Cancer Stage Research Articles

A prospective study to compare the diagnostic accuracy of 99mTc-CNDG SPECT/CT and contrast-enhanced CT in staging of non-small cell lung cancer

ObjectiveTo explore the value of 99mTc-isonitrile deoxyglucosamine (CNDG) SPECT/CT in the staging and resectability diagnosis of non-small cell lung cancer (NSCLC) compared with contrast-enhanced CT (CECT).MethodsThis research was approved by the hospital ethics review committee. Sixty-three patients with NSCLC received 99mTc-CNDG SPECT/CT, CECT and initial TNM staging before treatment. Thirty-three patients who underwent radical surgery underwent postoperative pathological TNM staging as the reference standard. Another thirty patients underwent radiochemotherapy; among them, the reference standard of 7 patients of N staging and 5 patients of M staging was based on biopsy pathology, and the diagnosis of the remaining lesions was confirmed by at least one different image or clinical imaging follow-up for more than 3 months. The McNemar test and receiver operating characteristic (ROC) curve analysis were used to compare the diagnostic accuracy of staging and resectability of 99mTc-CNDG SPECT/CT and CECT in NSCLC, respectively.ResultsFor all patients and surgical patients, the accuracies of 99mTc-CNDG SPECT/CT in diagnosing the T stage and N stage were higher than those of CECT (all patients: 90.5%, 88.9% vs. 79.4%, 60.3%; surgical patients: 81.8%, 78.8% vs. 60.6%, 51.5%), and the differences were statistically significant (all patients: T stage, P = 0.016; N stage, P = 0.000; surgical patients: T stage, P = 0.016; N stage, P = 0.004). For all patients, the accuracy of 99mTc-CNDG SPECT/CT in diagnosing the M stage was higher than that of CECT (96.8% vs. 90.5%), but the difference was not statistically significant (P = 0.289). ROC curve analysis showed that the accuracy of 99mTc-CNDG SPECT/CT in diagnosing the potential resectability of NSCLC was significantly better than that of CECT (P = 0.046).ConclusionThis preliminary clinical study shows that 99mTc-CNDG SPECT/CT is of great value for accurate clinical staging of NSCLC compared with CECT and can significantly improve the accuracy of resectability diagnosis.

A precise machine learning model: Detecting cervical cancer using feature selection and explainable AI

Cervical cancer is a cancer that remains a significant global health challenge all over the world. Due to improper screening in the early stages, and healthcare disparities, a large number of women are suffering from this disease, and the mortality rate increases day by day. Hence, in these studies, we presented a precise approach utilizing six different machine learning models (decision tree, logistic regression, naïve bayes, random forest, k nearest neighbors, support vector machine), which can predict the early stage of cervical cancer by analysing 36 risk factor attributes of 858 individuals. In addition, two data balancing techniques—Synthetic Minority Oversampling Technique and Adaptive Synthetic Sampling—were used to mitigate the data imbalance issues. Furthermore, Chi-square and Least Absolute Shrinkage and Selection Operator are two distinct feature selection processes that have been applied to evaluate the feature rank, which are mostly correlated to identify the particular disease, and also integrate an explainable artificial intelligence technique, namely Shapley Additive Explanations, for clarifying the model outcome. The applied machine learning model outcome is evaluated by performance evaluation matrices, namely accuracy, sensitivity, specificity, precision, f1-score, false-positive rate and false-negative rate, and area under the Receiver operating characteristic curve score. The decision tree outperformed in Chi-square feature selection with outstanding accuracy with 97.60%, 98.73% sensitivity, 80% specificity, and 98.73% precision, respectively. During the data imbalance, DT performed 97% accuracy, 99.35% sensitivity, 69.23% specificity, and 97.45% precision. This research is focused on developing diagnostic frameworks with automated tools to improve the detection and management of cervical cancer, as well as on helping healthcare professionals deliver more efficient and personalized care to their patients.

Atomic-Level Defect Engineering in GeP Nanoflake Biosensors for Gastric Cancer Diagnosis.

Defect engineering offers a promising approach to enhance the sensitivity of biosensing materials by creating abundant chemically active sites. Despite its potential, achieving precise control and modification of these defects remains a significant challenge. Herein, we propose atomic-level defect engineering in GeP two-dimensional (2D) layered materials, following precise in situ growing Au nanoparticles on the single defect active sites for the design of ultrasensitive biosensors. The GeP-based biosensor exhibits notable capabilities for miRNA detection with excellent chemical stability, sensitivity, selectivity, and an extremely low detection limit of 28.6 aM. When applied to clinical tissue samples from gastric cancer patients, the biosensor effectively quantified the miR378c biomarker, enabling accurate stage-specific monitoring. This research not only represents a crucial advancement in the field of biosensing materials through defect engineering but also provides a promising avenue for early cancer diagnosis, staging, and monitoring.

The EORTC 22922/10925 trial investigating regional nodal irradiation in stage I-III breast cancer: Outcomes according to locoregional and systemic therapies

The EORTC 22922/10925 trial aimed to investigate the impact on overall survival (OS) of elective internal mammary and medial supraclavicular (IM-MS) radiation therapy (RT) in breast cancer stage I–III. Surgery for the primary tumour and axillary lymph nodes, chest wall RT, boost RT after whole breast RT in breast conserving therapy (BCT), RT to operated axilla, and systemic therapy were per physician’s preference. The aim of the current analysis is to assess breast cancer outcomes according to different locoregional and systemic therapy used in the trial. Material/MethodsData with a median follow-up of 15.7 years were extracted from the trial’s case report forms. Kaplan-Meier curves of disease-free and OS and cumulative incidence curves of breast cancer events were produced. An exploratory analysis of the effect of the type of locoregional and systemic therapy on breast cancer outcomes was conducted using the Cox model or the Fine & Gray model accounting for competing risks, both models being adjusted for baseline patient and disease characteristics and treatment. The significance level was set at 5 %, 2-sided. ResultsOf the 4,004 patients included, 625 (16%) did not receive any postoperative systemic therapy, 1,185 (30%) received endocrine therapy only, 994 (25%) chemotherapy only, and 1,200 (30%) both chemotherapy and endocrine therapy, without differences between the randomisation arms.Administration and type of therapy was associated with age, menopausal status, clinical T- and N-stage and ER status (p < 0.0001). Local control was better with mastectomy (with/without postmastectomy RT) as compared to BCT, but mastectomy was associated with more distant metastasis (DM) as first event. Similarly, DM as first event occurred more in the BCT group that received a boost as compared to no boost and in those who received RT to the lower axillary level. IM-MS RT reduced significantly regional recurrences and improved disease-free survival in a sensitivity stratified analysis. OS was worse with mastectomy as compared to BCT and with irradiation of the axilla but better with sentinel node dissection and adjuvant combined chemo and hormonal therapy. ConclusionDifferent components of therapy influenced the site of first event. IM-MS RT improved outcomes in different breast cancer outcomes were most probably related that the group were balanced due to the trial arms and stratification methods.

ATM is a Prognostic Biomarker of Survival in Head and Neck Squamous Cell Carcinoma Patients

This review examines the role of ATM expression in head and neck squamous cell carcinoma (HNSCC). Analysis revealed significant overexpression of ATM in HNSCC cells compared to normal control samples, suggesting its involvement in cancer proliferation. ATM expression was notably upregulated across various clinical parameters, including different stages of cancer, racial groups, genders, and age groups, highlighting its role in cancer progression. Validation using the GEPIA2 tool confirmed strong ATM expression throughout all four stages of HNSCC, with the highest levels in stage II and the lowest in stage I. Promoter methylation analysis of ATM showed distinct patterns across different demographics and cancer stages, reinforcing its significance. The study also explored the relationship between ATM expression and patient outcomes using the KM plotter tool, finding that high ATM expression was associated with better overall survival (OS), while low ATM expression correlated with better disease-free survival (DFS). Genetic mutation analysis via cBioPortal identified minimal ATM mutations in HNSCC, including in-frame, splice, truncating, and missense mutations, suggesting their role in ATM dysregulation. The STRING tool was used to construct a protein-protein interaction (PPI) network, revealing that the ATM gene interacts with ten key genes (NBN, ATR, CHEK2, MDC1, MSH2, MSH6, MRE11, TP53, TP53BP1, BRCA1), indicating its involvement in various biological functions. Functional annotation of differentially expressed genes (DEGs) through the DAVID web server revealed their participation in critical biological processes, including double-strand break repair, cellular response to DNA damage, and DNA damage checkpoints. KEGG pathway analysis further linked DEGs to cellular senescence, platinum drug resistance, homologous recombination, p53 signaling, and the cell cycle, underscoring ATM’s multifaceted role in HNSCC.

Faecal haemoglobin concentration and colorectal cancer site, stage and grade in a symptomatic cohort.

Minimal evidence exists regarding faecal immunochemical tests (FITs) for colorectal cancer (CRC) site, stage and grade in symptomatic patients. The primary aim is to determine any association between faecal haemoglobin concentration (f-Hb) (analysed with OC-Sensor™ Pledia) and these prognostic factors. The secondary aim is to determine the association between f-Hb and anaemia, microcytosis and iron deficiency (Hb, mean corpuscular volume [MCV] and ferritin). Symptomatic 2-week wait CRC patients with FIT were included (July 2019-October 2022). Median f-Hb and interquartile range according to sex, stage, grade and site (right-sided, caecum to transverse colon, R-CRC; left-sided, splenic flexure to rectum, L-CRC) were compared using the Mann-Whitney U test. Hb, MCV and ferritin were categorized into two groups and the median f-Hb was compared using the Mann-Whitney U test. In all, 114 patients (57 women, 57 men) were studied; 46 had R-CRC (f-Hb = 113 μg Hb/g) and 68 had L-CRC (f-Hb = 342 μg Hb/g) (P = 0.07). Sixty-nine were moderately differentiated CRC (f-Hb = 183 μg Hb/g) and 29 were poorly differentiated (f-Hb = 866 μg Hb/g) (P = 0.04). By T-stage, 35 were early (T1/2) (f-Hb = 170 μg Hb/g) and 79 were advanced (T3/4) (f-Hb = 200 μg Hb/g) (P = 0.06). The relationship between f-Hb and Hb, MCV and ferritin was not significant. Poorly differentiated (P = 0.04) and later stage (P = 0.02) R-CRC had significantly lower f-Hb compared to L-CRC. Right-sided CRC is associated with lower f-Hb than left. Poorly differentiated and later staged L-CRC had higher median f-Hb. These data add to existing evidence suggesting that FIT may be less sensitive for right-sided CRC. Strategies to mitigate the potential for missed or FIT-negative right-sided CRC are required.

Theory and practice on mesentery margin in vessel-oriented complete mesentery resection of gastric cancer

The concept of mesenteric anatomy has been evolving in cognition. With the continuous development of endoscopic techniques, the submicroscopic structures of many mesenteries have been gradually understood, ultimately confirming the ubiquitous presence of mesenteries in the digestive organs. Based on various domestic and foreign mesenteric anatomical theories and combined with years of clinical practice, we have summarized and proposed a new concept and theory-vascular-guided complete mesenteric resection for gastric cancer. The theoretical basis is that, from the perspective of the embryonic development of the digestive tract, the rotation of the digestive tract and its associated mesentery is always centered on blood vessels. Therefore, the supply vessels and digestive tracts and their associated mesentery are naturally connected. The mesentery is a complex structure that encompasses blood vessels, nerves, and lymphatic tissues. The blood vessels serve as the boundary of the mesentery, ensuring that the lymphatic network that drains the tumor is maximally resected. This article focuses on the complete mesenteric resection margins in gastric cancer surgery, that is, the lateral boundary of the mesentery as the vascular-supplied guided resection boundary and its mesentery, and the base boundary as the mesenteric bed. Using precise vascular guidance to define the extent of mesenteric resection will help accurately define the mesenteric margin during radical resection for different stages of gastric cancer.

Advancing Oncology through Imaging: Evaluating FDG-PET's Role in Cancer Diagnosis and Staging

Purpose: Fluorine-18 fluorodeoxyglucose positron emission tomography (18F-FDG PET) represents a valuable functional molecular imaging technique. Through non-invasive means, 18F-FDG PET allows for the assessment of glucose metabolic activity in living biological systems. Its utility in oncology is well established, with applications in tumor diagnosis, staging, and treatment monitoring. The purpose of this study is to conduct a systematic review assessing the indicative value and effect on the clinical management of 18F-FDG PET/CT for various cancer types based on the current literature. Materials and Methods: An inclusive search of the PubMed, Google Scholar, and Science Direct databases was performed to identify relevant studies published from 2022 to the present. Records were screened according to predefined inclusion and exclusion criteria. A full-text review of the eligible studies was independently conducted by two reviewers. Results: Twenty-one primary research articles met the inclusion criteria and encompassed several cancer types. Evidence demonstrates superior detection, characterization, and staging compared with anatomical imaging alone. Advantages have been substantiated for head/neck, lung, and brain cancers, as well as lymphomas. The significant associations between 18F-FDG uptake and clinical features validated the molecular profiling capacity. Conclusion: 18F-FDG PET provides crucial metabolic tumor information, augmenting conventional approaches. Specific diagnostic values have been established for diverse oncological applications. While technical refinements are ongoing, 18F-FDG PET plays an expanding role in multimodal cancer algorithms according to guidelines. Continued investigation aims to further optimize these techniques and clarify their comparative effectiveness.

A Graph-Informed Modeling Framework Empowering Gene Pathway Discovery.

This study introduces a novel graph-informed modeling framework for improving the statistical analysis of gene expression data, particularly in the context of identifying differentially expressed gene pathways and gene expression-assisted disease classification in a high-dimensional data setting. By integrating gene regulatory network information into hypothesis testing for the difference between mean vectors and linear discriminant analysis, we aim to effectively capture and utilize previously validated external gene interaction information. Our method leverages a block-coordinate descent approach which enables us to incorporate mixed graph information into linear structural equation modeling, accommodating directed/undirected edges and potential cycles in gene regulatory networks. Extensive simulations under various data scenarios have demonstrated the effectiveness of our approach with improved power for gene pathway tests and disease classification over existing methods. An application to a lung cancer dataset from the Cancer Genome Atlas Program (TCGA) further exemplifies the potential of our graph-informed approach in empowering the detection of differentially expressed gene pathways and gene expression-based classification of different lung cancer stages. Our findings underscore the potential utility of incorporating gene regulatory network information in gene pathway analysis, setting the stage for future advancements in gene pathway discovery, disease diagnosis, and treatment strategies.

Unraveling molecular and clinical aspects of ALKBH5 as dual role in colorectal cancer.

This study investigates the dual role of ALKBH5, an eraser enzyme, in colorectal cancer (CRC), focusing on how N6-methyladenosine (m6A) mutations influence CRC development and progression. We reviewed various studies that highlighted the role of ALKBH5 in colorectal cancer (CRC). This includes the impact of ALKBH5 on tumor cell behavior including immune system interactions, invasion, and proliferation in CRC. We also looked into how ALKBH5 acts as a tumor suppressor under different conditions analyzed clinical data to assess the impact of ALKBH5 expression on outcomes in colorectal cancer patients. In CRC, ALKBH5 plays a dual role. In certain situations, it inhibits the progression of the tumor, but in other circumstances, it promotes tumor growth and immunosuppression. The interaction with RABA5 plays a role in the development of CRC. Having elevated levels of ALKBH5 has been associated with unfavorable patient outcomes, such as reduced survival rates and more advanced cancer stages. Various factors, including tumor differentiation, TNM stages, and carcinoembryonic antigen (CEA) levels, be linked to ALKBH5 expression. ALKBH5 plays a complicated and situation-specific role in colorectal cancer (CRC). Targeting ALKBH5 could result in novel therapy options that balance its tumor-promoting and tumor-fighting properties in CRC. Further research into m6A alterations and ALKBH5 could enhance CRC treatment approaches and patient outcomes.

Cell Migration-Proliferation Dichotomy in Cancer: Biological Fact or Experimental Artefact?

The migration-proliferation dichotomy (MPD) has long been observed in cultured cancer cells. This phenomenon is not only relevant to tumour progression but may also have therapeutic significance in clinical cancer. However, MPD has rarely been investigated in primary cancer. This study aimed to either confirm or disprove the existence of MPD in primary cancer. Using primary gastric, colorectal and prostate cancer (GC, CRC and PCa) cohorts from the Cancer Genome Atlas and Memorial Sloan Kettering Cancer Center, this study interrogated the MPD phenomenon by utilising RNA-Seq-based proliferation (CIN70 signature) and migration (epithelial-mesenchymal transition) indices, as well as gene set enrichment analyses (GSEA). Alternative hypothetical migration-proliferation models-The simultaneous migration-proliferation (SMP) and phenotype-refractory (PR) models-were compared to the MPD model by probing the migration-proliferation relationships within cancer stages and between early- and late-stage diseases using chi-square and independent T tests, z-score statistics and GSEA. The results revealed an inverse relationship between migration and proliferation signatures overall in the GC, CRC and PCa cohorts, as well as in early- and late-stage diseases. Additionally, a shift in proliferation- to migration dominance was observed from early- to late-stage diseases in the GC and CRC cohorts but not in the PCa cohorts, which showed enhanced proliferation dominance in metastatic tumours compared to primary cancers. The above features exhibited by the cancer cohorts are in keeping with the MPD model of the migration-proliferation relationship at the cellular level and exclude the SMP and PR migration-proliferation models.

Incidence and Dynamics of CRC Stage Migration: A Regional vs. a National Analysis.

Due to an increased rate of surveillance colonoscopy, we aim to determine the impact of stage migration on the incidence and overall survival (OS) of patients who underwent pathological staging of colorectal cancer (CRC) at our Health Network System. Two datasets were included: subjects from the tumor registry at a regional Comprehensive Cancer Center (n = 1385) and subjects from the Surveillance, Epidemiology, and End Results (SEER) national database (n = 202,391). A significant increase in the diagnosis of CRC Stage 1 and 4 was observed, with a decrease in stage 2, and no change in Stage 3 in the National datasets (p < 0.01). There was an increase in Stage 4 CRC diagnosis, with a concurrent decrease in stage 2, and no changes in stages 1 and 3 in the regional dataset (p < 0.05). OS followed the expected and progressive decrease in OS by stage (from 1 to 4, p < 0.01). The present findings confirmed CRC stage migration in our Health Network System, along with a national trend conducive to an increased OS for early CRC stages.

Impact of COVID-19 on 2021 cancer incidence rates and potential rebound from 2020 decline.

The COVID-19 pandemic led to substantial declines in cancer incidence rates in 2020, likely because of disruptions in screening and diagnostic services. This study aimed to assess the impact of the pandemic on cancer incidence rates in the United States using 2021 incidence data from the Surveillance, Epidemiology, and End Results program. The analysis compared observed 2021 cancer incidence rates with expected prepandemic trends, evaluating changes by individual cancer site and stage. Although incidence overall and in many cancer sites the rates were close to prepandemic levels, they did not exhibit a recovery that incorporated the delayed diagnoses from 2020. There were exceptions, however, such as metastatic breast cancer, which showed significantly higher observed rates than expected (rate ratio = 1.09, 95% confidence interval = 1.04 to 1.13). Ongoing monitoring and targeted interventions are needed to address the long-term consequences of the COVID-19 pandemic on cancer care and outcomes.

Clinical significance of RETN gene expression and rs3219175 G > a polymorphism in cancer

The inflammatory cytokine resistin, which is encoded by the RETN gene, plays a variety of roles in cancer. This study aimed to assess the relationship between RETN gene expression and cancer stage, survival prognosis, immune infiltration, and drug sensitivity, and whether the rs3219175 G > A polymorphism affected the expression of the RETN gene and cancer risk. The clinical significance of RETN gene expression and the rs3219175 polymorphism in cancer was analyzed by the GSCA platform, GTEx database and STATA software. The results showed that RETN gene expression was associated with the stage of thyroid carcinoma, survival prognosis and immune infiltration of certain cancers, and sensitivity to multiple drugs. The rs3219175 polymorphism could influence the expression of the RETN gene in a wide range of tissues. Furthermore, RETN gene rs3219175 polymorphism was significantly associated with cancer risk [GA vs. GG: OR = 2.27, 95%CI = 1.26–4.09; (GA + AA) vs. GG: OR = 2.23, 95%CI = 1.28–3.88; A vs. G: OR = 1.72, 95%CI = 1.15–2.58]. In conclusion, the current study suggested that resistin might serve as a prognostic marker and therapeutic target for certain cancers, and the rs3219175 polymorphism might be used as a marker for predicting cancer risk.

Improved quality of life in head and neck cancer patients treated with modern arc radiotherapy techniques - A prospective longitudinal analysis.

The present longitudinal study aimed to evaluate the potential impact of modern radiotherapy (RT) techniques on quality of life (QOL) in patients with head and neck (HNC) cancer. In this single-center prospective study, participants were asked to complete QOL questionnaires that included the EORTC QLQ-C30, QLQ-H&N 35 and utility score by time trade-off (TTO) at three time points (2 weeks, 3 months and 6 months) after completion of RT. All patients were treated by modern RT techniques [volumetric modulated arc therapy (VMAT) or helical tomotherapy (HT)]. Patients who developed recurrence or died before the 6-month follow-up were excluded. Linear mixed models with random intercepts for participants and restricted maximum likelihood estimates were used to assess the effect of our study variables (age, sex, primary site, cancer stage, treatment, radiation dose and radiation method). Overall changes in QOL, utility scores and symptom burdens at different time points were tested using paired t tests. A total of 45 patients were recruited from 2022 to 2023. Those who completed the surveys at 2 weeks with at least 1 follow-up (30 patients, 67%) were enrolled in the final analysis. The majority of these 30 patients were men (76.7%), had oral cancer (40%), had stage III or IV disease (60%), received surgical intervention (63%) and were treated with chemoradiation (80%). A curative total dose of 66 to 70 Gy was delivered to 23 (76.7%) patients, half of whom received HT. Patients who received chemotherapy had significantly lower global QoL scales (mean difference, 27.94; 95% CI, 9.33-46.55; p=0.005). Global QOL, physical function, symptoms of sticky saliva, cough, feelings of illness and weight loss improved significantly between 2 weeks and 3 months. There was no significant difference between 3 and 6 months. Interestingly, improvements in social function, social contact, pain and nutrition reached significance at 6 months. Subgroup analysis revealed greater pain relief over time for patients who underwent HT (p=0.030). Moreover, patients who participated in swallowing rehabilitation programs had a greater decrease in nausea and vomiting (p=0.036). HNC patients treated with modern RT techniques experience improved QOL and physical function over time. The most significant improvement occurs between 2 weeks and 3 months, after which the improvement plateaus. However, social function, social contact, pain and nutrition may require longer recovery intervals after treatment. HT with daily image guidance could provide a therapeutic opportunity for improving pain relief in patients with HNC.

Expression profiling of circulating lncRNA GIAT4RA, lncRNA AATBC, lncRNA Sirt1-AS, and SMARCB1 in lung cancer patients

Long noncoding RNAs (lncRNAs) are crucial regulators of biological processes such as transcription interference and activation, chromatin remodeling, and mRNA translation. Uncontrolled gene expression could result from various epigenetic modifiers, like lncRNAs. So, this study aimed to evaluate the expression profiles of lncRNA GIAT4RA, lncRNA AATBC, lncRNA Sirt1-AS, and SMARCB1 in lung cancer. The current study included lung cancer patients (n = 50), patients with chronic inflammatory diseases (n = 30), and healthy volunteers (n = 20). The expression of blood genes and the concentration of serum neuron-specific enolase were determined by real-time PCR and electrochemiluminescence immunoassay, respectively. The receiver operating characteristic and Kaplan-Meier analyses assess the sensitivity of genes as diagnostic and prognostic biomarkers, respectively. LncRNA GIAT4RA and lncRNA AATBC were upregulated, while lncRNA Sirt1-AS was significantly downregulated in all patients compared to the control group. SMARCB1 expression was significantly downregulated in chronic inflammatory patients, while in those with lung cancer, it showed an insignificant difference. The expression of lncRNA GIAT4RA and lncRNA AATBC was significantly related to the stage of lung cancer. The survival analyses showed that lower lncRNA Sirt1-AS was linked to lung cancer patients’ poorer disease-free survival and overall survival. Differences in lncRNA GIAT4RA, lncRNA AATBC, and lncRNA Sirt1-AS expression were detected in all patients. The consequent abnormal expression of lncRNAs could be crucial in lung cancer development. LncRNA GIAT4RA, lncRNA AATBC, and lncRNA Sirt1-AS may be utilized as promising diagnostic biomarkers. LncRNA AATBC, lncRNA Sirt1-AS, and SMARCB1 may be valuable prognostic biomarkers for lung cancer.

Oncological outcomes of stage I–II breast cancer treatment after subcutaneous/skin-sparing mastectomies with reconstruction

Aim. To study the recurrence of stage I–II breast cancer after subcutaneous/skin-sparing mastectomies with reconstruction with or without radiation therapy. Materials and methods. From 2013 to 2022, 984 patients diagnosed with breast cancer underwent 1020 subcutaneous/skin-sparing mastectomies with reconstruction at the P.A. Herzen Moscow State Medical Institute. Histological types are presented: cancer in situ – 7, invasive cancer without signs of specificity – 818, invasive lobular cancer – 105, combined cancer – 40, rare forms – 50. Subcutaneous mastectomy with reconstruction was performed in 617 (60.5 %), skin-sparing mastectomy in 403 (39.5 %) cases. Reconstruction with own tissues was performed in 5.7 %, expanders/implants in 94.3 % of patients. Patients with diagnosed mutations in the genes ВRCА1, 2, СНЕК2 amounted to 208 (21.1 %), while among patients with primary multiple synchronous cancer, the percentage with mutations was 25 %. Results. In the studied group of patients, recurrence of breast cancer was diagnosed in 40 (4.1 ± 0.1 %) cases, distant metastases – in 52 (5.3 ± 0.1 %) cases. The minimum time to relapse was 36 months, and the maximum was 108 months. In a single-factor analysis of the stage of the disease: at stage I, relapse was diagnosed in 25 (5.8 %) cases, at stage IIA (T2N0M0) – in 5 (2.0 %), at stage IIA (T1N1M0) – in 6 (4.2 %), at stage IIB T2N1M0 – in 4 (2.1 %) (p &gt; 0.05). The recurrence in the group with radiation therapy was 2.5 ± 0.6 (odd ratio 0.98, 95 % confidential interval 1.52–3.48), without radiation therapy 5.1 % (odd ratio 2.13, 95 % confidential interval 0.92–5.18) regardless of the stage of breast cancer (t-criterion &gt;2, p &gt; 0.05). In our study, the recurrence of breast cancer at the edge of R1 was 6.8 ± 2.5 %, at R0 – 3 ± 0.6 % (p &gt; 0.05). When analyzing age and risk of recurrence, we did not identify age dependence, up to 40 years the probability of recurrence is 4.3 ± 1 %, after 40 years – 3.3 ± 0.7 % (t-criterion 0.44, p &gt; 0.05). The dependence of the degree of malignancy of the tumor node and the frequency of recurrence is as follows: G1 – 2. 3 ± 2.3 %, G2 – 3 ± 0.7 %, G3 – 3.9 ± 1 %, when compared G3 c G1 (t-criterion 0.52, p&gt;0.05), when comparing G3 from G2 (t-criterion 0.49, p &gt; 0.05). Recurrence of breast cancer with triple negative type was diagnosed in 2.5 ± 0.9 % relative to other molecular biological types (t-criterion 1.49, p &gt; 0.05). We analyzed the dependence of relapse on the non-luminal and luminal HER2 positive types; the relapse was 5.4 ± 1.5 % (p &gt; 0.05); the dependence on the level of Ki-67; at a level of 40 %, the probability of recurrence is 4 ± 0.8 %, at a level &gt; 40 %, recurrence is 2 ± 0.8 % (t-criterion 1.77, p &gt; 0.05). A statistically significant difference in our study was revealed, in addition to radiation therapy, during neoadjuvant polychemotherapy, so in the group with neoadjuvant polychemotherapy, the recurrence was 2 ± 0.8 %, without neoadjuvant polychemotherapy – 4.1 ± 0.7 % (t-criterion 2.16, р &lt; 0.05). Conclusion. A link between breast cancer recurrence and morphological features (R1 resection margin, lymphovascular invasion, lymphatic tumor emboli, luminal and non-luminal HER2+ subtype, G3) and clinical characteristics (presence of mutations, location of a lesion in the gland, stages) was found. Further search for predictors of breast cancer recurrence after combination or integrated treatment is necessary.

Real-world evidence of survival outcomes in breast cancer subtypes after neoadjuvant chemotherapy in a Brazilian reference center.

Neoadjuvant chemotherapy (NAC), traditionally used for locally advanced disease, is now applied for operable disease, particularly to treat aggressive breast cancer (BC). This study aimed to characterize the pathological complete response (pCR) and its relationship with overall survival (OS) and disease-free survival (DFS) among BC patients receiving NAC in a Brazilian public reference center, as well as the association between pCR and BC subtypes. A retrospective cohort study used a comprehensive BC database from a Brazilian women's health reference center, including patients diagnosed between 2011 and 2020 who underwent NAC. We collected demographic, cancer-specific, and treatment-related data, analyzing OS and DFS based on pCR status using the semiparametric Kaplan-Meier method, with the date of BC diagnosis as the starting point. The study included 1,601 patients, with an average age of 49 years and a majority presenting stage IIIa disease (35%). Most had invasive nonspecial type (NST) BC (94%), and a significant portion (86.7%) exhibited a Ki-67 index <14. The overall pCR rate was 22.7%, with higher frequencies observed in the triple negative and luminal B subtypes. Patients who achieved pCR had significantly higher survival rates (89% alive vs. 61%, P<0.001) and better DFS (90% vs. 66%, P<0.001), except in the luminal A subtype, where pCR did not correlate with improved OS or DFS. These updated real-world data (RWD) from BC patients who underwent NAC in Brazil revealed a pCR rate of 22.7% in all cancer subtypes and stages. pCR was not associated with better outcomes in patients with luminal A, contrasting with other subtypes.

Air pollutants and primary liver cancer mortality: a cohort study in crop-burning activities and forest fires area.

Northern Thailand experiences high levels of air pollution in the dry season due to agricultural waste burning and forest fires. Some air pollutants can enter the bloodstream, and the liver has the role of detoxifying these along with other harmful substances. In this study, we assessed the effects of long-term exposure to air pollutants on liver cancer mortality in this area. A cohort of 10,859 primary liver cancer patients diagnosed between 2003 and 2018 and followed up to the end of 2020 were included in the study. Extended time-varying covariates of the annually averaged pollutant concentrations updated each year were utilized. The associations between air pollutants and mortality risk were examined by using a Cox proportional hazard model. Metastatic cancer stage had the highest adjusted hazard ratio (aHR) of 3.57 (95% confidence interval (CI):3.23-3.95). Being male (aHR = 1.10; 95% CI: 1.04-1.15), over 60 years old (aHR = 1.16; 95% CI: 1.11-1.21), having a history of smoking (aHR = 1.16; 95%CI: 1.11-1.22), and being exposed to a time-updated local concentration of PM2.5 of 40 μg/m3 (aHR = 1.10; 95% CI: 1.05-1.15) increased the mortality risk. We found that air pollution is one of several detrimental factors on the mortality risk of liver cancer.

The prognostic impact of tumor deposits in colorectal cancer: More than just N1c

ABSTRACTBackgroundThe identification of tumor deposits (TD) currently plays a limited role in staging for colorectal cancer (CRC) aside from N1c lymph node designation. The objective of this study was to determine the prognostic impact, beyond American Joint Committee on Cancer N1c designation, of TDs among patients with primary CRC.MethodsPatients who had resected stage I–III primary CRC diagnosed between 2010 and 2019 were identified from the National Cancer Institute's Surveillance, Epidemiology, and End Results database. Cancer‐specific survival (CSS) stratified by TD status and lymph node (N) status was calculated using the Kaplan–Meier method and multivariable Cox proportional hazards regression analyses.ResultsIn total, 147,783 patients with primary CRC were identified. TDs were present in 15,444 patients (10.5%). The presence of TDs was significantly associated with adverse tumor characteristics, including advanced pathologic stage, nodal status, and metastasis status. The presence of TDs was associated with worse CSS (hazard ratio [HR], 3.12; 95% confidence interval [CI], 3.02–3.22), as it was for each given N category (e.g., N2a and TD‐negative [HR, 2.50; 95% CI, 2.37–2.64] vs. N2a and TD‐positive [HR, 3.75; 95% CI, 3.49–4.03]). The presence of multiple TDs was also associated with decreased CSS for each given N category compared with a single TD (e.g. N2a with one TD [HR, 3.09; 95% CI, 2.65–3.61] vs. N2a with two or more TDs [HR, 4.32; 95% CI, 3.87–4.82]).ConclusionsTDs were identified as an independent predictor of a worse outcome in patients with CRC. The presence of TDs confers distinctly different CSS and provides important prognostic information among patients with CRC and warrants further investigation as a unique variable in future iterations of CRC staging.