Tumor Locations Research Articles

Surgical Outcomes for Nonmelanoma Skin Cancer of the Head and Neck.

There is no consensus on elective lymphatic dissection of the parotid and neck for nonmelanoma skin cancer (NMSC) due to challenges in detecting occult spread to these regions. This study aimed to summarize clinical data and evaluate correlations between risk factors, nodular metastasis, and the need for elective parotidectomy in patients with cutaneous squamous cell carcinoma (CSCC), Merkel cell carcinoma (MCC), and apocrine carcinoma (AC) of the head and neck, all with clear surgical margins and negative imaging results for regional metastases. We retrospectively reviewed 166 patients with CSCC, one with MCC, and one with AC of the head and neck, all treated surgically between September 2006 and July 2022. The neck and parotid nodes were imaged preoperatively, and nodular metastases were verified by pathological examination. Age, maximum primary tumor dimension, and primary tumor depth were evaluated in patients with and without nodular metastases. Seven patients developed nodular metastases after primary tumor excision. Facial paralysis occurred in three of five patients with parotid spread. Age and primary tumor size differed significantly between patients with and without nodular metastases (P < 0.05). Tumor depth did not differ significantly between these groups (P > 0.50). Negative imaging results of nodular metastases before primary tumor excision and clear margins did not imply exemption from nodular metastases postoperatively. Nodular spread of CSCC is associated with multiple risk factors rather than any single factor. Elective parotidectomy is recommended to prevent facial nerve invasion by occult nodular metastasis in patients with CSCCs with advanced age, large primary tumor size (≥T3), critical tumor locations, and/or pathological types with high metastatic potential.

Correlation between p53 immunoexpression and TP53 mutation status in extrapulmonary small cell neuroendocrine carcinomas and its association with patient survival.

Extrapulmonary small cell neuroendocrine carcinoma (EP-SCNC) is a rare malignancy with a poor prognosis. Despite its morphological similarity to lung small cell carcinomas, its oncogenesis remains uncertain. One hundred and seventy-one EP-SCNC were enrolled in a multicenter study, and all tissue samples underwent an immunohistochemical p53 analysis. One hundred twenty-five samples were molecularly analyzed using next-generation sequencing (NGS), comprising DNA and RNA analysis. p53 normal/wild type expression was detected in 68 cases (39.8%), whereas aberrant expression was detected in 103 cases (60.2%). Molecular TP53 alteration was detected in 92 out of 125 tumors (73.6%). The TP53 mutation was shown to be prognostic andassociated with shorter overall survival (p = 0.041). The multivariate analysis of p53 and TP53 mutational status found that it impacted overall survival relative to distinct sites of tumor locations (p = 0.004 and p = 0.001, respectively). Age did not influenced survival in the multivariate analysis of p53 and TP53 (p = 0.002; p < 0.001resp.). Among tumors with paired immunohistochemical and molecular results, 108 exhibited concordance between the immunohistochemical and molecular analysis, whereas 17 were discordant. Accordingly, p53 aberrant expression was tightly associated with a TP53 mutation (p < 0.001). In discordant cases, molecular analysis revealed no alteration in three tumors with p53 overexpression. In contrast, in 14 tumors with wild-type p53 expression, TP53 genetic alteration was detected. Possible causes of discordance are discussed in this manuscript. Furthermore, the incidence of aberrant p53 expression / TP53 molecular alteration was noticeably lower in EP-SCNC than in small-cell lung carcinomas. Therefore, in EP-SCNC, other driver mutations should be sought since personalized therapy can improve patient prognosis.

Progression of nutritional impact symptoms in cancer patients undergoing radiotherapy.

To analyze the presence of nutritional impact symptoms (NIS) throughout radiotherapy treatment in the head and neck, thorax, abdomen, and pelvis areas. A prospective cohort study was conducted with individuals undergoing radiotherapy for cancer. Three assessments were carried out: at the start of radiotherapy, midway through, and in the last week of treatment. Clinical, anthropometric data, and the Patient-Generated Subjective Global Assessment (PG-SGA) were used to assess symptoms. A total of 254 participants were evaluated at the start, 165 at the midpoint, and 120 at the end of the treatment. More than half of the participants at all stages were elderly. At the start, 51.6% were women, while at the end, 57.5% were men. Pelvic tumors were the most common, followed by tumors in the head and neck and thorax. The prevalence of NIS increased from 58.2% at the beginning to 76.9% at the midpoint (RR 1.32; 95% CI 1.17-1.48; p = < 0.001) and 78.3% at the end of treatment (RR 1.34; 95% CI 1.18-1.52; p = < 0.001). Odynophagia was the most reported symptom among patients with head and neck tumors, increasing from 24.5 to 66.6%, and from 3.0 to 22.2% by the end of treatment in patients with thoracic tumors. Diarrhea was common at the end of treatment among those with abdominal (69.2%) and pelvic (35.8%) tumors. NIS increased during radiotherapy. The location of tumors influences symptom prevalence, highlighting the need for continuous nutritional support.

Tumors of the orbit and periorbital region: 20-year experience of the N.N. Blokhin National Medical Research Center of Oncology

Introduction. Neoplasms of the orbit and periorbital region are usually represented by tumors of the eyelid skin skin of the periorbital region and paranasal mucosa. The most common histological types of this pathology are squamous cell and basal cell carcinomas. The main indications for orbital exenteration are tumor lesions in the extraocular muscles and orbital apex and irreversible vision loss in the affected eye at the time of surgery planning. In the absence of these pathologies organ-sparing surgery is recommended. Resection of orbital and periorbital tumors (including orbital exenteration) leads to cosmetic and functional defects therefore surgical treatment of this area should be performed only if other methods are impossible or ineffective.Aim. To analyze the experience of resection of orbital and periorbital tumors and to evaluate short- and long-term results of surgical treatment of this pathology.Materials and methods. Retrospective analysis of patients with tumors of the orbit and periorbital region who underwent organ-sparing and exenteration surgeries between 2003 and 2023 was performed.Results. Overall 5-year survival was 55 %. It varied depending on a number of factors. The best 5-year survival rates were observed for basal cell carcinoma of the eyelid skin and periorbital region (83 %) the worst for squamous cell carcinoma (34 %) and melanoma (41 %). For localized tumors (Т1) overall survival was 76 % for locally advanced (Т4) – 43 %.Conclusion. Orbital and periorbital neoplasms are characterized by a variety of tumor morphological types and locations which requires multidisciplinary approach to treatment and rehabilitation of patients with this pathology.

PET Imaging of Solid Tumors with a G-Quadruplex-Targeting 18F-Labeled Peptide Probe.

Positron emission tomography (PET) is a common imaging technique and can provide accurate information about the size, shape, and location of tumors. Recent evidence has shown that G-quadruplex structures (G4s) are identified in human oncogenes, and these special structures are recognized as diagnostic cancer markers and drug targets for anticancer therapies. Although a number of techniques for in vivo imaging of G4s have been developed, achieving sufficient sensitivity and selectivity in vivo remains challenging. Herein, we have engineered and developed a radiolabeled peptide probe [18F]AlF-NOTA-RHAU18 targeting mitochondrial DNA G4s for in vivo PET imaging. The results of the study indicate that this probe is able to visualize and detect solid tumors in living homozygous mice. In addition, the distribution of the probe in cancer cells was investigated using FITC-RHAU18. This work may offer new insights into the development of cancer diagnostic tools by targeting in vivo G4s.

Laparoscopic pancreatic enucleation: how far should we go for parenchyma preservation? A study by the French National Association of Surgery.

Pancreatic enucleation is indicated for selected patients and tumours with very low oncological risk to preserve a maximum of healthy pancreatic parenchyma. Minimally invasive pancreatic enucleation (MIPE) is increasingly performed. This study aims to assess the impact of tumor location and center experience on textbook outcomes (TBO) in patients undergoing MIPE. Retrospective nationwide multicentric cohort study including MIPE performed between 2010 and 2021. Tumor localization was classified as head/uncus, neck or body/tail (results are presented in this order). Centers were classified according to a mean volume of MI pancreatectomies performed per year: lower (< 5/year), intermediate (5 to 10/year) and higher volume (≥ 10/year). TBO was defined as meeting all 6 criteria: no postoperative pancreatic fistula (POPF), no post-pancreatectomy haemorrhage (PPH), no bile leak, no readmission, no mortality, and no severe morbidity. 27 participating centers performed 200 MIPE located in head/uncus (n = 65, 33%), neck (n = 26, 13%) and body/tail (n = 109, 55%), 8% of them performed by robotic approach. Mortality reached 1.5% (n = 3). Head/uncus lesions were larger (p = 0.03), frequently BD-IPMN (p = 0.04), with significant longer operative time (p = 0.002). TBO achievement was high across all tumor locations (52 vs. 73 vs. 67%, p = 0.09) with higher PPH (p = 0.03) or bile leaks (p = 0.03) for head/uncus lesions. In multivariate analysis, overweight (OR 0.49), preoperative biopsy (OR 0.41) and head/uncus lesion (OR 0.34) were independently associated with lower TBO. No independent risk factor was found for POPF or severe morbidity. While expertise level influenced indications, with more cystic lesions (p = 0.002), larger tumors (p = 0.003), 3D use (p = 0.001), and head/uncus lesions (p = 0.04) in high volume centers, TBO was not significantly different (p = 0.45). MIPE is feasible with 1.5% mortality whatever its localization with higher morbidity for head/uncus lesions, justified by the will to avoid pancreaticoduodenectomy. High volume centers push the limits of MIPE without increasing morbidity.

18F-FAPI-42 PET/CT and 18F-FDG PET/CT in Patients with Malignant Digestive System Neoplasms: A Head-to-Head Comparative Study.

Radionuclide-labeled fibroblast activation protein inhibitor (FAPI) is an emerging tumor tracer. We sought to assess the uptake and diagnostic performance of 18F-FAPI-42 PET/CT compared with simultaneous 2-deoxy-2[18F]fluoro-D-glucose (18F-FDG) PET/CT in primary and metastatic lesions in patients with malignant digestive system neoplasms and to determine the potential clinical benefit. Forty-two patients (men = 30, women = 12, mean age = 56.71 ± 13.26years) who underwent 18F-FDG PET/CT and 18F-FAPI-42 PET/CT simultaneously for diagnosis, staging, and restaging were enrolled. Quantitative data, including standardized uptake value (SUV), tumor-to-liver ratio (TLR), and tumor-to-blood pool ratio (TBR), were analyzed. Two independent readers performed a visual assessment of lesion number and location on PET/CT images. Interobserver agreement between two examinations was calculated using Cohen's kappa (κ). Primary tumor locations included the liver (n = 20), stomach (n = 9), pancreas (n = 5), and intestine (n = 10). More intense 18F-FAPI-42 uptake and higher tumor-to-background contrast were detected in most primary and metastatic lesions compared with 18F-FDG, contributing to improved diagnostic accuracy ranging from 95.24% to 100%. Moreover, additional lesions showing 18F-FAPI-42 uptake in primary, locoregional and distant metastatic lesions were visualized, especially in multiple liver and peritoneal metastases. Patient-based interobserver agreement varied from moderate to strong, with suboptimal outcomes observed in primary tumors (κ = 0.441, P = 0.01) and preferable results derived from metastatic liver and bone lesions (κ = 1 and 0.896, both P < 0.01). 18F-FAPI-42 PET/CT resulted in modified treatment strategies for 40.48% (17/42) of patients, while 18F-FDG PET/CT led to altered therapeutic regimens in only 4.8% (2/42) of patients. In selected patients with malignant digestive system neoplasms, our study shows that 18F-FAPI-42 PET/CT is a promising alternative for assessing primary tumors and metastases and aiding staging, restaging, and decision-making, with higher uptake and better lesion visualization compared with 18F-FDG. Additionally, it may shed light into the treatment selection and response assessment for FAP-targeted therapy or immunotherapy.

A comprehensive multicenter analysis of clinical, molecular, and imaging characteristics and outcomes of H3 K27-altered diffuse midline glioma in adults.

The objective was to comprehensively investigate the clinical, molecular, and imaging characteristics and outcomes of H3 K27-altered diffuse midline glioma (DMG) in adults. Retrospective chart and imaging reviews were performed in 111 adult patients with H3 K27-altered DMG from two tertiary institutions. Clinical, molecular, imaging, and survival characteristics were analyzed. Characteristics were compared between adult and 365 pediatric patients from a previous multicenter meta-analysis dataset. Cox analyses were performed to determine predictors of overall survival (OS) in adult patients. The median (range) age of adult patients was 40 (18-75) years, and 64 males and 47 females were included. Adults had a higher male proportion (57.7% vs 45.3%, p = 0.023), lower proportion of histological grade 4 (41.4% vs 74.0%, p < 0.001), and different tumor locations (p < 0.001) compared with pediatric patients; adults commonly showed a thalamus location (41.5%) followed by the spinal cord (27.0%), whereas pediatric patients predominantly showed a pons location (64.9%). The OS of adults was longer than that of pediatric patients (30.3 vs 12.0 months, p < 0.001, log-rank test). Older age at diagnosis (HR 0.96, p = 0.001), histologically lower grade (HR 0.25, p = 0.003), and gross-total resection of nonenhancing tumor (HR 0.15, p = 0.003) were independent favorable prognostic factors. Adult patients with H3 K27-altered DMG showed distinct clinical, histological, and imaging characteristics compared to pediatric counterparts, with a significantly better prognosis. The authors' results suggest that aggressive surgery should be pursued when deemed feasible for better survival outcomes.

A Novel Encoder Decoder Architecture with Vision Transformer for Medical Image Segmentation

Brain tumor image segmentation is one of the most critical tasks in medical imaging for diagnosis, treatment planning, and prognosis. Traditional methods for brain tumor image segmentation are mostly based on Convolution Neural Network (CNN), which have been proved very powerful but still have limitations to effectively capture long-range dependencies and complex spatial hierarchies in MRI images. Variability in the shape, size, and location of tumors may affect the performance and may get stuck into suboptimal outcomes. In these regards, new encoder-decoder architecture with the VisionTranscoder(ViT) is proposed, to enhance brain tumor detection and classification. The proposed VisionTranscoder exploits a transformer's ability in modeling global context through self-attention mechanisms, providing more inclusive interpretation of the intricate patterns in medical images and classification by capturing both local and global features. The proposed VisionTranscoder maintains the Vision Transformer in its encoder for processing images as sequences of patches to capture global dependencies often outside the view of traditional CNNs. Then the segmentation map is rebuilt at a high level of fidelity with the decoder through upsampling and skips connections to maintain detailed spatial information. The risk of overfitting is hugely reduced by design and advanced regularization techniques with extensive data augmentation. The dataset contains 7,023 human brain MRI images, all of which are in four different classes: glioma, meningioma, no tumor, and pituitary. Images from the 'no tumor' class, indicating an MRI scan without any detectable tumor, were taken from the Br35H dataset . The results show the efficiency of VisionTranscoder over a wide set of brain MRI scans, producing an accuracy of 98.5% with a loss of 0.05. This performance underlines the ability of it to accurately segment and classify a brain tumor without overfitting.

BRAF inhibitor monotherapy in BRAFV600E-mutated pediatric low-grade glioma: a single center's experience.

Pediatric low-grade gliomas (pLGGs) have an overall survival of over 90%; however, patients harboring a BRAFV600E alteration may have worse outcomes, particularly when treated with classic chemotherapy. Combined BRAF/MEK inhibition following incomplete resection demonstrated improved outcome in BRAFV600E altered pLGG compared to combined carboplatin/vincristine chemotherapy and is now considered the standard FDA-approved treatment for this group of tumors. The aim herein was to investigate the efficacy and tolerability of single agent BRAF inhibitor treatment in BRAFV600E altered pLGG. A single institution retrospective chart review analysis was performed on patients, 0 to 21 years of age, with newly diagnosed and/or progressive BRAFV600E mutated pLGGs (WHO Grade 1 or 2) at Children's Healthcare of Atlanta treated off-study with BRAF inhibitor monotherapy between 2013-2023. 2-year progression free survival (PFS) and objective tumor response was evaluated. All toxicities possibly associated with BRAF inhibition therapy were evaluated and described according to Common Terminology Criteria for Adverse Events version 5 (CTCAEv5). MRI brain imaging data at baseline and best response wasevaluated to identify patterns that may predict response to BRAF inhibition monotherapy. Fifteen patients diagnosed with BRAFV600E mutated pLGG, treated with monotherapy BRAF inhibition, were identified. Median age of diagnosis: 3.8 years (0.2 -18.1). Histologic diagnosis: pilocytic astrocytoma (PA) (N=4); ganglioglioma (GGL) (N=3); GGL, atypical (N=3); pleomorphic xanthroastrocytoma (PXA) (N=2); low-grade neuroepithelial tumor (N=1); infiltrating glioma (N=1); and LGG (NOS) (N=1). Tumor locations included: hypothalamus/optic chiasm (N=6); brainstem (N=4); third ventricle/thalamus (N=2); parietal/temporal lobe (N=2); and spinal cord (N=1). Mean duration of BRAF inhibitor monotherapy: 38.41 months (range 3.9-83.7). Median follow-up: 32.6 months (16 - 78.1). Two-year PFS for patients on BRAFi monotherapy for at least 10 months: 90% (95% CI: 73.2%-100%). Objective Response (OR) for 15 evaluable patients on BRAF inhibitor (BRAFi) therapy: 73% (0/15 CR + 6/15 PR + 5/15 MR) with Overall Response Rate (ORR=CR+PR): 40%. Overall, patients tolerated treatment well with Grade 1 rash being the most common toxicity. Two of 15 patients (13%) discontinued therapy due to toxicities, and 2 other patients switched within drug class from vemurafenib to dabrafenib due to toxicities. In this small cohort of incompletely resected BRAFV600E mutated pLGGs, BRAFi monotherapy was effective and well tolerated with an ORR comparable to published prospective outcomes of dual MEK/BRAF inhibitor therapy. This promising monotherapy treatment should be considered when choosing treatment for incompletely resected BRAFV600E-altered pLGGs.

Gastroenteropancreatic Neuroendocrine Tumors: Does Tumor Location Affect Prognosis?

Background: Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are rare entities. Generally, they can be localized anywhere in the gastrointestinal or hepatobiliary tract. The purpose of our study is to evaluate the effect of tumor location on prognosis in patients with GEP-NET undergoing surgery. Our secondary objective is to examine other factors affecting the prognosis of patients with GEP-NET. Methods: We retrospectively analyzed data from 30 patients with GEP-NET who underwent surgery in the General Surgery Clinic between 2012 and 2022. The gNET group (n=18) included tumors located in the gastrointestinal tract, while the pNET group (n=12) included tumors located in the hepatopancreatobiliary system. Surgical, laboratory, radiological, and pathological findings of the patients, as well as follow-up outcomes were recorded and statistically analyzed. Results: In subgroup comparison, tumor size was found to be larger in the pNET group (P=0.002). The statistical analysis of recurrence (16.7% versus 33.3%) and mortality rates (16.7% versus 41.7%) between the subgroups (P=0.329 and P=0.210, respectively) did not reveal a significant difference. When all patients were evaluated, it was observed that advanced age, presence of carcinoma diagnosis, higher tumor grade, advanced TNM stage, larger tumor size, presence of lymphovascular or perineural invasion, elevated mitotic index, higher Ki-67 index, and having received adjuvant therapy increased the rates of recurrence and mortality. Conclusion: There was no statistically significant difference in survival outcomes between the GEP-NET groups located in the gastrointestinal tract and the hepatopancreatobiliary system.

Small cell lung cancer unveiled: Exploring the untapped resource of circulating tumor cells-derived organoids.

Small cell lung cancer (SCLC) remains a challenge in oncology due to its aggressive behavior and dismal prognosis. Despite advances in treatments, novel strategies are urgently needed. Enter liquid biopsy-a game-changer in SCLC management. This revolutionary non-invasive approach allows for the analysis of circulating tumor cells (CTCs), offering insights into tumor behavior and treatment responses. Our review focuses on a groundbreaking frontier: harnessing CTCs to create three-dimensional (3D) organoid models. These models, derived from CTCs that break away from the primary tumor or metastatic locations, hold immense potential for revolutionizing cancer research, especially in SCLC. We explore the essential conditions for successfully establishing CTC-derived organoids-a transformative approach with profound implications for personalized medicine. Our evaluation spans diverse isolation techniques, shedding light on their advantages and limitations. Furthermore, we uncover the critical factors governing the cultivation of 3D organoids from CTCs, meticulously mimicking the tumor microenvironment. This review comprehensively elucidates the molecular characterization of these organoids, showcasing their potential in identifying treatment targets and predicting responses. In essence, our review amalgamates cutting-edge methodologies for isolating CTCs, establishing transformative CTC-derived organoids, and characterizing their molecular landscape. This represents a promising frontier for advancing personalized medicine in the complex realm of SCLC management and holds significant implications for translational research.

Swallowing, speech and voice impairments in head and neck cancer patients treated at a multidisciplinary integrated patient unit.

Head and neck cancer (HNC) is amongst the 10 most common cancers worldwide and has a major effect on patients' quality of life. Given the complexity of this unique group of patients, a multidisciplinary team approach is preferable. Amongst the debilitating sequels of HNC and/or its treatment, swallowing, speech and voice impairments are prevalent and require the involvement of speech-language pathologists (SLPs). In 2018, an integrated patient unit (IPU) for HNC patients was established which includes healthcare professionals from diverse fields including SLPs. To characterize the demographic and clinical profiles of HNC patients and assess SLP therapy efficacy in these patients with respect to swallowing, speech and voice functionality. Demographic and clinical information was collected for the first 100 HNC patients referred to SLP evaluation in the IPU. In addition, different measures of swallowing, speech and voice functionality were taken pre- and post-SLP therapy to estimate if and how the therapy improved the patients' performance in these aspects. Analysis revealed that 84%, 36.2% and 33% of the patients suffered from swallowing, speech and voice impairments, respectively. Treatment types (surgery and radiation, chemotherapy and radiation) and the prevalence of speech and voice impairments varied amongst tumour locations (larynx, oral cavity, pharynx), whilst swallowing impairments were highly prevalent across all tumour locations. Speech impairments were more common in patients treated with a combination of surgery and radiation. Comparison between pre- and post-SLP therapy-related measures revealed that swallowing, speech and voice functionality significantly improved following SLP therapy. The holistic, multidisciplinary approach in the IPU contrasts with the more segmented care typically provided in out-patient/community clinics, making SLP therapy within the IPU uniquely integrated and effective. The protocol established at the IPU provides a valuable framework for SLP assessment and therapy in HNC patients exhibiting swallowing, speech and voice impairments with the ultimate goal of improving their quality of life. What is already known on the subject Many HNC patients suffer from swallowing, speech and voice impairments which have a substantial impact on their quality of life. Nevertheless, many current clinical practices do not include SLPs as an integral part of the healthcare team. Moreover, there are no common guidelines for SLP therapy in this unique group of patients. What this paper adds to the existing knowledge In this study we provide a detailed demographic and clinical profile of a large cohort of HNC patients that were referred to SLP evaluation in a newly developed and designated IPU. We provide a comprehensive description of clinical interventions that were applied based on the location of the tumour and specific impairments related to it. Additionally, SLP therapy outcomes are described, showing a significant improvement in swallowing, speech and voice functionality. What are the potential or actual clinical implications of this work? Study results support the inclusion of an SLP in HNC patients' IPUs. The multidisciplinary healthcare approach enabled the provision of a tailored SLP therapy to the specific tumour types and impairments and proved efficient, resulting in favourable outcomes.

Long-term survival and risk factors in esophageal squamous cell carcinoma: A Kaplan-Meier and cox regression study.

The global incidence of esophageal cancer (EC) remains high. Despite advancements in medical technology and deeper research into the causes and treatment methods of EC, the effectiveness of treatment for EC is still unsatisfactory. Therefore, it is crucial to address the urgent problem of improving the long-term survival rate of EC patients and providing personalized treatment. To analyze the survival prognosis and influencing factors of esophageal squamous cell carcinoma (ESCC). A retrospective analysis was conducted on the clinical data of 115 patients with pT3N0M0 ESCC who underwent radical surgery alone from January 1, 2013, to December 31, 2019. The Kaplan-Meier method was used to evaluate the 1-year, 3-year, and 5-year survival rates and median survival time of the patients. The Cox proportional hazards regression model was used to assess the hazard ratios (HRs) and 95% confidence intervals (95%CIs) of risk factors. The 1-year, 3-year, and 5-year overall survival (OS) rates for the 115 EC patients analyzed were 85.22%, 50.43%, and 37.48%, respectively. The median OS was 37.00 (95%CI: 24.93-49.07) months, and the median disease-free survival was 21.00 (95%CI: 14.71-27.29) months. Both univariate and multivariate Cox regression analyses revealed that high body mass index (BMI; HR = 1.137, 95%CI: 1.054-1.226), positive perineural invasion (PNI; HR = 13.381, 95%CI: 4.899-36.547), and smoking (HR = 2.415, 95%CI: 1.388-4.203) were independent risk factors for a poor prognosis. In contrast, compared to the upper thoracic location of the tumor, middle thoracic (HR = 0.441, 95%CI: 0.240-0.810) and lower thoracic (HR = 0.328, 95%CI: 0.144-0.750) locations were protective factors. BMI, tumor location, PNI, and smoking are associated with the prognosis of ESCC patients. This study highlights the prognostic risk factors for T3N0M0 ESCC patients and offers personalized insights for clinical treatment.

Comparison of endoscopic and laparoscopic resection of gastric gastrointestinal stromal tumors: A propensity score-matched study.

Endoscopic resection (ER) and laparoscopic resection (LR) have been widely used for the treatment of non-metastatic gastric gastrointestinal stromal tumors (gGISTs) (2-5 cm), but there are no selection criteria for their application. To provide a reference for the development of standardized treatment strategies for gGISTs. Clinical baseline characteristics, histopathological results, and short-term and long-term outcomes of patients who treated with ER or LR for gGISTs of 2-5 cm in Taizhou Hospital of Zhejiang Province from January 2014 to August 2022 were retrospectively reviewed. Propensity score matching (PSM) was employed to achieve balance in baseline characteristics of the two groups. Among 206 patients, 135 were in the ER group and 71 in the LR group. The ER group had significantly smaller tumors [3.5 cm (3.0-4.0 cm) vs 4.2 cm (3.3-5.0 cm), P < 0.001] and different tumor locations (P = 0.048). After PSM, 59 pairs of patients were balanced. After matching, the baseline characteristics of the ER and LR groups did not differ significantly from each other. Compared with LR, ER had faster recovery of diet (P = 0.046) and fewer postoperative symptoms (P = 0.040). LR achieved a higher complete resection rate (P < 0.001) and shorter operation time (P < 0.001). No significant differences were observed in postoperative hospital stay (P = 0.478), hospital costs (P = 0.469), complication rates (P > 0.999), pathological features (mitosis, P = 0.262; National Institutes of Health risk classification, P = 0.145), recurrence rates (P = 0.476), or mortality rates (P = 0.611). Both ER and LR are safe and effective treatments for gGISTs. ER has less postoperative pain and faster recovery, while LR has a higher rate of complete resection.

Predictive factors for failure of neoadjuvant docetaxel, cisplatin, and 5-fluorouracil therapy in esophageal squamous cell carcinoma.

Recently, neoadjuvant chemotherapy comprising docetaxel, cisplatin, and 5-fluorouracil showed promising efficacy for esophageal squamous cell carcinoma. However, some patients do not achieve curative resection despite neoadjuvant chemotherapy using these drugs. This study aimed to clarify the pretherapeutic characteristics of these patients. We included 113 patients who underwent neoadjuvant chemotherapy with docetaxel, cisplatin, and 5-fluorouracil for potentially resectable esophageal squamous cell carcinoma and compared the clinical characteristics between patients who achieved curative resection (curative group) and those who failed to achieve curative resection after planned neoadjuvant chemotherapy (noncurative group). Moreover, we determined the factors predicting noncurative outcomes. Ninety-one (81%) and 22 patients (19%) were in the curative and noncurative groups, respectively. The noncurative group had significantly more tumors located in the upper third of the esophagus, larger-sized tumors, and borderline resectable tumors than the curative group (P = 0.003, 0.049, and <0.001, respectively). Moreover, the noncurative group had significantly higher serum squamous cell carcinoma antigen concentrations than the curative group (P = 0.008). Multivariable analysis identified tumor location in the upper third of the esophagus (odds ratio 7.31, P = 0.002), tumor size ≥50mm (odds ratio 4.71, P = 0.037), and borderline resectable tumors (odds ratio 6.65, P = 0.003) as independent predictors for noncurative outcomes. Tumor location in the upper third of the esophagus, larger-sized tumors, and borderline resectable tumors might be significant predictors for noncurative outcomes in patients who received neoadjuvant chemotherapy with docetaxel, cisplatin, and 5-fluorouracil.

Effectiveness of cognitive fusion transrectal ultrasound prostate biopsy when compared with final prostatectomy histology.

Prostate cancer (PCa) is the second most commonly diagnosed cancer in men. Cognitive fusion transrectal ultrasound prostate biopsy is one of several modalities for diagnosing this disease. However, no existing studies have shown the clear superiority of one image-guided technique over another. This investigation aimed to evaluate the efficacy of targeted biopsy through cognitive guidance, as well as to assess the accuracy of multiparametric magnetic resonance imaging (mpMRI) in the detection of PCa compared to the specimen obtained by radical prostatectomy (RP). We conducted a retrospective observational single-center study approved by the ethical committee, including men with prostate-specific antigen (PSA) levels between 2-10 mg/ml who underwent RP and cognitive fusion biopsy (CFB) between 2017 January and 2022 January. A total of 639 patients were analyzed, 83 of whom met the inclusion criteria and were enrolled in this study. The overall rate of PCa detection with CFB was 79.5% (median of specific PCa detection was 100%), and the rate of detecting clinically significant prostate cancer (csPCa) was 74.7%. In addition, there was 42.2% agreement between the International Society of Urological Pathology (ISUP) score of the CFB and the RP specimen, which increased to 56.6% when the systematic biopsy was added. Regarding the accuracy of mpMRI, several parameters were evaluated with respect to RP sample histology. Of these, tumor location had a total match rate of 39.8% and a partial match rate of 55.4%. Moreover, regarding extraprostatic extension (EPE), the present study found a significant association between the RP specimen and mpMRI (p = 0.002), with an agreement rate of 60% if it was present in the histology and 79.5% if it was not. Additionally, larger prostates and tumors located in the transition zone were significantly associated with a lower CFB accuracy (p = 0.001 and p = 0.030, respectively). After adjusting for all variables evaluated, only prostate volume remains statistically significant (p = 0.029). In this study, we conclude that mpMRI is highly accurate, allowing good characterization of suspicious tumors and reasonably guiding cognitive biopsy. However, the use of both targeted biopsy through cognitive guidance and systematic biopsy increases the diagnostic accuracy for PCa. Although there is no recommendation in the current literature for one guiding technique over another, we believe that cognitive-guided biopsy should only be reserved for centers with no access to ultrasound or magnetic resonance fusion software.

CECT and CT Perfusion Correlation with Pathological Differentiation of Pharyngeal and Laryngeal Cancers: Study from a Tertiary Care Center in Northeast India

Abstract Introduction Pharyngeal and laryngeal carcinomas, included under head and neck cancers, pose a significant challenge in India, accounting for around one-third of all cancer cases. Noninvasive techniques like contrast-enhanced computed tomography (CECT) and CT perfusion (CTp) can help explore the correlation between tumor differentiations, which can greatly benefit in the diagnosis, understanding of recurrence postintervention, and monitoring of the progress of the disease. Methods A hospital-based cross-sectional study was conducted for a duration of 18 months in a tertiary care center of northeast India with a sample of 40 patients. CECT and CTp were done and the variables were correlated with pathological differentiation of tumors. Results The mean age of the study population was 54 years. No statistically significant associations were noted between the age, size, margins, location, and T-staging of tumors with the pathological differentiation of tumors. However, significant association was found between the CTp parameters, namely blood flow (BF), blood volume, mean transit time, time to drain, and time to peak with respect to the pathological differentiation of tumors (p &lt; 0.05). Conclusion The addition of CTp to conventional CT sequences in the evaluation of pharyngeal and laryngeal cancers offers significant benefits in understanding the tumor physiology and behavior.

The Impact of Brain Tumors on Emotional and Behavioral Functioning.

While the physical manifestations of brain tumors are well-documented, their impact on the emotional and psychological landscape of patients is of equal importance. Patients frequently experience a range of challenges from depression, apathy, and increased aggression to personality changes. The complexity of these changes and their effects on emotional functioning are shaped by tumor characteristics, including location, growth rate,and the corresponding hormonal imbalances.These challenges may ripple outward, affecting not only the patients themselves but also their caregivers. This review aims to examine the diverse emotional experiences associated with various brain tumor types and locations, through understanding the neurobiological mechanisms underlying these changes. The impact of psychosocial factors on emotional distress and coping strategies is also explored, focusing on the critical role of social support and resilience. The need for integrated care that addresses both the physical and psychological aspects of brain tumors is essential for improving the quality of life (QoL) for patients and their families. The close relationship between emotional and cognitive difficulties is analyzed, stressing how these challenges can mutually reinforce each other, creating a convoluted and challenging situation for brain tumor patients. By understanding and addressing these issues, healthcare providers can better support patients and improve their overall QoL. This review seeks to consolidate the current understanding of this complicated relationship, drawing from an array of studies, reviews, and meta-analyses.

Understanding canine oral neoplasia: intrinsic rather than extrinsic features represent key risk factors in a 39-year analysis.

Canine oral neoplasia is often detected late in the course of the disease, necessitating radical surgeries frequently combined with adjuvant chemotherapy or radiotherapy for positive outcomes. Although there has been extensive analytical and epidemiologic work on human oral cancer, research in veterinary medicine has been lacking. This study aimed to evaluate the prevalence and risk factors associated with canine oral neoplasia to enhance early detection by improving screening. Patient data from 1985 to 2024 from the University of California-Davis Veterinary Teaching Hospital were bulk extracted to determine prevalence as well as the effect of clinical and environmental risk factors, including sex, breed, oral location, air quality, and periodontal disease status. The median air quality index (AQI) data were extrapolated from the Environmental Protection Agency's database. Periodontal disease status was evaluated on patient CT scans. The incidence of oral tumors was 4.59/1,000 patients. The median age upon diagnosis was 9.66 years, and 3 breeds were identified as significantly at risk compared to the general patient population. Air quality index, geographical location, and periodontal disease were not associated with oral neoplasia. Different tumor histologies had distinct oral predilection sites. Overall, there was a significant correlation between age/breed and oral neoplasms. Tumor locations were significantly different for each pathology. Other risk factors did not play a substantial role in disease. These findings can aid veterinarians and researchers in targeting screening and treatment strategies in high-risk dogs.