Cancer mortality in Europe, 2000-2004, and an overview of trends since 1975

45-Year-old with testicular mixed germ-cell tumor associated with massive hydrocele and a misleading CT scan showing bilateral testicles involvement: A case report

Testicular mixed germ cell tumors (TMGCTs) are rare malignancies, occasionally presenting with hydrocele, and potentially complicating the diagnosis. We report a 45-year-old male with a massive hydrocele and elevated AFP. CT suggested bilateral testicular tumors, but intraoperatively the left testis appeared normal and was preserved. Histopathology confirmed seminoma; however, due to high AFP, treatment followed TMGCT protocols. subsequent MRI of the left testis was negative. This case highlights the limitations of imaging and pathology alone and stresses the importance of integrating tumor markers, intraoperative findings, and clinical judgment for accurate diagnosis and optimal management of testicular tumors.

Machine learning-based prediction of distant metastasis risk in invasive ductal carcinoma of the breast

More than 90% of deaths due to breast cancer (BC) are due to metastasis-related complications, with invasive ductal carcinoma (IDC) of the breast being the most common pathologic type of breast cancer and highly susceptible to metastasis to distant organs. BC patients who develop cancer metastases are more likely to have a poor prognosis and poor quality of life, so it is extremely important to recognize and diagnose whether distant metastases have occurred in IDC as early as possible. In this study, we develop a non-invasive breast cancer classification system for detecting cancer metastasis. We used Anaconda-Jupyter notebooks to develop various Python programming modules for text mining, data processing, and machine learning (ML) methods. A risk prediction model was constructed based on four algorithms: Random Forest, XGBoost, Logistic Regression, and SVM. Additionally, we developed a hybrid model based on a voting mechanism using these four algorithms as the base models. The models were compared and evaluated by the following metrics: accuracy, precision, recall, F1-score, and area under the ROC curve (AUC) values. The experimental results show that the hybrid model based on the voting mechanism exhibits the best prediction performance (accuracy: 0.867, precision: 0.929, recall: 0.805, F1-score: 0.856, AUC: 0.94). This stable risk prediction model provides a valuable reference support for doctors in assessing and diagnosing the risk of IDC hematogenous metastasis. It also improves the work efficiency of doctors and strives to provide patients with increased chances of survival.

Diagnosis and management of indeterminate testicular lesions

The sophistication and accessibility of modern-day imaging result in frequent detection of small or equivocal lesions of the testes. Traditionally, diagnosis of a testicular lesion with any possibility of malignancy would usually prompt radical orchidectomy. However, awareness is growing that a substantial proportion of these lesions might be benign and that universal application of radical orchidectomy risks frequent overtreatment. Given the potentially profound effects of radical orchidectomy on fertility, endocrine function and psychosexual well-being, particularly in scenarios of an abnormal contralateral testis or bilateral lesions, organ-preserving strategies for equivocal lesions should be considered. Image-based active surveillance can be applied for indeterminate lesions measuring ≤15 mm with a low conversion rate to surgical treatment. However, these outcomes are early and from relatively small, selected cohorts, and concerns prevail regarding the metastatic potential of even small undiagnosed germ cell tumours. No consensus exists on optimal surveillance (short interval (<3 months) ultrasonography is generally adopted); histological sampling is a widespread alternative, involving inguinal delivery of the testis and excisional biopsy of the lesion, with preoperative marking or intraoperative ultrasonographic localization when necessary. Frozen section analysis in this context demonstrates excellent diagnostic accuracy. Histological results support that approximately two-thirds of marker-negative indeterminate solitary testicular lesions measuring ≤25 mm overall are benign. In summary, modern imaging detects many small indeterminate testicular lesions, of which the majority are benign. Awareness is growing of surveillance and organ-sparing diagnostic and treatment strategies with the aim of minimizing rates of overtreatment with radical orchidectomy.

Leydig cell tumor of the testis with characteristic contrast patterns of tumor and non-tumorous testicular parenchyma on MRI: a case report

PURPOSE

Testicular Leydig cell tumor (LCT) is a rare subtype of testicular neoplasms that occurs in the interstitial tissue of testes, accounting for 1-3% of total testicular masses removed annually. We report a case of 70-year-old man diagnosed as testicular LCT. This report demonstrates a testicular LCT with intratumoral and non-tumorous testicular parenchymal enhancement in the affected testis, which should be considered characteristic findings of LCT.

METHODS

Ultrasonography showed a hypoechoic mass. On magnetic resonance imaging, the tumor showed low signal intensity comparable to the surrounding testicular tissue on T1-weighted images (T1WI) and low signal intensity on T2-weighted images (T2WI). On gadolinium contrast-enhanced T1WI (CE-T1WI), the tumor showed a rapid and marked wash-in and subsequent prolonged washout. The spared, non-tumorous testicular parenchyma showed slow and progressive enhancement in the early phase, which was as strong as or stronger than that of the mass in the delayed phase. The patient underwent right orchiectomy.

RESULTS

Pathologically, the tumor was diagnosed as a testicular Leydig cell tumor (LCT). Leydig cell proliferation was observed with well-developed microvessels, atrophy of the seminiferous tubules, and stromal edema in the non-tumorous testicular parenchyma. Leydig cells in the non-tumorous parenchyma were positive for estrogen receptors.

CONCLUSION

Since the contrast findings in the non-tumorous testicular parenchymal region on CE-T1WI likely match the histopathological features of LCT, our case suggests that the presence of non-tumorous testicular parenchymal enhancement on imaging might indicate a diagnosis of LCT.

Ultra-Processed Food Intake and Risk of Colorectal Cancer: A Matched Case-Control Study

Colorectal cancer (CRC) is the third most prevalent and the second fatal cancer in the world. Ultra-processed foods (UPFs) are suggested to be related to various non-communicable diseases including cancers. However, studies on the relationship between UPFs and CRC are scarce. The aim of this study was to determine the association between consumption of UPFs and CRC. In a case-control study conducted in four hospitals in Tehran, Iran, consumption of UPFs in 71 CRC patients and 142 controls (patients with non-neoplastic diseases) were compared. Using 125-item semi-quantitative food frequency questionnaire, dietary intakes were assessed. We used Multivariate logistic regression to estimate the association between UPFs intake and risk of CRC. Intake of nondairy beverages (P = 0.009), processed meat and fast food (P = 0.04) was significantly higher in those in the highest tertile of UPFs intake compared to the lowest tertile. In addition, intake of UPFs was associated with higher risk of CRC. The association remained constant after adjustment for BMI, income, smoking, type of job, educational level, and physical activity (OR, 3.32; 95% CI, 1.44-7.61; P = 0.003). Results of this study indicate that the intake of UPFs is associated with increased odds of CRC.

A DSC Test for the Early Detection of Neoplastic Gastric Lesions in a Medium-Risk Gastric Cancer Area

In this study, we aimed to assess the accuracy of the proposed novel, noninvasive serum DSC test in predicting the risk of gastric cancer before the use of upper endoscopy. To validate the DSC test, we enrolled two series of individuals living in Veneto and Friuli-Venezia Giulia, Italy (n = 53 and n = 113, respectively), who were referred for an endoscopy. The classification used for the DSC test to predict gastric cancer risk combines the coefficient of the patient's age and sex and serum pepsinogen I and II, gastrin 17, and anti-Helicobacter pylori immunoglobulin G concentrations in two equations: Y1 and Y2. The coefficient of variables and the Y1 and Y2 cutoff points (>0.385 and >0.294, respectively) were extrapolated using regression analysis and an ROC curve analysis of two retrospective datasets (300 cases for the Y1 equation and 200 cases for the Y2 equation). The first dataset included individuals with autoimmune atrophic gastritis and first-degree relatives with gastric cancer; the second dataset included blood donors. Demographic data were collected; serum pepsinogen, gastrin G17, and anti-Helicobacter pylori IgG concentrations were assayed using an automatic Maglumi system. Gastroscopies were performed by gastroenterologists using an Olympus video endoscope with detailed photographic documentation during examinations. Biopsies were taken at five standardized mucosa sites and were assessed by a pathologist for diagnosis. The accuracy of the DSC test in predicting neoplastic gastric lesions was estimated to be 74.657% (65%CI; 67.333% to 81.079%). The DSC test was found to be a useful, noninvasive, and simple approach to predicting gastric cancer risk in a population with a medium risk of developing gastric cancer.

Personalized Injury Reduction Strategies in Sports Medicine: Lessons Learned from Advances in Breast Cancer Treatment: A Clinical Commentary

Background

Injury rates across sport have risen over the past twenty years, despite increased efforts in training and injury prevention. The rise in injury rates suggest that current approaches to estimating injury risk and risk management are not effective. One factor limiting progress is the inconsistency in screening, risk assessment, and risk management strategies to guide injury mitigation approaches.

Clinical Question

How can sports physical therapists identify and apply lessons learned from other healthcare fields to improve athlete injury risk and risk management strategies?

Key Results

Breast cancer mortality has consistently decreased over the last 30 years, largely attributed to advances in personalizing the prevention and treatment strategies which include modifiable and non-modifiable factors when assessing risk, the transition to personalized medicine, and the systematic approach used to investigate individual risk factors. Three critical phases have facilitated the identification and importance of individual risk factors and developing targeted, personalized strategies for breast cancer risk including: 1) Establishing the potential relationship between factors and outcomes; 2) Prospectively investigate the strength and direction of the relationship; 3) Investigating if intervening on identified factors alters prognosis.

Clinical Application

Applying lessons learned from other healthcare fields could improve shared decision making between the clinician and athlete concerning risk assessment and management. Examples include calculating only non-modifiable risk, creating individualized screening schedules based on risk assessment, or calculating the influence of each intervention on the athlete's injury risk. A systematic approach to identify and intervene on risk is needed to improve athlete outcomes.

Verification of radon, radium, polonium concentrations and lung cancer rates in blood of female hookah smokers

Hookah smoking has become very popular in Iraq among women and men. Hookah tobacco contains natural radioactive elements, such as radon, radium, and uranium, as well as toxic elements, such as polonium, which are released during the combustion of tobacco and are inhaled by smoking. Most reviews focus on hookah tobacco, and only a few have investigated the blood of hookah smokers. In this study, a CR-39 detector was used to measure radon, radium, and polonium concentrations and conduct risk assessments in female hookah smokers of different ages. The results show that the concentrations of radon-222, polonium-218, and polonium-214 varied between 61.62 and 384.80, 5.45–33.64 on the wall of the can, and 2.43–15.00 Bq/m3 on the surface of the detector, respectively. The effective radium-226 concentration varied between 4.52 and 56.31 Bq/kg. The absorbed effective dose varied between 1.55 and 9.71 mSv/y, which is within the recommended limit (3–10 mSv/y) by International Commission on Radiological Protection (ICRP). The average case of lung cancer 107.91 cppp, which exceeds the European Union (EU) limit (96.9–104.8 cppp). The rates of radon activity and radon exhalation from the intake of a natural radionuclide due to hookah smoking in a female’s blood were calculated and discussed. This study aimed to establish preliminary results on the risks of radioactivity concentrations and assess the dose in the blood of women who smoke hookah and assess the possibility of developing cancer.

Deescalating Follow-up After Hemithyroidectomy for Patients With Low-risk Papillary Thyroid Microcarcinoma

Importance

Structural recurrent disease (RD) after surgical treatment of papillary thyroid microcarcinoma (mPTC) is rare. We hypothesized that the RD rate after hemithyroidectomy in low-risk patients with mPTC is low.

Objective

To assess the occurrence of RD in Dutch patients with mPTC who received surgical treatment according to the Dutch guidelines.

Design, Setting, and Participants

This nationwide retrospective cohort study included all patients who had undergone surgery with a diagnosis of cN0/cNx mPTC in the Netherlands between January 2000 and December 2020 were identified from the Netherlands Cancer Registry database. Patients with preoperative lymph node metastases were excluded. Two groups were defined: group 1 (incidental), mPTC in pathology report after thyroid surgery for another indication; and group 2 (nonincidental), patients with a preoperative highly suspect thyroid nodule (Bethesda 5) or proven mPTC (Bethesda 6). Dutch guidelines state that a hemithyroidectomy is sufficient in patients with unifocal, intrathyroidal mPTC.

Main Outcomes and Measures

The occurrence of RD in patients with low-risk mPTC after hemithyroidectomy.

Results

In total, 1636 patients with mPTC were included. Patients had a median (IQR) follow-up time of 71 (32-118) months. Median (IQR) age at time of diagnosis was 51 (41-61) years and 1292 (79.0%) were women. Overall, RD after initial treatment was seen in 25 patients (1.5%). The median (IQR) time to RD was 8.2 (3.6-16.5) months and 22 of the 25 (88%) patients developed RD within 2 years. Recurrent disease was not significantly different between both groups (group 1, n = 15 [1.3%]; group 2, n = 10 [2.1%]; difference, 0.8%; 95% CI, -0.5% to 2.5%). Of the 484 patients with nonincidental mPTC (group 2), 246 (50.8%) patients were treated with a hemithyroidectomy and follow-up in accordance with Dutch guidelines. Lymph node metastases were found in 1 of 246 (0.4%) patients after hemithyreoidectomy, and new mPTC in the contralateral thyroid was detected in 3 of 246 (1.2%) patients. Median (IQR) follow-up of this patient group was 37 (18-71) months. The 10-year probability of RD was 1.3% for patients without vascular invasion and 24.4% for patients with vascular invasion.

Conclusions and Relevance

This nationwide cohort study found that overall, RD after hemithyroidectomy for patients with low-risk mPTC was rare (<2%). Based on these results, it seems reasonable to deescalate follow-up of patients with low-risk mPTC without vascular invasion after hemithyroidectomy. From a health care perspective, deescalation of follow-up may contribute to increased sustainability and accessibility to health care, both large challenges for the future.

Mortality patterns of soft-tissue sarcomas worldwide up to 2018, with predictions for 2025

OBJECTIVE

The epidemiological evidence on soft-tissue sarcoma (STS) mortality is inconsistent in geographic and time coverage. This study provides mortality trends for STSs in selected countries worldwide over the last 2 decades, together with predicted figures for 2025.

METHODS

We extracted official numbers of certified deaths coded as C47 (i.e. malignant neoplasm of peripheral nerves and autonomic nervous system) and C49 (i.e. malignant neoplasm of other connective and soft tissue) according to the 10th Revision of the International Classification of Disease and population estimates from the WHO and the Pan American Health Organization databases. We computed age-standardized (world standard population) mortality rates (ASMRs). We used joinpoint regression analysis to identify significant changes in trends and to predict death numbers and rates for 2025.

RESULTS

The pattern emerging from the number of deaths and ASMRs up to 2018 shows an increase in most countries in both sexes. Around 2015 to 2018, ASMRs differed by 2.5-fold in both sexes with the highest rates being registered in Central-Eastern Europe, North America and Australia, while the lowest ones in Latin America, Japan, and Korea. In 2025, the number of STS deaths is predicted to increase in most countries and both sexes, and unfavourable rates are predicted in Central Europe in both sexes.

CONCLUSION

In addition to improvements in STSs registration, unfavourable mortality rates reported in this study reflect inadequate referral of patients with STSs to high-volume multidisciplinary centres, as well as insufficient advancements in STS prevention, diagnosis, and treatments.

A new biomarker for lung metastasis in non-seminomatous testicular cancer: De Ritis Ratio

PURPOSE

We aimed to show that the De Ritis Ratio (DRR) may be a new biomarker for lung metastasis in non-seminomatous Testicular Cancers (TC).

MATERIAL AND METHODS

Patients who underwent radical orchiectomy due to TC between January 2010 and January 2021 were included in the study. Demographic characteristics, preoperative laboratory and radiological findings and pathological data of the patients were recorded. The DRR was calculated from preoperative peripheral blood analysis.

RESULTS

A total of 124 patients with non-seminomatous TC were included. Mean patient age was 30.67±7.45 years, and the mean tumour diameter was 4.69±2.55 cm. 61 patients had T1, 51 had T2, and 12 had T3 disease. 42 of them had lung metastasis; 82 of them had no lung metastasis. The optimal DRR threshold was 1.21 for lung metastasis. [Area Under the Curve (AUC): 0.724 with a sensitivity of 81% and specificity of 74%]. DRR was determined as an independent prognostic factor for lung metastasis in univariate and multivariate analyses (p=0.002).

CONCLUSIONS

A high preoperative DRR can be used to detect the presence of lung metastases in non-seminomatous TCs.

A Machine Learning Algorithm for Predicting the Risk of Developing to M1b Stage of Patients With Germ Cell Testicular Cancer

Objective

Distant metastasis other than non-regional lymph nodes and lung (i.e., M1b stage) significantly contributes to the poor survival prognosis of patients with germ cell testicular cancer (GCTC). The aim of this study was to develop a machine learning (ML) algorithm model to predict the risk of patients with GCTC developing the M1b stage, which can be used to assist in early intervention of patients.

Methods

The clinical and pathological data of patients with GCTC were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Combing the patient's characteristic variables, we applied six machine learning (ML) algorithms to develop the predictive models, including logistic regression(LR), eXtreme Gradient Boosting (XGBoost), light Gradient Boosting Machine (lightGBM), random forest (RF), multilayer perceptron (MLP), and k-nearest neighbor (kNN). Model performances were evaluated by 10-fold cross-receiver operating characteristic (ROC) curves, which calculated the area under the curve (AUC) of models for predictive accuracy. A total of 54 patients from our own center (October 2006 to June 2021) were collected as the external validation cohort.

Results

A total of 4,323 patients eligible for inclusion were screened for enrollment from the SEER database, of which 178 (4.12%) developing M1b stage. Multivariate logistic regression showed that lymph node dissection (LND), T stage, N stage, lung metastases, and distant lymph node metastases were the independent predictors of developing M1b stage risk. The models based on both the XGBoost and RF algorithms showed stable and efficient prediction performance in the training and external validation groups.

Conclusion

S-stage is not an independent factor for predicting the risk of developing the M1b stage of patients with GCTC. The ML models based on both XGBoost and RF algorithms have high predictive effectiveness and may be used to predict the risk of developing the M1b stage of patients with GCTC, which is of promising value in clinical decision-making. Models still need to be tested with a larger sample of real-world data.

Role of ctDNA in Breast Cancer

Breast cancer is currently classified by immunohistochemistry. However, technological advances in the detection of circulating tumor DNA (ctDNA) have made new options available for diagnosis, classification, biological knowledge, and treatment selection. Breast cancer is a heterogeneous disease and ctDNA can accurately reflect this heterogeneity, allowing us to detect, monitor, and understand the evolution of the disease. Breast cancer patients have higher levels of circulating DNA than healthy subjects, and ctDNA can be used for different objectives at different timepoints of the disease, ranging from screening and early detection to monitoring for resistance mutations in advanced disease. In early breast cancer, ctDNA clearance has been associated with higher rates of complete pathological response after neoadjuvant treatment and with fewer recurrences after radical treatments. In metastatic disease, ctDNA can help select the optimal sequencing of treatments. In the future, thanks to new bioinformatics tools, the use of ctDNA in breast cancer will become more frequent, enhancing our knowledge of the biology of tumors. Moreover, deep learning algorithms may also be able to predict breast cancer evolution or treatment sensitivity. In the coming years, continued research and the improvement of liquid biopsy techniques will be key to the implementation of ctDNA analysis in routine clinical practice.

Examination of clinical data and semen analysis results of patients undergoing orchiectomy for testicular tumor

OBJECTIVE

Testicular tumor constitutes 1% of male neoplasms. Infertility can be determined in patients with testicular tumors before orchiectomy due to the deterioration of spermatogenesis. The aim of this study was to show the clinical, radiological, and pathological characteristics and spermiogram results of patients with testicular tumor and their relationship with each other.

METHODS

The data of patients who underwent orchiectomy due to testicular tumor between 2016 and 2019 were reviewed retrospectively. These data included sociodemographic data of the patients, pretreatment spermiogram characteristics, level of serum tumor markers, characteristics of the ultrasonography, type of orchiectomy, and histopathological examination.

RESULTS

This study included 53 male patients, with a mean age of 33.51±12.86 years. The mean levels of all tumor markers were above the reference levels. The mean tumor size was 34.68±23.32 mm. Multiple localizations and microlithiasis were detected in 11.3 and 13.2% of the tumors, respectively. The most common masses were hypoechoic (n=37; 69.8%) and hypervascular (n=47; 81%). Spermiogram and cryopreservation were performed in 29 (54.7%) of 53 patients preoperatively. The mean sperm concentration before orchiectomy was 24.21×106 /mL and group A sperm motility 0.79%, group B sperm motility 39.10%, group C sperm motility 9.83%, and group D sperm motility 22.69% in testicular tumors.

CONCLUSION

Spermatogenesis adversely affected before the treatment due to local and systemic effects of testicular cancer. Fertility expectations can be increased in the subsequent years by semen analysis and referral to cryopreservation.

Tumor markers and 18F-FDG PET/CT after orchiectomy in seminoma: Is there any correlation?

OBJECTIVE

The aim of our study was to analyze the potential relationship between tumor markers and ¹⁸F-fluorodoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) results in patients affected by seminoma.

MATERIAL AND METHODS

65 ¹⁸F-FDG PET/CT scans of 41 patients with diagnosis of seminoma were analyzed and compared to alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG). PET/CT studies were analyzed qualitatively and measuring the maximum and mean standardized uptake value body weight max (SUVbwmax, SUVbwmean), maximum SUV lean body mass (SUVlbm), maximum SUV body surface area (SUVbsa), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of hypermetabolic lesions. All values were compared with serum markers.

RESULTS

31 PET/CT studies were true negative, 28 true positive, 6 false positive and 0 false negative with sensitivity of 100%, specificity of 84%, negative predictive value of 100%, positive predictive value of 82% and accuracy of 91%. No correlation between PET results and tumor marker levels was found and also between AFP and PET/CT semiquantitive parameters. All semiquantitative PET parameters were significantly related to hCG level.

CONCLUSIONS

¹⁸F-FDG PET/CT has good accuracy in evaluating patients with relapsed seminoma. HCG levels were significantly correlated with metabolic PET/CT parameters.

Active Surveillance for Papillary Thyroid Microcarcinoma in a Population with Restrictive Diagnostic Workup Strategies

Background: The worldwide incidence of papillary thyroid carcinoma (PTC) has increased. Efforts to reduce overtreatment follow two approaches: limiting diagnostic workup of low-risk thyroid nodules and pursuing active surveillance (AS) after diagnosis of microscopic PTC (mPTC). However, most studies on AS have been performed in countries with a relatively high proportion of overdiagnosis and thus incidental mPTC. The role of AS in a population with a restrictive diagnostic workup protocol for imaging and fine-needle aspiration remains unknown. Therefore, the aim of this study was to describe the proportion and characteristics of patients with mPTC in the Netherlands and to describe the potential candidates for AS in a situation with restrictive diagnostic protocols since 2007. Methods: All operated patients with an mPTC in the Netherlands between 2005 and 2015 were identified from the Netherlands Cancer Registry database. Three groups were defined: (Group 1) mPTC with preoperative distant or lymph node metastases, (Group 2) mPTC in pathology report after thyroid surgery for another indication, and (Group 3) patients with a preoperative high suspicious thyroid nodule or proven mPTC (Bethesda 5 or 6). Only patients in Group 3 were considered potential candidates for AS. Results: A total of 1018 mPTC patients were identified. Group 1 consisted of 152 patients with preoperatively discovered metastases. Group 2 consisted of 667 patients, of whom 16 (2.4%) had lymph node metastases. There were 199 patients in Group 3, of whom 27 (13.6%) had lymph node metastases. After initial treatment in Group 3, 3.5% (7/199) of the patients had recurrence. Conclusions: Restrictive diagnostic workup strategies of patients with small thyroid nodules lead to limited patients eligible for AS and a higher incidence of lymph node metastases. We believe that there is limited additive value for AS in countries with restrictive diagnostic workup guidelines such as in the Netherlands. However, if an mPTC is encountered, AS can be offered on an individual basis.

Construction and Validation of a Nomogram for Predicting Progression- Free Survival in Patients with Early-Stage Testicular Germ Cell Tumor

BACKGROUND

Testicular Germ Cell Tumor (TGCT) is the most common malignant tumor in young men, but there is a lack of a prediction model to evaluate the prognosis of patients with TGCT.

OBJECTIVE

To explore the prognostic factors for Progression-Free Survival (PFS) and construct a nomogram model for patients with early-stage TGCT after radical orchiectomy.

METHODS

Patients with TGCT from The Cancer Genome Atlas (TCGA) database were used as the training cohort; univariate and multivariate cox analysis was performed. A nomogram was constructed based on the independent prognostic factors. Patients from the Nanfang Hospital affiliated with Southern Medical University were used as the cohort to validate the predictive ability using the nomogram model. Harrell's concordance index (C-index) and calibration plots were used to evaluate the nomogram.

RESULTS

A total of 110 and 62 patients with TGCT were included in the training cohort and validation cohort, respectively. Lymphatic Vascular Invasion (LVI), American Joint Committee on Cancer (AJCC) stage and adjuvant therapy were independent prognostic factors in multivariate regression analyses and were included to establish a nomogram. The C-index in the training cohort for 1- , 3-, and 5-year PFS were 0.768, 0.74, and 0.689, respectively. While the C-index for 1-, 3-, and 5- year PFS in the external validation cohort were 0.853, 0.663 and 0.609, respectively. The calibration plots for 1-, 3-, and 5-year PFS in the training and validation cohort showed satisfactory consistency between predicted and actual outcomes. The nomogram revealed a better predictive ability for PFS than AJCC staging system.

CONCLUSION

The nomogram as a simple and visual tool to predict individual PFS in patients with TGCT could guide clinicians and clinical pharmacists in therapeutic strategy.

Serum carcinoembryonic antigen pre-operative level in colorectal cancer: revisiting risk stratification

BACKGROUND

Biomarkers may play a role as predictive and prognostic factors in colorectal cancer patients. The aims of the study were to verify the prognostic role of pre-operative serum carcinoembryonic antigen (CEA) level in predicting overall survival and risk of recurrence in a cohort of colorectal cancer patients and to evaluate optimal cut-off values.

METHODS

A retrospective cohort analysis was performed on colorectal cancer patients undergoing elective curative surgery between 2004 and 2019 at an Italian Academic Hospital. Main outcomes were overall survival, disease-free survival at 3-years and risk of local, loco-regional and distant recurrence during follow-up. A receiver operating characteristic (ROC) curve analysis was plotted using CEA pre-operative values and follow-up data in order to estimate the optimal cut-off values.

RESULTS

A total of 559 patients were considered. The mean CEA value was 12.1 ± 54.1 ng/mL, and the median 29.3 (0-4995) ng/mL. The ROC curve analysis identified 12.5 ng/mL as the best CEA cut-off value to predict the risk of metastatic development after surgery in stage I-III colorectal cancer patients, and 10 ng/mL as the best CEA cut-off value to predict overall survival and disease-free survival in stage III-IV patients. These data suggest a stratification of colorectal cancer patients in three classes of risk: a low risk class (CEA <10 ng/mL), a moderate risk class (CEA 10-12.5 ng/mL) and a high risk class (CEA >12.5 ng/mL).

CONCLUSION

In conclusion, pre-operative serum CEA measurements could integrate information to enhance patient risk stratification and tailored therapy.

Long-term survival after head and neck cancer surgery with immediate free flap reconstruction

BACKGROUND

Head and neck cancer is one of the most frequent cancers worldwide. A combination treatment including surgery is known to have a better survival rate than exclusive radiotherapy-chemotherapy. In extreme cases of non-metastatic patients who have voluminous tumor, or complex location, surgery with immediate reconstruction by free flap could be an option to improve long term survival.

PURPOSE

To share experience of long-term survival of patients with head and neck cancer who underwent oncologic surgery with immediate free flap reconstruction, and to analyze influencing factors.

METHODS

All consecutive patients treated with free flaps for reconstruction of extensive defects after resection of head and neck cancer in our center (Nancy, France) were retrieved from the hospital database. Data was recorded in a systematic way. Bivariate and multivariate Cox proportional hazards models were used for statistical analysis.

RESULTS

Between 1997 and December 2007, 70 patients underwent surgical resection of head and neck tumor with free flap reconstruction. 11 patients were excluded because of missing data. Follow-up time was 7.4 years, IQR from 4.3 to 11.3. Overall survival was 53.8%, 95% CI [39.9%; 65.8%] at 5 years and 38.6% [24.8%; 52.3%] at 10 years. Age>60 years at the surgery HR 2,373 (1,143; 4,927) and TNM score 3-4 HR 2,524 (1,093; 5,828) were statistically associated to a lesser survival rate.

CONCLUSION

The ability to successfully and safely perform free flaps increases treatment options for patients with advanced head and neck cancer in a selected population. it seems worthwhile to perform these microvascular reconstructions.

Tumor markers and18F-FDG PET/CT after orchiectomy in seminoma:Is there any correlation?

OBJECTIVE

The aim of our study was to analyze the potential relationship between tumor markers and ¹⁸F-fluorodoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) results in patients affected by seminoma.

MATERIAL AND METHODS

65 ¹⁸F-FDG PET/CT scans of 41 patients with diagnosis of seminoma were analyzed and compared to alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG). PET/CT studies were analyzed qualitatively and measuring the maximum and mean standardized uptake value body weight max (SUV_bwmax, SUV_bwmean), maximum SUV lean body mass (SUV_lbm), maximum SUV body surface area (SUV_bsa), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of hypermetabolic lesions. All values were compared with serum markers.

RESULTS

31 PET/CT studies were true negative, 28 true positive, 6 false positive and 0 false negative with sensitivity of 100%, specificity of 84%, negative predictive value of 100%, positive predictive value of 82% and accuracy of 91%. No correlation between PET results and tumor marker levels was found and also between AFP and PET/CT semiquantitive parameters. All semiquantitative PET parameters were significantly related to hCG level.

CONCLUSIONS

¹⁸F-FDG PET/CT has good accuracy in evaluating patients with relapsed seminoma. hCG levels were significantly correlated with metabolic PET/CT parameters.

Intricacies of Radiographic Assessment in Testicular Germ Cell Tumors

Testicular germ cell tumors (GCTs) are malignancies with a unique biology, pathology, clinical appearance, and excellent outcomes. A correct radiographic assessment of GCTs is extremely important for the clinical management in several typical scenarios. Advancements in the field of diagnostic medicine bring an increasing number of sophisticated imaging methods to increase the performance of imaging studies. The conventional computed tomography (CT) remains the mainstay of diagnostic imaging in the management of GCTs. While certain improvements in the sensitivity and specificity are suggested with magnetic resonance (MR) imaging with lymphotrophic nanoparticles in evaluating retroperitoneal lymph nodes during the staging procedure, further exploration in larger prospective studies is needed. A common diagnostic dilemma is assessing the post-chemotherapy residual disease in GCTs. Several studies have consistently shown advantages in the utility of positron emission tomography (PET) scanning in post-chemotherapy residual retroperitoneal lymph nodes in patients with seminoma, but not with non-seminoma. Recommendations suggest that seminoma patients with a residual disease in the retroperitoneum larger than 3 cm should be subjected for PET scanning with 18-fluorodeoxyglucose. Relatively high sensitivity, specificity and a negative predictive value (80-95%) may guide clinical decision to spare these patients of high morbidity of an unnecessary surgery. However, a positive predictive value of around 50% renders PET scanning difficult to interpret in the case of positive finding. These patients often require extremely difficult surgical procedures with the high risk of post-operative morbidity. Therefore, seminoma patients with PET positive residual masses larger than 3 cm still remain a serious challenge in the decision making of nuclear medicine specialist, oncologists, and urologic surgeons. In this article, we aim to summarize data on controversial dilemmas in staging procedures, active surveillance, and post-chemotherapy assessment of GCTs based on the available published literature.

A Topic Modeling Analysis of TCGA Breast and Lung Cancer Transcriptomic Data

Topic modeling is a widely used technique to extract relevant information from large arrays of data. The problem of finding a topic structure in a dataset was recently recognized to be analogous to the community detection problem in network theory. Leveraging on this analogy, a new class of topic modeling strategies has been introduced to overcome some of the limitations of classical methods. This paper applies these recent ideas to TCGA transcriptomic data on breast and lung cancer. The established cancer subtype organization is well reconstructed in the inferred latent topic structure. Moreover, we identify specific topics that are enriched in genes known to play a role in the corresponding disease and are strongly related to the survival probability of patients. Finally, we show that a simple neural network classifier operating in the low dimensional topic space is able to predict with high accuracy the cancer subtype of a test expression sample.

Radical inguinal orchidectomy: the gold standard for initial management of testicular cancer

Radical inguinal orchidectomy with division of the spermatic cord at the internal inguinal ring is the gold standard for diagnosis and local treatment of testicular malignancies. The technique is well established and described in detail in this paper, collating methods from various surgical textbooks and articles. We also discuss pre-operative considerations including fertility counselling and potential testicular prosthesis at time of orchidectomy, and the importance of contemplating differential diagnoses such as para-testicular sarcoma and primary testicular lymphoma (PTL) prior to performing radical orchidectomy (RO). The evidence and indications for new surgical techniques to treat local testicular malignancies are also described, including testis sparing surgery (TSS) and spermatic cord sparing orchidectomy.

Unusual case of classic testicular seminoma in a 90-year-old patient: a case report

BACKGROUND

Seminoma is the most common subtype of testicular cancer and occurs most commonly in patients aged 30-49 years, but decreases to a very low level in men in their 60s or older.

CASE PRESENTATION

A 90-year-old Syrian man with a 6-year history of an increase in size of his right scrotum, presented to the urological clinic and, on clinical examination, the findings suggested testicular tumor. After orchiectomy and histology results based on microscopic and immunohistochemical examinations, a pure seminoma was diagnosed, so we describe in this case report the second-oldest patient with classical seminoma in the medical literature.

CONCLUSION

This case report has been written to focus on the probability of any type of testicular tumor occurring at any age or decade; urologists should consider seminoma as a differential diagnosis with any testicular swelling even in elderly patients.

The role of partial orchidectomy in the management of small testicular tumours: Fertility and endocrine function

BACKGROUND

Radical orchidectomy in patients who are subsequently diagnosed with benign testicular tumours represents an overtreatment due to the deleterious effects on endogenous testosterone, fertility and body image. For these reasons, the option of partial orchidectomy (PO) should be considered in certain groups of patients. Patients with bilateral tumours (synchronous or metachronous) or a solitary testis where the lesion is no greater than 30% of the volume of the testis could be considered for a PO. Evidence has shown that PO is effective for small testicular masses with excellent survival and recurrence rates.

OBJECTIVES

Highlight the feasibility of maintaining post-operative fertility or normal semen parameters and endocrine function following PO.

MATERIALS AND METHODS

Data for this review were obtained through a search of the PubMed database. Papers were required to be in English and focus on adult human males.

RESULTS

Eligible and relevant papers were assessed for data regarding fertility, semen parameters and endocrine function following PO for a small testicular mass (STM).

CONCLUSION

It is possible to preserve both fertility and endocrine function after PO. Although patients may still require adjuvant radiotherapy for concomitant intratubular germ cell neoplasia (ITGCN) which results in subfertility, endocrine function is still conserved. However, it is possible to postpone radiotherapy and continue with clinical surveillance for the purposes of fertility preservation.

MeCP2 inhibits proliferation and migration of breast cancer via suppression of epithelial-mesenchymal transition

Methyl‐CpG‐binding protein 2 (MeCP2) is an important epigenetic regulator for normal neuronal maturation and brain glial cell function. Additionally, MeCP2 is also involved in a variety of cancers, such as breast, prostate, lung, liver and colorectal. However, whether MeCP2 contributes to the progression of breast cancer remains unknown. In the present study, we investigated the role of MeCP2 in cell proliferation, migration and invasion in vitro. We found that knockdown of MeCP2 inhibited expression of epithelial‐mesenchymal transition (EMT)‐related markers in breast cancer cell lines. In conclusion, our study suggests that MeCP2 inhibits proliferation and invasion through suppression of the EMT pathway in breast cancer.

Age-specific cancer rates: a bird's-eye view on progress

PURPOSE

We aim to shed light on progress in cancer medicine through studying time trends in age-specific rates of cancer incidence and mortality over the last quarter century.

METHODS

We analyzed age-specific incidence and mortality rates of all cancer sites combined using the high-quality population-based databases of Denmark, Finland, Norway, Sweden, and the Netherlands for the period 1990-2016.

RESULTS

Over these 26 years, cancer incidence rates increased in all investigated countries irrespective of age by about 22%. By contrast, cancer mortality rates decreased across all ages, also by about 22%, except ages 80+ years in Denmark, Norway, and Sweden, where they remained unchanged. This pattern is consistent with earlier diagnoses and more effective treatments of cancer.

CONCLUSIONS

This bird's-eye view on cancer reveals substantive progress in cancer medicine.

The prognostic value of the neutrophil-to-lymphocyte ratio in patients with testicular cancer

OBJECTIVES

To evaluate the potential prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in testicular cancer.

MATERIALS AND METHODS

80 patients with testicular cancer treated at our institution from 2005 to 2018 were retrospectively reviewed. Age, tumor markers, stage and histotype at final pathology, eventual medical treatment, tumor recurrence and follow-up data were extracted. The NLR was retrospectively calculated from blood tests. Data were analyzed by medians comparison, linear correlation, univariate and multivariate Cox regression and survival curve analysis.

RESULTS

Population's median age was 33 years and median follow-up was 40.5 months. Overall, the median NLR was significantly reduced after orchiectomy (2.2 [1.55-3.09] vs. 1.77 [1.34-2.46], M-W P<0.001). Post-orchiectomy NLR was higher in patients who had disease recurrence (2.51;IQ 1.84-3.74 vs 1.59; IQ 1.10-2.24; M-W P=0.001), regardless of disease's stage: HR=1,85 (95%CI 0,99-3,46) and HR=1,91 (95%CI 0,96-3,78) for stage disease I or stage II, respectively. After stratification of patients by post-orchiectomy NLR (optimal cut-off: 2.255), patients with lower NLR had significantly longer recurrence-free survival (107.7 months [95%CI 97,7-119,2] vs. 57.65 months [95%CI 48,2-81,1], P<0.001). Univariable and multivariable Cox proportional hazard analyses, showed post-orchiectomy NLR, histotype at final pathology and disseminated disease at diagnosis as predictors of recurrence.

CONCLUSION

NLR is a simple and wildly available biomarker. Higher post-orchiectomy NLR was found independently correlated to higher risk of recurrence, regardless of disease stage, which could potentially lead to a worse prognosis.

Bilateral Synchronous Testicular Germ Cell Tumors in Children: Case Report and Review of the Literature

Bilateral testicular tumors are very rare in pediatric patients and only a few case reports have been reported. These patients have a high risk of sterility due to bilateral orchiectomy and subsequent gonadotoxic treatments. Therefore, if possible, testis-sparing surgery should be performed in patients with benign masses and testicular tissue preservation may be recommended in order to maintain fertility in later life. We present a 23 months old boy with synchronous bilateral testicular tumor managed with unilateral orchiectomy and testis-sparing surgery and testicular tissue cryopreservation performed to the controlateral side. We also review the literature on bilateral testis tumors in children.

Prognosis of Patients With Testicular Carcinoma Is Dependent on Metastatic Site

Background: Existing data on the association of metastatic sites and prognosis of patients with metastatic testicular malignancy are limited. In this study, the association of survival outcome and the prognostic value of different metastatic sites in patients with metastatic testicular cancer was investigated.

Methods: A dataset from the Surveillance, Epidemiology and End Results (SEER) survey was selected for a retrospective metastatic testicular cancer cohort study. Patients with different metastatic sites were divided into corresponding groups for further analysis. Kaplan-Meier analysis with log-rank test was implemented for comparison of the survival distribution of cases. Multivariate Cox regression models were then applied to analyze the association of distant metastases with survival for all selected patients and subgroup based on different histological type with a single metastatic site.

Results: A total of 1,661 patients treated for metastatic testicular malignant tumors between 2010 to 2016 were enrolled in this cohort study. Upon initial diagnosis, 61.9, 15.2, 6.7, 6.4, and 36.2% of patients were found to have lung, liver, bone, brain, and distant lymph nodes metastatic sites, respectively. Patients with lung, liver, or bone metastases showed more undesirable prognosis for overall survival (OS) and cancer-specific survival (CSS), in contrast with those with distant lymph node metastases (all P < 0.05). In comparison with patients with more than one metastatic site, those with a single metastasis had extended OS and CSS (both P < 0.001). In patients with a single metastatic site, Kaplan-Meier analysis and multivariate Cox regression demonstrated the association of bone and liver with the worst two groups of OS and CSS. Multivariate Cox models based on histological type showed different prognostic values of metastases in patients with seminoma or non-seminomatous germ cell tumors.

Conclusion: There is much heterogeneity in the oncological outcome of site-specific metastatic patients. Metastatic profiles and the prognostic value of metastases are dependent on the histological type in TC patients. Distant lymph nodes and lung metastases indicate favorable prognostic factors, while bone and liver metastases indicate negative survival outcomes in TC.

Molecular classification of breast cancer: A retrospective cohort study

OBJECTIVES

The study was aimed to determine the distribution of various breast cancer molecular subtypes in Saudi Arabia. Further, association between these subtypes and different epidemiological features was assessed.

METHODS

A retrospective study was conducted between January 2012 and December 2018, at the King Abdul Aziz University Hospital. A total of 740 cases of breast cancer, using immunohistochemistry, were classified into 4 major molecular subtypes: luminal A, luminal B, HER2-positive, and triple negative. Chi-squared test was performed to evaluate the relationship between these subtypes and clinico-pathological features.

RESULTS

Luminal A (58.5%) subtype was the most prevalent, followed by triple negative (16%), luminal B (14%), and HER2-positive (11.5%). The average age of the patient at the time of diagnosis was found to be 49 years with an average tumor size of 3.2 cm. Out of all cases, 85% of cases were ductal, while 11.4% were lobular. 66.6% showed axillary lymph node metastases. While, 77% of lobular carcinomas were found almost exclusively in the luminal A and triple negative tumor subtype, 69.5% had modified radical mastectomy.

CONCLUSIONS

Luminal A tumor was the most prevalent subtype, while HER2-positive was the least prevalent. Luminal A tumors were mostly associated with lobular carcinomas. HER2-positive and triple negative tumors showed higher histological grade and larger tumor size at the time of diagnosis. These tumors were commonly found in women below the age of 50 years. Carcinoma-in-situ was less prevalent in HER2-positive tumors. Furthermore, a strong association was observed between axillary lymph node status and molecular subtypes.

Breast radiotherapy in elderly women: myths, controversies, and current techniques in the adjuvant setting

In developed countries, breast cancer (BC) is the most common type of cancer in women, mainly affecting patients over age 60. Due to the increasing life expectancy and population ageing, the incidence of BC is expected to increase significantly in the coming years. However, no standardized clinical guidelines are available to assist in decision-making in elderly patients. Moreover, there is a lack of quality scientific evidence to guide treatment selection in this patient population, who are underrepresented in clinical trials. Consequently, up to 50% of elderly women are treated suboptimally, which implies a worse prognosis and survival. Given that the current estimated life expectancy of a healthy 70-year-old woman is 15 years, any treatment capable of reducing the likelihood of disease recurrence and cancer-specific mortality in this patient population would be beneficial. Adjuvant radiotherapy (RT) is one of the pillars of treatment for BC and it plays a key role in improving local control (LC) and overall survival (OS). Adjuvant RT is clearly indicated in young patients who undergo breast-conserving surgery (BCS) as well as in high risk patients, regardless of age. However, the use of adjuvant RT in older patients with early-stage disease has decreased in recent years-even in patients who undergo BCS-due to outdated concerns about the possible side effects of RT and reports suggesting that RT can be omitted in low-risk patients. One of the greatest challenges currently facing radiation oncologists who specialise in the treatment of BC is the selection of elderly patients who are likely to benefit from adjuvant RT. There is also a clear need to critically evaluate the available evidence and to apply those findings to routine clinical practice. Given this context, the aim of the present review is to clarify the current role of adjuvant RT in the management of BC in older women-particularly those with early-stage disease-and to dispel the myths surrounding the use of RT to treat elderly women. This review primarily focuses on the indications, controversies, and irradiation techniques used in this patient subgroup.

TGF-β and microRNA Interplay in Genitourinary Cancers

Genitourinary cancers (GCs) include a large group of different types of tumors localizing to the kidney, bladder, prostate, testis, and penis. Despite highly divergent molecular patterns, most GCs share commonly disturbed signaling pathways that involve the activity of TGF-β (transforming growth factor beta). TGF-β is a pleiotropic cytokine that regulates key cancer-related molecular and cellular processes, including proliferation, migration, invasion, apoptosis, and chemoresistance. The understanding of the mechanisms of TGF-β actions in cancer is hindered by the "TGF-β paradox" in which early stages of cancerogenic process are suppressed by TGF-β while advanced stages are stimulated by its activity. A growing body of evidence suggests that these paradoxical TGF-β actions could result from the interplay with microRNAs: Short, non-coding RNAs that regulate gene expression by binding to target transcripts and inducing mRNA degradation or inhibition of translation. Here, we discuss the current knowledge of TGF-β signaling in GCs. Importantly, TGF-β signaling and microRNA-mediated regulation of gene expression often act in complicated feedback circuits that involve other crucial regulators of cancer progression (e.g., androgen receptor). Furthermore, recently published in vitro and in vivo studies clearly indicate that the interplay between microRNAs and the TGF-β signaling pathway offers new potential treatment options for GC patients.

Differentiated thyroid carcinoma: a 5-years survival study at a referral hospital in Brazil

BACKGROUND

Although the prognosis of differentiated thyroid carcinoma (DTC) therapy is considered excellent over time, some cases have a poorer prognosis and evolve into death.

OBJECTIVE

This study aimed to estimate the 5-year specific survival and to identify prognosis factors in a cohort of DTC adult subjects.

METHODS

Survival probability was estimated by Kaplan-Meier's method in a retrospective hospital-based cohort study. Comparisons were made by log-rank test. Prognosis factors were identified using Cox risk modeling and crude and adjusted Hazard Ratio measures were obtained. Two models were estimated, considering age grouping of the 7th and 8th editions of TNM.

RESULTS

Specific 5-year survival in the cohort was 98.5% (95%CI: 94.2 - 97.5). Considering TNM 7th edition, the risk estimates were 9.88 (95%CI: 1.67 - 58.33) for age group ≥ 55 years, 18.87 (95%CI: 7.38 - 48.29) for individuals with distant metastasis, 6.36 (95%CI: 2.26 - 17.91) for patients who underwent lymphadenectomy and 0.16 (95%CI: 0.06 - 0.43) for those who received radioiodine therapy. For TNM 8th edition, the risk estimates were 10.12 (95%CI: 2.05 - 50.09) for age group ≥ 55 years, 12.43 (95%CI: 4.58 - 33.77) for individuals with distant metastasis, 5.06 (95%CI: 1.82 - 14.05) for patients who underwent lymphadenectomy and 0.19 (95%CI: 0.07 - 0.51) for those who received radioiodine therapy.

CONCLUSIONS

This cohort had a very high survival over a 5-year period. The prognosis was negatively influenced by age, distant metastasis and lymphadenectomy, whereas radioiodine therapy was found to be protective.

The Exosome And Breast Cancer Cell Plasticity

Cancer cell plasticity is the ability of cancer cells to reversibly interchange between distinct cell status, which plays a key role in cancer progression. Cancer cell plasticity is now known to be shaped by the secreted nanoparticles termed exosomes which transport proteins and lipids as well as nucleic acids. These aspects have emerged as key determinants of tumor progression and targeting, with approaches such as immunotherapy showing promise in the clinic. While significant strides have been made in this research area, some very interesting questions still warrant more and deeper investigation. We provide a review of the interplay between exosomes and breast cancer cell plasticity, and the potential implication in metastases and drug-resistance.

Epidemiology and unmet needs of bladder cancer in Italy: a critical review

Bladder cancer is one of the most frequent cancers in high-income countries. Information on bladder cancer in Italy is scattered across scientific literature and institutional and educational resources and no attempt has been made yet to organize and summarize this information across various sources of available data. We, therefore, present herein a critical literature review of recent epidemiological and healthcare data, including patients' unmet needs. We undertook a critical review of the scientific and grey literature by exploring several different databases and search browsers. Available official statistics indicate a high burden of bladder cancer in Italy, where this neoplasm has one of the highest incidences worldwide and, in consideration of its relatively high survival, it ranks 4th in cancer prevalence. The limited therapeutic options for muscle-invasive and advanced/metastatic urothelial cancer are one of the major unmet needs for patients with this neoplasm, in Italy and worldwide. Advances in cancer immunotherapy and in understanding molecular biology of bladder cancer are, however, rapidly altering the therapeutic landscape for targeted subgroups of patients with advanced/metastatic disease. Other unmet needs include the low quality of life after radical cystectomy, the lack of widespread clinical pathway schemes to improve and standardize the quality of care and low Italian patients empowerment. Bladder cancer represents a health burden in Italy, with high incidence and prevalence rates, and important unmet needs for patients, including the limited therapeutic options for advanced/metastatic cancers, the low quality of life after radical cystectomy, the lack of widespread clinical pathway schemes, and the low patients empowerment.

CREB1/Lin28/miR-638/VASP Interactive Network Drives the Development of Breast Cancer

Breast cancer is one of the most common malignant tumors worldwide. Metastasis remains the leading cause of death in breast cancer patients. Research on the mechanism of breast cancer metastasis has become a core issue in breast cancer research. Our previous series of studies have shown that VASP, as a key oncogene, plays an important role in the development of various tumors such as breast cancer. In this study, we find that miR-638 can target to inhibit VASP expression, and Lin28 acts as an RNA-binding protein to regulate the processing of miR-638, which inhibits its maturation and promotes the expression of VASP. In addition, we also find that CREB1 acts as a transcription factor that binds to the promoter of Lin28 gene and activates the Lin28/miR-638/VASP pathway. Furthermore, CREB1 can also directly bind to the promoter of VASP, and activate VASP expression, forming a CREB/Lin28/miR-638/VASP interactive network, which plays an important role in promoting cell proliferation and migration in breast cancer. Our study explained the mechanism of CREB1/Lin28/miR-638/VASP network promoting the development of breast cancer, which further elucidated the mechanism of VASP as a key oncogene, and also provided a theoretical basis for expanding new approaches to tumor biotherapy.

Distribution of psychological distress is stable in recent decades and follows an exponential pattern in the US population

The prevalence of psychological distress is fairly stable in industrialised countries in recent decades, but the reasons for this stability remain unknown. To investigate the mechanisms underlying stability of psychological distress in the general population of the United States, we analysed the mathematical patterns of the distribution of psychological distress in recent decades. The present study utilised the Kessler psychological distress scale (K6) data from the 1997‒2017 United States National Health Interview Survey. We used overlap coefficients and graphical analysis to investigate the stability and mathematical patterns of the K6 distribution. Overlap coefficients and graphical analysis demonstrated that the distribution of K6 total scores was stable in the United States over the past two decades. Furthermore, the distributions of K6 total scores exhibited an exponential pattern, with the exception of the lower end of the distribution. These findings suggest that the lack of change in the prevalence of psychological distress over several decades is due to the stability of psychological distress distribution itself. Furthermore, the stability of the distribution of psychological distress over time may be linked to the exponential pattern of psychological distress distribution.

Trends in Breast Cancer Incidence and Stage Distribution Before and During the Introduction of the Mammography Screening Program in Lithuania

Background:

The aim of this study was to analyze the incidence trends of localized and advanced breast cancer (BC) before and during the implementation of the mammography screening program (MSP) in Lithuania.

Methods:

The study period was divided into 2 intervals: the prescreening period (1998-2005) and implementation period (2006-2012). Analysis was performed for 3 age-groups: 0 to 49 years, 50 to 69 (target population), and older than 70.

Results:

In all age-groups, the incidence of localized BC has shown a steady increase, while the incidence of advanced stage BC has decreased. In the target population, during the study period, the stage I BC incidence increased statistically significantly by 10.3% per year (from 3.3 per 100 000 in 1998 to 12.2 per 100 000 in 2012). The increase in localized BC was faster in the period before the implementation of the MSP than during the implementation in 2006 to 2012 (10.3% and 5.7%). A slightly statistically significant decrease was observed for advanced BC during the study period (−1.1% per year), while during the implementation of the MSP, significant changes were not seen.

Conclusions:

The results of our study indicate that the implementation of the MSP in Lithuania did not significantly influence trends of localized and advanced BC. Changes observed during the study period, including the prescreening and screening introduction periods, may reflect the general trends in the awareness of BC and improvements in diagnostics.

Global Trend of Breast Cancer Mortality Rate: A 25-Year Study

Background:

breast cancer is the most common cause of cancer death for women worldwide. In the past two decades, published epidemiological reports in different parts of the world show significant increase in breast cancer mortality rate. The aim of this study was to determine the 25-year trend of breast cancer mortality rate in 7 super regions defined by the Health Metrics and Evaluation (IHME), i.e. Sub-Saharan Africa, North Africa and Middle East, South Asia, Southeast Asia and East Asia and Oceania, Latin America and Caribbean, Central Europe and Eastern Europe and Central Asia, High-income.

Methods:

Our study population consisted of 195 world countries in the IHME pre-defined seven super regions. The age-standardized mortality rates from 1990 to 2015 were extracted from the IHME site. The reference life table for calculating mortality rates was constructed based on the lowest estimated age-specific mortality rates from all locations with populations over 5 million in the 2015 iteration of GBD. To determine the trend of breast cancer mortality rate, a generalized linear mixed model was fitted separately for each IHME region and super region.

Results:

Statistical analysis showed a significant increase for breast cancer mortality rate in all super regions, except for High-income super region. For total world countries, the mean breast cancer mortality rate was 13.77 per 100,000 in 1990 and the overall slope of mortality rate was 0.7 per 100,000 from 1990 to 2015. The results showed that Latin America and Caribbean the highest increasing trend of breast cancer mortality rate during the years 1990 to 2015 (1.48 per 100,000).

Conclusion:

In general, our finding showed a significant increase in breast cancer mortality rate in the world during the past 25 years, which could be due to increase in incidence and prevalence of this cancer. Low this increasing trend is an alarm for health policy makers in all countries, especially in developing countries and low-income regions which experienced sharp slopes of breast cancer mortality rate.

[Stage 1 germ-cell tumour]

Stage I germ-cell tumors are rare and highly curable diseases. As such, management of these tumours should carefully follow guidelines. Initial management is based on orchiectomy and several options as adjuvant therapy. Pro's and con's should be discussed with the patient for a personalized management. Patients with stage 1 germ-cell tumours should be addressed to expert centers.

Impact of increased aspartate aminotransferase to alanine aminotransferase (De Ritis) ratio in prognosis of testicular cancer

Purpose

Imaging studies can show metastasis in testicular cancer (TCa); however, a test for risk of metastasis in TCa has not been described. The ratio of aspartate aminotransferase to alanine aminotransferase, also called the De Ritis ratio (DRR), is used for many other malignancies. We aimed to evaluate the association between preoperatively assessed DRR and prognosis in patients with TCa.

Materials and Methods

One hundred twenty-eight patients with TCa were enrolled in a retrospective study between March 2007 and January 2017. Clinical, biochemical, and pathological data were recorded. Univariate and multivariate logistic regression analyses were used. The prognostic value of DRR and the threshold value were assessed by use of receiver operating characteristic curves. Significance was defined as p<0.05.

Results

Mean follow-up was 37±9.7 months. There were 45 and 73 TCa patients with and without lymph node metastasis, respectively. Lung metastases and other solid organ metastases occurred in 14 and 4 patients, respectively. The optimal DRR threshold was 1.30 for both retroperitoneal lymph node involvement and metastasis. DRR was determined as an independent prognostic factor for retroperitoneal lymph node involvement and organ metastasis in univariate and multivariate analyses (p<0.001, p=0.006 and p=0.002, p=0.047, respectively).

Conclusions

A preoperative DRR greater than 1.30 may be an independent risk factor for retroperitoneal lymph node involvement and organ metastases in patients with TCa.

How to estimate mortality trends from grouped vital statistics

Background

Mortality data at the population level are often aggregated in age classes, for example 5-year age groups with an open-ended interval for the elderly aged 85+. Capturing detailed age-specific mortality patterns and mortality time trends from such coarsely grouped data can be problematic at older ages, especially where open-ended intervals are used.

Methods

We illustrate the penalized composite link model (PCLM) for ungrouping to model cancer mortality surfaces. Smooth age-specific distributions from data grouped in age classes of adjacent calendar years were estimated by constructing a two-dimensional regression, based on B-splines, and maximizing a penalized likelihood. We show the applicability of the proposed model, analysing age-at-death distributions from cancers of all sites in Denmark from 1980 to 2014. Data were retrieved from the Danish Cancer Society and the Human Mortality Database.

Results

The main trends captured by PCLM are: (i) a decrease in cancer mortality rates after the 1990s for ages 50–75; (ii) a decrease in cancer mortality in later cohorts for young ages, especially, and very advanced ages. Comparing the raw data by single year of age, with the PCLM-ungrouped distributions, we clearly illustrate that the model fits the data with a high level of accuracy.

Conclusions

The PCLM produces detailed smooth mortality surfaces from death counts observed in coarse age groups with modest assumptions, that is Poisson distributed counts and smoothness of the estimated distribution. Hence, the method has great potential for use within epidemiological research when information is to be gained from aggregated data, because it avoids strict assumptions about the actual distributional shape.

Squamous Cell Carcinoma Developing from a Testicular Epidermal Cyst: A Case Report and Literature Review

A 50-year-old Japanese man with a two-year history of a painless right scrotal mass visited our hospital. Considering laboratory findings and computed tomography, the patient was diagnosed with an uncharacteristic testicular tumor. No metastases were present on radiographic study at the first visit. Emergent high radical orchiectomy was performed, and the tumor was identified as a squamous cell carcinoma (SCC) of a testicular epidermal cyst. He is alive without recurrence or metastasis six months after surgery. Testicular SCC is an extremely rare tumor. This is the third case of testicular SCC associated with an epidermal cyst in English literature.