Journal of the Egyptian National Cancer Institute最新文献

Background: The high incidence of primary and recurrent ovarian cancer after surgery imposes a significant economic burden. Cytoreductive Surgery combined with Hyperthermic Intraperitoneal Chemotherapy (CRS + HIPEC) shows promise as a treatment for epithelial ovarian cancer (EOC). This study aims to evaluate CRS + HIPEC's potential to improve survival outcomes, such as overall survival (OS) and progression-free survival (PFS) while reducing adverse events and enhancing cost-effectiveness.

Method: A literature review was conducted using the PRISMA framework on databases including Scopus, ProQuest, and PubMed, with quality assessment through the Newcastle-Ottawa Scale (NOS) and Risk of Bias (RoB) 2.0. Quantitative analysis employed RevMan 5.4.1 with a pooled randomized effect model using log [hazard ratio].

Result: From 15 studies involving 1982 participants, OS analysis showed significantly higher survival in the CRS + HIPEC group (HR = 0.67, p < 0.0004). Although PFS was higher in this group, the result was not statistically significant (HR = 0.86, p = 0.46). Adverse events were more likely in the intervention group compared to control group (OR = 1.81, p < 0.0001). Cost analysis revealed that the Incremental Cost-effectiveness Ratio per Quality-Adjusted Life Year (ICER/QALY) remains below Indonesia's GDP threshold.

Conclusion: CRS + HIPEC shows potential benefits in EOC management, particularly in OS and PFS improvement, alongside manageable adverse events and favorable cost-effectiveness. However, study design heterogeneity, differences in HIPEC protocols, and variations in patient populations limit the generalization of outcomes. The difference in response to HIPEC between primary and recurrent EOCs still needs further explanation.

Background: Lung cancer is the leading cause of cancer-related mortality worldwide. Approximately 15-20% of newly diagnosed individuals with primary lung cancer have small cell lung cancer, and more than 60% of patients have advanced-stage small cell lung cancer at the time of diagnosis. Patients with advanced-stage small-cell lung cancer may benefit from thoracic radiation therapy. This comprehensive meta-analysis was conducted to determine whether adding thoracic radiation to systemic chemotherapy increases 1-year and 2-year survival in patients with advanced-stage small-cell lung cancer.

Methods: The Science Direct, PubMed, Embase, and Wanfang databases were comprehensively searched from 1980 to 2022. The inclusion criteria for studies were as follows: (1) all patients had advanced-stage small cell lung cancer; (2) a group receiving thoracic radiation therapy combined with chemotherapy was compared with a group receiving only chemotherapy; and (3) 1-year and 2-year overall survival data were provided. Pooled relative risks (RRs) and risk differences (RDs) were calculated, publication bias was evaluated, and sensitivity analysis was conducted.

Results: Ten studies met the inclusion criteria. These studies included 922 patients (534 patients in the chemotherapy combined with thoracic radiation therapy (ChT/TRT) group and 388 patients in the chemotherapy (ChT) group). The results of the meta-analysis revealed that the addition of thoracic radiotherapy to chemotherapy increased the 1-year overall survival rate to 52%, whereas the 1-year overall survival rate was 32.2% when chemotherapy alone was used. The addition of thoracic radiotherapy to chemotherapy also increased the 2-year survival rate to 18.7%, compared with 10% in the ChT group. The ChT/TRT group had a significantly better 1-year overall survival rate than the ChT group, with a pooled RR of 1.61 (95% CI, 1.36-1.90, P < 0.00001) and a pooled RD of 0.2 (95% CI, 0.13-0.26, P < 0.00001). The ChT/TRT group also had a significantly better 2-year overall survival rate than the ChT group, with a pooled RR of 1.90 (95% CI, 1.34-2.68, P = 0.0003) and a pooled RD of 0.09 (95% CI, 0.05-0.13, P < 0.0001).

Conclusion: This study revealed that adding thoracic radiation therapy to chemotherapy increases both 1-year and 2-year survival in patients with extensive-stage small-cell lung cancer.

Background: Cytarabine is a prodrug which is activated to cytarabine triphosphate (Ara-CTP) through a series of phosphorylation steps. For considerable leukemic cell death, high level of Ara-CTP is required. Sterile alpha motif and histidine-aspartate domain-containing protein 1 (SAMHD1) and Nucleotide diphosphate kinase-2 (NME2) are genes involved in Ara-CTP metabolism. To best of our knowledge, there are no similar studies focused on the association of different polymorphisms involved Ara-C metabolism on the response to induction chemotherapy among adult AML Egyptian patients. Therefore, the aim of this study was to determine the effect of SAMHD1 rs28372906 and NME2 rs3744660 polymorphisms on AML complete remission rate (CR), overall survival (OS), and disease-free survival (DFS) among adult AML Egyptian patients, after Ara-C based induction therapy.

Methods: This study was a retrospective conducted at the National Cancer Institute, Cairo University, Egypt. The patient group included 136 adult patients with newly diagnosed AML, while the control group included 48 healthy subjects. The clinical history of all studied patients was collected from patient records. Patients and controls were genotyped for NEM2 (rs3744660) and SAMHD1 (rs28372906) by using Taq Man Genotyping assay and Taq Man genotyping master mix (REF: 4,371,353, Applied Biosystems, USA). Real-time PCR assay was performed on Thermo Fisher Quant Studio™ 3. The Statistical Package for Social Science version 21.0 was used to analyze our data.

Results: Regarding the SAMHD1 (rs28372906) polymorphism, we did not find any genotype variations between patient, and control groups, where all of them were AA genotype. Regarding NME2 (rs3744660) polymorphism the statistical analysis reported significant association between D28 blasts and OS (P-value = 0.043), while the remaining initial patient characteristics and response to induction were not associated with OS.

Conclusion: CR, DFS, and OS were not significantly associated to SAMHD1 rs28372906 and NME2 rs3744660 polymorphisms.

Background: Osteosarcoma (OS) is the most common primary bone cancer in children and adolescents. Between 35 and 45% of these patients do not respond to standard chemotherapeutic treatments, resulting in a very low 5-year survival rate of only 5-20%. This resistance often leads to treatment failure and unfavorable prognoses, highlighting the critical need for new therapeutic targets to improve treatment strategies. Autophagy-related gene 4 B (ATG4B) is a crucial cysteine protease for autophagosome formation. It is overexpressed and correlates with poor prognosis in various cancers. However, the relationship between ATG4B expression and angiogenesis in OS remains unexplored. This study investigated the expression levels of ATG4B and VEGF in OS and their correlation with clinicopathological data.

Materials and methods: This study included 67 paraffin-embedded OS tissue samples. ATG4B and VEGF expression levels were assessed via immunohistochemistry, and their associations with clinicopathological variables were statistically analyzed. Additionally, ATG4B gene expression in OS was examined via GEO datasets from https://www.ncbi.nlm.nih.gov .

Results: ATG4B and VEGF were expressed in 79.1% and 74.6% of the osteosarcoma samples, respectively. There was a significant positive correlation between ATG4B expression and tumor size, tumor stage, and histological response to neoadjuvant chemotherapy, with p values of 0.013, 0.008, and 0.022, respectively. VEGF expression was also significantly correlated with tumor size, tumor stage, and the presence of distant metastasis at diagnosis, with p values of 0.022, 0.044, and 0.013, respectively. A notable positive correlation between ATG4B and VEGF expression levels was observed (p=0.002), which was supported by the GEO dataset analysis. High ATG4B and VEGF overexpression were significantly associated with worse overall survival by univariate analysis.

Conclusions: The results suggest that ATG4B acts as a tumor promoter in OS, indicating its potential as a therapeutic target to inhibit tumor growth. Elevated ATG4B levels may also serve as a marker for poor prognosis. Additionally, VEGF overexpression is linked to a greater likelihood of pulmonary metastasis and a worse overall prognosis. The positive correlation between ATG4B and VEGF suggests that the absence of both markers could be indicative of a better chemotherapy response, offering insights into potential new treatment approaches.

Background: Desmoplastic small round cell tumor (DSRCT) poses a diagnostic challenge, initiating with imaging techniques like ultrasound, CT, MRI, and PET scans, with CT being the primary choice for abdominal tumor visualization. Despite advances, the absence of a standardized staging system complicates the diagnostic process.

Methods: A comprehensive literature review and search strategy, encompassing databases like PubMed and Cochrane was performed.

Results: Systemic chemotherapy, notably the P6 regimen, is the cornerstone of DSRCT treatment, while other options, including CDK4/6 inhibitors, antibody-drug conjugates, and anlotinib present varying efficacy. A novel chemotherapeutic agent, ONC-201, exhibits promise, inhibiting tumor growth in preclinical models. Surgical management, encompassing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC), reveals improved survival rates, particularly when combined with chemotherapy. Whole abdomen radiotherapy (WART) emerges as a post-chemotherapy treatment option, despite potential complications. A study employing whole abdominopelvic intensity-modulated radiation therapy (WAP-IMRT) suggests reduced radiation toxicity compared to conventional WART. Immunotherapy, targeting receptors such as B7-H3, GD2, EGFR, HER2, tyrosine kinase inhibitors, and androgen receptors is a promising avenue, especially in younger populations, given its favorable long-term effects. Additionally, the inclusion of CCDN1 genomic alterations further informs potential targeted therapies for DSRCT.

Discussion: This comprehensive review provides a current understanding of DSRCT diagnosis and treatment modalities, highlighting the ongoing challenges and promising avenues for future research. The integration of personalized approaches, novel chemotherapeutic agents, and evolving immunotherapy strategies holds the potential to enhance outcomes for individuals with DSRCT.

Background: Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide. Due to the advanced stage in which HCC presents, most patients are only eligible for transarterial chemoembolization (TACE) or radioembolization (Y⁹⁰). The purpose of this study is to examine the differences in survival and health-related quality of life (HRQOL) in patients diagnosed with HCC and treated with TACE or Y⁹⁰.

Methods: Two hundred thirty-four patients with HCC were enrolled in studies examining HRQOL between 2003-2009. HRQOL was evaluated using the Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep). Between-group differences were examined using chi-square and ANOVA. Survival was assessed using Kaplan-Meier and Cox regression analyses.

Results: Significant baseline differences between patients treated with TACE versus Y⁹⁰ were found. Patients who received Y⁹⁰ tended to be older (p < 0.001), female (p < 0.001), had fewer lesions (p = 0.03), had smaller tumors (p = 0.03), and were less likely to have vascular invasion (p = 0.04). After adjusting for demographic and disease-specific factors, no significant differences in HRQOL were observed at 3 months (p = 0.79) or 6 months (p = 0.75). Clinically meaningful differences were found, with the TACE group reporting greater physical, social, and emotional well-being at 3 and 6 months and greater overall HRQOL at 6 months. No significant differences in survival were found.

Conclusions: Treatment with TACE and Y⁹⁰ was similar with regard to survival. However, TACE showed statistically and clinically meaningful benefits in physical, social/family, and emotional well-being. Further research is warranted to identify profiles of patients who may demonstrate a preferential response to either TACE or Y⁹⁰.

Background: With the third incident rate and a second mortality rate, colorectal cancer (CRC) continues to be one of the most prevalent and deadly malignancies worldwide. Adenomas usually develop into adenocarcinomas in colorectal cancer (CRC), a process that can be halted by early detection and prevention care.

Main body: Faecal immunochemical testing (FIT) and endoscopies are examples of current screening tools that dramatically lower the incidence and death of colorectal cancer. Current development centre on non-invasive methods that provide better accuracy and lower dangers, such as blood-based liquid biopsies and imaging modalities like CT and MR colonography. For early detection, liquid biopsies-especially those using methylated DNA tests like SEPT9-offer encouraging outcomes. Circulating tumour DNA (ctDNA) has emerged as a crucial biomarker, increasing early identification and therapy monitoring. Proteomic and metabolic indicators further improve screening by figuring out who is at high risk and keeping an eye out for recurrence. The accuracy and detection rates of polyps have increased due to advancements in imaging technologies like as artificial intelligence (AI), narrow-band imaging (NBI), and high-definition colonoscopy. The emphasis has been on preventive measures, such as chemoprevention and lifestyle modifications, dietary fibre, regular exercise, and chemoprotective drugs like aspirin have demonstrated potential in lowering the incidence of colorectal cancer. There are still issues with the global implementation of screening, including differences in access to screening between socioeconomic and racial groups. Hope for more individualized and efficient CRC screening and prevention are provided by new research on biomarkers and technological advancements like artificial intelligence and polygenic risk classification.

Conclusion: With a variety of invasive and non-invasive techniques available to identify cancer early. With a variety of invasive and non-invasive techniques available to identify cancer early. To enhance prognosis and lower mortality, colorectal cancer screening has undergone tremendous advancement. Although colonoscopy and faecal immunochemical assays (FIT) are still good standards for detecting colorectal cancer (CRC), advances in liquid biopsy, proteomics, and imaging have transformed the field and offered less invasive, more precise choices, for early identification and surveillance, circulating tumour DNA (ctDNA) and other biomarkers show tremendous potential.

Introduction: The nodal positivity in advanced ovarian cancers is approximately 68-70% histopathologically. Even after neoadjuvant chemotherapy (NACT) chance of nodal positivity is around 50-80%. In the prevailing literature, the nodal burden is a neglected entity in both assessment and documentation and complete clearance during the CRS. We aim to highlight the importance of nodal dissection and propose a Nodal Cancer Index (NCI) like PCI for ovarian cancers based on our experience of 105 cases.

Materials and methods: We included 105 patients with advanced ovarian cancers who underwent CRS. Retroperitoneal lymph nodes and bilateral pelvic lymph node dissection were routinely done in all the cases. For Nodal Cancer Index calculation, the abdomen is divided into 13 zones, zones 1-6 for retroperitoneum, zones 1-6 for Pelvic nodes, and zone 0 for extra-abdominal nodes. Furthermore, a Nodal size score ranging from 1 to 3 has been proposed so that the Nodal Cancer Index ranges from 13 to 39.

Results: The median age of the patients was 51 years (range 19-71) and the most significant patients were in stage III (65.7%), and 34.3% had stage IV disease at presentation. The lymph nodes were found to be positive in 62 patients (59%), and the positivity rate was higher in patients who underwent upfront surgery 36 (58.1%) as compared to 26 (41.9%) in those who received NACT. The majority of the patients (56.6%) had positive lymph nodes in both the pelvic and retroperitoneal groups, whereas 19.3% had only pelvic nodes positive, and 24.2% had only retroperitoneal nodes positive. The probability of overall survival at 5 years in our patients was 48.9% (95% CI = 35.5-61).

Conclusion: The results of our analytic observation confirm that systemic lymphadenectomy of all 13 zones proposed by our study should be an integral part of optimal CRS in the advanced carcinoma ovary and this will help us manage these advanced cases in a better objective manner.

Objective: This meta-analysis investigates the association between acute lymphoblastic leukemia (ALL) susceptibility and IKZF1 gene SNPs.

Methods: Utilizing EMBASE, PubMed, and other databases, the study evaluated methodological quality through the Newcastle-Ottawa Scale (NOS) scoring and Hardy-Weinberg Equilibrium (HWE) value. The present meta-analysis used Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Review Manager 5.4 software was employed for data analysis, emphasizing genetic variants' significance (p < 0.05). Visualizations were achieved using funnel and Circos plots.

Results: A significant association was found between rs4132601 and ALL across genetic models, contrasting with the non-significant correlation for rs11978267. The findings underscore the complex interplay of genetic factors in ALL susceptibility, particularly related to IKZF1 SNPs. Ethnicity emphasizes the importance of diverse population considerations.

Conclusion: This meta-analysis highlights the significance of rs4132601 in ALL's genetic foundation, suggesting potential advancements in diagnostics. The lack of correlation for rs11978267 highlights the complexity of its genetic association. Future studies should prioritize larger, diverse samples for a comprehensive understanding and improved strategies for ALL diagnoses and treatments.

Background: Coinfections and reactivation of persistent or latent viral infections such as herpesviruses (HHV) and/or measles virus (MeV) have been reported among COVID-19 patients. However, there is limited information regarding cancer patients who experienced severe acute respiratory syndrome corona virus-2 (SARS-CoV-2). The primary purpose of this study was to investigate the interplay between SARS-CoV-2, HHV and MeV in cancer patients, aiming to provide insights into the pathophysiology of these infections and to enhance the patients' health outcomes.

Methods: A prospective observational study was conducted on 4 groups (n = 147): newly diagnosed cancer patients infected with SARS-CoV-2 (n = 37), newly diagnosed cancer patients non-infected with SARS-CoV-2 (n = 13), apparently normal individuals infected with SARS-CoV-2 (n = 82) and finally a normal control group (n = 15). All samples were tested for SARS-CoV-2 infection using the real-rime quantitative reverse transcription polymerase chain reaction (qRT-PCR). Antibody responses were analyzed using indirect enzyme-linked immunosorbent assay (ELISA), and antibody levels were compared between patients and controls. Potential re-activation was investigated using fourfold (i.e. 400%) rise model criterion.

Results: In all positive cases of SARS-CoV-2, recent infections or re-infection of herpes simplex viruses 1 and 2 (HSV1/2 or HHV1-2) were found to be significantly increased approximately three-fold higher in COVID-19 patients (p = 0.007) identified via pooled HSV1/2 IgM levels in plasma. Furthermore, reactivation of HSV1/2 was 29.7% in cancer/COVID-19 patients (n = 37) versus 0.0% of normal/COVID-19 group (n = 22) (p = 0.008). Likewise, Epstein-Barr Nuclear Antigen-1 (EBNA-1) IgG levels showed a ≥ fourfold increase in 20% (p = 0.034) of cancer patients (n = 50) versus 4.9% of controls (n = 41) for reactivation of Epstein-Barr virus (EBV or HHV-4). Obviously, MeV IgG levels increased up to 78.0% in cancer patients (n = 50) versus 17.5% in non-cancerous group (n = 40, p < 0.001). Reactivation of MeV in cancer and COVID-19 patients was 43.2% versus 30.8% cancer non-COVID-19 group, 3.3% normal COVID-19, and 0.0% in healthy volunteers (p < 0.001).

Conclusion: Cancer patients infected with SARS-CoV-2 were at increased risk of HHV and MeV co-infection and reactivation.