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Background: Multiple myeloma (MM) is a chronic hematological malignancy caused by a differentiated plasma cell disorder (Pawlyn, 2019). As a consequence of population aging, there has been an increase in incidence rates (Turesson et al 2018). In 2022, there were 187,744 new cases (Bray et al 2024). The incidence of MM in Brazil has not been estimated by the National Cancer Institute (INCA).

Objective: To analyse the incidence rates and trends of MM across states in Brazil from Population-Based Cancer Registries (PBCRs).

Methodology: Information was extracted from PBCR/INCA for the 1988-2020 period. Sociodemographic data were extracted from records of the Brazilian Institute of Geography and Statistics. Age-standardised incidence rates were calculated using the Segi global standard population. Trend analysis was performed using Join point Regression, version 4.7.0.0.

Results: The highest incidence rates of MM in males were observed in the cities of Natal (Rio Grande do Norte state) and Jaú (São Paulo state) at 3.55/100,000 and 2.9/100,000, respectively. In females, rates were highest in the cities of Natal (Rio Grande do Norte state) and Aracajú (Sergipe state) at 2.66/100,000 and 2.21/100,000, respectively. Trends showed an annual increase of 10.45% in Campinas for males and 9.04% for females. Median age at diagnosis in Brazil was 65 years for both sexes, while the North region had the lowest average age at 63.2 years, and the South region the highest at 68.0 years. Porto Alegre city (Rio Grande do Sul state) had the highest average of 70.0 years for females and 67.1 for males, while Roraima had the lowest at 61.2 years for females and 54.2 for males.

Conclusion: In Brazil, the average age of incidence varies by geographic region, but is higher among males. Incidence rates are highest in the Northeast and Southeast regions, whereas the greatest upward trends are in the Southeast and Midwest regions.

Background: Primary cardiac sarcomas are exceedingly rare tumours associated with a poor prognosis due to delayed diagnosis, advanced presentation and limited known chemotherapy efficacy. While surgical excision is the preferred treatment, it is often not feasible. The role of systemic therapy remains uncertain.

Methods: We analysed the medical records of patients diagnosed with primary cardiac sarcoma registered at a sarcoma clinic between January 2016 and July 2023. Clinicopathological and imaging data and treatment information were collected. Descriptive statistics were employed for clinicopathological characteristics, and Kaplan-Meier analysis was used for survival assessment.

Results: A total of 12 patients were identified with primary cardiac sarcoma, with a median age at diagnosis of 33 years (IQR 20.5; range: 17-53). At presentation, 66.7% had pericardial effusion requiring pericardiocentesis with or without pleuropericardial window. Half (6 of 12 patients) were misdiagnosed initially as either tubercular pericardial effusion or cardiac hydatid cyst. Upfront resection was done for 4 patients (33.3%), while 4 (33.3%) had locally advanced/unresectable disease and the remaining 4 (33.3%) presented with de-novo metastatic disease. Angiosarcoma constituted 50% (6 out of 12), all arising from the right atrium. Of the 12 patients included, 6 received a median two lines of therapy. Of the total 9 response assessments (both as first line and subsequent lines), 55.5% had an objective response rate with an 88.8% clinical benefit rate. The median progression-free survival for first-line systemic therapy was 5.4 months. The median overall survival for patients who received systemic therapy and the entire cohort were 19.2 and 5.1 months, respectively.

Conclusion: This study highlights the advanced presentation and poor outcomes in patients with cardiac sarcoma. Due to the rarity of the tumour, it is often misdiagnosed. Systemic chemotherapy could alleviate symptoms and prolong survival. However, sarcoma pathology is heterogenous and cannot be generalised.

Trial registration: As this is a retrospective observational study, no trial registration has been done.

Pancreatic ductal adenocarcinoma (PDAC) remains a leading cause of cancer-related mortality, largely due to a lack of highly safe and effective therapeutic options. A large proportion of the tumour's mass consists of a dense fibrous stroma, which could provide valuable therapeutic targets. This review elucidates the various possible stromal targets in PDAC, methods of targeting them and the outcomes of this targeting in in-vitro studies, studies on murine models of PDAC and clinical studies. While targeting some stromal components in PDAC yielded disappointing results in clinical studies, others have shown promise in multiple settings. More research efforts should be directed towards identifying additional stromal targets and evaluating their therapeutic potential. In addition, comprehensive clinical studies are essential to evaluate the safety and effectiveness of agents targeting stromal components of PDA of agents targeting stromal components of PDAC, both as monotherapies and in combination with standard surgical and pharmacological treatments for PDAC to improve patient's outcomes.

Background: WHO's Global Initiative for Childhood Cancer (GICC) aims to increase global survival of childhood cancers to 60% by the year 2030 with a focus on six index cancers. However, there is no nationally representative epidemiologic data on these index cancers in Nigeria.

Aim: To describe the distribution, outcomes and determinants of GICC six-indexed cancer in Nigeria.

Methodology: A multi-centre ambi-directional cohort study of children was done in children <19 years diagnosed with any of acute lymphoblastic leukaemia (ALL), Wilms tumour (WT), retinoblastoma (RB), Hodgkin lymphoma (HL), Burkitt lymphoma (BL) or low-grade glioma (LGG). Seven centres in the six geopolitical zones of the country participated. A 2-year study with 18 months of retrospective data collection (January 2022-June 2023) and follow up of subjects was done for 6 months (July-December 2023).

Results: A total number of 213 subjects were enrolled and ALL (n = 72;33.8%), WT (n = 57; 26.8%), RB (n = 52; 24.4%), BL (n = 17; 8.0%), HL (n = 13; 6.1%) and LGG (n = 2; 0.9%) accounted for the disease pattern. Median age at diagnosis was 5 years (51.6%). Mortality rate was 32.4% and treatment abandonment occurred in 37.6% of subjects. Treatment-related mortalities (TRMs) were 37.7% with infection and haemorrhage the commonest specific causes of TRM (36.1% and 42.5%). Only 7/95 (7%) of subjects with WT and RB stage III and IV benefited from RT. The most common reasons for non-RT were lack of funds (29%), lack of access to RT (54%) and lack of physicians' referral (11%). Only 10 (4.3%) of subjects were enrolled in a health insurance scheme. Independent risk factor for mortality was advanced disease stage (p = <0.001). Amongst the mortalities, 36% died within the first 3 months of diagnosis.

Conclusion: Treatment abandonment, mortality and TRM are high in Nigeria. To attain the GICC goal, there is a need to educate physician on treatment protocol, ensure availability of supportive care, health insurance, RT and tackle late presentation.

Background: Stage 1 seminoma is treated with high inguinal orchiectomy (HIO) followed by either chemotherapy, radiation therapy (RT) or active surveillance (AS).

Methods: This was a retrospective analysis of a prospectively collected dataset of patients with seminoma treated at a comprehensive cancer care centre in India. Adolescent and adult males with stage 1 seminoma were included.

Results: A total of 114 patients were analysed. The median age was 39 years (IQR: 32-48 years). Stage IA was more frequently seen and 105 (92.1%) patients underwent unilateral HIO. Chemotherapy was offered to 66 (57.9%) patients. AS was offered to 32 (28.1%) patients while RT was offered to 16 (14%). Only 14 (43.8%) of the 32 patients on AS strictly adhered to the institutional follow-up guidelines for at least 2 years post treatment. Of the 114 patients, 9 (7.9%) patients had radiological relapse, while 4 (3.5%) of them were symptomatic at relapse. Bleomycin, etoposide and cisplatin were the most common regimen offered on relapse. The median follow-up of the cohort was 70.6 months (95% CI: 59.1-82 months). The mean relapse-free survival (RFS) was 107.7 months (95% CI: 102.5-112.8 months). The 1-, 2- and 5-year RFS were 97.3%, 95.5% and 92.4%, respectively. The mean overall survival (OS) was 114.9 months (95% CI: 113.2-116.6 months). The 2-, 5- and 8-year OS were 100%, 98.9% and 98.9%, respectively. There was no statistically significant benefit of 2 cycles over 1 cycle of carboplatin in terms of median RFS (96.5 versus 108.8 months, p = 0.260) or 5-year OS (95% versus 100%, p = 0.192). There was no statistically significant difference in RFS (p = 0.355) or OS (p = 0.684) based on treatment offered at baseline. There was no difference in survival between patients who strictly adhered to follow-up guidelines versus those who did not.

Conclusion: In a developing nation with constrained resources, AS remains a good treatment option for stage 1 seminoma with excellent long-term outcomes and freedom from the toxicities of chemotherapy.

Background: Cervical cancer is the most common gynaecological cancer. Molecular, clinical and epidemiological studies have shown that high-risk human papillomavirus (HPV) infection plays a causal role in the aetiopathogenesis of cervical carcinoma. This study is to determine the serotype distribution of high-risk HPV deoxyribonucleic acid (DNA) in women with established cervical cancer and compare HPV DNA detected in cervicovaginal secretions with that extracted from formalin-fixed paraffin-embedded tissue (FFPE) section in Lagos State University Teaching Hospital, Southwest, Nigeria.

Methods: This was a comparative study involving subjects with clinical suspicion of cervical cancer. They had examination under anaesthesia, staging and biopsy done, and 44 of the subjects with histologically confirmed cervical cancer were recruited. Their cervico-vaginal secretion samples were taken for high-risk HPV and compared same with high-risk HPV obtained from tissue extraction. The result obtained was analysed using SPSS version 27.

Result: Of 44 subjects with tissue diagnosis of cervical cancer, high risk (hr) - HPV DNA was detected in 38 (86.4%) in both cervicovaginal secretions and the FFPE tissues of the subjects. Of the hr-HPV detected from the FFPE samples, HPV 16 was seen in 27 (61.4%) and HPV 18 in 16 (36.3%) subjects. Other HPV types identified include 45 in 7 (15.9%), HPV 58 in 5 (11.4%), HPV 51 in 3(6.8%), HPV 39 in 2 (4.5%), HPV 66 in 1 (2.3%) and HPV 73 in 1 (2.3%) of cases. There were 16 (36.4%) of single and 22 (50.0%) multiple serotypes of hr-HPV detected. Of the multiple serotypes, two serotypes in 21 (47.3%) cases and three serotypes (16, 18 and 58) in 1 (2.3%) case.The test kit detected the same number of hr-HPV as in tissue extraction (86.4%); however, with different serotypes. With tissue extraction more (serotypes) HPV 16 and 18 were detected compared to the use of cervicovaginal secretion (p = 0.001) and (p = 0.046).The commonest histological type of cervical cancer found among the subjects was squamous cell carcinoma (SCC) 38 (86.4%) and adenocarcinoma 4 (9.2%). Thirty-three subjects (86.8%) of those with SCC were positive for hr-HPV with serotypes 16 and 18, predominating.

Conclusion: The hr-HPV DNA detection rate on cervicovaginal secretion using the test kit is similar to that of tissue extraction FFPE, with serotypes 16 and 18 being predominant. This finding further confirms the reliability of the use of the HPV test kit on cervicovaginal secretion as a screening tool for premalignant and malignant lesions of the cervix.

Background: Pembrolizumab has been widely used to curb the disease progression of non-small-cell lung cancer (NSCLC), but 20% of patients treated with pembrolizumab have disease progression. MicroRNA-21 (miRNA-21) was highly expressed in NSCLC and promoted the occurrence of malignancy-related processes. However, the predictive value of miR-21 in NSCLC patients who underwent immunotherapy remains unknown. We aim to investigate the predictive role of miR-21 in NSCLC patients who received pembrolizumab-based combination therapy.

Methods: We included 136 advanced NSCLC patients and miR-21 levels were identified. The combined positive score (CPS) was calculated and CPS≥1 was considered PD-L1 positive tumour cells in patients with NSCLC. Circulating miR-21 expressions between responders and non-responders were analysed. The overall survival (OS) and progression-free survival (PFS) according to miR-21 status were also investigated.

Results: Patients categorised as responders had significantly lower expression of miRNA-21 (p < 0.001). Notably, miR-21 levels were also lower in patients with CPS≥1 (p < 0.001). According to the 50th percentile of miR-21 concentrations, patients with lower miR-21 levels had significantly improved OS (69.6 (95% CI: 63.8-75.4) versus 14.4 (95% CI: 9.9-18.9), p<0.001) and PFS than those with higher miR-21 levels (64.2 (95% CI: 58-70.4) versus 17.0 (95% CI: 16.5-17.5), p<0.001).

Conclusion: MiR-21 levels were significantly correlated with the therapeutic effect and prognosis of NSCLC patients who received immunotherapy. MiR-21 holds promise as a potential biomarker of response to immunotherapy in NSCLC and it may suggest that miR-21 could be regarded as a novel indicator for prognostic prediction in NSCLC patients.

Cirrhosis is the fourteenth leading cause of death globally and significantly increases the risk of hepatocellular carcinoma (HCC). Polymorphisms in the vitamin D receptor (VDR) can influence inflammation, fibrosis progression and cancer susceptibility. We analysed the association of genetic polymorphisms of the VDR (VDR-rs2228570, VDR-rs731236 and VDR-rs7975232) in cirrhosis with or without HCC, considering clinical, biochemical profiles and survival. A total of 158 patients with cirrhosis, with or without HCC, were studied and distributed into Group 1 (G1 = 60): cirrhosis and HCC; Group 2 (G2 = 98): isolated cirrhosis and control group (G3 = 225): without liver disease. Genetic polymorphisms were analysed by real-time polymerase chain reaction; clinical and biochemical profiles were obtained from medical records. A significance level of α = 5% was adopted. The homozygous mutant for VDR-rs731236 and rs7975232 predominated in G1 compared to other groups (p < 0.05). For VDR-rs2228570, the homozygous mutant predominated in patients, while heterozygotes were found in controls (p > 0.05). A positive correlation between vitamin D and parathyroid hormone was observed in patients (R² = 0.3273). VDR-rs2228570 emerged as a protective factor for G2 (p = 0.0057) and was associated with increased survival, as was rs7975232. In conclusion, VDR-rs731236 and VDR-rs7975232 are associated with cirrhosis and HCC, with VDR-rs7975232 identified as independent predictors for isolated cirrhosis. VDR-rs2228570 confers protection and is associated with increased survival in cirrhosis, as well as a better clinical profile for both conditions in the Brazilian cohort. These findings highlight the potential clinical relevance of VDR polymorphisms as biomarkers for risk assessment and prognosis in cirrhosis and HCC.

Background: Colorectal cancer (CRC) is a leading cause of cancer morbidity and mortality in Tanzania. Non-metastatic CRC is a potentially curable disease that requires multidisciplinary management. This study aimed to evaluate clinicopathologic characteristics for CRC, treatment patterns and select quality metrics at Ocean Road Cancer Institute from 2014 to 2019, the time period immediately preceding the release of Tanzania's first National Cancer Treatment Guidelines in 2020.

Methods: Quality metrics were selected a priori based upon existing international quality measures, the newly released Tanzania National Cancer Treatment Guidelines and key stakeholder input. Demographic, clinicopathologic and treatment data were abstracted from medical charts for all adult patients with newly diagnosed non-metastatic CRC presenting to Ocean Road Cancer Institute from 2014 to 2019. A clinician reviewed all case report forms for quality assurance. Patient characteristics, treatment patterns and quality metrics were examined using descriptive analyses.

Results: Of 678 patients with CRC, 421 (62%) had non-metastatic disease. Of those with non-metastatic disease, 92 (22%) had colon cancer, 175 (42%) had rectal cancer and 154 (36%) were classified as CRC primary site not otherwise specified. Most patients with colon cancer (n = 86, 93%) underwent surgical resection. Quality of adjuvant chemotherapy was high for colon cancer, with most patients receiving timely treatment (73% within 8 weeks of surgery) and most (81%) with stage III disease receiving appropriate treatment. Documentation in surgical pathology reports was poor, with only 5 of 78 (6%) documenting examination of >12 lymph nodes. Among rectal cancer patients, use of preoperative chemoradiation (7%) and perioperative chemotherapy (27%) was low for locally advanced disease. Overall, only 42 (24%) of patients with rectal cancer underwent surgery and 42 (24%) received no treatment.

Conclusion: The majority of patients with non-metastatic colon cancer received high-quality care, whereas care delivery was less consistent among patients with rectal cancer. This suggests possible challenges in delivering complex, multidisciplinary care in low-resource settings. These findings will serve as a contemporary benchmark for future evaluations of the Tanzanian National Cancer Treatment Guidelines and their impact on CRC care and outcomes.

Background and purpose: A high-quality treatment planning process is crucial in advanced radiotherapy techniques to ensure adequate dose to the target volume (TV) and sparing of organs at risk (OARs). This process often requires intensive labor, creating barriers for deployment in low- and middle-income countries (LMICs). We aimed to establish the feasibility of implementing knowledge-based auto-planning to facilitate clinical efficiency and increase patient throughput in an LMIC.

Materials and methods: We evaluated 60 randomly selected VMAT manual plans (VMPs), including 10 for each of the following sites: head and neck, oesophagus, breast, prostate, cervical, and rectal cancers. Using the same CT-structure datasets, volumetric modulated arc therapy auto-plans (VAPs), which involved matching the patient's CT-structure datasets with corresponding model structures before optimisation, were generated using RapidPlan^® knowledge-based models. The plans were compared using different dosimetric parameters, average planning times (APT) and plan scores, the latter of which was used for quantification of plan quality.

Results: The APT was 29.5 ± 3.0 minutes for VAPs compared to 43.2 ± 12.0 minutes for VMPs (p < 0.01), an approximate 33.0% time saving. The average plan scores were 73.9% ± 9.5% and 74.8% ± 10.5% for VAPs and VMPs, respectively (p = 0.50). The average homogeneity and conformity indices were 0.12 ± 0.05 and 0.93 ± 0.04 for VAPs compared to 0.09 ± 0.04 and 0.94 ± 0.03 for VMPs, respectively. For prostate and breast cases, both methods achieved the rectum's V50Gy ≤ 50% and spinal cord's Dmax ≤ 39.0 Gy constraints; however, VAPs projected lower doses than the corresponding VMPs (16.5 ± 4.3 versus 30.6 ± 13.1: p = 0.01) and (6.0 ± 1.6 versus 19.6 ± 2.3: p < 0.01).

Conclusion: The knowledge-based VAP-generated technique offers adequate dose coverage, homogeneity and conformity to the TV while sparing OARs, is less dependent on the planner's experience, saves planning time and holds tremendous potential for improving radiotherapy workflow in LMICs.