Nhiều ung thư nguyên phát trên một bệnh nhân

TÓM TẮT Đặt vấn đề: Bệnh cảnh một bệnh nhân mắc nhiều ung thư nguyên phát đã được coi là hiếm gặp, tuy nhiên trong thời gian gần đây cho thấy tần suất mắc bệnh nhiều ung thư nguyên phát (MPMN) trên một bệnh nhân ngày có xu hướng gia tăng. Qua 17 trường hợp được thông báo nhằm mục đích rút kinh nghiệm chẩn đoán để có hướng xử lý kịp thời và tốt hơn trong điều trị và tiên lượng; tạo điều kiện triển khai các nghiên cứu có giá trị hơn trong tương lai Báo cáo các trường hợp: Trong 17 trường hợp: 10 nữ và 7 nam: 4/17 (23,5%) MPMN cùng lúc, 13/17 (76,5%) MPMN phát triển sau đó. Hầu hết bệnh nhân trên 60 tuổi,các ung thư nguyên phát thứ 1 thường thấy ở các vị trí đường tiêu hóa: GIST 4/17 (23,5%) đại trực tràng 2/17 (11,8%), vú 6/17 (35,3%), phổi 2/117 (11,8 %) và ung thư thứ 2 và thứ 3 thường thấy ở đường tiêu hóa 6/17 (35,3 %), phụ khoa 5/17 (29,4%) vú 2/17 (11,8%) và phổi 3/17 (17,6%), 15/17 (88,2%) trường hợp mắc ung thư ở 2 vị trí và 2/17 (11,8 %) trường hơp mắc bệnh ở 3 vị trí. Kết luận: Bệnh cảnh mắc nhiều ung thư trên một bệnh nhân không còn là hiếm gặp. Việc chẩn đoán bệnh cần phải được lưu ý trong thời gian theo dõi bệnh. ABSTRACT A CASE SERIES OF MULTIPLE PRIMARY MALIGNANT NEOPLASMS Background: The development of improved diagnostic techniques, increased incidence of long term survival and life expectancy of cancer patients lead to the higher frequency of multiple primary malignant neoplasms (MPMN). This article aims to report series of cases our observed trend of increasing, in prevalence of both synchronously and metachronously second and third primary malignancy. Among the patients have been diagnosed with a cancer and reviewed in the relevant literature. Case series: Among 17 cases of MPMN that have been reported, 4/17 were synchronous (23.5%) and 13/17 were metachronous (76.5%), out of 17 patients, 10 were femals and 7 were males. The majority of the cases were over 60 years of age. In this report, the most common types of cancer were GIST (Stomach, Small intestine): 4/17 (23.5%); Breast: 6/17 (35.3%), Adenocarcinome of lung and colorectal: 2/17 (11.8%) as the first primary and Adenocarcinoma of gastrointestinal tract: 6/17 (35.3%), lung: 2/17 (11.8%), gynecologic tumors: 5/17 (29.4%), Breast: 2/17 (11.8%), lung: 3/17 (17,6%) as the second or the third primary cancer.Among 17 such patients, 15 and 2 primary malignant lessions occured at 2 sites and 3 sites respectively. Conclusion: The incidence of MPMN has not been rare at all. The diagnosis of MPMN should not be overlooked during follow - up. The doctor - patient relationship remains a critical factor in management. The clinicians should be aware of cases that cancer patients have metastasis in unusual sites and inconsistent clinical progression. Keywords: Multiple malignant neoplasms, primary.

Gynecologic organ involvement and incidental gynecologic organ neoplasms in female patients with urothelial carcinoma of the bladder undergoing anterior pelvic exenteration in Rajavithi Hospital

Objective: To evaluate the pathological data of the bladder and gynecologic organs obtained from anterior pelvic exenteration and review the incidence of gynecologic organ involvement and primary gynecologic tumor. Materials and Methods: The clinicopathological data of 70 patients who were diagnosed with bladder transitional cell carcinoma and underwent anterior pelvic exenteration in Rajavithi Hospital between January 2008 and October 2020 were analyzed to examine and determine any correlations. Results: Thirteen (18.5%) patients had gynecologic organ involvement. This consisted of 4 cases (5.7%) involving the uterus, 7 (10%) involving the vagina, 2 (2.8%) involving the ovaries, and 10 (14.2%) involving the cervix. Female patients with gynecologic organ invasion were more likely to have a high pathological T stage (p < 0.001), and have pre-operative hydronephrosis (p = 0.002). From multivariate logistic regression, pre-operative hydronephrosis was associated with increased risk of gynecologic organ invasion (odds ratio 9.57; 95% confidence interval, 1.86 - 49.18; p = 0.007). There were 23 (32%) female patients incidentally diagnosed with benign gynecologic tumors, specifically 16 (22%) cases of myoma uteri, 7 (10%) of adenomyosis and 4 (2.8%) with ovarian cysts. No patient was diagnosed as having primary gynecologic malignancy. Conclusions: The incidence of gynecologic organ involvement in female patients who had undergone anterior pelvic exenteration for urothelial carcinoma of the bladder was 18.5%. Pre-operative hydronephrosis was a risk factor associated with increased risk of gynecologic organ involvement. Information from this study may allow better identification of candidates for gynecologic organ sparing surgery.

Machine Learning-Based Gynecologic Tumor Diagnosis and Its Postoperative Incisional Infection Influence Factor Analysis

Various factors influencing postoperative incisional infection in gynecologic tumors were analyzed, and the value of quality nursing intervention was studied. In this study, 74 surgically treated gynecologic tumor patients were randomly selected from within the hospital as the study population and were divided into study and control groups. For this purpose, the whole-group random sampling method is utilized to compare the postoperative incisional infection rates of the two groups, analyze their influencing factors, and develop quality nursing interventions. In this paper, a breast cancer diagnosis prediction model was developed by combining the self-attentive mechanism. The preprocessing work such as data quantification and normalization was performed first which is followed by adding the preprocessed data to the self-attentive mechanism. This model has solved the problem that recurrent neural networks (RNNs) could not extract and calculate the features at the same time. Likewise, it has solved the drawback that the RNN could not consider global features at the same time when extracting the features, and then, the feature matrix extracted by the self-attentive mechanism was added to the adaptive neural network. The adaptive neural network model for breast cancer diagnosis prediction was constructed and, finally, relevant parameters of the adaptive neural network model were adjusted according to different tasks to make the model performance optimal. Experimental results showed that the postoperative incision infection rate of patients in the study group was 2.70%, which was significantly lower than that of 21.62% in the control group ( P < 0.05 ). Likewise, operation time, operation method, hospitalization time, preoperative fever, diabetes mellitus, and anemia were the main influencing factors of postoperative incision infection in women with gynecologic tumors. The time of surgery, surgical method, long hospital stay, preoperative fever, diabetes, and anemia are the main factors that lead to postoperative incisional infection in female gynecologic tumor patients.

Fusion genes in gynecologic tumors: the occurrence, molecular mechanism and prospect for therapy

Gene fusions are thought to be driver mutations in multiple cancers and are an important factor for poor patient prognosis. Most of them appear in specific cancers, thus satisfactory strategies can be developed for the precise treatment of these types of cancer. Currently, there are few targeted drugs to treat gynecologic tumors, and patients with gynecologic cancer often have a poor prognosis because of tumor progression or recurrence. With the application of massively parallel sequencing, a large number of fusion genes have been discovered in gynecologic tumors, and some fusions have been confirmed to be involved in the biological process of tumor progression. To this end, the present article reviews the current research status of all confirmed fusion genes in gynecologic tumors, including their rearrangement mechanism and frequency in ovarian cancer, endometrial cancer, endometrial stromal sarcoma, and other types of uterine tumors. We also describe the mechanisms by which fusion genes are generated and their oncogenic mechanism. Finally, we discuss the prospect of fusion genes as therapeutic targets in gynecologic tumors.

Photothermal Therapy via NIR II Light Irradiation Enhances DNA Damage and Endoplasmic Reticulum Stress for Efficient Chemotherapy

Ovarian cancer has the highest death rate in gynecologic tumors and the main therapy for patients with advanced is chemotherapy based on cisplatin. Additionally, hyperthermic intraperitoneal has been used in clinic to obtain better efficacy for patients. Hence, combined photothermal therapy with platinum drugs in a new delivery system might bring new hope for ovarian cancer. A reduction sensitive polymer encapsulating a Pt (IV) prodrug and a near infrared II (NIR II) photothermal agent IR1048 to form nanoparticles were reported to enhance the efficacy of ovarian cancer treatment. At the same time, endoplasmic reticulum stress indicates an imbalance in proteostasis which probably caused by extrinsic stress such as chemotherapy and the temperature changed. The efficacy of nanoparticles containing Pt (IV) and IR1048 under NIR II light might be caused via increased DNA damage and endoplasmic reticulum (ER) stress.

Aidi injection, a traditional Chinese biomedical preparation, for gynecologic tumors: A systematic review and PRISMA-compliant meta-analysis

Aidi injection (ADI), a traditional Chinese biomedical preparation, is a promising adjuvant therapy for gynecologic tumors (GTs), including cervical cancer (CC), endometrial cancer (EC), and ovarian cancer (OC). Although studies have reported positively on ADI therapy, its exact effects and safety in GT patients remain controversial. Therefore, a wide-ranging systematic search of electronic databases was performed for this meta-analysis. Data from 38 trials including 3,309 GT patients were analyzed. The results indicated that the combination of conventional treatment and ADI markedly improved the patients’ overall response rate (P &lt; 0.00001), disease control rate (P &lt; 0.00001), and quality of life (P &lt; 0.05) compared with conventional treatment alone. Furthermore, patient immunity was enhanced with combined treatment, as indicated by significantly increased percentages of CD3+ (P = 0.005) and CD4+ (P &lt; 0.00001) and increased CD4+/CD8+ ratio (P = 0.001). Most of the adverse events caused by radiochemotherapy such as gastrointestinal issues, leukopenia, thrombocytopenia, and hepatotoxicity, (P &lt; 0.05 for all) were significantly alleviated when ADI was used in the GT patients. However, other adverse events such as nephrotoxicity, diarrhea, alopecia, and neurotoxicity did not significantly differ between the two groups. Overall, these results suggest that the combination of conventional and ADI treatment is more effective than conventional treatment alone.

GYNOCARE Update: Modern Strategies to Improve Diagnosis and Treatment of Rare Gynecologic Tumors—Current Challenges and Future Directions

More than 50% of all gynecologic tumors can be classified as rare (defined as an incidence of ≤6 per 100,000 women) and usually have a poor prognosis owing to delayed diagnosis and treatment. In contrast to almost all other common solid tumors, the treatment of rare gynecologic tumors (RGT) is often based on expert opinion, retrospective studies, or extrapolation from other tumor sites with similar histology, leading to difficulty in developing guidelines for clinical practice. Currently, gynecologic cancer research, due to distinct scientific and technological challenges, is lagging behind. Moreover, the overall efforts for addressing these challenges are fragmented across different European countries and indeed, worldwide. The GYNOCARE, COST Action CA18117 (European Network for Gynecological Rare Cancer Research) programme aims to address these challenges through the creation of a unique network between key stakeholders covering distinct domains from concept to cure: basic research on RGT, biobanking, bridging with industry, and setting up the legal and regulatory requirements for international innovative clinical trials. On this basis, members of this COST Action, (Working Group 1, “Basic and Translational Research on Rare Gynecological Cancer”) have decided to focus their future efforts on the development of new approaches to improve the diagnosis and treatment of RGT. Here, we provide a brief overview of the current state-of-the-art and describe the goals of this COST Action and its future challenges with the aim to stimulate discussion and promote synergy across scientists engaged in the fight against this rare cancer worldwide.