Factors Associated with Advanced Disease Stage at Diagnosis in a Study of Patients with Newly Diagnosed Breast Cancer

Abstract Background Ethiopia recently implemented the ‘test and treat’ strategy for all HIV-infected individuals receiving a diagnosis at the health facility level. However, the impact of this policy in terms of timely HIV diagnosis and factors associated with it were not evaluated. Therefore, this study aimed to determine the magnitude and predictors of delayed HIV diagnosis among newly diagnosed people living with HIV in the northwest, Ethiopia. Methods In this cross-sectional study, a total of 759 newly diagnosed patients were recruited consecutively. The multistage sampling technique was employed to select health facilities and all newly diagnosed patients were included. Delayed HIV diagnosis was defined when there is an established AIDS-defining clinical condition (WHO clinical stage III or IV), irrespective of CD4 count. Data were entered into Epi-Data version 3.5 and exported to STATA version 14 for further analysis. Taking into account the nested structure of the data, multilevel logistic regression analysis has been employed. Four models containing variables of interest were fitted. Multivariate multilevel logistic regression analysis was performed to estimate the adjusted odds ratios (AOR) at a 95% confidence interval (CI). Results A one-fourth of newly diagnosed HIV patients diagnosed at advanced disease stage. After controlling for other individual and health facility level factors, factors associated with delayed HIV diagnosis were: Patients who had completed secondary school or higher (AOR = 2.08, 95% CI = 1.06, 4.08), patients who presented to health facilities with HIV symptoms (AOR = 5.87, 95% CI = 3.57, 9.62), being non-working functional status (AOR = 4.80, 95% CI = 2.58, 8.92) and HIV diagnosis at hospitals (AOR = 2.16, 95% CI = 1.08, 4.31). Conclusion The magnitude of delayed HIV diagnosis was improved. In addition to individual-level factors, it is important to address health facility-related factors to improve earlier HIV diagnosis. Here, we recommend using both clinical and laboratory characteristics of a patient particularly, baseline CD4 count and viral load to identify patients diagnosed with advanced disease stage. Moreover, public health interventions are important targeted on factors associated with delayed HIV diagnosis.

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High levels of periostin correlate with increased fracture rate, diffuse MRI pattern, abnormal bone remodeling and advanced disease stage in patients with newly diagnosed symptomatic multiple myeloma

Blood Cancer Journal ◽

10.1038/bcj.2016.90 ◽

2016 ◽

Vol 6 (10) ◽

pp. e482-e482 ◽

Cited By ~ 7

Author(s):

E Terpos ◽

D Christoulas ◽

E Kastritis ◽

T Bagratuni ◽

M Gavriatopoulou ◽

...

Keyword(s):

Multiple Myeloma ◽

Bone Remodeling ◽

Advanced Disease ◽

Disease Stage ◽

Fracture Rate ◽

Newly Diagnosed ◽

Advanced Disease Stage

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Total Diagnostic Delay in Oral Cancer may be Related to Advanced Disease Stage at Diagnosis

Journal of Evidence Based Dental Practice ◽

10.1016/j.jebdp.2012.03.018 ◽

2012 ◽

Vol 12 (2) ◽

pp. 84-86 ◽

Cited By ~ 5

Author(s):

Jennifer L. Cleveland ◽

Gina Thornton-Evans

Keyword(s):

Oral Cancer ◽

Advanced Disease ◽

Diagnostic Delay ◽

Disease Stage ◽

Stage At Diagnosis ◽

Advanced Disease Stage

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Nephrotoxicity in patients with cancer treated with immune checkpoint inhibitors.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e14558 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e14558-e14558

Author(s):

Evangelos Eleutherakis Papaiakovou ◽

Efstathios Kastritis ◽

Flora Zagouri ◽

Dimitra Grapsa ◽

Ioannis Ntanassis-Stathopoulos ◽

...

Keyword(s):

Renal Function ◽

Immune Checkpoint ◽

Impaired Renal Function ◽

Immune Checkpoint Inhibitors ◽

Advanced Disease ◽

Checkpoint Inhibitors ◽

Disease Stage ◽

Clinicopathological Parameters ◽

Stage At Diagnosis ◽

Advanced Disease Stage

e14558 Background: Despite their efficacy in various cancer types, administration of immune checkpoint inhibitors (ICIs) may be complicated by the development of immune-related adverse events (IrAE). Nephrotoxicity represents a relatively rare but clinically significant adverse event, associated with the administration of ICI. Methods: The medical records of 294 patients with solid tumors or hematological malignancies that received ICIs for at least 4 weeks were retrospectively reviewed. Demographic, clinicopathological, treatment, toxicity and outcome data were recorded. ICI-associated nephrotoxicity was correlated with the remaining clinicopathological parameters as well as with progression-free survival (PFS) and overall survival (OS). Results: The majority of patients were male (70.4%), with bladder cancer or renal cell carcinoma (38.1% and 27.6%, respectively), and stage IV disease (56.8%), and had received ICI as monotherapy (68,7%). Nephrotoxicity during immunotherapy administration was observed in 20/ 294 (6.8%) patients, was mild (grade 1) and reversible in 55% and 75% of these cases, respectively, and was significantly associated with nephrotoxicity from previously administered therapy (p = 0,008), impaired renal function at initiation of ICIs (p = 0.044). and advanced disease stage at diagnosis (p = 0,028). No correlation between ICI-nephrotoxicity and PFS or OS was observed. Conclusions: ICI-associated nephrotoxicity was a relatively infrequent IrAE in our patient population, most commonly mild and reversible, and with no significant effect on survival. Preexisting treatment-related nephrotoxicity, impaired renal function and/or advanced disease stage at diagnosis may represent significant predisposing factors for its development.

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The use of insulin and the effect on survival of non-small cell lung cancer patients

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e22073 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e22073-e22073

Author(s):

S. Y. Farhan ◽

M. Jankowski ◽

A. Hanbali ◽

D. Wang

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Advanced Disease ◽

Small Cell ◽

Disease Stage ◽

Diabetic Patients ◽

Stage At Diagnosis ◽

Small Cell Lung ◽

Cancer Specific Survival ◽

Advanced Disease Stage

e22073 Background: Diabetes mellitus (DM) is one of the common morbidities in United States. Insulin therapy has been frequently used in its treatment. Some studies have postulated that activation of Insulin and Insulin-like growth factor (IGF) pathway may contribute to cancer proliferation, growth and resistance to anticancer therapies. The impact of insulin on diabetic patients with non-small cell lung cancer (NSCLC) has not been reported. Methods: 1,233 patients with NSCLC diagnosed between January 1999 and December 2004 were identified from the Tumor Registry at Henry Ford Health System. Based on inclusion criteria, data from 1,206 patients were extracted from the electronic medical records. Statistical analyses were performed between insulin and non insulin users. Results: Out of 1,206 patients, 193 patients had NSCLC and DM. Data was available from 192 patients. Sixty (31.3%) were on insulin at the time of NSCLC diagnosis and defined as insulin users, while 132 were not on insulin and defined as non- users (68.7%). Demographics, co-morbidities, disease stage at diagnosis, therapeutic interventions, and laboratory values were analyzed for overall and cancer-specific survival. More insulin users (81%) than non-users (64%) presented with advanced disease (stage ≥ 3) at diagnosis (P=0.02). Although no significant difference of Hemoglobin A1c was observed, the median survival from all causes of death was 6.5 months for insulin-users versus 9.9 months for non-users (P=0.08). When survival time was calculated from cancer-specific death, the median survival between insulin and non-insulin users was 7.2 months versus 38.7 months, respectively (P=0.002), with a hazard ratio (HR) for insulin use equals 1.91. Results from our univariable and multivariable analyses will be presented at the ASCO annual meeting in detail. Conclusions: This data indicates that the use of insulin may adversely affect the biology and clinical course of NSCLC with a tendency of advanced disease stage at diagnosis and a shorter cancer-specific survival time. Prospective study of DM with NSCLC or other cancer diagnosis will improve our understanding of this potential adverse effect on cancer biology and provide scientific rational to target IGF-pathway especially in diabetic patients. No significant financial relationships to disclose.

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Loss of cIAP1 in Endothelial Cells Limits Metastatic Extravasation through Tumor-Derived Lymphotoxin Alpha

Cancers ◽

10.3390/cancers13040599 ◽

2021 ◽

Vol 13 (4) ◽

pp. 599

Author(s):

Lazaros Vasilikos ◽

Kay Hänggi ◽

Lisanne M. Spilgies ◽

Samanta Kisele ◽

Stefanie Rufli ◽

...

Keyword(s):

Tumor Cell ◽

Tumor Cells ◽

Advanced Disease ◽

Disease Stage ◽

Stromal Compartment ◽

Tumor Load ◽

Smac Mimetics ◽

Advanced Disease Stage ◽

Lymphotoxin Alpha ◽

Open Question

In this study, we determined whether Smac mimetics play a role in metastasis, specifically in circulation, tumor extravasation and growth in a metastatic site. Reports suggest inducing the degradation of IAPs through use of Smac mimetics, alters the ability of the tumor cell to metastasize. However, a role for the immune or stromal compartment in affecting the ability of tumor cells to metastasize upon loss of IAPs has not been defined. To address this open question, we utilized syngeneic tumor models in a late-stage model of metastasis. Loss of cIAP1 in the endothelial compartment, rather than depletion of cIAP2 or absence of cIAP1 in the hematopoietic compartment, caused reduction of tumor load in the lung. Our results underline the involvement of the endothelium in hindering tumor cell extravasation upon loss of cIAP1, in contrast to the immune compartment. Endothelial specific depletion of cIAP1 did not lead to cell death but resulted in an unresponsive endothelium barrier to permeability factors causing a decrease in tumor cell extravasation. Surprisingly, lymphotoxin alpha (LTA), and not TNF, secreted by the tumor cells, was critical for the extravasation. Using TCGA, we found high LTA mRNA expression correlated with decreased survival in kidney carcinoma and associated with advanced disease stage. Our data suggest that Smac mimetics, targeting cIAP1/2, reduce metastasis to the lung by inhibiting tumor cell extravasation.

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