The Impact of Chronic Kidney Disease on the Mortality Rates of Patients with Urological Cancers-An Analysis of a Uro-Oncology Database from Eastern Europe

(1) Background: The relationship between chronic kidney disease (CKD) and urological cancers is complex, as most of these cancers are diagnosed in patients with advanced ages, when the kidney function may be already impaired. On the other hand, urological cancers could represent a risk factor for CKD, significantly reducing the life expectancy of the patients. The main objective of our study was to analyze the impact of CKD on the overall mortality of patients diagnosed with the most frequent types of urological cancers. (2) Material and Methods: We conducted an observational retrospective cohort study on a group of 5831 consecutive newly diagnosed cancer patients, followed over a 2-year period (2019-2020), from a large Oncology Hospital in Romania. From this group, we selected only the patients diagnosed with urological malignancies, focusing on prostate cancer, bladder cancer and renal cancer; finally, 249 patients were included in our analysis. (3) Results: In the group of patients with prostate cancer (n = 146), the 2-year overall mortality was 62.5% for patients with CKD, compared with 39.3% for those with no initial CKD (p < 0.05). In the group of patients with bladder cancer (n = 62), the 2-year overall mortality was 80% for patients with initial CKD, compared with 45.2% for the patients with no initial CKD (p < 0.05). Finally, in the group of patients with renal cell carcinoma (n = 41), the 2-year overall mortality was 60% for patients with initial CKD, compared with 50% for the patient group with no initial CKD (p < 0.05). Various correlations between specific oncologic and nephrological parameters were also analyzed. (4) Conclusions: The presence of CKD at the moment of the urological cancer diagnosis is associated with significantly higher 2-year mortality rates.

Nutritional Interventions to Improve Cachexia Outcomes in Cancer—A Systematic Review

Background and Objectives: The prevalence of cachexia has increased across all of the cancer types and accounts for up to 20% of cancer-related deaths. This paper is a systematic review of nutritional interventions aiming to improve cachexia outcomes in cancer, focusing on weight gain. Materials and Methods: A search in Medline and Elsevier databases for articles up until the 23 January 2022, was conducted. Results: Out of 5732 screened records, 26 publications were included in the final analysis. Four randomized clinical trials showed a significant body weight (BW) increase in patients treated with eicosapentaenoic acid (EPA), β-hydroxy-beta-methyl butyrate (β-HMB), arginine, and glutamine or marine phospholipids (MPL). An upward BW trend was observed in patients treated with L-carnitine, an Ethanwell/Ethanzyme (EE) regimen enriched with ω-3 fatty acids, micronutrients, probiotics, fish oil, a leucine-rich supplement, or total parental nutrition (TPN) with a high dose of a branched-chain amino acid (BCAA). Conclusions: Although clinical trials relating to large numbers of nutritional supplements present promising data, many trials provided negative results. Further studies investigating the underlying mechanisms of action of these nutritional supplements in cancer cachexia are needed. Early screening for cancer cachexia risk and nutritional intervention in cancer patients before aggravating weight loss may stabilize their weight, preventing cachexia syndrome. According to the GRADE methodology, no positive recommendation for these nutritional supplements may be expressed.

The Role of Nut and Seed Consumption in Colorectal Cancer: A Narrative Review

Given the increased incidence of colorectal cancer worldwide, especially in developed and developing countries, is comes as no surprise that researchers are concentrating on methods to combat this public health issue, through investigating both lifestyle interventions and treatment options. Although treatment options are being constantly discovered and developed, researchers have also begun investigating the influence that nutrition and lifestyle have on CRC. Among the food categories, nuts and seeds boast numerous beneficial effects for cardiovascular health and metabolic balance and they contain a plethora of phytochemicals and antioxidants. The present narrative review aims to offer a broad perspective to date on the known effects of this consumption on colorectal cancer. For this purpose, articles were identified by conducting a search in the PubMed and Google Scholar databases, using search phrases such as ″nut intake and colorectal cancer″ and ″seed consumption and colorectal cancer”, narrowing the search pool to those articles published between 2019 and 2022. The search returned eight relevant papers, all of which were validated by a second author. While the existing research is divided between those studies which have found no significant link between nut consumption and colorectal cancer protection and those which have, there is a consensus regarding the necessity for further research on this subject, as well as the possible mechanisms which might be involved in the protective effect observed by some researchers.

Endothelial corneal cell damage after pars plana vitrectomy: analogy of different intraocular tamponade agents

A reduction in the corneal endothelial cells multitude after anterior pole intervention is well established in numerous researches, but there are few articles that follow the impact of vitreoretinal interventions on the cornea, especially when endotamponade agents are used. The assessment of the endothelial corneal cells is needed since it facilitates the personal evaluation of the functional endothelial stock. Specular microscopy investigation offers a scale of the functional strength of the endothelium of cornea, which is vital before all intraocular interventions.

Endotamponade agents are very suitable and important tools in the surgical treatment of retinal detachment, but their use must be differentiated depending on the uniqueness of each patient. This research shows corneal endothelial damages caused by intraocular tamponade agents of different types in the case of pars plana vitrectomy for cases of multitude retinal detachments. The purpose of the research was to determine the changes that appear in the endothelium of the cornea and to deal with the results when different tamponade agents are used in the surgical cure for retinal detachment. Specular endothelial corneal microscopy records were achieved and the modifications of the following parameters revealed corneal implication: mean endothelial cell densities, average cell area, coefficient of variation, hexagonality and corneal center thickness. On the first day and at three months postoperatively, a statistically significant reduction was observed for the CV, MCD, and HEX parameters (p 0.001), but no statistically significant difference of the two endotamponade agents (for MCD, p=0.15; for CV, p=0.63; for HEX, p=0.93) was noticed. AVG parameter had a statistically significant decrease (p 0.001) and there was also a statistically significant difference of the two endotamponade agents (p=0.03), patients with gas tamponade presenting a superior result. On the first day and at three months postoperatively, the corneal center thickness presented a statistically significant increase (p 0.001) and there was a statistically significant difference between the two endotamponade agents (p=0.03), patients with gas endotamponade presenting a superior result. In conclusion, using the intraocular tamponade agents helps reestablish the functional-anatomical recovery of the retina after surgery, but their special indication must be well-established for each case of retinal detachment.

Comparative hematological profiles for dose-dense vs. regular anthracycline-based neoadjuvant chemotherapy in non-metastatic breast cancer

The aim of the present study was to examine both the feasibility and toxicity of neoadjuvant dose-dense chemotherapy in women with non-metastatic breast cancer. A search within the OncoHelp Association breast cancer database has been performed in order to identify all non-metastatic breast cancer patients who underwent an initial consultation with a medical oncologist between March 2016 and April 2020. The inclusion criteria used were: i) Age, ii) follow-up care obtained at OncoHelp Association, iii) the intent to treat with a neoadjuvant dose-dense anthracycline every two weeks for four cycles (C1-C4) followed by paclitaxel every two weeks for four cycles, with white blood cell growth factor support, and iv) regular anthracycline-based chemotherapy every three weeks for four cycles, followed by paclitaxel every three weeks for four cycles, v) weight, vi) height, vii) Eastern Cooperative Oncology Group (ECOG) performance status, viii) hemoglobin (Hb) level, ix) Platelet count and x) neutrophil count.

Predictors of the response to nivolumab immunotherapy in the second or subsequent lines for metastatic non-small cell lung cancers

Checkpoint inhibitors represent the first therapeutic class to replace chemotherapy lines for the treatment of metastatic non-small cell lung cancer (NSCLC), due to improved overall survival and tolerability. Nivolumab, a fully human anti-programmed cell death-1 immunoglobulin G4 monoclonal antibody, is the first immune checkpoint inhibitor approved by the US Food and Drug Administration in 2014 for cases of metastatic melanoma and in 2015 for cases of squamous cell lung cancer and kidney cell cancer. The present study aimed to identify predictive markers (favorable or unfavorable) for time to treatment discontinuation using nivolumab in the second or subsequent line of therapy of metastatic NSCLC cases. Analysis of a group of 78 NSCLC patients treated with nivolumab allowed the identification of negative predictive markers, related to the presence of metastases (adrenal in men under 65 years, liver, brain and the number of metastatic sites) and the hematological profile (neutrophilia at the initiation of treatment and lymphocyte variation at 6 weeks of treatment).

Role of combining neutrophil-to-lymphocyte ratio and pretreatment body mass index in predicting progression-free survival in patients with non-small cell lung cancer treated with nivolumab

Identifying markers capable of predicting outcomes in lung cancer patients treated with nivolumab represents a growing research interest. The combination of neutrophil-to-lymphocyte ratio (NLR) and body mass index (BMI) may help predict treatment efficacy. Thus, the present study aimed to investigate the influence of NLR and BMI on progression-free survival (PFS) in non-small-cell lung cancer (NSCLC) patients treated with nivolumab. A retrospective study was made on 80 patients with NSCLC that were treated with nivolumab at the OncoHelp Oncology Center, Timisoara, Romania after platinum-based chemotherapy, from January 2018 to April 2020. Patients were administered nivolumab at a dose of 3 mg/m² or 240 mg total dose, every 2 weeks. The predictive impact of NLR (baseline at 2 and 4 weeks after the start of nivolumab) and BMI for disease progression was assessed. Median PFS for subjects with NLR <3 before treatment was 18.5 weeks, while in subjects with NLR ≥3 was 14 weeks (P=0.50). Median PFS for subjects with NLR2 <3 at 2 weeks after treatment was 21 weeks, while in subjects with NLR2 ≥3, PFS was 14 weeks (P=0.17). Median PFS for subjects with NLR4 <3 at 4 weeks after treatment was 23 weeks, while in subjects with NLR4 ≥3, PFS was 19 weeks (P=0.33). Multivariate analysis for the association with PFS showed that baseline NLR, male sex and BMI were associated independently, thus we could develop a significant statistical model [AUROC=0.76, 95% CI (0.45-0.89), P=0.03], a new predictive score for PFS. The assessment of NLR and BMI may represent simple and useful biomarkers; combining them and taking into consideration the male sex may predict PFS in patients with advanced NSCLC treated with nivolumab.

Determining factors of renal dysfunction during cisplatin chemotherapy

Cisplatin remains one of the most active antineoplastic treatments used in oncology, being the most prestigious exponent of the golden age in chemotherapy at the end of the 20th century. This chemotherapeutic drug is used for curative or palliative treatments in testicular, ovarian, head and neck neoplasms, sarcomas and lymphomas. The limiting dose adverse effect of cisplatin is nephrotoxicity. The present study aimed to evaluate the magnitude of the damage to renal function and to identify the risk or protective factors in renal toxicity. The retrospective study was performed using 81 consecutive patients who underwent at least three cycles of cisplatin chemotherapy. The results indicate an average decline in glomerular filtration rate (GFR) of 9 ml/min. Women appear to be less by a decline in renal function (a relative decline of GFR of -5% for women compared to -9% for men). The decline in GFR was found to be proportional to age; overweight (not obese) individuals had the best renal function behavior under cisplatin treatment, while the association of anaemia appears to be a risk factor for renal toxicity. The use of cisplatin in oncology in the last years may have decreased, either by using combination chemotherapy instead of monotherapy, or by its displacement by newly discovered treatments (e.g., immunotherapy in lung cancer). Therefore, it is possible that the profile of patients who are exposed to this drug and the duration of exposure have been modified compared to previous studies. The objectives of the present study were to assess the magnitude of the renal function damage during cisplatin treatment and to identify the risk and the protective factors in term of renal toxicity.

Endurance of erythrocyte series in chemotherapy

Hematopoietic bone marrow toxicity is most often the limiting factor for chemotherapy doses. Increasing the intensity of chemotherapy doses (higher doses or more frequent administration) would improve antitumor effects, but the hematological toxicity does not allow these dose increases. This study evaluated the impact of chemotherapies on the parameters belonging to the red blood cell series in the hemogram and aimed to identify some particular evolution profiles. We selected 855 evaluations performed before the administration of chemotherapy belonging to the treatments initiated during the period December 2018-February 2020, containing 5-fluorouracil, cisplatin, docetaxel, epirubicin or pemetrexed. The data of the 644 evaluations related to the cycles 1-4 of chemotherapy were subject to this processing. The average relative loss of hemoglobin is -11% after the first three cycles of treatment, with statistically significant differences in hemoglobin levels in favor of men. There are risk factors associated with higher average losses, such as age <50 years or >65 years (statistically significant), body mass index (BMI) >25, cisplatin treatment (insufficient number of cases to reach statistical significance).