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Lau, Paul, Joseph L. Chin, Stephen Pautler, Hassan Razvi, and Jonathan I. Izawa. "NMP22 is predictive of recurrence in high-risk superficial bladder cancer patients." Canadian Urological Association Journal 3, no. 6 (May 1, 2013): 454. http://dx.doi.org/10.5489/cuaj.1173.
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Introduction: The nuclear matrix protein 22 (NMP22) assay hasbeen shown to have greater sensitivity for the diagnosis and detectionof recurrent urothelial carcinoma of the bladder (UCB) overthat of traditional urine cytology. We assessed the use of NMP22to predict which high-risk superficial UCB patients will have recurrence,progression or disease-related death; we compared theseresults to standard urine cytology.Methods: One hundred consecutive patients with high-risk superficialUCB were enrolled. During surveillance, urine was collectedfor cytology and NMP22 testing. Patients were followed for atleast 6 months. Retrospective chart review was undertaken to collectdata on previous tumour history, tumour characteristics, diseaserecurrences, progression and death. Kaplan-Meier analyseswere performed to determine the significance between NMP22-positive and -negative patients in terms of recurrence-free, progression-free and overall survival. Similar analyses were performedfor urine cytology.Results: From 94 eligible patients, 15 and 79 were NMP22 positiveand negative, respectively. The baseline characteristics betweenthe 2 groups were not significantly different in terms of patientcharacteristics, prior tumour history or intravesical therapiesreceived. Mean recurrence-free survival time was significantlylower in the NMP22 positive group (p = 0.038); however, meanprogression-free and overall survival were not significantly differentbetween the 2 groups (p = 0.297 and 0.519, respectively).Urine cytology demonstrated no significant predictive power fordisease recurrence, progression or survival.Conclusion: The nuclear matrix protein 22 assay appears to havepredictive value for future tumour recurrences, but not progressionor overall survival in patients with high-risk superficial UCB.Introduction : Il a été montré que le test de dépistage de la protéine22 de la matrice nucléaire (NMP22) présentait une sensibi -lité supérieure pour le diagnostic et le dépistage du carcinomeurothélial récurrent de la vessie, en comparaison avec la cytologieurinaire classique. Nous avons évalué l’emploi de la NMP22pour prédire la récurrence, la progression de la maladie et le décèsrelié à la maladie chez des patients atteints de carcinome urothélialde la vessie (CUV) superficiel et présentant un risque élevé. Lesrésultats ont été comparés à ceux obtenus avec une épreuve decytologie urinaire standard.Méthodologie : Cent patients consécutifs présentant un CUV superficielà risque élevé ont été inscrits à l’étude. Pendant la périodede surveillance, un échantillon d’urine a été recueilli en vue del’épreuve de cytologie et du test de dépistage de la NMP22. Lesuivi a duré au moins 6 mois. Un examen rétrospectif des dossiersa fourni des données concernant les antécédents tumoraux, lescaractéristiques de la tumeur, les récurrences, la progression etles décès. Des analyses de Kaplan-Meier ont été effectuées afinde déterminer le niveau de signification entre les patients NMP22-positifs et négatifs en matière de délai sans récurrence, de délaisans progression et de survie globale. Des analyses similaires ontété réalisées pour les données obtenues par cytologie urinaire.Résultats : Sur les 94 patients admissibles, 15 patients étaientNMP22-positifs et 79, NMP22-négatifs. Les caractéristiques audépart entre les deux groupes n’étaient pas significativement différentesen ce qui concerne les caractéristiques des patients, lesantécédents tumoraux et les antécédents de traitements intravésicaux.Le délai moyen de survie sans récurrence était significativementmoins long dans le groupe de patients NMP22-positifs(p = 0,038); cela dit, le délai moyen sans progression et la survieglobale moyenne n’étaient pas significativement différents entreles deux groupes (p = 0,297 et 0,519, respectivement). L’épreuvede cytologie urinaire n’a montré aucune puissance de prédictionsignificative concernant la récurrence de la maladie, la progressionou la survie.Conclusion : Le test de dépistage de la protéine 22 de la matricenucléaire semble avoir une certaine valeur prédictive concernantles récurrences tumorales, mais non la progression ou la survieglobale chez les patients atteints de CUV superficiel présentantun risque élevé de récurrence.
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Vandenberghe, Hélène, and Stéphane Blot. "Les incontinences urinaires d’origine neurologique chez le chien et le chat : physiopathogénie, diagnostic et traitement." Le Nouveau Praticien Vétérinaire canine & féline 15, no. 67 (2017): 26–33. http://dx.doi.org/10.1051/npvcafe/67026.
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La continence urinaire résulte d’une coordination entre la phase de stockage des urines par le bas appareil urinaire et la miction. Elle est sous contrôle des nerfs hypogastriques procédant du segment médullaire L1-L4 et pelviens et honteux procédant du segment médullaire S1-S3, dont la coordination est médiée par des réflexes spinaux segmentaires et des voies supraspinales. Une incontinence urinaire est fréquemment rencontrée lors de maladie neurologique. On parle de vessie MNC lors d’atteinte suprasacrée, crâniale à S1, à l’origine d’une perte de réflexe de miction. La cause la plus fréquente est une hernie discale thoracolombaire de stade avancé. Une vessie MNP est consécutive à une atteinte sacrée (S1-S3). L’obtention d’une anamnèse précise, la réalisation d’un examen clinique et neurologique exhaustif permettent de caractériser précisément l’incontinence. Dans certains cas, un profil urodynamique permet d’obtenir des éléments complémentaires et constitue un support pour le suivi. Une prise en charge adaptée et précoce est nécessaire. Toute incontinence urinaire neurogène est responsable d’une rétention urinaire et la vidange vésicale et la surveillance des infections du tractus urinaire constituent les pierres angulaires de la prise en charge, concomitantes au diagnostic et au traitement de la maladie neurologique. L’on pourra s’aider dans certains cas de drogues modulant le fonctionnement de la vessie et des sphincters.
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Leon, P. "Cancer de la vessie : diagnostic et principes de traitement." EMC - Urologie 42, no. 2 (April 2024): 1–23. https://doi.org/10.1016/s1762-0953(22)45297-6.
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Larré, S., P. Leon, and A. El Bakri. "Cancer de la vessie : diagnostic et principes de traitement." EMC - Urologie 34, no. 3 (July 2016): 1–17. https://doi.org/10.1016/s1762-0953(16)56049-x.
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Jarero, Ignacio, Lucina Artigas, Susana Uribe, Laura Evelyn Garcia, Maria Alicia Cavazos, and Martha Givaudan. "Étude pilote de recherche sur l'apport du protocole de traitement intégratif de groupe par la désensibilisation et le retraitement par les mouvements oculaires chez des patientes atteintes de cancer." Journal of EMDR Practice and Research 10, no. 3 (2016): 84E—92E. http://dx.doi.org/10.1891/1933-3196.10.3.84.
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L'objectif de cette recherche est d'évaluer l'efficacité du protocole de traitement intégratif de groupe par la désensibilisation et le retraitement par les mouvements oculaires (PTIG-EMDR) dans la réduction des symptômes d'état de stress post-traumatique (ESPT) liés au diagnostic et au traitement de différents types de cancer chez des femmes adultes. La thérapie intensive PTIG-EMDR a été administrée pendant trois jours consécutifs, deux fois par jour, à 24 femmes adultes diagnostiquées avec différents types de cancer (cancer du col de l'utérus, du sein, du côlon, de la vessie et de la peau) et présentant des symptômes d'ESPT liés à leur diagnostic et à leur traitement. Les données ont été analysées à l'aide d'une ANOVA factorielle sur les effets du PTIG-EMDR, évalués avec le Short PTSD Rating Interview (entretien court d'évaluation de l'ESPT) comme variable dépendante, et le groupe (deux groupes de patientes : phase active et phase de suivi du traitement du cancer) et le temps (quatre intervalles de temps) comme variables indépendantes. Des analyses post hoc ont été effectuées. Les résultats ont montré des effets principaux significatifs pour le temps et le groupe. Aucune interaction importante n'a été observée. Les résultats ont également montré une amélioration subjective globale chez les participantes. Cette étude pilote suggère qu'une administration intensive du PTIG-EMDR peut être un apport valable pour des patients atteints du cancer et présentant des symptômes d'ESPT liés au diagnostic et au traitement. D'autres recherches comportant des études contrôlées randomisées seront nécessaires pour démontrer l'efficacité du PTIG-EMDR sur cette population.
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Miles, Brendan J. W., Adrian S. Fairey, Michael Eliasziw, Eric P. Estey, Peter Venner, Daygen Finch, Kiril Trpkov, and Bernhard J. Eigl. "Referral and treatment rates of neoadjuvant chemotherapy in muscle-invasive bladder cancer before and after publication of a clinical practice guideline." Canadian Urological Association Journal 4, no. 4 (April 17, 2013): 263. http://dx.doi.org/10.5489/cuaj.878.
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Introduction: The objective of this study was to compare referraland treatment rates of neoadjuvant chemotherapy for patients withmuscle-invasive bladder cancer before and after publication of aclinical practice guideline.Methods: This was a retrospective comparative cohort study of236 patients diagnosed with clinical stage ≥ T2 bladder cancerin Alberta, Canada. Patients were divided into 2 groups basedon the time of diagnosis relative to the publication of the AlbertaGenitourinary Oncology Group Clinical Practice Guideline onBladder Cancer (CPG), which recommends cisplatin-based neoadjuvantchemotherapy for muscle-invasive disease. The pre-CPGgroup included patients (n = 129) diagnosed prior to publicationof the CPG (November 1, 2002 to October 31, 2004, inclusively).The post-CPG group included patients (n = 107) diagnosed afterpublication of the CPG (November 1, 2005 to October 31, 2007).There was an accrual blackout period of 6 months before and afterthe CPG release date. The primary analysis compared the twogroups with respect to neoadjuvant chemotherapy referral rates,treatment-offered rates and treatment-administered rates.Results: Referral to medical oncology regarding neoadjuvantchemotherapy occurred in 2.3% and 23.4% of patients in thepre- and post-CPG groups, respectively (p < 0.01). Neoadjuvantchemotherapy was offered to 0.8% and 18.7% of patients in thepre- and post-CPG groups, respectively (p < 0.01). Neoadjuvantchemotherapy was administered to 0.8% and 14.0% of patients inthe pre- and post-CPG groups, respectively (p < 0.01).Interpretation: Neoadjuvant referral and treatment rates increasedafter publication of the CPG. However, overall referral and treatmentrates remained low, which warrants additional exploration.Introduction : L’objectif de l’étude était de comparer les taux derecommandation et de traitement par chimiothérapie néoadjuvantechez les patients atteints de cancer de la vessie avec envahissementmusculaire avant et après la publication d’un guide de pratiqueclinique.Méthodologie : Il s’agit ici d’une étude comparative rétrospectivede cohorte comptant 236 patients de l’Alberta, au Canada, chezqui on avait diagnostiqué un cancer de la vessie de stade cliniqueT2 ou pire. Les patients ont été répartis en 2 groupes selon que leurdiagnostic avait été posé avant ou après la publication du guidede pratique clinique sur le cancer de la vessie (GPC) de l’AlbertaGenitourinary Oncology Group, qui recommande une chimiothérapienéoadjuvante à base de cisplatine pour le traitement descas de cancer avec envahissement musculaire. Le groupe pré-GPCcomprenait des patients (n = 129) chez qui le diagnostic avaitété posé avant la publication du GPC (du 1er novembre 2002 au31 octobre 2004, inclusivement). Le groupe post-GPC incluait despatients (n = 107) chez qui le diagnostic avait été posé après lapublication du GPC (du 1er novembre 2005 au 31 octobre 2007).Une période cumulative de censure a été calculée 6 mois avant etaprès la date de publication du GPC. L’analyse préliminaire a comparéles deux groupes quant aux taux de recommandation de lachimiothérapie néoadjuvante, aux taux d’offre et d’administrationdu traitement.Résultats : La chimiothérapie néoadjuvante a été recommandée chez2,3 et 23,4 % des patients dans les groupes pré-GPC et post-GPC,respectivement (p < 0,01). Elle a été offerte à 0,8 % et 18,7 % despatients de ces mêmes groupes (p < 0,01), et administrée à 0,8 et14,0 % des patients des groupes pré-GPC et post-GPC, respectivement(p < 0,01).Interprétation : Les taux de recommandation et de traitement concernantla chimiothérapie néoadjuvante ont augmenté après lapublication du GPC, mais sont tout de même demeurés faibles,ce qui nécessite une analyse plus poussée.
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Kachuri, L., P. De, LF Ellison, and R. Semenciw. "Tendances concernant l'incidence du cancer, la mortalité par cancer et la survie au cancer au Canada entre 1970 et 2007." Maladies chroniques et blessures au Canada 33, no. 2 (March 2013): 80–92. http://dx.doi.org/10.24095/hpcdp.33.2.03f.
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Introduction La surveillance des tendances concernant le cancer peut aider à évaluer les progrès réalisés dans la lutte contre le cancer ainsi qu'à renforcer les activités de prévention. La présente étude, fondée sur les données des bases de données nationales, consiste en un examen des tendances à long terme relatives à certains cancers au Canada. Méthodologie Nous avons examiné les changements annuels dans les tendances relatives aux taux d'incidence et de mortalité normalisés selon l'âge observés entre 1970 et 2007 selon le sexe pour tous les cancers combinés, pour les quatre cancers les plus courants (cancer de la prostate, cancer du sein, cancer du poumon, cancer colorectal) et pour les cancers dont les tendances ont été marquées par les changements les plus importants au cours des dernières années. Le rapport de survie relative à cinq ans pour les années 1992 à 2007 a également été calculé. Résultats Pendant la période visée par l'étude, les taux d'incidence de l'ensemble des cas de cancer primitif combinés ont augmenté de 0,9 % par année chez les hommes et de 0,8 % par année chez les femmes. Les taux concernant le mélanome, le cancer de la thyroïde, le cancer du foie, le cancer de la prostate, le cancer du rein, le cancer colorectal, le cancer du poumon, le cancer du sein et le cancer de la vessie ont augmenté à des rythmes variables, et les taux concernant le cancer du larynx, le cancer de la bouche, le cancer de l'estomac et le cancer du col de l'utérus ont diminué. Pour l'ensemble des cancers combinés et pour la plupart des cancers examinés, à l'exception du mélanome et du cancer du poumon chez les femmes, les taux de mortalité ont diminué significativement. Les taux de survie qui ont le plus augmenté sont ceux du cancer de la prostate, du cancer du foie, du cancer colorectal et du cancer du rein. Bien que les tendances globales concernant les taux de mortalité et la survie indiquent que des progrès notables ont été réalisés dans la lutte contre le cancer, la tendance à la hausse des taux d'incidence de certains cancers soulignent la nécessité de poursuivre les efforts dans le domaine de la prévention.
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Siproudhis, L., and S. Henno. "Dépistage du cancer de l’anus et des lésions précancéreuses du canal anal." Côlon & Rectum 14, no. 3 (August 2020): 127–32. http://dx.doi.org/10.3166/cer-2020-0133.
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Il existe aujourd’hui deux modalités de dépistage et de suivi des lésions de dysplasies et de cancer de l’anus. L’une est très consommatrice d’énergie et de temps (anuscopie haute résolution répétée), et l’autre est celle d’une approche minimaliste (anuscopie). La première expose à une mauvaise observance et de nombreux perdus de vue, la seconde à un diagnostic et une prise en charge trop tardifs (cancer invasif) quand la surveillance et le traitement de la dysplasie de haut grade peuvent apparaître des objectifs ambitieux mais cohérents.
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Compérat, E. "Primo-diagnostic de cancer de vessie chez les patients âgés de 80ans et plus : une étude rétrospective monocentrique de 195 patients." Progrès en Urologie 26, no. 13 (November 2016): 763. http://dx.doi.org/10.1016/j.purol.2016.07.191.
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Leveridge, Michael J., and Michael A. S. Jewett. "Recent developments in kidney cancer." Canadian Urological Association Journal 5, no. 3 (April 4, 2013): 195. http://dx.doi.org/10.5489/cuaj.642.
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Renal cell carcinoma (RCC) diagnosis and management haveundergone significant shifts in the recent past. The increasing rateof diagnosis of small renal masses, often in patients at high risk ofmorbidity with operative treatment, has led to studies, trials anddiscoveries in renal mass biopsy, active surveillance and minimallyinvasive thermal ablation. At the other end of the disease spectrum,targeted systemic therapies for metastatic RCC have supplantedcytokine-based treatment, with significant benefits to progressionand survival. Recent reviews and trials have also cemented the roleof partial nephrectomy as standard surgical management for mostlow-stage masses, and the roles of regional lymphadenectomy andadrenalectomy concomitant with nephrectomy have been clarified.This review aims to highlight recent evidence that has emerged inthe management of this complicated oncologic issue.Le diagnostic d’hypernéphrome et la prise en charge de cettemaladie ont fait l’objet d’importants changements au cours desdernières années. Le taux accru de cas de petites masses rénales,souvent chez des patients présentant un risque élevé de morbiditéavec le traitement chirurgical, a amené la conduite d’étudeset d’essais qui ont entraîné des découvertes touchant la biopsiedes masses rénales, la surveillance active et l’ablation thermiqueminimalement invasive. À l’autre bout du spectre pathologique, lestraitements généraux ciblés de l’hypernéphrome métastatique ontsupplanté le traitement à base de cytokines, ce qui a amené desavantages significatifs sur le plan de la progression et de la survie.Des articles de synthèse et des essais récents ont aussi confirméle rôle de la néphrectomie partielle en tant que prise en chargechirurgicale standard pour la plupart des masses de faible stade,et les rôles de la lymphadénectomie régionale et de la surrénalectomieen concomitance avec une néphrectomie ont été clarifiés.Le présent article vise à faire ressortir les données récentes dans laprise en charge de ce problème oncologique complexe
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Joshi, Virendra, Alok Shah, Ian Brown, Clay Winterford, and Michelle Hill. "Complement component C9 as a new biomarker for esophageal adenocarcinoma." Journal of Clinical Oncology 35, no. 4_suppl (February 1, 2017): 19. http://dx.doi.org/10.1200/jco.2017.35.4_suppl.19.
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19 Background: Esophageal adenocarcinoma (EAC) continues an upward trend. Mortality rate and treatment costs for EAC are very high overall and significantly increase with disease stage. Diagnosis at early stage (T1) compared to advanced stage (T3) improves 5 year survival from 20% to 80-90%. Endoscopic surveillance has been ineffective in reducing EAC. Therefore the need for better diagnostic tools for early detection.Previously we reported validation of a list of serum glycoprotein biomarker candidates for EAC in an Australian cohort (Shah et al. 2015 Mol Cell Proteomics. 14:3023-39.). Here we further evaluate the serum and tissue expression of top candidate C9 in an independent cohort from the USA. Methods: Serum samples (n=38) and FFPE tissue sections (n=34) were collected from participants with IRB approved protocol, from the Ochsner Clinic undergoing endoscopic surveillance for Barrett’s and esophageal cancer. Serum glycoprotein candidates were measured using lectin magnetic bead array-coupled multiple reaction monitoring assay (Shah et al. 2015 Mol Cell Proteomics. 14:3023-39.). Immunohistochemistry was optimised for complement component C9 antibody. Initial evaluation of 2 different antibodies gave similar results, thereafter, a polyclonal antibody from Sigma Aldrich was used. Staining was assessed by a gastrointestinal pathologist. Results: Specific glycosylated forms of 3 candidate serum biomarkers were confirmed to be significantly different between EAC and benign groups (p<0.05, Kruskal-Wallis). The diagnostic value for the 3 individual markers, complement component C9, gelsolin and alpha-1-antichymotrypsin (Serpin A3) was 0.71 to 0.82 area under the receiver operating curve (AUROC). A multivariate panel consisting of 8 glycoprotein biomarkers achieved AUROC of 0.96, indicative of high diagnostic value. Immunohistochemistry of tissues detected high levels of C9 in BE and EAC compared to normal squamous epithelium. Infiltrated lymphocytes showed variable staining. Conclusions: We propose a novel candidate biomarker complement component C9 which could add to current endoscopic surveillance strategy for early detection of adenocarcinoma.
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Doyle-Lindrud, Susan. "Testicular Cancer: Implications for Primary Care Providers." Clinical Scholars Review 1, no. 2 (November 2008): 114–20. http://dx.doi.org/10.1891/1939-2095.1.2.114.
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Germ cell tumors are the most common solid tumor in men between 15 and 34 years of age. Survival from germ cell tumor is high, with a 5-year survival rate of 90% (Schmoll et al., 2004). Because this cancer affects young men, they have many years to manifest the long-term side effects of treatment. Second primary cancers are a leading cause of death among testicular cancer survivors (Zagars, Ballo, Lee, & Strom,2004). This case study reviews the clinical course of a 27-year-old male with a newly diagnosed nonseminoma germ cell tumor. Diagnostic and treatment-related issues for both patient and health care provider are addressed. Guidelines for the surveillance of nonseminoma patients after treatment and the implications of long-term follow-up are reviewed.
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Vaylet, F., F. Rivière, H. Le Floch, A. Bonnichon, A. Mairovitz, E. Staub, G. Bonardel, et al. "18F-FDG-TEP : sa place dans le diagnostic et la surveillance du cancer bronchique non à petites cellules." Revue des Maladies Respiratoires 24, no. 8 (October 2007): 35–39. http://dx.doi.org/10.1016/s0761-8425(07)78132-9.
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Laaliaoui, Aymen, and Taouil Fatimzahra. "Cancer du col utérin invasif et grossesse : à propos d’un cas." Revue Internationale Médico-Chirurgicale 1, no. 1 (December 1, 2024): 4–6. https://doi.org/10.70602/rimc.24.1.1.4.6.
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Cet article discute du diagnostic et de la prise en charge du cancer du col utérin pendant la grossesse, une situation relativement rare mais avec une incidence significante. Le cancer du col est le cancer le plus fréquemment découvert chez les femmes enceintes, affectant principalement celles de la trentaine avec une parité élevée. Environ 1 à 3 % des cancers du col sont diagnostiqués pendant la grossesse, souvent lors des examens prénatals tels que les frottis cervico-vaginaux. L’étude clinique présentée concerne une patiente de 36 ans, sans antécédents pathologiques, diagnostiquée avec un carcinome épidermoïde bien différencié du col utérin après une césarienne prophylactique. L’article souligne l’importance de dépister systématiquement les anomalies cervicales chez les femmes enceintes pour une détection précoce. Les résultats montrent que les cancers diagnostiqués pendant la grossesse tendent à être à un stade précoce comparé à ceux détectés en dehors de la grossesse. La gestion de ces cas nécessite une équipe multidisciplinaire, incluant obstétriciens, oncologues et chirurgiens cancérologues, pour évaluer et décider du traitement approprié en fonction du stade de la tumeur et de la gestation. Les recommandations pour la prise en charge incluent une surveillance étroite et une planification collaborative entre les professionnels de la santé et les patientes, afin d’optimiser les résultats pour la mère et l’enfant.
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Gainon, Bart, and Waeber. "Comment évaluer le risque oncologique d'un patient souffrant de dermatomyosite?" Praxis 92, no. 41 (October 1, 2003): 1734–39. http://dx.doi.org/10.1024/0369-8394.92.41.1734.
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Dermatomyosite et polymyosite sont des affections inflammatoires rares d'étiopathogénie obscure dont la prise en charge clinique reste un défi thérapeutique. Ces situations cliniques peuvent classiquement être associées à un risque accru de survenue d'un processus néoplasique et nécessitent une surveillance très attentive pour exclure la présence d'un cancer. Une situation clinique singulière est décrite où l'évolution d'une dermatomyosite fut défavorable malgré différentes approches thérapeutiques. En dépit d'un suivi clinique attentif, d'un bilan biologique et radiologique extensifs, une néoplasie ovarienne ne fut découverte que très tardivement, à savoir plus de 12 mois après le diagnostic initial de dermatomyosite. Cette situation nous a encouragé à revoir attentivement la littérature pour déterminer le risque de néoplasie, ainsi que le suivi à adopter chez les patients souffrant de polymyosite ou dermatomyosite.
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Chaoui, A., M. Nassiri, M. Jiddi, S. Ali Robleh, H. Elhaoury, M. Madhar, C. Rachid, and Y. Najeb. "LIPOSARCOME DE BAS GRADE ET PIEGE DIAGNOSTIC: A PROPOS DUN CAS." International Journal of Advanced Research 10, no. 04 (April 30, 2022): 1033–35. http://dx.doi.org/10.21474/ijar01/14640.
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Le liposarcome est lun des plus communs sarcomes des tissus mous, il represente pres dun quart des neoplasmes des parties molles. Cependant cest un cancer rare puisquil ne represente quenviron 10% de lensemble des cancers chez lhomme. Nous rapportons le cas dun jeun patient de 36 ans, presentant une masse de la face antero-externe de la cuisse gauche de consistance molle, douloureuse, mobile par rapport au plan superficiel, sans signes inflammatoires en regard, de 12cm du grand axe, evoluant depuis 2 mois dans un contexte de conservation de letat general. Le bilan biologique standard etait normal. La radiographie de la cuisse gauche na pas revelee danomalies osseuses ni de calcifications au niveau des parties molles. Ces caracteristiques evoquaient un lipome dont lexerese a ete programmee. Letude anatomopathologique et immunohistochimique de la piece operatoire ont objective un liposarcome peripherique bien differencie de bas grade appele aussi tumeur lipomateuse atypique (OMS 2013) (Grade 1 selon FNCLCC). Un bilan dextension a ete realise fait dune IRM de la cuisse gauche etait negatif. En accord avec le comite doncologie de notre CHU, une intervention de reprise dexerese a ete realisee elle a consiste en une excision de la cicatrice precedente puis, en bloc, de laponevrose et du tissu musculaire sur toute la hauteur du site initial de la tumeur en le debordant de deux centimetres environ. Une surveillance clinique locale et regionale post-operatoire du patient a 4,6 mois et un an plus trad na pas revelee danomalie.
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Evola, Giuseppe, Marco Vacante, and Francesco R. Evola. "Confocal laser endomicroscopy as a new diagnostic tool for poorly differentiated gastric adenocarcinoma." World Journal of Clinical Cases 12, no. 26 (September 16, 2024): 5845–49. http://dx.doi.org/10.12998/wjcc.v12.i26.5845.
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Gastric cancer (GC) is a multifactorial disease, where both environmental and genetic features can have an impact on its occurrence and development. GC represents one of the leading causes of cancer-related deaths worldwide. GC is most frequent in males and is believed to arise from a series of premalignant lesions. The detection of GC at an early stage is crucial because early GC, which is an invasive stomach cancer confined to the mucosal or submucosal lining, may be curable with a reported 5-year survival rate of more than 90%. Advanced GC usually has a poor prognosis despite current treatment standards. The diagnostic efficacy of conventional endoscopy (with light endoscopy) is currently limited. Confocal laser endomicroscopy is a novel imaging technique that allows real-time in vivo histological examination of mucosal surfaces during endoscopy. Confocal laser endomicroscopy may be of great importance in the surveillance of precancerous gastric lesions and in the diagnosis of GC. In this editorial we commented on the article about this topic published by Lou et al in the recent issue of the World Journal of Clinical Cases .
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Tyan, Alexandra S., Grigoriy G. Karmazanovskij, Natalia A. Karelskaya, Evgeniy V. Kondratyev, and Alexander D. Kovalev. "Radiomics for diagnosing clinically significant prostate cancer PI-RADS 3: what is already known and what to do next?" Digital Diagnostics 5, no. 1S (July 3, 2024): 121–23. http://dx.doi.org/10.17816/dd627093.
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BACKGROUND: Prostate cancer is currently the second most commonly diagnosed cancer in men. The second edition of the Prostate Imaging Magnetic Resonance Imaging Data Assessment and Reporting System (PI-RADS) was released in 2019 to standardize the diagnostic process. Within this classification, the PI-RADS 3 category indicates an intermediate risk of clinically significant prostate cancer. There is currently no consensus in the literature regarding the optimal treatment for patients in this category. Some researchers advocate for biopsy as a means of further evaluation, while others propose a strategy of active surveillance for these patients. AIM: The aim of this study is to analyze and compare existing diagnostic models based on radiomics to differentiate and detect clinically significant prostate cancer in patients with a PI-RADS 3 category. MATERIALS AND METHODS: A comprehensive search of the PubMed, Scopus, and Web of Science databases was conducted using the following keywords: PI-RADS 3, radiomics, texture analysis, clinically significant prostate cancer, with additional emphasis on studies evaluated by Radiology Quality Score. The selected studies were required to meet the following criteria: (1) identification of PI-RADS 3 according to version 2.1 guidelines, (2) use of systemic biopsy as a control, (3) use of tools compatible with the IBSI standard for analyzing radiologic features, and (4) detailed description of methodology. Consequently, four meta-analyses and 12 original articles were selected. RESULTS: Radiomics-based diagnostic models have demonstrated considerable potential for enhancing the accuracy of detecting clinically significant prostate cancer in the PI-RADS 3 category using the PI-RADS V2.1 system. However, studies by A. Stanzione A. et al. and J. Bleker et al. have identified quality issues with such models, which constrains their clinical application based on low Radiology Quality Score values. In contrast, the works of T. Li et al. and Y. Hou et al. proposed innovative methods, including nomogram development and the application of machine learning, which demonstrated the potential of radiomics in improving diagnosis for this category. This indicates the potential for further development and application of radiomics in clinical practice. CONCLUSIONS: Although the models developed today cannot completely replace PI-RADS, the inclusion of radiomics can greatly enhance the efficiency of the diagnostic process by providing radiologists with quantitative and qualitative criteria that will enable the diagnosis of prostate cancer with greater confidence.
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Basier, S., M. C. Pheulpin, and B. Guillonneau. "Cancer de la prostate : souffrir de sa guérison." Psycho-Oncologie 13, no. 1 (March 2019): 34–38. http://dx.doi.org/10.3166/pson-2019-0081.
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Le diagnostic précoce du cancer de la prostate permet à des patients de choisir de vivre avec un cancer peu menaçant, via une surveillance active (SA) qui mène souvent à une chirurgie, dont les effets secondaires s’inscrivent dans une forme de chronicité, impactant vie quotidienne, image de soi et sexualité. Qu’implique sur le plan psychique de vivre avec un cancer non traité, mais surveillé ? Comment vivre après une intervention chirurgicale aux conséquences mutilantes, handicapantes, portant atteinte au narcissisme ? Objectif : Interroger les remaniements psychiques à l’œuvre chez des patients diagnostiqués d’un cancer de la prostate, opérés soit après plus d’un an de SA, soit sans délai. Méthode : Dans le cadre d’une recherche doctorale en cours, des entretiens semi-directifs sont proposés en préopératoire, six semaines après, puis six mois. Ces entretiens sont appuyés par des autoquestionnaires ainsi que des tests projectifs : le Rorschach et le TAT (Thematic Apperception Test). Résultats : Les patients opérés après avoir vécu une SA ont bénéficié d’une temporalité particulière au cours de laquelle la plupart d’entre eux ont pu accepter l’inacceptable et tolérer l’idée d’avoir un cancer et vivre avec. Si cette période permet à certains de se préparer à l’évolution de leur cancer et à son traitement par ablation, souvent synonyme de guérison, les effets secondaires de la chirurgie restent parfois très difficiles à vivre, surtout lorsqu’ils s’installent dans la durée et impactent le quotidien, constituant alors une nouvelle forme de chronicité. Vivre avec un « corps cancéreux » en SA n’est pas ici une épreuve physique où le corps est le siège de douleurs physiques et de fatigue, mais essentiellement une épreuve psychique. De façon paradoxale, le « corps guéri » subit des transformations en période postopératoire, des bouleversements qui touchent et atteignent l’image que l’homme a de lui-même. Conclusion : Compte tenu des progrès de la médecine dans le dépistage et le traitement curatif du cancer de la prostate, quels sont les enjeux actuels du dépistage précoce ? Peut-on réellement parler de guérison lorsque le vécu subjectif des patients va à l’encontre de la définition habituelle de ce terme ? La « guérison chronique » succéderait-elle à la « maladie chronique » ?
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Băţ, Dumitriţa, Eliza Cloţea, Nicolae Gică, Aida Petca, Ioana-Emanuela Atanasescu, Scurtu Francesca, Claudia Mehedinţu, and Aniela-Roxana Nodiţi. "Cancerul de sân în timpul sarcinii: review." Obstetrica şi Ginecologia 3, no. 1 (October 29, 2024): 127–31. https://doi.org/10.26416/obsgin.72.3.2024.10389.
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Breast cancer during pregnancy (BCDP) is a rare yet complex condition that presents distinctive diagnostic and therapeutic challenges. This article provides an overview of the incidence, clinical manifestations, diagnostic techniques and treatment strategies pertinent to expectant mothers diagnosed with breast cancer. BCDP occurs in approximately one in every 3000 pregnancies, with a higher prevalence observed in women aged 30 to 40 years old. Nevertheless, as more women put off having children, the incidence of this kind of cancer is predicted to increase much more. After-pregnancy breast cancer is typically triple-negative, being associated with worse prognosis and outcomes. Regardless of the stage at diagnosis, Howlader et al.’s extensive analysis of the Surveillance, Epidemiology, and EndResults (SEER) database, which included 196,094 patients, revealed that triple-negative breast cancer (TNBC) subtype accounted for 9.7% of all cases, being associated with the lowest cancer-specific survival. However, it has been noted that this malignancy is linked to a particular set of genes that can be targeted precisely to treat this fatal illness. In fact, gene-based drugs combined with other cancer treatments are currently being considered for combination therapy. The physiological changes that occur in the breasts during pregnancy can hinder early detection of breast cancer, as the clinical presentation may closely resemble that seen in non-pregnant females. Fortunately, pregnant patients can safely utilize diagnostic imaging modalities such as magnetic resonance imaging (MRI) and ultrasound to evaluate breast masses effectively. Treatment options for breast cancer during pregnancy, which may include chemotherapy and surgical interventions, are designed to optimize outcomes for both the mother and the fetus. To achieve the best results, it is essential to foster multidisciplinary collaboration among neonatologists, obstetricians and oncologists.
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Ali, Sophia, Ahmed Elsherif, Juan Jaume, Abed Kanzy, Feras Khogeer, Mohammed Madkhali, Azra Niaz, et al. "OR09-1 Decoding Cancer Immunoediting of Tumor Microenvironment Provides Immunogenomic Marker for Thyroid Cancer Screening." Journal of the Endocrine Society 6, Supplement_1 (November 1, 2022): A795. http://dx.doi.org/10.1210/jendso/bvac150.1645.
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Abstract Thyroid cancer will become 4th most common cancer in women by 2030. Thyroid cancer is the most prevalent endocrine malignancy of women with an age-standardized rate of 10.1/100,000 while in men it is 3.1/100,000. The microenvironment of thyroid cancer has a high degree of immune invasion, characterized by the presence of T effector (Teff, CD4, and CD8) cells. In our previous study based on 127 human FNA thyroid samples, we reported a dominant T cell species characterized by the deficiency of CD4 and CD8 expression (CD3+CD4-CD8-) Double Negative (DN) T cells, seem to have a regulatory function towards thyroid cancer immune tolerance (1-3). Here, in another cohort study (46 patients), FNAs of thyroids showed that DN T-cells were significantly more abundant in lymphocytic infiltrates of thyroid cancer patients (post-operatively confirmed diagnosis by an academic pathologist), and if the DN T cell population exceeded our defined threshold (>9.14%), it indicated a high likelihood of cancer presence (96.6% sensitivity, 95% CI, 0.915 to 1.000). Conversely, DN T cells below the threshold (<9.14%) provide 100% specificity in predicting benignity of thyroid nodules. This study identifies DN T cell quantification as an accurate rule-out test. The high specificity of the test is promising since it abolishes false-positive diagnoses and unnecessary surgical procedures. Current molecular diagnostic testing, based on the identification of tumor gene mutations in FNA samples usually reduces the risk of cancer rather than guarantee the absence of cancer which leads to 70% of unnecessary thyroidectomies. The present study proposes DN T cell quantification as a diagnostic signature for thyroid cancer. Its integration with RNA transcriptomics may provide a simplified technology for thyroid cancer screening and active surveillance. References 1. Imam S, Paparodis R, Sharma D, et al. 2014 Lymphocytic profiling in thyroid cancer provides clues for failure of tumor immunity. EndocrRelat Cancer 21. 2. Imam S, Dar P, Paparodis R, et al. 2019 Nature of coexisting thyroid autoimmune disease determines success or failure of tumor immunity in thyroid cancer. J Immunother Cancer 7. 3. Imam S, Jaume J C 2021 Stratifying risk of malignancy in indeterminate thyroid nodules and immuno-genomic markers for early detection of thyroid cancer. International Application No. PCT/US2021/012057, Publication Number WO/2021/138661 Presentation: Saturday, June 11, 2022 11:30 a.m. - 11:45 a.m.
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Chikouche, Ammar, Nadia Ould Bessi, and Nawel Habak. "Molecular analysis of an Algerian family of MEN2A at the CPMC, Algiers." Batna Journal of Medical Sciences (BJMS) 7, no. 2 (November 9, 2020): 197–200. http://dx.doi.org/10.48087/bjmscr.2020.7230.
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La NEM2A, qui se caractérise par l’association d’un cancer médullaire de la thyroïde (CMT) à un phéochromocytome et/ou une hyperparathyroïdie, fait partie avec la NEM2B et le CMTF des Néoplasies Endocriniennes Multiples de type 2 (ou NEM2). Ces NEM2 constituent des affections héréditaires rares, de transmission autosomique dominante dues à des mutations du proto-oncogène RET. La recherche de mutations du proto-oncogène RET chez un cas index NEM2A permet d’une part de conforter le diagnostic clinique et d’autre part d’identifier précocement grâce au dépistage génétique, parmi les apparentés du cas index, ceux qui sont porteurs de l’anomalie génétique, avant toute manifestation biologique ou clinique, pour une meilleure prise en charge. Les objectifs sont la caractérisation de la mutation ponctuelle du protooncogène RET chez le cas index et dépister chez les apparentés du cas index, les porteurs de la mutation germinale. Dans ce travail, nous avons mis au point les techniques de diagnostic génotypique par PCR/séquençage des 7 exons du proto-oncogène RET (8, 10, 11, 13, 14, 15, 16) les plus fréquemment affectés. L’étude a été réalisée chez une femme avec CMT et phéochromocytome bilatéral (NEM2A). La mutation retrouvée chez le cas index, a été recherchée chez les apparentés, 2 sœurs adultes présentant chacune un CMT et 07 enfants apparemment sains. La mutation identifiée chez le cas index (C634Y / exon 11) est retrouvée chez les 02 apparentés cliniquement atteints, ainsi que chez 04 des 07 enfants cliniquement sains. Cette mutation C634Y, commune au CMT et à la NEM2A, nous oblige à considérer les cas de CMT présentant cette mutation comme des NEM2A potentiels et de leur assurer une surveillance clinique et biologique identique. Une thyroïdectomie prophylactique sera proposée aux porteurs sains.
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Chikouche, Ammar. "Tumor markers in routine practice." Batna Journal of Medical Sciences (BJMS) 8, no. 2 (December 28, 2021): 128–35. http://dx.doi.org/10.48087/bjmsra.2021.8208.
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Les marqueurs tumoraux sont des molécules biochimiques de nature très différentes secrétées lors de l’apparition d’un cancer. Le marqueur idéal spécifique, sensible, d’apparition précoce, dont les taux sont corrélés à la masse tumorale n’existe pas. Les marqueurs tumoraux sont dosés par différentes méthodes immunologiques qui sont importantes à connaitre. Les marqueurs tumoraux permettent de supposer le type de cancer primitif, sa localisation mais peuvent être présents lors d’affections bénignes. Les marqueurs tumoraux sont d’un intérêt certain selon les étapes de la prise en charge du cancer ; le dépistage, le diagnostic, le pronostic de la maladie, l’évaluation du traitement et la surveillance post thérapeutique. L’intérêt le plus remarquable est noté lors du suivi en cours ou après un traitement tel que la chimiothérapie. Lors du suivi, il est important de noter les différents dosages du marqueur pour tracer une courbe de cinétique qui va révéler si bonne ou mauvaise évolution de la maladie. Les dosages des marqueurs tumoraux doivent être considérés selon la présence ou l’absence d’une insuffisance rénale.
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Debernardi, Silvana, Evelyn Kurotova, Nurshad Ali, Mariam Mahamood, Ismita Chhetri, Steve Pereira, Patrick Wilson, et al. "Abstract B018: UroPanc: A large prospective observational study for validation of urinary biomarker test for the earlier detection of pancreatic adenocarcinoma." Cancer Research 84, no. 17_Supplement_2 (September 15, 2024): B018. http://dx.doi.org/10.1158/1538-7445.pancreatic24-b018.
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Abstract Introduction. A bleak prognosis of Pancreatic ductal adenocarcinoma (PDAC) is largely due to late diagnosis and highly accurate, non-invasive diagnostic tests are urgently needed to improve patients’ survival. Our group has previously reported on urinary biomarker panel, comprising of LYVE1, REG1B and TFF1 (1-2), which distinguished controls from PDAC stages I-II with AUC 0.936 and sensitivity/specificity (SN/SP)>85%. We constructed the logistic regression based algorithm for interpretation of the data, PancRISK (3), which enables the stratification of high- risk patients into those with ‘average’ or ‘elevated’ risk of developing PDAC. Recently, we showed that our panel combined with CA19-9 can detect PDAC up to 2 years before clinical diagnosis (4). Aim. Here, we report on the design and interim analysis of the UroPanc Trial (ClinicalTrials.gov NCT04449406), which aims to evaluate the accuracy of the urinary biomarker panel and the affiliated PancRISK. We plan to recruit two cohorts: the first one comprises asymptomatic individuals that have high risk of developing PDAC due to familial history and genetic syndroms - these will be recruited through the EUropean Registry Of familial PAncreatic Cancer and hereditary pancreatitis (EUROPAC) (PI: Prof W Greenhalf and team, Liverpool, UK). The second cohort comprises patients with symptoms suggestive of PDAC – such patients are recruited at gastrointestinal clinics at University College London Hospitals (UCLH, PI: Prof S Pereira and team), and The Royal London Hospital (PI: Dr P Wilson).Methods. The urinary proteins are assayed by commercially available ELISAs. Plasma CA19-9 is measured at The Doctors Laboratory in London, UK using Cobas601E, Roche platform. The statistical analysis and accuracy of the test is measured by c-statistics, SN/SP and positive/negative predictive value. The results are compared to imaging and histopathology records (where available). Human factor and budget impact analysis of the future inclusion of the urine test into the diagnostic and surveillance pathways for PDAC patients is ongoing (PI: Dr M Z Ni and the team, Imperial College London, UK). Results and conclusions. At present, 1067 patients have been recruited, and urine samples from 825 patients have been assayed. An interim analysis has shown promising results with SP of 91% and SN of 86%, and accuracy of cancer detection of 90%. Combined with the health economic analysis, we currently work towards the future implementation of this test into clinical practice, with the potential to significantly improve the current diagnostic pathway for individuals at risk of pancreatic cancer. 1. Radon, TP, et al. Clin Cancer Res, 2015; 21:3512-21. 2. Debernardi, S, et al. PLOSMed, 17(12); e1003489. 3. Blyuss, O, et al. Br J Cancer, 2020; 122:692-6. 4. Debernardi, S, et al. Int J Cancer, 2023; 152:769–80. Citation Format: Silvana Debernardi, Evelyn Kurotova, Nurshad Ali, Mariam Mahamood, Ismita Chhetri, Steve Pereira, Patrick Wilson, Bill Greenhalf, Melody Z Ni, Oleg Blyuss, Tatjana Crnogorac-Jurcevic. UroPanc: A large prospective observational study for validation of urinary biomarker test for the earlier detection of pancreatic adenocarcinoma [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Pancreatic Cancer Research; 2024 Sep 15-18; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(17 Suppl_2):Abstract nr B018.
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Chaidarun, Tanyawan, Meredith Sorensen, and Sushela Chaidarun. "ODP493 Malignant Struma Ovarii with Papillary Thyroid Carcinoma and concomitant High Risk Thyroid Nodule." Journal of the Endocrine Society 6, Supplement_1 (November 1, 2022): A771. http://dx.doi.org/10.1210/jendso/bvac150.1593.
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Abstract Introduction Struma ovarii is a rare teratoma consisting of >50% thyroid tissue. Malignant transformation very seldomly occurs; most pathology shows papillary thyroid carcinoma. The risk and prevalence of concurrent thyroid gland neoplasm is unclear. Thyroid cancer surveillance post-oophorectomy in these patients may be pertinent but has not yet been established. Case Report A nulliparous 54 year-old woman with one year of menopause without HRT had pelvic and back pain. Imaging detected bilateral ovarian teratomas. Pathology from laparoscopic bilateral salpingo-oophorectomy revealed a 10.7×9.9×10.9cm noninvasive struma ovarii with focal papillary thyroid carcinoma of the left ovary and a benign teratoma of the right ovary. Importantly, the patient had a known thyroid nodule. Two years prior, a FNA of the 1.4cm hypoechoic, hypervascular nodule in the left lower pole yielded benign (Bethesda 2) cytology. After struma ovarii resection, thyroid ultrasound showed highly suspicious TIRAD5. She denied symptoms of hyper- or hypothyroidism and had a normal TSH. She consequently underwent two FNA biopsies, both of which were non-diagnostic. The patient deferred further attempts. History of an initial benign biopsy and stability of the nodule size provide some reassurance. With the patient's reluctance for surgery, serial thyroglobulin (Tg) and ultrasounds will be followed. Post-operative Tg was normal with negative Tg antibody. If Tg becomes markedly elevated, a thyroidectomy will be indicated. Discussion Given the TIRAD5 nodule, this patient's risk of thyroid malignancy is 60-70%. This is compounded with her setting of malignant struma ovarii, which may imply genetic predisposition for thyroid carcinogenesis. Since cytology could not be obtained on the two recent biopsies, definitive pathology by diagnostic lobectomy or thyroidectomy may be considered. A total thyroidectomy would provide the advantage of following Tg for cancer surveillance of both thyroid and ovarian malignancies. There is scant evidence on the treatment of malignant struma ovarii. A few small case series and a pooled review of 57 cases of low-risk (confined to the ovary) malignant struma ovarii in which 50 patients did not undergo thyroidectomy/I-131 ablation showed only a 7.5% recurrence rate at 25 years (Marti et al Thyroid 2012 Apr; 22 (4): 400-406). Hence, this study recommends reserving prophylactic thyroidectomy for patients with extra-ovarian extension or metastases. Treatment of malignant struma ovarii may be extrapolated from those used in differentiated thyroid cancer; high-risk lesions would be those measuring >4cm, have local or distant invasion, or have a BRAF mutation (indicating an aggressive tumor). In conclusion, conservative measures of the thyroid gland with a suspicious nodule may be acceptable in patients with noninvasive malignant struma ovarii, provided strict adherence to cancer surveillance of Tg with both thyroid and pelvic sonography. Presentation: No date and time listed
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Xie, Lin, Jay Onysko, and Howard Morrison. "Incidence du cancer chez les enfants au Canada : variations démographiques et géographiques des tendances (1992‑2010)." Promotion de la santé et prévention des maladies chroniques au Canada 38, no. 3 (March 2018): 91–130. http://dx.doi.org/10.24095/hpcdp.38.3.01f.
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Introduction La surveillance des tendances de l’incidence du cancer chez les enfants peut éclairer la recherche, les politiques et les programmes en matière d’étiologie. Cette étude donne lieu au premier rapport sur les variations démographiques et géographiques des tendances de l’incidence de groupes diagnostiques détaillés chez les enfants de la population générale au Canada. Méthodologie Les données du Registre canadien du cancer ont servi à calculer les taux d’incidence normalisés selon l’âge (TINA) annuels de 1992 à 2010 chez les enfants de moins de 15 ans selon le sexe, l’âge et la région pour les 12 principaux groupes et certains sous‑groupes diagnostiques de la 3e édition de la Classification internationale du cancer chez les enfants (CICE). Les tendances temporelles ont été examinées à partir des variations annuelles en pourcentage (VAP) au moyen d’une régression Joinpoint. Résultats Les TINA annuels du cancer chez les enfants ont augmenté de 0,5 % (intervalle de confiance [IC] à 95 % = 0,2 à 0,9) chez les garçons chaque année entre 1992 et 2010, tandis que l’incidence chez les filles a augmenté de 3,2 % (IC = 0,4 à 6,2) chaque année depuis 2004 après une stabilisation initiale. L’augmentation globale la plus importante a été observée chez les enfants de 1 à 4 ans (VAP = 0,9 %, IC = 0,4 à 1,3). Par région, c’est en Ontario entre 2006 et 2010 que les taux globaux ont le plus augmenté (VAP = 5,9 %, IC = 1,9 à 10,1) et ils ont augmenté de façon non significative dans les autres régions entre 1992 et 2010. On a mesuré en 2006-2010 les TINA annuels moyens de tous les cancers confondus les plus faibles dans les Prairies (149,4 pour 1 million) et les plus élevés en Ontario (170,1 pour 1 million). Les TINA des leucémies, du mélanome, des carcinomes, du cancer de la thyroïde, des épendymomes et de l’hépatoblastome ont augmenté dans tous les groupes d’âge, et les TINA du neuroblastome ont augmenté chez les enfants de 1 à 4 ans. L’incidence de l’astrocytome a diminué chez les enfants de 10 à 14 ans (VAP = −2,1 %, IC = −3,7 à −0,5) ainsi que chez les garçons (VAP = −2,4 %, IC = −4,6 à −0,2) et les filles (VAP = −3,7 %, IC = −5,8 à −1,6) en Ontario au cours de la période étudiée. Conclusion Les tendances à la hausse de l’incidence de tous les cancers confondus et de certaines tumeurs malignes correspondent aux tendances signalées dans d’autres pays développés. Elles sont explicables par des variations démographiques, par des variations de l’exposition aux facteurs étiologiques ou par des changements apportés aux méthodes de codification, de diagnostic et de déclaration du cancer. Une baisse significative de la tendance de l’astrocytome chez les 10 à 14 ans a été observée pour la première fois.
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Chikouche, Ammar, Mebarek Boudissa, Belaid Ait Abdelkader, Malika Ait Abdallah, Hakima Boumaza, Naziha Zeraoulia, and Lakhdar Griene. "Multiple endocrine neoplasia type 2A associated with a de novo mutation of proto-oncogene RET." Batna Journal of Medical Sciences (BJMS) 2, no. 2 (December 30, 2012): 117–20. http://dx.doi.org/10.48087/bjmsoa.2015.2203.
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Introduction : Nous rapportons un cas de néoplasie endocrinienne multiple de type 2 (NEM2) associé à une mutation du proto-oncogène RET. Objectifs : Rechercher et identifier une mutation du protooncogène RET chez le cas index de NEM2 pour confirmer le diagnostic clinique. Dépister, chez les apparentés, ceux qui portent la mutation familiale pour leur faire bénéficier d’une prise en charge médicale étroite et thérapeutique avant toute manifestation clinique et biologique. Matériels et méthodes : Il s’agit d’une patiente âgée de 18 ans qui présente un cancer médullaire. Un prélèvement sur tube EDTA a été acheminé au laboratoire de Biologie moléculaire accompagné d’une demande d’analyse génotypique du gène RET, d’un arbre généalogique et d’une fiche de consentement. L’extraction d’ADN a été faite par la méthode de précipitation aux sels. L’étude génétique a été réalisée par une amplification des différents exons par PCR suivie d’un séquençage sur ABI 3130 Applied Biosystems. Après avoir retrouvé la mutation chez le cas index, des apparentés ont bénéficiés de l’analyse génétique. Il s’agit du père âgé de 63 ans, de la mère âgée de 58 ans et de la sœur âgée de 22 ans. Résultats : Le cas index présente une mutation au niveau l'exon 11 du proto-oncogène RET. Cette mutation provoque le remplacement de la cystéine au niveau du codon 634 par l'arginine (mutation C634R). Le père, la mère et l’unique sœur qui sont apparemment en bonne santé, ne présentent pas la mutation. Conclusion : Cette mutation a été décrite et retrouvée spécifiquement dans des cas de NEM2A. Cela impose la recherche d’un phéochromocytome et surveillance biologique et médicale. Uniquement la patiente cliniquement affectée est porteuse de la mutation du gène RET. Cela signifie que cette mutation C634R est de novo. Les parents non porteurs de la mutation sont rassurés et il n’est pas nécessaire de faire l’étude génotypique d’autres apparentés sauf si la patiente a des enfants.
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Iacucci, M., R. J. M. Ingram, A. Bazarova, R. Cannatelli, N. Labarile, O. M. Nardone, T. L. Parigi, et al. "DOP14 Validation of a new OPtical diagnosis Training platform to Improve dysplasia Characterisation in Inflammatory Bowel Disease (OPTIC-IBD): A multicentre randomised controlled study." Journal of Crohn's and Colitis 16, Supplement_1 (January 1, 2022): i063—i064. http://dx.doi.org/10.1093/ecco-jcc/jjab232.053.
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Abstract Background Inflammatory bowel disease (IBD) increases colorectal cancer risk. To mitigate this patients undergo endoscopic surveillance to detect dysplasia. However, chronic inflammation alters mucosal and vascular colonic architecture, complicating lesion recognition. Endoscopic advances enhance our ability to accurately characterise these lesions. But training on optical diagnosis of dysplastic lesions in IBD is not widely available. We aim to fill this gap by developing and validating the new OPTIC-IBD online training platform (Figure 1, NCT04924543, funding GutsUK TRN2019-03). Methods We designed an interactive, self-directed, multi-modality learning module. This includes surveillance principles, optical diagnosis methods, characterisation approach, classifications (SCENIC, Kudo, FACILE1), examples and self-assessments. We invited participants from Canada, Italy and the UK, including novice (<100 lifetime colonoscopies), intermediate and experienced endoscopists (≥1000). Assessments comprised 24 short endoscopic videos of IBD colonic lesions, divided into 8 non-dysplastic (hyperplastic, inflammatory, sessile serrated lesion [SSL]) and 16 dysplastic lesions (SSL-D, low grade and high grade dysplasia, cancer). Participants classified lesions, predicted histology and rated their confidence. All participants completed online training and feedback. The videos were repeated in a random order after ≥7 days. Participants were then randomised 1:1 to get feedback and extra training. All had a final assessment at 60 days with prior/new videos and similar case mix. We report diagnostic performance for dysplasia, interrater reliability and rater confidence. Results We present a planned interim analysis of 77 participants after pre- and post-course assessments (Table 1). Diagnostic accuracy improved (primary endpoint: 44.5 to 54.0%, P<0.0001), particularly for novice and intermediate endoscopists. Sensitivity for dysplasia increased (50.3 to 59.1%) in line with prior experience. Specificity and accuracy were most improved for high confidence diagnoses (44.9 to 70.3% and 55.0 to 64.6%). In multilevel logistic regression, training was associated with correct diagnoses for high confidence (OR 1.40, 1.13–1.77) but not low confidence ratings (OR 1.09, 0.96–1.25). Training improved precision between participants (Table 2) and their confidence (Table 3). Conclusion The OPTIC-IBD training module improved participants’ accuracy, precision and confidence in optical diagnosis of dysplasia. Next, we will study the training approaches and classification systems that can best be adopted by non-experts and trainees. Our refined training platform will be made available to improve quality of endoscopic care for people with IBD. Reference 1. Iacucci et al Endoscopy 2019;51(2):133
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Tremblay, Dominique, Karine Bilodeau, Catherine Prady, and Nassera Touati. "Staging the development and implementation of a Coordinated Cancer Care Model using risk-based survivorship care: A deliberative discussion among multiple stakeholders." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e18027-e18027. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e18027.
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e18027 Background: Risk-based survivorship care has become one of the best practices care recommended by the Institute of Medicine. It involves coordinated follow-up services based on the risk of long-term and late effects, cancer recurrence and an individualised care plan. Risk-based care requires specific knowledge about cancer histology, treatments, and potential consequences of cancer and its treatment to guide surveillance, screening and counseling. Diagnostic and treatment details and their associated health risks may not be known by survivors or their multiple care providers. Implementing risk-based survivorship care is often challenging for providers. This presentation report on a deliberative workshop on the development and planning of a risk-based survivorship care model. Methods: The deliberative workshop is part of a larger study in two regional cancer networks in Quebec, selected for there differences (geographic location, population size, academic mandate). A total of 25 key informants (researchers, managers, family physicians, oncologists, cancer survivors, nurses, social workers) participated into the workshop on October 2nd, 2018. Deliberative discussion between local stakeholders followed by videoconference, getting together stakeholders from both networks was drawn from Gupta et al 3 steps: 1) identify the problem; 2) develop the innovation; 3) design the pilot test. Results: Although the context of the network was different, main issues were similar: 1) there is no common understanding of the concept “risk-based survivorship care”, either for survivors, primary care providers and cancer specialist; 2) “silo functioning” within and between teams is a main barriers to ensure care coordination based on risk assessment; 3) organizational assets should be formalized to insure safe coordination of survivorship care based on cancer risk assessment. Conclusions: Given the recognized importance of risk-based survivorship care and implementation challenges, deliberative discussions may provide a useful lens to inform translation of this model into real practices and guide empirical studies.
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Chalasani, Venu, Carlos H. Martinez, Darwin Lim, Mazen Abdelhady, and Joseph L. Chin. "Surgical cryoablation as an option for small renal masses in patients who are not ideal partial nephrectomy candidates: intermediate-term outcomes." Canadian Urological Association Journal 4, no. 6 (April 22, 2013): 399. http://dx.doi.org/10.5489/cuaj.954.
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Objective: There has been increasing interest in surveillance andablative techniques for small renal masses (SRM), given the increasingnumber being diagnosed at smaller sizes. Of the currently availableablative techniques, radiofrequency ablation and cryoablationhave been the popular ones. We describe our intermediate-termoutcomes with using cryoablation for SRM in patients who werenot ideal candidates for partial nephrectomy.Materials and methods: Nineteen patients treated with cryoablationwere included. Patients with renal lesions <4 cm were consideredfor cryoablation, and all patients were treated between 2002 and2007. Access was either laparoscopic (transperitoneal) or via opensurgical techniques. From 2002 to 2004, the CryoCare System(Endocare, Inc., Irvine, CA) was used, with probe sizes rangingfrom 3 to 5 mm. Before 2004, the SeedNet system (Galil Medical,Arden Hills, MN) was used, with 17-gauge (1.47 mm) IceRod cryoneedles.Recurrence-free survival (RFS) and overall survival (OS)were calculated using Kaplan Meier methodology.Results: The mean age was 56.7 years. The mean tumour size was2.6 cm (range 1.2-4.0 cm). There were no intraoperative or postoperativecomplications in the 19 patients. One patient has beenlost to follow-up; mean follow up was 41.6 months (range 7-84months) in the cohort. Recurrence, defined as either increase insize of lesion or enhancement on follow-up imaging, was seen in4 patients. There was 1 non-cancer specific death, and 1 cancerspecific death.Conclusions: The 4-year RFS rate and OS rate were 83.6% and94.1%, respectively, in patients with SRM who were unsuitablefor partial nephrectomy.Objectif : Le diagnostic étant de plus en plus précoce, on note unintérêt croissant pour les techniques de surveillance et d’ablationdes petites masses rénales. Parmi les techniques actuelles, l’ablationpar radiofréquence et la cryoablation sont les plus utilisées. Nousprésentons ici nos résultats à moyen terme avec la cryoablationde petites masses rénales chez des patients à qui la néphrectomiepartielle ne convenait pas.Matériel et méthodologie : Dix-neuf patients traités par cryoablationont été inclus. Les patients présentant des lésions rénales de < 4 cmétaient considérés, et tous les patients ont été traités entre 2002 et2007. L’abord se faisait par laparoscopie (transpéritonéale) ou parchirurgie ouverte. De 2002 à 2004, on a eu recours au systèmeCryoCare (Endocare, Inc., Irvine, Calif.), avec des sondes de 3 à5 mm. Avant 2004, on utilisait le système SeedNetMC (Galil Medical,Arden Hills, Minn.), avec des cryo-aiguilles IceRod de calibre 17(1,47 mm). Les taux de survie sans récurrence (SSR) et de survieglobale (SG) ont été calculés par la méthode de Kaplan Meier.Résultats : L’âge moyen était de 56,7 ans; la taille moyenne destumeurs était de 2,6 cm (de 1,2 à 4,0 cm). Aucun des 19 patientsn’a présenté de complication intra ou postopératoire. Un patient aété perdu de vue lors du suivi. La durée moyenne du suivi était de41,6 mois (7 à 84 mois). Quatre patients ont présenté une récurrence,définie comme une augmentation de la taille de la lésionou une lésion plus visible lors des épreuves d’imagerie de suivi.Un patient est décédé de causes non liées au cancer, et un autre,des suites du cancer.Conclusions : Les taux de SSR et de SG après 4 ans étaient de83,6 % et de 94,1 %, respectivement, chez des patients avecpetites masses rénales à qui une néphrectomie partielle ne convenaitpas.
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Tønjum, T. K., K. Anisdahl, T. Folseraas, H. Midgard, and M. L. Høivik. "P302 Malignancy surveillance in patients with primary sclerosing cholangitis and Inflammatory Bowel Disease – keeping up with international guidelines? A Norwegian cohort study." Journal of Crohn's and Colitis 16, Supplement_1 (January 1, 2022): i331—i332. http://dx.doi.org/10.1093/ecco-jcc/jjab232.429.
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Abstract Background Primary sclerosing cholangitis (PSC), especially PSC in inflammatory bowel disease (PSC-IBD), increases risk of developing several types of cancers, including cholangiocarcinoma (CCA), gall bladder cancer and colorectal cancer (CRC) – highlighting the need for frequent and thorough screening employing several diagnostic modalities, in these patients. We aimed to assess whether current international guidelines for malignancy surveillance were followed for the PSC-IBD population at the Department of Gastroenterology (DoG) at Oslo University Hospital (OUH). Methods Data from health records of patients at DoG OUH containing the term ‘PSC’ was screened for IBD and PSC diagnoses, disease activity and severity, as well as follow-up of PSC disease progression and surveillance of PSC-associated malignancies. All data was collected in the last quarter of, 2020 and registered in the local IBD registry. Results Clinical characteristics [Table 1] and surgical intervention for PSC-IBD [Table 2] are displayed below. In the last year, magnetic resonance cholangiopancreatography (MRCP) was performed in, 16 patients (26%), while, 47 (78%) had an abdominal ultrasound (US). Colonoscopy or other lower endoscopy was performed within the last year in a total of, 42 patients (69%). In those who had not undergone colectomy, 33/40 (83%) underwent colonoscopy in the last year, while, 31/40 (78%) had biopsies taken. Conclusion Abdominal US and colonoscopy with biopsies should be performed annually in all PSC-IBD patients1,2, meaning, on average, about one fifth of PSC-IBD patients at OUH may be at risk of unnecessary and preventable affliction. Also, there is a void of guidelines regarding CRC screening in colectomised patients. Evidence for screening for CCA with MRCP remains unclear3, but when performed may indicate severe economic impact on public health systems. References 1. Chapman MH et al. British Society of Gastroenterology and UK-PSC guidelines for the diagnosis and management of primary sclerosing cholangitis. Gut., 2019;68(8):1356–78. 2. Aabakken L et al. Role of endoscopy in primary sclerosing cholangitis: European Society of Gastrointestinal Endoscopy (ESGE) and European Association for the Study of the Liver (EASL) Clinical Guideline. Endoscopy., 2017;49(6):588–608. 3. Schramm C, Eaton J, Ringe KI, Venkatesh S, Yamamura J. Recommendations on the use of magnetic resonance imaging in PSC - A position statement from the International PSC Study Group. Hepatology., 2017;66(5):1675–88.
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Chae, Young Kwang, Liam Il-Young Chung, Rade Tomic, and Ankit Bharat. "Abstract CT278: [DREAM] Double lung transplant registry aimed for lung-limited malignancies - a prospective registry study for medically refractory cancers." Cancer Research 84, no. 7_Supplement (April 5, 2024): CT278. http://dx.doi.org/10.1158/1538-7445.am2024-ct278.
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Abstract BackgroundAdenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) are listed as ‘special circumstances’ for lung transplantation according to a consensus document from the International Society for Heart and Lung Transplantation (ISHLT) (Weill D et al., 2015). Five studies have reported on lung transplantation in carefully selected subsets of patients with multifocal lung adenocarcinoma (Raemdonck DV et al., 2016; Glanville AR et al., 2018). The 5-year survival rate of bilateral sequential lung transplantation was estimated at over 50% in patients with multifocal BAC, invasive adenocarcinoma, and NSCLC (Ahmad U et al., 2012; Paloyan EB et al., 2000; Zorn GL et al., 2003; de Perrot M et al., 2004). Another a case series reported a post-transplant recurrence-free survival of 23 to 56 months in three patients (Garver RI et al., 1999). Moreover, there is an unmet need for patients who have lung-limited metastasis after successful treatment for primary tumors such as sarcomas or colorectal cancer (CRC). As with liver transplantation for CRC patients who have liver-confined metastases (Dueland S et at., 2020; Hernandez-Alejandro R et al., 2022), the applicability of lung transplantation in lung-limited metastatic patients should be explored. There is also an unmet need for patients with respiratory failure with a history of cancer in the last 5 years. MethodsThis is a prospective registration trial to evaluate outcomes of patients who undergo double lung transplantation for the treatment of the select groups of medically refractory cancers (primary lung cancers or metastatic cancers in lungs). Overall survival (OS), disease-free survival (DFS), allograft rejection (AR) and allograft survival (AS) as well as molecular and genetic biomarkers will be monitored to investigate the correlation with prognosis.The study duration will be 10 years including surveillance. Recruitment is to occur during the first 5 years of the study. The goal is to enroll 125 participants through the Northwestern Medicine Clinical Programs.Essential Criteria:1.The tumor should be without any extrapulmonary metastasis as determined by standard of care diagnostic and staging workup.2.All standard of care or experimental oncological treatments known to improve survival should have failed or deemed infeasible 3.Patients should meet the general criteria for lung transplant evaluation and listing Study cohorts:•Cohort A: Primary lung cancers - Examples include, but not limited to, invasive mucinous/non-mucinous non-small cell lung cancers and multifocal carcinomas.•Cohort B: Metastatic cancers to the lung only - Examples include, but not limited to, germ cell tumors, head & neck tumors, colorectal tumors, renal cell tumors, testicular cancers.•Cohort C: Respiratory failure with a history of cancer in the last 5 years- Examples include, but not limited to interstitial lung disease (ILD), pulmonary fibrosis (idiopathic or secondary), advanced chronic obstructive pulmonary disease (COPD), bronchiectasis, emphysema, cystic fibrosis (CF), emphysema due to alpha-1 antitrypsin deficiency, and pulmonary arterial hypertension (PAH) Clinical trial registry number : NCT05671887.Enrollment began November 16, 2022. Trial is open and continues to enroll participants as of Jan 8, 2024. Citation Format: Young Kwang Chae, Liam Il-Young Chung, Rade Tomic, Ankit Bharat. [DREAM] Double lung transplant registry aimed for lung-limited malignancies - a prospective registry study for medically refractory cancers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr CT278.
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Patwardhan, M. B., G. P. Samsa, M. A. Michael, R. G. Prosnitz, D. A. Fisher, C. R. Mantyh, and D. C. McCrory. "Quality measures for the diagnosis and management of colorectal cancer." Journal of Clinical Oncology 24, no. 18_suppl (June 20, 2006): 16031. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.16031.
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16031 Background: The huge burden of illness from colorectal cancer (CRC) can be reduced by improving the quality of care for CRC patients. Identifying appropriate quality measures that can assess the processes of care is the first step in this process. Therefore we conducted a comprehensive literature search to identify process measures available in the United States to assess the quality of care for diagnosing and managing patients with CRC and the extent to which they were field-ready. Methods: We conducted a standard literature search using MEDLINE and the Cochrane Database; also explored gray literature, and identified 3771 abstracts. By sequential exclusion, 74 of them were finally included. We included quality measures from traditional QI literature, and supplemented them with those included in studies where these measures were used as part of their research agenda. All measures were abstracted into evidence tables and evaluated using a set of standard criteria regarding their importance, usability, and scientific acceptability. In order to assess the extent to which they were field-ready, we devised a summary rating scale for each quality measure using three criteria: importance and usability, scientific acceptability, and extent of testing. Results: Overall, the coverage of general process measures in CRC is extensive. Process measures are available for diagnostic imaging, staging, surgical therapy, adjuvant chemotherapy, adjuvant radiation therapy, and colonoscopic surveillance. The highest rated measures were those related to chemotherapy (abstract submitted by Morse et al) and pathology reporting. There were no process measures for assessing the quality of: polyp removal, surgical management of stage IV rectal cancer, hepatic metastasis, chemotherapy for stage II colon cancer, stage IV rectal cancer, radiation for stage IV rectal cancer, and notes for endoscopy, surgery, chemotherapy and radiology - all because of lack of guidelines. Conclusions: Our evidence report suggests that we need to actively pursue the task of developing scientifically accurate quality measures for leverage points in the diagnosis and management of CRC; so we can evaluate the quality of care delivered by providers and initiate quality improvement activities, with the aim of providing better patient care. No significant financial relationships to disclose.
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Cunliffe, Amy, Rand Hawari, Angana Mitra, Bipin Mathew, William Merchant, Hayley Smith, Andrew Muinonen-Martin, and Maulina Sharma. "CPC12 A metastatic melanoma mimic: malignant peripheral nerve sheath tumour in the setting of a rare germline BAP1 disease-causing variant." British Journal of Dermatology 191, Supplement_1 (June 28, 2024): i13. http://dx.doi.org/10.1093/bjd/ljae090.025.
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Abstract BAP1 tumour predisposition syndrome (BAP1-TPDS) is a newly recognized cancer syndrome that predisposes patients to uveal melanoma, malignant mesothelioma, renal cell carcinoma, cutaneous melanomas and an emerging range of other cancers. We previously presented a 48-year-old patient with an isolated melanoma metastasis on his wrist arising on a background of a germline BAP1 mutation. We wish to provide an update on his diagnosis, which has been revised to a malignant peripheral nerve sheath tumour (MPNST). To our knowledge, there is only one published similar case in a patient with BAP1-TPDS (Kaszuba MC, Pulido JS, Folpe AL et al. Malignant peripheral nerve sheath tumor in a patient with BAP1 tumor predisposition syndrome. World Neurosurg 2018; 109: 362–4). The patient initially presented to the hand surgeons with a 5-year history of a subcutaneous swelling on his right wrist associated with paraesthesia and pain. Excision biopsy of the lesion revealed a perineural encapsulated pleomorphic tumour with large atypical cells and small neurofibroma-appearing cells at the periphery. Immunohistochemistry showed expression of S100, SOX10 and calretinin, and negative melan-A. Next-generation sequencing revealed BAP1 loss with high variant allele frequency. The patient’s mother died from metastatic uveal melanoma, his maternal grandmother had a history of mesothelioma and his aunt died of a brain tumour. Germline testing showed the patient to be heterozygous for the pathogenic BAP1 sequence variant c.122+1del. We initially presented this case as a stage IV metastatic melanoma deposit on the right wrist originating from a pT4a BAP1 inactivated primary melanoma on the back. This skin lesion had been present for 10 years without change and there was no visceral organ involvement. Due to the unusual nature of the presentation further input from a specialist skin cancer multidisciplinary team with an interest in BAP1-TPDS led to a revised diagnosis of an MPNST on the wrist. The primary melanoma diagnosis was changed to a low-risk BAP1 melanocytoma, based on histological and immunohistochemical findings. Two other low-risk melanocytomas were also excised. The patient was referred to the sarcoma multidisciplinary team, for wide local excision of the MPNST, staging scans and surveillance, including annual ophthalmology review, dermatology review and renal imaging. BAP1 loss in MPNST has only been described once before, interestingly with a splice receptor germline disease-causing variant (Kaszuba et al.). Our case highlights the potential diagnostic complexity associated with BAP1-TPDS for the dermatologist and dermatopathologist. Clinicians should be aware of the proposed surveillance guidelines, while being mindful that the spectrum of associated cancers is expanding. For complex cases like ours, gaining input from centres with experience managing patients with BAP1-TPDS can refine the diagnosis, with important implications for prognosis and patient outcomes.
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Srour, Samer A., Susan S. Devesa, Lindsay M. Morton, David P. Check, Rochelle E. Curtis, Martha S. Linet, and Graca M. Dores. "Incidence and Patient Survival of Myeloproliferative Neoplasms (MPNs) and Myelodysplastic/Myeloproliferative Neoplasms (MDS/MPNs) in the United States: A Population-Based View of the Modern Diagnostic Era." Blood 126, no. 23 (December 3, 2015): 2806. http://dx.doi.org/10.1182/blood.v126.23.2806.2806.
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Abstract Introduction: Epidemiologic information on myeloproliferative neoplasms (MPNs) and myelodysplastic (MDS)/MPNs is largely derived from single institution and European population-based studies. Further, descriptive data encompassing the era of the World Health Organization classification (WHO) of hematopoietic neoplasms and JAK2 V617 mutation testing are sparse. Therefore, we utilized population-based data to comprehensively assess incidence and patient survival of MPNs and MDS/MPNs in the United States (US) during 2001-2012. Methods: Using data from the National Cancer Institute's Surveillance, Epidemiology and End Results Program (SEER) Program, we assessed the incidence rates (IRs), IR ratios (IRRs), and 95% confidence intervals (CI) for each MPN and MDS/MPN entity. We assessed IRs overall and according to sex, race/ethnicity, calendar year of diagnosis, and method of diagnostic confirmation. We utilized the SEER*Stat Survival Session to calculate 5-year relative survival (RS) and 95% CI for each disease entity overall and according to sex and age at diagnosis. Results: A total of 44,912 patients were diagnosed with MPNs and MDS/MPNs during 2001-2012. IRs were highest for polycythemia vera (PV) (n=10,812; IR=10.9 per 1,000,000 person-years) and essential thrombocythemia (ET) (n=9,394; IR=9.6). Except for ET and mastocytosis, the overall IRs for all entities were significantly higher among males than females, with male-to-female IRRs ranging from 1.4-2.3. PV incidence peaked in 2003-2004 and progressively decreased thereafter in contrast to IRs for ET which markedly increased after 2003-2004, with a suggestion of decrease after 2008. BCR-ABL1-positive chronic myelogenous leukemia (CML) IRs increased progressively over the study period while CML, NOS decreased over the study decade. All evaluable MPNs were associated with lower IRs among Hispanic whites than non-Hispanic whites (NHWs), with the exception of BCR-ABL1-positive CML, chronic eosinophilic leukemia (CEL), and juvenile myelomonocytic leukemia which occurred similarly among both groups. Except for CEL, Asians/Pacific Islanders had significantly lower MPN IRs than NHWs. ET, MPN-unclassifiable, and CEL IRs were 18%, 19%, and 60% higher, respectively, among blacks than NHWs. Among males and females, for all evaluable MPNs and MDS/MPNs, five-year RS was more favorable for younger (<60 years) than older (>60 years) individuals. Patients with PV or ET had the most favorable RS among both sexes and age groups, ranging from 92.0%-96.7% among those <60 years and 79.1%-87.9% among those >60 years. Patients with chronic neutrophilic leukemia, chronic myelomonocytic leukemia, and atypical BCR-ABL1 -negative CML patients had the least favorable 5-year RS (<35%). Females generally had more favorable survival than males, except for older males with PV who had significantly better survival than older women (RS IRR=1.08, 95%CI=1.03-1.13). Conclusion: MPNs are a heterogeneous group of diseases and varying age, sex, and racial/ethnic incidence patterns support distinct etiologies and/or susceptible populations. The introduction of JAK2 V617 mutation testing in 2005 may have had a differential impact on IRs of PV and ET. Less favorable RS among older ages for all MPN subtypes suggests the need for inclusion of these individuals in clinical trials as new treatments become available. Disclosures No relevant conflicts of interest to declare.
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Schroers-Martin, Joseph G., Joanne Soo, Gabriel Brisou, Florian Scherer, David M. Kurtz, Brian Sworder, Michael S. Khodadoust, et al. "Tumor-Confirmed Follicular Lymphoma Mutations Are Detectable in Peripheral Blood Years Prior to Clinical Diagnosis." Blood 138, Supplement 1 (November 5, 2021): 709. http://dx.doi.org/10.1182/blood-2021-151058.
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Abstract Background: Mutations in chromatin modifying genes (CMGs) including KMT2D, CREBBP, EZH2, and EP300 have been inferred as early events in follicular lymphoma (FL) by truncal status in mature tumors and persistence between diagnosis and relapse. We previously reported frequent detection of CREBBP lysine acetyltransferase (KAT) domain mutations in pre-diagnostic blood and tissue specimens from individuals later developing FL (Schroers-Martin et al, ASH Annual Meeting 2017). However, the limited availability of paired tumor biopsies has precluded confirmation of concordance between precursor lesions and subsequent clinical malignancy. Methods: The American Cancer Society (ACS) Cancer Prevention Study-II (CPS-II) LifeLink cohort collected screening blood or saliva samples from over 100,000 cancer-free American participants between 1998 and 2002. To evaluate detection of tumor-confirmed variants in pre-diagnostic specimens, we identified 29 FL patients with available FFPE tumor biopsy and screening sample (Fig A). The median age at screening was 71 years (range 56-83) with a median time to FL diagnosis of 56 months (TTD, range 6-139). Tumor biopsies were sequenced utilizing hybrid capture sequencing for commonly mutated lymphoma genes. DNA extracted from pre-diagnostic blood or saliva cell pellet specimens was sequenced utilizing error-corrected CAPP-Seq (Newman et al Nat Biotech 2016) to a median depth of 5204x. We sequenced to similar depths peripheral blood DNA from control cohorts of individuals with detectable t(14;18) but no subsequent lymphoma diagnosis (n=14) and healthy individuals without detectable t(14;18) by PCR (n=20). Results: Coding mutations were identified from all tumors with a mutational distribution similar to prior FL sequencing studies. Tumor-derived variants were detected in 7 of 29 paired pre-diagnostic specimens (24%) at a median TTD of 44 months (range 11-112 months, Fig B). The statistical significance of detection was assessed using a previously described approach based on Monte Carlo sampling (Newman et al Nat Biotech 2016) and the error distribution of affected loci in control cohorts. While an outlier case contained concordant TNFRSF14, FOXO1, and STAT6 mutations 90 months pre-diagnosis at an elevated allelic fraction (AF) of 1.8%, the mean AF of other detected precursor variants was 0.091%. Individuals with detected variants were not older (Fig C) nor significantly closer to clinical diagnosis (Fig D). The most frequently detected lesions were CREBBP (6/15 cases, 40%) and BCL2 (3/13, 23%) with one case demonstrating a fuller mutational profile including FOXO1 and ARID1A at 44 months before diagnosis. All detected precursor CREBBP variants localized to the KAT domain, reflecting prior observations in pre-diagnostic samples without confirmatory biopsy (Fig E). Of note, saliva cell pellets may contain 30% or more hematopoietic DNA (Kaur et al Chimerism 2012) and we detected tumor-confirmed variants in both saliva and blood screening specimens (Fig F) with no significant difference in AF (Fig G). In an illustrative independent case with available imaging, a patient undergoing radical prostatectomy was found to have involvement of a pelvic lymph node with in situ follicular neoplasia (ISFN). Staging PET/CT showed no evidence of FL (Fig H) and he was followed expectantly for 4 years without emergent disease. Eight years after surgery he presented with inguinal swelling and bilateral FDG-avid adenopathy on PET/CT. Excisional biopsy confirmed low grade FL and sequencing for M7-FLIPI revealed a CREBBP KAT domain variant. Retrospective sequencing of serial peripheral blood specimens from his initial surveillance showed detectable CREBBP R1446C at the earliest collected time point (AF range 0.019-0.046%) rising to AF 0.082% after clinical diagnosis. Conclusions: Precursor FL mutations are detectable in peripheral blood and saliva years prior to clinical diagnosis with a spectrum of variants enriched in CREBBP and BCL2 and concordant with subsequent FL tumors. Such lesions may assist in stratifying individuals at elevated risk of clinical malignancy, including after identification of pathologic precursors such as ISFN. Figure 1 Figure 1. Disclosures Kurtz: Foresight Diagnostics: Consultancy, Current holder of stock options in a privately-held company; Roche: Consultancy; Genentech: Consultancy. Khodadoust: Alexion, AstraZeneca Rare Disease: Other: Study investigator; CRISPR Therapeutics, Nutcracker Therapeutics: Research Funding; Myeloid Therapeutics: Membership on an entity's Board of Directors or advisory committees. Diehn: Roche: Consultancy; AstraZeneca: Consultancy; RefleXion: Consultancy; BioNTech: Consultancy; Varian Medical Systems: Research Funding; Illumina: Research Funding; CiberMed: Current holder of stock options in a privately-held company, Patents & Royalties; Foresight Diagnostics: Current holder of individual stocks in a privately-held company, Current holder of stock options in a privately-held company. Roulland: BMS: Research Funding. Alizadeh: Bristol Myers Squibb: Research Funding; Gilead: Consultancy; CAPP Medical: Current holder of individual stocks in a privately-held company, Current holder of stock options in a privately-held company; Celgene: Consultancy, Research Funding; Roche: Consultancy, Honoraria; Janssen Oncology: Honoraria; Foresight Diagnostics: Consultancy, Current holder of individual stocks in a privately-held company, Current holder of stock options in a privately-held company; Cibermed: Consultancy, Current holder of individual stocks in a privately-held company, Current holder of stock options in a privately-held company; Forty Seven: Current holder of individual stocks in a privately-held company, Current holder of stock options in a privately-held company.
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Shultz, Carl, Lauren Sigler, Jesse Manikowski, Amanda Young, and Joseph Vadakara. "Time to Diagnosis of Chronic Lymphocytic Leukemia in a Health System Setting." Blood 132, Supplement 1 (November 29, 2018): 5835. http://dx.doi.org/10.1182/blood-2018-99-111730.
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Abstract Introduction Chronic lymphocytic leukemia (CLL) is a low-grade malignancy that is generally indolent and often asymptomatic at presentation. While it can present with anemia, thrombocytopenia, progressive splenomegaly and adenopathy, it is usually diagnosed on routine laboratory studies with confirmatory flow cytometry. Complications of CLL include lack of appropriate immune response and surveillance, which may lead to more frequent infections and the development of second primary neoplasms, most commonly cutaneous malignancies. Prior studies have investigated the time to diagnose CLL from the onset of clinical signs and symptoms. One study looking at the Surveillance, Epidemiology, and End-Results (SEER) database found that the median time to diagnosis from the onset of signs or symptoms was approximately 63 days (1). While early diagnosis may not change the natural history of the disease, it may lead to earlier initiation of preventive strategies such as vaccinations and skin cancer screening. The purpose of this study is to investigate the time to diagnosis of patients with CLL from the onset of lymphocytosis meeting criteria for CLL to confirmatory flow cytometry and its correlation with patient characteristics within a rural health system. Methods A retrospective cohort analysis of patients with CLL who had an absolute lymphocyte count (ALC) greater than 5,000/microL and a flow cytometry was performed within the Geisinger Health System from 1997 to 2018. Patient age, sex, date of first lymphocytosis meeting diagnostic criteria, and date of flow cytometry was electronically extracted from the EMR. This data was then cross-referenced with the cancer registry database for accuracy of the diagnosis. To determine any difference between groups and the time from first ALC meeting criteria to confirmatory flow cytometry performed, the Wilcoxon Two-Sample Test was utilized. Associations between two continuous variables (age and time from first ALC meeting criteria to confirmatory flow cytometry performed, initial lymphocyte count and time from first ALC meeting criteria to confirmatory flow cytometry performed) were measured using the Pearson Correlation Coefficients. Results A total of 268 patients were identified. Univariate statistics are reported in Table 1. The median time from lymphocytosis to flow for our study was 7.5 days (IQR: 0 - 335) with a mean of 347 days (range: 0 - 5335 days). Just over half (53.8%) had a diagnosis within the first two weeks; however, greater than 20% were diagnosed after one year and just over 5% after five years (table 2). There was a positive correlation between age and time from lymphocytosis to flow (r=0.178, p=0.0034). Therefore, an increase in age at diagnosis was associated with an increase in time from initial lymphocytosis to flow. A weak negative correlation was seen between the degree of initial lymphocytosis and time from lymphocytosis to flow (r=-0.105, p=0.0867). Therefore, a lower lymphocyte count was associated with a slightly longer time to diagnosis. There was no significant difference between median time from lymphocytosis to flow in females (7 days IQR: 0 - 510) and males (8 days IQR: 0 - 271) with a p-value 0.4570. Conclusion This study demonstrates that there can be a broad range of time to diagnosis of CLL (figure 1). While gender did not play a significant role, increased age and lower initial lymphocyte value were associated with a delay in diagnosis. Larger studies are needed to include a more diverse population to confirm these predictive associations. Further data analyses are required to assess for co-morbidities and other characteristics in the identified at risk patient groups to help facilitate earlier diagnosis and appropriate preventative measures. References 1. Friese CR, Earle CC, Magazu LS, et al. Timeliness and quality of diagnostic care for medicare recipients with chronic lymphocytic leukemia. Cancer. 2011;117(7):1470-1477. doi:10.1002/cncr.25655 Disclosures No relevant conflicts of interest to declare.
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Baltz, Katrin M., Matthias Krusch, Tina Baessler, Anita Bringmann, Lothar Kanz, Peter Brossart, and Helmut R. Salih. "Neutralization of Tumor-Derived Soluble Glucocorticoid-Induced TNF-Related Protein (GITR) Ligand Present in Cancer Patient Sera Increases Anti-Tumor Reactivity of NK Cells." Blood 110, no. 11 (November 16, 2007): 314. http://dx.doi.org/10.1182/blood.v110.11.314.314.
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Abstract Glucocorticoid-induced TNF-related protein (GITR) and its ligand (GITRL) are members of the TNF/TNF receptor (TNFR) superfamily, which mediates multiple cellular functions including proliferation, differentiation, and cell death. Recently we reported that NK cells express GITR while tumor cells express GITRL, and GITR-GITRL interaction downregulates NK cell-mediated anti-tumor immunity (Baltz et al., FASEB J 2007). Many TNF family members are released as soluble forms, which affects cell-cell interactions by reduction of ligand density and distally modulates effector cells bearing the respective receptor. Here we report that human tumor cells spontaneously release a soluble form of GITRL (sGITRL), which can be detected in tumor cell culture supernatants by ELISA (detection limit 0.01ng/ml). We demonstrated that NK cell cytotoxicity and IFN-γ production in cocultures with the tumor cell lines SK-Mel (Melanoma), PC-3 (prostate), HCT116 (colon), and LX-1 (lung) were significantly (both p<0.01, Mann-Whitney U-test) and concentration dependently reduced (up to 50%) by tumor-derived sGITRL, and NK cell effector functions could be restored by neutralization of sGITRL using a GITR-Fc fusion protein. While tumor-derived GITRL did not induce apoptosis in NK cells, it diminished nuclear localized RelB indicating that sGITRL negatively modulates NK cell NF-κB activity. Furthermore, we demonstrate that significantly elevated sGITRL levels (mean 0.4ng/ml, range from 0.01 to 3.5ng/ml) were contained in 40 out of 50 sera of patients with various cancers (colon, lung and germ line), while sera of healthy volunteers (n=8) contained no detectable levels of sGITRL. Addition of sGITRL containing patient sera to cocultures of NK cells and GITRL-negative tumor cells significantly reduced NK cell cytotoxicity and IFN-γ production about 30% and 45%, respectively (both p<0.05, Mann-Whitney U-test). Again the inhibitory effects of sGITRL on NK cell effector functions could be completely restored by neutralization of sGITRL with GITR-Fc. The strong correlation of tumor incidence and elevated sGITRL levels clearly suggests that sGITRL is released at significant amounts from malignant cells in vivo and may reduce immune surveillance of human tumors. Our data indicate that determination of sGITRL levels may be implemented as an immunological diagnostic marker in tumor patients, and GITRL-neutralization may be employed in therapeutic strategies like adoptive NK cell transfer.
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Zhang, Xianyu, Zhujia Ye, Yanling Yin, Liuhong Zeng, Jun Wang, Shan Lei, Marina Bibikova, Zhiwei Chen, Jian-Bing Fan, and Da Pang. "Abstract P1-05-11: Improving the Performance of Early Breast Cancer Diagnosis by a Model Combining Breast Ultrasound with Methylation Markers in Non-Invasive Circulating Tumor DNA." Cancer Research 83, no. 5_Supplement (March 1, 2023): P1–05–11—P1–05–11. http://dx.doi.org/10.1158/1538-7445.sabcs22-p1-05-11.
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Abstract Background Breast cancer is one of the most common cancers worldwide with the highest incidence among females in 2020 [1]. The application of breast ultrasound benefits the diagnosis of breast cancer at the early stage, but also leads to over-diagnosis. Patients with breast nodules detected by ultrasound at BI-RADS 4a or higher are usually advised to have a fine needle biopsy or surgery, although the PPVs of BI-RADS 4a and 4b categories are low (6% and 25%, respectively) [2]. Methods In this study, AnchorIRIS™ assay was used for analyzing the methylated status of cfDNA. Target enrichment was performed using an AnchorDx breast cancer-specific methylation panel consisting of 129,794 methylated markers. One hundred and twelve pairs of breast tissue and plasma samples (Malignant: Benign= 56: 56) and 40 leukocyte samples (Malignant: Benign = 20: 20) were used to identify reliable breast cancer-specific methylation markers with low noise background. Finally, a methylation model trained on 307 plasma samples (train set: test set = 214: 93) was selected for differentiating benign from malignant nodules, which was validated by two independent sets (Validation-1: Malignant: Benign = 42:46; Validation-2: Malignant: Benign = 62: 46).Results This methylation model exhibited a powerful performance on differentiating benign from malignant nodules with an AUC of 0.837 (95% CI: 0.757-0.918) in the test set, and maintained a stable predictive power with AUCs of 0.820 and 0.801 in two independent validation sets, respectively. In addition, this methylation model can reflect the difference in methylation signals between metastatic and non-metastatic cancers three years in advance. In contrast to ultrasound, the prediction rate of breast cancer is more accurate across the different age groups using the methylation model, especially for younger women less than 40 years old. Under the ultrasound BI-RADS 4 category, the accuracy (ACC) of the methylation model (IndVal-1, 73.02%; IndVal-2, 78.31%) is on average 22% higher than ultrasound (IndVal-1, 55.56%; IndVal-2, 51.81%). In both of the independent validation sets, the overall accuracy (78.7%) and specificity (SP) (58.7%) at the sensitivities above 95% of the combined model is greater than applying either ultrasound (ACC: 65%; SP: 26.1%) or the methylation model (ACC: 70.6%; SP: 52.2%) alone. Conclusion This methylation model has great potential for the diagnosis of early-stage breast cancer. It improves the diagnostic accuracy of the indeterminate breast nodules, which may assist in decreasing the unnecessary biopsies or surgeries of patients with benign lesions. The methylation model also has the potential in predicting metastatic and non-metastatic breast cancers that is valuable for patient surveillance and risk prediction. References: [1]. Siegel RL, Miller KD, Jemal A: Cancer statistics, 2020. CA Cancer J Clin 70:7-30, 2020 [2]. Spinelli Varella MA, Teixeira da Cruz J, Rauber A, et al: Role of BI-RADS Ultrasound Subcategories 4A to 4C in Predicting Breast Cancer. Clin Breast Cancer 18:e507-e511, 2018 Citation Format: Xianyu Zhang, Zhujia Ye, Yanling Yin, Liuhong Zeng, Jun Wang, Shan Lei, Marina Bibikova, Zhiwei Chen, Jian-Bing Fan, Da Pang. Improving the Performance of Early Breast Cancer Diagnosis by a Model Combining Breast Ultrasound with Methylation Markers in Non-Invasive Circulating Tumor DNA [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-05-11.
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Cogle, Christopher R., Michelle R. Iannacone, Ashley Cole, Daohai Yu, Alan F. List, and Dana Rollison. "High Rate of Uncaptured Myelodysplastic Syndrome Cases at the State Cancer Registry Level." Blood 116, no. 21 (November 19, 2010): 1890. http://dx.doi.org/10.1182/blood.v116.21.1890.1890.
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Abstract Abstract 1890 The myelodysplastic syndromes (MDS) became reportable malignancies to U.S. population-based cancer registries including the Surveillance, Epidemiology and End Results (SEER) Program in 2001. Registries capture information on MDS cases through reports sent by hospitals and physicians’ offices. Electronic pathology (E-path) reports generated by private pathology laboratories are another potential source for finding cases; however, the sheer volume of E-path reports generated and the limited resources of cancer registries preclude the review of all E-path reports. Therefore, some registries rely on probability scoring based on keyword hits to identify reports most likely consistent with a diagnosis of cancer. Given the diverse morphologic features of MDS pathology and our earlier observation that MDS is often diagnosed and managed in the outpatient setting (Rollison, et al. Blood 2008), we hypothesized that MDS is often not captured by state cancer registries. To estimate the proportion of uncaptured MDS cases in Florida, all E-Path reports sent to Florida Cancer Data System (FCDS), the state cancer registry, in 2006 were queried using a unique keyword search strategy based on an algorithm of identifying bone marrow biopsy reports that met the inclusion and exclusion diagnostic terminology for MDS. Of 7,111 E-path reports identified, only 18% corresponded to individuals registered in FCDS as having been diagnosed with MDS. To estimate the percentage of uncaptured MDS cases in the remaining 82% of E-Path reports, a stratified random sample of E-path reports were reviewed by a single hematologist/oncologist to determine whether the E-path reports were consistent with MDS and to assign an MDS subtype. The strata for random sampling included: 1) reports that linked individuals registered as having been diagnosed with cancers other than MDS in FCDS (48%) versus those that did not link to FCDS (34%) and 2) four categories based on number of keyword hits. Overall, E-path reports corresponding to 285 individuals were reviewed, of which 71 were determined to have MDS. The percentage of uncaptured cases seemed to be lower for those individuals that were registered in FCDS as having a previous cancer (17%) than that for those who did not link to FCDS (28%) and increased with number of keyword hits. Based on the percentages of uncaptured cases estimated within each of the eight strata, and the distribution of those stratified factors in the total sampling frame, we estimated that 641 MDS cases were likely uncaptured, representing approximately 45% of the captured and uncaptured cases combined. Thus, current case finding mechanisms by population-based cancer registries capture approximately half of the true MDS cases. Compared to MDS cases captured by FCDS, uncaptured MDS cases were younger (< 65) (p=0.01), less likely to have Refractory Anemia (RA) and more likely to have Refractory Cytopenia with Multilineage Dysplasia (RCMD) (p=0.002). Gender and race seemed to be similar between the groups. Together, these data indicate that current population-based case finding methods are not capturing a large percentage of MDS cases. Application of a keyword search strategy to identify cases among E-Path reports is a feasible technique to improve MDS case ascertainment in population-based cancer registries until greater resources are committed. Disclosures: No relevant conflicts of interest to declare.
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Mesonero Gismero, F., Y. Zabana, A. Fernández-Clotet, A. Sola, B. Caballol, E. Leo, M. J. García, et al. "P104 Inflammatory complications of the pouch, and therapetic requirements after colectomy in patients with ulcerative colitis. Results from the RESERVO Study of GETECCU." Journal of Crohn's and Colitis 15, Supplement_1 (May 1, 2021): S198—S199. http://dx.doi.org/10.1093/ecco-jcc/jjab076.232.
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Abstract Background Pouchitis and other inflammatory pouch diseases (IPD) are frequent in pouch-carrying patients operated for a previous diagnosis of ulcerative colitis. We evaluated characteristics and differences in therapeutic requirements between pouchitis, Crohn′s-like disease of the pouch (CDP) and cuffitis. Methods This is a retrospective and multicentric Spanish cohort of GETECCU (RESERVO Study), including pouch-carrying patients (operated 1995 to 2016) with previous ulcerative colitis, ileostomy closure and subsequent diagnosis of IPD (pouchitis, CDP or cuffitis), following ECCO diagnostic criteria1. Follow up extended to June 2020. Pouchitis was categorized attending current classifications. Use of medical and surgical therapies was collected and differences between pouchitis and CDP were analyzed using descriptive and comparative statistics. Results A total of 338 patients were included. Demographic and clinical characteristics are presented in Table 1. The most frequent IPD was pouchitis (n=258, 76%), followed by CDP (n=55, 16%) and cuffitis (n=25, 7.4%). Pouchitis was diagnosed at a median time of 27 (range 1–342) months. Prevalence according to pouchitis classification is presented in Figure 1. CDP was diagnosed at a median time of 77 (range 5–324) months, around 75% with a previous pouchitis diagnosis. Location of CDP (not mutually excludent) was pouch CDP (91%), 87% pre-pouch ileitis, and 41% perianal disease. Regarding behavior: 26 (47%) were inflammatory, 12 (22%) stricturing and 17 (31%) penetrating (8 rectovaginal fistulas). Cuffitis was diagnosed at a median time of 18 (range 1–219) months. Medical and surgical therapies used are shown in Figure 2. Immunosuppressants (58.2 vs 22.4%, p 0.001), biologics (74.5 vs 34.8%, p 0.0001), and surgery (41.8 vs 21.3%, p 0.003) were more used in CDP than in pouchitis. Conclusion Pouchitis and CDP are heterogeneous inflammatory pouch complications with a wide and high therapeutic requirement. CDP presents a later diagnosis and has higher therapeutic needs than pouchitis. 1. Fernando Magro, Paolo Gionchetti, Rami Eliakim et al, for the European Crohn’s and Colitis Organisation [ECCO], Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 1: Definitions, Diagnosis, Extra-intestinal Manifestations, Pregnancy, Cancer Surveillance, Surgery, and Ileo-anal Pouch Disorders, J Crohns Colitis 2017; 11(6): 649–670.
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Ross, Julie A., Kimberly J. Johnson, James R. Cerhan, Cindy K. Blair, John T. Soler, and Phuong L. Nguyen. "Significant Recent Declines In Adult Leukemia Incidence Rates In the United States." Blood 116, no. 21 (November 19, 2010): 873. http://dx.doi.org/10.1182/blood.v116.21.873.873.
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Abstract Abstract 873 Each year in the United States, approximately 45,000 individuals are newly diagnosed with leukemia and 22,000 will die of the disease. Due to this poor survival, leukemia ranks fifth in person years of life lost among specific cancers. Little is known about causes, although exposure to solvents, radiation, pesticides and, to a modest extent, cigarette smoke has been implicated for some subtypes. The last comprehensive report of leukemia trends covered the period 1973–1998 [Xie Y et al, Cancer 2003]. Evaluation of recent leukemia incidence trends could provide important new etiologic insights. Using Surveillance, Epidemiology and End Results (SEER) Program data, we analyzed leukemia incidence trends in U.S. adults (≥ 20 years of age) by age, leukemia subtype (acute myeloid (AML), acute lymphoid (ALL), chronic myeloid (CML), chronic lymphoid (CLL)) sex, race, and ethnicity for the period 1987–2007. Frequencies, age-adjusted incidence rates (IR, per million), and trends were calculated along with annual percent change (APC) and corresponding 95% confidence intervals (CI). Joinpoint analyses were used to detect any significant directional changes in IRs over the period. Of 43,970 newly diagnosed cases identified, IRs increased with age and were consistently higher in males than females for all four subtypes. The highest IRs occurred for CLL (54.4), followed by AML (38.3), CML (20.6) and ALL (7.0). With regard to trends, IRs for CLL (APC -0.5; CI: -0.9, -0.1) and CML (APC -1.2; CI: -1.6, -0.8) declined over the time period; declines were observed in males and females, and by race and ethnicity. Male(M):Female(F) IR ratios remained relatively constant at approximately 2.0 and 1.7, respectively. For ALL, IRs decreased in males (APC -0.9; CI: -1.9, 0.2) but slightly increased in females (APC 0.4; CI: -1.0, 1.7), which was most notable in Hispanics (APC 4.0; CI: 1.2, 6.8). In contrast to CML and CLL, the overall M:F rate ratio for ALL decreased, although it did not reach statistical significance (p=0.08). For AML, IRs increased significantly for males (APC 1.0; CI: 0.3,1.6) and females (APC 1.7; CI: 0.7, 2.7) from 1987–2000 and 1987–2001, respectively. However, since then, AML IRs for males have been significantly decreasing by 4.2% per year (CI: -6.4, -2.1), while IRs for females have been decreasing by 1.6% per year (CI: -4.1, 0.9). Across the entire time period 1987–2007, there was a statistically significant negative trend (p=0.002) in the M:F IR ratio for AML. Decreasing IRs across many leukemias since 1987 are unlikely to reflect changes in screening or diagnostic coding practices. Instead, these observations may reflect temporal changes in etiologically relevant environmental exposures. Of note, the prevalence of cigarette smoking in the population has decreased and occupational safety practices (e.g., reducing solvent/radiation/pesticide exposure) have improved over the last several decades, which could contribute to the gradual decreases in some IRs observed. In contrast, the rapid and significant decrease noted for AML since 2000, especially following a significant increase, was striking and deserved additional scrutiny. We further consulted with our cancer registry colleagues to determine whether the introduction of myelodysplastic syndrome (MDS) as a new malignancy in SEER in 2001 could be influencing recent AML trends given the (apparently) coincidental overlap in time periods. Of note, approximately one third of MDS patients subsequently develop AML. We learned that AML following an MDS diagnosis from 2001–2009 was not reportable to SEER and therefore not counted. We are not aware that this has been documented in the literature. However, beginning for 2010 diagnoses, SEER changed this practice such that AML following MDS will be captured as a second malignancy. Based on these changes in AML surveillance, it will especially be important to monitor future trends for this malignancy. Overall, this study demonstrates the value of in-depth analyses of SEER cancer IRs and trends; analyses may reveal patterns of clinical and/or etiological importance, or, in the instance of AML, unpublished coding rule changes. Disclosures: No relevant conflicts of interest to declare.
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Cohen, Aileen Cleary, Nancy Davidson, Jason Scharf, and Derek Middlebrook. "Cost Burden Analysis of Ineffective Induction Chemotherapy in Elderly Patients with AML." Blood 114, no. 22 (November 20, 2009): 4531. http://dx.doi.org/10.1182/blood.v114.22.4531.4531.
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Abstract Abstract 4531 Introduction According to the Surveillance, Epidemiology, and End Results (SEER) database 12,810 patients will be diagnosed with acute myeloid leukemia (AML) in 2009 with an incidence rate of 3.5 per 100,000 persons in the United States. The SEER data estimates that 55% of those diagnosed are 65 years or older. Standard first line therapy for the treatment of AML consists of at least one round of chemotherapy commonly referred to as induction. A significant portion of those patients who receive standard induction chemotherapy will have leukemia that fails to show a complete response as defined by less than 5% leukemia blasts in the bone marrow with normal tri-lineage hematopoiesis and peripheral blood count recovery (Mueller S, et al. BMC Cancer 2006, 6:143). Age, patient performance status, the presence of secondary AML, cytogenetics, and molecular markers are prognostic for particular cohorts of patients, however, there is currently no means to predict whether an individual's leukemia will or will not undergo a complete response (CR) after the administration of standard AML induction chemotherapy. Methods A budget impact model was designed to assess the incremental societal cost and incremental cost to a typical national health plan of treating patients who will fail induction therapy. The analysis only evaluated elderly patients over the age of sixty five. Data were gathered from the peer reviewed literature. All costs have been updated to 2009 dollars using the medical care component of the consumer price index. The patient population was determined to be 6,981 patients in 2009 with 30% receiving induction therapy (Menzin J, et al. Arch Intern Med. 2002; 162:1597-1603) and only 38% demonstrating a CR (Appelbaum FR, et al. Blood 2006 107:3481-5) resulting in 1,303 patients failing during induction therapy. The costs were taken from Menzin et al., which used Medicare claims data to determine the associated costs of AML patients during the first two years post diagnosis. In the model Medicare payments are used as a proxy for direct costs to society and a national health plan. These reimbursements are able to capture the costs of the initial hospital visit, lab/diagnostic/radiology, supportive care, drugs, and adverse events through the observation of payments across all appropriate settings of care (inpatient hospitalization, skilled nursing facility, outpatient hospital/clinical, physician's office, home health, and hospice). A patient undergoing chemotherapy incurred costs of $120,468 over two years, while a patient avoiding chemotherapy only incurred costs of $40,720. Results The incremental cost of a patient receiving induction therapy was calculated to be $79,748. For a national health care plan with an assumed average of one million members results in a cost of $283,856 to treat patients whose leukemia would not respond to induction chemotherapy. The overall societal impact of treating this patient population with ineffective therapy is $104 million. Conclusions Patients who are subjected to ineffective chemotherapy face the cytotoxic effects of the treatment, none of the benefits of treatment response, and impose a significant cost burden to themselves and the healthcare payment system. Diagnostics currently in development that can identify patients at the time of diagnosis with disease unresponsive to therapy may have the ability to alleviate unnecessary costs, while steering patients to better tailored and more effective therapies. Disclosures: Cleary Cohen: Nodality, Inc: Employment. Middlebrook:Nodality Inc: Employment.
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Sannareddy, Aishwarya, Laura Turer, Jimmy Lee, Kailee Gaines, Hetalkumari Patel, Pearl Abraham, Ashley Jones, et al. "Incidence of Invasive Fungal Infections in CAR T-Cell Therapy Recipients: A Single-Center Retrospective Analysis." Blood 142, Supplement 1 (November 28, 2023): 6921. http://dx.doi.org/10.1182/blood-2023-186596.
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Background: CAR T-cell therapy has transformed the treatment of hematologic malignancies, but challenges persist due to toxicities like cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), and infections. Rates of invasive fungal infections (IFI) post CAR T-cell therapy are estimated to range from 1% to 7% (Haidar et al. Clin Infect Dis, 2020). Some centers use positive fungal biomarkers, such as serum (1à3)-β-D-glucan (B-DG) and galactomannan (GM), alongside surveillance radiographic imaging to guide preemptive fungal therapy in this population. The objective of the study was to assess the diagnostic performance of surveillance B-DG and GM for the diagnosis of IFI in recipients of BCMA and CD19-directed CAR T for multiple myeloma (MM) and non-Hodgkin lymphoma (NHL), respectively. Methods: We conducted a retrospective analysis on adult patients who received BCMA-directed CAR T therapy for MM or CD19-directed CAR T for NHL at our institution between 2018-2023. IFI was defined using the Revised European Organization for Research and Treatment of Cancer and the Mycoses Study Group (EORTC/MSG) criteria (Donnelly et al. Clin Infect Dis, 2020). Only patients with proven or probable infection were included in the analysis. The choice of antifungal prophylaxis was determined based on the treating physician's discretion. In the most cases, B-DG and GM monitoring was done prior to apheresis, before CAR T infusion, and subsequently every 14 days for a duration of 6 months. All patients were followed until 7/12/2023, or until their data were censored at the last follow-up. The cumulative incidence was calculated using Kaplan-Meier method, considering the time to IFI, with IFI-free death and disease relapse as competing risks. Statistical analysis was performed using IBM SPSS (version 29.0). Result: Among the 148 subjects in this study, 51 patients (34.5%) received BCMA CAR T, and 97 (65.5%) received CD19 CAR T therapy. The median age at CAR T infusion was 66 years (range 36-78) in the BCMA cohort and 65 years (range 27-83) in the CD19 cohort (p=0.64). The BCMA cohort had a higher number of prior therapies, with a median of 6 (range 2-15) compared to the CD19 cohort, which had a median of 4 (range 2-12) (p<0.001). The median follow-up from CAR T infusion was 9.5 months (range 0-63) in both cohorts, with 12 months (range 0-63) in the BCMA cohort and 8 months (range 0-49) in the CD19 cohort. All patients received prophylactic antifungal agents, including anti-yeast (fluconazole, n=95), and anti-mold (micafungin n=5, isavuconazole n=1, or Posaconazole n=52). Among the BCMA cohort, 92% of the patients received anti-yeast prophylaxis, while 8% were given anti-mold prophylaxis. In the CD19 cohort, 49.5% received anti-yeast prophylaxis, while 50.5% received anti-mold prophylaxis. Out of the 148 patients, 21 individuals (14%) exhibited elevated B-DG levels, while only 2 patients (1%) showed elevated GM levels. However, 20 out of 21 (95%) cases with positive B-DG, and all cases with positive GM were deemed to be false positives. Among these false positives, 60% were attributed to IVIG administration, while the cause for the remaining cases remained unknown (Table 1). Only one patient in this study developed IFI. The patient received anti-yeast prophylaxis (Fluconazole) at CAR-T and had a disseminated Rhizopus infection on day 13 post CD19 CAR T, which ultimately resulted in the patient's death. The 1-year cumulative incidence of IFI, considering competing risks, was 0.7% (95% confidence interval [CI], 0- 2.1). The median progression-free survival (PFS) in the overall cohort was 11.7 months (95% CI, 6.9-16.6), with 8.6 months (95% CI, 3.2-13.97) in the BCMA cohort and 14.6 months (95% CI, NR-NR) in the CD19 cohort (p=0.324). The median overall survival (OS) of the study cohort was 32.4 months (95% CI, 16.3-48.4), with 41.4 months (95% CI, 16.74-66.08) in the BCMA cohort and 23.98 months (95% CI, NR-NR) in the CD19 cohort (p=0.260). Conclusion: The rate of IFI in our cohort was low (0.7%) post-CAR T therapy. The diagnostic performance of serial monitoring of B-DG and GM for the diagnosis of IFI is poor in recipients of BCMA-directed CAR T therapy for MM or CD19-directed CAR T for NHL.
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Pandey, Arti S., Roya Mostafavi, Sara Lewis, Rose McGee, Alise Blake, Stacy Hines-Dowell, Leslie Taylor, et al. "Outcomes of Germline Genetic Testing in Children with Hematologic Malignancies Undergoing Allogeneic Transplantation." Blood 144, Supplement 1 (November 5, 2024): 1331. https://doi.org/10.1182/blood-2024-210448.
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Allogeneic hematopoietic cell transplantation (HCT) is an established therapeutic strategy for many hematologic malignancies (HM). Consideration of heritable predisposition to HM is especially relevant for decision-making in HCT when family members are being considered as donors. For example, germline pathogenic variants (PV) are estimated to be present in up to 14% of patients with acute myeloid leukemia (AML) (Guijarro F et. al., Blood Adv, 2023) and 4% of those with acute lymphoid leukemia (ALL) (Bloom M et al. 2020 Expert Rev Hematol, 2020). Nevertheless, it remains unclear how often patients being considered for HCT undergo genetic evaluation and whether the information is used in real-world clinical practice. To address this gap, we investigated the outcomes of cancer predisposition evaluation and germline genetic testing (GGT) for pediatric patients with HM undergoing HCT. Retrospective data were gathered through record review for pediatric patients with HM (AML, ALL, myelodysplastic syndrome) undergoing HCT at St. Jude Children's Research Hospital between 1/1/2017 and 12/31/2023. Descriptive data analysis was done using the R statistical program. Genetic counseling and GGT for genes associated with cancer predisposition (CP), bone marrow failure (BMF), and/or primary immunodeficiency (PID) were offered. Variants of uncertain significance in genes associated with hereditary HM (VUS-HM) were also explored. Of 287 HCT recipients, 224 (78%) met with a genetic counselor and 189 (66%) underwent GGT. GGT was completed before the 1st, 2nd or 3rd transplants in 140 (74%), 20 (11%) and 1 (0.5%) case, respectively, and after the final transplant in 28 (15%). Among these recipients, 34 (18%) tested positive for a PV and 37 (19.6%) harbored a VUS-HM. Genes with PV and VUS-HM aligned with the recipient's HM in 11/34 (32%) and 13/37 (35%) cases. Two VUS, one in BRCA2 and one in ETV6, were subsequently upgraded to likely pathogenic based on internal laboratory data and persistent thrombocytopenia/leukemia, respectively. Thus, the diagnostic yield of GGT was 36/189 (19%) with 12/36 (33%) PV aligning with the clinical presentation. Of the 34 recipients with a PV in a CP, BMF or PID gene, 25 underwent transplantation using a family donor (FD), among whom 4 (16%) were positive for the same PV. One FD underwent GGT 12 years after her son's HCT and tested positive for the CEBPA PV present in her son. He developed donor-derived AML and underwent a 2nd HCT using a FD negative for the CEBPA PV and remains in remission 7 years later. A patient with B-ALL and an ATM PV received HCT from a FD harboring the ATM PV and is in remission 4 years post-HCT. Two FDs harbored germline PVs, one in ELP1 and the other in MUTYH. The FD with an ELP1 PV was chosen as donor for a B-ALL patient with germline FANCA and ELP1 PVs, since the only other FD carried the FANCA PV; this recipient died 1-year post-HCT. Finally, a FD with a MUTYH PV was chosen due to the lack of other donor options; the patient died 1-year post-HCT. Among 19 recipients harboring VUS-HM, 4 FD underwent GGT for the VUS-HM and were negative. Testing was not deemed indicated for 15 FD based on absence of the relevant clinical phenotype (e.g., in NF1, PTPN11) or normal blood counts (e.g., ANKRD26, RUNX1). In conclusion, almost one in five recipients undergoing GGT were carriers of a PV, with most PVs involving genes not generally associated with the child's HM. Since not all patients were seen by a genetic counselor, it is possible that the prevalence of germline PV is greater than reported. Given the high incidence of germline PV in this population, it is critical that both recipients and FD are evaluated as early as possible in the transplantation evaluation process for the presence of PV and concerning VUS, such as those affecting HM genes, to ensure optimal donor selection, minimize post-HCT adverse events, enable surveillance for subsequent malignancies, and inform genetic counseling and GGT testing of relatives. While the implications following use of FD with PV affecting HM genes are well understood, further study is needed to elucidate the impacts of using FD harboring PV in genes not generally associated with HM (e.g., BRCA1, BRCA2, etc.).
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Gu, Xiaorong, Yahan Zhang, Songa Bae, Dongxu Jiang, Daniel Vail, Simon Schlanger, Jaroslaw Maciejewski, and Babal K. Jha. "Loss of TET2 Creates a Distinct Immunopeptidome in Acute Myeloid Leukemia." Blood 144, Supplement 1 (November 5, 2024): 4154. https://doi.org/10.1182/blood-2024-208025.
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Background: Antibodies directed against leukemia-specific antigens have been an early form of immunotherapy. Chimeric antigen receptor T-cell therapy (CART) has shown tremendous success in lymphoid neoplasia, but both CART cells and antibodies are limited due to their restriction to cell surface-expressed proteins. In contrast, T cell responses recognizing leukemia cells via tumor-specific peptides have a broader spectrum of targets and are believed to mount the strongest tumor surveillance and anti-tumor response. One major roadblock in developing effective immune therapies is the inability to identify tumor cell-specific neoantigens that can distinguish normal cells from cancer cells. Neoantigens can induce anti-tumor effects through inducible T-cell responses, thereby activating cellular immunotherapy with the potential to eradicate Acute Myeloid Leukemia (AML). Selected studies have shown that neoantigens encoded by recurrent genetic aberrations in AML can be targeted using immunotherapy. Loss of function TET2 mutations (TET2MT) have been frequently identified in myeloid neoplasia (MN), contributing to disease pathogenesis and clonal expansion as indicated by high prevalence of TET2MT in clonal hematopoiesis of indeterminate potential (CHIP). Targeting TET2MT in AML may not only effectively eradicate leukemia, but also pre-malignant hematopoietic stem cells, thereby disrupt clonal proliferation at its source. Here we report the identification of neoantigens associated with TET2MT that will help to develop novel therapeutic strategy. Methods: We utilized CRSPR-Cas9 edited clonal isogenic TET2WT and TET2KO cells derived from THP1 (Guan et al., Blood Cancer Discov, 2021). Three independent biological replicates of TET2ko and TET2WT were used for immunoaffinity purification of cell surface HLA bound peptides. The solubilized HLA complexes were dissociated in acid and filtered through 5kDa NMWCO ultrafiltration to remove non-peptide small molecules. Resulting peptide fractions were analyzed on an Orbitrap mass spectrometer. The raw data files were searched with Protein discovery with 5% FDR and peptide with 7-15 amino acids in length. HLA-A binding peptides were identified by mapping peptide FASTA sequences and HLA class alleles in the Net MHC pan 4.1 database. Results: Through optimized immunopeptidome workflow, we found that the amount of antibody used in immunoprecipitation was critical for maximum enrichment of immunopeptides. Over 5000 HLA-A binding peptides were enriched for quality analysis. From all identified peptides, about 30% were filtered out as non-immunopeptides due to their lengths not being within 7-15 amino acids and derivation from most abundant cellular proteins. The majority of identified peptides were 9mers. We used unsupervised alignment and clustering of peptide sequences based on HLA-A binding motifs. About 98% of the eluted peptides clustered into five motifs with high affinities for HLA-A binding, typically featuring leucine (L) at positions 2 and 9. We also calculated the immunogenicity of eluted peptides in silico using the Immune Epitope Database (IEDB) based on T-cell preferences for amino acids. 21.8% of eluted peptides had an immunogenicity score above 0.2, suggesting they are likely T-cell epitopes. Protein pathway analysis revealed the top contributing functional groups, including antigen processing, separation of sister chromatids, cell cycle checkpoints, and DNA repair. TET2 deficiency created a distinct immunopeptidome, with about threefold more eluted peptides identified in isogenic TETKO compared to TET2WT, suggesting higher possible T-cell immunogenicity. A total of 389 peptides were either exclusively identified in TETKO cells or exhibited a 2-fold higher mass intensity compared to TET2WT. From these enriched in TETKO cells, 10 peptides were selected based on their higher immunogenicity and signal intensity for further evaluation as potential targets for immunotherapeutic approaches. Conclusions: Our study revealed that TET2 loss leads to a unique peptide repertoire, suggesting enhanced T-cell immunogenicity. Our findings offer promising avenues for the development of novel diagnostic tools and therapeutic strategies targeting TET2-associated neoantigens in AML, with the potential to improve patient outcomes by reducing the risk of relapse and eradicating both malignant and pre-malignant cells.
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Ma, Xiaomei, Arlene S. Swern, Pavel Kiselev, Albert Fliss, Jane J. Lu, Bart L. Scott, David P. Steensma, and Mary M. Sugrue. "Use of an Electronic Medical Record (EMR) Database to Identify a Real-World Cohort of US Patients (Pts) with Myelodysplastic Syndromes (MDS)." Blood 126, no. 23 (December 3, 2015): 3319. http://dx.doi.org/10.1182/blood.v126.23.3319.3319.
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Abstract Introduction: Clinical trial data for MDS pts may not be representative of the general MDS pt population because some pts may be ineligible for clinical trials or may decline to participate. The GE Centricity™ EMR database (GE Healthcare IT, Princeton, NJ, USA), which is anonymized and compliant with the Health Insurance Portability and Accountability Act of 1996, contains clinical practice data from > 38 million US pts from 1994 onward (Asche CV, et al. ISRN Cardiol. 2011;2011:924343). Pt diagnoses in the database can be determined using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes; however, cohorts selected this way may include pts without MDS due to coding errors. We accessed the GE EMR database to identify a large, real-world cohort of MDS pts and compared them with MDS pts reported to the well-established, population-based Surveillance, Epidemiology, and End Results (SEER) Program. Methods: The GE EMR database is generally representative of the US population and contains data from single-physician offices to large practices and networks, covering 49 US states. Of > 30,000 participating clinicians, two-thirds are primary care physicians; the remainder are specialists. Using this database, we assembled a retrospective cohort of MDS pts with data entered during January 2006-February 2014. MDS pts were initially identified by the presence of ≥ 1 MDS-specific ICD-9-CM diagnosis code (codes: 238.72-238.75). Several different approaches were developed, evaluated, and applied to refine this cohort by excluding pts with a lower likelihood of MDS (Figure). Results: The Initial Cohort comprised 9,645 pts with ≥ 1 MDS-specific ICD-9-CM code; 31% of pts received supportive treatment (hematopoietic growth factors, iron-chelating therapy, or transfusions) and 8% received active treatment (azacitidine, decitabine, or lenalidomide). However, only 9% of pts in this cohort received transfusions; fewer than expected. This may be due to unrecorded transfusions occurring outside the EMR system, a limitation that may apply to other EMR databases. The Initial Cohort included 563 pts with ≥ 2 MDS-specific ICD-9-CM codes (Figure; 1st Modified Cohort); 15% of these pts had received transfusions; considerably higher than in the Initial Cohort. To exclude pts unlikely to have MDS in the Initial Cohort, the inclusion criteria were modified to include only pts with ≥ 1 MDS entry plus an entry for MDS-specific active treatment (N = 1,208) (Figure; 2nd Modified Cohort); supportive treatment was insufficient for inclusion as it is not MDS-specific. As diagnosis of MDS requires hemoglobin (Hb) measurement and bone marrow (BM) aspirate or biopsy prior to diagnosis, inclusion criteria were refined to include only those pts with either ≥ 2 MDS entries or ≥ 1 entry for MDS plus ≥ 1 of the following: prior MDS-specific active treatment; ≥ 2 Hb tests ≤ 1 year prior to code entry; or ≥ 1 BM procedure ≤ 1 year prior to code entry (N = 5,623) (Figure; 3rd Modified Cohort). This cohort was then further refined by excluding pts whose EMR included terms indicative of a non-diagnosis of MDS, such as "rule out," resulting in a Final Cohort of 5,162 pts most likely to have MDS (Figure; Final Cohort) whose baseline characteristics were generally comparable to MDS pts reported to the SEER Program during 2001-2011 (Table). In this Final Cohort, 35% received supportive care alone while 13% received active treatment; unrecorded transfusions may have contributed to underreporting of supportive care. Treatment patterns and the impact of variables such as age, insurance type, geographical location, and comorbidities will be presented. Conclusions: By leveraging the GE Centricity EMR database and evaluating different approaches for the ascertainment of MDS pts, we identified a large, real-world cohort of MDS pts whose baseline characteristics are comparable to MDS pts from the SEER Program. Although characteristics between the modified cohorts were similar, the Final Cohort was selected based on clinical and diagnostic features associated with the diagnosis of MDS in real-world clinical practice. Our methodology can inform other investigators interested in utilizing EMR databases for cancer outcomes research, and the cohort we identified will be useful in the further characterization of treatment patterns and outcomes of MDS pts who are more representative than participants of clinical trials. Disclosures Ma: Incyte Corporation: Consultancy; Celgene Corporation: Consultancy. Swern:Celgene Corporation: Employment, Equity Ownership. Kiselev:Celgene Corporation: Consultancy. Fliss:Celgene Corporation: Employment, Equity Ownership. Lu:Celgene Corporation: Employment. Scott:Celgene Corporation: Consultancy, Speakers Bureau. Steensma:Incyte: Consultancy; Amgen: Consultancy; Celgene: Consultancy; Onconova: Consultancy. Sugrue:Celgene Corporation: Employment, Equity Ownership.
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"Diagnostic et suivi du cancer de la vessie." Revue Française des Laboratoires 2000, no. 325 (September 2000): 73. http://dx.doi.org/10.1016/s0338-9898(00)80532-6.
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Bohner, Perrine, Matyas Pal, François Crettenand, Beat Roth, and Ilaria Lucca. "Blasenkrebs: Die Herausforderung einer auf den Patienten und die Tumoreigenschaften zugeschnittenen Nachsorge." Urologie in der Praxis, June 22, 2023. http://dx.doi.org/10.1007/s41973-023-00218-0.
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RésuméLe cancer de la vessie (CV) est un cancer fréquent avec une évolution hétérogène nécessitant un suivi de longue durée. Sa prise en charge ainsi que sa surveillance sont couteuses. Le suivi des patients ne consiste pas uniquement d’un un suivi oncologique mais également un suivi fonctionnel et métabolique. Ces deux aspects ont un impact important sur la qualité de vie du patient. Une prise en charge individualisée pourrait permettre une diminution du nombre d’examens et des coûts tout en garantissant un suivi oncologique optimal.
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Campagna, J., R. Touzani, G. Gravis, P. Marino, J. Walz, M. K. Bendiane, A. D. Bouhnik, and G. Pignot. "L’annonce du cancer au diagnostic de Tumeur de vessie non infiltrant le muscle modifie-t-elle la qualité de vie et l’observance des patients ? Données de la cohorte prospective française VICAN." Progrès en Urologie, August 2021. http://dx.doi.org/10.1016/j.purol.2021.08.035.
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