The Prognostic Significance of Pretreatment White Blood Cell and Platelet Counts for Survival Outcome in Primary Lung Cancer

Background

In Vietnam, lung cancer ranks second among common types of cancer. Although there have been many advances in the diagnosis and treatment of lung cancer, it is still one of the deadliest types of cancer.

Objective

We investigated the prognostic value of pretreatment white blood cell (WBC) and platelet counts of patients with lung cancer.

Methods

This was a prospective, descriptive study with longitudinal follow-up. Data from 203 patients with stage IIIA-IV lung cancer presenting at Can Tho City Oncology Hospital between June 2020 and June 2022 were analyzed. Complete blood cell counts were obtained using standard methods. Lung cancer diagnoses and histological classifications were obtained from cancer registries. The optimal overall survival cutoff point for pretreatment WBC and platelet counts was determined using maximally selected rank statistics.

Results

The median follow-up was 6 (interquartile range 4-8) months and the median age was 61.3 years. The number of male patients was higher than the number of female patients. Most (71.4%) patients had adenocarcinoma; 62.1% of the patients had a WBC count of > 10 × 109/L and 38.4% had a platelet count of > 400 × 109/L. The median overall survival (OS) of all patients was 8 months. The 3-month, 6-month, and 1-year OS was 88.7%, 62.4%, and 28.3%, respectively. Patients with a WBC count of <9.18 × 109/L had a higher OS than those with a count of ≥ 9.18 × 109/L (17 months versus 8 months; p < 0.001) Patients with a platelet count of < 453 × 109/L had a higher OS than those with a count of ≥ 453 × 109/L (8 months versus 7 months; p < 0.001).

Conclusion

White blood cell and platelet count tests are routine investigations that are valuable, in combination with other factors, for predicting OS of lung cancer patients. They can help clinicians to monitor treatment response and survival.

Level-2 Oncoplastic Surgical Techniques for Breast Cancer: A Preliminary Vietnamese Report

Background

Breast cancer is the most common malignancy and remains the first cause of death related to cancer among Vietnamese women, with an incidence of 21,555 cases in 2020. Most breast cancer patients present with invasive disease and relatively large tumor sizes. While oncoplastic surgery (OPS) are commonly applied in Western countries, data on Asian population remains relatively limited.

Objective

This study aims to assess the outcomes of level-2 oncoplastic techniques in breast-conserving surgeries at the Vietnam National Cancer Hospital.

Methods

From January 2017 to June 2021, a cohort of 257 breast cancer patients who underwent breast-conserving surgery with OPS techniques were examined. Surgical complications, cosmetic outcome, recurrence and survival rates were assessed.

Results

The mean age was 47.6±9.4 years, most patients had breast cup sizes B and C. The mean tumor size upon pathological examination was 2.00 ± 0.74 cm. Only 7 cases required reoperation, resulting in a mastectomy rate of 1.17%. The overall complication rate was low at 11.46%, with 9 cases (3.56%) experiencing delayed complications. Cosmetic results were rated as "excellent" in 20.6% and "good" in 60.5%, with a statistically significant difference. The rates of local recurrence, regional recurrence, and distant metastasis at five years were 2.78%, 1.19%, and 2.36%, respectively.

Conclusion

The level 2 oncoplastic techniques had low complication rates, favorable oncological outcomes, and cosmetically satisfying results.

Relationship between PET/CT images and KRAS gene mutations in colorectal cancer in Vietnamese patients

OBJECTIVE

We conducted this study to determine the relationship among standardized uptake value (SUV), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) indexes of Flourine-18 fluorodeoxyglucose positron emission tomography/computed tomography18 (FDG-PET/CT) imaging and Kirsten rat sarcoma (KRAS) gene mutations in colorectal cancer (CRC).

PATIENTS AND METHODS

This cross-sectional study was conducted in Bach Mai Hospital from 2020 to 2022. It included newly diagnosed CRC patients who underwent PET/CT examination prior to primary tumor resection. The maximum SUV (SUVmax - SUVmean), MTV, and TLG were considered. All pathologically confirmed CRC patients were accepted with further KRAS mutation status analysis.

RESULTS

We enrolled 63 newly diagnosed CRC patients who underwent PET/CT examination prior to primary tumor resection. Among them, 31 (49.2%) patients had KRAS gene mutation. Patients with KRAS mutation status showed significantly different and higher SUVmax (p-value = 0.025), SUVmax t/b (p-value = 0.013), SUVmax t-b (p-value = 0.014), MTV (p-value = 0.023), and TLG (p-value = 0.011) than patients with WT KRAS. Other characteristics, including age, gender, tumor location, SUVb, SUVmean, SUVmax of lymph nodes, and SUVmax of liver metastasis, were insignificantly different between the two groups of patients with KRAS mutation status. Receiver operating curve analysis showed that the area under the curve was 0.672 for SUVmax (p-value = 0.019), SUVt/b (p-value = 0.045), and SUVt-b (p-value = 0.020).

CONCLUSIONS

We observed a relationship, considering the quantitative parameters (SUVmax, SUVmax, SUVmax t-b, MTV, and TLG), between 18FDG-PET/CT images and the KRAS gene mutation in CRC by analyzing 63 patients prior to treatment.

Prognostic Significance of PD-L1 Expression and Standardized Uptake Values in the Primary Lesions of Stage IV Adenocarcinoma Lung Cancer

Background

This study evaluated the prognostic ability of ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET)/computed tomography (CT) in patients with stage IV adenocarcinoma lung cancer to detect protein death-ligand 1 (PD-L1) expression levels.

Methods

In total, 86 patients with stage IV adenocarcinoma lung cancer underwent ¹⁸F-FDG PET/CT imaging and PD-L1 expression evaluation before treatment from February 2019 to November 2020 at Bach Mai Hospital, Hanoi, Vietnam. The assessed patient characteristics in this study included sex, age, smoking status, epidermal growth factor receptor (EGFR) mutation, PD-L1 expression level, survival status, tumor, node, and metastasis (TNM) stage, and metastasis locations.

Results

The average age was 62.23 ± 9.51 years, and men and women represented 67.4% and 32.6% of the population, respectively. The EGFR mutation rate was 36%. PD-L1 expression was negative (detected in <1% of the tumor) in 40.7% of cases and positive in 59.3% of cases (detected in 1–49% of the tumor in 32.6%; detected in ≥50% of the tumor in 26.7%). The mean maximum standardized uptake value (SUV_max) was 11.09 ± 3.94. SUV_max was significantly higher in PD-L1–positive tumors than in PD-L1–negative tumors (12.24 ± 4.01 and 9.43 ± 3.22, respectively; p = 0.001). Receiver operating characteristic curve analysis revealed an area under the curve of SUVmax was 0.681 (95% confidence interval 0.570–0.793, p = 0.004). Compared with PD-L1–negative cases, SUV_max was significantly different in all PD-L1–positive cases (p = 0.001), weakly PD-L1–positive cases (1–49%, p = 0.005), and strongly PD-L1–positive cases (≥50%, p = 0.003). PD-L1 expression levels were significantly associated with SUV_max (p = 0.001), tumor size (p = 0.022), and EGFR mutation status (p = 0.045).

Conclusions

SUV_max in the primary lesions was able to predict PD-L1 expression and may play a role in predicting PD-L1 immunotherapy efficacy in patients with stage IV lung adenocarcinoma.