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Ditto A, Longo M, Chiarello G, Mariani L, Paolini B, Leone Roberti Maggiore U, Martinelli F, Bogani G, Raspagliesi F. Are biomarkers expression and clinical-pathological factors predictive markers of the efficacy of neoadjuvant chemotherapy for locally advanced cervical cancer? Eur J Surg Oncol 2024; 50:108311. [PMID: 38554552 DOI: 10.1016/j.ejso.2024.108311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 03/03/2024] [Accepted: 03/24/2024] [Indexed: 04/01/2024]
Abstract
INTRODUCTION To predict the overall pathologic response to neoadjuvant chemotherapy (NACT) of patients with locally advanced cervical cancer (LACC) creating a prediction model based on clinical-pathological factors and biomarkers (p53, Bcl1 and Bcl2) and to evaluate the prognostic outcomes of NACT. MATERIALS AND METHODS This is a retrospective study of 88 consecutive patients with LACC who underwent NACT followed by nerve sparing surgery with retroperitoneal lymphadenectomy at National Cancer Institute of Milan, between January 2000 and June 2013. Clinical pathologic data were retrieved from the institutional database. Biomarkers (p53, Bcl1 and Bcl2) were evaluated before and after NACT in the specimen. To investigate their role as predictors of response, we tried several statistical machine learning algorithms. RESULTS Responders to NACT showed a 5-years survival between 100%(CR) and 85.7%(PR). Clinical factors were the most important predictor of response. Age, BMI and grade represented the most important predictors of response at random forest analysis. Tree-based boosting revealed that after adjusting for other prognostic factors, age, grade, BMI and tumor size were independent predictors of response to NACT, while p53 was moderately related to response to NACT. Area under the curve (crude estimate): 0.871. Whereas Bcl1 and Bcl2, were not predictors for response to NACT. The final logistic regression reported that grade was the only significant predictor of response to NACT. CONCLUSION Combined model that included clinical pathologic variables plus p53 cannot predict response to NACT. Despite this, NACT remain a safe treatment in chemosensitive patients avoiding collateral sequelae related to chemo-radiotherapy.
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Affiliation(s)
- Antonino Ditto
- Gynecological Oncology Department, Fondazione IRCCS Istituto Dei Tumori, Milan, Italy.
| | - Mariangela Longo
- Gynecological Oncology Department, Fondazione IRCCS Istituto Dei Tumori, Milan, Italy
| | - Giulia Chiarello
- Gynecological Oncology Department, Fondazione IRCCS Istituto Dei Tumori, Milan, Italy
| | - Luigi Mariani
- Statistics Department, Fondazione IRCCS Istituto Dei Tumori, Milan, Italy
| | - Biagio Paolini
- Pathology Department, Fondazione IRCCS Istituto Dei Tumori, Milan, Italy
| | | | - Fabio Martinelli
- Gynecological Oncology Department, Fondazione IRCCS Istituto Dei Tumori, Milan, Italy
| | - Giorgio Bogani
- Gynecological Oncology Department, Fondazione IRCCS Istituto Dei Tumori, Milan, Italy
| | - Francesco Raspagliesi
- Gynecological Oncology Department, Fondazione IRCCS Istituto Dei Tumori, Milan, Italy
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Bao W, Li Z. Efficacy and safety of neoadjuvant chemotherapy containing anti-angiogenic drugs, immunotherapy, or PARP inhibitors for ovarian cancer. Crit Rev Oncol Hematol 2024; 194:104238. [PMID: 38128630 DOI: 10.1016/j.critrevonc.2023.104238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/30/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
Ovarian cancer is the most lethal gynecologic malignancy. The standard treatment involves chemotherapy with platinum-paclitaxel following cytoreductive surgery. For patients battling widespread and aggressive tumor spread, neoadjuvant chemotherapy (NACT) followed by interval debulking surgery emerges as an encouraging alternative. However, the effectiveness of this strategy is often limited by advanced-stage diagnosis and high likelihood of recurrence. The high mortality rate necessitates the exploration of targeted therapies. Present results signal promising efficacy and acceptable toxicities of anti-angiogenic drugs, immunotherapy, or PARP inhibitors used in chemotherapy. However, the potential integration of these drugs into NACT raises questions about response rates, surgical outcomes, and adverse events. This review delves into the findings from all published articles and ongoing studies, aiming to summarize the clinical use of anti-angiogenic drugs, immunotherapy, or PARP inhibitors in NACT, highlight the positive and negative aspects, and outline future perspectives.
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Affiliation(s)
- Wanying Bao
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Zhengyu Li
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China.
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Nath J, Das A, Khanikar D, Ahmed S, Kakati K. Chondroblastic Osteosarcoma of the Maxilla with Poor Response to Neoadjuvant Chemotherapy: A Rare Case Report and Updated Review of Literature. Indian J Otolaryngol Head Neck Surg 2023; 75:4041-4046. [PMID: 37974676 PMCID: PMC10645781 DOI: 10.1007/s12070-023-04037-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 06/23/2023] [Indexed: 11/19/2023] Open
Abstract
Craniofacial osteosarcoma is a relatively rare disease entity. In the craniofacial region, mandible is the commonest site followed by maxilla and skull bone. Due to its rare occurrence standard treatment guidelines are not formulated as in long bone or extremity sarcoma. Here we have reported a locally advanced case of a maxillary osteosarcoma of chondroblastic variant who was initially considered for neoadjuvant chemotherapy. However there was radiological evience of disease progression. Then the patient was considered for surgery followed by adjuvant radiotherapy. A literature review of the published cases of maxillary chondroblastic osteosarcoma has also been done here.
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Affiliation(s)
- Jyotiman Nath
- Department of Radiation Oncology, Dr B Borooah Cancer Institute, Guwahati, India
| | - Anupam Das
- Department of Head and Neck Surgery, Dr B Borooah Cancer Institute, Guwahati, Assam 781016 India
| | - Duncan Khanikar
- Department of Medical Oncology, Dr B Borooah Cancer Institute, Guwahati, India
| | - Shiraj Ahmed
- Department of Oncopathology, Dr B Borooah Cancer Institute, Guwahati, India
| | - Kaberi Kakati
- Department of Head and Neck Surgery, Dr B Borooah Cancer Institute, Guwahati, Assam 781016 India
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Khare S, Santosh I, Laroiya I, Singh T, Bal A, Singh G. Assessment of Pathological Complete Response Using Vacuum-Assisted Biopsy in Breast Cancer Patients Who Have Clinical and Radiological Complete Response After Neo-Adjuvant Chemotherapy. Breast Cancer (Auckl) 2023; 17:11782234231205698. [PMID: 38024141 PMCID: PMC10655653 DOI: 10.1177/11782234231205698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 09/18/2023] [Indexed: 12/01/2023] Open
Abstract
Background Any treatment protocol that leads to complete elimination of surgery may lead to a better patient acceptance of breast cancer treatments. Objectives We conducted this study to assess the feasibility of preoperative vacuum-assisted biopsies in identifying pathological complete response (pCR) and its accuracy in correlation to final histopathology report (HPR), in an Indian setting. Methods This was a prospective study conducted between October 1, 2019, and March 31, 2021. Patients with early breast cancer, estrogen and progesterone receptors negative and either Her2 positive or negative, and who were fit to undergo marker placement at the centre of the tumour and to receive third-generation chemotherapy (4 cycles of 3 weekly doxorubicin and cyclophosphamide followed by 4 cycles of 3 weekly docetaxel) were included in the study. Following the enrolment, a tissue marker was placed at the centre of the tumour and appropriate chemotherapy was started. Patients who achieved clinical complete response were subjected to ultrasound-guided vacuum-assisted biopsy (VAB) from the tumour bed before surgery. Pathology results of the VAB and resected specimen were then compared. Descriptive statistics were used in the study. Results Eighteen patients were enrolled in the study, with a mean age of 43.6 ± 9.8 years. However, only 10 were eligible for VAB procedure, and sensitivity and specificity were calculated based on the results of these 10 patients only. Vacuum-assisted biopsy showed sensitivity of 50% and specificity of 100% in identifying pCR. Combination of mammography, ultrasonography, and VAB showed sensitivity of 77.8% and specificity of 66.7% in identifying pCR. Conclusion Vacuum-assisted biopsy of tumour bed may not be sensitive enough to eliminate surgery even in patients who have had exceptional response to neo-adjuvant chemotherapy.
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Affiliation(s)
- Siddhant Khare
- Department of General Surgery, PGIMER, Chandigarh, India
| | | | - Ishita Laroiya
- Department of General Surgery, PGIMER, Chandigarh, India
| | - Tulika Singh
- Department of Radiodiagnosis, PGIMER, Chandigarh, India
| | - Amanjit Bal
- Department of Histopathology, PGIMER, Chandigarh, India
| | - Gurpreet Singh
- Department of General Surgery, PGIMER, Chandigarh, India
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Agrawal M, Konduru V, Riju J, Singh A, Joel A, Karuppusami R, Tirkey AJ. Definitive Surgery after Neoadjuvant Chemotherapy for Locally Advanced Oral Cavity Cancers: Experience from a Tertiary Care Center. South Asian J Cancer 2023; 12:341-348. [PMID: 38130286 PMCID: PMC10733068 DOI: 10.1055/s-0043-1768038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Mansi AgrawalVidya KonduruBackground Oral cavity cancers require definitive surgical resection as the primary treatment, but with advanced T stage, complete resection with pathologically negative margins might be difficult to achieve. Induction chemotherapy helps achieve the balance between resection and morbidity in locally advanced technically unresectable tumors. The aim of this study was to analyze the impact of surgery in locally advanced, technically unresectable oral cavity cancers after neoadjuvant chemotherapy (NACT). Materials and Methods A retrospective analysis of patients with borderline resectable, locally advanced oral cavity cancers who were given NACT between February 2017 and December 2021 was conducted. Data regarding clinical and pathological characteristics, NACT, surgery, adjuvant therapy, and recurrences was analyzed. Results Of the 69 patients in the study, 69.6% had tongue cancer, rest were gingivobuccal complex cancers. All tumors were resected based on the post-NACT tumor volume and clear margins were achieved in 42% of cases. About 85.4% of the tongue cancers required a lesser resection than anticipated, thereby following the concept of organ and functional preservation post-NACT as proposed by Licitra et al. About 30.4% had ypT0 and 17.4% had ypN0. Recurrence and survival rates noted in our study were comparable to those reported in literature. Lymph node density of more than or equal to 0.07 was found in all recurrent cases. Conclusions Induction chemotherapy offers a chance of achieving adequate surgical resection while reducing morbidity and improving functional outcomes for patients with technically unresectable oral cavity cancers. Nodal disease may not respond to chemotherapy as well as the primary tumor. There is a need for comprehensive evaluation of prognostic factors, which could help identify the patients who will most benefit with NACT.
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Affiliation(s)
- Mansi Agrawal
- Department of Head and Neck Surgery, Unit-2, Christian Medical College, Vellore, Tamil Nadu, India
| | - Vidya Konduru
- Department of Head and Neck Surgery, Unit-2, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jeyashanth Riju
- Department of Head and Neck Surgery, Unit-2, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ashish Singh
- Department of Medical Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anjana Joel
- Department of Medical Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Reka Karuppusami
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Amit Jiwan Tirkey
- Department of Head and Neck Surgery, Unit-2, Christian Medical College, Vellore, Tamil Nadu, India
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Yin R, Guo Y, Wang Y, Zhang Q, Dou Z, Wang Y, Qi L, Chen Y, Zhang C, Li H, Jian X, Ma W. Predicting Neoadjuvant Chemotherapy Response and High-Grade Serous Ovarian Cancer From CT Images in Ovarian Cancer with Multitask Deep Learning: A Multicenter Study. Acad Radiol 2023; 30 Suppl 2:S192-S201. [PMID: 37336707 DOI: 10.1016/j.acra.2023.04.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 06/21/2023]
Abstract
RATIONALE AND OBJECTIVES Accurate prediction neoadjuvant chemotherapy (NACT) response in ovarian cancer (OC) is essential for personalized medicine. We aimed to develop and validate a deep learning (DL) model based on pretreatment contrast-enhanced CT (CECT) images for predicting NACT responses and classifying high-grade serous ovarian cancer (HGSOC) to identify patients who may benefit from NACT. MATERIALS AND METHODS This multicenter study, which contained both retrospective and prospective studies, included consecutive OC patients (n = 757) from three hospitals. Using WHO RECIST 1.1 for the reference standard, a total of 587 women with 1761 images were included in the training and validation sets, 67 women with 201 images were included in the prospective sets, and 103 women with 309 images were included in the external sets. A multitask DL model based on the multiperiod CT image was developed to predict NACT response and HGSOC. RESULTS Logistic regression analysis showed that peritoneal invasion, retinal invasion, and inguinal lymph node metastasis were independent predictors. The DL achieved promising segmentation performances with DICEmean= 0.83 (range: 0.78-0.87). For predicting NACT response, the DL model combined with clinical risk factors obtained area under the receiver operating characteristic curve (AUCs) of 0.87 (0.83-0.89), 0.88 (0.86-0.91), 0.86 (0.82-0.89), and 0.79 (0.75-0.82) in the training, validation, prospective, and external sets, respectively. The AUCs were 0.91 (0.87-0.94), 0.89 (0.86-0.91), 0.80 (0.76-0.84), and 0.80 (0.75-0.85) in four sets in HGSOC classification. CONCLUSION The multitask DL model developed using multiperiod CT images exhibited a promising performance for predicting NACT response and HGSOC with OC, which could provide valuable information for individualized treatment.
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Affiliation(s)
- Rui Yin
- School of Biomedical Engineering & Technology, Tianjin Medical University, Tianjin, China (R.Y., X.J.)
| | - Yijun Guo
- Department of Breast Imaging, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China (Y.G., Z.D., W.M.)
| | - Yanyan Wang
- Department of CT and MRI, Shanxi Tumor Hospital, Taiyuan, China (Y.W.)
| | - Qian Zhang
- Department of Radiology, Baoding No. 1 Central Hospital, Baoding, China (Q.Z.)
| | - Zhaoxiang Dou
- Department of Breast Imaging, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China (Y.G., Z.D., W.M.)
| | - Yigeng Wang
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China (Y.W.)
| | - Lisha Qi
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China (L.Q.)
| | - Ying Chen
- Department of Gynecologic Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China (Y.C.)
| | - Chao Zhang
- Department of Bone Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China (C.Z.)
| | - Huiyang Li
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China (H.L.)
| | - Xiqi Jian
- School of Biomedical Engineering & Technology, Tianjin Medical University, Tianjin, China (R.Y., X.J.)
| | - Wenjuan Ma
- Department of Breast Imaging, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China (Y.G., Z.D., W.M.).
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Li X, Zhang Y, Wu H, Li S, Ge S, Gao J. A case of neoadjuvant chemotherapy in pregnancy with cervical cancer (IB3). Cancer Treat Res Commun 2023; 38:100749. [PMID: 38184968 DOI: 10.1016/j.ctarc.2023.100749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/07/2023] [Accepted: 07/22/2023] [Indexed: 01/09/2024]
Abstract
Compared with the early symptoms of non-pregnancy, the early pregnancy with cervical cancer is often confused with threatened abortion, so it is difficult to diagnose and delay the time of treatment. At present, compared with cervical cancer, there is no clear and standard treatment for cervical cancer in pregnancy. At present, the diagnosis and treatment plan is mainly made according to the pathological examination, staging, fetal development (whether there is abnormality on ultrasound and whether the chromosome karyotype is normal or not) and the pregnant women and their family members' pregnancy wishes. A case of pregnancy complicated with cervical cancer who was terminated by planned cesarean section after neoadjuvant chemotherapy (NACT) with irregular vaginal bleeding as the first symptom was analyzed retrospectively.
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Affiliation(s)
- Xiaohua Li
- Obstetrics gynecology, People's Hospital of Hebei province, Shijiazhuang, Hebei, 050000, China.
| | - Yu Zhang
- Obstetrics gynecology, People's Hospital of Hebei province, Shijiazhuang, Hebei, 050000, China
| | - Haiying Wu
- Genetics, People's Hospital of Hebei province, Shijiazhuang, Hebei, 050000, China
| | - Shaoqiong Li
- Genetics, People's Hospital of Hebei province, Shijiazhuang, Hebei, 050000, China
| | - Shuxian Ge
- Genetics, People's Hospital of Hebei province, Shijiazhuang, Hebei, 050000, China
| | - Jian Gao
- Department of Reproductive Genetics, Hebei People's Hospital
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Di Paola V, Mazzotta G, Conti M, Palma S, Orsini F, Mola L, Ferrara F, Longo V, Bufi E, D'Angelo A, Panico C, Clauser P, Belli P, Manfredi R. Image-Guided Localization Techniques for Metastatic Axillary Lymph Nodes in Breast Cancer; What Radiologists Should Know. Cancers (Basel) 2023; 15:cancers15072130. [PMID: 37046791 PMCID: PMC10093304 DOI: 10.3390/cancers15072130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 04/14/2023] Open
Abstract
Targeted axillary dissection (TAD) is an axillary staging technique after NACT that involves the removal of biopsy-proven metastatic lymph nodes in addition to sentinel lymph node biopsy (SLNB). This technique avoids the morbidity of traditional axillary lymph node dissection and has shown a lower false-negative rate than SLNB alone. Therefore, marking positive axillary lymph nodes before NACT is critical in order to locate and remove them in the subsequent surgery. Current localization methods include clip placement with intraoperative ultrasound, carbon-suspension liquids, localization wires, radioactive tracer-based localizers, magnetic seeds, radar reflectors, and radiofrequency identification devices. The aim of this paper is to illustrate the management of axillary lymph nodes based on current guidelines and explain the features of axillary lymph node markers, with relative advantages and disadvantages.
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Affiliation(s)
- Valerio Di Paola
- Department of Bioimaging, Radiation Oncology and Hematology, UOC of Radiodiagnostica Presidio Columbus, Fondazione Policlinico Universitario A. Gemelli IRCSS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Giorgio Mazzotta
- Institute of Radiology, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Marco Conti
- Department of Bioimaging, Radiation Oncology and Hematology, UOC of Radiologia Toracica e Cardiovascolare, Fondazione Policlinico Universitario A. Gemelli IRCSS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Simone Palma
- Department of Bioimaging, Radiation Oncology and Hematology, UOC of Radiodiagnostica Presidio Columbus, Fondazione Policlinico Universitario A. Gemelli IRCSS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Federico Orsini
- Institute of Radiology, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Laura Mola
- Institute of Radiology, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Francesca Ferrara
- Institute of Radiology, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Valentina Longo
- Institute of Radiology, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Enida Bufi
- Department of Bioimaging, Radiation Oncology and Hematology, UOC of Radiologia Toracica e Cardiovascolare, Fondazione Policlinico Universitario A. Gemelli IRCSS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Anna D'Angelo
- Department of Bioimaging, Radiation Oncology and Hematology, UOC of Radiologia Toracica e Cardiovascolare, Fondazione Policlinico Universitario A. Gemelli IRCSS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Camilla Panico
- Department of Bioimaging, Radiation Oncology and Hematology, UOC of Radiologia Toracica e Cardiovascolare, Fondazione Policlinico Universitario A. Gemelli IRCSS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Paola Clauser
- Department of Biomedical Imaging and Image-Guided Radiotherapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Paolo Belli
- Institute of Radiology, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
- Department of Bioimaging, Radiation Oncology and Hematology, UOC of Radiologia Toracica e Cardiovascolare, Fondazione Policlinico Universitario A. Gemelli IRCSS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Riccardo Manfredi
- Department of Bioimaging, Radiation Oncology and Hematology, UOC of Radiodiagnostica Presidio Columbus, Fondazione Policlinico Universitario A. Gemelli IRCSS, Largo A. Gemelli 8, 00168 Rome, Italy
- Institute of Radiology, Catholic University of the Sacred Heart, Largo A. Gemelli 8, 00168 Rome, Italy
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Spelbrink EM, Brown TL, Brimble E, Blanco KA, Nye KL, Porter BE. Characterizing a rare neurogenetic disease, SLC13A5 citrate transporter disorder, utilizing clinical data in a cloud-based medical record collection system. Front Genet 2023; 14:1109547. [PMID: 37025451 PMCID: PMC10072280 DOI: 10.3389/fgene.2023.1109547] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/22/2023] [Indexed: 04/08/2023] Open
Abstract
Introduction: SLC13A5 citrate transporter disorder is a rare autosomal recessive genetic disease that has a constellation of neurologic symptoms. To better characterize the neurologic and clinical laboratory phenotype, we utilized patient medical records collected by Ciitizen, an Invitae company, with support from the TESS Research Foundation. Methods: Medical records for 15 patients with a suspected genetic and clinical diagnosis of SLC13A5 citrate transporter disorder were collected by Ciitizen, an Invitae company. Genotype, clinical phenotypes, and laboratory data were extracted and analyzed. Results: The 15 patients reported all had epilepsy and global developmental delay. Patients continued to attain motor milestones, though much later than their typically developing peers. Clinical diagnoses support abnormalities in communication, and low or mixed tone with several movement disorders, including, ataxia and dystonia. Serum citrate was elevated in the 3 patients in whom it was measured; other routine laboratory studies assessing renal, liver and blood function had normal values or no consistent abnormalities. Many electroencephalograms (EEGs) were performed (1 to 35 per patient), and most but not all were abnormal, with slowing and/or epileptiform activity. Fourteen of the patients had one or more brain magnetic resonance imaging (MRI) reports: 7 patients had at least one normal brain MRI, but not with any consistent findings except white matter signal changes. Discussion: These results show that in addition to the epilepsy phenotype, SLC13A5 citrate transporter disorder impacts global development, with marked abnormalities in motor abilities, tone, coordination, and communication skills. Further, utilizing cloud-based medical records allows industry, academic, and patient advocacy group collaboration to provide preliminary characterization of a rare genetic disorder. Additional characterization of the neurologic phenotype will be critical to future study and developing treatment for this and related rare genetic disorders.
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Affiliation(s)
- Emily M. Spelbrink
- Stanford University School of Medicine, Department of Neurology and Neurological Sciences, Palo Alto, CA, United States
| | - Tanya L. Brown
- Treatments for Epilepsy and Symptoms of SLC13A5 Foundation, TESS Research Foundation, Menlo Park, CA, United States
| | | | - Kirsten A. Blanco
- Invitae, San Francisco, CA, United States
- Department of Genetics, Stanford University, Stanford, CA, United States
| | - Kimberly L. Nye
- Treatments for Epilepsy and Symptoms of SLC13A5 Foundation, TESS Research Foundation, Menlo Park, CA, United States
| | - Brenda E. Porter
- Stanford University School of Medicine, Department of Neurology and Neurological Sciences, Palo Alto, CA, United States
- *Correspondence: Brenda E. Porter,
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Spirina LV, Avgustinovich AV, Bakina OV, Afanas’ev SG, Volkov MY, Kebekbayeva AY. LC3B, mTOR, AMPK Are Molecular Targets for Neoadjuvant Chemotherapy in Gastric Cancers. Curr Issues Mol Biol 2022; 44:2772-2782. [PMID: 35877414 PMCID: PMC9315670 DOI: 10.3390/cimb44070190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 11/19/2022] Open
Abstract
Autophagy plays a dual role in oncogenesis processes. On one hand, autophagy enhances the cell resistance to oncogenic factors, and on the other hand, it participates in the tumor progression. The aim of the study was to find the associations between the effectiveness of the FLOT regimen in resectable gastric cancers (GCs) with the key autophagy-related proteins. Materials and Methods: The study included 34 patients with morphologically verified gastric cancer. All patients had FLOT neoadjunvant chemotherapy (NACT) (fluorouracil, leucovorin, oxaliplatin, and docetaxel) followed by gastrectomy. The studied tissue material was the non-transformed and tumor tissues obtained during diagnostic video gastroscopy in patients before the start of the combined treatment and after surgical treatment, frozen after collection. The LC3B, mTOR, and AMPK expression was determined by real-time PCR. The content of the LC3B protein was determined by Western blotting analysis. Results: The mRNA level and the content of the LC3B protein were associated with the tumor stage and the presence of signet ring cells. The AMPK mRNA level was increased in patients with the T4N0-2M0 stage by 37.7 and 7.33 times, which was consequently compared with patients with the T2N0M0 and T3N0-1M0 stages. The opposite changes in the mTOR and AMPK in the GCs before anti-cancer therapy were noted. The tumor size and regional lymph node affections were associated with a decrease in the mTOR mRNA level. A decrease in the mTOR expression was accompanied by an increase in the AMPK expression in the GCs. The mTOR expression was reduced in patients with a cancer spreading; in contrast, AMPK grew with the tumor size. There was an increase in the LC3B expression, which can probably determine the response to therapy. An increase in LC3B mRNA before the start of treatment and the protein content in cancers after NACT with a decrease in therapy effectiveness was recorded. There was an increase in the protein level in patients with partial regression and stabilization by 3.65 and 5.78 times, respectively, when compared with patients with complete tumor regression was noted. Conclusions: The anticancer effectiveness in GCS is down to the LC3B, mTOR, and AMPK expression. These were found to be entire molecular targets affecting the cancer progression and metastasis as well as the NACT effectiveness.
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Affiliation(s)
- Liudmila V. Spirina
- Biochemistry and Molecular Biology Department, Siberian State Medical University, 2, Moskovsky Trakt, Tomsk 634050, Russia; (O.V.B.); (A.Y.K.)
- Tomsk National Research Medical Center of the Russian Academy of Sciences, Cancer Research Institute, 5 Kooperativny Street, Tomsk 634050, Russia; (A.V.A.); (S.G.A.); (M.Y.V.)
- Correspondence:
| | - Alexandra V. Avgustinovich
- Tomsk National Research Medical Center of the Russian Academy of Sciences, Cancer Research Institute, 5 Kooperativny Street, Tomsk 634050, Russia; (A.V.A.); (S.G.A.); (M.Y.V.)
| | - Olga V. Bakina
- Biochemistry and Molecular Biology Department, Siberian State Medical University, 2, Moskovsky Trakt, Tomsk 634050, Russia; (O.V.B.); (A.Y.K.)
- Institute of Strength Physics and Materials Science of the Siberian Branch of the Russian Academy of Sciences, 2/4, pr. Akademicheskii, Tomsk 634055, Russia
| | - Sergey G. Afanas’ev
- Tomsk National Research Medical Center of the Russian Academy of Sciences, Cancer Research Institute, 5 Kooperativny Street, Tomsk 634050, Russia; (A.V.A.); (S.G.A.); (M.Y.V.)
| | - Maxim Yu. Volkov
- Tomsk National Research Medical Center of the Russian Academy of Sciences, Cancer Research Institute, 5 Kooperativny Street, Tomsk 634050, Russia; (A.V.A.); (S.G.A.); (M.Y.V.)
| | - Amina Y. Kebekbayeva
- Biochemistry and Molecular Biology Department, Siberian State Medical University, 2, Moskovsky Trakt, Tomsk 634050, Russia; (O.V.B.); (A.Y.K.)
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Kadian LK, Arora M, Prasad CP, Pramanik R, Chauhan SS. Signaling pathways and their potential therapeutic utility in esophageal squamous cell carcinoma. Clin Transl Oncol 2022; 24:1014-1032. [PMID: 34990001 DOI: 10.1007/s12094-021-02763-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 12/16/2021] [Indexed: 12/12/2022]
Abstract
Esophageal cancer is a complex gastrointestinal malignancy with an extremely poor outcome. Approximately 80% of cases of this malignancy in Asian countries including India are of squamous cell origin, termed Esophageal Squamous Cell Carcinoma (ESCC).The five-year survival rate in ESCC patients is less than 20%. Neo-adjuvant chemo-radiotherapy (NACRT) followed by surgical resection remains the major therapeutic strategy for patients with operable ESCC. However, resistance to NACRT and local recurrence after initial treatment are the leading cause of dismal outcomes in these patients. Therefore, an alternative strategy to promote response to the therapy and reduce the post-operative disease recurrence is highly needed. At the molecular level, wide variations have been observed in tumor characteristics among different populations, nevertheless, several common molecular features have been identified which orchestrate disease progression and clinical outcome in the malignancy. Therefore, determination of candidate molecular pathways for targeted therapy remains the mainstream idea of focus in ESCC research. In this review, we have discussed the key signaling pathways associated with ESCC, i.e., Notch, Wnt, and Nrf2 pathways, and their crosstalk during disease progression. We further discuss the recent developments of novel agents to target these pathways in the context of targeted cancer therapy. In-depth research of the signaling pathways, gene signatures, and a combinatorial approach may help in discovering targeted therapy for ESCC.
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Affiliation(s)
- L K Kadian
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - M Arora
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - C P Prasad
- Department of Medical Oncology (Lab), Dr. B. R. Ambedkar-IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - R Pramanik
- Department of Medical Oncology, Dr. B. R. Ambedkar-IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - S S Chauhan
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India.
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12
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Qian B, Yang J, Zhou J, Hu L, Zhang S, Ren M, Qu X. Individualized model for predicting pathological complete response to neoadjuvant chemotherapy in patients with breast cancer: A multicenter study. Front Endocrinol (Lausanne) 2022; 13:955250. [PMID: 36060977 PMCID: PMC9428399 DOI: 10.3389/fendo.2022.955250] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 07/26/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Pathological complete response (pCR) is considered a surrogate for favorable survival in breast cancer (BC) patients treated with neoadjuvant chemotherapy (NACT), which is the goal of NACT. This study aimed to develop and validate a nomogram for predicting the pCR probability of BC patients after NACT based on the clinicopathological features. METHODS A retrospective analysis of 527 BC patients treated with NACT between January 2018 and December 2021 from two institutions was conducted. Univariate and multivariate logistic regression analyses were performed to select the most useful predictors from the training cohort (n = 225), and then a nomogram model was developed. The performance of the nomogram was evaluated with respect to its discrimination, calibration, and clinical usefulness. Internal validation and external validation were performed in an independent validation cohort of 96 and 205 consecutive BC patients, respectively. RESULTS Among the 18 clinicopathological features, five variables were selected to develop the prediction model, including age, American Joint Committee on Cancer (AJCC) T stage, Ki67 index before NACT, human epidermal growth factor receptor 2 (HER2), and hormone receptor (HR) status. The model showed good discrimination with an area under the receiver operating characteristic curve (AUC) of 0.825 (95% CI, 0.772 to 0.878) in the training cohort, and 0.755 (95% CI, 0.658 to 0.851) and 0.79 (95% CI, 0.724 to 0.856) in the internal and external validation cohorts, respectively. The calibration curve presented good agreement between prediction by nomogram and actual observation, and decision curve analysis (DCA) indicated that the nomogram had good net benefits in clinical scenarios. CONCLUSION This study constructed a validated nomogram based on age, AJCC T stage, Ki67 index before NACT, HER2, and HR status, which could be non-invasively applied to personalize the prediction of pCR in BC patients treated with NACT.
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Affiliation(s)
- Bei Qian
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Yang
- Department of Breast Surgery, Department of General Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jun Zhou
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Longqing Hu
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shoupeng Zhang
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Xincai Qu, ; Min Ren, ; Shoupeng Zhang,
| | - Min Ren
- Department of Breast Surgery, Department of General Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, China
- *Correspondence: Xincai Qu, ; Min Ren, ; Shoupeng Zhang,
| | - Xincai Qu
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Xincai Qu, ; Min Ren, ; Shoupeng Zhang,
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13
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Ye P, Duan H, Zhao Z, Fang S. A Practical Predictive Model Based on Ultrasound Imaging and Clinical Indices for Estimation of Response to Neoadjuvant Chemotherapy in Patients with Breast Cancer. Cancer Manag Res 2021; 13:7783-7793. [PMID: 34675673 PMCID: PMC8519354 DOI: 10.2147/cmar.s331384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/16/2021] [Indexed: 12/26/2022] Open
Abstract
Purpose Clinical responses of neoadjuvant chemotherapy (NACT) are associated with prognosis in patients with breast cancer. The selection of suitable variables for the prediction of clinical responses remains controversial. Herein, we developed a predictive model based on ultrasound imaging and clinical indices to identify patients most likely to benefit from NACT. Patients and Methods We recruited a total of 225 consecutive patients who underwent NACT followed by surgery and axillary lymph node dissection at the Sixth Hospital of Ning Bo City of Zhe Jiang Province between January 1, 2018, and March 31, 2021. All patients had been diagnosed with breast cancer following the clinical examination. First, we created a training cohort of patients who underwent NACT+surgery (N=180) to develop a nomogram. We then validated the performance of the nomogram in a validation cohort of patients who underwent NACT+ surgery (N=45). Multivariate logistic regression was then used to identify independent risk factors that were associated with the response to NACT; these were then incorporated into the nomogram. Results Multivariate logistic regression analysis identified several significant differences as to clinical responses of NACT, including neutrophil–lymphocyte ratio (NLR), body mass index (BMI), pulsatility index (PI), resistance index (RI), blood flow, Ki67, histological type, molecular subtyping, and tumor size. The performance of the nomogram score exhibited a robust C-index of 0.89 (95% confidence interval [CI]: 0.83 to 0.95) in the training cohort and a high C-index of 0.87 (95% CI: 0.81 to 0.93) in the validation cohort. Clinical impact curves showed that the nomogram had a good predictive ability. Conclusion We successfully established an accurate and optimized nomogram incorporated ultrasound imaging and clinical indices that could be used preoperatively to predict clinical responses of NACT. This model can be used to evaluate the risk of clinical responses to NACT and therefore facilitate the choice of personalized therapy.
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Affiliation(s)
- Pingping Ye
- Department of Ultrasonography, The Sixth Hospital of Ningbo City of Zhejiang Province, Ningbo, 315100, People's Republic of China
| | - Hongbo Duan
- Department of Ultrasonography, The Sixth Hospital of Ningbo City of Zhejiang Province, Ningbo, 315100, People's Republic of China
| | - Zhenya Zhao
- Department of Imaging, The First Hospital of Ningbo City of Zhejiang Province, Ningbo, 315010, People's Republic of China
| | - Shibo Fang
- Department of Ultrasonography, The Sixth Hospital of Ningbo City of Zhejiang Province, Ningbo, 315100, People's Republic of China
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Sharma A, Mahajan S, Agrawal SK, Ahmed R, Dey D. Assessment of skin response in T4b breast carcinoma patients post-neoadjuvant chemotherapy. Ecancermedicalscience 2021; 15:1271. [PMID: 34567256 PMCID: PMC8426019 DOI: 10.3332/ecancer.2021.1271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Indexed: 12/09/2022] Open
Abstract
Background Breast cancer patients with skin ulcerations, satellite nodules or Peau d'orange at presentation are classified with stage 4 breast cancer (T4b). Neoadjuvant chemotherapy (NACT), followed by mastectomy, is the commonly accepted treatment in such patients for fear of adverse outcomes with breast conservation surgery (BCS) and uncertainty over sparing initially involved skin irrespective of the response to chemotherapy. Identifying patients with skin resolution post-NACT can help surgeons in decision-making. Aim To assess skin response in T4b breast cancer patients post-NACT and find the correlation between various clinical and pathological factors associated with no skin involvement on final histology. Methodology Records of breast cancer patients managed at the Tata Medical Center, Kolkata, with NACT for T4b breast carcinoma patients who underwent mastectomy were reviewed between January 2014 and December 2018. Final histology was checked for dermal involvement with the tumour. The Mann-Whitney U test was used for continuous variables for descriptive data, and Pearson's chi-squared and Fischer's exact tests were applied for categorical data. p-value < 0.05 was taken as significant. Results A total of 285 records mentioning skin involvement were reviewed, out of which 111 patients fulfilled the AJCC criterion. The median age at diagnosis of T4b breast cancer was 50 years. The median clinical size pre-chemotherapy was 7 cm. Residual median tumour size on final histology was reported as 1 cm. 78/111 patients showed a post-NACT response of 50% or more, and 43/111 showed a response of more than 90%. 57 (51.4%) patients showed skin involvement on final histopathology, while 54 (48.6%) patients did not.ER negative tumours were more likely to show no dermal involvement (p = 0.006). Residual tumour size of less than 1 cm on final histology (p < 0.05) and nodal stage were significant predictors of dermal response. Conclusion Approximately half of the T4b breast cancer patients showed resolution of dermal skin involvement post-NACT. ER negative and those with residual tumour size less than 1 cm post-NACT are more likely to show dermal resolution. This can help surgeons plan a BCS or skin sparing mastectomy for such patients who usually end up having a mastectomy.
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Affiliation(s)
- Abhishek Sharma
- Department of Breast Oncosurgery, Tata Medical Center, Kolkata 700156, India
| | - Shagun Mahajan
- Department of Breast Oncosurgery, Tata Medical Center, Kolkata 700156, India
| | | | - Rosina Ahmed
- Department of Breast Oncosurgery, Tata Medical Center, Kolkata 700156, India
| | - Debdeep Dey
- Department of Pathology, Tata Medical Center, Kolkata 700156, India
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Abstract
Cervical cancer continues to be a major public health concern in India and other low- and middle-income countries. Tata Memorial Centre, India, has been at the forefront in providing treatment, developing best practice guidelines for low-cost efficacious interventions, conducting practice-changing randomized trials and engaging in regional and international collaborations for education and research in cervical cancer. This review summarizes how cervical cancer research and clinical care has evolved over the past two decades at the Tata Memorial Centre, right from testing low-cost public health screening of cervical cancers to the incorporation of the latest technological advancements and providing high-quality evidence for therapeutic management of cervical cancer. The various ongoing strategies for improving survival, toxicity reduction, translational research studies, educational activities and teaching programmes initiated by the Tata Memorial Centre at both national and international levels are discussed.
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Affiliation(s)
- Anuj Kumar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Supriya Chopra
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India,For correspondence: Dr Supriya Chopra, Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400 012, Maharashtra, India e-mail:
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Parmar V, Koppiker CB, Dixit S. Breast conservation surgery & oncoplasty in India - Current scenario. Indian J Med Res 2021; 154:221-228. [PMID: 35295011 PMCID: PMC9131752 DOI: 10.4103/ijmr.ijmr_3901_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Breast cancer incidence is on the rise in India as in rest of the world. While the advances in overall cancer care are at par, the surgical interventions have not been changing at the same pace in India, as in the rest of the developed world. Partly, this is due to the relatively more advanced state of cancer at detection and partly due to lack of awareness resulting in apprehension and slow acceptance of de-escalation of surgical interventions by the treating surgeons, and the beneficiaries, the patients. The article looks at the current scenario, available evidence on the practices and pitfalls with possible solutions for advancing surgical care of breast cancer in India.
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Affiliation(s)
- Vani Parmar
- Division of Breast Surgical Oncology, Department of Surgical Oncology, Advanced Centre for Treatment Research & Education in Cancer, Tata Memorial Centre, and Homi Bhabha National Institute, Navi Mumbai, India,For correspondence: Dr Vani Parmar, Department of Surgical Oncology, Advanced Centre for Treatment Research & Education in Cancer, Tata Memorial Centre & Homi Bhabha National Institute, Kharghar, Navi Mumbai 410 210, Maharashtra, India e-mail:
| | | | - Santosh Dixit
- Centre for Translational Cancer Research, An Initiative of Prashanti Cancer Care Mission & Indian Institute of Science Education & Research, Pune, Maharashtra, India
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Berg T, Jensen MB, Jakobsen EH, Al-Rawi S, Kenholm J, Andersson M. Neoadjuvant chemotherapy and HER2 dual blockade including biosimilar trastuzumab (SB3) for HER2-positive early breast cancer: Population based real world data from the Danish Breast Cancer Group (DBCG). Breast 2020; 54:242-247. [PMID: 33186804 PMCID: PMC7670201 DOI: 10.1016/j.breast.2020.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Dual blockade with trastuzumab and pertuzumab combined with neoadjuvant chemotherapy (NACT) has been increasingly used for HER2-positive tumours >2 cm and/or with positive axillary lymph nodes in order to evaluate pathologic response and obtain better surgical management. SB3 is a registered biosimilar trastuzumab approved following a phase III trial demonstrating similar efficacy in the neoadjuvant setting as trastuzumab. However, the study was done without pertuzumab. METHOD The database of the Danish Breast Cancer Group was used to extract data on all patients who started NACT with SB3 and pertuzumab between September 1, 2018 and August 31, 2019. The primary endpoint was pathological complete response (pCR) rate. RESULTS In total 215 patients received NACT and dual blockade. The median age was 55 (24-81). NACT used was cyclophosphamide and epirubicin followed by weekly paclitaxel (62% on six cycles, 35% on eight cycles) or other chemotherapy followed by weekly paclitaxel (3%). Overall, 56% of patients achieved pCR. 60 of 88 node-positive patients pre-NACT achieved ypN0(i-) after neoadjuvant treatment. pCR rate was significantly associated with estrogen receptor status and malignancy grade. An association with CEP17/HER2-ratio was assessed. CONCLUSION Real world data on dual blockade with SB3 and pertuzumab in combination with NACT in a nationwide population-based study show a pCR rate comparable to that seen in previous clinical studies.
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Affiliation(s)
- Tobias Berg
- Department of Oncology, University Hospital Copenhagen, Rigshospitalet, Juliane Maries Vej 5, 2100, Copenhagen, Denmark; Danish Breast Cancer Group, Department of Oncology, University Hospital Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Maj-Britt Jensen
- Danish Breast Cancer Group, Department of Oncology, University Hospital Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Erik H Jakobsen
- Department of Oncology, Sygehus Lillebælt, Beriderbakken 4, 7100, Vejle, Denmark
| | - Sami Al-Rawi
- Department of Oncology, Region Zealand, Ringstedgade 61, 4700, Næstved, Denmark
| | - Julia Kenholm
- Department of Oncology, Hospital Unit West, Gl. Landevej 61, 7400, Herning, Denmark
| | - Michael Andersson
- Department of Oncology, University Hospital Copenhagen, Rigshospitalet, Juliane Maries Vej 5, 2100, Copenhagen, Denmark
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Zhang Y, Grant MS, Zhang X, Paraghamian SE, Tan X, Clark LH. Comparing Laparotomy with Robot-assisted Interval Debulking Surgery for Patients with Advanced Epithelial Ovarian Cancer Receiving Neoadjuvant Chemotherapy. J Minim Invasive Gynecol 2020; 28:1237-1243. [PMID: 33248314 DOI: 10.1016/j.jmig.2020.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/12/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
STUDY OBJECTIVE Compare survival of patients with advanced epithelial ovarian cancer (EOC) undergoing interval debulking surgery (IDS) with either robot-assisted (R-IDS) or open (O-IDS) approach. Second, we assessed the impact of adjuvant and neoadjuvant chemotherapy (NACT) cycles as independent variables associated with survival in this patient population. DESIGN Retrospective cohort study. SETTING Single tertiary care center. PATIENTS Total of 93 patients diagnosed with advanced EOC who underwent NACT before primary debulking surgery after consultation with a gynecologic oncologist. INTERVENTIONS All patients underwent IDS after completion of NACT with either R-IDS or O-IDS between 2011 and 2018 at a single tertiary care center. Exclusion criteria included receiving fewer than 3 or more than 6 cycles of NACT or having concurrent diagnoses of other malignancies during the treatment period. MEASUREMENTS AND MAIN RESULTS A total of 93 patients were identified (n = 43 R-IDS; n = 50 O-IDS). Median age (63.0 vs 66.2 years) did not differ between the 2 groups (p = .1). Of the total patients, 91% were optimally cytoreduced (57% R0 and 34% R1), and R0 rate was not influenced by surgical modality (52% O-IDS vs 63% R-IDS, p = .4). Progression-free survival (PFS) and overall survival (OS) did not differ between patients undergoing O-IDS and those undergoing R-IDS (PFS 15.4 vs 16.7 months, p = .7; OS 38.2 vs 35.6 months, p = .7). Cytoreduction to R0 improved both PFS and OS independent of surgical approach. Subgroup analysis showed that, specifically in patients undergoing R-IDS, receiving >6 total cycles of chemotherapy was independently associated with both decreased PFS (hazard ratio 3.85; 95% confidence interval, 1.52-9.73) and OS (hazard ratio 3.97; 95% confidence interval, 1.08-14.59). When analyzed separately, neither NACT nor adjuvant cycle numbers had any effect on survival. CONCLUSION In this retrospective study of patients with advanced EOC undergoing IDS after NACT, the use of robot-assisted surgery did not affect debulking success or oncologic survival indices. Receiving >6 total cycles of chemotherapy before IDS was associated with a decrease in both PFS and OS in patients undergoing R-IDS in this cohort and warrants further investigation.
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Affiliation(s)
- Yingao Zhang
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine (Drs. Zhang, Paraghamian, Clark, and Ms. Grant).
| | - Megan S Grant
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine (Drs. Zhang, Paraghamian, Clark, and Ms. Grant)
| | - Xinyi Zhang
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health (Dr. Tan and Ms. Zhang), University of North Carolina, Chapel Hill, North Carolina
| | - Sarah E Paraghamian
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine (Drs. Zhang, Paraghamian, Clark, and Ms. Grant)
| | - Xianming Tan
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health (Dr. Tan and Ms. Zhang), University of North Carolina, Chapel Hill, North Carolina
| | - Leslie H Clark
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine (Drs. Zhang, Paraghamian, Clark, and Ms. Grant)
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Bansal A, Srinivasan R, Rohilla M, Sundaram A, Rai B, Rajwanshi A, Suri V, Saha SC, Gupta N, Gupta P, Dey P. Morphologic and Immunocytochemical Features of High-Grade Serous Carcinoma of Ovary in Ascitic Fluid Effusion and Fine-Needle Aspiration Cytology. Am J Clin Pathol 2020; 154:103-114. [PMID: 32271370 DOI: 10.1093/ajcp/aqaa028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES High-grade serous carcinoma (HGSC) is the most common ovarian malignancy. The role of cytopathology in obtaining tissue diagnosis before institution of neoadjuvant chemotherapy (NACT) was evaluated. METHODS All histopathology-proven HGSC specimens between 2015 and 2018 with prior cytopathologic diagnosis by ascitic fluid evaluation or fine-needle aspiration (FNA) of ovarian mass were reviewed with cell block immunocytochemistry for CK7, CK20, PAX8, WT1, and p53. RESULTS Of 288 cases of HGSC, pre-NACT cytology diagnosis was established in 32% (93/288), with specific HGSC diagnoses made on ascitic fluid in 88% (82/93) and by ovarian mass FNA in 12% (11/93). The ascitic fluid showed moderate/high cellularity with papillary clusters in 76% (71/93) cases. Cell block immunocytochemistry showed tumor cells positive for CK7, PAX8, and WT1. p53 showed mutant or null-type positivity in 65% (33/51) and 33% (17/51) of cases, respectively, with 100% concordance with subsequent histopathology specimens. Poor/intermediate response to chemotherapy was shown in 75% of cases. CONCLUSIONS Combined assessment of cytomorphology, cell block histomorphology, and ancillary immunohistochemical testing, including PAX8, WT1, and p53, allows for specific pre-NACT diagnoses of HGSC in ascitic fluid and ovarian FNA cytology. This practice allows for initiation of chemotherapy and diminution of disease burden prior to definitive surgical therapy.
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Affiliation(s)
- Akriti Bansal
- Cytology and Gynaecological Pathology, Chandigarh, India
| | | | - Manish Rohilla
- Cytology and Gynaecological Pathology, Chandigarh, India
| | | | - Bhavana Rai
- Radiotherapy and Oncology, Chandigarh, India
| | | | - Vanita Suri
- Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subhash C Saha
- Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nalini Gupta
- Cytology and Gynaecological Pathology, Chandigarh, India
| | | | - Pranab Dey
- Cytology and Gynaecological Pathology, Chandigarh, India
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Ouyang P, Cai J, Gui L, Liu S, Wu NYY, Wang J. Comparison of survival outcomes of neoadjuvant therapy and direct surgery in IB2/IIA2 cervical adenocarcinoma: a retrospective study. Arch Gynecol Obstet 2020; 301:1247-1255. [PMID: 32221709 PMCID: PMC7181442 DOI: 10.1007/s00404-020-05505-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 03/12/2020] [Indexed: 02/01/2023]
Abstract
PURPOSE This retrospective study compared the efficacy and survival of patients with cervical adenocarcinoma (IB2/IIA2; FIGO2009) treated with neoadjuvant chemotherapy before radical surgery (NACT + RS), neoadjuvant chemoradiation therapy before radical surgery (NACRT + RS), or primary radical surgery (RS). METHODS Between January 2008 and November 2015, 91 patients diagnosed with stage IB2/IIA2 cervical adenocarcinoma were enrolled, including 29 patients who received RS, 24 patients who received NACT + RS, and 38 patients who received NACRT + RS. RESULTS The characteristics of patients were balanced among the three groups, and the median follow-up time was 72 months. The 5 year disease-free survival (DFS) rate was 75.8% and the 5 year overall survival (OS) rate was 85.0%. Univariate analysis revealed that effectiveness of neoadjuvant treatment, tumor size, lymph node metastases, and depth of stromal invasion were the factors predicting recurrence and mortality. Multivariate Cox proportional analysis revealed that the occurrence of a lymph node metastasis was an independent prognostic factor of DFS (hazard ratio [HR] = 0.223; 95% confidence interval [CI]: 0.060-0.827) and OS (HR = 0.088; 95% CI: 0.017-0.470). On survival analysis of preoperative adjuvant chemotherapy and primary surgery, the 5 year OS (P = 0.010) and DFS (P = 0.016) rates for the NACRT + RS group were significantly lower than those for the RS group. CONCLUSION Stage IB2/IIA2 cervical adenocarcinoma patients who received primary RS had a better DFS and OS than those who received preoperative NACRT. There was no significant difference when compared to the preoperative NACT group.
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Affiliation(s)
- Peilin Ouyang
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, 283, Tongzipo Road, Changsha, Hunan, People's Republic of China
- Xiangya School of Medicine, Central South University, Changsha, Hunan, People's Republic of China
| | - Jingting Cai
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, 283, Tongzipo Road, Changsha, Hunan, People's Republic of China
| | - Lin Gui
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, 283, Tongzipo Road, Changsha, Hunan, People's Republic of China
| | - Shan Liu
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, 283, Tongzipo Road, Changsha, Hunan, People's Republic of China
| | - Na-Yi Yuan Wu
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, 283, Tongzipo Road, Changsha, Hunan, People's Republic of China.
| | - Jing Wang
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, 283, Tongzipo Road, Changsha, Hunan, People's Republic of China.
- Xiangya School of Medicine, Central South University, Changsha, Hunan, People's Republic of China.
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21
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Akkiprik M, Koca S, Uğurlu MÜ, Ekren R, Peker Eyüboğlu İ, Alan Ö, Erzik C, Güllü Amuran G, Telli TA, Güllüoğlu MB, Sezerman U, Yumuk PF. Response Assessment With Molecular Characterization of Circulating Tumor Cells and Plasma MicroRNA Profiling in Patients With Locally Advanced Breast Cancer During Neoadjuvant Chemotherapy. Clin Breast Cancer 2020; 20:332-343.e3. [PMID: 32201164 DOI: 10.1016/j.clbc.2020.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/30/2020] [Accepted: 02/18/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Cells detaching from the primary tumor site are metastasis initiator cells, and the detection of CTC, known as liquid biopsy, is an important test of biomarkers of cancer progression. We investigated the molecular characterization of circulating tumor cells (CTCs), profiled the plasma microRNA (miR) content, and analyzed the relationship with the clinical outcomes by sampling the peripheral blood from patients with locally advanced breast cancer before and after neoadjuvant chemotherapy. PATIENTS AND METHODS Markers of breast cancer, epithelial-mesenchymal transition (EMT), drug resistance, and stem cells were used for CTC isolation and characterization. Plasma miR profiles were obtained from selected patients with CTC positivity determined using next-generation sequencing. RESULTS The proportion of CTC, EMT, and stem cell marker positivity was 16.7%, 8.3%, and 25% before and 18.2%, 15.2%, and 9.1% after treatment, respectively. A significant correlation was found between the pretreatment CTCs and ALDH1 positivity (P = .0245). These CTCs with stemness properties were observed in most hormone receptor-positive, human epidermal growth factor receptor 2-negative cases and were also present with a high incidence in cases of early metastasis. miR-146b-5p and miR-199a-5p, which are involved in metastasis, invasion, and EMT, were accompanied by CTC positivity, and miR-4646-3p was associated with the development of early metastasis. CONCLUSIONS Molecular characterization of CTCs and miR profiling of serial samples from patients with locally advanced breast cancer during neoadjuvant chemotherapy appears to be a very useful in predicting cure and clinical course and might be a key to developing new targeted therapies.
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Affiliation(s)
- Mustafa Akkiprik
- Department of Medical Biology, School of Medicine, Marmara University, Istanbul, Turkey.
| | - Sinan Koca
- Department of Medical Oncology, Umraniye Education Research Hospital, Istanbul, Turkey
| | - M Ümit Uğurlu
- Department of General Surgery, School of Medicine, Marmara University, Pendik-Istanbul, Turkey
| | - Rüçhan Ekren
- Department of Biostatistics and Medical Informatics, Acıbadem University, Istanbul, Turkey
| | - İrem Peker Eyüboğlu
- Department of Medical Biology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Özkan Alan
- Department of Medical Oncology, School of Medicine, Marmara University, Pendik-Istanbul, Turkey
| | - Can Erzik
- Department of Medical Biology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Gökçe Güllü Amuran
- Department of Medical Biology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Tuğba Akın Telli
- Department of Medical Oncology, School of Medicine, Marmara University, Pendik-Istanbul, Turkey
| | - M Bahadır Güllüoğlu
- Department of General Surgery, School of Medicine, Marmara University, Pendik-Istanbul, Turkey
| | - Uğur Sezerman
- Department of Biostatistics and Medical Informatics, Acıbadem University, Istanbul, Turkey
| | - Perran Fulden Yumuk
- Department of Medical Oncology, School of Medicine, Marmara University, Pendik-Istanbul, Turkey
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22
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Fagotti A, Gueli Alletti S, Corrado G, Cola E, Vizza E, Vieira M, Andrade CE, Tsunoda A, Favero G, Zapardiel I, Pasciuto T, Scambia G. The INTERNATIONAL MISSION study: minimally invasive surgery in ovarian neoplasms after neoadjuvant chemotherapy. Int J Gynecol Cancer 2020; 29:5-9. [PMID: 30640676 DOI: 10.1136/ijgc-2018-000012] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 09/23/2018] [Accepted: 09/25/2018] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES The aim of this retrospective multicenter study was to investigate the extent, feasibility, and outcomes of minimally invasive surgery at the time of interval debulking surgery in different gynecological cancer centers. METHODS/MATERIALS In December 2016, 20 gynecological cancer centers were contacted by e-mail, to participate in the INTERNATIONAL MISSION study. Seven centers confirmed and five were included, with a total of 127 patients diagnosed with advanced epithelial ovarian cancer after neoadjuvant chemotherapy and minimally invasive interval surgery. Only women with a minimum follow-up time of 6 months from interval surgery or any cancer-related event before 6 months were included in the survival analysis. Baseline characteristics, chemotherapy, and operative data were evaluated. Survival analysis was evaluated using the Kaplan-Meier method. RESULTS : All patients had optimal cytoreduction at the time of interval surgery: among them, 122 (96.1%) patients had no residual tumor. Median operative time was 225 min (range 60 - 600) and median estimated blood loss was 100 mL (range 70 - 1320). Median time to discharge was 2 days (1-33) and estimated median time to start chemotherapy was 20 days (range 15 - 60). Six (4.7%) patients experienced intraoperative complications, with one patient experiencing two serious complications (bowel and bladder injury at the same time). There were six (4.7%) patients with postoperative short-term complications: among them, three patients had severe complications. The conversion rate to laparotomy was 3.9 %. Median follow-up time was 37 months (range 7 - 86): 74 of 127 patients recurred (58.3%) and 31 (24.4%) patients died from disease. Median progression-free survival was 23 months and survival at 5 years was 52 % (95% CI: 35 to 67). CONCLUSIONS Minimally invasive surgery may be considered for the management of patients with advanced ovarian cancer who have undergone neoadjuvant chemotherapy, when surgery is limited to low-complexity standard cytoreductive procedures.
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Affiliation(s)
- A Fagotti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy.,Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - S Gueli Alletti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - G Corrado
- Department of Experimental Clinical Oncology, Gynecologic Oncology Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - E Cola
- Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - E Vizza
- Department of Experimental Clinical Oncology, Gynecologic Oncology Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - M Vieira
- Department of Gynecologic Oncology, Hospital de Cancer de Barretos, São Paulo, Brazil
| | - C E Andrade
- Department of Gynecologic Oncology, Hospital de Cancer de Barretos, São Paulo, Brazil
| | - A Tsunoda
- Department of Gynecologic Oncology, Hospital de Cancer de Barretos, São Paulo, Brazil
| | - G Favero
- Department of Gynecology, Instituto do Câncer do Estado de São Paulo-ICESP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - I Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain
| | - T Pasciuto
- Statistics Technology Archiving Research (STAR) Center, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - G Scambia
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy.,Universita' Cattolica del Sacro Cuore, Rome, Italy
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23
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Garziera M, Cecchin E, Giorda G, Sorio R, Scalone S, De Mattia E, Roncato R, Gagno S, Poletto E, Romanato L, Ecca F, Canzonieri V, Toffoli G. Clonal Evolution of TP53 c.375+1G>A Mutation in Pre- and Post- Neo-Adjuvant Chemotherapy ( NACT) Tumor Samples in High-Grade Serous Ovarian Cancer (HGSOC). Cells 2019; 8:cells8101186. [PMID: 31581548 PMCID: PMC6829309 DOI: 10.3390/cells8101186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/22/2019] [Accepted: 09/30/2019] [Indexed: 12/25/2022] Open
Abstract
Carboplatin/paclitaxel is the reference regimen in the treatment of advanced high-grade serous ovarian cancer (HGSOC) in neo-adjuvant chemotherapy (NACT) before interval debulking surgery (IDS). To identify new genetic markers of platinum-resistance, next-generation sequencing (NGS) analysis of 26 cancer-genes was performed on paired matched pre- and post-NACT tumor and blood samples in a patient with stage IV HGSOC treated with NACT-IDS, showing platinum-refractory/resistance and poor prognosis. Only the TP53 c.375+1G>A somatic mutation was identified in both tumor samples. This variant, associated with aberrant splicing, was in trans configuration with the 72Arg allele of the known germline polymorphism TP53 c.215C>G (p. Pro72Arg). In the post-NACT tumor sample we observed the complete expansion of the TP53 c.375+1G>A driver mutant clone with somatic loss of the treatment-sensitive 72Arg allele. NGS results were confirmed with Sanger method and immunostaining for p53, BRCA1, p16, WT1, and Ki-67 markers were evaluated. This study showed that (i) the splice mutation in TP53 was present as an early driver mutation at diagnosis; (ii) the mutational profile was shared in pre- and post-NACT tumor samples; (iii) the complete expansion of a single dominant mutant clone through loss of heterozygosity (LOH) had occurred, suggesting a possible mechanism of platinum-resistance in HGSOC under the pressure of NACT.
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Affiliation(s)
- Marica Garziera
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, 33081 Aviano, Italy.
| | - Erika Cecchin
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, 33081 Aviano, Italy.
| | - Giorgio Giorda
- Gynecological Oncology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, 33081 Aviano, Italy.
| | - Roberto Sorio
- Medical Oncology Unit C, Centro di Riferimento Oncologico (CRO), IRCCS, 33081 Aviano, Italy.
| | - Simona Scalone
- Medical Oncology Unit C, Centro di Riferimento Oncologico (CRO), IRCCS, 33081 Aviano, Italy.
| | - Elena De Mattia
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, 33081 Aviano, Italy.
| | - Rossana Roncato
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, 33081 Aviano, Italy.
| | - Sara Gagno
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, 33081 Aviano, Italy.
| | - Elena Poletto
- Medical Oncology, "Santa Maria della Misericordia" University Hospital, ASUIUD, 33100 Udine, Italy.
| | - Loredana Romanato
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, 33081 Aviano, Italy.
| | - Fabrizio Ecca
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, 33081 Aviano, Italy.
| | - Vincenzo Canzonieri
- Pathology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, 33081 Aviano, Italy.
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy.
| | - Giuseppe Toffoli
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, 33081 Aviano, Italy.
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24
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Napolitano F, Formisano L, Giardino A, Girelli R, Servetto A, Santaniello A, Foschini F, Marciano R, Mozzillo E, Carratù AC, Cascetta P, De Placido P, De Placido S, Bianco R. Neoadjuvant Treatment in Locally Advanced Pancreatic Cancer (LAPC) Patients with FOLFIRINOX or Gemcitabine NabPaclitaxel: A Single-Center Experience and a Literature Review. Cancers (Basel) 2019; 11:E981. [PMID: 31337045 PMCID: PMC6678351 DOI: 10.3390/cancers11070981] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/09/2019] [Accepted: 07/10/2019] [Indexed: 02/07/2023] Open
Abstract
The optimal therapeutic strategy for locally advanced pancreatic cancer patients (LAPC) has not yet been established. Our aim is to evaluate how surgery after neoadjuvant treatment with either FOLFIRINOX (FFN) or Gemcitabine-NabPaclitaxel (GemNab) affects the clinical outcome in these patients. LAPC patients treated at our institution were retrospectively analysed to reach this goal. The group characteristics were similar: 35 patients were treated with the FOLFIRINOX regimen and 21 patients with Gemcitabine Nab-Paclitaxel. The number of patients undergoing surgery was 14 in the FFN group (40%) and six in the GemNab group (28.6%). The median Disease-Free Survival (DFS) was 77.10 weeks in the FFN group and 58.65 weeks in the Gem Nab group (p = 0.625), while the median PFS in the unresected group was 49.4 weeks in the FFN group and 30.9 in the GemNab group (p = 0.0029, 95% CI 0.138-0.862, HR 0.345). The overall survival (OS) in the resected population needs a longer follow up to be completely assessed, while the median overall survival (mOS) in the FFN group was 72.10 weeks and 53.30 weeks for the GemNab group (p = 0.06) in the unresected population. Surgery is a valuable option for LAPC patients and it is able to induce a relevant survival advantage. FOLFIRINOX and Gem-NabPaclitaxel should be offered as first options to pancreatic cancer patients in the locally advanced setting.
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Affiliation(s)
- Fabiana Napolitano
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy
| | - Luigi Formisano
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy
| | - Alessandro Giardino
- Pancreatic Surgery Unit, Pederzoli Hospital, Peschiera del Garda, 37019 Verona, Italy
| | - Roberto Girelli
- Pancreatic Surgery Unit, Pederzoli Hospital, Peschiera del Garda, 37019 Verona, Italy
| | - Alberto Servetto
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy
| | - Antonio Santaniello
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy
| | - Francesca Foschini
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy
| | - Roberta Marciano
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy
| | - Eleonora Mozzillo
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy
| | - Anna Chiara Carratù
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy
| | - Priscilla Cascetta
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy
| | - Pietro De Placido
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy
| | - Sabino De Placido
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy
| | - Roberto Bianco
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy.
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Rao JS, Hanumappa HK, Joseph EP, Chowdappa RG, Ramesh R. Elevated Neutrophil-Lymphocyte Ratio in Luminal-Type Locally Advanced Breast Cancer to Circumvent Neo-Adjuvant Chemotherapy. Indian J Surg Oncol 2019; 10:454-9. [PMID: 31496590 DOI: 10.1007/s13193-019-00944-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 05/21/2019] [Indexed: 10/26/2022] Open
Abstract
Neutrophil-Lymphocyte Ratio (NLR) provides an understanding of the systemic inflammatory conditions. NLR plays an important role as a predictor of mortality in breast and other malignancies. The application of NLR to predict prognosis of Locally Advanced Breast Cancer (LABC) has not been well developed. In this retrospective study, we establish a relationship of pre-treatment NLR with the Pathological Complete Response (pCR) in LABC patients to enhance decision-making and treatment protocols. Data of women diagnosed with carcinoma breast between January 2015 and December 2017 was retrieved from hospital records of a tertiary medical centre in Bangalore, India, after obtaining institutional ethical clearance. LABC patients were categorized into pCR(+) and pCR(-). NLR was calculated and divided into quartiles. The cutoff NLR was determined using the Receiver Operating Characteristic (ROC) curve. Statistical analysis was performed on 119 LABC patients, of which 25 (21%) achieved pCR. Oestrogen Receptor (ER) positivity was significantly lower in pCR(+) than in pCR(-) (p = 0.012). NLR of 2.46 (AUC, 0.744; 95% CI [0.201-0.584]; p = 0.056) was considered the optimum cutoff for pCR(+). A sensitivity of 54%, specificity of 8%, positive predictive value of 1% and high Negative Predictive Value (NPV) of 84% was achieved in the study. A relationship between pCR and the pre-treatment NLR determined a significantly high NPV. Poor pCR in luminal A/B subtype presents with elevated NLR. Therefore, in luminal type A/B (ER- and PR-positive) with elevated NLR (poor outcome) and low pCR (poor response to NACT), the decision of eliminating NACT could be considered, thereby recommending surgical intervention.
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Jiang QX, Jiang YX, Wang X, Luo SJ, Zhou R, Linghu H. Multifactorial impact on the outcome of interval debulking surgery in patients with advanced epithelial ovarian or peritoneal cancers. Clin Chim Acta 2019; 495:148-53. [PMID: 30885671 DOI: 10.1016/j.cca.2019.03.1613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 03/12/2019] [Accepted: 03/13/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To evaluate the impact of multiple clinical features upon the outcome of interval cytoreductive surgery and thus upon the survival in patients with advanced ovarian cancer and primary peritoneal carcinoma. METHODS A retrospective analysis of patients receiving NACT followed by IDS between 2009 and 2017. Patients were analyzed according to the pre-NACT CA125, pre-IDS CA125, pre-IDS CA125 decline, patients' pre-IDS BMI, multisite bowel involvement and different working years of surgeons, for their influence upon the IDS outcome (e.g. optimal vs suboptimal) and the survival. RESULTS After interval debulking surgery following 1-6 cycles of NACT, all patients analyzed were identified as optimal (n = 113) and suboptimal (n = 47) based on patients' record. The PFS/OS were 21/68 months and 9/26 months in optimal and suboptimal groups, respectively (p = .000, p = .000). Although differential levels of pre-IDS CA125, pre-IDS CA125 decline, bowel involvement and surgeons' working years were found to be significantly different between the two groups, surgeons' working years and multisite bowel invasion were the independent factors for IDS outcome, and the latter one was also highly related to survival. CONCLUSIONS Following NACT, the rate of optimal IDS might be improved for patients without multisite bowel involvement. For those with bowel involvement, management strategy made by well-experienced surgeons might be a key factor for the outcome of IDS.
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Zhang X, Lv Z, Lou H. The clinicopathological features and treatment modalities associated with survival of neuroendocrine cervical carcinoma in a Chinese population. BMC Cancer 2019; 19:22. [PMID: 30616631 PMCID: PMC6323736 DOI: 10.1186/s12885-018-5147-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 11/28/2018] [Indexed: 11/18/2022] Open
Abstract
Background Neuroendocrine cervical carcinoma (NECC) is a rare but aggressive form of cervical cancer representing less than 3% of all cervical cancer cases. The objective of this study is to evaluate the effects of the clinicopathologic features and treatment modalities on the survival of patients with NECC. Methods In all, 89 stage I-IV patients with NECC that were diagnosed and treated between 2006 and 2014 at the Zhejiang Cancer Hospital were retrospectively recruited in this study. The Kaplan-Meier method, Cox regression analysis models and the log-rank test were used for the statistical analyses. Results NECC patients with advanced FIGO stage, tumor size > 4 cm, lymph node metastasis (LNM) and lymph-vascular space invasion (LVSI) were more likely to have significantly worse survival. Neither neo-adjuvant chemotherapy (NACT) nor radiotherapy (RT) was associated with improved overall survival. In the stratified analysis of stage I-IIA patients, those with advanced FIGO stage (P = 0.018), LNM (P = 0.008) and LVSI (P = 0.024) were associated with significantly worse survival. Patients without LNM who did not receive RT had significantly better survival rates than those who received RT (HR = 3.363, 95%CI = 1.245–10.619; P = 0.018). Moreover, for stage I-IIA patients with tumor size > 4 cm, NACT was not associated with a significantly better survival rate compared with no NACT (P = 0.600). None of the clinicopathologic features or treatment modalities was an independent prognostic factor in the multivariate analysis. Conclusions In conclusion, advanced FIGO stage, tumor size > 4 cm, LNM and LVSI were associated with poor survival. For stage I-IIA patients, RT should be carefully used in patients who are negative for LNM, and NACT may not be the optimal treatment for patients with tumor size > 4 cm.
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Affiliation(s)
- Xiaojing Zhang
- Department of Gynecological Oncology, Zhejiang Cancer Hospital, 1 Banshan East Road, Hangzhou, 310022, People's Republic of China
| | - Zunfu Lv
- Department of Agriculture and Food Science, Zhejiang A&F University, Lin'an, 311300, People's Republic of China
| | - Hanmei Lou
- Department of Gynecological Oncology, Zhejiang Cancer Hospital, 1 Banshan East Road, Hangzhou, 310022, People's Republic of China.
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Kaigorodova EV, Savelieva OE, Tashireva LA, Tarabanovskaya NA, Simolina EI, Denisov EV, Slonimskaya EM, Choynzonov EL, Perelmuter VM. Heterogeneity of Circulating Tumor Cells in Neoadjuvant Chemotherapy of Breast Cancer. Molecules 2018; 23:E727. [PMID: 29565320 DOI: 10.3390/molecules23040727] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/14/2018] [Accepted: 03/18/2018] [Indexed: 12/12/2022] Open
Abstract
The biological properties of circulating tumor cells (CTCs), and their dynamics during neoadjuvant chemotherapy are important, both for disease progression prediction and therapeutic target determination, with the aim of preventing disease progression. The aim of our study was to estimate of different CTC subsets in breast cancer during the NACT (neoadjuvant chemotherapy). The prospective study includes 27 patients with invasive breast cancer, T2-4N0-3M0, aged 32 to 60 years. Venous heparinized blood samples, taken before and after biopsy, after each courses of chemotherapy (on days 3-7), and before surgical intervention, served as the material for this study. Different subsets of circulating tumor cells were determined on the basis of the expression of EpCAM, CD45, CD44, CD24, and N-Cadherin using flow cytometry. As the result of this study, it has been observed that significant changes in the quantity of the different subsets of circulating tumor cells in patients' blood were observed after carrying out the 3rd course of NACT. NACT causes significant changes in the quantity of six CTC subsets, with various combinations of stemness and epithelial-mesenchymal transition (EMT) properties.
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29
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Haque N, Uddin AFMK, Dey BR, Islam F, Goodman A. Challenges to cervical cancer treatment in Bangladesh: The development of a women's cancer ward at Dhaka Medical College Hospital. Gynecol Oncol Rep 2017; 21:67-72. [PMID: 28725676 PMCID: PMC5502821 DOI: 10.1016/j.gore.2017.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/26/2017] [Accepted: 06/02/2017] [Indexed: 11/29/2022] Open
Abstract
Cervical cancer is the second most common cause of female cancer mortality worldwide. Concurrent chemoradiotherapy represents the standard of care for patients with stages IB2 to IVa cervical cancer. Unfortunately radiation therapy capacity is severely limited to non-existent in many Low and Middle-Income Countries. One solution has been to use chemotherapy to reduce tumor size to allow for radical surgery or in the case of inoperable cancers, as a placeholder until radiation is available. In Bangladesh, there has been the progressive development of resources for the treatment of women with gynecologic cancers. However, radiation therapy resources are limited with a six-month waiting period to receive radiation. Neoadjuvant chemotherapy (NACT) remains the main primary treatment intervention for women with advanced cervical cancer in Bangladesh. This implementation study summarizes of the experience and challenges to caring for women in a new gynae-oncology ward at Dhaka Medical College Hospital, a 2600 bed government hospital in Dhaka, Bangladesh. The literature on cervical cancer treatment in Bangladesh is nonexistent. The majority of women are diagnosed with stages III and IV cervical cancers. Radiation therapy is an extremely limited resource in Bangladesh with only one machine per over 10 million people. The strategy has been to treat woman with chemotherapy in the hopes of making their cancers surgically resectable. Systematic reviews of neoadjuvant chemotherapy show pathologic responses but no improvement in long term survival.
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Affiliation(s)
- N Haque
- Department of Obstetrics and Gynecology, Gynae Oncology Unit, Dhaka Medical College, Dhaka, Bangladesh
| | - A F M K Uddin
- Department of Radiation Oncology, National Institute of ENT, Dhaka, Bangladesh
| | - B R Dey
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - F Islam
- Department of Obstetrics and Gynecology, Gynae Oncology Unit, Dhaka Medical College, Dhaka, Bangladesh
| | - A Goodman
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Feng Y, He F, Yan S, Huang H, Huang Q, Deng T, Wu H, Gao B, Liu J. The Role of GOLPH3L in the Prognosis and NACT response in Cervical Cancer. J Cancer 2017; 8:443-454. [PMID: 28261346 PMCID: PMC5332896 DOI: 10.7150/jca.17096] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/29/2016] [Indexed: 12/02/2022] Open
Abstract
Background: We previously reported GOLPH3L is a novel oncogene associated with ovarian cancer. The role of GOLPH3L in cervical cancer and its cellular functions has not been determined. This study investigated clinical significance of GOLPH3L and potential proteins and pathways associated with GOLPH3L in cervical squamous cell carcinoma. Methods: Immunohistochemistry and western blot were used to examine the expression of GOLPH3L in cervical squamous cell carcinoma tissue specimens and adjacent non-cancerous tissues. The clinical and prognostic significance of GOLPH3L expression was statistically analyzed. Cell proliferation rate, cell cycle progression, apoptosis and cisplatin response in GOLPH3L silenced SiHa and HeLa cells were also examined. Phospho-antibody array was used to identify changes in protein phosphorylation and the corresponding signaling pathways associated with these changes. Results: GOLPH3L overexpressed in cervical cancer tissue specimens compared with normal adjacent non-cancerous tissues. Increased GOLPH3L expression was associated with FIGO staging (P=0.033), cervical stromal invasion (P=0.037), cervical canal stromal invasion (P=0.027), lymph node metastasis (P=0.016) and positive surgical margins (P=0.015). Patients with lower expression of GOLPH3L demonstrated longer progression-free survival and overall survival compared with those with higher expression. The tissue samples from patients who poorly responded to neoadjuvant chemotherapy (NACT) exhibited increased GOLPH3L expression levels compared with tissue samples from patients who achieved a pathologic complete response (pCR). Patients with lower GOLPH3L expression level, poorer tumor differentiation, shorter NACT treatment intervals and smaller tumor sizes were more likely to achieve a pCR after NACT. Knockdown GOLPH3L in cells was associated with an induction of cell cycle arrest, increased apoptosis and cisplatin sensitivity, and a reduction in cellular viability. Phospho-antibody array suggested GOLPH3L plays a role in mediating cell cycle arrest. Conclusions: This study provides a potential biomarker for predicting prognosis and NACT response in patients with cervical squamous cell carcinoma. The functional role of GOLPH3L in cervical cancer merits further investigation.
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Affiliation(s)
- Yanling Feng
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510080, China
| | - Fan He
- Department of Molecular Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Shumei Yan
- Department of Pathology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - He Huang
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510080, China
| | - Qidan Huang
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510080, China
| | - Ting Deng
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510080, China
| | - Huini Wu
- Department of Biology, University of Illinois at Chicago, Chicago, IL 60607, United States
| | - Bei Gao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jihong Liu
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou 510080, China
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Georgeena P, Rajanbabu A, Vijaykumar DK, Pavithran K, Sundaram KR, Deepak KS, Sanal MR. Surgical treatment pattern and outcomes in epithelial ovarian cancer patients from a cancer institute in Kerala, India. Ecancermedicalscience 2016; 10:619. [PMID: 26913070 PMCID: PMC4754116 DOI: 10.3332/ecancer.2016.619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the treatment and survival pattern of patients with advanced epithelial ovarian cancer. Methods and results Retrospective study of all advanced epithelial ovarian cancer patients treated in the department of gynaecologic oncology from an academic centre, in a four year period from 1 January 2008–31 December 2011. Selection criteria All patients with advanced epithelial ovarian cancer (stage III and IV) who underwent surgery from 2008–2011and had a follow-up of at least three months after completion of treatment were included. The decision on whether primary surgery or neoadjuvant chemotherapy (NACT) in advanced ovarian cancer was based on age, performance status, clinical and imaging findings. Results A total of 178 cases of epithelial ovarian cancer were operated on during this four year period. Among them 28 patients were recurrent cases, 22 had early stages of ovarian cancer, and the rest 128 had stage III and IV ovarian cancer. In these 128 patients, 50(39.1%) underwent primary surgery and 78(60.9%) had NACT followed by surgery. In the primary surgery group 36(72.0%) patients had optimal debulking while in the NACT group 59(75.6%) patient had optimal debulking. With a median follow-up of 34 months, the median overall survival (OS) and progression free survival (PFS) was 53 and 49 months respectively. Patients who underwent primary surgery had better median PFS than patients who had NACT (56 months versus 39 months, p = 0.002). In stage III C the difference median PFS was significant for those treated with primary surgery when compared with NACT (55 months versus 39 months, p = 0.012). In patients who had optimal debulking to no residual disease (n = 90), primary surgery gave a significant improved PFS (59 months versus 38 months, p = 0.001) when compared with NACT. In univariate analysis, NACT was associated with increased risk of death (HR: 0.350; CI: 0.177–0.693). Conclusion In advanced epithelial ovarian cancer, primary surgery seems to have a definite survival advantage over NACT in patients who can be optimally debulked to no residual disease.
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Affiliation(s)
- P Georgeena
- Public Health Research Department, Amrita Institute of Medical Sciences, Kochi, Kerala 682041, India
| | - Anupama Rajanbabu
- Department of Gynaecologic Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala 682041, India
| | - D K Vijaykumar
- Department of Gynaecologic Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala 682041, India
| | - K Pavithran
- Department of Medical Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala 682041, India
| | - K R Sundaram
- Department of Biostatistics, Amrita School of Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala 682041, India
| | - K S Deepak
- Department of Biostatistics, Amrita School of Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala 682041, India
| | - M R Sanal
- Clinical Research Department, Amrita Institute of Medical Sciences, Kochi, Kerala 682041, India
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He D, Duan C, Chen J, Lai L, Chen J, Chen D. The safety and efficacy of the preoperative neoadjuvant chemotherapy for patients with cervical cancer: a systematic review and meta analysis. Int J Clin Exp Med 2015; 8:14693-14700. [PMID: 26628951 PMCID: PMC4658840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 06/20/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To evaluate the safety and efficacy of the preoperative neoadjuvant chemotherapy for patients with cervical cancer. METHODS A systematic literature search was conducted using the PubMed, EMBASE and Cochrane databases. Studies comparing combined neoadjuvant chemotherapy treatment (NACT)/radical surgery treatment (RST) with RST alone in patients with cervical cancer were eligible for inclusion. RESULTS Eight studies were finally included in this meta analysis, involving a total of 1302 patients. Meta analysis shows that NACT might have lower lymph node metastasis than RST [OR=0.57, 95% CI (0.41, 0.79), P=0.0008]. However, there are no differentiation between two groups in operation time [SMD=0.16, 95% CI (-0.08, 0.48), P=0.19], intraoperative estimated blood loss [SMD=0.20, 95% CI (-0.19, 0.58), P=0.48], intraoperative and postoperative complication rates [OR=1.33, 95% CI (0.45, 3.92), P=0.60], overall survival rate [OR=1.07, 95% CI (0.48, 2.41), P=0.86] and recurrence rate [OR=1.06, 95% CI (0.56, 2.03), P=0.85]. CONCLUSIONS The safety and efficacy of two treatments are similarly. However, NACT can reduce the rate of lymph node metastasis, which is an independent risk factor for cervical cancer prognosis and may improve the prognosis of cervical cancer.
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Affiliation(s)
- Du He
- Department of Oncology, The Central Hospital of Enshi Autonomous Prefecture Enshi, Hubei Province, China
| | - Chunyan Duan
- Department of Oncology, The Central Hospital of Enshi Autonomous Prefecture Enshi, Hubei Province, China
| | - Jun Chen
- Department of Oncology, The Central Hospital of Enshi Autonomous Prefecture Enshi, Hubei Province, China
| | - Lin Lai
- Department of Oncology, The Central Hospital of Enshi Autonomous Prefecture Enshi, Hubei Province, China
| | - Jiaquan Chen
- Department of Oncology, The Central Hospital of Enshi Autonomous Prefecture Enshi, Hubei Province, China
| | - Dian Chen
- Department of Oncology, The Central Hospital of Enshi Autonomous Prefecture Enshi, Hubei Province, China
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