Indian Journal of Cancer
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Item Tata Memorial Centre Evidence Based Management of Breast cancer(Medknow Publications, 2024-03) Wadasadawala, T; Joshi, S; Rath, S; Popat, P; Sahay, A; Gulia, S; Bhargava, P; Krishnamurthy, R; Hoysal, D; Shah, J; Engineer, M; Bajpal, J; Kothari, B; Pathak, R; Jaiswal, D; Desai, S; Shet, T; Patil, A; Pai, T; Haria, P; Katdare, A; Chauhan, S; Siddique, S; Vanmali, V; Hawaldar, R; Gupta, S; Sarin, R; Badwe, RThe incidence of breast cancer is increasing rapidly in urban India due to the changing lifestyle and exposure to risk factors. Diagnosis at an advanced stage and in younger women are the most concerning issues of breast cancer in India. Lack of awareness and social taboos related to cancer diagnosis make women feel hesitant to seek timely medical advice. As almost half of women develop breast cancer at an age younger than 50 years, breast cancer diagnosis poses a huge financial burden on the household and impacts the entire family. Moreover, inaccessibility, unaffordability, and high out-of-pocket expenditure make this situation grimmer. Women find it difficult to get quality cancer care closer to their homes and end up traveling long distances for seeking treatment. Significant differences in the cancer epidemiology compared to the west make the adoption of western breast cancer management guidelines challenging for Indian women. In this article, we intend to provide a comprehensive review of the management of breast cancer from diagnosis to treatment for both early and advanced stages from the perspective of low-middle-income countries. Starting with a brief introduction to epidemiology and guidelines for diagnostic modalities (imaging and pathology), treatment has been discussed for early breast cancer (EBC), locally advanced, and MBC. In-depth information on loco-regional and systemic therapy has been provided focusing on standard treatment protocols as well as scenarios where treatment can be de-escalated or escalatedItem Role of methylene blue dye in sentinel node biopsy in N0 oral cavity squamous cell carcinoma(Medknow Publications, 2024-03) Upadhyay, K; Gupta, V; Sahu, PK; Basu, A; Bhatia, R.Background: Presence of neck nodes in cases of head neck squamous cell cancers is an adverse prognostic factor. Elective neck dissection is traditionally recommended along with primary disease resection. Sentinel lymph node (SLN) is the first draining node. Sentinel lymph node biopsy (SNB) is a minimally invasive technique to identify occult nodal metastasis in early HNSCC. Methods: The objective of this study is to determine the identification rate of SNB using methylene blue dye (MBD) in N0 neck of Oral Squamous cell carcinoma (OSCC) and estimating specificity, sensitivity, negative predictive value and positive predictive value of SNB with frozen section (FS) analysis and in comparison to post-operative histopathological examination (HPE). It is a cross-sectional study conducted at a tertiary care centre, Lucknow, India. 21 patients of N0 OSCC from January 2019 to May 2020, were included. All patients underwent peritumoral injection with MBD. Sentinel nodes were harvested and sent for FS. Depending on FS findings, appropriate neck dissection was performed. Results: SLN was identified at level Ib and II in 19 patients (90.47%). The sensitivity, specificity, PPV and NPV in identifying SLN using MBD versus FS were 100.00%, 11.11%, 15.79% and 100.00% respectively. Whereas, SLN using MBD versus HPE specimens were 100.00%, 10.52%, 10.52% and 100.00% respectively. Conclusion: Despite having 100% sensitivity, MBD alone has poor specificity. With this poor discriminatory power, it is unlikely to be employed as a diagnostic test alone. It is recommended to rely on per-operative FS for taking decision as far as extent of neck dissection in N0 neck is concerned.Item Assaying of p53 Autoantibodies in saliva for the detection of oral squamous cell carcinoma. A road not taken(Medknow Publications, 2024-03) Sreelatha, SV; Shetty, S; Karnaker, VK; Jacob, AM; Chowdhury, CRBackground: Autoantibody detection is a promising approach to cancer screening. Serum p53 antibodies have been time tested in various cancers, including oral squamous cell carcinoma (OSCC). This study is aimed to detect and determine the level of p53 autoantibodies (p53?AAbs) in saliva. The association of clinicopathological features among patients with and without OSCC was also explored as a novel method for the detection of autoantibodies. Methods: One hundred preoperative saliva samples from patients with histologically confirmed OSCC and a hundred from normal healthy individuals were collected. Anti p53 detection kit assessed levels of salivary p53?AAbs. The cut?off value was 1.3 U/mL by Enzymelinked immunosorbent assay (ELISA). The p53?AAb levels were expressed in terms of the median and interquartile range (IQR). Fischer抯 exact test and Chi?square test were used to determine the association with clinicopathological features among patients with OSCC and healthy controls with tobacco consumption habits. Results: Median level of p53?AAb is 0.234 U/mL (IQR 0.180.37U/mL) in healthy controls and 0.285U/mL (IQR 0.160.58U/mL) in OSCC. p53?AAbs was positive in 15% of 100 patients with OSCC, which was statistically higher (P < 0.001) among OSCC, and controls were negative for p53?AAb. No significant correlation of p53?AAbs with the patient抯 age, gender, site, clinical staging (TNM), and pathologic grade was observed. However, a significant association was seen between the node involvement and salivary p53?AAbs. Conclusion: Salivary p53?AAb positivity was seen in a higher proportion in OSCC patients than in healthy controls with tobacco consumption, and the levels did differ significantly among OSCC and healthy controlsItem Tata Memorial Centre Evidence Based Use of Nuclear medicine diagnostic and treatment modalities in cancer(Medknow Publications, 2024-03) Puranik, AD; Choudhury, S; Ghosh, S; Dev, ID; Ramchandani, V; Uppal, A; Bhosale, V; Palsapure, A; Rungta, R; Pandey, R; Khatri, S; George, G; Satamwar, Y; Maske, R; Agrawal, A; Shah, S; Purandare, NC; Pangarajan, VPET/CT and radioisotope therapy are diagnostic and therapeutic arms of Nuclear Medicine, respectively. With the emergence of better technology, PET/CT has become an accessible modality. Diagnostic tracers exploring diseasespecific targets has led the clinicians to look beyond FDG PET. Moreover, with the emergence of theranostic pairs of radiopharmaceuticals, radioisotope therapy is gradually making it抯 way into treatment algorithm of common cancers in India. We therefore would like to discuss in detail the updates in PET/CT imaging and radionuclide therapy and generate a consensus-driven evidence based document which would guide the practitioners of Oncology.Item Retrospective audit of the yield of internal mammary lymph node dissection and literature review in the management of breast cancer(Medknow Publications, 2024-03) Joshi, S; Chigurupati, P; Reddy, A; Noronha, J; Hawaldar, R; Nair, N; Parmar, V; Chitkara, G; Thakkar, P; Shet, T; RA, BBackground:Treatment of lymph node basins is prognostic and therapeutic for axillary lymph nodes(ALN) as well as internal mammary lymph nodes (IMLNs) in breast cancer. IMLNs can be the first echelon node for the inner/central quadrants of the breast. We evaluated the yield of IMLN dissection (IMLND) mainly in patients with inner and central tumors. Methods: IMLND was performed in 199 patients between 2000 and 2018, 127 of whom had tumors in the inner/ central quadrants. Clinico?pathological data were retrieved from Electronic Medical Records (EMR). Results: The median age was 50 (range: 24�). Primary surgery was performed in 82 (41.2%), while 117 (58.8%) were operated post?chemotherapy. Overall, 124/199 (62.3%) had nodes identified in the specimen, more often in primary (61/82, 74.4%) than post?chemotherapy settings (63/117, 53.8%) (P = 0.003). A median of 1 (average: 1.24, range: 0� lymph nodes was dissected, and 1 (average: 1.5, range: 1� was involved. IMLN was positive in 46/199 (23.1%) patients, not significantly different in primary (21/82, 25.6%) versus post?chemotherapy (25/117, 21.4%) settings (P = 0.545). IMLN was involved in 44.8% of patients with ?4 involved ALN and 8.2% with uninvolved ALN (P < 0.001). In the absence of ALN involvement and <2cm pT size, 9% of patients had positive IMLN in inner/central quadrant tumors. In univariate analysis, ALN positivity (P < 0.001), pT size (P = 0.023), and grade (P = 0.041) in primary and ALN involvement (P = 0.011) in post?chemotherapy patients were associated with IMLN involvement. On logistic regression, tumor size (OR: 13.914, P = 0.017) and ALN involvement (OR: 11.400, P = 0.005) in primary surgery and ALN involvement (OR: 7.294, P = 0.003) in post?chemotherapy patients correlated with IMLN involvement. Conclusions:In inner/central quadrant tumors, IMLN is more likely involved with high ALN burden and tumor size>2 cm, whereas those with ?2cm inner/central quadrant tumors and negative ALN have <10% probability of IMLN involvement.Item Prevalence of asymptomatic brain metastases in metastatic nonsquamous nonsmall cell lung cancer: Treatment implications for resource-constrained settings(Medknow Publications, 2024-03) Shukla, S; Prasad, KT; Ahuja, CK; Muthu, V; Singh, NBackground: Brain metastases (BM) are common in metastatic nonsmall cell lung cancer (NSCLC). However, routine neuroimaging in asymptomatic patients with metastatic NSCLC is controversial as there is no conclusive evidence of benefit from the detection and treatment of asymptomatic BM. Herein, we evaluated the prevalence of asymptomatic BM and its treatment implications in a resource?limited setting. Methods: Consecutive patients with newly diagnosed, treatment?na飗e, metastatic, nonsquamous NSCLC (NS?NSCLC) were included. Subjects who already had clinical or radiological features suggestive of BM were excluded from the study. All eligible subjects underwent contrast?enhanced magnetic resonance imaging (MRI) of the brain. Management of the detected BM was at the discretion of the treating clinicians. Results: Among 809 subjects who were screened, 100 (12.4%) were included in the study and underwent MRI. BM was present in 30 (30%) of the subjects and absent in the remaining 70 subjects. A majority of BM were multiple (70%), involved the frontal lobe commonly (73.3%), and had a mean (standard deviation) size of 13.2 (7.3) mm. Detection of BM resulted in a treatment alteration in 17 (17%) of the study subjects (brain irradiation, n = 17, change in targeted therapy, n = 3) with BM. There was no difference in survival of patients who underwent treatment alteration for management of BM compared to those who did not (P = 0.132). Conclusions: About one?third of patients with metastatic NS?NSCLC had BM in MRI despite the absence of symptoms. Despite treatment of the majority of the patients with BM with brain irradiation, there was no demonstrable survival benefit. Hence, we conclude that although routine neuroimaging of asymptomatic patients with newly diagnosed metastatic NSCLC may result in treatment alteration (primarily brain irradiation) in a small proportion of patients, it may not influence outcomes in resource?constrained settings.Item Analysis of discordant PET and CT findings in 18F-FDG PET-CT scans in the management of oncology patients(Medknow Publications, 2024-03) Sunny, SS; Oommen, R; Hephzibah, J; Shanthly, N; Mathew, D; EapenBackground: Discordant findings are often noted between PET?CT and CT images of 18F?FDG PET?CT scans and cause ambiguity in image interpretation.This study aimed at determining the significance of these findings in the management of oncology patients. Context: Discordant findings are often noted between PET?CT and CT images of 18F?FDG PET?CT scans and cause ambiguity in image interpretation. Aim: This study aimed at determining the significance of these findings in the management of oncology patients. Methods: This was an observational, descriptive study. Hence, retrospective analysis of all discordant findings in oncology patients undergoing a PETCT imaging between Jan 2013 and Jan 2016 was done. Those patients who had a follow?up period of minimum 1 year in either of the following forms � repeat PETCT imaging, other radiological imaging, clinical, or histopathological evidence were included. From all the discordant lesions, the sensitivity, specificity, positive predictive, negative predictive value, and accuracy of both PET?CT and CT modalities were determined. Results: Of 348 discordant lesions, 16.7% was noted in soft tissues, 25% in viscera, 28.7% in lungs, 14.1% in lymph nodes, and 15.5% in bones. At the end of followup, 15.2% lesions were PET true positive, 57.5% PET true negative, 10.1% CT true positive lesions, 13.8% CT true negative, and 3.4% were inconclusive. Conclusion: 18F?FDG PET?CT is superior to CT imaging and should be considered as the first?line imaging modality in oncology patients.Item Role of Serine arginine protein kinase 1 and Minichromosome maintenance protein 2 in predicting epithelial ovarian cancer response to treatment and prognosis(Medknow Publications, 2024-03) Elkholy, E; Abdou, AG; Alhanafy, AM; Hashem, T; Hassan, R; Shehata, M.Background: Serine?Arginine (SR) proteins are a conserved family of proteins involved in RNA splicing and are reported to be over?expressed in multiple cancers. The aim of the study is evaluation of the expression of Serine arginine protein kinase 1 (SRPK1) and Minichromosome maintenance protein 2 (MCM2) in epithelial ovarian cancer (EOC) and their correlation with clinicopathological features, response to therapy, progression?free survival (PFS), and cancer?specific survival (CSS). Methods: This study was carried out on surgical specimens of 65 patients diagnosed with EOC which were submitted to immunohistochemical staining by SRPK1 and MCM2 antibodies. Results: About 89.2% of cases showed SRPK1 expression and its high expression was significantly associated with type II tumors and advanced stage. All cases showed nuclear immunoreaction for MCM2 with high expression in 49.2% of cases. There was a significant relationship between high values of SRPK1 H?score and percentage of MCM2. Postmenopause, type II pathology, advanced stage, absence of complete response to the treatment, resistance to platinum?based chemotherapy, and surgery done by a general surgeon were the factors affecting PFS. Response to treatment and platinum sensitivity were the most independent factors affecting patients� PFS. The factors associated with shorter CSS were suboptimal debulking, advanced stage, absence of complete response to the treatment, platinum resistance, and high SRPK1. High SRPK1 expression and platinum sensitivity were the independent factors affecting patients� CSS. Conclusions: SRPK1 is an unfavorable biomarker in EOC patients because of its association with aggressive histologic type, advanced International Federation of Gynecology and Obstetrics (FIGO) stage, and worse survival. SRPK1 could promote the proliferation of EOC by up?regulation of MCM2.Item Brain metastasis of hepatocellular carcinoma- single center experience(Medknow Publications, 2024-06) Rahatli, S; Oguz, A; Abduyev, Z; Altundag, OBackground: Although the most common intracranial neoplasm in the adult population is metastatic tumors, brain metastasis from hepatocellular carcnoma (HCC) are very rare. The aim of this study is to analyze patients with advanced HCC, in order to determine the incidence of brain metastasis and evaluate the clinicopathologic properties. Methods: The records of HCC patients treated in our university between 2011 and 2019 were reviewed retrospectively. Patient characteristics, symptoms, laboratory data, treatment modalities, and survival after both the diagnosis of HCC and detection of brain metastasis were recorded. Results: Of the 119 hepatocellular carcinoma patients, 34 had metastasis, 8 of which were to the brain. The median time elapsed between the diagnosis of HCC and brain metastasis was 14.6 months and the median overall survival after the detection of brain metastasis was 1.6 months. In 34 patients with metastasis, median survival was 26.2 months for those without brain metastasis, whereas it was 15.8 months for those with brain metastasis (P = 0.460). The survival times after brain metastasis were 11.6 and 3.9 months for the two patients treated with regorafenib and sorafenib after the detection of brain metastasis, respectively. Conclusion: In this study, it was found that patients who were clinically eligible to receive tyrosine kinase inhibitors survived longer after the detection of brain metastasis. Our study shows that multidisciplinary evaluation of these patients is vital for treatment guidance, and survival outcomes can be improved with the advancements in surgical and radiotherapy techniques even in patients with poor prognosis.Item Assessment of serum microRNA-21 and miRNA-205 as diagnostic markers for stage I and II breast cancer in Indian population(Medknow Publications, 2024-06) Rama, K; Bitla, AR; Hulikal, N; Yootla, M; Yadagiri, LA; Asha, T; M, M; PVLN, SRBackground: Current markers(carcinoembryonic antigen [CEA] and carbohydrate antigen 15-3 [CA15-3]) lack sensitivity in diagnosis of breast cancer. The aberrantly expressed circulating miRNAs were shown as diagnostic markers in breast cancer. However, there are very few studies from the Indian population. We studied the diagnostic utility of miRNA-21, miRNA-155 and miRNA-205 compared to CEA and CA15-3 in stage I and II breast cancer patients. Materials and Methods: Sixty newly diagnosed women with stage I/II breast cancer and 20 healthy controls were recruited. Expression of circulating miRNAs was studied using reverse transcription-polymerase chain reaction, whereas CEA and CA 15-3 were analyzed by enzyme-linked immunosorbent assay. Results: miRNA-21 and miRNA-155 were upregulated, miRNA-205 down-regulated (P < 0.05) and serum CEA and CA15-3 levels increased in breast cancer patients (P < 0.001). Receiver operating characteristic curve analysis showed significant area under curve (AUC) for all markers(0.656 to 0.993; P = 0.015 to <0.001) validating their diagnostic potential. Unlike CEA and CA15-3, miRNAs retained their sensitivity even at higher cut-offs(95% CI of mean). Logistic regression analysis showed significant association between disease and marker positivity for miRNA-21 and miRNA-205 but not for miRNA-155. Combining CA15-3 with miRNAs did not improve their diagnostic performance. However, combining CEA with either miRNA-21 (AUC = 0.742; P < 0.001 versus AUC = 0.656; P = 0.018) or miRNA-205 (AUC = 0.733; P < 0.001 versus AUC = 0.700; P < 0.001) increased its diagnostic performance. Conclusion: Our study shows miRNA-21 and miRNA-205, are useful as diagnostic markers for breast cancer in the Indian population and combination of these miRNAs with CEA but not with CA 15-3 improved their diagnostic performance.Item Primary extranodal lymphomas: Five-year experience from a tertiary care center of North India(Medknow Publications, 2024-03) Mishra, P; Prashar, M; Rehman, N; Sinha, A; Raman, DKBackground: Primary extranodal lymphomas (pENL) are lymphomas with minimal nodal involvement and dominant extranodal disease. We aimed to study the prevalence and clinicopathological characteristics of pENL presenting at our center over 5 years from January 2015 to January 2020. Methods: This is a cross?sectional study of pENL patients in which relevant clinical and laboratory data was collected including demography, site, stage, international prognostic index?revised, imaging findings, hematological, and biochemical parameters and comorbidities including underlying immunodeficiency. The paraffin blocks were subjected to routine hematoxylin and eosin stain and immunohistochemistry with standard lymphoma panel. Results:Of 341 lymphomas, 73 (21.4%) were pENL with commonest site being gastrointestinal tract(31.5%) followed by head and neck (23.2%) and soft tissues(9.6%). Diffuse large B?cell lymphoma (DLBCL) (39.7%) was the commonest histological type (germinal center type�%, nongerminal center�%) followed by marginal zone lymphomas (MZL) (23.3%) and primary CNS lymphoma (8.2%). Primary breast lymphoma, primary bone marrow lymphoma, and follicular lymphoma constituted 4.1, 5.4, and 4.1% of pENL, respectively. There was a case of high grade B cell lymphoma of ileum with features intermediate between DLBCL and Burkitt. Other unusual pENL were anaplastic DLBCL of tonsils, DLBCLs of bone marrow with M band, MZL of base of tongue, Richter抯 transformation of tonsillar small lymphocytic lymphoma, and follicular lymphoma presenting as pericardial mass. Of 12 cases of T?non?Hodgkin lymphoma, commonest were mycosis fungoides (4/12) followed by mediastinal T?lymphoblastic lymphoma (2/12) and peripheral T?cell lymphoma (2/12). Conclusion: pENL has unique clinical presentation depending on the location with site?specific distribution of histological subtypesItem Evaluation of late effects during a 21-year follow-up of pediatric Hodgkin lymphoma survivors: Experience of a pediatric cancer center in Turkey, as a developing country model(Medknow Publications, 2024-06) Tacyildiz, N; Cakmak, HM; Unal, E; Dincaslan, H; Tany?ld?z, G; 謟demir, S?; Kartal, O; Yilmaz, Y; Yavuz, G; Kuzu, I.Background: Long-term survivors of Hodgkin lymphoma (HL) are at risk of developing a range of late effects, with a second malignant neoplasm and cardiovascular diseases being the leading causes of death in these patients. The present study aims to evaluate the late side effects in children with HL. Materials and Methods: Out of 53 HL patients, we assessed the long-term effects of childhood HL survivors (HLSs; n = 50) diagnosed between 1998 and 2019. Patient data related to chronic health conditions, and sociodemographic characteristics were compared with their siblings (n = 56). Results: The cumulative overall survival (OS) at 1, 5, and 10 years from diagnosis was 98.1 � 1.9%, 93.3 � 3.8%, and 93.3 � 3.8%, respectively. Groups of HLSs and their siblings were matched according to age and gender. Compared with siblings, survivors had will be changed as 慳 higher frequency of nephrotoxicity (P = 0.02)�, cardiotoxicity (P = 0.12), thyroid dysfunction (P = 0.001), health care service usage (P < 0.01), limitation of physical function (P = 0.01), and pulmonary disease (P = 0.01). The control group of siblings had a higher incidence of marital status(P < 0.01), parenthood (P = 0.01), and smoking habit (P = 0.03). Thyroid dysfunction was associated with neck radiotherapy (P < 0.01). No secondary neoplasm was detected. In relapsed, refractory setting (n = 10), autologous transplantation (n = 9) is performed after a complete remission. Brentuximab vedotin with or without bendamustine and rituximab is also used in selected patients. Conclusions: Increased number of chronic health conditions and social problems point to the significance of long-term follow-up of HLSs. We are currently preparing a survivorship guideline appropriate for Turkey抯 conditions. Implications for Cancer Survivors: Renal, heart, pulmonary impairment, thyroid dysfunction, limitation in physical functioning, and deterioration in social status (marriage, having children, education).Item Efficacy and safety of apatinib for elderly patients with previously treated extensive-stage colorectal cancer patients and the prognostic significance of common adverse reactions(Medknow Publications, 2024-06) Yu, Y; Li, Y; Xu, C; Zhang, WBackground: This study was designed to investigate the efficacy and safety of apatinib monotherapy in the treatment of elderly patients with advanced colorectal cancer (CRC) who have progressed on the standard regimens. Methods: The data of 106 elderly patients with advanced CRC who have progressed on standard treatment were analyzed. The primary endpoint of this study was progression-free survival (PFS), the secondary endpoints were objective response rate (ORR), disease control rate (DCR), and overall survival (OS). The safety outcomes were assessed by the proportion and severity of adverse events. Results: Efficacy was assessed using the best overall response of patients during treatment with apatinib, including 0 patients with complete response, 9 patients with partial response, 68 patients with stable disease, and 29 patients with progressive disease. ORR and DCR were 8.5 and 72.6%, respectively. The median PFS of 106 patients was 3.6 months, and the median OS was 10.1 months. The most frequent adverse reactions of elderly patients with advanced CRC receiving apatinib treatment were hypertension (59.4%) and hand杅oot syndrome (HFS) (48.1%). The median PFS of patients with and without hypertension was 5.0 and 3.0 months, respectively (P = 0.008). The median PFS of patients with and without HFS was 5.4 and 3.0 months, respectively (P = 0.013). Conclusions: The clinical benefit of apatinib monotherapy was observed in elderly patients with advanced CRC who have progressed on the standard regimens. The adverse reactions of hypertension and HFS were positively related to treatment efficacyItem Primary adenocarcinoma of colon: A clinicopathological study with the prevalence and correlation of CDX2 biomarker expression - A tertiary care center experience(Medknow Publications, 2024-06) Issac, R; Masih, D; Ranjan, M; Pulimood, ABBackground: Colorectal cancer is one of the alarming health problems worldwide. Prognostic biomarkers are the key for risk stratification in patients with colon cancer and the decision to recommend adjuvant chemotherapy. It has been difficult to identify a single prognostic biomarker for colon cancer. Currently, tumor stage, tumor grade, and microsatellite instability remain the most important prognostic variables that aid in the treatment of patients with colon cancer. Some studies highlighted that CDX2 immunohistochemistry negativity is an independent prognostic factor and indicates a worse survival rate. Our aim was to study the prevalence of CDX2 biomarker expression in patients diagnosed with primary adenocarcinoma and to correlate this with the clinical profile and pathological features. Methods: Endoscopic mucosal biopsies and resection specimens of 148 patients diagnosed with colonic adenocarcinoma were analyzed. CDX2 immunohistochemistry was performed, and the result was correlated with clinicopathological features. The results were presented as mean, frequencies, and percentages. Pearson抯 Chi-square test was used to assess the associations between clinicopathological parameters and CDX2 immunohistochemistry negativity. Results: The prevalence of CDX2 expression by immunohistochemistry in colon cancer was found to be 92%. CDX2 biomarker negativity was found to be higher in left-sided colon cancers, poorly differentiated adenocarcinoma, mucinous carcinoma, and higher TNM stages. Conclusion: CDX2-negative tumors are often associated with several adverse prognostic variables (e.g., advanced stage, poor differentiation, and metastasis). Thus, sub-classification of colon cancer based on the CDX2 biomarker aids to separate them into prognostically relevant categories.Item Plasmacytoid urothelial carcinoma � A clinicopathological case series of an aggressive variant of urothelial cancer(Medknow Publications, 2024-06) Gajaria, PK; Menon, S; Bakshi, G; Prakash, G; Joshi, A; Murthy, V; Desai, SBBackground: Many new morphological variants of urothelial carcinoma of urinary bladder have been described in the literature, plasmacytoid/signet ring cell/diffuse variant being one of the rare amongst these. Till date, no case series has been reported from India, describing this variant. Materials and Methods: We retrospectively analyzed the clinicopathological data of 14 patients diagnosed at our center with plasmacytoid urothelial carcinoma. Results: Seven cases (50%) were pure forms while the remaining 50% of cases had a concurrent conventional urothelial carcinoma component. Immunohistochemistry was performed to rule out other mimickers of this variant. Treatment-related data were available for seven patients, while follow-up was available for nine cases. Conclusion: Overall, plasmacytoid variant of urothelial carcinoma is considered to be an aggressive tumor with poor prognosis.Item Clinical risk factors and Risk assessment model for Anastomotic leakage after Rectal cancer resection(Medknow Publications, 2024-06) Ding, R; He, M; Cen, H; Chen, Z; Su, YBackground: Anastomotic leakage (AL) is the most serious complication after rectal cancer surgery. Risk factors associated with AL have been documented in previous studies; however, the consensus is still lacking. In this retrospective study, we aimed to identify risk factors for AL after rectal cancer resection and to create an accurate and effective tool for predicting the risk of this complication. Methods: The study cohort comprised of 276 patients with rectal cancer who had undergone anterior resection between 2015 and 2020. Twenty-four selected variables were assessed by univariate and multivariate logistic regression analyses to identify independent risk factors of AL. A risk assessment model for predicting the risk of AL was established on the basis of the regression coefficients of each identified independent risk factor. Results: Anastomotic leakage occurred in 20 patients (7.2%, 20/276). Multivariate analysis identified the following variables as independent risk or protective factors of AL: perioperative ileus (P < 0.001, odds ratio [OR] = 14.699), tumor size ?5 cm (P = 0.025, OR = 3.925), distance between tumor and anal verge <7.5 cm (P = 0.045, OR = 3.512), obesity (P = 0.032, OR = 7.256), and diverting stoma (P = 0.008, OR = 0.143). A risk assessment model was constructed and patients were allocated to high-, medium-, and low-risk groups on the basis of risk model scores of 5� 2� and 0� respectively. The incidences of AL in these three groups were 61.5%, 11.9%, and 2.0%, respectively (P < 0.001). Conclusions: Our risk assessment model accurately and effectively identified patients at high risk of AL and could be useful in aiding decision-making aimed at minimizing adverse outcomes associated with leakage.Item Pneumothorax in lung metastasis of advanced soft tissue sarcoma patients treated with oral pazopanib(Medknow Publications, 2024-06) Sarkar, S; Mishra, PK; Mukhopadhyay, S; Sen, S; Biswas, B.Aim: Data on occurrence of pneumothorax after the use of oral pazopanib in advanced soft tissue sarcoma (STS) with lung metastases are scarce in literature. We aimed to evaluate those in our patients. Methods: This was a single center retrospective study of incidence of pneumothorax in patients with lung metastases in advanced STS treated with oral pazopanib between July, 2016 and December, 2020. Patients were treated with pazopanib usually from 2nd line onwards with a dose ranging from 400 mg to 800 mg once daily. Results: Total of 34 patients with lung metastasis in a setting of advanced STS were treated with oral pazopanib during the study period. The setting of pazopanib use was 2nd line in four and 1st line in one of them. The starting dose was 600 mg once daily in three patients, 400 mg OD in one patient, and 800 mg OD in one patient. Five patients developed pneumothorax with duration on pazopanib of 6, 7, 24, 6, and 2.5 months, respectively. Three patients had symptoms and required chest tube drainage. None of them were smokers or had any other underlying lung disease. The disease response of those patients was stable disease in four and partial response in one during treatment with pazopanib. One patient had a rechallenge with further pazopanib course without any recurrence of pneumothorax. Conclusions: Pneumothorax is a rare pulmonary complication after pazopanib use in patients with lung metastasis. Clinicians should be aware of this rare complication as literature is scarce. Rechallenge with pazopanib is feasible after pneumothorax.Item Determinants of pathological complete response to neoadjuvant chemotherapy in breast cancer: A single-institution experience(Medknow Publications, 2024-06) Joshi, S; Chougle, Q; Noronha, J; Hawaldar, R; Nair, N; Vanmali, V; Parmar, V; Thakkar, P; Chitkara, G; Shet, T; Badwe, RABackground: Neoadjuvant chemotherapy (NACT) is routinely used in all cases of locally advanced breast cancer and some cases of early breast cancer. We previously reported a pathological complete response (pCR) rate of 8.3%. With the increasing use of taxanes and human epidermal growth factor receptor 2 (HER2)-directed NACT, we conducted this study to understand the current pCR rate and its determinants. Methods: A prospective database of breast cancer patients who underwent NACT followed by surgery between January and December 2017 was evaluated. Results: Of the 664 patients, 87.7% were cT3/T4, 91.6% were grade III, and 89.8% were node-positive at presentation (54.4% cN1, 35.4% cN2). The median age was 47 years; median pre-NACT clinical tumor size was 5.5 cm. Molecular subclassification was 30.3% hormone receptor positive (HR+) HER2?, 18.4% HR+HER2+, 14.9% HR?HER2+, and 31.6% triple negative (TN). Both anthracyclines and taxanes were given preoperatively in 31.2% patients whereas 58.5% of HER2 positive patients received HER2-targeted NACT. The overall pCR rate was 22.4% (149/664), 9.3% in HR+HER2?, 15.6% in HR+HER2+, 35.4% in HR?HER2+, and 33.4% in TN. On univariate analysis, duration of NACT (P < 0.001), cN stage at presentation (P = 0.022), HR status (P < 0.001), and lymphovascular invasion (P < 0.001) were associated with pCR. On logistic regression, HR negative status (Odds ratio [OR] 3.314, P < 0.001), longer duration of NACT (OR 2.332, P < 0.001), cN2 stage (OR 0.57, P = 0.012), and HER2 negativity (OR 1.583, P = 0.034) were significantly associated with pCR. Conclusion: Response to chemotherapy depends on molecular subtype and duration of NACT. A low rate of pCR in the HR+ subgroup of patients warrants reconsideration of neoadjuvant strategies.Item The effect of the social support perceived by the women receiving chemotherapy on functional and psychosocial conditions: A cross-sectional, descriptive and correlational study(Medknow Publications, 2024-06) Ataman, H; Tuna, RBackground: Today, cancer is one of the most important health problems with fatal results. Individuals with cancer have to cope with many functional and psychosocial problems in the course of the disease besides physical impairments. The effect of social support of women receiving chemotherapy on their functional and psychosocial conditions was determined. Methods: This study had a cross-sectional, descriptive, and correlational design. The study was conducted with 330 women patients in a state hospital located in Istanbul, Turkey, which has an outpatient chemotherapy unit and is one of the hospitals where outpatient chemotherapy is applied most. Results: In the study, it was determined that there was a very high positive correlation between the social support perceived by the women with cancer and self-esteem and a very high negative correlation of self-esteem with fatigue and depression (P < 0.001). In contrast, there was a very high negative correlation between social support and self-esteem with many of the functional symptoms and a very high positive correlation between social support and self-esteem with fatigue and depression (P < 0.001). Education, number of children, economic situation, family structure, self-esteem, fatigue, and depression variables explained 33% of cancer patients� social support. Conclusion: The management of the functional and psychosocial symptoms of women with cancer is closely related to the perceived social support. In the management of the functional and psychosocial symptoms of women with cancer, it is important to provide and maintain psychological support by involving the patients� families in the treatment process.Item Sleep quality, mental health, and quality of life in women with breast cancer(Medknow Publications, 2024-06) Emre, N; Y?lmaz, SBackground: Breast cancer is the most frequent malignancy among women and its prevalence keeps growing. Today, it is important to optimize the quality of life of breast cancer patients because the survival rates increase with early diagnosis and treatments. Our aim was to examine the sleep quality of patients with breast cancer, compare them with the healthy control group, and evaluate the relationship between quality of life and mental health. Materials and Methods: This cross-sectional study included 125 patients diagnosed with breast cancer and 125 healthy control patients who were admitted to the general surgery department of a university. Results: In 60.8% of breast cancer patients, sleep quality was poor and sleep subscale scores were high. In addition, these patients had a poorer sleep quality, higher score of anxiety and depression, and lower quality of life (in terms of physical subcomponent) compared with the control group. Moreover, although age, marital status, education status, time of cancer diagnosis, menopausal status, surgical method did not have any effect on sleep quality in patient group; low income, accompanying chronic diseases, and increased levels of anxiety and depression worsened sleep quality and increased the risk. Conclusion: In patients with breast cancer, poor sleep quality, score of anxiety and depression were higher, and worsened the quality of life. In addition, low income, presence of concomitant chronic diseases, and anxiety score posed an increased risk for poor sleep quality. Therefore, physical and mental evaluation of breast cancer patients during and after treatment should not be ignored.