The gulf journal of oncology最新文献

Objective: Gallbladder carcinoma is the most frequent biliary tract carcinoma with over all very poor prognosis. Epidermal growth factor receptor (EGFR) is known to be involved in carcinogenesis and overexpressed in various malignancies including head and neck, breast, lung and colon carcinomas. This study was done to explore the expression of EGFR in gallbladder carcinoma cases in the north Indian population so that it may be used as a therapeutic target in these patients.

Materials and methods: 59 cases of gallbladder carcinoma diagnosed by histopathological examination were included in study. Expression of EGFR was seen by immunohistochemistry method on histopathology slides.

Results: Out of 59 gallbladder carcinoma cases 46 (78%) were female and 13 (22%) were male with female to male ratio of 3.54:1. Mean age was 51.71±11.32 years. On histopathological examination 51 (86.4%) cases were conventional adenocarcinoma, 2 (3.4%) adenosquamous carcinoma, 2 (3.4%) mucinous adenocarcinoma, 2 (3.4%) papillary adenocarcinoma, 1 (1.7%) signet ring cell carcinoma and 1 (1.7%) squamous cell carcinoma histological subtypes. EGFR expression was present in 31 (52.5%) of gallbladder carcinoma cases and strong EGFR expression was significantly associated with poor differentiation of tumour.

Conclusion: In our study EGFR was positive in the majority of gallbladder carcinoma cases. There was inverse correlation between differentiation of tumor and EGFR expression. Strong EGFR expression was significantly higher in poorly differentiated tumors compared to well differentiated tumors suggesting its role in prognosis. This also suggest that EGFR might have a role in tumor progression and aggressiveness. Therefore, EGFR have potential to be used as therapeutic target in significant number of patients. More larger sample studies are required to confirm our findings. EGFR may be further studied as therapeutic target in clinical trials in the Indian population to improve morbidity and mortality of gallbladder carcinoma patients.

Key words: EGFR Expression, Gallbladder Carcinoma, Immunohistochemistry, Targeted Therapy.

Background: Advanced gastric cancer is associated with poor survival despite chemotherapy. Maintenance chemotherapy has been successfully tried in lung cancer and colorectal cancers however there is scarce literature on maintenance therapy in advanced gastric cancer. We report a prospective non-randomized single-arm trial of capecitabine maintenance after response to docetaxel, cisplatin, and 5-Flurouracil-based chemotherapy.

Methods: 50 patients with advanced gastric cancer, who had achieved response or had stable disease after 6 cycles of Docetaxel, Cisplatin, and 5-Flurouracil (D 75 mg/m2, C 75 mg/m2, FU 750 mg/m2/d d1-d5, q3 weeks) chemotherapy were prospectively selected to receive maintenance chemotherapy with capecitabine (1000mg/ m2 bid d1-d14 q21 days) until progression.

Results: During the median follow-up period of 18 months all patients had progressed, however, there was no treatment-related death, the median time to tumor progression was 10.3 months, with grade 3 and 4 toxicities in 10-15% of patients, and treatment delays in 75% of patients.

Conclusions: Our study has shown that maintenance chemotherapy with capecitabine post-first-line docetaxel, cisplatin, and 5-FU-based chemotherapy is effective and delays tumor progression. However, toxicity was a concern in our study which led to treatment-related delays but without any treatment-related death. Most patients continued therapy till progression.

Prostate sarcoma is an extremely rare malignancy that accounts for only %0.1 of all neoplasms of the prostate gland. Primary prostate leiomyosarcoma (PLSOP) is the most common subtype in adults. Due to the fact that it is an extremely rare malignancy, case reports have been reported frequently and several publications in the form of case series. The number of case reports in the world is less than 200. Our opinion is that publishing such rare diseases and bringing them to the literature will have positive benefits both scientifically and for the patients. We present a patient with PLSOP and discuss the clinical, diagnostic and therapeutic aspects of this rare malignancy. Keywords: Prostate, Leiomyosarcoma, Cancer, Prognosis.

Objective: The purpose is to study the prevalence of BRCA1 and BRCA2 mutations in high-risk Bahraini patients diagnosed with breast cancer, its relation to family history, and to determine the clinicopathologic features of breast cancer associated with these genetic mutations, over a period of 7 years.

Background: Breast cancer is the most common type of cancer occurring in women and the second most common type generally. Approximately 12% of women worldwide will develop carcinoma of the breast sometime during their life. Additionally, 72% of women with an inherited BRCA1 mutation and 69% of those with a mutated BRCA2 will develop breast cancer by 80 years of age. The incidence of breast cancer in Bahraini women have increased over the last decade. Still, the data on BRCA1 & BRCA2 mutations in relation to breast cancer patients is limited in the Arab region, not omitting Bahrain as a country with deficient BRCA prevalence data.

Methods: This retrospective study was carried out in Salmaniya Medical Complex, Bahrain, to determine the prevalence of BRCA1 and BRCA2 mutations and to observe the breast cancer's histopathologic features that are associated with these mutations.

Results: 271 patients underwent the BRCA gene testing between 2013 and 2019. Out of 271 patients, 35 were excluded. Out of the 236 breast cancer patients, 219 (93%) did not have the mutation. The BRCA gene was carried by a total of 17 (7%) patients; 13 (5%) BRCA1 and 4 (2%) BRCA2. Thirteen BRCA carrier patients had invasive ductal carcinoma (IDC) (76%), 2 had ductal carcinoma in situ (DCIS) (12%), while 2 patients' histopathology was not available. Molecular subtypes showed 4 triple negative basal sub-type (TNBC), 10 positive ER and PR hormonal status, 1 positive HER-2, while 2 patients' hormonal receptor status was not available. Two BRCA1 carriers had both breast and ovarian cancers. A total of 5 (2%) breast cancer male patients were among the tested population, out of which, 1 (0.4% of the total and 20% of the male patients) was a BRCA2 carrier. Out of the 236 patients, 76 (32%) were younger than 40 years of age at the time of diagnosis. Then again, out of the 17 BRCA carrier patients, 7 (41%) were younger than 40 years.

Conclusion: The prevalence of BRCA mutation in high risk Bahraini breast cancer patients is 7%. Among those patients, BRCA1 mutation is the most prevalent (5%) and invasive ductal carcinoma (IDC) is the most common histopathological subtype. However, there was not enough data to conclude the most prevalent molecular subtype of breast cancer in BRCA carriers due to deficiency of overseas pathology reports for patients operated outside Bahrain. When developing treatment plans for younger patients with breast cancer, inherited syndromes and precisely BRCA mutations need to be considered. Bahrain is implementing genetic testing for breast cancer patients

Background: Breast cancer, as the most prevalent cancer among females, exerts physical and mental impacts on both patients and their husbands. The present study aimed at investigating various dimensions of self-concept among husbands of Iranian women with mastectomy.

Methods: This study was conducted on 23 patients with mastectomy and their husbands and therapists using directed content analysis according to Callista-Roy adaptation model. The participants were interviewed regarding how they coped with cancer through video call, and 'physical dimensions' and 'self-concept' subcategories were identified. Content analysis was done using the Elo and Kyngus approach.

Results: The results revealed two main themes, namely 'exposure to physical challenges' and 'weakened to strengthened self-concept'.

Discussion and conclusion: This research showed the existence of many physical and mental problems of women undergoing mastectomy, and it is recommended to do interventions to reduce these complications.

Purpose: The primary aim of this study is to determine the relationship between tumor-stroma ratio (TSR) and traditional prognostic factors in luminal early breast cancer in women treated at the medical oncology department of the military hospital of Rabat in Morocco.

Methods: A retrospective study was performed on primary invasive ER+/HER2- breast cancer in the period from January 1st, 2019 to December 31st, 2019. Prognostic factors included age, tumour size, lymph nodes status, Scarff-Bloom-Richardson grading, lymphovascular invasion (LVI), Ki67 and the stage of the disease. The type of Adjuvant systemic therapy was also reported .Two independent pathologists have assessed TSR by microscopic evaluation of haematoxylin and eosin tumor slides .Patients with less than 50% stroma were classified as low-stroma, the others are classified as high-stroma.

Results: Of 53 ER+/HER2- operable breast cancer, 41.5% patients had low-stroma and 58.5% patients had high stroma-tumour. High stroma was significantly associated with more stage III (p=0.041), more LVI (0.034), high Ki-67 (p=0.002) and more luminal B disease (p=0.001). Also, high stroma received more adjuvant chemotherapy (p=0.005). The results are maintained in univariate analysis.

Conclusions: Data suggest that TSR can be used to guide decisions on adjuvant systemic therapy for ER+/HER2- breast cancer. The integration in routine of this simple and reproducible parameter requires a homogenization of the techniques as well as a prospective validation.

Objective: Groin dissection has been a nightmare for many surgeons due to its higher morbidity especially flap necrosis. Various modifications in incisions have been described in the literature to reduce the complications but with variable outcomes. By our novel "River Flow" incision technique, we have significantly reduced the procedure related complications without compromising onco surgical principles.

Methods: A prospective longitudinal clinical observational study was designed after Institutional Ethical Committee clearance, aiming to minimize the rate of complications, especially flap necrosis. All patients who underwent unilateral/bilateral ilio-inguinal block dissection (IIBD) from January 2014 to December 2021 were included in the study. The "River Flow" incision was made and standard ilio-inguinal block dissection was performed. Flap viability, seroma formation, lymphedema, infection, etc. were observed and noted during hospitalization and on followup. Clavien- Dindo classification was used to grade the postoperative complications. We have taken our historical data of 235 groin dissections as a control and compared them with the results of the present study. It is one of the largest studies on groin dissection so far.

Results: A total of 138 patients underwent 240 groin dissections. The most common diagnosis was carcinoma penis (44.9%) followed by carcinoma vulva (22.4%). Overall, the outcome of all groin dissections showed no postoperative mortality. None of the patients had complete flap necrosis. But in our historical data, the flap necrosis rate was 38%. The most common complication observed was seroma formation in 13.7% of cases followed by surgical site infection (6.52%). All the complications were managed conservatively. The postoperative stay of the patients was also significantly less. The median hospital stay was 3 days.

Conclusion: "River Flow" incision technique is a simple but effective novel surgical technique for therapeutic ILND for any surgical setup without the learning curve. It can avoid flap necrosis, and decrease morbidity significantly without compromising the onco surgical principle of standard groin dissection.

Key words: Groin dissection, skin necrosis, river flow incision.

Background and objective: Pancreatic cancer (PC) is the seventh leading cause of death among cancers mortality. Pancreatic carcinogenesis remains poorly understood. There is still an urge to allocate other related risk factors that may help in better recognition of this pathogenesis. There is increasing evidence suggested that peptic ulcer disease (PUD), and its treatment might affect the development of PC however, studies findings reported conflicting results. Our meta-analysis aimed to study the association between PUD and its treatments (proton pump inhibitors [PPIs] and histamine-2 receptor antagonists [H2RAs]) and risk of PC.

Methods: We searched PubMed/MEDLINE, Embase, and Cochrane library databases from inception through January 2022. We included case-control studies, cohort, and randomized control trials which reported the association between PUD, PPIs, and H2RAs and the risk of PC. Odds ratio (OR) were used to calculate pooled estimates for PC risk. The association were evaluated using random-effects models, in two sided statistical tests.

Results: A total of 22 publications were retained for the meta-analysis. PUD was associated with a significant increase in PC risk (OR 1.26, 95% CI= 1.01-1.57, P= 0.038, I2= 92%). The risk of developing PC were significant in patients receiving PPIs (OR 1.76, 95% CI= 1.26-2.46, P=0.001, I2= 98%) and H2RAs (OR 1.25, 95% CI = 1.042- 1.49, P= 0.016, I2= 80%).

Conclusions: There is a 1.26-fold increase risk of PC in patients with PUD. The elevated PC is also attributable to 1.76-fold greater risk in PPIs group compared to 1.25-fold in H2RAs group.

Introduction: With the introduction of neoadjuvant chemotherapy, increased expertise in surgical oncology, and advanced skeletal imaging techniques, limb salvage surgery is becoming the standard of care for treating malignant bone tumors. However, few studies have examined the outcomes of limb salvage surgery with relatively large sample sizes in developing countries.

Materials and methods: Therefore, we conducted a retrospective study of 210 patients who received limb salvage surgery at King Hussein Cancer Center in Amman, Jordan, over a follow-up period of 1 to 14.5 years (2006-2019).

Results: Negative resection margins occurred in 203 (96.7%) patients and local control occurred in 178 (84.8%) patients. The mean functionality outcome for all patients was 90%, and 153 (72.9%) patients did not experience any complications. The 10-year survival rate for all patients was 69.7%, and the rate of secondary amputations was 4%.

Conclusion: Therefore, we conclude that the outcomes of limb salvage surgery in a developing country are comparable to those in developed countries when adequate resources and trained orthopedic oncology teams are available.

Background: Oral submucous fibrosis (OSMF), a premalignant condition of oral cavity is associated with usage of smokeless tobacco. The growing prevalence and cultural acceptance of consumption of flavored arecanut and related products along with traditional smokeless tobacco products are confounding the scenario.

Objectives: To find out clinical staging of OSMF and correlate it with consumption of smokeless tobacco usage related factors among subjects with oral sub mucous fibrosis in Ahmedabad city.

Methods: A cross sectional hospital-based study was conducted on 250 randomly selected clinically diagnosed OSMF subjects. The data regarding various demographic details and habit related factors was recorded in a pre-designed study proforma. The data obtained was statistically analyzed.

Results: Among 250 OSMF subjects, 9% were having grade I, 32% were having grade II, 39% were having grade III and 20% were having grade IV OSMF. 81.6% of males and 18.4% of females were having OSMF. The youngest age when habit was initiated was around of 8 years which is alarming in nature. The lowest duration reported to develop OSMF was 6 months. Statistically significant difference was observed between gender, duration, chewing time, swallowing of tobacco juice and clinical staging of OSMF.

Conclusion: It is alarming that around 70% of the total subjects of OSMF were in the younger age group. The community-oriented outreach programs along with strict policy formulation and implementation should be developed to curb the usage of arecanut and smokeless tobacco derivatives.

Key words: arecanut, smokeless tobacco, OSMF.