South Asian Journal of Cancer最新文献

Objective: The aim of the study was to construct a nomogram that is easily reproducible, accurate, and cost-effective in predicting cervical lymph nodal metastasis in buccal mucosa cancer.

Methodology: Patients who underwent radical resection of a primary tumor of the buccal mucosa with neck dissection were enrolled. Clinical characteristics independently associated with lymph nodal metastasis in multivariate analyses were adopted to build the model.

Results: Patients who underwent surgery (January 2021-December 2021) were included as the model development cohort ( n  = 127). Depth of invasion, perineural invasion, lymphovascular invasion, and the worst pattern of invasion were independent predictors of lymph nodal metastasis. The nomogram model based on these four predictors showed good discrimination accuracy in percentage prediction of lymph nodal metastasis.

Conclusion: This study proposes a simple predictive model for the risk of nodal metastasis in buccal mucosa squamous cell cancer. The study has strength that, it is based on a large sample, proposed model being simple size, and based on parameters empirically supported as well as established in literature, easy to use in routine clinical practice, and cost-effective.

Background: Tyrosine kinase inhibitors like imatinib have become the cornerstone of therapy in chronic phase-chronic myeloid leukemia (CML-CP). However, the role of hydroxyurea (HU), a deoxyribonucleic acid synthesis inhibitor, has been less explored in the disease. Hence, the present study was conducted to compare the efficacy of structured dose of HU based on baseline total leukocyte count (TLC) with imatinib in CML patients.

Method: An open-label randomized controlled trial was conducted in 90 newly diagnosed CML-CP patients, aged ≥ 18 years. Patients were randomized to receive either baseline leucocyte count-based structured dose of HU with imatinib or imatinib monotherapy for 3 months. Quantitative real-time polymerase chain reaction for BCR-ABL1 to assess early molecular response (EMR) and safety evaluation according to the Common Terminology Criteria for Adverse Events version 5 was done.

Results: Median age of patients was 36.5 years (36 [interquartile range [IQR]: 30-45] in I-HU, 38 [IQR: 31-47] in imatinib monotherapy) with male predominance. Fatigue was the most common symptom at diagnosis. Splenomegaly was seen in 89% (median spleen size: 10 [IQR: 6-15] cm). At 3 months, complete hematological response was seen in 74 patients (36 in I-HU, 38 in imatinib monotherapy). Overall, 68 patients achieved EMR (34 in I-HU, 34 in imatinib monotherapy, p  = 0.53). The most common hematological toxicity, anemia, was seen in 80 patients (41 in I-HU, 39 in imatinib monotherapy). In 37 patients, nonhematological toxicities seen were nausea and vomiting (20 in I-HU, 17 in imatinib monotherapy). No dose limiting toxicities were reported.

Conclusion: Addition of upfront TLC-based dosing of HU to imatinib was not found to significantly improve the hematological response and EMR at 3 months. However, long-term studies with a larger sample size with structured dose of HU can be undertaken as it forms a preferred adjunctive therapy for initial, rapid cytoreduction in hyperviscosity or leukostasis-related symptoms in patients of CML.

Objectives: The use of immunotherapies in the treatment of melanoma has significantly improved the survival of patients with advanced disease. Historically, histamine has been implicated in the pathogenesis of several cancers. Cimetidine does play a role in modulating the immune system and was advocated as an immunotherapeutic agent since the 1970s. Cimetidine has been showing promise in conjunction with standard care in many cancers in vitro and in vivo. However, its effects in melanoma have not been explored yet. Our study was designed to determine if cimetidine taken in the perioperative period improves the disease-free survival (DFS) or overall survival in patients with the American Joint Committee on Cancer, seventh edition (AJCC 7) stage 2 melanoma.

Materials and methods: We have reviewed all the patients with stage 2 melanoma in our center in a retrospective cohort to assess the difference in survival between patients who received H2 blockers in the perioperative period and those who did not.

Statistical analysis and results: Thirty-two patients were included in the analysis. Nine of 32 patients received H2 blockers in the perioperative period. All the patients were males except for one female in the control group (4.3%). The age in the analyzed population ranged between 51 and 92 years; the median age was 70 years (mean: 71; standard deviation: 10). The median overall survival of the patients who received H2 blockers was 112.7 months and it was 77.2 months for those who did not receive H2 blockers. There was no difference in DFS between the two groups ( p  = 0.5395), and there was no difference in the overall survival ( p  = 0.4770). The cumulative dose was strongly correlated with the overall survival in the patients who received H2 blockers ( r  = 0.8341, p  = 0.0196).

Conclusion: Despite having a small treatment group, we were able to detect a strong correlation between the cumulative dose of H2 blockers received and the overall survival.

Background and objectives: There are limited data on the requirement and duration of white blood cell (WBC) growth factor (GF) administration in patients receiving biweekly docetaxel, oxaliplatin, leucovorin, 5 Fluorouracil (mFLOT) or modified FOLFIRINOX (oxaliplatin, irinotecan, leucovorin, 5 Fluorouracil (mFOLFIRINOX) regimens.

Methods: The data of 749 patients with pancreatic, gastric, and colorectal adenocarcinomas treated with mFOLFIRINOX or mFLOT for at least three cycles between January 2018 and December 2022 were retrieved.

Results: Of the 749 patients, 387 (52%) received mFLOT, while 362 (48%) received mFOLFIRINOX. Increased use of GF was seen in patients with diabetes mellitus (70 vs. 53%; p  < 0.001), prior chemotherapy (82 vs. 49%; p  < 0.001), prior pelvic radiotherapy (89 vs. 54%; p  < 0.001), prior surgery (70 vs. 49%; p  < 0.001), and stage I to III cancers as opposed to stage IV cancers (61 vs. 48%; p  = 0.006). The use of GF resulted in a statistically lesser incidence of all-grades neutropenia (2.6 vs. 18.4%; p  < 0.001), grade 3/4 neutropenia (1.2 vs. 12.5%; p  < 0.001), and the primary endpoint of febrile neutropenia (FN; 1.2 vs. 6.1%; p  = 0.001). There were no differences in the incidence of all grades of neutropenia (3.7 vs. 1.9%; p  = 0.527), grade 3/4 neutropenia, and the primary endpoint of FN (1.2 vs. 1.1%; p  = 0.079) in patients receiving single-day versus multiday GF, respectively.

Interpretation and conclusion: The use of GF reduces the rates of FN by approximately 80% in patients receiving mFLOT and mFOLFIRINOX, although incidences of FN are low with these regimens. The incidence of febrile neutropenia was similar with single-dose versus multiday GF in efficacy when administered with mFLOT and mFOLFIRINOX chemotherapy.

Objectives: Cutaneous and subcutaneous lesions often go unnoticed or disregarded, yet they can harbor malignant potential. These seemingly innocuous bumps and lumps vary in size and nature, necessitating thorough evaluation by health care professionals. In this study encompassing 9,202 day-surgery procedures, we sought to elucidate the malignancy risk associated with cutaneous/subcutaneous lesions.

Materials and methods: Conducted as a descriptive case-control investigation, our study enrolled patients undergoing excision for such lesions from 2009 to 2018. Patients were stratified into study (malignancy confirmed by histopathology) and control groups. Comprehensive data collection included demographic profiles, pathology reports, surgical details, and follow-up outcomes.

Results: Analysis of 9,202 excision procedures involving 8,962 patients revealed epidermal/tricholemmal cyst as the most prevalent lesion type (34.5%), followed by lipomas (21.8%). Malignancies were identified in 1.1% of cases, predominantly affecting older individuals (mean age: 60.3 ± 16.2 years). While malignancy incidence correlated with advancing age, no significant gender disparity was observed ( p  < 0.001 and p  = 0.353, respectively).

Conclusion: Our findings underscore the imperative of vigilance toward cutaneous and subcutaneous lesions, as they may harbor malignancy. Timely assessment by health care providers is paramount to promptly identify and manage potentially malignant lesions. With malignancy detected in over 1% of cases, our study emphasizes the necessity for meticulous evaluation and appropriate intervention strategies to mitigate associated risks effectively.

Background: Cancer is one of the leading causes of mortality and morbidity worldwide. According to the report from the Iranian Ministry of Health, cancer ranks as the third most common cause of death in Iran. Consequently, acquiring information about cancer statistics and their trends is crucial for cancer prevention and control. In this study, we examined the trends and epidemiology of cancer in Bam City, Iran, from 2014 to 2019.

Material and methods: This cross-sectional study was conducted using cancer registry data spanning from 2014 to 2019 in Bam, located in Kerman Province. Common cancers were determined based on the reported number of cancer cases and age-standardized rates. Data analysis was performed using SPSS (version 22) and GraphPad Prism (version 9).

Results: In this study, we examined 1,290 cases of cancer registered in Bam City, Kerman Province, from 2014 to 2019. Of our study population, 42.8% (552 cases) were women. The sex ratio (male to female) for all cancers during the 6-year study period was 1.34. The highest number of cancer cases among men occurred in 2016, while among women, it was in 2017. The age-standardized incidence rate did not display a clear increasing or decreasing trend; instead, we observed fluctuations over the 6-year period for both sexes. Notably, the age-standardized incidence rate trend for males consistently remained higher than that for females.

Conclusion: Fluctuations of the trend in our study can be attributed to reasons such as referral of cases to other cities with better medical facilities and weakness in the cancer registration system of deprived areas such as Bam. Nevertheless, to reduce the burden of cancer, each individual should be aware of the most preventable risk factors, such as an unhealthy lifestyle and occupational exposure. To achieve this goal, the government should prioritize improving the accuracy and completeness of cancer registry centers.

Introduction: Marginal mandibulectomy (MM) offers a conservative alternative to segmental resections for patients with oral squamous cell carcinoma (OSCC) requiring clear margins without evident bone invasion. Despite its potential benefits, real-world outcomes related to surgical margins and oncological outcomes have not been studied sufficiently.

Methods: This ambispective cohort study analyzed 183 patients undergoing MM from January 2015 to March 2021 to achieve clear margins without clinical bone involvement. The primary objective is to assess the disease-free survival (DFS) in patients with OSCC requiring MM to achieve clear surgical margins, and the secondary objective is to assess the impact of microscopic bone involvement on these outcomes. Kaplan-Meier estimates facilitated the survival analysis.

Results: The cohort primarily comprised males (83.2%) with a median age of 50 years, the predominant subsite being the bucco-alveolar complex (94%). Microscopic bone involvement was found in 8.74% of patients. The distribution of surgical margins was 84.24% negative, 15.22% close, and 0.54% positive. The cohort's 3-year DFS and overall survival (OS) rates are 65 and 70%, respectively. Patients with microscopic bone involvement experienced lower DFS (odds ratio [OR] = 0.251, p  = 0.013), and perineural invasion was also a significant negative prognostic factor for DFS (OR = 0.4, p  = 0.01). Statistical analyses revealed significant differences in survival distributions based on bone involvement ( p  = 0.049).

Conclusion: While MM can achieve favorable surgical margins in selected OSCC patients, microscopic bone involvement compromises DFS. Given the low incidence of bone involvement and high rate of negative margins, more conservative approaches might be justified in select patients. However, these findings require further validation in a larger cohort.

In India and other lower-middle-income countries, the progress in the management of Wilms tumor (WT) has lagged behind when compared to the developed countries. In the current study, we highlight the outcomes of 61 children with WT treated at an oncological center in northern India. Our study found that the patient demographics, including age and gender distribution, closely paralleled other Indian studies. Notably, 24% of patients had distant metastasis at diagnosis. An upfront biopsy was performed in majority of the patient with a remarkable concordance rate of over 90%, with no significant complications associated with the procedure. Our surgical approach, guided by image-defined risk factors, resulted in 84% of patients undergoing delayed surgery after chemotherapy. Notably, the incidence of intraoperative complications, including tumor spill, was minimal. Treatment abandonment and toxic death due to sepsis emerged as significant challenges, affecting 22% and 7% of our patient cohort, respectively. The 3-year event-free survival (EFS) and overall survival were 70% and 84%, respectively. The age group of 6 to 8 years and stage V disease emerged as adverse factors influencing EFS. In summary, our study highlights the multifaceted nature of WT management in resource-constrained settings with survival rates promising but still lagging behind high-income countries. Addressing challenges such as treatment abandonment and reducing toxic death is imperative to enhance outcomes of WT in India.

Objective: This study investigated the distribution of cancer cases across different age groups, sexes, and regions in Himachal Pradesh, India, with the aim of informing targeted public health strategies.

Materials and methods: Cancer incidence data were collected from various age groups, sexes, and blocks.

Statistical analysis: Chi-square tests were used to assess the significance of differences in cancer patient distribution according to age, sex, and region.

Results: Cancer incidence increased with age, peaking in the 58 to 67 years age group. The highest number of patient was reported, particularly among individuals aged 38 years and above. Minimal cases were observed in the youngest age groups (< 17 and 18-27 years), while a significant increase was noted in the middle age groups (28-57 years). Cancer cases were nearly equally distributed between males (50.1%) and females (49.9%). A chi-square value of 180.18 indicated a statistically significant difference in cancer incidence according to age and sex. Gender-specific trends revealed higher cancer incidences in females during middle age (28-57 years) and in males during older age (58 years and above). The highest number of cases was 18.1%, followed by 14.7 and 14.6%, while the lowest incidence was 1.5%.

Conclusion: The present study underscores the need for comprehensive and targeted public health strategies to manage cancer burdens effectively. Focusing on high-incidence regions and ensuring equitable health care access for all genders can improve cancer outcomes and reduce mortality rates associated with the disease.