Tertiary Care Cancer Center Research Articles

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Mesothelioma: Outcomes From a Tertiary Cancer Care Center in India

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Mesothelioma: Outcomes From a Tertiary Cancer Care Center in India

Acute myeloid leukemia in the next-generation sequencing era : Real-world data from an Austrian tertiary cancer care center.

Next-generation sequencing (NGS) has recently entered routine acute myeloid leukemia (AML) diagnostics. It is paramount for AML risk stratification and identification of molecular therapeutic targets. Most NGS feasibility and results data are derived from controlled clinical intervention trials (CCIT). We aimed to validate these data in areal-world setting. This study retrospectively analyzed 447 AML patients treated at an Austrian tertiary cancer care center. A total of 284 out of the 447 cases were treated between 2013-2023 when NGS was locally available for the clinical routine. The NGS was successfully performed from bone marrow biopsies and aspirates, with processing times decreasing from 22days in 2013/2014 to 10days in 2022. Molecular therapeutic target(s) were identified by NGS in 107/284 (38%) cases and enabled risk stratification in 10 cases where conventional karyotyping failed. Concerning molecular landscape, TET2 (27%), FLT3 (25%), DNMT3A (23%), and NPM1 (23%) were most frequently mutated. Comparing older and younger patients (cut-off 70years) showed enrichment in older people for mutations affecting DNA methylation (72% vs.45%; P < 0.001) and the spliceosome (28% vs. 11%; P = 0.006) and more cellular signaling mutations in younger patients (61% vs. 46%; P = 0.022). Treatment outcomes corroborated asignificant survival benefit in the recent NGS era and patients treated with novel/molecularly targeted drugs. Ultimately, biospecimens of these patients are stored within aleukemia biobank, generating avaluable tool for translational science. Our study validates data from CCIT and supports their relevance for treatment decisions in areal-world setting. Moreover, they demonstrate the feasibility and benefits of NGS within aroutine clinical setting.

Socioeconomic Factors' Impact on Survivorship in Patients with Cervical Cancer: A Study from the Tertiary Cancer Center in Muzaffarpur, North Bihar, India

ObjectiveTo ascertain the survivorship among cervical cancer patients and the factors responsible for early death. In India, cervical cancer ranks second among cancer-related deaths among women. Estimating the survivability rate of patients with cervical cancer who come to our tertiary cancer care center was imperative, as was figuring out.What was causing the greater death rate.MethodThe present study is a retrospective audit of cervical cancer registered at our hospital-based cancer registry from 2021 till date.ResultThe three-year survival rate among women with late-stage cervical cancer was 45%, while 100% of women with early-stage care were alive at the end of three years. The survival rate was also poor among women belonging to middle and low socioeconomic status and illiterate women.ConclusionAmong women who have cervical cancer, those with early-stage cancer, who are literate and those who belong to above middle socioeconomic status have higher survivorship than their counterparts.

A retrospective audit of audiology encounters in patients undergoing Cisplatin treatment at a large Australian tertiary cancer care centre.

To identify the number and timing of audiology encounters for adult oncology patients in a tertiary care setting in Australia. A retrospective case review was completed for 149 patients who received Cisplatin chemotherapy (CT) at a large, publicly funded tertiary hospital in Brisbane, Queensland, Australia between 1st January and 31st December 2019. Patient data was extracted from the Queensland Oncology Repository (QOR) provided by Cancer Alliance Queensland (CAQ). The number of audiology encounters was low overall with a median of 0 and interquartile range (IQR) of 0-1. Of the entire patient cohort, there was a mean of 1.2 encounters with 56% of patients not engaging with audiology. Where audiology did occur, encounters were most likely before or early in the CT treatment period. This study has demonstrated engagement with audiology services for patients undergoing CT treatment was limited with the few audiology engagements occurring before or early in the CT treatment period. Further research is needed to identify the barriers and facilitators to accessing audiological ototoxic monitoring (OtoM) during chemotherapy treatment in hospitals in Australia. Early identification of ototoxic hearing loss offers the opportunity to minimise further exposure to the ototoxic agent, minimise functional and communication impacts for the patient and provide early opportunity for discussion, education and counselling with patients, carers and their treating team. This, in turn, is expected to improve health related quality of life.

Dose-adjusted direct oral anticoagulants (DOACs) in patients with acute leukemia: experience of a tertiary cancer care center.

Dose-adjusted direct oral anticoagulants (DOACs) in patients with acute leukemia: experience of a tertiary cancer care center.

EP.12A.37 Erlotinib: A Beacon of Hope in EGFR TKI-Progressed Lung Cancer, A Real-World Experience from a Tertiary Care Cancer Centre in South India

EP.12A.37 Erlotinib: A Beacon of Hope in EGFR TKI-Progressed Lung Cancer, A Real-World Experience from a Tertiary Care Cancer Centre in South India

Myeloid sarcoma: A 7-year retrospective study from a tertiary cancer care center, illustrating the clinical, morphological, and immunohistochemical features

Myeloid sarcoma: A 7-year retrospective study from a tertiary cancer care center, illustrating the clinical, morphological, and immunohistochemical features

Feasibility, Safety, and Factors Predicting Completion of CROSS Protocol–Based Neoadjuvant Chemoradiotherapy for Esophageal Squamous Carcinoma: Experience from an Indian Tertiary Care Cancer Center

Background Neoadjuvant chemoradiotherapy (NACRT) using the ChemoRadiotherapy for Oesophageal cancer followed by Surgery Study (CROSS) protocol has improved esophageal cancer outcomes. This study reports the real-world experience of the CROSS regimen for esophageal squamous cell carcinoma (ESCC) regarding its feasibility, safety, and predictors of treatment completion from an Indian tertiary center. Methodology A retrospective review was conducted for patients with ESCC receiving CROSS (radiation dose: 41.4 Gy) or a modified CROSS (mCROSS; radiation dose: 45 Gy) protocol NACRT between 2015 and 2022. We studied the treatment tolerability, factors predicting NACRT completion, and the effect of completion of its chemotherapy component on the pathological outcomes. Results Of the109 patients (68.8% males; mean age, 56 ± 9 years; Charlson's comorbidity index [CCI] &gt;2, 19.3%; stage III–IVA, 58%; mean tumor length, 5.5 ± 2.1cm; CROSS, 70.6%; mCROSS, 29.4%), all except 4 completed radiotherapy but only 58 (53.2%) patients completed ≥4 cycles of chemotherapy. Forty-nine patients belonged to the “extended” CROSS trial inclusion criteria. Among the 60 patients who fulfilled the CROSS inclusion criteria, only 51.7% were able to complete ≥4 chemotherapy cycles. The commonest reason for noncompletion of chemotherapy was the occurrence of neutropenia (60.8%). Pretreatment hemoglobin (≥12 vs. &lt;12 g%; odds ratio [OR]: 2.76; 95% confidence interval [CI]: 1.10–6.96; p = 0.031), a low CCI (≤2 vs. &gt;2; OR: 2.98; 95% CI: 1.02–8.73; p = 0.047), and radiation therapy techniques (conformal vs. conventional; OR: 3.29; 95% CI: 1.14–9.50; p = 0.028) were associated with completion of chemotherapy (≥4 cycles). Although there was a trend toward improved R0 resection (95.7 vs. 91.4%), reduced node positivity (17.0 vs. 31.4%), and a high pCR (57.4 vs. 48.6%) in patients completing chemotherapy (≥4 cycles) compared with those not completing chemotherapy (&lt;4 cycles), these differences were statistically nonsignificant. Conclusion In this study, ESCC patients receiving the CROSS protocol NACRT could complete their radiotherapy component, but a significant proportion exhibited poor chemotherapy tolerance. Neutropenia was a major factor limiting chemotherapy delivery, but anemia, high CCI, and conventional radiation techniques were also associated with noncompletion of chemotherapy. The omission of a few chemotherapy cycles had no significant effect on the pathological response; however, its impact on cancer survival requires further evaluation.

To study the efficacy of romiplostim in chemotherapy-induced thrombocytopenia in head and neck cancer patients

Objectives Scheduled delivery of adequate dose of chemotherapy is important to replicate the results expected from original trials. In head and neck malignancies, undue delay of chemotherapy is likely to be associated with poor control or progression. Chemotherapy-induced thrombocytopenia (CIT) is one of the reasons to delay chemotherapy. Thrombopoietin agonists (TPO-A) have been found to increase platelet counts by increasing production and mobilization of platelets. Romiplostim is a TPO agonist, studied widely and found to have good impact on prevention and treatment of CIT. The purpose of this study was to analyze the use and effect of romiplostim in CIT in locally advanced head and neck cancer patients. Material and Methods It is a retrospective study regarding practices of romiplostim use in controlling CIT, among patients of locally advanced head and neck carcinoma undergoing induction chemotherapy at a tertiary care cancer center. Data regarding delays in chemotherapy, response assessment, and modification of chemotherapy doses were also noted. Results Out of a total of 110 patients of head and neck malignancy enrolled during the study period, 18 patients received romiplostim support at least once in chemotherapy cycles and were analyzed. All patients were locally advanced and planned for induction chemotherapy. Median platelet counts before starting romiplostim was 76,000 per cumm. A median delay of ten days was noted among these cases where romiplostim was introduced after the first cycle of chemotherapy. Patient receiving romiplostim after the second cycle (n = 6) showed a median delay of 11.5 days (6–18 days) in the initiation of subsequent chemotherapy. None of them was shifted out of chemotherapy plan due to low platelet count. No dose reduction was noted in any of the cases. Conclusion This study provides a good insight about feasibility of using romiplostim in this subset of patients without delay, dose reduction, or discontinuation of chemotherapy.

SP3.3 - Real World Experience of 600+ Minimally Invasive Abdominoperineal Resections (APR) Done for Low Rectal Cancers in Tertiary Cancer Care Center

Abstract Introduction APR is standard of care surgery for low rectal cancers involving sphincter. Surgery is commonly done in minimally invasive way. Robotic surgery has recently gained popularity due to ease of procedure. Margin positivity and local recurrence still remain a challenge. Methods It is a retrospective study from prospectively maintained database from Aug 2013 to Aug 2023. Surgical and oncological outcome were analyzed using SPSS version 25 software. Results Total 657 minimally invasive APRs were done. All were done in supine lithotomy position. 570 were laparoscopic and 87 robotic. Mean age was 48.4 years. 6 cases were converted to open (5 lap and 1 robotic). Mean BMI was 22.3. Mean distance from anal verge was 3 cm. Majority patients were cT3 (74%). Median blood loss was 150 ml. Clavien Dindo grade III and beyond complications were seen in 11.2%. Mean hospital stay was 7 days. Mean nodes harvested were 13. Mean no of positive nodes were 1.22. Extended resections (extended TME) were 25% in lap and 42% in robotic. Poorly differentiated and signet histology was seen in 27%. CRM positivity was 6.9%. It increases to 15.5% in signet ring histology. Median follow up achieved was 46 months. Local recurrence was 5.5%. Distant recurrence was 20%. 3-year OS and DFS were 73% and 63% respectively. Conclusion In high volume minimally invasive surgery centre, MIS abdominoperineal resection - both laparoscopic and robotic has acceptable surgical and oncological outcomes.

Real-World Experience of Clinical Outcomes of Microscopic Margin Positivity After Radical Gastrectomy from a Tertiary Cancer Center in Northeast India

AbstractSurgical resection for gastric adenocarcinoma (GAC) remains the only potentially curative treatment, and the use of neoadjuvant and adjuvant therapy improves survival in patients with advanced gastric cancer. Margin-positive resection is a known poor prognostic factor. A retrospective observational study of patients undergoing radical gastrectomy of any type for GAC was done at a tertiary care cancer center in Northeast India. The study included patients who were operated on from 1 January 2017 to 31 December 2021 (5 years), and they were followed up to 31 March 2024. A total of 172 patients underwent gastrectomy of any type for GAC during the study period of which 13 patients were found to have microscopic positive (R1) histopathological margin (7.6%). The median age of the patients with positive margins was 48 years (range 27 to 69 years). The male-to-female ratio was 9:4. Ten patients (77%) had poorly differentiated or signet-ring cell carcinoma. The distal margin was the most frequent margin which was positive (84.6%). Neoadjuvant chemotherapy was used in only 23.1% patients. At the end of our study period, only 1 patient out of 13 patients was alive. Median disease-free survival (DFS) was 16.2 months (95% confidence interval 1.2 to 31.1 months). Median overall survival (OS) was 20.2 months (95% confidence interval 9.3 to 31.2 months). Patients who have microscopic positive margins after gastrectomy are found to have a high incidence of poorly differentiated or signet-ring cell carcinoma.

Diagnostic Accuracy and Incremental Value of Contrast-Enhanced Mammography Compared With Full Field Digital Mammography in a Tertiary Cancer Care Center.

To assess the diagnostic accuracy and incremental value of contrast-enhanced mammography (CEM) compared with full-field digital mammography (FFDM). A retrospective analysis was performed with 150 consecutive patients who underwent CEM at our institute between November 2020 and February 2021, fulfilling the inclusion criteria. The first round of analysis included a review of FFDM with an interpretation of findings as per the Breast Imaging Reporting and Data System (BIRADS) lexicon and the assignment of the BIRADS category to the detected abnormalities. After this documentation, a second round of analysis included a review of recombined subtracted images of CEM. The diagnostic accuracy of FFDM and CEM was calculated with histopathology as the gold standard. Among the 150 cases assessed, 202 lesions were detected with histopathological correlation, of which 42 were benign and 160 were malignant. The sensitivity of FFDM was 90.6% compared to 98.12% for CEM. The specificity of FFDM was 66.7% compared to 76.19% for CEM. The negative predictive value (NPV) of FFDM was low, at 65.12%; CEM showed a better NPV, at 91.43%. The positive predictive value (PPV) was almost the same, at 94.01% for CEM and 91.19% for FFDM. The area under the curve (AUC) was superior for CEM compared to that of FFDM, with a value of 0.87. FFDM had a low sensitivity, especially in dense breast parenchyma, at 88.79% and a specificity of 70%, whereas CEM showed a higher sensitivity, specificity, and NPV, measuring 99.14%, 76.67%, and 95.83%, respectively. Superior sensitivity and high NPV for CEM make it a preferable modality compared with FFDM, especially in dense breast parenchyma, where CEM overcomes the limitations of FFDM. We conclude that CEM is superior to FFDM in evaluating the extent of disease, additional satellite lesion detection, and ruling out ambiguous findings.

Nd-YAG laser-assisted pulmonary metastasectomy: initial experience from a tertiary care cancer center in India.

Pulmonary metastasectomy is recommended for metastatic lung lesions when R0 resection is possible, the primary site is in controlled status, surgery is of low risk, and extrathoracic metastases are absent. We present the initial experiences of laser-assisted surgery (LAS) for pulmonary metastatic lesions from a tertiary care cancer center in India. All patients undergoing non-anatomical pulmonary metastasectomy between September 2022 and January 2023 for synchronous and metachronous lesions, operated on by a single consultant thoracic oncosurgeon in a tertiary care center of India, were identified from a prospective database. Ten patients with 124 metastatic lesions were included in the study. A hybrid approach (video-assisted thoracoscopic surgery (VATS) with mini-thoracotomy) was performed. Measurements of total lesion volume and lung parenchyma resected were taken from the final histopathological analysis of the intraoperative sample. LAS was performed for 102 lesions and stapled wedge resection for 22 lesions. Evidence of malignancy was noted in 88/102 (86.3%) of the lesions excised. Patients with LAS had advantages of parenchyma preservation, less postoperative morbidities, and shorter hospital stays. LAS of pulmonary metastatic lesions addresses more lesions in a single sitting; the bilateral lung lesions can be operated and has parenchyma preserving and good sealant properties. The online version contains supplementary material available at 10.1007/s12055-024-01723-8.

Laparoscopic Sentinel Lymph Node Mapping Using Indocyanine Green Dye in Endometrial Cancer: Experience from a Tertiary Cancer Care Centre in South India

Laparoscopic Sentinel Lymph Node Mapping Using Indocyanine Green Dye in Endometrial Cancer: Experience from a Tertiary Cancer Care Centre in South India

Pilot Testing and Vernacular Translation of EORTC Patient Satisfaction Questionnaire (PATSAT-C33 and OUT-PATSAT7) at a Tertiary Care Cancer Center in India

Purpose Pilot testing and translation of the English version of European Organization for Research and Treatment of Cancer (EORTC) patient satisfaction cancer core questionnaire (PATSAT-C33) and complementary outpatient module (OUT-PATSAT7) into two Indian vernacular languages (Hindi and Marathi). Methods Patients undergoing fractionated radiotherapy for cancer with basic proficiency in respective language were included in the study after written informed consent. The English version of EORTC PATSAT-C33 and OUT-PATSAT7 questionnaire was pilot tested in 20 patients. The questionnaire was then translated into two Indian vernacular languages (Hindi and Marathi) using EORTC translation methodology. This included forward-translation by two independent professional translators into target languages (Hindi and Marathi) to create an intermediate version; back-translation into English by another independent pair of linguistic experts; and harmonization by comparing back-translated versions (English) to the original English version for reconciliation. The EORTC translation group provided suggestions and proofread the reconciliated versions (Hindi and Marathi) which were then administered to 20 patients in each language. Semistructured interviews were conducted for patients to identify problems in understanding the translation versions to make appropriate corrections/modifications to the questionnaire. Results Pilot testing of English version of PATSAT-C33 and OUT-PATSAT7 did not pose any major difficulty leading to subsequent translation into both target languages (Hindi and Marathi). Reconciliated version of the translated questionnaires was arrived at after incorporating suggestions and proofreading by the EORTC translation group. Pilot testing of the reconciliated questionnaires (Hindi and Marathi) did not identify major problems in understanding, difficult/confusing words, or upsetting questions leading to the adoption of the reconciliated version as final translated questionnaire without further modifications. Conclusion The English version of PATSAT-C33 and OUT-PATSAT7 has been successfully translated into Hindi and Marathi languages using standardized EORTC methodology. Psychometric properties of the same are currently being tested for validation in a larger Indian cohort.

Outcomes of Squamous Cell Carcinoma Oropharynx in Elderly Patients Treated with External Beam Radiation Therapy - A Retrospective Study from Tertiary Care Cancer Center - India

Background: Majority of Elderly patients with oro-pharyngeal Squamous cell (OPSCC) are treated with External beam Radiation Therapy(EBRT) alone, the benefit of chemotherapy after 70years is doubtful, we aim to analyze outcomes and morbidity in elderly OPSCC treated with EBRT. Methods: Retrospective study, all patients with Oropharyngeal squamous cell carcinoma histology, more than or equal 70 years of age, having performance status Eastern Cooperative Oncology Group (ECOG) 0-2, All stages other than metastatic disease, who were registered and treated with Radical radiation therapy alone at our institute from January 2015 to December 2018 were included. Having ECOG performance status 3-4, Patients treated with brachytherapy, or concurrent chemoradiation, synchronous primaries, re-irradiation are excluded from this study. Entire cohort of 30 patients (25 male, 5 female) were treated with EBRT, who received total dose 50Gy to 66Gy were included for analysis. Results: 90% of cases (27/30) were locally advanced (Stage III &amp; IV), At median follow up duration of 18months (range 1 to 81 months), at 3, 4, and 5 years OS was 36.7% (95% Confidence interval (CI) = 19.4% - 54%), 23.3% (95% CI = 8.2% - 38.4%) and 19.4% (95% CI = 5.1 - 33.7%) respectively. Conclusion: compared to young, elderly OPSCC has poor outcomes, this subset may do as well as young people if treated with multi modality treatment with proper selection. By addressing the risk factors , using preventive measures, early detection , and ensuring access to the adequate health care facilities are pivotal in reducing the burden of cancer. Poor representations of this subset of population in clinical trails, facing challenges treating with multi modality approach may be one of the reason for poor outcomes compared to the young patients, needs prospective trails specifically focusing on this group of patients should be performed.

Clinical course of atypical parathyroid neoplasm with soft tissue extension.

The American Joint Committee on Cancer (AJCC) TNM staging system defines atypical parathyroid neoplasia (APN) as tumor in situ (Tis) and reserves the definition of parathyroid carcinoma (PC) to parathyroid tumor with invasion into surrounding structures. Because the parathyroid gland has no true capsule, "extension" with APN versus microscopic "invasion" of surrounding soft tissue can be difficult and confusing for clinicians. We aimed to determine the clinical course of atypical parathyroid neoplasm with and without soft tissue extension and parathyroid carcinoma with only soft tissue invasion (pT1) and to report the outcomes. Following an IRB-approvedprotocol, we identified all patients treated for parathyroid neoplasm or cancer at our single tertiary care cancer center from 1990 to 2021. We excluded all patients with evidence of clinical or pathologic gross invasion into surrounding structures (pT2 or higher), lymph node involvement, or metastatic disease. By definition, this excluded all cases where the distinction was clinically evident to the surgeon at the time of the operation based on finding a hard, firm, sticky, or discolored parathyroid gland. Only patients with pathologic T1 (pT1) parathyroid carcinoma or APNwere included. All pathologic examinations were independently re-reviewed by a single designated expert senior endocrine pathologist. The definition of APN strictly followed the WHO definition of a clinically worrisome lesion having features including fibrous bands or increased mitotic rate, necrosis, or trabecular growth that did not meet robust criteria for frank invasion. Pathologic T1 disease was defined as invasion limited to soft tissue. Analyses were performed using R version 4.0.2 and Jamovi. Of all PCpatients at our institution, only 71met the strict inclusion criteria of APN or pT1. Forty-four patients had pT1 disease and 27 had APN: 12 of the APN had soft tissue extension, and 15 had no soft tissue extension. The groups were similar with regard to age at diagnosis (p = 0.328). The average follow-up duration was 84 months from initial surgical intervention. Of the 12 with APN, one patient (1/12; 8%) with soft tissue extension recurred, developed distant metastases, and subsequently died during follow up. Of the 44 patients with pT1 PC, six developed distant metastases and 13 (13/44; 30%) died during the follow-up period. One patient with APN and soft tissue extension recurred and died and no patient with APN and no soft tissue extension died. Patients with APN and extension into soft tissue have a clinical course similar to that of APN without soft tissue extension. APN with soft tissue extension is a different disease from pT1 disease with invasion of soft tissue. The pTis classification appears justified for APN with and without soft tissue extension.

Cost-effectiveness of treating childhood acute myeloid leukemia at a tertiary care center in North India.

Childhood cancers are a significant global health concern, particularly in low- and middle-income countries (LMICs), where over 80% of childhood cancer patients reside. In India, acute myeloid leukemia (AML) constitutes a significant portion of childhood cancers; however, the data on the cost-effectiveness of childhood AML treatment in India and other LMICs remain limited. The study focused on children (<15years of age) diagnosed with AML at a tertiary care cancer center in North India. Data, including treatment outcome, treatment-related morbidity, mortality, and costs were retrospectively collected from the electronic medical record and hospital database. Cost-effectiveness was assessed using disability-adjusted life years (DALY) averted in relation to the country-specific cost-effectiveness threshold. Among 59 AML patients, treatment-related high mortality rates, abandonment, and limited access to bone marrow transplantation were notable challenges. Intensive chemotherapy resulted in substantial sepsis-related complications, with treatment-related mortality reaching 30%. The 3-year event-free survival and overall survival of the 43 patients who received intensive therapy were 24.5%±7.6% and 27.9%±8.3%, respectively. Despite these challenges, treating childhood AML was still found to be cost-effective. The total cost per newly diagnosed patient treated with curative intent was $4454. Cost per DALY averted accounted for 24% of the gross domestic product (GDP) per capita, rendering the treatment to be cost-effective with a stringent cost-effectiveness threshold utilized. The study underscores the challenges faced while treating childhood AML in LMICs, including treatment-induced high sepsis-related mortality and abandonment. Despite these challenges, it remains cost-effective to treat childhood AML in India. Future efforts should focus on reducing treatment-related morbidity and mortality to further improve outcomes and cost-effectiveness.

Prevalence of pathogenic or likely pathogenic germline mutations in patients with metastatic renal cell cancer.

110 Background: Data from the West suggests that 5-10% of patients with metastatic renal cell cancer (RCC) are known to harbor a pathogenic/likely pathogenic mutation in the RCC-associated genes. However, there are no data from the Indian subcontinent in this regard. Methods: This study was a prospective single-center cohort study conducted at a large tertiary care cancer center in northern India. Patients newly diagnosed with metastatic RCC were eligible to participate and, if willing, were offered pretest counseling and germline genetic testing. We performed whole exome sequencing on blood samples using next-generation sequencing on the Illumina platform. The frequency and spectrum of pathogenic/likely pathogenic (P/LP) variants were determined and classified using the ACMG guidelines, and clinical characteristics associated with mutation status were analyzed using a Fisher's exact test. Results: A total of 156 patients with metastatic RCC were enrolled in this study from October 2023 to February 2024. The median age at diagnosis was 44 years, and 67% were men. Histologically, 64% had clear cells, 12% had papillary, and 8% had unknown histology. In RCC-associated genes, 6 patients (3.8%) had P/Lp mutations, of which 4 had mutations in FH and 2 in VHL. Further P/LP variants in the non-RCC genes were detected in 12 additional patients (7.7%), of which 4 were in ATM, 2 in BRIP1, and one each in BRCA1, BARD1, PALB2, MUTYH, MSH6, and PMS2, respectively. The presence of germline P/LP mutation was associated with non-clear histology but not with age and sex. Patients with a P/LP mutation were more likely to have a family history of other cancers (most common, breast cancer) in first and second-degree relatives. Conclusions: 11.5% of patients with metastatic RCC were detected with germline P/LP variants, of which one-third had one of the RCC genes, and the rest had non-RCC gene mutations. Patients with mRCC should have access to germline genetic testing, and the gene panel for patients needs to be expanded to include genes previously classified as non-RCC genes.

Happiness and Impacts of Various Factors on the Happiness of Physicians Working in a Cancer Institute, North East India

Objective: To identify how happy are the physicians working in an Oncology setup and how different factors influence the happiness levels of these doctors working in this challenging setup. Materials and methods: This is an observational study designed to be carried out at a Tertiary Cancer Care Centre. The survey was conducted from 1st July to August 30th, 2023. Self-administered Oxford Happiness Questionnaire was used, which is a closed-ended questionnaire. Those who were not willing to participate and whose work/ course duration was less than 6 months were not included in the study. Stephen Wright scoring was used. A score between 1-2 was interpreted as not happy, 2-3 meant somewhat unhappy, 3-4 was for not particularly happy, 4 represented somewhat happy, 4-5 was interpreted as rather happy or pretty happy, a score between 5-6 means very happy, 6 meant too happy. Results: Out of 93 study subjects, 54 were men (58%) and 39 (42%) were women. Of 93 doctors, 68 (73.1%) were happy. Of 68 doctors, a somewhat happy category was 31 (33.3%) doctors, followed by 29 (31.2%) being pretty happy, and 8(8.6%) doctors who were very happy. Twenty-five (26.9%) doctors were unhappy. Conclusion: The majority of doctors working in an oncology set-up were happy with no difference in gender. However, men were more likely to be very happy compared to women.