ecancermedicalscience最新文献

Background: Hepatocellular carcinoma (HCC) is a complex malignancy influenced by genetic, epigenetic and immune-related factors. The tumour immune microenvironment plays a critical role in HCC progression and response to immunotherapy. Identifying key immune-related gene signatures through clustering techniques can provide insights into tumour biology and therapeutic targets.

Methods: We employed K-means, Markov Clustering Algorithm (MCL) and density-based spatial clustering of applications with noise (DBSCAN) to analyse immune-related genes in HCC. Functional enrichment analysis was conducted using Gene Ontology (GO) biological process, cellular component and molecular function categories, along with pathway analysis from Kyoto encyclopedia of genes and genomes (KEGG) and Reactome databases. Additionally, protein-protein interaction (PPI) hub analysis and microRNAs (miRNA) target predictions were integrated to understand the regulatory networks.

Results: K-means clustering segregated immune genes into three clusters, with major histocompatibility complex (MHC) class II genes forming a distinct cluster. MCL and DBSCAN identified a more unified immune cluster incorporating both MHC class I and II molecules, suggesting their coordinated role in antigen presentation. GO analysis revealed enrichment in antigen processing and presentation pathways, immunoglobulin-mediated responses and glutamate receptor signaling. KEGG pathway analysis highlighted associations with autoimmune diseases and viral infections. PPI hub analysis identified CD4, CD74 and HLA-DQA1 as central nodes, while miRNA analysis suggested regulatory interactions affecting immune gene expression.

Conclusion: Our clustering analysis highlights distinct immune-related gene signatures in HCC, emphasising the role of antigen presentation and immune modulation in tumour progression. The findings provide a foundation for further investigation into immunotherapeutic strategies targeting key immune pathways in HCC.

Incidence and mortality rates of cervical cancer remain high in Southern Africa (SA). We explored awareness of cervical cancer symptoms and risk factors, as well as risk lay beliefs among women recently diagnosed with cervical cancer from SA and Zimbabwe. Patients were asked to complete a locally validated questionnaire with unprompted, open-ended questions to assess awareness of cervical cancer symptoms and risk factors. Among 501 women (SA 285, Zimbabwe 216), 46% (229) were able to recall one or more symptoms (SA 24%, Zimbabwe 76%) and 19% (93) were able to recall one or more risk factors of cervical cancer (SA 27%, Zimbabwe 73%). In SA, factors associated with increased symptom awareness included higher education level (completion of secondary education compared to not completing secondary education; adjusted odds ratios (aOR) 2.74, 95% confidence interval (CI) 1.17-6.43) as well as living in urban and peri-urban areas compared to living in rural areas (Urban: aOR 2.98, 95% CI 1.35-6.80; Peri-urban: aOR 3.28, 95% CI 1.13-9.35). Having a self-reported history of a chronic condition was associated with lower risk factor awareness compared to not having a self-reported chronic condition (aOR 0.07, 95% CI 0.00-0.42). In Zimbabwe, those who self-reported living with HIV were more likely to know one or more risk factors compared to those without HIV (aOR 2.69, 95% CI 1.31-5.67). Overall, 90 (18%) women mentioned at least one lay belief about risk factors for cervical cancer, with the most reported being inserting herbs, creams or objects into the vagina (9%, n = 43). The low levels of cervical cancer awareness in two Southern African countries highlight the urgent need to improve cervical cancer awareness, as low levels of awareness can impact timely cancer diagnosis and limit the uptake of cervical cancer prevention programs.

Background: Cancers in adolescents and young adults (AYAs; ages 15-39 years) differ from those in children and older adults. AYAs with cancers have received less research focus over the years despite their unique medical, psychological, socioeconomic and sexual concerns. The burden of cancer among this age group in Nigeria is unknown. This study aims to determine the pattern of cancers in AYAs seen in a radiation oncology clinic in Nigeria.

Method: A retrospective study among AYAs (15-39 years) with cancer who presented at a Radiation Oncology Clinic in Nigeria between January 2018 and December 2023.

Results: There were 529 new cancer cases among AYAs, accounting for 14.1% of all cancer cases seen during the period. The male-to-female ratio was 1:3. The majority (72.8%) were in the 30-39 age range, with a mean age of 32.06 ± 6.18 years. Females had a higher mean age (33.01 ± 5.31 years) than males (29.43 ± 7.57 years) (p < 0.001). Breast (39.1%), bone and soft tissue (12.9%) and cervix (11.6%) were the most common sites of cancer in AYAs. Among the males, bone and soft tissue (20.0%), nasopharynx (13.6%) and sinonasal (10.7%) were the most common sites, while breast (52.2%), cervix (15.4%) and bone and soft tissue (10.0%) were the most common sites among females.

Conclusion: AYAs accounted for 14.1% of all new cancer cases. Breast cancer was the most common cancer among female AYAs, while bone and soft tissue cancers were the most common among males.

Purpose: Modern radiotherapy is a complex, technology-driven process that requires precise planning and delivery to maximise tumour control and minimise harm to normal tissues. Errors in radiotherapy can result in underdosing tumours or overdosing healthy tissues, posing serious risks to patients. In the Eastern Mediterranean Region and Turkey (EMRO+T), variations in workforce expertise, institutional policies and regulatory frameworks contribute to inconsistencies in incident reporting and safety practices. While some centers adhere to international guidelines, others lack structured mechanisms for reporting and learning from errors. A regional incident learning system (ILS) could standardise reporting, enhance safety culture and improve patient outcomes.

Methods: A cross-sectional survey assessed the state of radiotherapy ILS in EMRO+T. Ethical approval was obtained (CCCRC-94-2023), and the survey was distributed via Research Electronic Data Capture to 671 radiation oncology professionals. It gathered data on institutional classification, patient volume, technologies, local ILS presence, adherence to guidelines and perceptions of a regional ILS. Responses from 135 participants across healthcare settings were analysed.

Results: Most respondents (66%) were from government hospitals, and 29.5% worked in private institutions. About 25% of centers treated over 2,000 patients annually, and advanced techniques such as intensity-modulated radiotherapy (75.2%) and stereotactic body radiotherapy (52%) were widely used. However, only 70.7% adhered to international reporting guidelines, and just 48.4% had a local ILS. Barriers included a lack of leadership support (51%) and confidentiality concerns. Although 62% supported reporting by all staff, opinions on confidentiality varied. Regular incident review occurred in 64% of institutions and 91.7% strongly supported a regional ILS.

Conclusion: A regional ILS would foster knowledge-sharing, encourage a non-punitive culture and enhance transparency, accountability and continuous quality improvement in patient safety.

Background: ehealth improves the health-related quality of life for cancer patients and their families by providing easier access to medical information, promoting self-management, and providing personalised care through digital platforms. However, there is still a dearth of comprehensive understanding of their influences in developing countries.

Objectives: To identify several ehealth interventions accessible to family caregivers of people with cancer in developing countries and to assess the impact of these interventions on their health-related quality of life.

Methods: The review will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. Health databases and search engines, including PubMed, Medline via Ovid, Embase via Ovid, and CINAHL via EBSCOhost, will be used. We will include quantitative or mixed method research evaluating e-health, with a particular emphasis on the health-related quality of life of family caregivers of cancer patients. Studies from developing countries, including peer-reviewed journals and grey literature, will be considered without regard to publication date.The study selection process involves screening titles and abstracts for relevance, then, doing a full-text assessment against the inclusion criteria. The Cochrane Risk of Bias tool for randomised controlled trials and ROBINS-I V2 for non-randomised studies will be employed to assess the quality of the included studies. The A Measurement Tool to Assess Systematic Reviews will assess the quality of this systematic review.

Implications: This review offers a thorough and impartial summary of current research on e-health tools and their impact on the health-related quality of life of family caregivers of cancer patients. It seeks to inform evidence-based decision-making across healthcare, policy development, and research design by identifying knowledge gaps, emphasising areas requiring further investigation, and steering future research.

Systematic review registration: PROSPERO CRD42024622302 https://www.crd.york.ac.uk/PROSPERO/view/CRD42024622302.

We report a case of pyrexia of unknown origin presenting with lactic acidosis and hypoglycaemia. He further developed Guillain-Barre syndrome (GBS) and Hemophagocytic lymphohistiocytosis (HLH). The bone marrow biopsy ultimately reported Diffuse large B cell lymphoma (DLBCL). A 74-year-old gentleman visited the hospital in January 2024 with a fever since 2 weeks. He further developed hypoglycemic episodes and lower limb followed by upper limb weakness. On physical examination, he was febrile, tachypnoec with hepatomegaly and bilateral lower limb weakness with grade 3 power proximally and extensor plantar reflexes. Peripheral smear showed a leucoerythroblastic picture and 3% atypical lymphoid cells. Procalcitonin, lactate dehydrogenase and Ferritin were markedly elevated, suggestive of HLH. The bone marrow biopsy ultimately revealed DLBCL. He was diagnosed with GBS, Warburg phenomenon and HLH secondary to DLBCL. Intravenous steroids were started for secondary HLH and after he became hemodynamically stable was initiated on chemotherapy with Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, Prednisolone (R-CHOP) regimen. After four cycles of R mini-CHOP, positron emission tomography-computed tomography showed a good response. Further two cycles of R mini-CHOP was given with methotrexate for central nervous system prophylaxis. This case portrays an atypical presentation of DLBCL with Warburg syndrome, GBS and HLH. Despite the adverse clinical course, the patient responded favourably to chemotherapy.

Background: Adenoid cystic carcinoma of the breast (ACCB) is a rare histological subtype of breast cancer characterised by unique clinical features and management challenges. ACCB remains poorly understood, with limited data on its epidemiology, treatment outcomes and prognostic factors. This study aimed to elucidate the landscape of ACCB in a real-world context.

Methods: A retrospective cohort study was conducted on patients diagnosed with ACCB in a Brazilian cancer center between January 2007 and October 2021. Clinical and pathological data were systematically collected from electronic medical records. Statistical analyses were performed to identify factors associated with prognosis and assess the impact of treatment interventions.

Results: Twenty-one female patients with confirmed ACCB were included in the study. The median age at diagnosis was 55.2 years. Most patients had basaloid (38.1%) or classic (19.0%) histological subtypes. Adjuvant radiotherapy was associated with a trend towards better recurrence-free survival among patients with localised disease HR 0.21, CI 95% 0.04-1.06, p = 0.059). In the metastatic setting, systemic chemotherapy used for breast cancer demonstrated limited efficacy, with a median progression-free survival of 1.8 to 2.8 months. Despite the overall poor prognosis, two patients with low-volume metastatic disease had long-term survival following local therapy.

Conclusion: Given the rarity of ACCB and the absence of a standard management approach, this small study suggests a potential benefit of local therapies in adjuvant and metastatic settings while indicating the limited efficacy of systemic chemotherapy. Personalised treatment strategies tailored to ACCB are essential to optimising patient outcomes.

Endometrial cancer (EC) treatment changed substantially with the introduction of molecular classification. There is a paucity of data regarding the added value of L1CAM in patients with p53 aberrant tumours. The present study aimed to analyse the prognostic value of L1CAM associated with p53 aberrant EC. Patients with EC treated between 2010 and 2016 were retrospectively evaluated. Patients included in this analysis must have reviewed high-grade histologies (endometrioid grade 3, serous, clear cell, carcinosarcoma, mixed and undiffrentiated). Samples were subjected to immunohistochemistry for L1CAM and p53. Recurrence-free survival (RFS) and overall survival (OS) were analysed by the Kaplan-Meier method and log-rank test. Cox proportional hazards regression was performed for multivariable analysis. From 2010 to 2016, 464 patients met the inclusion criteria. Patients with p53 wild type and L1CAM negative (p53wt/L1CAMneg) corresponded to 13.6% (59 patients) of the population, p53 wild type and L1CAM positive (p53wt/L1CAMpos) to 11.7 % (51 patients), aberrant p53 and L1CAM negative (p53ab/L1CAMneg) to 32.9% (143 patients) and aberrant p53 with L1CAM positive (p53ab/L1CAMpos) to 41.8% (182 patients). In univariate and multivariate analysis, compared to patients with p53wt/L1CAMneg, the presence of p53wt/L1CAMpos, p53ab/L1CAMneg and p53ab/L1CAMpos was statistically associated with a worse RFS (HR 2.02; HR 2.20 and HR 2.99, respectively) and OS (HR 2.39; RH 2.31 and RH 2.94, respectively). In the present analysis of a high histological risk population, stages I-IV, we observed that the presence of p53ab/L1CAMpos was associated with a worse RFS and OS when comparing p53wt/L1CAMneg patients. Patients with L1CAMpos had the same worse prognosis as p53ab tumours.

Background: Cervical cancer remains a significant public health issue, particularly in low-income countries. It is the fourth most common cancer among women globally, with an estimated 570,000 new cases and 311,000 deaths in 2018.

Objective: This study aimed to examine the stages of cervical cancer at diagnosis and identify factors contributing to late-stage presentation among women in a tertiary care hospital in Nigeria.

Methods: A retrospective study analysed data from women diagnosed with cervical cancer between 2017 and 2021. Demographic, reproductive and clinical data were extracted from medical records.

Results: Of the 102 women who presented during the study period, only 57 (55.9%) had complete staging, clinical and demographic data; these complete cases were included to ensure data integrity. From this population, 73.7% were aged 50 years or older and 56.1% presented with late-stage disease. Additionally, anaemia (packed cell volume <30%) was present in 75.4% of women. Postcoital bleeding was reported in 35.1% of cases. Women with no formal education had higher odds of late-stage diagnosis odds ratios (OR: 4.40, 95% CI: 1.08-17.82). Postmenopausal women also had higher odds of late-stage diagnosis (OR: 4.46, 95% CI: 1.27-15.70).

Conclusion: A late-stage cervical cancer diagnosis is prevalent among women in Nigeria, particularly among those with lower educational levels and postmenopausal women. Targeted awareness programmes, expanded screening (including integration into well-woman/postmenopausal care) and improved healthcare infrastructure, including consistent documentation of screening history and human papillomavirus vaccination, are essential for reducing the burden of cervical cancer in this context.