Changes in body composition during neoadjuvant therapy can affect prognosis in rectal cancer patients: An exploratory study Publication date: Available online 1 November 2019 Source: Current Problems in Cancer Author(s): Paola De Nardi, Mariachiara Salandini, Damiano Chiari, Nicolò Pecorelli, Giulia Cristel, Anna Damascelli, Monica Ronzoni, Luca Massimino, Francesco De Cobelli, Marco Braga Abstract Aim: To establish the correlation between changes in body composition after neoadjuvant chemoradiotherapy (nCRT) and postoperative outcomes, in patients with advanced low rectal cancer. Methods: Patients with clinical stage T≥3 or N+ rectal cancer who underwent nCRT and surgical resection were studied. Skeletal muscle, visceral, and subcutaneous fat cross-sectional area were measured by computed tomography before and after nCRT. Postoperative morbidity, pathologic response to nCRT, overall and disease-free survival was assessed. Results: Fifty-two patients, median age 62 (range 32-79) were studied. A skeletal muscle loss >2% significantly correlated with a shorter disease-free survival both in the overall population (P = 0.048) and in the subgroup of N0 patients (P = 0.048). A subcutaneous fat loss >5% was also associated with a shorter disease-free survival (P = 0.012) in the whole population. Conclusions: Skeletal muscle loss, after neoadjuvant chemoradiotherapy, negatively impacts on disease-free survival in surgically treated rectal cancer patients.

Prognostic significance of the skeletal muscle index and an inflammation biomarker in patients with breast cancer who underwent postoperative adjuvant radiotherapy Publication date: Available online 1 November 2019 Source: Current Problems in Cancer Author(s): Xin Hua, Jia-Peng Deng, Zhi-Qing Long, Wen-Wen Zhang, Xin Huang, Wen Wen, Ling Guo, Zhen-Yu He, Huan-Xin Lin Abstract Background: Given the growing evidence that sarcopenia and inflammation influence the survival of patients with cancer, we evaluated the prognostic significance of the skeletal muscle index (SMI) combined with an inflammation marker in patients with breast cancer who underwent postoperative adjuvant radiotherapy. Methods: We conducted a retrospective analysis of 301 patients with breast cancer who received postoperative adjuvant radiotherapy between 2010 and 2012. The SMI was measured using preradiotherapy computed tomography (CT) simulation images at the level of the fourth thoracic vertebra (T4). Receiver operating characteristic curve analyses were used to determine the optimal cutoff values for the SMI and inflammatory marker. Patients were divided into 2 groups (high SMI and low SMI), based on the SMI cutoff of 10.57 cm2/m2. Results: Patients in the high-SMI group had a median overall survival (OS) of 62.4 months, which was significantly shorter than those in the low-SMI group, with a median OS of 68.5 months (P = 0.025). Patients in the high-SMI group had a median recurrence-free survival (RFS) of 62.3 months, which was shorter but not significantly than the median RFS of 65.2 months of the low-SMI group (P = 0.159). Univariate and multivariate survival analyses revealed SMI was an independent predictor of OS (P = 0.044). The SMI-MLR combination was found to be an independent predictor of OS (P = 0.006) and RFS (P = 0.009). Conclusions: The current findings support the SMI as a promising indicator for predicting clinical outcomes in patients with breast cancer receiving postoperative adjuvant radiotherapy. A high SMI accompanied by systemic inflammation was significantly associated with reduced OS and RFS.

Radiation oncologists' perspectives on reducing radiation-induced heart disease in early breast cancer Publication date: Available online 1 November 2019 Source: Current Problems in Cancer Author(s): Hoda Mahdavi Abstract Radiotherapy (RT) as an adjuvant treatment for breast cancer (BC), has caused a reduction of recurrences and BC-related deaths. But it has also induced cardiovascular mortality. Oxidative stress is the principle mediator of RT-induced heart disease, similar to many conventional cardiovascular risk factors. The aggregate effect of cardiovascular conditions, RT of heart substructures, implied techniques, and population cardiac mortality rates is not well understood. Due to uncertainties in this field, this article aims to briefly review the recommended strategies for risk assessment, plan optimization, and screening for prevention of RT-induced heart disease in BC patients.

Factors associated with mortality from lung cancer in India Publication date: Available online 1 November 2019 Source: Current Problems in Cancer Author(s): Manas Pratim Roy. Abstract Objective: Lung cancer is the most common cancer in the world. There is scarcity of research papers at national level on its sociodemographic dimensions. The present paper aims to correlate death from lung cancer with certain demographic factors. Methods: Retrieved data from National Family Health Survey 4, Global Adult Tobacco Survey 2: India 2016-2017 and India: Health of the Nation's States were analyzed, as state and/or Union Territories unit of analysis. Spearman correlation coefficient and multivariate linear regression were used for finding out association with smoking, smokeless tobacco, alcohol consumption, second hand smoking, per capita income and use of clean fuel. Results: Except Kerala, most of the states with higher death rate were confined to north India. Smoking (r = 0.575, P= 0.001), SHS at home and work (r = 0.476, P= 0.008 and r = 0.374, P= 0.042, respectively) were significantly related to deaths from ca lung. On regression, clean fuel was found significantly associated with ca lung mortality. Conclusion: There is need to put emphasis on tobacco cessation and primary prevention of smoking.

The risk of melanoma in patients with chronic lymphocytic leukemia; a population-based study Publication date: Available online 1 November 2019 Source: Current Problems in Cancer Author(s): Tarek Turk, Anas M. Saad, Muneer J. Al-Husseini, Mohamed M. Gad Abstract Introduction: Melanoma is a highly malignant tumor that has been repeatedly reported in chronic lymphocytic leukemia (CLL) patients. We aim to assess the epidemiologic characteristics of this association and emphasize the importance of carefully approaching such cases. Methods: Patients who were diagnosed with CLL between 2000 and 2015 and registered in the Surveillance, Epidemiology and End Results (SEER) database of the US National Cancer Institute were identified using the SEER*stat software (version 8.3.5). The Multiple Primary Standardized Incidence Ratios session of the SEER*stat software (version 8.3.5) was used to calculate the observed/expected (O/E) ratios of melanoma. Results: 48,876 CLL cases were reviewed, of which 474 developed a second primary melanoma of the skin. O/E ratio was 2.07 (95% CI 1.89-2.27), and excess risk was 9.7 per 10,000. The increase in melanoma risk was higher within the first 5 years following CLL diagnosis; O/E = 2.22 (95% CI 1.56-2.14) and excess risk was 10.43 per 10,000. It was higher in males compared to females O/E was 2.10 (95% CI 1.89-2.33) and 1.98 (95% CI 1.62-2.40) in males and females, respectively, and in people aged 45-64; O/E = 2.30 (95% CI 1.95-2.70). Out of 7827 CLL patients receiving chemotherapy, 70 later developed melanoma with a significant O/E of 2.28 (95% CI 1.77-2.88) and an excess risk of 10.66 per 10,000. Conclusion: CLL increases the risk of developing melanoma, especially within 5 years of the diagnosis, and in white males aged between 45-64 years. It is crucial to keep rigorous screening, high-suspicion and close follow-up for recurrence in consideration while managing these patients.

Comparison of CA 125 alone and risk of ovarian malignancy algorithm (ROMA) in patients with adnexal mass: A multicenter study Publication date: Available online 1 November 2019 Source: Current Problems in Cancer Author(s): Hyun-Jin Choi, Yoo-Young Lee, Insuk Sohn, Yong-Man Kim, Jae-Weon Kim, Sokbom Kang, Byoung-Gie Kim Abstract Background: This multicenter study aimed to evaluate the performance of CA 125 and risk of ovarian malignancy algorithm (ROMA) in differentiating epithelial ovarian cancer (EOC) from benign adnexal mass. Methods: We consecutively enrolled 782 patients referred to tertiary hospitals with adnexal mass requiring surgical treatment. A total of 322 patients with benign adnexal disease and 327 patients with EOC were included in the analysis. Results: Using reference cut-off values in premenopausal women, ROMA had better specificity (0.926 vs 0.787, P < 0.001) and accuracy (0.875 vs 0.777, P < 0.001) than CA 125 alone and comparable sensitivity (0.707 vs 0.747, P = 0.549). Using optimum cut-off values in premenopausal women, CA 125 and ROMA had comparable specificity (0.922 vs 0.947, P < 0.001) and accuracy (0.871 vs 0.868, P = 0.879); however, sensitivity for CA 125 was inferior to that of ROMA (0.707 vs 0.613, P = 0.039). In postmenopausal women, sensitivity, specificity, and accuracy were comparable between CA 125 alone and ROMA using either reference cut-off values or optimum cut-off values. Conclusions: ROMA showed better diagnostic performance in differentiating EOC from benign adnexal tumors among premenopausal women. However, in postmenopausal women, ROMA did not show any benefit over CA 125 alone.

Efficacy of zoledronic acid for prevention of bone loss in early-stage breast cancer patients receiving adjuvant therapy: A meta-analysis of 13 randomized controlled trials Publication date: Available online 1 November 2019 Source: Current Problems in Cancer Author(s): Mei Mei, Zijian Xiang, Jinghua Yang, Ruolan Xiang Abstract Early-stage breast cancer (BC) patients receiving adjuvant therapy suffer from bone loss and increased fracture risk. Zoledronic acid (ZA) has been confirmed to inhibit bone metastasis and improve survival outcomes in early BC postmenopausal patients receiving adjuvant therapy. However, the efficacy of ZA for prevention of adjuvant therapy-induced bone loss from 2 different early BC groups, namely premenopausal and postmenopausal patients, still remain unclear. To obtain detailed characteristics, we performed this meta-analysis. PubMed, EMBASE, and Cochrane were searched. In premenopausal BC patients and postmenopausal BC patients, to assess bone loss, we calculated the weighted mean differences with 95% confidence intervals (CI) to evaluate lumbar spine (LS) bone mineral density (BMD), total hip (TH) BMD, and femoral neck (FN) BMD in ZA and non-ZA group with follow-up of 12 months. Thirteen randomized controlled trials (RCTs) encompassing 7375 patients were included. In a mixed population of early BC patients receiving adjuvant therapy, ZA significantly increased LS BMD (P < 0.00001), TH BMD (P < 0.00001), and FN BMD (P = 0.01) compared with non-ZA group. In premenopausal patient subgroup, LS BMD was greatly higher in patients with ZA compared to controls (0.06 g/cm2; 95% CI: 0.05-0.08), whereas there were no differences in TH BMD and FN BMD between patients with ZA and controls. In postmenopausal patient subgroup, both LS BMD (0.06 g/cm2; 95% CI: 0.05-0.07) and TH BMD (0.04 g/cm2; 95% CI: 0.03-0.04) were significantly higher in patients with ZA compared to controls, but there was no difference in FN BMD between patients with ZA and controls. To sum up, ZA prevents bone loss in early-stage BC patients receiving adjuvant therapy at different skeletal sites. In premenopausal patients, effectiveness of ZA in prevention of bone loss is confirmed at LS site, but not at TH and FN site. In postmenopausal patients, ZA has a satisfying efficacy for prevention of bone loss at LS and TH site, but not at FN site.

Harlequin sign in Pancoast tumor Publication date: Available online 1 November 2019 Source: Current Problems in Cancer Author(s): Rohit Kumar, Shruti Bhandari, Goetz H Kloecker

Identification of prognosis biomarkers of prostatic cancer in a cohort of 498 patients from TCGA Publication date: Available online 20 September 2019 Source: Current Problems in Cancer Author(s): Zhiqiang Chen, Haiyi Hu Abstract Objective: Prostatic cancer (PCa) is the first common cancer in male, and the prognostic variables are beneficial for clinical trial design and treatment strategies for PCa. This study was performed to identify more potential biomarkers for the prognosis of patients with PCa. Methods and results: The transcriptome data and survival information of a cohort including 498 subjects with PCa were downloaded from TCGA. A total of 4293 differentially expressed genes (DEGs), including 1362 prognosis-related DEGs, were identified in PCa tissues compared with normal tissues. Upregulated genes, including serine/arginine-rich splicing factors (SRSFs; such as SRSF2, SRSF5, SRSF7 and SRSF8), and ubiquitin conjugating enzyme E2 (UBE2) members (such as UBE2D2, UBE2G2, UBE2J1 and UBE2E1), were identified as negative prognostic biomarkers of PCa, as the high expression of them correlated with poor overall survival of PCa patients. Several downregulated Golgi-ER traffic mediators (such as SEC31A, TMED2, and TMED10) were identified as positive prognostic biomarkers of PCa, as the high expression of them correlated with good overall survival of PCa patients. Conclusions: These genes were of great interests in prognosis of PCa, and some of them may be constructive for the augmentation of clinical trial design and treatment strategies for PCa.

Hopelessness is associated with poor sleep quality after breast cancer surgery among Tunisian women Publication date: Available online 17 September 2019 Source: Current Problems in Cancer Author(s): Feten Fekih-Romdhane, Leila Achouri, Abir Hakiri, Olfa Jaidane, Khaled Rahal, Majda Cheour Abstract Background: Sleep disorders are a common complaint in breast cancer patients. These women suffer from fear of death, fear of suffering, treatment complications as well as social devaluation; all leading to feelings of hopelessness. The objectives of this work were to evaluate the quality of sleep in a group of breast cancer women, and to analyze the association between sleep quality, depression, and hopelessness. Methods: A cross-sectional study was carried out over a period of 3 months, including 50 women suffering from breast cancer and having received a surgical treatment of their disease. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). The evaluation of depression was performed using the Beck Depression Inventory (BDI-II). Hopelessness was measured with the Beck hopelessness scale (BHS). All participants were screened using the Arab-language version of these scales. Results: Of 66% of breast cancer patients were considered as poor sleepers (PSQI scores >5), 30% of our sample had a moderate to severe depression, and 24% had a high level of hopelessness. PQSI scores were negatively correlated with depression (P < 0.001) and hopelessness scores (P < 0.001). Multivariate analysis retained as main predictors of the sleep quality habitation and hopelessness scores. After controlling for demographic (age) and social (habitation) variables, hopelessness significantly contributed to sleep quality. Conclusion: Hopelessness was positively associated to sleep disorders in women suffering from breast cancer. Hopelessness requires an appropriate management in order to prevent depression and suicide and to improve the quality of life of these patients.