Diabetes Mellitus as a Prognostic Factor for Locally Advanced Rectal Cancer

Metformin Does not Affect Outcomes in Patients With Locally Advanced Rectal Cancer Treated With Neoadjuvant Therapy and Resection

INTRODUCTION

There is emerging evidence that metformin may have a protective effect in patients with cancer. However, its current evidence in locally advanced rectal cancer (LARC) is inconclusive. We aim to assess the effect of metformin on long-term outcomes in patients with LARC who received neoadjuvant therapy and surgical resection.

METHODS

A retrospective review of 324 patients with nonmetastatic LARC who received neoadjuvant therapy and major surgical resection from 2004 to 2018. There were 27 patients who received metformin before surgery and 297 patients who did not receive metformin.

RESULTS

Metformin users were associated with a significantly higher age, BMI, ASA score, and 30-day readmissions (P < .05). There was no difference in overall survival (OS, P = .18) or disease-free survival (DFS, P = .33) between the two groups. On Cox regression, metformin intake did not predict OS (HR 0.85, 95% CI 0.4-1.77) when controlled for age (HR 1.04, 1.02-1.06), sex (HR 1.13, 0.69-1.85), BMI (HR 0.97, 0.92-1.02), ASA score (HR: 1.7, 1.06-2.73), TNT (HR 0.31, 0.1-0.92), pathological Stage III disease (HR 2.55, 1.51-4.32), extramural vascular invasion (EMVI) (HR 3.06, 1.7-5.5), and adjuvant therapy (HR 0.1, 0.04-0.27 for <25 months OS and HR 0.3, 0.15-0.59 for ≥25 months). Disease-free survival showed a similar trend with no significant effect of metformin (HR 0.77, 0.39-1.52) when controlled for age, sex, BMI, ASA, TNT, Stage III disease, EMVI, and adjuvant therapy.

CONCLUSION

Metformin does not affect long-term survival in LARC treated with neoadjuvant therapy followed by surgical resection. Studies with larger sample sizes are needed to validate the findings further.

The Characteristics of Sentinel Lymph Node Biopsy in Cutaneous Melanoma and the Particularities for Elderly Patients-Experience of a Single Clinic

BACKGROUND

Melanoma is a malignant tumor that determines approximately 80% of deaths as skin cancer-related. The sentinel lymph node (SLN) represents the first filter of tumor cells toward systemic dissemination. The primary objective was to outline the surgical specifics of the sentinel lymph node biopsy (SLNB) technique, correlate the location of the lymph node with the radiotracer load, and identify the characteristics of older patients.

METHODS

In this prospective study, 122 cases of malignant melanoma needing SLNB technique were included, between June 2019 and November 2022, resulting in 162 lymph nodes removed.

RESULTS

Patients' mean age was 54.3 ± 14.4 years old, the prevalence of 70 years and older being 20.5%. The rate of positive SLN was 24.6%, with a single drainage in 68.9% of cases. The frequency of seroma was 14.8%, while reintervention 1.6%. The inguinal nodes had the highest preoperative radiotracer load (p = 0.015). Patients 70 years old or older had significantly more advanced-stage melanoma (68.0% vs. 45.4%, p = 0.044, OR = 2.56) and a higher rate of positive SLN (40.0% vs. 20.6%, p = 0.045,OR = 2.57). Melanoma of the head and neck was more common among older individuals (32.0% vs. 9.3%, p = 0.007,OR = 4.60).

CONCLUSIONS

The SLNB has a low rate of surgical complications and the positivity of SLN is not related to radiotracer load. Elderly patients are at risk for head and neck melanoma, have more advanced stages, a higher SLN positivity, and a greater rate of surgical complications.

Biomarkers Involved in the Mineral-Bone Disorders Secondary to Chronic Hemodialysis

Introduction. Chronic kidney disease (CKD) is one of the most prevalent public health problems of the elderly population. End-Stage Renal Disease (ESRD)’s most common treatment is dialysis. There are some dissimilarities between the sexes that are apparent in the status and the possible outcomes of CKD. This study aims to shed some light on these somewhat overlooked wwwvariations and their implications.

Materials and methods. We conducted an observational study on subjects with CKD, undergoing hemodialysis for at least 2 years. For participation, we selected an equal number of men and women, which were divided into 2 groups according to gender. Plasma levels of the following parameters were monitored: creatinine, urea, bicarbonate, phosphorus, calcium, alkaline phosphatase, vitamin D, FGF-23 and TNF-alpha. The differences of the variables between the two groups were evaluated using TTEST and CORREL test.

Results. A significant correlation was between the plasma levels of FGF-23 and gender (p =0.02). Regarding the plasmatic levels of urea, besides the expected difference in pre- and post- dialysis levels, we obtained a significant correlation between its post-dialysis value and gender (p =0.045). In regard to the plasmatic levels of the alkaline phosphatase, there was a significant correlation between its value and gender (p =0.01).

Conclusions. There is a significant correlation between the plasmatic levels of creatinine, urea, alkaline phosphatase, vitamin D, FGF-23 and gender. Women present lower levels of creatinine and urea, while men present lower plasmatic levels of vitamin D, alkaline phosphatase and FGF-23.

Rectal Cancer and Diabetes Relationship: An Evidence-Based Overview for Healthcare Providers

As the third most frequently diagnosed cancer through the worldwide, colorectal cancer (CRC) is the fourth leading cause and account for around 8% of all cancer-related death. Diabetes mellitus (DM) is a complex metabolic disorder characterized by chronic hyperglycemia and inflammation due to deficiency in insulin secretion or dysregulation of the insulin action pathway, which further leads to dysfunction and failure of multiple organs. Many advances have been made in the diagnosis and management of rectal cancer. Although colorectal cancer survival is severely dependent on the stage of disease at diagnosis, it might also be influenced by several risk factors. The relationship between colorectal cancer and diabetes is a complex one and can raise problems in both diagnosis and the management of patients with both conditions. Metabolic pathways of the type II diabetes, glucose intolerance and obesity can be considered as a link to rectal cancer. This article provides not just an overview of the epidemiology, diagnosis and management of CRC and DM, but also highlights of CRC and DM relationship.

In Vivo Sentinel Lymph Node Detection with Indocyanine Green in Colorectal Cancer

Introduction: The indocyanine green fluorescence imaging system allows the identification of lymphatic vessels, lymph nodes and blood flow during surgery. Colorectal cancer is the second commonest cancer in women, the third in men, being the fourth commonest cause of cancer death. One of the most important factors for staging and prognosis in colorectal cancer is the involvement of the regional lymph nodes. In the literature, there are several methods for identifying sentinel lymph nodes, including methylene blue, technetium (99m Tc) and indocyanine green. The current article presents the use of indocyanate in the identification of sentinel node/nodes in malignant tumors of the colon, by a technique performed in vivo, before the primary ligation of the vascular pedicles. Material and methods:The study was prospectively conducted on a group of 23 patients who had undergone a standard surgical resection - 21 of them for a malignant tumor of the colon and two patients for a malignant rectal tumor - in the 1st General Surgery Department, Emergency University Hospital, Bucharest, Romania, between January 2020-March 2022. During surgery, sentinel lymph node detection was performed using indocyanine green and the Karl Storz® Vitom ICG probe. Sentinel lymph nodes were separately excised and sent to the Department of Pathological Anatomy for analysis. Results:Sentinel nodes were successfully identified in 13 patients and the overall identification rate was 56.52% (13/23 cases). In seven cases, the number of invaded nodes was the same as that of identified and invaded sentinel nodes. Complete lymphadenectomy was performed in all cases regardless of the staining status of the sentinel lymph nodes. Conclusions:The use of fluorescence imaging with indocyanine green in colorectal cancer remains controversial. Since no specific receptor target is used, the fluorescent signal is not specific for lymph node metastases. The learning curve is particularly important for increasing the accuracy of the technique and is responsible for the negative results in some cases. Cases in which lymph nodes have not been invaded require further evaluation through immunohistochemistry and chain polymerization reaction (RT-PCR).

The Microbiota and the Relationship with Colorectal Cancer: Surgical Complications—A Review

Colorectal cancer (CRC) is one of the most common cancers and represents a major global health burden. While genetics are implicated in a portion of CRC patients, most cases are sporadic. A new possibility of tumor initiation and promotion might be microbiome composition. It was recently shown that bacteria from the gut microbiome might be used as biomarkers for CRC detection, especially Fusobacterium nucleatum, Peptostreoptococcus stomatis, Parvimonas mica, Solobacterium moorei, and Peptostreptococcus anaerobius. Conversely, the healthy gut microbiome is mostly colonized by Bacterioides (Bacterioides fragilis, vulgatus, uniformis), Firmicutes (Clostridium spp., Ruminococcus faecis, Enterococcus faecium), and Actinobacteria (Bifidobacterium bifidum). Some strains of gut bacteria favor tumor promotion through DNA and RNA damage (directly or through interaction with other known food carcinogens) and through local immune inhibition. It is possible that bacteria (e.g., Bacillus polyfermenticus, Alistipes shahii, Lactobacillus casei) exist with protective functions against tumor promotion. Despite current advances in colorectal cancer treatment, especially in the medical oncology and radiotherapy domains, surgery remains the mainstay of curative treatment for colorectal cancer patients, even in the oligometastatic setting. Surgical complications like anastomotic leakage, excessive blood loss, abscess, and abdominal sepsis can reduce 1-year and 5-year overall survival and increase the recurrence rates for these patients; therefore, we reviewed currently published data focusing on the relationship between gut microbiota and postoperative complications for colorectal cancer patients.

Blood Group Type Association with Head and Neck Cancer

Background: We conducted an analysis to check whether the ABO blood group impacts the susceptibility or protection against different types of head and neck cancers. Method: We analyzed the medical records of 61,899 cancer patients from “Prof. Dr. Alexandru Trestioreanu” Institute of Oncology from Bucharest, along with the corresponding blood group type. Data were scraped using Python. For analysis, we used Chi-square test. Results: The blood group count was A (245, 45.12%) followed by 0 (160, 24.66%), B (110, 20.26%), and AB (28, 5.16%). Hypopharyngeal cancer was associated with B group, oral cavity cancer was associated with a lower risk in patients with B group while AB patients had a higher risk for oral cavity cancer (χ² = 36.136, df = 18, p = 0.007). Conclusion: Blood group B is associated with an increased incidence for hypopharyngeal cancer, whereas, for the oral cavity, was associated lower incidence. Blood antigen A is associated with a higher risk of oral cavity cancer development, independent of B blood antigen.