Association of the human papillomavirus infection with the recurrence of sinonasal inverted papilloma: a systematic review and meta-analysis

Background: Although the role of human papillomavirus (HPV) in sinonasal inverted papilloma (SNIP) has been investigated, the link between HPV infection and SNIP recurrence remains controversial. This meta-analysis aimed to investigate the association between HPV infection and recurrence of SNIP. Methods: The PubMed, Web of Science, Google Scholar, and Cochrane Library databases were searched (until 16 June 2021) to collect all relevant articles. The pooled odds ratio (OR) with 95% confidence interval (CI) was calculated using the fixed effects model. In addition, subgroup analysis, assessment of publication bias, and sensitivity analyses were performed. Results: Fourteen eligible articles, including 592 patients with SNIP, were included in this study. Pooled analysis revealed that HPV-positive cases exhibited a significantly higher OR of tumour recurrence than HPV-negative counterparts). A significant association between HPV infection and tumour recurrence remained stable in subgroup analyses according to the publication year of the studies. Conclusions: Our meta-analysis demonstrates that HPV infection is significantly associated with the recurrence of SNIP, suggesting the pathological role of HPV in SNIP. These results suggest that HPV infection should be considered in the management of SNIP.

Repeat Breast-Conserving Surgery Versus Salvage Mastectomy for Ipsilateral Breast Tumour Recurrence After Breast-Conserving Surgery in Breast Cancer Patients: A Meta-Analysis

BackgroundSalvage mastectomy (SM) is the standard surgery for ipsilateral breast tumour recurrence (IBTR). However, whether repeat breast-conserving surgery (RBCS) is an alternative method remains unclear. We performed a meta-analysis to compare the effects of RBCS and SM after IBTR for breast-conserving surgery (BCS).MethodsWe searched PubMed, Cochrane, Wiley Online and Embase for controlled studies comparing RBCS and SM after IBTR for BCS (published between 1993 and 2019, published in English). Our main endpoints were the secondary local recurrence rate (SLRR), distant metastasis rate (DMR) and overall survival (OS). We used a random-effects model or fixed-effects model for data pooling.ResultsFifteen of the 424 eligible studies were ultimately included, and all studies were retrospective cohort studies (n=2532 participants). 1) SLRR: The SLRR of RBCS was higher than SM (pooled relative rate (pRR) = 1.87, 95% CI 1.22 - 2.86, P=0.004). Stratified analysis was performed according to whether radiotherapy was performed after salvage surgery (radiotherapy group: 2ndRT, no radiotherapy group: no-2ndRT), and the following results were revealed: pRR=0.43 (95% CI 0.20-0.95, P=0.04) for group 2ndRT; and pRR=2.30 (95% CI 1.72-3.06, P<0.00001) for group no-2ndRT. These results showed that the main cause of heterogeneity was salvage radiotherapy. 2) DMR: No significant difference in the DMR was observed between RBCS and SM (pRR = 0.61, 95% CI 0.37 - 1.01, P=0.05). 3) OS: No significant difference in OS was observed between RBCS and SM (pRR=0.65, 95% CI 0.39 - 1.08, P=0.10).ConclusionsThe SLRR of RBCS was higher than SM for ITBR after BCS, but survival was not affected. RBCS may be used as an alternative for IBTR patients after BCS with strict control for several indications, such as tumor size, recurrence interval and biological behavior, and attaching importance to subsequent salvage radiotherapy and systematic therapy.

Inhibition of Post-Surgery Tumour Recurrence via a Sprayable Chemoimmunotherapy Gel Releasing PD-L1 Antibody and Platelet-Derived Exosomes

Background: Melanoma is the most serious type of skin cancer, and surgery is an effective method to treat melanoma. Unfortunately, local residual micro-infiltrated tumour cells and systemic circulating tumour cells (CTCs) are significant causes of treatment failure, leading to tumour recurrence and metastasis. Methods: Exosomes were isolated from platelets by differential centrifugation, and exosome-loaded doxorubicin (PexD) was prepared by mixing exosomes with doxorubicin (DOX). PexD and an anti-PD-L1 monoclonal antibody (aPD-L1) were coencapsulated in fibrin gel. The synergistic antitumour efficacy of the gel containing PexD and aPD-L1 was assessed both in vitro and in vivo. Results: Herein, we developed an in situ-formed bioresponsive gel combined with chemoimmunotherapeutic agents as a drug reservoir that could effectively inhibit both local tumour recurrence and tumour metastasis. In comparison with a DOX solution, PexD could better bind to tumour cells, induce more tumour immunogenic cell death (ICD) and promote a stronger antitumour immune response. PexD could enter the blood circulation through damaged blood vessels to track and eliminate CTCs. The concurrent release of aPD-L1 at the tumour site could impair the PD-1/PD-L1 pathway and restore the tumour-killing effect of cytotoxic T cells. This chemoimmunotherapeutic strategy triggered relatively strong T cell immune responses, significantly improving the tumour immune microenvironment. Conclusion: Our findings indicated that the immunotherapeutic fibrin gel could “awaken” the host innate immune system to inhibit both local tumour recurrence postsurgery and metastatic potential, thus, it could serve as a promising approach to prevent tumour recurrence.

P.165 Surgery for recurrent GBM: deciding when to operate

Background: Previous studies have found conflicting results regarding the role of repeat surgery on overall survival (OS) in patients with GBM. We used a novel approach that includes time to tumour recurrence as an additional prognostic factor in order to determine which patients benefit most from repeat surgery. Methods: A retrospective chart review from 1992-2018 was performed on all adult (≥ 18 years old) patients with primary GBM that received surgery for recurrent disease and compared to publicly available data from The Cancer Genome Atlas (TCGA) of adult patients with primary GBM that did not undergo surgery for recurrent disease. Results: A total of 672 adult patients with GBM were included in the study, including 87 that received surgery at tumour recurrence (surgery cohort). The surgery cohort had longer OS and similar complication rates to those that did not receive surgery at recurrence, independent of time to tumour recurrence (p < 0.0001 and p = 0.4, respectively). Within the surgery cohort, patients with tumour recurrence >6 months demonstrated additional survival benefit (p < 0.0001). Conclusions: Surgery for recurrent GBM leads to improved survival without increased complications. Patients with tumour recurrence >6 months benefit most from repeat surgery.

Mesenteric Variceal Haemorrhage and Ectopic Cushing’s Syndrome as Presenting Features of a Pancreatic Neuroendocrine Tumour Recurrence

Pancreatic neuroendocrine tumours can have varied and complex presentations. Whilst hormone hypersecretion often induces characteristic clinical syndromes, non-specific symptoms may arise due to localized tumour effects. Malignant invasion of local vasculature is an increasingly recognized complication of these neoplasms and can be associated with significant morbidity. Herein, we present the case of a 47-year-old male with a recurrence of a pancreatic neuroendocrine tumour who presented with unusual upper gastrointestinal bleeding. The tumour had recurred within the superior mesenteric vein, replacing the vessel and invading its branches. This resulted in porto-mesenteric hypertension and the formation of bleeding mesenteric varices. The patient subsequently developed progressive metabolic disturbances and was diagnosed with ectopic Cushing’s syndrome, despite his primary tumour having been non-functional. This case demonstrates not only a rare pattern of tumour recurrence but also the potential for pancreatic neuroendocrine tumours to de-differentiate and change from non-functional to hormone secreting, a phenomenon which may complicate diagnosis and management.

EP.TH.43Biliary cooling during radiofrequency ablation of liver tumours close to central biliary tree: A systematic review and pooled analysis

Aims Biliary cooling during radiofrequency ablation (RFA) of liver tumours has been proposed as a protective measure for RFA-related biliary complications in cases whereby the RFA-site is close to central biliary tree. This systematic review aims to assess the effect of biliary cooling on i) the development of biliary complications and ii) tumour recurrence rates at ablation site. Methods A systematic literature search was performed using the PubMed/EMBASE databases using PRISMA methodology (2000-2019). The initial search yielded 75 reports which were potentially suitable for inclusion. Studies reporting at least one outcome of interest were considered to be suitable for inclusion. Conference abstracts, case reports and animal studies were excluded. Data was retrieved on patient demographics, tumour characteristics, method of cooling, biliary complications, local tumour recurrence and duration of follow-up. Results The final number of studies which met the inclusion criteria was 7, involving 100 patients. There were no randomized controlled trials identified after the literature search. The mean age of the patients included was 65 years. Biliary cooling was performed with the use of a nasobiliary tube in 4 out of 7 studies, via a choledochal incision in 2 out of 7 studies and through the cystic duct in a single study. The overall biliary stricture rate was 2% and the overall tumour recurrence rate at RFA treated site was 14.5%. Conclusion Biliary complications appear to be low after biliary cooling during RFA close to central biliary tree. More evidence is required to assess the tumour recurrence rates.

Static permeability assessment method to distinguish brain tumour recurrence from pseudoprogression

Aims It is common to have adjuvant chemo-radiotherapy after primary brain tumour resection. It is a known side effect that enhancing lesion could be seen in radiation territory after treatment, termed as pseudoprogression. It has been a difficult task to distinguish brain between tumour recurrence from pseudoprogression after radiotherapy. Timing of occurrence of these can overlap. It is important to distinguish the two as management is completely different. Early intervention in recurrence could improve survival time while pseudoprogression could be self-limiting. Surgical resection of pseudoprogression could be counter-productive. The radiological approach has been relying on multimodality investigation and close follow up. It has come to our institution notice that there is a new technique which could distinguish the two conditions efficiently. That's static permeability assessment method, also known as treatment response assessment maps (TRAMs). Our experience with it so far has been beneficial. Method This is a retrospective case series review of primary brain tumour treatment in our neurosurgical institution in 2020. Two high resolution 3D T1-weighted brain MRI images were acquired after a standard dose of gadolinium based contrast agent was injected. The first acquisition began five minutes after injection, and the second began 60 – 105 minutes post contrast injection. The TRAMs technique is based on image subtraction that is post processed after acquisition. The resultant subtracted image set was mapped to grey scale values, where voxels showing contrast clearance were light grey/white, and those showing contrast accumulation were dark grey/black. The zero value (i.e. no clearance or accumulation) was therefore mid-grey. Those with contrast clearance is associated with tumour recurrence. TRAMs images were compared to serial follow up imaging and histopathology results to determine the diagnostic accuracy of the technique. Results We have identified 21 patients in this period who had concern of either of pseudoprogression or tumour recurrence/progression. There were 6 females and 15 males, mean age 51. There were 14 glioblastoma multiforme (GBM), 5 astrocytoma, 1 oligodendroglioma and 1 post radiotherapy arteriovenous malformation. 17 cases were found to have clear cut recurrence, pseudoprogression or mixture of both in TRAMS. These findings are backed up by histology or repeated follow up scan. 4 cases were considered as equivocal. In retrospect, these cases have challenging interpretation due to poor case selection. TRAMs could distinguish high grade transformation as well as detecting recurrence. In some difficult cases, it is found that both pseudoprogression and recurrence could happen together. Conclusion TRAMs is a useful adjunct to the multimodalities of diagnostic techniques in tricky situation. This has provided an efficient and easy to use tool for radiologists to come up with the answer. We are the first independent centre to report on this technique. This is still early days and fine-tuning of its use is still undergoing. It is clear this has saved precious resources and has given patients more suitable care. We think it would be beneficial for us to share our experience with others and hope to get future collaboration with other centres.

Survival Time among Young and Old Breast Cancer Patients in Relation to Circulating Blood-Based Biomarkers, Acute Radiation Skin Reactions, and Tumour Recurrence

<b><i>Introduction:</i></b> It has been suggested that age could influence the treatment-induced side effects and survival time of cancer patients. The influence of age on blood-based biomarkers, acute radiation skin reactions (ARSRs), and survival time of breast cancer patients was analysed. <b><i>Materials and Methods:</i></b> Two hundred ninety-three individuals, 119 breast cancer patients, and 174 healthy blood donors were included. <b><i>Results:</i></b> Before radiotherapy (RT), decreased levels of lymphocytes, interleukin 2, platelet-derived growth factors, and tumour necrosis factor but increased levels of monocyte-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, C-reactive protein, and macrophage inflammatory protein 1b (MIP1b) were detected in the patient group. All of the patients developed ARSRs and intensity of ARSRs was inversely related to the MIP1b level before RT. Fifteen out of 119 (13%) patients deceased during follow-up time. No influence of age (≤50 compared to &#x3e;50 years) on survival time was detected (<i>p</i> = 0.442). Tumour recurrence, found in 11 out of 119 (9%) patients, had impact on survival time of these patients (<i>p</i> &#x3c; 0.001). <b><i>Conclusions:</i></b> The level of circulating MIP1b before RT was associated with intensity of ARSRs. Tumour recurrence, but not age, was associated with poor survival time. Analysis of circulating MIP1b was low cost, rapid, and could be done in routine laboratory facility. Since RT almost always induces ARSRs, the possibility of using MIP1b as a prognostic biomarker for ARSRs is of interests for further investigation.