Clinical outcome of patients diagnosed with testicular sex cord stromal tumors.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e17055-e17055
Author(s):  
Syed Abdullah Javaid Bukhari ◽  
Maira Iqbal Malik ◽  
Paul Hutton ◽  
Emilio Porfiri ◽  
Mariam Jafri
Keyword(s):  
High Risk ◽  
Relapse Rate ◽  
Tumour Size ◽  
Disease Free Survival ◽  
Histological Features ◽  
Stromal Tumors ◽  
Post Surgery ◽  
Radiological Staging ◽  
Metastatic Setting ◽  
Sex Cord Stromal Tumors

e17055 Background: Testicular Sex Cord Stromal Tumors (TSCST) are rare representing approximately 5% of testicular cancers. Leydig Cell Tumours (LCT) constitute 1-3% of testicular tumours, occur commonly in third to sixth decade and are up to 50mm in diameter. Sertoli Cell Tumours(SCT) constitute less than 1%, occur commonly in the fourth decade and have an average diameter of 35mm. High-risk histological features include; tumour size, increased mitotic activity, pleomorphic nuclei, necrosis, vascular invasion and rete testis invasion. Management is surgical with no standard chemotherapy or radiotherapy in adjuvant or metastatic setting. Methods: A retrospective review of epidemiology, radiological staging, histopathological features, relapse rate and treatment in 82 patients diagnosed with TSCST between 4/12/2001 -27/12/2018 at a tertiary referral centre. Results: 2,170 testicular cancer patients were diagnosed in this period of whom 82 patients (3.8%) had TSCST. 65 patients (2.9% ) had LCT,13 patients (0.59%) had SCT, 3 patients had Unclassified SCST and 1 patient had Mixed SCST. Median patient age for LCT was 43 years, SCT was 29 years, unclassified SCST was 46 years and for mixed SCST was 49 years (age range of TSCST was 18 - 82 years). Median size of LCT was 11mm (range 4 – 28 mm) in 43 patients and of SCT was 16mm (range 7 – 60mm) in 10 patients. 79 patients (3.6% ) presented with stage 1 disease. One patient with LCT and 4 high risk histological features on initial diagnosis had local retroperitoneal recurrence 4 years later and underwent surgical resection with 1year distant disease-free survival. On distant relapse, he was treated with mitotane. One patient presented with metastatic SCT with 4 histological high risk features. He was treated with carboplatin and etoposide. Median survival in the metastatic disease was 10.5 months. Conclusions: TSCST have an excellent prognosis with over 98% of patients are free of disease post-surgery. Our relapse rate is 1.2% which is lower than previously reported and is confined to patients with high risk features. Metastatic LCT and SCT are resistant to chemotherapy with poor survival.

scholarly journals Ovarian sex cord-stromal tumors: an update on clinical features, molecular changes, and management

2021 ◽  
pp. ijgc-2020-002018
Author(s):  
Rehab Al Harbi ◽  
Iain A McNeish ◽  
Mona El-Bahrawy
Keyword(s):  
Hormonal Therapy ◽  
Clinical Presentation ◽  
Therapeutic Modality ◽  
Biological Behavior ◽  
Molecular Changes ◽  
Histological Features ◽  
Stromal Tumors ◽  
Tumor Subtypes ◽  
Tumor Types ◽  
Sex Cord Stromal Tumors

Sex cord stromal-tumors are rare tumors of the ovary that include numerous tumor subtypes of variable histological features and biological behavior. Surgery is the main therapeutic modality for the management of these tumors, while chemotherapy and hormonal therapy may be used in some patients with progressive and recurrent tumors. Several studies investigated molecular changes in the different tumor types. Understanding molecular changes underlying the development and progression of sex cord-stromal tumors provides valuable information for diagnostic and prognostic biomarkers and potential therapeutic targets for these tumors. In this review, we provide an update on the clinical presentation, molecular changes, and management of sex cord-stromal tumors.

Association of pathological response to neoadjuvant pembrolizumab with tumor PD-L1 expression and high disease-free survival (DFS) in patients with resectable, local-regionally advanced, head and neck squamous cell carcinoma (HNSCC).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6006-6006
Author(s):  
Trisha Michel Wise-Draper ◽  
Vinita Takiar ◽  
Michelle Lynn Mierzwa ◽  
Keith Casper ◽  
Sarah Palackdharry ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Group ◽  
Disease Free Survival ◽  
Immune Checkpoint Blockade ◽  
Skin Wound ◽  
High Risk Group ◽  
Pathological Response ◽  
Intermediate Risk ◽  
Positive Margins ◽  
Post Surgery

6006 Background: Patients with resected HNSCC, with high-risk (positive margins, extracapsular spread [ECE]) or intermediate-risk pathological features have an estimated 1-year DFS of 65% and 69%, respectively. Immune checkpoint blockade improved survival of patients with recurrent/metastatic HNSCC, and preclinical models indicate radiotherapy (RT) synergizes with anti-PD-1. Therefore, we administered the PD-1 inhibitor pembrolizumab (pembro) pre- and post-surgery with adjuvant RT +/- cisplatin in patients with resectable, locoregionally advanced (clinical T3/4 and/or ≥2 nodal metastases) HNSCC (NCT02641093). Methods: Eligible patients received pembro (200 mg I.V. x 1) 1-3 weeks before resection. Adjuvant pembro (q3 wks x 6 doses) was administered with RT (60-66Gy) with or without weekly cisplatin (40mg/m2 X 6) for patients with high-risk and intermediate-risk features, respectively. The primary endpoint was 1-year DFS estimated by Kaplan Meier curves. Safety was evaluated by CTCAE v5.0. Pathological response (PR) to neoadjuvant pembro was evaluated by comparing pre- and post-surgical tumor specimens for treatment effect (TE), defined as tumor necrosis and/or histiocytic inflammation and giant cell reaction to keratinaceous debris. PR was classified as no (NPR, < 20%), partial (PPR, ≥20% and < 90%) and major (MPR, ≥90%). Tumor PD-L1 immunohistochemistry was performed with 22c3 antibody and reported as combined positive score (CPS). Results: Ninety-two patients were enrolled. Seventy-six patients received adjuvant pembro and were evaluable for DFS. Patient characteristics included: median age 58 (range 27 – 80) years; 32% female; 88% oral cavity, 8% larynx, and 3% human papillomavirus negative oropharynx; 86% clinical T3/4 and 65% ≥2N; 49 (53%) high-risk (positive margins, 45%; ECE, 78%); 64% (44/69 available) had PD-L1 CPS ≥1. At a median follow-up of 20 months, 1-year DFS was 67% (95%CI 0.52-0.85) in the high-risk group and 93% (95%CI 0.84-1) in the intermediate-risk group. Among 80 patients evaluable for PR, TE scoring resulted in 48 NPR, 26 PPR and 6 MPR. Patients with PPR/MPR had significantly improved 1-year DFS when compared with those with NPR (100% versus 68%, p = 0.01; HR = 0.23). PD-L1 CPS ≥ 1 was not independently associated with 1-year DFS, but was highly associated with MPR/PPR (p = 0.0007). PPR/MPR in PD-L1 CPS < 1, ≥1 and ≥20, were estimated as 20, 55 and 90%, respectively. Grade ≥ 3 adverse events occurred in 62% patients with most common including dysphagia (15%), neutropenia (15%), skin/wound infections (10%), and mucositis (9%). Conclusions: PR to neoadjuvant pembro is associated with PD-L1 CPS≥1 and high DFS in patients with resectable, local-regionally advanced, HNSCC. Clinical trial information: NCT02641093.

scholarly journals Accelerated Partial Breast Irradiation: Macrophage Polarisation Shift Classification Identifies High-Risk Tumours in Early Hormone Receptor-Positive Breast Cancer

Cancers ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 446
Author(s):  
Sören Schnellhardt ◽  
Ramona Erber ◽  
Maike Büttner-Herold ◽  
Marie-Charlotte Rosahl ◽  
Oliver J. Ott ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Hormone Receptor ◽  
Tumour Size ◽  
Disease Free Survival ◽  
Accelerated Partial Breast Irradiation ◽  
Partial Breast Irradiation ◽  
M2 Macrophage ◽  
Breast Irradiation ◽  
Hormone Receptor Positive

Studies have demonstrated correlations between accumulations of tumour-associated macrophages (TAMs), especially of M2-like phenotype, and increased mortality in advanced breast cancer. We investigated the prognostic potential of both main macrophage phenotypes in early hormone receptor-positive (HR+) breast cancer. The studied cohort of 136 patients participated in an institutional APBI phase II trial. Patient selection was characterized by HR+, small tumour size and no metastasis. Tissue microarrays from pre-RT resection samples were double stained for CD68/CD163 using immunohistochemistry. CD68+/CD163− cells were considered M1-like macrophages and CD68+/CD163+ was representative of M2-like macrophages. M1 and M2 macrophage densities were analysed semi-automatically in the stromal and intraepithelial tumour compartment. Low M1 and high M2 densities were strongly associated with decreased disease-free survival (DFS). Combined TAM phenotype densities were studied after defining a macrophage shift classification: M1-shifted (M1 high, M2 low) and non-shifted (M1 low, M2 low; M1 high, M2 high) tumours entailed a favourable outcome. In contrast, M2-shifted (M1 low, M2 high) TAM populations were associated with extremely reduced DFS. Thus, the full predictive potential of TAMs was revealed in a combined analysis of both phenotypes. The M2-shifted subgroup of tumours is classified as high-risk and probably not suitable for partial breast irradiation.

scholarly journals Prognostic factors in differentiated thyroid carcinomas and their implications for current staging classifications

2004 ◽  
Vol 11 (3) ◽  
pp. 571-579 ◽  
Author(s):  
Arja Jukkola ◽  
Risto Bloigu ◽  
Tapani Ebeling ◽  
Pasi Salmela ◽  
Guillermo Blanco
Keyword(s):  
Prognostic Factors ◽  
Survival Rate ◽  
High Risk ◽  
Tumour Size ◽  
Disease Free Survival ◽  
Entire Group ◽  
Thyroid Carcinomas ◽  
Risk Of Death ◽  
Extrathyroidal Invasion ◽  
Definition Of

Differentiated thyroid carcinomas (DTC) (papillary, follicular and follicular type of papillary) have a favourable prognosis, but a proportion of patients develop recurrences and eventually die of the disease. Various prognostic factors have been identified and been used to create the current staging classifications (AGES, AMES, MACIS, EORTC, UICC-TNM). We examined 499 DTC patients retrospectively to validate known prognostic factors that enable them to be recognised as having either a low or a high risk of death related to a recurrence of DTC, by reference to the current staging classifications. Sixty-nine of them (14%) had local or distant recurrences, the mean time to recurrence being 7.7 years. The 10-year disease-free survival rate was 80%, and the ten-year overall survival rate for the entire group was 91%, with a mean survival time of 8.7 years. Male gender, a follicular type of tumour, larger tumour size, extrathyroidal invasion outside the capsule and nodal metastases were all related to a higher incidence of tumour recurrence, and the follicular type of histology, age >45 years, larger tumour size and local invasion entailed poorer survival. The AMES and to some extent the EORTC classification were not reproducible in this material, mainly because some prognostic variants were no longer encountered or were insufficient in number to allow reliable conclusions to be drawn. The MACIS staging classification leaves the definition of the intermediate and high risk groups too wide and is therefore not very reliable. Pooling of stages I and II improved the relevance of the TNM classification. All the current staging classifications are able to discern a low risk DTC group well. We achieved a highly accurate definition of risk in the present material using only two parameters, age (cut-off value 50 years) and extracapsular invasion of the thyroid gland.

scholarly journals Virškinimo trakto stromos navikų diagnostika Valstybiniame patologijos centre 2003–2004 metais

2006 ◽  
Vol 4 (2) ◽  
pp. 0-0
Author(s):  
Mindaugas Plečkaitis ◽  
Ugnius Mickys ◽  
Darius Dasevičius
Keyword(s):  
High Risk ◽  
Gastrointestinal Stromal Tumors ◽  
Proliferative Activity ◽  
Biological Behavior ◽  
Cell Type ◽  
Ki 67 ◽  
Histological Features ◽  
Stromal Tumors ◽  
Cd 117 ◽  
The Mean

Mindaugas Plečkaitis1, Ugnius Mickys2, Darius Dasevičius21 Vilniaus greitosios pagalbos universitetinė ligoninė,Šiltnamių g. 29 LT-04130, Vilnius2 Valstybinis patologijos centras,Baublio g. 5, LT-08406 VilniusEl. paštas: [email protected]; [email protected] Tikslas Išanalizuoti GIST atvejus, diagnozuotus Valstybiniame patologijos centre 2003–2004 m., apibendrinti histologinius šių navikų požymius, įvertinti histologinių požymių sąsajas su piktybinės biologinės elgsenos rizikos grupėmis. Medžiaga ir metodai Įvertinti pacientų amžių, pasiskirstymą pagal lytį, navikų lokalizaciją, daugybiškumą, metastazes, recidyvus. Papildomai įvertinti histologinius naviko požymius: histologinį piešinį (mišrus, šeivinis, epitelioidinis), organoidinių struktūrų formavimą, ritmines naviko ląstelių branduolių lygiavimosi (palisading) struktūras, ląstelių perinuklearinę vakuolizaciją, naviko miksoidinę stromą, koaguliacinę nekrozę, įsiskverbimą į savąjį gleivinės dangalą (lamina propria), dydį, mitozių kiekį, imunoprofilį. Remiantis navikų dydžiu ir mitozių kiekiu 50-yje didelio padidinimo regos laukų (pagal C.D.M. Fletcher), GIST suskirstyti į piktybinės biologinės elgsenos rizikos grupes. Rezultatai Ištirta 50 GIST atvejų. Ligonių amžiaus vidurkis 64,38 ± 14,26 metų, mediana – 68 metai. Moterų buvo 36, vyrų – 14. Nustatytos 7 (14%) GIST metastazės. Dauginių GIST diagnozuoti 4 atvejai (8%). Šių navikų recidyvų per tirtą laikotarpį nebuvo. Maždaug pusė pavienių navikų rasta skrandyje (45,7%), rečiau – plonojoje žarnoje (15,2%), rečiausiai – storojoje žarnoje (4,3%). Mišrių ir šeivinių GIST kiekis beveik nesiskyrė (atitinkamai 46,2% ir 43,6%), rečiau pasitaikė epitelioidinių navikų (10,3%). GIST dydis svyravo nuo 0,5 cm iki 25 cm (vidurkis 6,4 ± 5,3 cm; mediana 4,9 cm). Dauguma mūsų imunotipuotų GIST buvo teigiami CD 117 ir CD34 žymenims, o pusė navikų – teigiami a-lygiųjų raumenų aktinui. Didesnė dalis į rizikos grupes mūsų suskirstytų pavienių navikų (41,7%) buvo didelės piktybinės biologinės elgsenos rizikos. Koaguliacinė nekrozė buvo 86,7%, o naviko plitimo į savąjį gleivinės dangalą požymiai – 60% didelės piktybiškumo rizikos pavienių GIST. Ki-67 proliferacinis aktyvumas >10% naviko ląstelių populiacijos buvo būdingas didelės rizikos GIST, o Ki-67 proliferacinis aktyvumas <5% nekoreliavo su GIST piktybinės biologinės elgsenos rizikos grupėmis.. Išvada Tyrimo rezultatai parodė, kad naviko koaguliacinės nekrozės, plitimas į savąjį gleivinės dangalą, Ki-67 proliferacinis aktyvumas >10% naviko ląstelių populiacijos gali būti papildomi histologiniai kriterijai tikslesnei GIST prognozei nustatyti, nes yra būdingesni didelės rizikos GIST. Reikšminiai žodžiai: gastrointestininės stromos navikai, CD117, piktybinės biologinės elgsenos rizika Diagnostics of gastrointestinal stromal tumors in the National Centre of Pathology 2003–2004 Mindaugas Plečkaitis1, Ugnius Mickys2, Darius Dasevičius21 Vilnius University Emergency Hospital,Baublio str. 5, LT-08406 Vilnius, Lithuania2 National Center of Pathology,Akademijos str. 4, LT-08663 Vilnius, LithuaniaE-mails: [email protected], [email protected] Objective To review GIST cases diagnosed in 2003–2004 at the Lithuanian State Centre of Pathology, to evaluate the histological findings and to correlate histological features with the risk of malignant biological behavior. Materials and methods To evaluate the patiens’ age and sex distribution, localization, ]metastases, GIST relapses and multiple tumors. Additionally, to estimate the histological features: histological pattern (spindle, epithelioid or mixed cell type), nesting, palisading, perinuclear vacuolization of tumor cells, myxoid stroma, foci of coagulative necrosis, mucosal invasion, size, mitotic rate, immunophenotype and risk of malignant biological behavior (according to C.D.M. Fletcher) of GIST. Results Fifty GIST cases were analysed. The mean age of 36 females and 14 males was 64.38 ± 14.26 years, mediana 68 years. There were found 7 metastases (14%), 4 multiple GISTs (8%) and no one relapse case in our research. 45.7% of GISTs were localised in the stomatch, 15.2% in small intestine and 4.3% in large intestine. 46.2% of GISTs were of mixed type, 43.6% of spindle cell type and 10.3% of epithelioid type. The mean size of GISTs was 6.4 ± 5.3 cm, mediana 4.9 cm. Most of GISTs were positive to CD117 and to CD34, and one half of the tumors to a-actin. 41.7% of solitary GISTs showed a high risk of malignant biological behavior. Foci of coagulative necroses were found in 86.7% and mucosal invasion in 60% of solitary GISTs with a high risk of malignant biological behavior. Ki-67 proliferative activity >10% was characteristic of GISTs with a high risk of malignant biological behavior, whereas Ki-67 proliferative activity <5% did not correlate with the risk groups of malignant biological behavior. Conclusion The results of the research have shown that invasion of the mucosa, necrotic foci, Ki-67 proliferative activity more than 10% are characteristic of GISTs with a high risk of malignant biological behavior and should be used as additional predictors for the malignant potential of these tumors. Key words: gastrointestinal stromal tumors, CD 117, risk of malignant biological behavior

Fludarabine and cytosine are less effective than standard ADE chemotherapy in high-risk acute myeloid leukemia, and addition of G-CSF and ATRA are not beneficial: results of the MRC AML-HR randomized trial

Blood ◽  
2006 ◽  
Vol 107 (12) ◽  
pp. 4614-4622 ◽  
Author(s):  
Donald W. Milligan ◽  
Keith Wheatley ◽  
Timothy Littlewood ◽  
Jenny I. O. Craig ◽  
Alan K. Burnett ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
High Risk ◽  
Relapse Rate ◽  
Myeloid Leukemia ◽  
Remission Rate ◽  
Disease Free Survival ◽  
High Dose ◽  
Standard Chemotherapy ◽  
All Trans Retinoic Acid ◽  
Acute Myeloid

AbstractThe optimum chemotherapy schedule for reinduction of patients with high-risk acute myeloid leukemia (relapsed, resistant/refractory, or adverse genetic disease) is uncertain. The MRC AML (Medical Research Council Acute Myeloid Leukemia) Working Group designed a trial comparing fludarabine and high-dose cytosine (FLA) with standard chemotherapy comprising cytosine arabinoside, daunorubicin, and etoposide (ADE). Patients were also randomly assigned to receive filgrastim (G-CSF) from day 0 until neutrophil count was greater than 0.5 × 109/L (or for a maximum of 28 days) and all-trans retinoic acid (ATRA) for 90 days. Between 1998 and 2003, 405 patients were entered: 250 were randomly assigned between FLA and ADE; 356 to G-CSF versus no G-CSF; 362 to ATRA versus no ATRA. The complete remission rate was 61% with 4-year disease-free survival of 29%. There were no significant differences in the CR rate, deaths in CR, relapse rate, or DFS between ADE and FLA, although survival at 4 years was worse with FLA (16% versus 27%, P = .05). Neither the addition of ATRA nor G-CSF demonstrated any differences in the CR rate, relapse rate, DFS, or overall survival between the groups. In conclusion these findings indicate that FLA may be inferior to standard chemotherapy in high-risk AML and that the outcome is not improved with the addition of either G-CSF or ATRA.

scholarly journals Analysis of the Safety and Pregnant Outcomes of Fertility-Sparing Surgery in Ovarian Malignant Sex Cord-Stromal Tumors: A Multicenter Retrospective Study

2021 ◽  
Author(s):  
Junting Li ◽  
Ran Chu ◽  
Gang Chen ◽  
Yuanming Shen ◽  
Yanhui Lou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
High Risk ◽  
Stromal Tumors ◽  
High Risk Factors ◽  
Fertility Sparing Surgery ◽  
Fertility Sparing ◽  
Stage Ia ◽  
Staging Surgery ◽  
Sex Cord Stromal Tumors

Abstract Background: To assess the difference in survival between fertility-sparing surgery (FSS) and radical surgery (RS) and explore pregnant outcomes after FSS in stage I malignant sex cord-stromal tumors (MSCSTs).Methods: We performed a multicenter retrospective cohort study on patients who were diagnosed with stage IA or IC MSCSTs. Inverse Probability of Treatment Weighting was performed between the FSS and RS groups. The Chi-square test and Kaplan-Meier method were used to compare the categorical variables and disease-free survival (DFS). The binary logistic regression analysis and Cox proportional hazards regression analysis were used to identify high-risk factors related to DFS and pregnancy.Results: A total of 107 patients were included, of whom 54 (50.5%) women underwent FSS, and 53 (49.5%) women underwent RS. After IPTW, 208 patients were obtained, and all of the covariates were well balanced. After a median follow-up time of 50 months (range 7-156 months), there was no significant difference of DFS between the two groups in both unweighted cohort (P=0.969) or weighted cohort (P=0.792). In the weighted cohort, stage IC (P=0.014), tumor diameter >8 cm (P=0.003), incomplete staging surgery (P=0.003) and no adjuvant chemotherapy (P <0.001) were 4 high-risk factors associated with a shorter DFS. Among 14 patients who had pregnancy desire, 11 (78.6%) women conceived successfully, and the live birth rate was 76.9%. In univariate analysis, only adjuvant chemotherapy (P=0.009) was associated with infertility.Conclusions: On the premise of complete staging surgery, FSS is safe and feasible in stage IA and IC MSCSTs with satisfactory reproductive outcomes.

scholarly journals Hydroxysteroid 11-Beta Dehydrogenase 1 Overexpression with Copy-Number Gain and Missense Mutations in Primary Gastrointestinal Stromal Tumors

2018 ◽  
Vol 7 (11) ◽  
pp. 408 ◽  
Author(s):  
Chien-Feng Li ◽  
Ting-Ting Liu ◽  
Jui-Chu Wang ◽  
Shih-Chen Yu ◽  
Yen-Yang Chen ◽  
...  
Keyword(s):  
In Situ Hybridization ◽  
High Risk ◽  
Copy Number ◽  
Gastrointestinal Stromal Tumors ◽  
Disease Free Survival ◽  
Copy Number Gain ◽  
Missense Mutations ◽  
Stromal Tumors

The lipid-metabolizing enzymes remain underexplored in gastrointestinal stromal tumors (GISTs). Through transcriptomic reappraisal, hydroxysteroid 11-beta dehydrogenase-1 (HSD11B1) was identified as a top-upregulated, progression-associated gene. To validate the clinical relevance of HSD11B1, the informative results of Sanger sequencing (n = 58), mRNA quantification by branched-chain DNA in situ hybridization assay (n = 70), copy number assay by fluorescent in situ hybridization (n = 350), and immunohistochemistry (n = 350) were correlated with clincopathological variables, KIT/PDGFRA/BRAF genotypes, and disease-free survival (DFS). HSD11B1 was stably silenced to explore its oncogenic function. HSD11B1 mRNA varied between high-risk and non-high-risk groups (p = 0.009) and positively correlated with HSD11B1 immunoexpression (r = 0.783, p < 0.001). HSD11B1 copy-number gain (CNG), including polysomy (5.4%) and amplification (12%), associated with HSD11B1 overexpression (p < 0.001). Predominantly involving the homodimer interface-affecting exon 6 or exon 7, missense HSD11B1 mutations (17.2%) were related to high risk (p = 0.044), age ≥70 years (p = 0.007), and shorter DFS among relapsed cases (p = 0.033). CNG was related to unfavorable KIT/PDGFRA/BRAF genotypes (p = 0.015), while HSD11B1 overexpression was preferential in non-gastric cases (p < 0.001). Both abnormalities strongly associated with risk levels (both p < 0.001) and shorter univariate DFS (both p < 0.0001), and HSD11B1 CNG remained prognostically independent (p < 0.001) with a 3-fold increased hazard ratio. In vitro, HSD11B1 knockdown significantly inhibited proliferation and caused G2/M arrest. In conclusion, HSD11B1 overexpression may occur owing to CNG, confer a pro-proliferative function, and predict a worse prognosis in GISTs.

scholarly journals Surgical Approaches and Oncological Outcomes in the Management of Duodenal Gastrointestinal Stromal Tumors (GIST)

2021 ◽  
Vol 10 (19) ◽  
pp. 4459
Author(s):  
Nikolaos Vassos ◽  
Aristotelis Perrakis ◽  
Werner Hohenberger ◽  
Roland S. Croner
Keyword(s):  
High Risk ◽  
Surgical Approach ◽  
Tumor Size ◽  
Gastrointestinal Stromal Tumors ◽  
Tumor Biology ◽  
Disease Free Survival ◽  
Extended Resection ◽  
Stromal Tumors ◽  
Duodenal Gist ◽  
Increased Risk

Background: Duodenal gastrointestinal stromal tumors (GIST) are a rare subset of GIST. Their surgical management in this anatomically complex region consists of varied approaches, and the administration of imatinib mesylate (IM) has not been clarified. Methods: We retrospectively reviewed patients with duodenal GIST treated during a 10-year-period. We analysed the clinicopathological characteristics and survival factors and evaluated the perioperative and long-term outcomes based on the extent of resection ((ocal-resection (LR) versus pancreaticoduodenectomy (PD)) and the IM-administration. The median follow-up period was 60 months (range, 12–140). Results: A total of thirteen patients (M:F = 7:6) with median age of 64 years (range, 42–77) underwent resection of duodenal GIST. Median tumor size was 5.2 cm (range, 1.5–13.3). Eight patients (61.5%) underwent LR and five patients (38.5%) PD. R0-resection was achieved in 92.5%. Neoadjuvant IM-therapy was administered in five patients leading to tumor downsizing and in 40% to less-extended resection. The PD group consisted of larger tumors with higher mitotic count, mostly located in D2 (p = 0.031). The PD group had longer operative time (p = 0.026), longer hospital stay (p = 0.016), and higher rate of postoperative complications (p = 0.128). The actuarial 1-, 3-, and 5-year overall survival were 92.5%, 84%, and 73.5%, respectively, whereas the disease-free survival rates at 1, 3, and 5 years were 91.5%, 83%, and 72%, respectively. A tendency towards increased risk of disease recurrence was demonstrated for patients with tumor >5 cm and high-risk potential. There was not statistic survival benefit for one or the other surgical approach. Conclusion: The type of resection depends on duodenal site of origin and tumor size. LR can be the treatment of choice for duodenal GIST whenever technically feasible. Recurrence of duodenal GIST is dependent on tumor biology rather than surgical approach. Administration of IM in neaodjuvant setting should be considered in cases with high-risk GIST scheduled for PD since it might facilitate less-extended resection.

scholarly journals Immune Microenvironment-Related Genes Contribute to Clinical Prognosis in Patients with Triple-Negative Breast Cancer

2021 ◽  
Author(s):  
Dandan Feng ◽  
Jie Gao ◽  
Tianshu Yang ◽  
Yanli Ren ◽  
Wei Liu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Survival Analysis ◽  
High Risk ◽  
Triple Negative Breast Cancer ◽  
Triple Negative ◽  
Disease Free Survival ◽  
Functional Enrichment ◽  
Clinical Prognosis ◽  
Network Analyses ◽  
Post Surgery

Abstract Background:Triple-negative breast cancer (TNBC) is a high-risk breast cancer subtype, which accounts for 15% to 20% of all breast cancers and generally has a poor prognosis. TNBC patients have high recurrence post-surgery and high risk of metastasis to other organs. The tumor microenvironment (TME) plays important roles in the carcinogenesis, development, and metastasis of tumors. Methods: This study aimed to investigate the effects of immune and stromal cell-related genes on TNBC prognosis. The ESTIMATE algorithm was used to calculate the immune/stromal scores of TNBC samples from the GEO database. The samples were divided into high- and low- score groups and the differential expression genes were identified using the limma package within R. Functional enrichment and protein-protein interaction (PPI) network analyses revealed that these genes are primarily involved in immune responses. Results:Survival analysis in both GSE21653 and KM-plotter website showed that 36 genes were significantly related to disease-free survival (DFS) of TNBC. Another survival analysis by R package survival in GSE58812 indicated that 14 genes of 36 were greatly interrelated to DFS of TNBC. Moreover, the expression levels of some of these genes were verified through immunohistochemical staining and RT-qPCR. Finally, four genes importantly associated with TNBC prognosis were identified with Cox-LASSO analysis. Time-dependent receiver-operating characteristic (ROC) analysis displayed an area under the curve (AUC) of 0.95 for one-year survival rate, indicating the four genes performed very well for prognosis prediction. Conclusions:In conclusion, we identified four genes, including BIRC3, CD8A, GNLY and TRIM22, that are possibly associated with the TME and are potential prognostic and therapeutic markers of TNBC.

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