Indian journal of cancer最新文献

Background: Neoadjuvant chemotherapy (NACT) is routinely used in all cases of locally advanced breast cancer and some cases of early breast cancer. We previously reported a pathological complete response (pCR) rate of 8.3%. With the increasing use of taxanes and human epidermal growth factor receptor 2 (HER2)-directed NACT, we conducted this study to understand the current pCR rate and its determinants.

Methods: A prospective database of breast cancer patients who underwent NACT followed by surgery between January and December 2017 was evaluated.

Results: Of the 664 patients, 87.7% were cT3/T4, 91.6% were grade III, and 89.8% were node-positive at presentation (54.4% cN1, 35.4% cN2). The median age was 47 years; median pre-NACT clinical tumor size was 5.5 cm. Molecular subclassification was 30.3% hormone receptor positive (HR+) HER2-, 18.4% HR+HER2+, 14.9% HR-HER2+, and 31.6% triple negative (TN). Both anthracyclines and taxanes were given preoperatively in 31.2% patients whereas 58.5% of HER2 positive patients received HER2-targeted NACT. The overall pCR rate was 22.4% (149/664), 9.3% in HR+HER2-, 15.6% in HR+HER2+, 35.4% in HR-HER2+, and 33.4% in TN. On univariate analysis, duration of NACT ( P < 0.001), cN stage at presentation ( P = 0.022), HR status ( P < 0.001), and lymphovascular invasion ( P < 0.001) were associated with pCR. On logistic regression, HR negative status (Odds ratio [OR] 3.314, P < 0.001), longer duration of NACT (OR 2.332, P < 0.001), cN2 stage (OR 0.57, P = 0.012), and HER2 negativity (OR 1.583, P = 0.034) were significantly associated with pCR.

Conclusion: Response to chemotherapy depends on molecular subtype and duration of NACT. A low rate of pCR in the HR+ subgroup of patients warrants reconsideration of neoadjuvant strategies.

Background: Mitochondrial defects are thought to play a role in cancer initiation and progression for a long time. Because of the absence of protective histones and an inefficiency in the DNA repair process, mitochondrial DNA is known to be prone to mutations. The deletion of 4977bp is one of the most common mutations in human cancers. This study aimed to investigate the relationship between 4977bp common deletion and Esophageal Squamous Cell Carcinoma Disease (SCC) to provide prognostic information.

Methods: By using a PCR protocol, this study identified the 4977bp deletion of mtDNA. A PCR method was used on tumor samples from 41 squamous cell carcinoma patients and blood samples from 50 healthy individuals to detect DNA.

Results: Among the 41 tumor samples (80.5%), 33 were found to have the 4977bp deletion, while none of the blood samples from healthy individuals contained it.

Conclusions: It is shown that the deletion of 4977bp of mtDNA correlates significantly with SCC in this study. A 4977bp deletion could be used as an effective cancer screening indicator and biomarker for early diagnosis and prevention of cancer.

Background: There is limited data comparing pain management following various minimally invasive oncological surgeries (MIOS). This retrospective audit was planned to determine the severity of pain and to study the analgesic modalities offered to these patients. Secondary objectives included studying opioid requirements, non-opioid analgesics, their side effects, and the influence of comorbidities on the choice of pain modalities.

Methods: Following approval and registration of trial (CTRI/2018/10/016220), data were collected retrospectively from adult patients who underwent elective MIOS for abdominal tumors from August 2017 to July 2018. Pain scores (PS) on the day of surgery, and the average, worst PS, and the morphine equivalent (ME) dose in the perioperative period was recorded. Emergency surgeries and thoracic-abdominal MIOS were excluded. The association between the type of surgery, pain modalities, and PS were compared using Chi-square test. ME dose consumption of patients and type of surgery were compared using ANOVA with Bonferroni's correction.

Results: Out of the 349 patients' data that were analyzed, 76% had mild, 22% had moderate, and 2% had severe pain after surgery. Port site infiltration was done in 27% of cases and epidural analgesia in 46 patients (13%). PS and opioid consumption (ME = 5.7 ± 5.2 mg) was significantly higher following pelvic surgeries when compared to other urological and diagnostic MIOS. American Society of Anesthesiologists Physical Status did not affect PS or choice of pain management technique.

Conclusion: Most of the patients experience mild pain at movement in the immediate postoperative period, pelvic MIOS (abdominoperineal resection/exenteration surgeries) have higher PS and opioid consumption than other MIOS.

Abstract: We describe an interesting upper gastrointestinal endoscopy image of a mass seen in the stomach of a 19-year-old boy who presented to us with an upper gastrointestinal bleed without any history of pain or illness in the past and was diagnosed as a primitive neuroectodermal tumor or Ewing's sarcoma of the stomach.

Background: In metastatic colorectal cancer (mCRC), the genetic structure and cell metabolism of the primary tumor lesion might be different from metastatic lesions. It is thought that cell-level glucose metabolism may differ due to the difference in RAS wild and mutant mCRC patients' prognosis. In this study, we aimed to compare 2-deoxy-2-[fluorine-18]-fluoro-D-glucose Positron Emission Tomography (18F-FDG PET/CT) uptake levels for KRAS mutation status and primary-metastatic tumor localization.

Methods: Our study is a retrospective cohort analysis that included RAS mutation status study and staging-oriented 18F-FDG PET/CT conducted on mCRC patients.

Results: There was no significant relationship between metastasis and primary tumor maximum Standardized uptake value (SUVmax) values according to the KRAS mutational status (P > 0.05). Patients with liver metastasis along with mutant BRAF mutation status had significantly higher SUVmax values in PET-CT scans (P = 0.04). There was a negative correlation between SUVmax values of lung metastases and overall survival (r = -0.35, P = 0.04). Patients with high carcinoembryonic antigen (CEA) levels had significantly higher SUVmax values of lung metastasis than patients with normal CEA levels (P = 0.009). Patients with high CA19-9 levels had significantly higher SUVmax values of liver, peritoneal, and bone metastasis than patients with normal CA19-9 levels (P = 0.002, P = 0.001, P = 0.004, respectively). There was no significant correlation between SUVmax values of metastasis and Lactate dehydrogenase (LDH) values. Liver metastasis of right-sided mCRCs had significantly higher SUVmax values (P = 0.03).

Conclusion: We could not demonstrate a significant association between KRAS mutation and SUVmax values of PET scan in primary or metastatic tumor sites in advanced CRC.

Background: Serine-Arginine (SR) proteins are a conserved family of proteins involved in RNA splicing and are reported to be over-expressed in multiple cancers. The aim of the study is evaluation of the expression of Serine arginine protein kinase 1 (SRPK1) and Minichromosome maintenance protein 2 (MCM2) in epithelial ovarian cancer (EOC) and their correlation with clinicopathological features, response to therapy, progression-free survival (PFS), and cancer-specific survival (CSS).

Methods: This study was carried out on surgical specimens of 65 patients diagnosed with EOC which were submitted to immunohistochemical staining by SRPK1 and MCM2 antibodies.

Results: About 89.2% of cases showed SRPK1 expression and its high expression was significantly associated with type II tumors and advanced stage. All cases showed nuclear immunoreaction for MCM2 with high expression in 49.2% of cases. There was a significant relationship between high values of SRPK1 H-score and percentage of MCM2. Postmenopause, type II pathology, advanced stage, absence of complete response to the treatment, resistance to platinum-based chemotherapy, and surgery done by a general surgeon were the factors affecting PFS. Response to treatment and platinum sensitivity were the most independent factors affecting patients' PFS. The factors associated with shorter CSS were suboptimal debulking, advanced stage, absence of complete response to the treatment, platinum resistance, and high SRPK1. High SRPK1 expression and platinum sensitivity were the independent factors affecting patients' CSS.

Conclusions: SRPK1 is an unfavorable biomarker in EOC patients because of its association with aggressive histologic type, advanced International Federation of Gynecology and Obstetrics (FIGO) stage, and worse survival. SRPK1 could promote the proliferation of EOC by up-regulation of MCM2.

Background: Presence of neck nodes in cases of head neck squamous cell cancers is an adverse prognostic factor. Elective neck dissection is traditionally recommended along with primary disease resection. Sentinel lymph node (SLN) is the first draining node. Sentinel lymph node biopsy (SNB) is a minimally invasive technique to identify occult nodal metastasis in early HNSCC.

Methods: The objective of this study is to determine the identification rate of SNB using methylene blue dye (MBD) in N0 neck of Oral Squamous cell carcinoma (OSCC) and estimating specificity, sensitivity, negative predictive value and positive predictive value of SNB with frozen section (FS) analysis and in comparison to post-operative histopathological examination (HPE). It is a cross-sectional study conducted at a tertiary care centre, Lucknow, India. 21 patients of N0 OSCC from January 2019 to May 2020, were included. All patients underwent peritumoral injection with MBD. Sentinel nodes were harvested and sent for FS. Depending on FS findings, appropriate neck dissection was performed.

Results: SLN was identified at level Ib and II in 19 patients (90.47%). The sensitivity, specificity, PPV and NPV in identifying SLN using MBD versus FS were 100.00%, 11.11%, 15.79% and 100.00% respectively. Whereas, SLN using MBD versus HPE specimens were 100.00%, 10.52%, 10.52% and 100.00% respectively.

Conclusion: Despite having 100% sensitivity, MBD alone has poor specificity. With this poor discriminatory power, it is unlikely to be employed as a diagnostic test alone. It is recommended to rely on per-operative FS for taking decision as far as extent of neck dissection in N0 neck is concerned.

Background: The relationship between neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in peripheral blood and prognosis after castration therapy for prostate cancer remains unclear.

Methods: A total of 186 patients with prostate cancer treated between January 2018 and March 2021 were selected as the study subjects. All patients underwent castration therapy. Patient follow-up records for 2 years were examined to assess progression-free survival. NLR, PLR, and PSA levels were measured in the participants' blood. Logistic regression analysis was used to identify factors affecting the occurrence of castration-resistant prostate cancer. Kaplan-Meier survival curves were plotted to analyze progression-free survival, and ROC curves were plotted to assess the predictive value of NLR and PLR for progression-free survival.

Results: In the stable group, NLR, PLR, PSA levels, bone metastasis ratio, and Gleason score ≥8 were significantly lower than in the progression group. T3 stage, N0 stage, and M0 stage were significantly higher in the progression group, with statistical significance (P < 0.05). NLR, PLR, and PSA levels were all significantly linearly correlated (P < 0.05). High NLR, high PLR, high PSA, high bone metastasis, Gleason score <8, T3 stage, and N0 stage were independent risk factors for poor prognosis after castration therapy for prostate cancer, with statistical significance (P < 0.05). Patients with low NLR had significantly better progression-free survival than the high NLR group, and patients with low PLR had significantly better progression-free survival than the high PLR group, with statistical significance (P < 0.05). The area under the curve for NLR and PLR in predicting progression-free survival after castration therapy for prostate cancer was both greater than 0.90, indicating high clinical utility.

Conclusion: Peripheral blood NLR and PLR after castration therapy for prostate cancer are highly correlated with patient prognosis quality and can serve as important potential indicators for predicting patient prognosis quality.