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Objective: Hepatocellular carcinoma (HCC) is a complex and multifaceted disease that is increasingly prevalent globally. The involvement of immune cells in the tumour microenvironment has been linked to the progression of HCC, but the exact cause-and-effect relationship is not yet clear. In this study, we utilise Mendelian randomization (MR) to investigate the potential causal links between immune factors and the development of HCC.

Method: We executed a comprehensive MR study, leveraging publicly accessible genetic datasets to explore the potential causal links between 731 types of immune cells and HCC. Our analysis primarily applied inverse variance weighting and weighted median methods. To evaluate the robustness of our findings and probe for the presence of heterogeneity and pleiotropy, we also conducted thorough sensitivity analyses.

Results: We found 36 immune cells were associated with HCC, CD64 on CD14- CD16+ monocytes (OR = 1.328, 95% CI = 1.116- 1.581, p = 0.001), CD3- lymphocyte %lymphocytes (OR = 1.341, 95% CI = 1.027- 1.750, p = 0.031), HLA DR on CD14+ monocytes (OR = 1.256, 95% CI = 1.089- 1.448, p = 0.002), CD19 on CD19 on Plasma Blast-Plasma Cell (OR = 1.224, 95% CI = 1.073- 1.396, p = 0.003), CCR2 on monocytes (OR = 1.204, 95% CI = 1.073- 1.351, p = 0.002) and Naive CD4+ T cell Absolute Count (OR = 0.797, 95% CI = 0.655- 0.969, p = 0.023) were the most strongly associated with HCC. Among them, CD64 on CD14- CD16+ monocytes, CD3 - lymphocyte %lymphocytes, HLA DR on CD14+ monocytes and CD19 on Plasma Blast-Plasma Cells are the risk factors, while Naive CD4+ T cell Absolute Count are protective factors for HCC.

Conclusion: Our MR analysis of the role of immune cells and HCC provides a framework for knowledge of circulating immune status. Systematic assays of infiltrating immune cells in HCC can help dissect the immune status of HCC, assess the current use of checkpoint blockers, and most importantly, aid in the development of innovative immunotherapies. Further research is necessary to validate these findings and explore the underlying mechanisms that influence the immune response to HCC.

The relationship between cancer and thrombosis was initially highlighted in the 19th century. Vascular complications in oncology can be arterial or venous thrombosis, and incidental pulmonary embolism is a growing challenge. We aimed to describe the frequency and clinical characteristics of cancer patients with incidental venous thromboembolism (iVTE). We conducted a descriptive study at the Yaounde General Hospital. We included patients with a confirmed diagnosis of cancer, followed up on an outpatient basis, in whom an iVTE was identified on a computed tomography scan performed to evaluate tumour status over a 6-month period. Of the 359 patients, 19 had venous thromboses, representing a frequency of 5.3%. The mean age was 51.2 years. The sex ratio was 1.1 in favour of males. Comorbidities found were diabetes, hypertension and obesity. Colon cancer (5), ovarian cancer (3) and lung cancer (3) were the most frequent diagnoses. All patients had advanced disease with 14 (73.7%) being naive to anticancer treatment. Pulmonary arteries were the most affected vessel (63.1%). The frequency of iVTE in a sub-Saharan context was around 5%.

Background: The aim was to conduct a pilot study in a middle-income country testing the use of the Toronto Childhood Cancer Staging System by Population-Based Cancer Registry (PBCR).

Methods: This study involved first the translation of the Australian pediatric cancer staging manual for 16 types of pediatric tumours. Four PBCRs from different regions of Brazil were selected for a pilot study. The study period was from 2005 to 2014, and data were collected from notification sources, including hospitals, pathological laboratories and routine medical records, and staging was done retrospectively.

Results: We identified 1,560 pediatric cancer cases diagnosed between 2005 and 2014. Notably, 94.7% met Tier 1 criteria, and 91.9% met Tier 2 criteria. The PBCR from Curitiba (south region) demonstrated higher staging feasibility (99.3% Tier 1; 96.7% Tier 2) than from Aracaju (northeast) (87.5% Tier 1; 81.3% Tier 2). Most cases had localised or regional disease (77.7%), while 14.3% were metastatic, and 8.0% could not be staged. Osteosarcoma had the highest metastasis rate (50.0%).

Conclusion: Our study demonstrates the feasibility of collecting pediatric cancer stage data from population-based registries in resource-limited settings, advancing our understanding of pediatric cancer outcomes in Brazil.

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a major side effect associated with chemotherapy. It can lead to detrimental dose reductions and discontinuation of treatment because of its significant effect, which impairs the quality of life among the surviving population of cancer patients. This study assesses the prevalence and predictors of CIPN among female breast cancer patients receiving chemotherapy at the Lagos University Teaching Hospital and Lagos State University Teaching Hospital (LUTH and LASUTH), respectively.

Methods: 261 women with histologically confirmed breast cancer who had just concluded first line chemotherapy were recruited for this study. The relevant data was obtained using a designed/semi-structured questionnaire for patient demographic information, and clinical information was retrieved from the participants' medical records, CIPN symptoms were collected using the European Organisation for Research and Treatment of Cancer CIPN20 and analysed.

Results: Two hundred and sixty-one female breast cancer patients receiving either neoadjuvant or adjuvant chemotherapy were enrolled in the study. The mean age was 49.98 +/- 11.4 years. 72.9% (183) among the study participants reported symptoms of CIPN at the end of chemotherapy. One hundred and fifty-seven (62.5%) had mild neuropathy, 23(9.2%) had moderate neuropathy and 3 (1.2%) had severe neuropathy. 31.1% (74) of patients at 2 months after completion of chemotherapy still reported symptoms of CIPN. Numbness in both hands and legs was found to be the most common symptom reported by the participants and the majority of the participants experienced mild to moderate symptoms.

Conclusion: The prevalence of CIPN was high at the completion of chemotherapy (72.9%), and there was a significant decline in the prevalence at two months after completion of treatment (31.1%). Numbness was the most commonly reported symptom among the participants and the majority of the participants experienced mild symptoms of peripheral neuropathy.

Acute leukemia (AL) is a diverse group of hematological malignancies characterised by the accumulation of immature blast cells in the bone marrow. Accurate classification into acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL) is essential for treatment and prognosis. This study aimed to assess the performance of glass slide morphology (GSM) using a light microscope versus whole slide imaging (WSI) in diagnosing and classifying AL, using flow cytometry as the gold standard test. Peripheral smears and bone marrow aspirates from 97 patients suspected of AL were stained with Romanowsky stain and reviewed by a single hematologist. For GSM, the hematologist was provided with a single slide, which was to be evaluated under a light microscope. For WSI, the Alexapath mobile scanner (ADA1) was used to scan the slides for review by the hematologist. Patient identification was concealed from the interpreting hematologist, and an interval of 2 weeks was set between the review of GSM and WSI of the same patient. The sensitivity and specificity of GSM and WSI were compared to the results of flow cytometry. Out of the 97 patients suspected to have AL, 47 were confirmed to have AL by flow cytometry. Among these, 19 (40.4%) were diagnosed with AML and 28 (59.6%) with ALL. GSM demonstrated high sensitivity (89.4%) and specificity (90.0%) for diagnosing AL, but lower sensitivity in distinguishing AML (57.9%) from ALL (75.0%). Similarly, WSI exhibited a reasonable sensitivity (80.9%) and high specificity (98.0%) for diagnosing AL, but lower sensitivity in differentiating AML (57.9%) and ALL (46.4%). GSM and WSI are reasonable and acceptable techniques for accurately screening AL cases and accelerating referral to tertiary centers of excellence.

Spread of lung cancer to the leptomeninges is rare and difficult to treat. Standard therapy comprises CNS-penetrant targeted agents with or without intrathecal chemotherapy. We performed a retrospective analysis of 16 patients with advanced NSCLC and leptomeningeal disease treated with intrathecal pemetrexed 50 mg. All tumours were adenocarcinoma histology; 13 (81.3%) had EGFR mutations, and 3 (18.8%) had no targetable mutations. Prior therapies included EGFR-directed tyrosine kinase inhibitors (TKI) with/without chemotherapy/antiangiogenic agents (9 [56.3%]), chemotherapy alone (4 [25%]), intrathecal methotrexate with/without hydrocortisone (3 [18.9%]), and radiation (12 [75%]). Presenting symptoms of leptomeningeal disease included headache (10 [62.5%]), dizziness (8 [50%]), and seizures (7 [43.8%]). Systemic therapy administered along with intrathecal pemetrexed included osimertinib (5 [31.3%]), gefitinib in 1 (6.3%), chemotherapy in 4 (25%) (pemetrexed + carboplatin-2, cisplatin + etoposide-1, paclitaxel-1), chemotherapy + oral TKI in 5 (31.3%) and no systemic therapy in 1 (6.3%). Neurological symptoms following intrathecal pemetrexed included headache in 1 (6.3%) patient which was likely due to raised intracranial pressure from underlying leptomeningeal disease, and anxiety/uneasiness in 1 (6.3%). Grade 3 or higher toxicities included thrombocytopenia (6 [37.5%]), anaemia (4 [25%]), neutropenia (4 [25%]), febrile neutropenia (3 [18.8%]), mucositis (4 [25%]), diarrhoea (1 [6.3%]), rash (1 [6.3%]) and hypokalemia (1 [6.3%]. Most toxicities were likely caused by systemic chemotherapy, rather than by intrathecal pemetrexed. Intrathecal pemetrexed was delayed in 9 (56.3%) patients, due to cytopenias/febrile neutropenia (8 [50%]) and poor general condition (1 [6.3%]). Median OS from diagnosis of leptomeningeal disease was 7.5 months (95% CI: 1.2-13.8). Median OS from start of intrathecal pemetrexed was 2.7 months (95% CI, 1.1-4.3). Thus, intrathecal pemetrexed combined with systemic antitumor therapy was tolerable, with promising clinical outcomes in patients with NSCLC and leptomeningeal disease. It is important to explore this option, especially in driver mutation-negative NSCLC patients.

Basal cell carcinoma (BCC) is the most common non-melanoma type of skin cancer described in humans that originates in the epidermis, more specifically in the basal layer and its appendages. Environmental, genetic and phenotypic factors contribute to the onset of this cancer; however, damage caused by ultraviolet radiation from sunlight is the primary risk factor. The emergence of this neoplasm in unexposed body areas, such as the soles, groin, armpit, scrotum or vulva is very rare. We present this case of a 71-year-old man with a tumour in the middle raphe of the scrotum histologically confirmed as BCC, which was successfully surgically managed.

Introduction: Numerous challenges hinder the development of multidisciplinary medical education in a resource-constrained environment. Communal tumour boards built through networking could be a suitable model for the effective management of diseases and enhancement of medical education. This study evaluated the impact of an integrated care pathway for patients with musculoskeletal tumours via multi-institutional networking in a metropolis.

Methodology: Musculoskeletal tumours managed in different institutions in a large metropolis were included for discussion at monthly meetings, under the aegis of the Lagos Musculoskeletal Oncology Network (LAMON). The cases discussed were collated and presented by designated senior residents. The meetings ensured adherence to agreed national and international guidelines in the management of musculoskeletal tumours. Decisions about the treatment modalities were planned at the meetings. The impact on medical residency training was evaluated using the achievement of significant milestones by the residents supported by the network.

Results: The tumour board network included health professionals from various specialist hospitals in the metropolis. Within the decade (2013-2022), 1,272 patients were reviewed of which 968 patients had definitive histological diagnoses. There was an improvement in limb salvage rate and disease outcome. The tumour board supported significant milestones in graduate medical training, including the completion of 4 residents' fellowship dissertations, 22 conference presentations by residents, the publication of 12 articles by residents and the completion of an orthopaedic oncology subspecialty fellowship by 9 orthopaedic surgeons.

Conclusion: The tumour board/network improved the outcome of musculoskeletal tumours over the study period. The network improved the education of medical doctors and increased the capacity for training newer instructors in a resource-limited environment. Perhaps with appropriate social and corporate support, communal tumour boards like LAMON may translate into a good model for multidisciplinary care of diseases and capacity building in resource-limited settings.

Breast cancer is the most common malignancy in terms of incidence and is the leading cause of cancer deaths among women worldwide. In the Philippines, 33,079 new cases of breast cancer were documented in 2020 comprising 17.5% of all new cancer diagnoses. With a rate of 27 deaths per 100,000 people, the Philippines is the frontrunner in Asia for breast cancer mortality. HER2/neu-positive breast cancer, a more aggressive subtype associated with poorer survival outcomes, is present in about 23.5%. Fortunately, the emergence of HER2-targeted therapies has considerably improved disease-free survival and overall survival. This article reviews the most recent data in the HER2+ early breast cancer space.

Background: Health literacy connotes understanding health-related issues and applying a clear understanding of implications in making decisions about one's healthcare needs. Early detection and prompt treatment are cornerstone strategies of breast cancer control. This study assessed the relationship between health literacy and breast cancer prevention practices.

Methods: This study was conducted in Lagos State. Participants' socio-demographic characteristics, knowledge about breast cancer, attitude towards breast cancer and practice of screening methods available were obtained. Health literacy was assessed with the health literacy domain of a validated questionnaire (Cronbach's alpha of 0.75) validated by test-retest reliability) that evaluated the ability to use a language to understand health instructions, cognitive awareness of basic health-related situations, symptom recognitions and health actions required. Health literacy variables were measured on a 19-point rating scale.

Results: Most participants(40%) were between the ages of 31 and 40, while women aged 60 years and above constituted the least proportion (3.1%) of the sample. The mean health literacy score was 12.27 (SD+1.5). A significant proportion(78.4%) of the women had heard of breast cancer. Participants with university/HND education are less likely (OR = 0.431; 95%CI = 0.039,0.759) to have low health literacy. Also, participants with higher income were less likely to have low health literacy, and knowledge of breast cancer risk factors was generally low.

Conclusion: This study shows an above-average mean health literacy score amongst these women; however, inadequate knowledge of risk factors still exists. Education level and income are significant in increasing health literacy on breast cancer preventive practices amongst market women in Lagos, Nigeria.