Whole-body MRI surveillance in TP53 carriers is perceived as beneficial with no increase in cancer worry regardless of previous cancer: Data from the Swedish TP53 Study

BACKGROUND

To evaluate the psychosocial consequences of surveillance with whole-body MRI (WB-MRI) in individuals with the heritable TP53-related cancer (hTP53rc) syndrome, also known as the Li-Fraumeni syndrome, with regard to cancer worry, perceived benefits and risks to surveillance and overall health.

PATIENTS AND METHODS

Since 2016, the national Swedish TP53 Study (SWEP53) has offered surveillance with WB-MRI to all individuals with hTP53rc syndrome. Seventy-five individuals have been included in the study. Sixty consecutive participants fulfilled a base-line evaluation as well as an evaluation after 1 year with structured questionnaires including the Cancer Worry Scale (CWS), perceived benefits and risks of surveillance, and the 36-item Short Form Survey (SF-36). Individuals with or without previous personal cancer diagnosis were enrolled and results at baseline and after 1 year of surveillance were compared. For SF-36, a comparison with the normal population was also made.

RESULTS

Participants with previous cancer tend to worry more about cancer, but both individuals with and without cancer had a positive attitude toward surveillance with no differences regarding perceived benefits and barriers to surveillance. Participants with a previous cancer scored significantly lower on some of the SF-36 subscales, but between-group differences were found only for social functioning after 1 year.

CONCLUSIONS

Surveillance with WB-MRI is feasible from a psychosocial point of view both among TP53 carriers with as well as without a previous history of cancer and does not increase cancer worry in any of the groups.

PLAIN LANGUAGE SUMMARY

Individuals with heritable TP53-related cancer syndrome (also known as the Li-Fraumeni syndrome) have a high lifetime risk of developing cancer. These TP53 carriers are offered surveillance with whole-body MRI to detect cancer early. There are few reports of the psychosocial impact of surveillance. In this study, we wanted to evaluate cancer worry, benefits and barriers to participation, and perceived overall health. Our study shows no increase in cancer worry after 1 year of surveillance, regardless of previous cancer.

HCC-Mark: a simple non-invasive model based on routine parameters for predicting hepatitis C virus related hepatocellular carcinoma

BACKGROUND

Early detection of hepatocellular carcinoma (HCC) is crucial in providing more effective therapies. As routine laboratory variables are readily accessible, this study aimed to develop a simple non-invasive model for predicting hepatocellular cancer.

METHODS

Two groups of patients were recruited: an estimation group (n = 300) and a validation group (n = 625). Each comprised two categories: hepatocellular cancer and liver cirrhosis. Logistic regression analyses and receiver operating characteristic (ROC) curves were used to develop and validate the HCC-Mark model comprising AFP, high-sensitivity C-reactive protein, albumin and platelet count. This model was tested in cancer patients classified by the Barcelona Clinic Liver Cancer (BCLC), Cancer of Liver Italian Program (CLIP) and Okuda systems, and was compared with other non-invasive models for predicting hepatocellular cancer.

RESULTS

HCC-Mark produced a ROC AUC of 0.89 (95% CI 0.85-0.90) for discriminating hepatocellular carcinoma from liver cirrhosis in the estimation group and 0.90 (0.86-0.90) in the validation group (both p < 0.0001). This AUC exceeded all other models, that had AUCs from 0.41 to 0.81. AUCs of HCC-Mark for discriminating patients with a single focal lesion, absent macrovascular invasion, tumour size <2 cm, BCLC (0-A), CLIP (0-1) and Okuda (stage Ι) from cirrhotic patients were 0.88 (0.85-0.90), 0.87 (0.85-0.89), 0.89 (0.85-0.93), 0.87 (0.84-0.89), 0.85 (0.82-0.87) and 0.86 (0.83-0.89), respectively (all p < 0.0001).

CONCLUSION

HCC-Mark is an accurate and validated model for the detection of hepatocellular cancer and certain of its clinical features.

HCC-Mark: a simple non-invasive model based on routine parameters for predicting hepatitis C virus related hepatocellular carcinoma

BACKGROUND

Early detection of hepatocellular carcinoma (HCC) is crucial in providing more effective therapies. As routine laboratory variables are readily accessible, this study aimed to develop a simple non-invasive model for predicting hepatocellular cancer.

METHODS

Two groups of patients were recruited: an estimation group (n = 300) and a validation group (n = 625). Each comprised two categories: hepatocellular cancer and liver cirrhosis. Logistic regression analyses and receiver operating characteristic (ROC) curves were used to develop and validate the HCC-Mark model comprising AFP, high-sensitivity C-reactive protein, albumin and platelet count. This model was tested in cancer patients classified by the Barcelona Clinic Liver Cancer (BCLC), Cancer of Liver Italian Program (CLIP) and Okuda systems, and was compared with other non-invasive models for predicting hepatocellular cancer.

RESULTS

HCC-Mark produced a ROC AUC of 0.89 (95% CI 0.85-0.90) for discriminating hepatocellular carcinoma from liver cirrhosis in the estimation group and 0.90 (0.86-0.90) in the validation group (both p < 0.0001). This AUC exceeded all other models, that had AUCs from 0.41 to 0.81. AUCs of HCC-Mark for discriminating patients with a single focal lesion, absent macrovascular invasion, tumour size <2 cm, BCLC (0-A), CLIP (0-1) and Okuda (stage Ι) from cirrhotic patients were 0.88 (0.85-0.90), 0.87 (0.85-0.89), 0.89 (0.85-0.93), 0.87 (0.84-0.89), 0.85 (0.82-0.87) and 0.86 (0.83-0.89), respectively (all p < 0.0001).

CONCLUSION

HCC-Mark is an accurate and validated model for the detection of hepatocellular cancer and certain of its clinical features.

Whole-body MRI within a surveillance program for carriers with clinically actionable germline TP53 variants - the Swedish constitutional TP53 study SWEP53

Background

The current guidelines in Sweden regarding individuals with a clinically actionable (i.e. pathogenic or likely pathogenic) germline TP53 variant recommend patients to take part of the national Swedish P53 Study (SWEP53).

Methods

The study comprises a patient registry (mandatory for all participants) and three optional parts: a biobank, a surveillance program and a psychosocial evaluation of the surveillance. All known adult eligible carriers regardless of age are offered to take part of the surveillance program offering MRI yearly of the whole-body, breast, and brain as well as breast ultrasound. A special surveillance program is offered for individuals 15–18 years old with a 50% risk of being a mutation carrier or with a verified TP53 variation, includes ultrasound of the abdomen and urine corticosteroid profiles. Clinically motivated further examinations are performed upon need. The national inclusion is performed through the six clinical genetic units in Sweden at Umeå, Uppsala, Stockholm, Gothenburg, Linköping and Lund, and the surveillance is mainly performed through the oncology clinics.

Results

To date, a total of 41 adults and 11 children have been included in the study.

Conclusions

The SWEP53 is the first structured national surveillance program including radiological and clinical routines for TP53 mutation carriers in the Scandinavian setting. The aim of this publication is to present and describe the ongoing Swedish surveillance study to encourage the initiation of similar studies and to contribute to the knowledge of adequate clinical handling of these cancer prone families.

Trial registration

Trial registration number: ISRCTN13103571, retrospectively registered on 14/10/2019.

Obstructive uropathy in Sudanese patients

In this paper we describe the causes, patterns of presentation, and management of obstructive uropathy in Sudanese patients in a retrospective multi-center audit. All patients who presented with obstructive uropathy during 2005 were included in this study. All of the patients were subjected to serial investigations including imaging and tests of renal function. Diversion, stenting, and/or definitive surgery were performed in order to relieve the obstruction. Five hundred twenty patients were diagnosed with obstructive uropathy during this period; 345 (66%) patients presented with chronic obstruction and 175 (34%) with acute obstruction. Of the study patients, 210 (40%) presented with significant renal impairment; 50 (23%) of them required emergent dialysis. The patterns of clinical presentation of the obstructed patients included pain at the site of obstruction in 48%, lower urinary tract symptoms in 42%, urine retention in 36.5%, mass effect in 22%, and anuria in 4%. Patients in the pediatric age group constituted 4% of the total. The common causative factors of obstruction included congenital urethral valves, pelvi-ureteral junction obstruction, urolithiasis, and iatrogenic trauma, especially in the obstetric practice. Renal function was completely recovered with early management in 100% of patients with acute obstruction and was stabilized in 90% of patients with chronic obstruction. Four patients were diagnosed with end-stage renal failure; two of them were transplanted. The mortality rate in this study was less than 0.3%.

[Bilateral anterior panuveitis as early manifestation of syphilis in a patient with HIV infection]

INTRODUCTION

Syphilis is a dangerous sexually transmitted infection which can be effectively treated with penicillin to avoid late-onset diseases. Even if syphilis is diagnosed an HIV infection should be excluded.

PATIENT

A 32-year-old homosexual man complained about a decreased bilateral visual acuity after a feverish infection with lymphadenitis colli. With slit-lamp biomicroscopy a bilateral panuveitis with papillary edema, endothelial cells and episcleritis was found. After antimycotic and antiviral therapy, his visual acuity decreased and symptoms progressed. In the lab routine we found lues and HIV infections and started an intravenous penicillin therapy immediately. A few days later the symptoms improved and visual acuity increased.

CONCLUSION

Lues serology should be incorporated into routine lab diagnostics to aid the detection and to start the right therapy as soon as possible.

Factors limiting the effectiveness of prenatal screening for anencephaly and spina bifida in a high-risk area

The effectiveness of a prenatal screening programme in reducing the birth prevalence of anencephaly and spina bifida (ASB) is influenced by three principal factors: the proportion of affected pregnancies screened (uptake), the proportion of affected pregnancies detected on screening (sensitivity) and the proportion of affected pregnancies terminated when detected (compliance). The purpose of the study was two-fold: to develop an epidemiologically-based method for the retrospective monitoring of these three factors and to attempt to quantify their relative importance in relation to the outcome of screening. Data on births and terminations associated with ASB for the period 1976-1986 were obtained from the Glasgow Register of Congenital Anomalies and from the Department of Medical Genetics, Yorkhill Hospitals. Increasing proportions of affected pregnancies screened, detected and terminated were observed, to a greater degree for anencephaly than for spina bifida. The relationships between uptake, sensitivity, compliance and terminations are described in the form of a simple arithmetic expression. In policy terms, further efforts are required to increase all three in order to improve the effectiveness of screening for spina bifida.

Carcinoma of the thyroid in Khartoum

One hundred and twelve patients with thyroid malignancy seen at The Radio-isotope Centre, Khartoum (RICK) during the period 1982-1989 were studied. The female to male ratio was 2.5:1.0 with a high incidence of the disease between the ages of 40 and 70 years. Follicular carcinoma was the commonest (42%) followed by papillary (22.3%) and anaplastic (21.4%). Goitre was the main presenting symptom (92.9%). Cervical lymphadenopathy was present almost equally in these three histological types, 26.6%, 32%, and 33% respectively. Blood borne metastasis was seen in 32 (28.6%) patients in the whole series. Follicular carcinoma had the highest incidence of blood borne metastasis (21 out of 47 patients) being mostly osseous (16 patients). Anaplastic and squamous cell carcinoma showed a locally aggressive behaviour to nearby structures resulting in hoarseness of voice, dyspnoea and dysphagia indicating advanced disease. Most patients presented with advanced disease limiting the option of total thyroidectomy (40%). A high index of clinical suspicion is needed in areas of endemic goitres in order that selected cases can be subjected to surgery at an earlier stage of the disease. Doctors and medical assistants should be taught how to diagnose solitary thyroid nodules and clinically hard glands so that they can be evaluated at an earlier stage of the disease.

The Chief Scientist reports.... Pattern of decline in prevalence of anencephaly and spina bifida in a high risk area

The results of three studies spanning the period 1964 to 1989 were aggregated in an attempt to identify secular trends which might contribute to aetiological understanding of anencephaly and spina bifida (ASB). All data related to the prevalence of ASB in a geographically defined population in Glasgow, a known high risk area of neural tube defects. Multiple sources of ascertainment were employed to identify affected cases, whether live births, still births or induced abortions following prenatal diagnosis. The birth prevalence of ASB dropped by 82%, from 5.63 per 1,000 births in 1964-1968 to 1.04 per 1,000 births in 1979-1989, while the pregnancy prevalence (adjusted by including induced abortions) declined by 46%, from 5.63 per 1,000 births in 1964-1968 to 3.02 per 1,000 births in 1979-1989. Thus, prenatal screening contributed just under half of the observed decline in ASB birth prevalence. The pregnancy prevalence appeared to decline throughout the 1970's and early 1980's, and to increase again, temporarily, in the mid-1980s. These data could be interpreted as being broadly consistent with socio-economic hypotheses of ASB aetiology.

The impact of diagnostic ultrasound on the prediction of intrauterine growth retardation in developing countries

The purpose of this report is to throw light on the problem of intrauterine growth retardation in our society, and to show how this situation could be affected by the introduction of diagnostic ultrasound in our antenatal service. A series of 828 pregnant women were serially examined by ultrasound during the course of pregnancy. Among the whole series (no. 828) there were 98 growth retarded neonates (11.8%). Antenatal ultrasonic evaluation could predict 89.7% of these cases, while only 34.7% of cases could have been predicted by fundal palpation. Among the different etiological factors, maternal anemia was the most common (25%).