Indian journal of cancer最新文献

Abstract: Chylous ascites is an uncommon complication seen in gynecological malignancies. The incidence of postoperative chylous ascites in gynecological malignancies is 0.17%. It is the extravasation of milky chyle into the peritoneal cavity due to lymphatic obstruction or injury and is diagnosed by the detection of triglyceride levels greater than 200 mg/dl in ascitic fluid. The site of leakage can be determined by lymphangiography or lymphoscintigraphy. The majority of the cases of chylous ascites can be treated by conservative methods, such as a dietary modification to a low-fat high-protein diet, bowel rest, total parenteral nutrition, medications, and large-volume paracentesis. If these measures fail, surgical modalities such as laparotomy or peritoneovenous shunting are employed. In our case, the patient was successfully managed on dietary modification alone. This case report emphasizes the importance of conservative management for chylous ascites following surgery and radiotherapy in endometrial carcinoma.

Background: Prolactin (PRL) plays an important role in mammary epithelial cell development and lactation. Increased levels of PRL are observed in human breast cancer, but the underlying mechanism and prognostic significance of PRL are still controversial. In this study, we sought to determine the significance of PRL in Chinese postmenopausal women with breast cancer.

Methods: Plasma PRL levels in 326 healthy individuals and 333 postmenopausal breast cancer patients were analyzed. Immunohistochemical staining of cytoplasmic prolactin receptor (PRL-R) was performed. Moreover, the relationships between plasma PRL and clinicopathological parameters as well as survival in breast cancer patients were evaluated.

Results: We found that high plasma levels of PRL was more common in breast cancer patients than in healthy individuals. We also observed that high level of PRL was associated with adverse prognostic factors, such as larger tumor size, more lymph node metastasis, advanced tumor stage, negative estrogen receptor (ER) expression, and negative progesterone receptor (PR) expression of breast cancer. Kaplan-Meier analysis showed that high plasma level of PRL correlated with poor disease-free and overall survival, while Cox regression models demonstrated that high plasma level of PRL was an independent prognostic marker for disease-free survival. The rate of PRL-R positivity among those with high plasma PRL was significantly higher than that of patients with low PRL (P < 0.05).

Conclusion: The plasma PRL level and PRL-R expression in tumor tissue may be prognostic for Chinese postmenopausal women with breast cancer. The inhibition of PRL and PRL-R signaling is a potential therapeutic approach for endocrine therapy in breast cancer.

Abstract: T-cell acute lymphoblastic leukemia/lymphoma (T-ALL/LBL) is a neoplasm of lymphoblasts that is usually TdT-positive and variably expresses CD1a, CD2, cytoplasmic CD3 (cytoCD3), CD4, CD5, CD7, and CD8. Acute undifferentiated leukemia (AUL) is a rare entity and is defined by the expression of not more than one membrane marker for any given lineage. Blasts express HLA-DR, CD34, and/or CD38 and may be positive for terminal deoxynucleotidyl transferase (TdT). Mixed-phenotype acute leukemia (MPAL) is a hematologic malignancy with immunophenotypic co-expression of markers from at least two cell lineages. In this case series of acute leukemia, we emphasize on key diagnostic or biological points of acute leukemia of ambiguous lineage versus T-ALL and provide a relevant literature review. A diagnosis of AUL can be debatable for our cases; however, the positivity of CD5 and CD7 (bright) ruled out AUL. Although cyCD3 is a T-cell lineage-specific marker of T-ALL, its negativity does not always rule out the diagnosis as several cases have been reported with a negative cyCD3, as reported in our cases.

Background: Psychosocial issues adversely impact children with cancer but are seldom addressed.

Materials and methods: Children with cancer who were consecutively referred to the pediatric psycho-oncologist from June 2016 to September 2018 were included in a retrospective study. Psychosocial issues were categorized as disease related (DR), treatment related (TR), interpersonal related (IPR), and academic related (AR). The interventions provided were classified as counseling, prolonged psychotherapy, and referral to a child psychiatrist for pharmacologic therapy.

Results: The mean age of the 212 children included in the study was 10.7 ± 4.2 years, and the male to female ratio was 1.8:1. Of the 212 children, AR, TR, DR, and IPR concerns were identified in 93 (44%), 61 (29%), 41 (19%), and three (1%) patients, respectively. Fourteen of the 212 (7%) patients had concerns spanning all four domains. Thirty-six (48%) of the 56 children aged ≤7 years were identified to have TR issues. Of the 99 children aged ≥13 years, 65 (61%) demonstrated AR issues.

Conclusions: Children with cancer experience several psychosocial issues. They can be classified into specific clusters that differ across different age groups. The majority of patients with psychosocial concerns can be managed with psychotherapy.

Abstract: Ewing's sarcoma (ES) is a rare sarcoma of bone and soft tissue that uncommonly involves head and neck. Accurate diagnosis of ES family of tumors is crucial for appropriate clinical management of patients. The present case demonstrates the importance of advanced imaging technologies to aid in proper diagnosis of ES.

Background: This study was conducted to investigate the clinical and pathological characteristics of patients with pregnancy-associated gastric cancer.

Materials and methods: A retrospective study was performed on nine patients with pregnancy-associated gastric cancer. The clinical data were analyzed.

Results: The main symptoms were nausea and vomiting (four cases), epigastric pain (two cases), and chest tightness/abdominal distension (two cases). CA19-9 was increased in six patients of whom five patients showed increased carcinoembryonic antigen (CEA) . The histological types were mainly poorly differentiated adenocarcinoma (five cases) and signet ring cell carcinoma (four cases). The most common metastasis sites were peritoneum (four cases) and ovary (three cases). One case was human epidermal growth factor receptor 2 (HER2) positive. Only three patients underwent radical resection, followed by chemotherapy (oxaliplatin plus S-1 [SOX]). Six patients with advanced cancer were mainly treated with oxaliplatin plus paclitaxel or SOX. After treatment, eight patients were followed up for 1-16 (mean 8.3) months. At 12-14 (mean 12.8) months after treatment, four patients were still alive (44.4%), including three cases of radical gastrectomy and one case with abdominal metastasis. Four patients died 1, 3, 4, and 16 months after diagnosis. Six newborn infants survived without tumor metastasis.

Conclusion: Pregnancy-associated gastric cancers are usually of poor differentiation and high malignancy and may present without specific clinical symptoms. CEA and CA19-9 can be used to assist the diagnosis of gastric cancer during pregnancy. Gestational age, pathological type, stage, and patient's wishes should be considered in planning treatment to maximize the benefits of mother and fetus.

Objective: To assess the role of omental and ovarian chemotherapy response score (CRS) and CA125 as a predictor of prognosis in patients with tubo-ovarian high-grade serous carcinoma (HGSC)/primary peritoneal carcinoma (PPC) receiving neoadjuvant chemotherapy (NACT). In addition, to study the correlation of omental CRS with chemoresistance.

Methods: A retrospective record review of patients with tubo-ovarian HGSC/PPC receiving NACT followed by interval debulking surgery (IDS) between January 2012 and May 2020 was done. The slides of the omentum and ovarian tissue of the patients were retrieved and reviewed by a trained pathologist. During analysis, CRS 1 and CRS 2 were merged together for comparison against CRS 3.

Results: A total of 44 patients with a mean age of 54 years were included in the study. Among the patients, 29.5%, 38.6%, and 31.8% had a CRS of 1, 2, and 3, respectively, on the omental specimen and 31.8%, 43.2%, and 25% on the ovarian specimen. Median PFS and OS was significantly better with omental CRS 3 (P = < 0.0001 and P = < 0.00065). No significant difference in median OS of patients was noted with ovarian CRS 1, 2, or 3 (P = 0.057); however, the median PFS was significantly better in patients with CRS 3 on ovarian tissue (P = 0.036). Platinum resistance was significantly lower in patients with CRS 3 on omentum (P = 0.001). The value of CA125 post NACT had a significant association with PFS on both univariate and multivariate analyses. There was no statistically significant correlation between CA125 and omental CRS.

Conclusion: Omental CRS has a prognostic significance for patients with tubo-ovarian HGSC/PPC receiving NACT and correlates significantly with PFS and OS. Ovarian CRS correlates significantly only with PFS. Post NACT CA125 value had a significant association with PFS.

Background: Pineoblastomas are highly aggressive malignant grade-IV tumors of embryonal origin with poor prognosis, accounting for < 0.1% of all brain tumors, affecting mainly the pediatric and adolescent cases but extremely rare in adults with an incidence of 0.1%-<1%. With scarce Indian and world data involving adult patients due to its rarity and lack of large prospective cohorts, this study was undertaken to determine survival outcomes in adult cases undergoing surgery, postoperative radiation therapy, and chemotherapy in terms of clinical response, prognosis, and disease progression.

Methods: Intake, treatment, and follow-up of patients were done from July 2009 to July 2021. A total of 1085 cases of primary brain tumors comprising malignant and benign adult and pediatric patients were registered over the study period. Adult pineoblastomas constituted 10/1085 (0.9%) cases of all primary brain tumors. All eligible patients underwent surgery, postoperative radiation therapy with concurrent chemotherapy, followed by adjuvant chemotherapy. Univariate Cox regression analysis was used to identify possible prognostic factors. Kaplan-Meier survival analysis was performed to estimate survival.

Results: The median disease-free survival was 63 months, and the median overall survival was 83 months. Poor performance status (P = 0.043), greater presenting symptoms (P = 0.041), and presence of residual disease (P = 0.000) were identified as independent predictors of reduced disease-free survival, without affecting overall survival.

Conclusion: We undertook this study keeping the dose of postoperative radiation therapy and chemotherapy regimens constant for all patients irrespective of surgical status to maintain uniformity in the survival quotient. Despite the limitations, this study may represent the largest analysis of adult pineoblastomas reported in Indian literature to date.

Background: Pulmonary complications are the main cause of postoperative mortality in patients undergoing esophagectomy. The aim of this study was to identify the risk factors associated with major pulmonary complications in these patients.

Methods: This was a retrospective cohort study of patients who underwent esophagectomy between January 2004 and December 2014. We retrieved data on patient- and surgery-related variables and the postoperative complications from medical records, including age, gender, physical status as per the American Society of Anesthesiologists' (ASA) classification, smoking status, hemoglobin, albumin, creatinine, forced expiratory volume in the first second (FEV1), neoadjuvant therapy, type of surgery (transthoracic vs. others), thoracic approach (minimally invasive vs. open), lymphadenectomy type (three field or abdominal vs. two field), intraoperative blood loss, operative time, and use of epidural analgesia. We classified pulmonary complications using the Clavien-Dindo system. Multivariable logistic regression analysis was used to derive the odds ratios (OR) with 95% confidence intervals (CI) to identify significant risk factors for major pulmonary complications (Clavien-Dindo grade 3 or more).

Results: We obtained relevant data on 1189 patients operated during the study period. Increasing age (OR 1.03, 95% CI 1.01; 1.04; P < 0.01), FEV1% less than 70% (OR 1.71, 95% CI 1.03; 2.83; P = 0.04), three-field lymphadenectomy (OR 2.12, 95% CI 1.50; 3.01; P < 0.01), and use of analgesia techniques other than epidural (OR 1.51, 95% CI 1.07; 2.13; P = 0.02) were independent predictors of major pulmonary complications.

Conclusions: The recognition of factors associated with increased risk of pulmonary complications in patients undergoing esophagectomy could help in risk stratification, preoperative optimization, and early detection of complications.