Risultati per: Carcinoma della prostata

Circulation, Volume 148, Issue Suppl_1, Page A12450-A12450, November 6, 2023. Case Presentation:59 year-old woman with CKD stage 3b and hypertension presented with 3 months of progressive dyspnea, abdominal distension, bilateral lower extremity edema, and a 60-pound weight gain. Physical exam noted diffuse anasarca, with stable hemodynamics on room air. EKG revealed low voltage leads and chest X-ray demonstrated an enlarged cardiac silhouette. CT abdomen was remarkable for significant ascites, body wall edema, and a suspicious large right renal mass. Diagnostic paracentesis indicated cardiac ascites. Echocardiogram showed preserved ejection fraction, moderate pericardial effusion and an enlarged right side of the heart. Right heart catheterization confirmed high-output heart failure (HOHF). A suspected renal mass-related arteriovenous fistula (AVF) was confirmed through inferior vena caval and renal venogram blood gas sampling, indicating arteriovenous shunting within the renal mass. Hepatic venogram excluded portal hypertension. MRI abdomen confirmed a large necrotic right renal mass consistent with renal cell carcinoma (RCC). Symptoms significantly improved after nephrectomy, with aggressive diuresis, and therapeutic paracenteses leading to an 80-pound weight loss. Postoperative echocardiography illustrated decrease in pericardial effusion and right ventricular size. Cardiac MRI and stress test were unremarkable prior to planned immunotherapy for stage III RCC.Discussion:AVF and HOHF associated with malignancy are unusual presentations. RCC is the most prevalent underlying malignancy linked with AVF and is hypothesized to be a result of hypervascularity caused by a VHL gene mutation. The most often utilized imaging modalities for detecting a tumor-related AVF are contrast enhanced CT or MRI. When imaging is inconclusive, a venogram with blood gas sample, as observed in our case, may be considered to establish an RCC-associated AVF.

Circulation, Volume 148, Issue Suppl_1, Page A16055-A16055, November 6, 2023. Introduction:Nonbacterial thrombotic endocarditis (NBTE) or Marantic endocarditis, involves formation of sterile platelet & fibrin thrombi on undamaged cardiac valves & adjacent endocardium. The vegetation is associated with embolization.Case presentation:A middle-aged female without cardiac history presented to the ED with blurred vision & fatigue for 3 days. The patient was afebrile with a BP of 183/97mmHg. Physical examination showed decreased visual acuity in the left eye. The EKG was normal. The patient underwent a CT scan brain that showed suspicion of bilateral occipital strokes. MRI brain revealed multiple small acute infarcts in the bilateral cerebral hemispheres & cerebellum. Blood cultures were negative. Telemetry did not show atrial fibrillation. Given a suspicion of cardioembolic stroke, the patient underwent a transesophageal echocardiogram (TEE) which demonstrated a trileaflet aortic valve (AV) with abnormal irregular thickening of leaflets, concerning for vegetation & moderate-severe aortic regurgitation (AR). figure 1. Our patient was diagnosed with marantic endocarditis based on TEE & serial negative cultures. Apixaban was started. Further workup of the patient revealed bilateral pulmonary emboli. Abdominal imaging revealed a pelvic mass, ultimately diagnosed as clear-cell ovarian cancer. Interval TEE at 3 months demonstrated complete resolution of vegetations with preserved cusp motion & mild AR. A shared decision was made to continue lifelong anticoagulation.Discussion:NBTE commonly involves mitral & AV. Risk factors include trauma, circulating immune complexes, hypercoagulability, malignancy & acute inflammation. Symptoms result from embolization, valve dysfunction, or impaired cardiac function. It is based on imaging after ruling out infectious etiologies. Management is anticoagulation & valve replacement with the treatment of the underlying etiology. Valve replacement prevents future embolic complications.

This randomized clinical trial examines whether lapatinib combined with a cisplatin-based combination radiation regimen is effective for the treatment of patients with locally advanced head and neck cancer with poor prognosis.

This cohort study examines whether patients with cutaneous Merkel cell carcinoma are at increased risk of developing subsequent other cancers.

New England Journal of Medicine, Ahead of Print.

Objectives
Ovarian serous carcinoma (OSC) is a major cause of gynaecological cancer death, yet there is a lack of reliable prognostic models. To address this, we developed and validated a nomogram based on conventional clinical characteristics and log odds of positive lymph nodes (LODDS) to predict the prognosis of OSC patients.

Setting
A Real-World Retrospective Cohort Study from the Surveillance, Epidemiology and End Results programme.

Participants
We obtained data on 4192 patients diagnosed with OSC between 2010 and 2015. Eligibility criteria included specific diagnostic codes, OSC being the primary malignant tumour and age at diagnosis over 18 years. Exclusion criteria were missing information on various factors and unknown cause of death or survival time.

Primary and secondary outcome measures
The primary outcome were overall survival (OS) and ovarian cancer-specific survival (OCSS).

Results
For OS and OCSS outcomes, we selected 7 and 5 variables, respectively, to establish the nomogram. In the training and validation cohorts, the C index for OS or OCSS was 0.716 or 0.718 and 0.731 or 0.733, respectively, with a 3-year time-dependent area under the curve (AUC) of 0.745 or 0.751 and a 5-year time-dependent AUC of 0.742 or 0.751. Calibration curves demonstrated excellent consistency between predicted and observed outcomes. The Net Reclassification Index, integrated discrimination improvement and decision curve analysis curves indicated that our nomogram performed better than the International Federation of Gynaecology and Obstetrics (FIGO) staging system in predicting OS and OCSS for OSC patients in both the training and validation cohorts.

Conclusion
Our nomogram, which includes LODDS, offers higher accuracy and reliability than the FIGO staging system and can predict overall and OCSS in OSC patients.

New England Journal of Medicine, Ahead of Print.

Studio su Jama, su 900 pazienti dal 2015 in Piemonte e Vda

Objective
Uncommon and particularly deadly, pulmonary sarcomatoid carcinoma (PSC) is an aggressive type of lung cancer. This research aimed to create a risk categorisation and nomogram to forecast the overall survival (OS) of patients with PSC.

Methods
To develop the model, 899 patients with PSC were taken from the Surveillance, Epidemiology, and End Results database from the USA. We also used an exterior verification sample of 34 individuals with PSC from Fujian Provincial Hospital in China. The Cox regression hazards model and stepwise regression analysis were done to screen factors in developing a nomogram. The nomogram’s ability to discriminate was measured employing the area under a time-dependent receiver operating characteristic curve (AUC), the concordance index (C-index) and the calibration curve. Decision curve analysis (DCA) and integrated discrimination improvement (IDI) were used to evaluate the nomogram to the tumour–node–metastasis categorisation developed by the American Joint Committee on Cancer (AJCC-TNM), eighth edition, and an additional sample confirmed the nomogram’s accuracy. We further developed a risk assessment system based on nomogram scores.

Results
Six independent variables, age, sex, primary tumour site, pathological group, tumour–node–metastasis (TNM) clinical stage and therapeutic technique, were chosen to form the nomogram’s basis. The nomogram indicated good discriminative ability with the C-index (0.763 in the training cohort and 0.746 in the external validation cohort) and time-dependent AUC. Calibration plots demonstrated high congruence between the prediction model and real-world evidence in both the validation and training cohorts. Nomogram outperformed the AJCC-TNM eighth edition classification in both DCA and IDI. Patients were classified into subgroups according to their risk ratings, and significant differences in OS were observed between them (p

Introduction
Oropharyngeal squamous cell carcinoma (OPSCC) is increasingly prevalent and has significantly heterogeneous risks of survival for diagnosed individuals due to the inter-related risk factors. Precise prediction of the risk of survival for an individual patient with OPSCC presents a useful adjunct to therapeutic decision-making regarding the management of OPSCC. The aim of this systematic review, critical appraisal and meta-analysis is to assess prognostic prediction models for OPSCC and lay a foundation for future research programmes to develop and validate prognostic prediction models for OPSCC.

Methods and analysis
This protocol will follow the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocol statement. Based on predefined criteria, electronic databases including MEDLINE, Embase, Web of Science, the Cochrane Library and China National Knowledge Infrastructure (CNKI) will be searched for relevant studies without language restrictions from inception of databases to present. This study will systematically review published prognostic prediction models for survival outcomes in patients with OPSCC, describe their characteristics, compare performance and assess risk of bias and real-world clinical utility. Selection of eligible studies, data extraction and critical appraisal will be conducted independently by two reviewers. A third reviewer will resolve any disagreements. Included studies will be systematically summarised using appropriate tools designed for prognostic prediction modelling studies. Risk of bias and quality of studies will be assessed using the Prediction Model Risk of Bias Assessment Tool and the Transparent Reporting of a multivariable prediction model for individual prognosis or diagnosis. Performance measures of these models will be pooled and analysed with meta-analyses if feasible.

Ethics and dissemination
This review will be conducted completely based on published data, so approval from an ethics committee or written consent is not required. The results will be disseminated through a peer-reviewed publication.

PROSPERO registration number
CRD42023400272.

Zhou J, Wu Z, Zhang Z, et al. Pan-ERBB kinase inhibition augments CDK4/6 inhibitor efficacy in oesophageal squamous cell carcinoma. Gut 2022;71:665–75. doi:10.1136/gutjnl-2020-323276 Following publication of the original article, authors identified an error in figure 3B, specifically: TE9 cell line total HER3, total AKT and total ERK lanes appear to be misused. The correct figure is presented below. This correction does not affect the result and conclusions of the study. We apologise for this error and any inconvenience caused. Figure 3 Pan ERBB and CDK4/6 pathway dual inhibition demonstrated efficacy in ESCC. (A) Images showing crystal violet staining of representative squamous carcinoma cell lines on treatment with afatinib (20 nM), palbociclib (500 nM), the combination or with DMSO control for 7–10 days. Data from one representative experiment are presented (n=2). (B) Immunoblot analysis of genes involved in ERBB signalling pathway and cell-cycle pathway in TE9, TE11 and KYSE180 cells…

Objective
Selecting interventions for patients with solitary hepatocellular carcinoma (HCC) remains a challenge. Despite gross classification being proposed as a potential prognostic predictor, its widespread use has been restricted due to inadequate studies with sufficient patient numbers and the lack of established mechanisms. We sought to investigate the prognostic impacts on patients with HCC of different gross subtypes and assess their corresponding molecular landscapes.

Design
A prospective cohort of 400 patients who underwent hepatic resection for solitary HCC was reviewed and analysed and gross classification was assessed. Multiomics analyses were performed on tumours and non-tumour tissues from 49 patients to investigate the mechanisms underlying gross classification. Inverse probability of treatment weight (IPTW) was used to control for confounding factors.

Results
Overall 3-year survival rates varied significantly among the four gross subtypes (type I: 91%, type II: 80%, type III: 74.6%, type IV: 38.8%). Type IV was found to be independently associated with poor prognosis in both the entire cohort and the IPTW cohort. The four gross subtypes exhibited three distinct transcriptional modules. Particularly, type IV tumours exhibited increased angiogenesis and immune score as well as decreased metabolic pathways, together with highest frequency of TP53 mutations. Patients with type IV HCC may benefit from adjuvant intra-arterial therapy other than the other three subtypes. Accordingly, a modified trichotomous margin morphological gross classification was established.

Conclusion
Different gross types of HCC showed significantly different prognosis and molecular characteristics. Gross classification may aid in development of precise individualised diagnosis and treatment strategies for HCC.

Introduction
The feasibility and efficacy of surgical resection following systemic therapy for intermediate-stage hepatocellular carcinoma (HCC) beyond the Up-to-7 criteria is unclear. The combination of lenvatinib (LEN) and transcatheter arterial chemoembolisation (TACE), termed LEN–TACE sequential therapy, has shown a high response rate and survival benefit in patients with intermediate-stage HCC. This trial aims to evaluate the efficacy and safety of LEN–TACE sequential therapy and the feasibility of surgical resection for intermediate-stage HCC beyond the Up-to-7 criteria.

Methods and analysis
This is a multicentre, single-arm, prospective clinical trial. Thirty patients with intermediate-stage HCC beyond the Up-to-7 criteria will be enrolled. Patients eligible for this study will undergo LEN–TACE sequential therapy in which LEN is administered for 4 weeks, followed by TACE, and then further LEN for another 4 weeks. Patients will be assessed for efficacy of LEN–TACE sequential therapy and resectability, and surgical resection will be performed if the HCC is considered radically resectable. The primary outcome of this study is the resection rate after LEN–TACE sequential therapy. The secondary outcomes are the objective response rate of LEN–TACE sequential therapy, safety, curative resection rate, overall survival and recurrence-free survival.

Ethics and dissemination
This trial was approved by the Institutional Review Board of Hiroshima University, Japan (approval no. CRB210003), and has been registered with the Japan Registry of Clinical Trials (jRCTs061220007). The results of this study will be submitted for publication in a peer-reviewed journal and shared with the scientific community at international conferences.

Trial registration number
jRCTs061220007 (https://jrct.niph.go.jp/latest-detail/jRCTs061220007).

“Orgoglio per le campagne di prevenzione nel primo anno”

This systematic review and meta-analysis evaluates the efficacy and safety of immune checkpoint inhibitors in the treatment of advanced hepatocellular carcinoma with Child-Pugh class B liver function.

This cohort study of adults with Merkel cell carcinoma evaluates the association of Mohs micrographic surgery vs wide local excision with overall survival.