Tumor-related Factors Research Articles

Interval breast cancer: radiological surveillance in screening Egyptian population

BackgroundInterval cancers might be divided into true negative interval cancer where a new lesion is detected that no sign of disease could be detected on previous screening mammogram. For false-negative interval cancers, those missed for overt symptoms and those missed for mild or undetectable ones, this includes interpretive error as benign interval cancer (benign mimics), subtle changes, masked carcinoma or slowly growing or patient factors, such as the dense breast parenchyma. Technical failure interval cancer hampered the reader to discover the abnormality. The aim of this study was to relate the risk factors for the development of the interval breast cancer such as breast density, positive family history of breast cancer in Egyptian population. Highlight the causes of missed breast cancer in order to overcome it in the future radiological interpretation.MethodsA total of 74,546 screening mammographic examinations were performed in the radiology department at specialized breast cancer center in the period between 2015 and 2021 with about 844 pathologically proved malignant cases. Out of the 844 pathologically proven breast cancer cases, 185 breast cancer patients were interval breast cancer having reported normal examination in the previous year, 88 were true interval breast cancer and 97 were missed on mammography and detected later on. The cases were subjected to full-field digital mammogram (FFDM), complementary ultrasound, contrast-enhanced digital mammography (CEDM) and magnetic resonance imaging (MRI) in some cases, and all cases were histopathologically proven by either fine needle aspiration, core needle biopsy (CNB) or open biopsy.ResultsThe mean age of the patients was 53.5 years (range 36–83 years). The overall breast cancer detection rate was 11 per 1000 women. The 185 interval cancers were present at a rate of 3.8 per 1000 women. True negative interval breast cancers where 88 cancers were not present in retrospect on screening mammograms, 17 cases present with benign findings (benign mimics mass or calcifications) and 80 cancers were missed cancers. Analysis of the cause of missed carcinoma revealed patient-related, tumor-related, or provider-related factors. Tumor factors were the most commonly encountered, accounting for 49.5% (48 cases), then provider factors in 25.8% (25 cases) while the patient factors were the least commonly encountered in 24.7% (24 cases). Recorded positive family history found in about 35% (31cases) of the true interval breast cancers.ConclusionsAlthough mammography is the standard for detecting early breast cancer, some cancers can be missed due to various causes. Mammographic interpretation must meet high standards to reduce missed cancers. Radiologists should carefully assess screening views and order additional imaging if needed. Palpable lesions and clinical data should be further examined with ultrasound and contrast imaging if necessary. Always compare current images with previous examinations to check for any changes in lesion size. When one pathology is found, search for additional lesions.

Factors associated with delay in diagnosis of oral cancers

BackgroundOral cancer is one of the ten most common malignancies in the world and approximately 90 % of cases are OSCC. Despite the progress in available treatment modalities, the mortality of patients with OSCC has remained steadily high during the last 20 years. Survival data is strongly influenced by the timing of diagnosis: with more than 50 % of patients being diagnosed at an advanced stage, and their 5-year survival rate being less than 50 %. Therefore, early diagnosis plays a crucial role in improving a patient's prognosis, as early stage cancers show a survival rate of over 90 %, whereas it drops to 5–20 % stage III and IV disease. This prospective study has been conducted with an aim of assessing diagnostic delays and looking at the various patient and tumour factors and their association with them. MethodologyThis prospective observational study was conducted from December 2023 to February 2024. The cases for the present study included cases of oral squamous cell carcinoma diagnosed by clinical, radiological and/or histological confirmation. The patient delay was recorded in days as informed by the patients themselves, about the onset of their symptoms to time taken to seek medical attention. This was then associated with various patient and tumour related factors. ResultA total of 120 (n) patients were interviewed and these patient's case sheets were recruited for the present study. The median primary delay for the entire population was found to be 90 days while the median secondary delay was 11 days. The median total delay was found to be 106 days. The median total delay was higher among females and younger population though this was not statistically significant. However education showed a significant impact with literate patients presenting much earlier. Smoking and alcohol abuse did not show a significant effect on delay. Various tumour factors also did not show any statistically significant effect on delay although, patients with advanced stage and nodal secondaries presented at a much later time. ConclusionBoth patient and tumour related factors as well as the decisions made during the first contact with health care providers influence delay before specialist consultation. Raising awareness of HNC symptoms among the general population and GPs is the way to get patients to curative treatment without long delay.

Chemotherapy Resistance in Cancer: Mechanism and Roadmap to Evade Exploring Apoptosis

Chemotherapy resistance indicates the non-responsiveness of cancer cells to the cytotoxic and inhibitory effects of chemo drugs attributed to either intrinsic or extrinsic resistance mechanisms in cancer cells. Studies so far indicate that drug resistance can be triggered by a multitude of factors such as the over-expression of drug efflux pumps, DNA repair mechanisms, modifications in the drug target such as point mutations and gene amplification, over-expression of anti-apoptotic proteins and down-regulation of pro-apoptotic signals, presence of cancer stem cells and immune-suppressive cells, excessive cytokine production, tumor heterogeneity, epigenetic changes, activation of alternate pro-survival signaling pathways, etc. Both host and tumor-related factors can contribute to therapy resistance. Currently, chemo resistance poses the foremost setback in the successful treatment of cancer, and it exerts significant stress on the available medical resources. Besides the costs associated with the treatment, patients go through severe emotional and physical trauma. Chemotherapy resistance is also a major contributor to accelerated metastasis and invasion. Dose-escalation is not always practical since the associated side effects may increase apart from increasing the treatment costs. Several studies are ongoing to address this issue productively, such as therapeutic molecules designed to restore the apoptotic machinery. Site-specific delivery of pro-apoptotic agents such as small molecules, antibodies, peptides, etc. targeting the apoptosis pathway is also thoroughly studied. Moreover, the efficacy of combination strategies is also a topic of research.

Risk factors associated with postoperative respiratory failure after esophagectomy for esophageal cancer

Aim: Respiratory failure is common after esophagectomy for esophageal cancer (EC). This study aimed to identify the risk factors associated with postoperative respiratory failure following esophagectomy for EC. Methods: A single-center observational study from China was conducted on 262 patients with EC who underwent thoracoscopic esophagectomy between April 2014 and June 2016. The patients were divided into two groups: group I (respiratory failure) and group II (without respiratory failure). Demographic and perioperative variables, tumor-related factors, surgical factors, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, and clinical course were compared between the groups. Univariable and multivariable logistic regression analyses were performed to assess the risk factors of postoperative respiratory failure after esophagectomy. Results: Among the 262 patients, 24 (9.2%) developed respiratory failure. Univariable analysis revealed several risk factors, including age, smoking, comorbidities, partial pressure of oxygen (PO2), partial pressure of carbon dioxide (PCO2), forced vital capacity (FVC), FVC percentage (FVC%), urine volume during surgery, and APACHE II score. Multivariable analysis showed that age, comorbidities of diabetes mellitus (DM), FVC%, urine volume during surgery, and APACHE II score were independent predictors of respiratory failure. Specifically, elderly patients (> 65 years) with comorbidities of DM, lower FVC%, higher urine volume during surgery, and elevated APACHE II score were found to be more susceptible to respiratory failure, resulting in prolonged hospitalization and increased healthcare burden. These findings emphasize the importance of considering these factors in the management and care of patients at risk of respiratory failure. Conclusions: As a common complication following esophagectomy for EC. Respiratory failure is significantly associated with age, comorbidities of DM, FVC%, urine volume during surgery, and APACHE II score in the dataset. The findings will contribute to the evaluation of the risk of respiratory failure and guide early intervention strategies in clinical decision-making.

Predictive Factors in Metastatic Melanoma Treated with Immune Checkpoint Inhibitors: From Clinical Practice to Future Perspective.

The introduction of immunotherapy revolutionized the treatment landscape in metastatic melanoma. Despite the impressive results associated with immune checkpoint inhibitors (ICIs), only a portion of patients obtain a response to this treatment. In this scenario, the research of predictive factors is fundamental to identify patients who may have a response and to exclude patients with a low possibility to respond. These factors can be host-associated, immune system activation-related, and tumor-related. Patient-related factors can vary from data obtained by medical history (performance status, age, sex, body mass index, concomitant medications, and comorbidities) to analysis of the gut microbiome from fecal samples. Tumor-related factors can reflect tumor burden (metastatic sites, lactate dehydrogenase, C-reactive protein, and circulating tumor DNA) or can derive from the analysis of tumor samples (driver mutations, tumor-infiltrating lymphocytes, and myeloid cells). Biomarkers evaluating the immune system activation, such as IFN-gamma gene expression profile and analysis of circulating immune cell subsets, have emerged in recent years as significantly correlated with response to ICIs. In this manuscript, we critically reviewed the most updated literature data on the landscape of predictive factors in metastatic melanoma treated with ICIs. We focus on the principal limits and potentiality of different methods, shedding light on the more promising biomarkers.

Short-term pain control after palliative radiotherapy for uncomplicated bone metastases: a prospective cohort study.

This study aimed at evaluating the efficacy of different radiotherapy (RT) fractionation regimens in managing uncomplicated painful bone metastases (BM) and identifying predictive factors for pain control. Patients with 1 to 4 symptomatic BM from any primary solid tumors and a life expectancy exceeding 3months were included in the study and received palliative RT, with SBRT restricted in the context of oligometastatic disease or in patients with good prognosis. Pain analysis using the Brief Pain Inventory (BPI) tool was conducted at baseline, 1 and 3months after RT. Analgesic intake was recorded as morphine-equivalent doses (OME). Pain response was assessed using the International Consensus on Palliative Radiotherapy Endpoint (ICPRE). Multivariate logistic regression analyzed patient-related, tumor-related, and treatment-related factors predicting BM pain control at 3months post-RT. From Feb 2022 to Feb 2023, 44 patients with 65 symptomatic BM were investigated. Breast (32%) and lung (24%) tumors were the most common primary tumors. Treatment plans included 3DCRT (60%) and VMAT (40%), with a median biological effective dose for tumors (BED) of 29Gy [14-108]. All patients completed the 3-month follow-up. Pain response rates were 62% at 1month and 60% at 3months. Responders had better PS ECOG scores (67%; P = 0.008) and received active systemic therapies (67%: P = 0.036). Non-responders had lower pretreatment BPI (mean: 13.7 vs. 58.2; P = 0.032), with significantly higher values after 1month (mean: 9.1 vs. 5.3, P = 0.033). Baseline BPI (OR: 1.17; 95% CI: 1.032-1.327; P = 0.014) and BPI at 1month (OR: 0.83; 95% CI: 0.698-0.976; P = 0.025) were independent predictors of pain response at 3months. Our findings show that palliative RT ensured short-term pain control in patients with BM, regardless of tumor type and dose-fractionation regimen. A larger sample size and a longer follow-up could potentially identify which patients are likely to benefit most from RT, and which fractionation might be indicated for achieving a durable pain relief. A multidisciplinary approach is paramount to provide a better care to BM patients.

Textbook outcomes after oesophagectomy: a single-centre observational study

BackgroundTextbook outcomes is a composite quality assurance tool assessing the ideal perioperative and postoperative course as a unified measure. Currently, its definition and application in the context of oesophagectomy in Australia is unknown. The aim of this study was to assess the textbook outcomes after oesophagectomy in a single referral centre of Australia and investigate the association between textbook outcomes and patient, tumour, and treatment characteristics.MethodsAn observational study was retrospectively performed on patients undergoing open, laparoscopic, or hybrid oesophagectomy between January 2010 and December 2019 in a single cancer referral centre. A textbook outcome was defined as the fulfillment of 10 criteria: R0 resection, retrieval of at least 15 lymph nodes, no intraoperative complications, no postoperative complications greater than Clavien-Dindo grade III, no anastomotic leak, no readmission to the ICU, no hospital stay beyond 21 days, no mortality within 90 days, no readmission related to the surgical procedure within 30 days from admission and no reintervention related to the surgical procedure. The proportion of patients who met each criterion for textbook outcome was calculated and compared. Selected patient-related parameters (age, gender, BMI, ASA score, CCI score), tumour-related factors (tumour location, tumour histology, AJCC clinical T and N stage and treatment-related factor [neoadjuvant chemotherapy and surgical approach]) were assessed. Disease recurrence and one year survival were also evaluated.Results110 patients who underwent oesophagectomy were included. The overall textbook outcome rate was 24%. The difference in rates across the years was not statistically significant. The most achieved textbook outcome parameters were ‘no mortality in 90 days’ (96%) and ‘R0 resection’ (89%). The least frequently met textbook outcome parameter was ‘no severe postoperative complications’ (58%), followed by ‘no hospital stays over 21 days’ (61%). No significant association was found between patient, tumour and treatment characteristics and the rate of textbook outcome. Tumour recurrence rate and overall long term survival was similar between textbook outcome and non-textbook outcome groups. Patients with R0 resection, no intraoperative complication and a hospital stay less than 21 days had reduced mortality rates.ConclusionsTextbook outcome is a clinically relevant indicator and was achieved in 24% of patients. Severe complications and a prolonged hospital stay were the key criteria that limited the achievement of a textbook outcome. These findings provide meticulous evaluation of oesophagectomy perioperative care and provide a direction for the utilisation of this concept in identifying and improving surgical and oncological care across multiple healthcare levels.

Prognostic value of the ratio of pretreatment carcinoembryonic antigen to tumor volume in rectal cancer.

As a commonly used biomarker in rectal cancer (RC), the prognostic value of carcinoembryonic antigen (CEA) remains underexplored. This study aims to evaluate the prognostic value of pretreatment CEA/tumor volume in RC. This retrospective study included patients who underwent pretreatment magnetic resonance imaging (MRI) with histologically confirmed primary rectal adenocarcinoma from November 2012 to April 2018. Patients were divided into high-risk and low-risk groups according to the median values of CEA/Diapath (CEA to pathological diameter), CEA/DiaMRI (CEA to MRI tumor diameter), and CEA/VolMRI (CEA to MRI tumor volume). Cox regression analysis was utilized to determine the prognostic value of CEA, CEA/Diapath, CEA/DiaMRI, and CEA/VolMRI. Stepwise regression was used to establish nomograms for predicting disease-free survival (DFS) and overall survival (OS). Predictive performance was estimated by using the concordance index (C-index) and area under curve receiver operating characteristic (AUC). A total of 343 patients [median age 58.99 years, 206 (60.06%) males] were included. After adjusting for patient-related and tumor-related factors, CEA/VolMRI was superior to CEA, CEA/Diapath, and CEA/DiaMRI in distinguishing high-risk from low-risk patients in terms of DFS [hazard ratio (HR) =1.83; P=0.010] and OS (HR =1.67; P=0.048). Subanalysis revealed that CEA/VolMRI stratified high death risk in CEA-negative individuals (HR =2.50; P=0.038), and also stratified low recurrence risk in CEA-positive individuals (HR =2.06; P=0.024). In the subanalysis of stage II or III cases, the highest HRs and the smallest P values were observed in distinguishing high-risk from low-risk patients according to CEA/VolMRI in terms of DFS (HR =2.44; P=0.046 or HR =2.41; P=0.001) and OS (HR =1.96; P=0.130 or HR =2.22; P=0.008). The nomograms incorporating CEA/VolMRI showed good performance, with a C-index of 0.72 [95% confidence interval (CI): 0.68-0.79] for DFS and 0.73 (95% CI: 0.68-0.80) for OS. Higher CEA/VolMRI was associated with worse DFS and OS. CEA/VolMRI was superior to CEA, CEA/Diapath, and CEA/DiaMRI in predicting DFS and OS. Pretreatment CEA/VolMRI may facilitate risk stratification and treatment decision-making.

Assessment of geriatric and clinical domains for development and validation of a novel nomogram to predict the prognosis of older patients with breast cancer: a real-world retrospective cohort study

BackgroundBreast cancer is a relatively heterogeneous disease in the older population. Survival in older breast cancer patients is not only affected by tumor-related factors, but also by geriatric assessment domains. How tumor clinical factors and geriatric factors specifically affect the survival rate of older patients and how to combine these two factors to predict the risk of death in older patients with breast cancer remain clinical questions to be addressed.MethodWe used the Peking Union Medical College Hospital database to identify older patients (≥65 years) who were newly diagnosed with breast cancer between January 2013 and December 2019. Of the 641 eligible patients, we retrospectively analyzed the clinical and geriatric data of 556 patients who formed our study population. The primary outcomes were overall survival (OS) and breast cancer-specific survival (BCSS). Univariate and multivariate Cox regression analyses were conducted to identify independent prognostic factors and construct a nomogram to predict the 1-, 3-, and 5-year survival rates. The performance of the constructed nomogram was evaluated using calibration curve, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA).ResultsMultivariate Cox regression analysis revealed seven independent prognostic factors associated with OS in older patients with breast cancer: age, tumor stage, lymph node stage, intrinsic molecular subtype, functional status, comorbidities, and psychological state. Nomogram based on these seven factors yielded excellent performance, with area under the ROC curve (AUROC) of 0.748. Similarly, the nomogram for BCSS had an AUROC of 0.760. Moreover, the calibration curve and DCA revealed good predictive accuracy between the actual and predicted probabilities.ConclusionIndependent prognostic factors for OS and BCSS in older patients with breast cancer in China were determined in our study. A novel nomogram for predicting the 1-, 3-, and 5-year OS and BCSS in this patient population was developed and validated. The nomogram exhibited good accuracy, indicating its potential for clinical decision making and improving outcomes.

Transitioning from Da Vinci Si to Xi: assessing surgical outcomes at a high-volume robotic center.

In the emerging field of robotics, only few studies investigated the transition between different robotic platforms in terms of surgical outcomes. We aimed at assessing surgical outcomes of patients receiving robot-assisted radical prostatectomy (RARP) and robot-assisted partial nephrectomy (RAPN) at a high-volume robotic center during the transition from Si to Xi Da Vinci surgical systems. We analyzed data of 1884 patients undergoing RARP (n = 1437, 76%) and RAPN (n = 447, 24%) at OLV hospital (Aalst, Belgium) between 2011 and 2021. For both procedures, we assessed operative time, estimated blood loss, length of stay, and positive surgical margins. For RARP, we investigated length of catheterization and PSA persistence after surgery, whereas warm ischemia time, clampless surgery, and acute kidney injury (AKI) were assessed for RAPN. Multivariable analyses (MVA) investigated the association between robotic platform (Si vs. Xi) and surgical outcomes after adjustment for patient- and tumor-related factors. A total of 975 (68%) and 462 (32%) patients underwent RARP performed with the Si vs. Xi surgical system, respectively. Baseline characteristics did not differ between the groups. On MVA, we did not find evidence of a difference between the groups with respect to operative time (estimate: 1.07) or estimated blood loss (estimate: 32.39; both p > 0.05). Median (interquartile range [IQR]) length of stay was 6 (3, 6) and 4 (3, 5) days in the Si vs. Xi group, respectively (p < 0.0001). On MVA, men treated with the Xi vs. Si robot had lower odds of PSM (Odds ratio [OR]: 0.58; p = 0.014). A total of 184 (41%) and 263 (59%) patients received RAPN with the Si and Xi robotic system, respectively. Baseline characteristics, including demographics, functional data, and tumor-related features did not differ between the groups. On MVA, operative time was longer in the Xi vs. Si group (estimate: 30.54; p = 0.006). Patients treated with the Xi vs. Si system had higher probability of undergoing a clampless procedure (OR: 2.56; p = 0.001), whereas the risk of AKI did not differ between the groups (OR: 1.25; p = 0.4). On MVA, patients operated with the Xi robot had shorter length of stay as compared to the Si group (estimate: -0.86; p = 0.003), whereas we did not find evidence of an association between robotic system and PSM (OR: 1.55; p = 0.3). We found that the Xi robot allowed for improvements in peri-operative outcomes as compared to the Si platform, with lower rate of positive margins for RARP and higher rate of off-clamp procedures for RAPN. Hospital stay was also shorter for patients operated with the Xi vs. Si robot, especially after robot-assisted partial nephrectomy. Awaiting future investigations-in particular, cost analyses-these results have important implications for patients, surgeons, and healthcare policymakers.

Comparison of the Clinical Efficacy of Gemcitabine and Pirarubicin in the Treatment of Bladder Cancer after Electroresection

Objective: This paper aims to compare the effects of gemcitabine and pirarubicin in treating bladder cancer after electroresection. Methods: Bladder cancer patients who underwent bladder cancer resection in our hospital from January 2018 to January 2022 were selected as research subjects. According to the computer grouping method, 60 patients were divided into Group A (pirarubicin) and Group B (gemcitabine), and the therapeutic effects of the two groups of patients were compared. Results: The statistical significance of the tumor markers and related factor levels of patients in Group A and Group B before treatment was not established (P &gt; 0.05). The levels of tumor markers and related factors of patients in Group B after treatment were lower than those of Group A (P &lt; 0.05). There was no difference in the quality of life scores of patients in Group A and Group B before treatment (P &gt; 0.05). After treatment, the quality of life scores of patients in Group B was higher than those in Group A (P &lt; 0.05). The incidence rates of dysuria, hematuria, cystitis, and rash in Group B patients were less than those in group A (P &lt; 0.05). The recurrence rate of patients in Group B was higher than in group A (P &lt; 0.05). Conclusion: Both gemcitabine and pirarubicin are commonly used chemotherapy drugs after electroresection for bladder cancer. Compared with pirarubicin, gemcitabine is more effective and can improve the quality of life of bladder cancer patients.

Upper Tract Urothelial Carcinoma (UTUC) Diagnosis and Risk Stratification: A Comprehensive Review.

Diagnosis and risk stratification are cornerstones of therapeutic decisions in the management of patients with upper tract urothelial carcinoma (UTUC). Diagnostic modalities provide data that can be integrated, to provide nomograms and stratification tools to predict survival and adverse outcomes. This study reviews cytology, ureterorenoscopy and the novel tools and techniques used with it (including photodynamic diagnosis, narrow-band imaging, optical coherence tomography, and confocal laser endomicroscopy), and biopsy. Imaging modalities and novel biomarkers are discussed in another article. Patient- and tumor-related prognostic factors, their association with survival indices, and their roles in different scores and predictive tools are discussed. Patient-related factors include age, sex, ethnicity, tobacco consumption, surgical delay, sarcopenia, nutritional status, and several blood-based markers. Tumor-related prognosticators comprise stage, grade, presentation, location, multifocality, size, lymphovascular invasion, surgical margins, lymph node status, mutational landscape, architecture, histologic variants, and tumor-stroma ratio. The accuracy and validation of pre-operative predictive tools, which incorporate various prognosticators to predict the risk of muscle-invasive or non-organ confined disease, and help to decide on the surgery type (radical nephroureterectomy, or kidney-sparing procedures) are also investigated. Post-operative nomograms, which help decide on adjuvant chemotherapy and plan follow-up are explored. Finally, a revision of the current stratification of UTUC patients is endorsed.

Real-world treatment outcomes of metastatic biliary tract cancer patients in Japan: the Tokushukai REAl-world data project 04 (TREAD 04).

To investigate temporal trends in treatment patterns and prognostic factors for overall survival in patients with metastatic biliary tract cancer. From the Tokushukai REAl-world Data project, we identified 945 patients with metastatic biliary tract cancer treated with gemcitabine, tegafur/gimeracil/oteracil, gemcitabine plus cisplatin, gemcitabine plus tegafur/gimeracil/oteracil or gemcitabine plus cisplatin and tegafur/gimeracil/oteracil between April 2010 and March 2022. Stratified/conventional Cox regression analyses were conducted to examine the association between overall survival and patient- and tumour-related factors, study period, hospital volume, hospital type and first-line chemotherapy regimen. Using inverse probability of treatment weighting with propensity scores, overall survival was also compared between monotherapy and combination therapy groups. We enrolled 366 patients (199 men; median age, 72years). Over a median follow-up of 5.2months, the median overall survival was 7.0months (95% confidence interval 6.2-9.0), and the median time to treatment failure was 3.5months (95% confidence interval 3.1-4.5). Median overall survival and time to treatment failure for gemcitabine/tegafur-gimeracil-oteracil/gemcitabine plus cisplatin/gemcitabine plus tegafur-gimeracil-oteracil/gemcitabine plus cisplatin and tegafur-gimeracil-oteracil regimen were 6.2/6.6/7.9/16.2/15.1 and 2.8/3.4/4.1/15.3/7.4months, respectively. Primary disease site, previous surgery, previous endoscopic procedures and hospital type were identified as significant prognostic factors. Inverse probability of treatment weighting analysis demonstrated that combination therapy had a significantly better prognosis than monotherapy (hazard ratio 0.61, 95% confidence interval 0.43-0.88, P=0.006). Our real-world data analysis showed that standard care for metastatic biliary tract cancer is widely used in hospitals throughout Japan and verified the survival benefits of combination therapy over monotherapy observed in prior clinical trials. UMIN000050590 (http://www.umin.ac.jp/ctr/index.htm).

Biomarkers for Immunotherapy in Driver-Gene-Negative Advanced NSCLC.

Outcome improvement in patients with driver-gene-negative advanced non-small cell lung cancer (NSCLC) has been significantly enhanced through targeting the immune system, specifically the PD-L1/PD-1 axis. Nevertheless, only a subset of patients with advanced NSCLC may derive benefits from immuno-monotherapy or immunotherapy combined with chemotherapy. Hence, in order to identify patients who will gain the maximum advantage from immunotherapy, it is crucial to investigate predictive biomarkers. This review provides a summary of the currently identified biomarkers associated with the extent of benefit from immuno-monotherapy or immunotherapy combined with chemotherapy in patients with advanced NSCLC. These biomarkers can be categorized into three groups: tumor-related, tumor-microenvironment-related, and host-factor-related.Tumor-related factors include PD-L1 expression, tumor mutational burden and specific genetic mutations, while tumor-microenvironment-related factors include extracellular vesicles and T-cell receptors, and host-related factors include systemic inflammation, circulating fatty acid profile, and the microbiome.

Perioperative Outcomes following Surgery of Brain Tumors: Assessment and Analysis of Risk Factors

Introduction: Cranial neurosurgery carries significant morbidity and mortality. Hence it is imperative to combine the latest available technological equipment with surgeon’s experience to prevent or reduce perioperative complications. It is also equally important to have a preoperative general assessment of the patient with functional status in particular to predict postoperative outcomes. Methods: This is a prospective study consisting of 122 patients selected over a period of 5 years (March 2017-March 2022). The patient database was retrieved from the medical record department, Nobel Institute of Neurosciences, Nobel Medical College Teaching Hospital, Biratnagar, Nepal and the approval of Institutional review committee was obtained. Age, gender, tumor related factors (site, extent and size), preoperative Glasgow Coma Scale (GCS) score, Karnofsky Performance Status (KPS) score and Modified Rankin scale (mRS) grade and their correlation with patient’s perioperative outcome were assessed. Results: Significant correlation was found between preoperative KPS score, mRS grade and patient’s perioperative outcome (low KPS score &lt;70 and high mRS grade was associated with adverse outcomes). There was no positive correlation between age, gender and tumor related factors with outcomes. Conclusion: Low KPS score &lt;70 and a high Modified Rankin scale score were associated with adverse perioperative outcomes in patient’s undergoing elective craniotomy for brain tumor surgery.

Impact of pathological nodal staging and tumour differentiation on survival and postoperative radiotherapy in completely resected stage IIIA Non-small-cell lung cancer

BackgroundTumour differentiation is an important index for adjuvant therapy in many cancers; however, non-small cell lung cancer (NSCLC) is an exception. Furthermore, postoperative radiotherapy (PORT) is controversial in patients with NSCLC with N0-1 and N2 disease. We aimed to evaluate the impact of tumour-related factors on overall survival (OS), cancer-specific survival (CSS), and distant control (DC) in patients with completely resected stage IIIA NSCLC. Materials and MethodsPatients with stage IIIA non-metastatic NSCLC who underwent complete resection and adjuvant chemotherapy were identified from the Taiwan Cancer Registry (January 2007–December 2017). Logistic regression analysis was performed to determine the factors associated with PORT. Survival and relapse outcomes were compared using log-rank tests and Cox regression analysis. Sensitivity analysis was performed using propensity score-matched pairs. ResultsIn total, 1,897 patients were included and stratified according to PORT use (PORT vs. non-PORT). After adjusting for covariates, PORT was not found to be associated with improved survival outcomes. In patients with poorly differentiated tumours and N2 disease, absolute benefits for OS (adjusted hazard ratio [aHR] 0.76), CSS (aHR 0.80), and DC (aHR 0.74) were observed. Multivariable hazard models of propensity score-matched pN2 disease and poorly differentiated tumour subgroups also showed significant survival benefit with PORT treatment. ConclusionsPatients with poorly differentiated tumours and receiving PORT for pN2 disease showed a lower risk of distant recurrence and more favourable survival outcomes in stage IIIA NSCLC with R0 resection.

Robot-assisted Radical Prostatectomy Performed with Different Robotic Platforms: First Comparative Evidence Between Da Vinci and HUGO Robot-assisted Surgery Robots

BackgroundIn the field of robotic surgery, there is a lack of comparative evidence on surgical and functional outcomes of different robotic platforms. ObjectiveTo assess the outcomes of patients receiving robot-assisted radical prostatectomy (RARP) at a high-volume robotic center with daVinci and HUGO robot-assisted surgery (RAS) surgical systems. Design, setting, and participantsWe analyzed the data of 542 patients undergoing RARP ± extended pelvic lymph node dissection at OLV hospital (Aalst, Belgium) between 2021 and 2023. All procedures were performed by six surgeons using daVinci or HUGO RAS robots; the use of one platform rather than the other did not follow any specific preference and/or indication. Outcome measurements and statistical analysisMultivariable analyses investigated the association between robotic system (daVinci vs HUGO RAS) and surgical outcomes after adjustment for patient- and tumor-related factors. Urinary continence recovery was defined as the use of no/one safety pad. Results and limitationsA total of 378 (70%) and 164 (30%) patients underwent RARP with daVinci and HUGO RAS surgical systems, respectively. Despite a higher rate of palpable disease in the HUGO RAS group (34% vs 25%), baseline characteristics did not differ between the groups (all p > 0.05). After adjusting for confounders, we did not find evidence of a difference between the groups with respect to operative time (estimate: 16.71; 95% confidence interval [CI]: –6.35, 39.78; p = 0.12), estimated blood loss (estimate: 3.12; 95% CI: –67.03, 73.27; p = 0.9), and postoperative Clavien-Dindo ≥2 complications (odds ratio [OR]: 1.66; 95% CI: 0.34, 8.15; p = 0.5). On final pathology, 55 (15%) and 20 (12%) men in, respectively, the daVinci and the HUGO RAS group had positive surgical margins (PSMs; p = 0.5). On multivariable analyses, we did not find evidence of an association between a robotic system and PSMs (OR: 1.08; 95% CI: 0.56, 2.07; p = 0.8). Similarly, the odds of recovering continence did not differ between daVinci and HUGO RAS cases after both 1 mo (OR: 0.78; 95% CI: 0.45, 1.38; p = 0.4) and 3 mo (OR: 1.17; 95% CI: 0.49, 2.79; p = 0.7). ConclusionsAmong patients receiving RARP with daVinci or HUGO RAS surgical platforms, we did not find differences in surgical and functional outcomes between the robots. This may be a result of a standardized surgical technique that allowed surgeons to transfer their skills between robotic systems. Awaiting future investigations with longer follow-up, these results have important implications for patients, surgeons, and health care policymakers. Patient summaryWe compared surgical and functional outcomes of patients receiving robot-assisted radical prostatectomy with daVinci versus HUGO robot-assisted surgery (RAS) robots. The two platforms were able to achieve similar outcomes, suggesting that the introduction of HUGO RAS is safe and allows for optimal outcomes after radical prostatectomy.

Prognostic Factors for Survival in Adult Patients with Cerebral Low-Grade Glioma

Background Low-grade gliomas are considered a therapeutic dilemma because of the heterogeneity of their clinical behavior. Patients affected by these tumors are often young and management decisions should put into consideration the potential indolent nature of these tumors and the potential long-term side effects of available therapies. Aim of the Work to analyze the collective data from studies to define prognostic factors for overall survival in adult patients with cerebral low-grade gliomas. Materials and Methods We prepared this systematic review with a careful following of the Cochrane Handbook for Systematic Reviews of Interventions guidelines. We conducted a literature search till December 2020 using PubMed, Scopus, Web of Science, and Cochrane Library. We performed a search for all published articles that evaluated the impact of several factors (patient’s age, KPS, neurological symptoms, histological subtype, pre-op tumor size, tumor crossing the midline, tumor enhancement, extent of resection, radiotherapy, and chemotherapy) on the overall survival (OS) and progression-free survival (PFS) of adult patients with cerebral low-grade glioma (LGG), Studies were independently assessed for risk of bias using (Cochrane Risk of Bias 2.0) for randomized controlled trials, and (Newcastle–Ottawa Scale) for retrospective cohort studies. Results Patient-related factors (age was found significant according to 14 of total 19 studies, KPS according to 7 of total 11 studies, and presence of seizures according to 5 of total 7 studies). Tumor-related factors (tumor subtype was significant according to 10 of total 13 studies, IDH-mutation according to 4 of total 5 studies, 1p/19q codeletion according to 5 of total 5 studies, and tumor enhancement according to 4 of total 7 studies), and treatmentrelated factors (extent of resection was significant according to 18 of total 20 studies, while timing and dose of radiation, combined chemotherapy and radiotherapy failed to show major statistical significance, with better PFS in delayed radiotherapy “till progression”, and slightly better OS in combined chemo, radiotherapy). Conclusion Highly significant factors are extent of tumor resection, patient’s age, pre-op tumor volume and molecular subtype.

The use of distraction osteogenesis for the reconstruction of bone defects following resection of malignant bone tumours

The reconstruction of extensive bone defects following resection of malignant bone tumours is achallenge and is mainly influenced by tumour-related factors. In defect reconstructions using distraction osteogenesis isotropic, high-quality (new) bone is formed. For the reconstruction of bone defects and secondary limb length discrepancies following tumour resection, predominately threetechniques have been described: bone transport, primary shortening and secondary lengthening, as well as "bio-expandable tumour endoprostheses". The use of distraction osteogenesis represents an excellent method for defect reconstruction and treatment of secondary limb length discrepancies following bone tumour resection. Due to the complex anatomical preconditions in tumour patients, ahigh degree of expertise in distraction osteogenesis (and tumour endoprostheses) is paramount. Therefore, treatment of these patients at highly specialised centres is recommended.

Oncologic outcomes following radical nephroureterectomy for upper tract urothelial carcinoma: a literature review.

Radical nephroureterectomy (RNU) represents the gold standard treatment for non-metastatic upper tract urothelial cancer. We sought to provide a comprehensive review of reported oncologic outcomes of the RNU procedure and of factors that might impact these outcomes. A non-systematic review of the literature was conducted by performing an electronic literature search using PubMed with "radical nephroureterectomy" and "oncologic outcomes" as free text search terms. Both original articles and systematic reviews were considered. Search was limited to articles in English that were published in the last 20 years. Open and laparoscopic RNU offer comparable oncologic outcomes. In more recent years, the discussion has de facto shifted towards the "oncological safety" of robotic RNU, which also seems to offer comparable oncologic outcomes. Several studies have looked at the impact of different treatment-, patient- and tumor-related factors. Among treatment-related factors, attention has been given to diagnostic ureteroscopy and the risk of intravesical recurrence. Surgical wait time and perioperative blood transfusion have also been studied. Perioperative chemotherapy, specifically adjuvant therapy, was shown to improve survival. Among patient-related factors, baseline chronic kidney disease, diabetes mellitus, body mass index, and systemic inflammation have gained recent attention. Some tumor related factors, such as stage, grade, location, and multifocality may negatively impact survival outcomes. Lymphovascular invasion and histologic variants are clinically significant pathological findings. RNU is a procedure with measured long-term oncologic outcomes. Minimally invasive techniques have gained an established role as they seem to offer comparable oncologic "safety", although special attention is needed in relation to the method of bladder cuff excision. Robotic RNU is gaining popularity, and while evidence remains limited, the current literature supports the oncologic safety of this procedure. Several factors, which can be categorized as treatment-related, patient-related, and tumor-related, might impact the oncologic outcomes of UTUC patients undergoing RNU. These factors can provide crucial information to stratify patients based on their relative risk of disease recurrence and mortality which may guide clinical decision-making.