Colorectal cancer and Blastocystis sp. infection

BACKGROUND

Blastocystis sp. is a common intestinal protozoan found worldwide. Based on gene analysis, 17 subtypes (STs, ST1-ST17) have been identified, 9 of which have been isolated from humans. Differences in clinical consequences may depend on differences among the STs. Here, we evaluated the prevalence of Blastocystis sp. in patients with colorectal cancer (CRC) compared to a control group and assessed the relationships between Blastocystis sp. infection and sex; age; and CRC grade, stage, and location.

METHODS

The study included 107 CRC patients (41 women and 66 men, median age 65 years); 124 subjects without colorectal cancer or a history of oncological disease comprised the control group (55 women and 69 men, median age 63). Stool samples were collected from patients before oncological treatment and examined using light microscopy (iodine-stained smear). Additionally, PCR-based identification of Blastocystis sp. was performed in 95 stool samples from CRC patients and 76 stool samples from the control group.

RESULTS

Light microscopy showed that the prevalence of Blastocystis sp. was significantly higher in CRC patients than in the control group (12.15% and 2.42%, respectively; p = 0.0041). Multivariate analysis showed that the odds of Blastocystis sp. infection were fivefold higher in the CRC group than in the control group. PCR-based molecular examinations demonstrated that the proportion of patients infected with Blastocystis sp. was significantly higher in the CRC group than in the control group (12.63% and 2.63%, respectively; p = 0.023). The predominant ST in the CRC group was ST3, detected in nine patients (75%), followed by ST1 (2 patients, 16.7%) and ST2 (1 patient, 8.3%). No association was found between Blastocystis sp. infection and age, sex, or CRC stage, grade, or location.

CONCLUSIONS

The results showed that CRC was associated with an increased risk of opportunistic Blastocystis sp. infection, even before oncological treatment. To the best of our knowledge, this is the first report estimating the prevalence of Blastocystis sp. infection in CRC patients before oncological treatment in Europe.

Association of COMT gene variability with pain intensity in patients after total hip replacement

Pain is one of the most interdisciplinary clinical symptoms of a disease. The aim of the study was to evaluate the association of COMT gene polymorphism with pain perception in patients after total hip replacement (THR). The study included 195 patients qualified for surgical treatment (THR) due to osteoarthritis. Patients previously undergoing hip replacement subsequently underwent multimodal pain management therapy, in accordance with the recommendations for treating postoperative pain. The intensity of pain was measured three times at pre-defined time intervals: 1.5, 6 and 12 months after hip replacement, using the visual analogue scale. Single nucleotide polymorphism (SNP) in the COMT gene rs4680: A>G (Val158Met), rs6269: A>G (promoter region), rs4633: C>T (His62His) and rs4818: C>G (Leu136Leu) was genotyped. COMT SNP frequency distribution was analysed. For rs6269 and rs4818, the minor allele was the G allele (38.7 and 38.5%, respectively). It was also observed that rs4633 (T) allele frequency (50%) equalled that of the rs4680 (A) allele (50%). We assessed COMT haplotype frequency in the patients studied. The most frequent haplotype was haplotype M (ATCA) (50%), the rarest haplotype was haplotype R (ATGG), with a frequency of 0.3%. The most frequent diplotype was H/M, which was found in 37.95% of the patients. The frequency of other diplotypes was: M/M-24.10%, H/H-15.90% and L/M-13.33%. The study showed a significant association of rs4818 G allele and equivalent COMT H haplotype with lower sensitivity to pain after hip replacement.

Colorectal cancer and Cryptosporidium spp. infection

Transient or constant impaired immunity is often associated with neoplastic disease or oncological treatment. Among the most common pathogens found in patients with HIV or patients undergoing chemotherapy are protozoans of the Cryptosporidium genus, which cause diarrhea in humans and animals. The present study determined the frequency of Cryptosporidium spp. infections in patients with colorectal cancer (N = 108; 42 women; 66 men; median age, 65 years), before beginning oncological treatment, compared to a control group (N = 125; 56 women, 69 men; median age, 63 years) without colorectal cancer or a history of oncological disease. We also assessed whether Cryptosporidium spp. infections were associated with age, gender, cancer stage (based on Astler-Coller or TNM classification), histological grade, or cancer location. Patients were treated at the Pomeranian Medical University, in 2009-2014. The presence of Cryptosporidium spp. antigen was determined in stool samples, analyzed with a commercial immunoenzymatic test. Cryptosporidium spp. infections occurred significantly more often (p = 0.015) in patients (13%) compared to controls (4%). The patient group showed no significant relationship between Cryptosporidium spp. infection and sex, age, tumor location, cancer grade, or stage. A multivariate logistic regression analysis adjusted for age and sex that included all subjects (patient + control groups, n = 233) showed that the odds of a Cryptosporidium spp. infection were more than three-fold higher in patients than in controls, and more than six-fold higher among men than among women.

CONCLUSIONS

1) Cryptosporidium spp. infections occurred significantly more frequently in patients with colorectal cancer (before oncological treatment) compared to controls, independent of age and sex. 2) Cryptosporidium spp. infections were not associated with the colorectal cancer stage, grade, or location or with patient age. 3) Male gender was significantly related to the frequency of Cryptosporidium spp. infections, independent of age and the presence of colorectal cancer.

The usefulness of D-dimer in diagnosis and prediction of venous thromboembolism in patients with abdominal malignancy

THE AIM

of the study was to evaluate the usefulness of D-dimer evaluation in the diagnosis and prediction of venous thromboembolism (VTE) of lower extremities in patients operated on for abdominal tumors depending on the chosen cut-off point for this parameter.

MATERIAL AND METHODS

We included 150 patients operated on for abdominal cancer in our department between October 2014 and June 2016. In these patients, concentration of D-dimer was determined, medical histories were taken, and physical examinations were performed. Ultrasound exams of the veins of the lower limbs were performed three times in every patient in order to confirm or exclude VTE.

RESULTS

When a standard cut-off point (500 ng/ml) was used, in 46% of cancer patients D-dimer values were elevated despite the lack of VTE. We did not detect any influence of cancer stage on the value of D-dimer. However, if cut-off point was 1440 ng/ml, which has been suggested in the literature, only 14% of patients were false positive. When the upper cut-off value for D-dimer was raised, the effect of cancer stage on the value of this parameter could be seen.

CONCLUSION

The concentration of D-dimer is often elevated in patients with active cancer, but is not a sufficient criterion for diagnosis of VTE. The concentration of D-dimer before surgery does not determine the risk of postoperative thromboembolic complications. This is undoubtedly related to the widespread use of effective thromboprophylaxis. According to the literature, ultrasound is the optimum method for detection of VTE in surgically treated cancer patients. The effect of cancer stage on the value of D-dimer is revealed only when the cut-off point in this group is 1440 ng/ml, instead of 500 ng/ml which is used for the general population.

Baseline chromogranin A and its dynamics are prognostic markers in gastroenteropancreatic neuroendocrine tumors

Aim: This study assessed whether absolute chromogranin A (CgA) values at various stages of treatment have prognostic value in patients with pancreatic and midgut neuroendocrine tumors, subjected to peptide receptor radionuclide therapy with 90Y-[DOTA0, D-Phe1, Tyr3]-octreotate. Patients & methods: CgA was determined before peptide receptor radionuclide therapy, 6 weeks, 6, 12, 18 and 24 months after the last dose of 90Y-[DOTA0, D-Phe1, Tyr3]-octreotate. The primary end point was overall survival. Results: Elevated baseline CgA concentrations and their relative increase within the first year of observation were unfavorable predictors of overall survival, but not progression. Conclusion: Even a single baseline measurement of CgA can be useful in establishing prognosis in this group, if this parameter exceeds its upper normal limit more than tenfold.

The Influence Of Obesity On Results Of AT (Doxorubicin Plus Docetaxel) Neoadjuvant Chemotherapy In Locally Advanced Breast Cancer Patients

The achieve pathologic complete response is proven to be the most important parameter of prognosis. Thereports evaluating the impact of obesity on the obtained pathologic response to chemotherapy are unequal. The aim of the study was to evaluate in locally advanced breast cancer patients, treated with AT(doxorubicin plus docetaxel) neoadjuvant chemotherapy: 1. The relationship of obesity with obtaining pathological response. 2. The relationship of obesity and free of disease recurrence survival (DFS) and overall survival (OS) associated with the tumour.

MATERIAL AND METHODS

A retrospective study was carried out in a group of 105 patients with locally advanced breast cancer, treated with AT neoadjuvant chemotherapy and then treated with radical surgery. Two variants of pathological response have been adopted: a pCR (T0N0) and pCR1 (TisN0, TxN1, T1N0, T1N1, T0N1). The relationship of obesity with pathological response and survival was investigated.

RESULTS

In univariate analysis the pCR1 was obtained with its arising from the borderline of statistical significance with lower incidence of obesity. In pCR1 multivariate analysis, negative pCR1 relationship with obesity was on the borderline of the statistical significance. The multivariate analysis showed a significant negative association OS with obesity (p=0.047) and positive with the occurrence of menopause (p = 0.029).

CONCLUSIONS

In patients with locally advanced breast cancer treated with AT neoadjuvant chemotherapy. 1. Obesity seems to be an independent and unfavourable predictor of the lack of obtaining pCR1 pathological response 2. In the multivariate analysis, the obesity was a significant independent factor related to shorter OS.

Immunohistochemical analysis of thymidylate synthase expression in gastric carcinoma: correlation with clinicopathological parameters and survival

The correlation of thymidylate synthase (TS) expression in gastric cancers with tumor histology and prognostic or predictive information remains unclear. Most studies have involved Asian populations, with few conducted in European cohorts. Moreover, all published studies analyze TS expression using semi-quantitative methods. This retrospective study evaluated the association of TS expression in tumor cells with gastric carcinoma histological type, with selected clinicopathological parameters, and with the prognosis of patients who underwent surgical treatment. TS expression was detected using immunochemistry and objectively assessed by computerized image analysis of tumor cells in 100 gastric cancers. We found that high TS expression was significantly more common in intestinal than in diffuse type of gastric cancer according to Lauren classification (P=0.0003); in type I carcinomas compared to type IV according to Goseki classification (P=0.002); and in gastric cancers in men than women (P=0.04). Low TS expression was found more often in carcinomas in the middle and lower third of the stomach than in cancers in the upper third of the stomach (P=0.009 and P=0.001, respectively). In the subgroup of 25 patients without lymph node metastases (stage I+II), high TS expression was associated with better DFS (83% for high TS expression versus 38,5% for low TS expression, P=0.03). The results (1) indicate significant correlation between the Lauren and Goseki histopathological classifications of gastric cancer and TS expression in tumor cells, (2) suggest that high TS expression may be a positive prognostic marker with regard to DFS in patients with gastric cancer without involvement of regional lymph nodes who underwent radical surgical treatment and were not treated with preoperative chemotherapy. Prognostic results need confirmation in larger cohorts.