation between stagingnon-seminomacancer and chemotherapyresponse. Data on age, location of tumor, staging, serum levels of the tumor marker post operative, adjuvant therapy, chemotherapy side effects, and response of patient to chemotherapy were gained from medical records inSoetomo Hospital Surabaya from January 2012 to December 2015, and analyzed with SPSS. Correlation between staging and chemotherapyresponse, correlation primary tumor staging (pT) and Metastasis (M), correlation regional lymph nodes staging (N) and metastasis (M), correlation serum tumor marker and chemotherapy response was proccessed by Spearman correlation test. There were no significant correlation between pT staging and M and no significant correlation between N and M staging. Based on tumor markers (S), mostly patients were S2. There were no significant correlation between the response to chemotherapy and serum tumor marker levels. In category of staging group, the mostare 14 patientsstage III. BEP was the most adjuvant Chemotherapy.Nausea and vomiting were The most complained during chemotherapy. Anemia were the most hematologic side effects of chemotherapy.There are no significant correlation between the staging of non-seminoma and the response to chemotherapy. Conclusion: Non seminoma mostly happened in young males. Non-seminoma responses to chemotherapy. Patients in early stage would give a good response to chemotherapy compared to those with advanced stage. After chemotherapy, evaluation should be done to the patients' complaints and complete blood count to detect side effects.