South Asian Journal of Cancer最新文献

Cancer cachexia syndrome is characterized by involuntary weight loss which usually occurs in advanced malignancies. The pathogenicity of this syndrome is multifactorial, due to a complex interaction of tumor and host factors. The syndrome is closely related to the prognostication of malignancies. Several research works are in progress to target the major effectors of cancer cachexia syndrome. This letter is a nutshell on the current status of the cancer cachexia syndrome-the crosstalks and potential therapeutic targets.

This report is based upon the case of a young lady who presented with a history of a breast lump, which despite clinically resembling a carcinoma, was subsequently diagnosed to be a primary breast lymphoma (PBL). Though rare in incidence, PBL may masquerade as breast carcinoma. PBL accounts for about 1.7-2.2% of all extranodal non-Hodgkin's lymphoma, and is accountable for up to 0.5% of all breast malignancies. Given that the treatments of breast carcinoma and PBL are markedly different, it is very essential that core-biopsy be preferred in every patient being evaluated for carcinoma of the breast. The diagnosis of diffuse large B cell lymphoma (DLBCL) was confirmed by immunohistochemistry, and the patient has been treated with six-cycles of chemotherapy followed by involved field-radiotherapy to the right breast. After a year's follow-up, the patient remains free of disease.

Purpose: Epithelioid glioblastoma (GBM) is a rare variant of GBM. The study aimed to look into clinicopathological details and outcomes of patients with epithelioid GBM harboring BRAFV600E mutation from a single institution.

Methods: Ten cases of epithelioid GBM diagnosed over the past 5 years were reviewed. All patients underwent surgical resection followed by adjuvant treatment as per protocol after initial diagnosis. Of these, seven patients were planned to redo surgery, reradiation, BRAF with MEK inhibitors, and bevacizumab based on clinical condition, magnetic resonance imaging findings, and progression-free survival after their recurrence. Four recurrent patients had received dabrafenib and trametinib.

Results: All tumor locations were supratentorial. The median follow-up was 2.3 years and the median time to recurrence was 19 months from the diagnosis (range 4-36 months). Four recurrent patients received BRAF + MEK inhibitors. One patient who started dabrafenib and trametinib experienced local progression after 33 months, followed by lung and bone metastasis. One patient died due to multiple subacute hemorrhages, who was a known case of congenital vascular malformations, and two patients remained disease-free after a year and 2 years.

Conclusion: Epithelioid GBM is a very rare, but well-documented entity. Therefore, careful preoperative imaging and detailed evaluation of genetic studies including BRAF V600E mutation are necessary for accurate diagnosis and appropriate selection of treatment for epithelioid GBM. Dabrafenib plus trametinib showed clinically meaningful activity in patients with BRAF V600E mutation-positive recurrent high-grade glioma.

Introduction: Breast cancer is a highly heterogenous tumor with different subtypes showing varying prognosis. Tumor budding is an unfavorable histological feature of many epithelial cancers. The purpose of this study is to analyze the association between tumor bud density with various histological and immunohistochemical characteristics and to explore its prognostic role in breast carcinoma.

Materials and methods: A retrospective analysis was performed on 100 patients of breast cancer diagnosed in our institute from January to December 2017. Hematoxylin and eosin (H&E) stained slides from tumors and immunohistochemical slides were reviewed independently by two pathologists, and clinical data were acquired from computerized records. Patients on neoadjuvant chemotherapy were excluded from the study.

Results: The study comprised 100 patients of invasive breast carcinoma. The median age was 52 years, and 96% were invasive ductal carcinoma. The median follow-up was 34 months. High tumor bud density was substantially correlated with primary tumor staging (T3, T4; 73% [11/15] cases) and lymph node staging (N2, N3; 68% [13/19] cases) with p -values of 0.017 and 0.023, respectively. Systemic metastasis (85% [6/7] cases) was significantly associated with high tumor bud density ( p =0.025) but lymphovascular invasion (LVI) and perineural invasion (PNI) were not significantly associated with tumor bud density ( p  = 0.762 and 0.862, respectively). Patients with N2 nodal stage had low event-free survival rate than N0/N1 nodal stage irrespective of tumor bud status. Grade 3 tumors with high tumor bud density had worse event-free survival than any other grades. There was no association of tumor bud density with tumor staging, necrosis, PNI, LVI, estrogen receptor (ER), progesterone receptor (PR) and Her2/neu , and event-free survival.

Conclusion: Strong relationships have been found between tumor bud density and poor prognostic variables such as primary tumor staging and lymph node staging. These results provide credence to the idea that tumor bud density can be an assessable prognostic feature that should be taken into account while reporting breast cancer cases. Tumor bud density evaluation has to be standardized nevertheless if it is to be widely adopted.

Objectives: Colorectal cancer is one of the most frequent cancers worldwide and is still a major cause of cancer mortality. Her2/neu, Ki67 score, and tumor budding are independent prognostic factors in colorectal carcinomas. The objectives of the study were to evaluate Her2/neu expression, Ki67 score, and tumor budding index at invasive margin in colorectal carcinoma and find out their possible correlations with different clinicopathological factors.

Materials and methods: An institution-based observational cross-sectional study was conducted for 18 months. Forty-one patients with histologically proven diagnosis of colorectal carcinoma were included. Histopathological and immunohistochemical analyses (Her2/neu and Ki-67) of each case were done.

Statistical analysis: Data analysis was done using the SPSS software.

Results: A significant correlation was found between tumor budding status and pathological T stage, Dukes' and American Joint Committee on Cancer stages, and between tumor-infiltrating lymphocytes status and Ki-67 expression status ( p  < 0.05).

Conclusion: The prognostic importance of tumor budding in colorectal carcinoma is very clear. Considering the small sample size of the present study, the prognostic values of Her2/neu and Ki-67 are required to be explored further in larger cohorts in the future.

Objectives: Adjuvant chemoradiation followed by chemotherapy is the current standard of care in high-risk endometrial cancer after the PORTEC-3 trial. There is a lack of data on this treatment regimen in the South Asian patient cohort. The present study aims to assess toxicity profiles and outcomes in this cohort of patients.

Materials and methods: High-risk endometrial cancer patients planned for adjuvant chemoradiation followed by chemotherapy were included. Toxicity was graded using the Radiation Therapy Oncology Group and Common Terminology Criteria for Adverse Events criteria. Disease-free survival (DFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Survival curves were compared using the log-rank test. Cox regression analysis was done to find out the predictors of DFS.

Results: This study included 58 patients treated from October 2016 to August 2022. Median age was 61 years (interquartile range [IQR] 56-66), with Fédération Internationale de Gynécologie et d'Obstétrique Stages I = 26 (44.8%), II = 5 (8.6%), and III = 27 (46.6%). p53 positivity was seen in 38 (65.5%) patients. Intensity-modulated radiotherapy was used in 44 (79.3%) patients. There was no treatment discontinuation during chemoradiation. Acute Grade 2 and above toxicity during chemoradiation were diarrhea in 10 (17.2%) and hematological in 2 (3.4%). For the planned adjuvant chemotherapy in 55 patients, 51 (92.7%) completed four cycles. Grade 2 or above neuropathy was seen in 11 (20%), with 5 (9%) having persisting neuropathy at 1-year follow-up. At a median follow-up of 31 months, 15 (25.8%) patients recurred; distant = 13 and isolated para-aortic = 2. The median time to recurrence was 16 months (IQR 12-22), with 80% (12 out of 15) of recurrence within the first 2 years of follow-up. The actuarial 5-year DFS and OS were 63.8 and 76.5%, respectively. In univariate analysis, p53 positivity and lymphovascular space invasion were predictors for DFS, with p -values 0.031 and 0.027, respectively. There was no significant predictor identified in multivariate analysis.

Conclusion: There is good tolerance and compliance to adjuvant chemoradiation and chemotherapy in this South Asian cohort of patients with high-risk endometrial cancer, with no toxicity-related treatment breaks during radiation. The majority of the recurrences were seen at distant sites and within the first 2 years of follow-up. These findings are in line with the outcomes of the PORTEC-3 trial.

Introduction  Epithelial ovarian cancer (EOC) is one of the leading causes of mortality among women worldwide. The present study aimed to estimate the frequency of various histopathological types, clinical and surgico-pathological factors, and spectrum of lymph node (LN) metastasis in early and advanced EOC. Material and Methods  Women with EOCs who underwent cytoreductive surgery (CRS) between January 2019 and May 2022 were included. The distribution of Clinico-demographic parameters, histological type, stage, and LN metastasis were analyzed. Results  A total of 101 women with EOCs underwent CRS, out of which 5 (4.95%) with coexistent endometrial cancer were excluded ( N  = 96). Fifty women (52%) underwent primary CRS and 46 (48%) women underwent interval CRS. The mean age of the women was 48.42 ± 11.6 years. Initial serum cancer antigen 125 (CA 125) level was elevated (>35 U/mL) in 88 (91.67%) women and normal in 8 (8.33%) women. Complete cytoreduction was achieved in 75 (78.12%) cases. High-grade serous carcinoma was the most common histology (66/96, 68.75%), followed by mucinous carcinoma (15/96, 15.63%), endometrioid carcinoma (6/96, 6.25%), low-grade serous carcinoma (4/96, 4.17%), and carcinosarcoma (2/96, 2.08%). The majority of women, 69 (71.88%), were in stages III and IV at presentation. Most serous carcinomas were diagnosed at stage III (71.22%) or IV (13.64%). In contrast, the majority of endometrioid, mucinous, and clear cell carcinomas were diagnosed at stages I and II. Seventy-five women (78.13%) with EOC underwent pelvic and/or para-aortic lymphadenectomy, out of which 23 (30.67%) were histologically positive. Three out of 23 patients (13%) with early-stage disease showed positive LNs. Conclusion  Serous carcinoma ovary is the most common histological subtype, presenting mostly in the advanced stage. A significant number of affected women were younger at presentation and diagnosis was made a decade earlier than the western population. A systematic pelvic and para-aortic lymphadenectomy in apparently early-stage (pelvic confined) ovarian cancer could detect additional LNs in 13% of women, especially in high-grade tumors and serous histology, suggesting the role of systematic lymphadenectomy for accurate staging in apparently early-stage ovarian cancer.

Purpose: Pilot testing and translation of the English version of European Organization for Research and Treatment of Cancer (EORTC) patient satisfaction cancer core questionnaire (PATSAT-C33) and complementary outpatient module (OUT-PATSAT7) into two Indian vernacular languages (Hindi and Marathi).

Methods: Patients undergoing fractionated radiotherapy for cancer with basic proficiency in respective language were included in the study after written informed consent. The English version of EORTC PATSAT-C33 and OUT-PATSAT7 questionnaire was pilot tested in 20 patients. The questionnaire was then translated into two Indian vernacular languages (Hindi and Marathi) using EORTC translation methodology. This included forward-translation by two independent professional translators into target languages (Hindi and Marathi) to create an intermediate version; back-translation into English by another independent pair of linguistic experts; and harmonization by comparing back-translated versions (English) to the original English version for reconciliation. The EORTC translation group provided suggestions and proofread the reconciliated versions (Hindi and Marathi) which were then administered to 20 patients in each language. Semistructured interviews were conducted for patients to identify problems in understanding the translation versions to make appropriate corrections/modifications to the questionnaire.

Results: Pilot testing of English version of PATSAT-C33 and OUT-PATSAT7 did not pose any major difficulty leading to subsequent translation into both target languages (Hindi and Marathi). Reconciliated version of the translated questionnaires was arrived at after incorporating suggestions and proofreading by the EORTC translation group. Pilot testing of the reconciliated questionnaires (Hindi and Marathi) did not identify major problems in understanding, difficult/confusing words, or upsetting questions leading to the adoption of the reconciliated version as final translated questionnaire without further modifications.

Conclusion: The English version of PATSAT-C33 and OUT-PATSAT7 has been successfully translated into Hindi and Marathi languages using standardized EORTC methodology. Psychometric properties of the same are currently being tested for validation in a larger Indian cohort.

The liver plays a crucial role in immune system regulation, but dysregulation of immunological networks contributes to chronic liver diseases like hepatocellular carcinoma. This malignant tumor is the third leading cause of cancer death. An imbalanced immune system, characterized by alterations in immune cell count, cytokine levels, and inhibitory receptors, can impact metastasis by suppressing the immune system's ability to fight cancer cells. This study aims to investigate the potential biomarkers playing a crucial role in immune dysregulation resulting in hepatocellular carcinoma metastasis. A comprehensive and systematic literature review was conducted using both free words and search terms. The data extraction was then performed by a thorough literature screening. Next, the meta-analysis was performed using the metabin function of the meta library in R to evaluate the patient cases reporting metastasis in the event group. A total of 1,008 cases were considered, with 357 as events and 651 as nonevents. The results of the meta-analysis demonstrated the significant role of biomarkers in immune dysregulation causing metastasis (risk ratio = 0.54, 95% confidence interval: 0.4972, 0.6048, I ²  = 92.4%, p  < 0.01). In addition to the immune dysregulation explored in this study, the impact of tumor size on hepatocellular carcinoma progression and metastasis is a crucial consideration. A notable difference of 41 more cases was reported for larger tumor sizes. The study integrates immune dysregulation biomarkers and tumor size factors influencing hepatocellular carcinoma metastasis, offering valuable insights for future research and therapeutic interventions for improved clinical outcomes.

Introduction: International recommendation supports induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) as a new standard of care for locally advanced nasopharyngeal cancer (LA-NPC) which give a survival benefit. TPF is one of the IC regimens which consists of docetaxel (75 mg/m ² , 1 hour infusion), cisplatin (75 mg/m ² , 0.5-3 hours), and 5-fluorouracil (600 mg/m ² , 4 days). Previous retrospective study in Chinese population reported low-dose TPF (L-TPF), consists of docetaxel (60 mg/m ² ), cisplatin (65 mg/m ² ), and then 5-fluorouracil (550 mg/m ² /d; 5 days), showed better tolerance and compliance rates, with similar efficacy to high-dose TPF (H-TPF). Thus, we aim to evaluate the current evidence of the effect of L-TPF compared with H-TPF on survival and tolerance as IC in LA-NPC.

Methods: Data were collected from PubMed, PubMed Central, and Science Direct, using combinations of keywords related to neoadjuvant chemotherapy (NAC) or IC, TPF dose regimen, and LA-NPC. The included studies investigated the efficacy and toxicity of IC with a TPF regimen. The quality of each included study was assessed using the Newcastle-Ottawa scale for cohort studies and the JADAD scale for randomized controlled trial (RCT). Only moderate- and good-quality studies were further evaluated in the meta-analysis.

Results: A total of six studies consisting of 509 NAC patients were included. All the studies evaluated overall survival (OS) and progression-free survival (PFS). Quantitative analysis showed that L-TPF + CCRT significantly showed good OS (hazard ratio [HR] = 0.50; 95% confidence interval [CI], 0.33-0.76; p  = 0.001) but not PFS (HR = 0.45; 95% CI, 0.16-1.25; p  = 0.13). Common chemotoxicities that were found in both groups were neutropenia and anemia.

Conclusion: L-TPF IC had a significant positive effect on the survival of LA-NPC patients. Further, larger multicenter RCT studies are needed to focus on evaluating the optimal TPF regimen dose in LA-NPC.