Locoregional Therapies for Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis

Hepatocellular carcinoma is the fourth leading cause of cancer worldwide, and the fastest increasing cause of cancer mortality in the United States. Its propensity for vascular invasion leads to the presence of portal vein tumor thrombus in up to half of patients. PVTT results in a classification of advanced disease, given the risk recurrence secondary to intravascular spread, and formal guidelines recommend systemic therapy in these patients. However, recent advances in locoregional therapies including TACE, TARE, and ablation have demonstrated the potential to drastically improve overall survival in patients with HCC complicated by PVTT.

AIRPORT ALoSP AND INTEGRATED RISK APPROACH FOR SSPs

This work proposed the development of a methodology for risk management in airports for ICAO’s State Safety Programmes (SSP). To do so we investigated the nature of the airport safety events occurred in busiest Brazilian airports and proposed a risk index capable to provide the Acceptable Level of Safety Performance (ALoSP) ICAO demands to their signatory States. The approach allowed us to rank airports per their risk in relation to the ALoSP calculated and proposed State optimized regulatory actions to where the risk is. Research found the high concentration on risk recurrence among 31 airports. Only 4 concentrated 30% of all the recurrence of risk, 8 were responsible for 50% and 17 represented approximately 80% of the total risk load in Brazilian airport operations. Five groups of airports are proposed as per their safety performance (Safety+2, Safety+1, Neutral, Safety-1 and Safety-2). Their measured performance showed statistically significant differences. Safety+1 group presented a safety performance 1.49 times better than ALoSP and 3.52 times better than worst group of airports (Safety-2). The Safety+2 group is 3.76 times safer than ALoSP and 8.88 times safer than Safety-2 group. Safety-1 group presented a risk level 1.51 times higher than ALoSP and Safety-2 performed 2.35 times riskier than the ALoSP. This matrix way of problem solving brings more effectiveness and rationality to the SSP’s, amplifying their effectiveness.

A Nomogram for the Determination of the Necessity of Concurrent Chemotherapy in Patients With Stage II–IVa Nasopharyngeal Carcinoma

BackgroundThe efficiency of concurrent chemotherapy (CC) remains controversial for stage II–IVa nasopharyngeal carcinoma (NPC) patients treated with induction chemotherapy (IC) followed by intensity-modulated radiotherapy (IMRT). Therefore, we aimed to propose a nomogram to identify patients who would benefit from CC.MethodsA total of 434 NPC patients (stage II–IVa) treated with IC followed by IMRT between January 2010 and December 2015 were included. There were 808 dosimetric parameters extracted by the in-house script for each patient. A dosimetric signature was developed with the least absolute shrinkage and selection operator algorithm. A nomogram was built by incorporating clinical factors and dosimetric signature using Cox regression to predict recurrence-free survival (RFS). The C-index was used to evaluate the performance of the nomogram. The patients were stratified into low- and high-risk recurrence according to the optimal cutoff of risk score.ResultsThe nomogram incorporating age, TNM stage, and dosimetric signature yielded a C-index of 0.719 (95% confidence interval, 0.658–0.78). In the low-risk group, CC was associated with a 9.4% increase of 5-year locoregional RFS and an 8.8% increase of 5-year overall survival (OS), whereas it was not significantly associated with an improvement of locoregional RFS (LRFS) and OS in the high-risk group. However, in the high-risk group, patients could benefit from adjuvant chemotherapy (AC) by improving 33.6% of the 5-year LRFS.ConclusionsThe nomogram performed an individualized risk quantification of RFS in patients with stage II–IVa NPC treated with IC followed by IMRT. Patients with low risk could benefit from CC, whereas patients with high risk may require additional AC.

Gene expression assays gather evidence that they can provide useful therapeutic information in young women

Gene expression assays have been shown to be therapeutically beneficial in young women with lobular disease and long-term consequences.Prospective randomized studies consistently suggest that chemotherapy may be avoided in women over 50 years old with an intermediate risk recurrence score (pN0) or a low genetic risk (MammaPrint) (pN0–1); nevertheless, a slight benefit from adjuvant chemotherapy can not be ruled out in women 50 years or less. In order to quantify the incremental advantage of a specific therapy technique, the ESMO Magnitude of Clinical Benefit Scale was recently used for EBC therapies. For optimum individual benefit in early luminal EBC, risk-adapted treatment concepts are still crucial. More de-escalation trials are required in order to optimize adjuvant therapy in EBC. An endocrine-based approach with abemaciclib, in addition to adjuvant chemotherapy, has recently emerged as an alternate option for treatment intensification in high-risk luminal EBC.

Machine learning radiomics for predicting recurrence risk in patients with early-stage invasive breast cancer

There are no satisfying approaches to identify high- and low-risk recurrence patients with early-stage breast cancer in current clinical practice. Patients might be overtreated or undertreated due to the inaccurate prediction of recurrence risk. Herein, machine learning magnetic resonance imaging radiomic-based signature that integrates the intratumoral and peritumoral radiomic signatures, and clinicopathological characteristics was developed to classify high- and low-risk recurrence patients and predict recurrence within multicentre cohorts. The radiomic-clinical signature could also discriminate high- from low-risk recurrence patients among different breast cancer molecular subtype, and HR+/Her2-, T1N0M0 stage patients. Furthermore, it was observed that the neoadjuvant chemotherapy improved survival in high-risk Luminal subtype patients compared with the adjuvant chemotherapy. The survival-associated radiomic features also showed the correlation with the immune microenvironment. The radiomic-clinical signature presented the feasibility of predicting recurrence risk and assisting clinical decision-making in early-stage invasive breast cancer patients.

Diagnosis of epilepsy after first seizure. Introducing the SWISS FIRST study

Diagnosis of epilepsy after a first unprovoked seizure is possible according to the guidelines by the International League Against Epilepsy, if the risk recurrence of a second unprovoked seizure is exceeding 60%. However, this cutoff constitutes only a proxy depending on the patients’ history, magnetic resonance imaging (MRI), and electroencephalography (EEG) findings but nevertheless also from the treating neurologists’ individual experience. In a Switzerland-wide observational study, we aim to recruit patients that were admitted to the emergency department with the referral diagnosis of a first and unprovoked seizure. We make use of optimized MRI protocols to identify potential structural epileptogenic lesions, introduce new imaging-based markers of epileptogenecity, and use most recent postprocessing methods as automatic morphometry, spike map analysis, and functional connectivity. With these diagnostic tools, we aim to segregate patients that present with epileptic seizures versus mimicks and non-epileptic seizures and stratify for every finding in MRI and EEG its predictive value for a second unprovoked seizure. These findings shall support neurologists to calculate and not only estimate the seizure recurrence rate in future.

Chronic lymphocytic thyroiditis (CLT) has a negative prognostic value in papillary thyroid cancer of the young and middle ages: a retrospective analysis of 635 patients

Background: The study was aimed at investigating the potential role of chronic lymphocytic thyroiditis (CLT) in papillary thyroid cancer (PTC) prognosis in distinct age groups, as well as the association between CLT and recurrence risk estimation.Methods: A total of 635 adult patients were retrospectively analyzed. On the basis of postoperative pathology examination, 188 patients were diagnosed with coexistent CLT and the remaining 447 were classified as non-CLT. Then the characteristics of CLT-coexisted patients and non-CLT ones were compared respectively when patients were aged ≥55 years or below. The association among postoperative clinicopathological features were also analyzed using multivariate regression. In addition, the prognostic value of several variables relating to high-risk recurrence were estimated within different age groups.Results: When divided in two age groups (55 years as the line), non-CLT group had a remarkable frequency of small size lesion (D max ≤1cm) compared with CLT-coexisted patients (54.6% to 43.0%, p =0.016). In addition, non-CLT patients tended to have intrathyroidal extension as opposed to those with coexistent CLT (20.2% to 28.2%, p =0.05). In multivariate analysis, CLT still significantly acted as an independent risk factor of greater lesion size (D min >1 cm) (OR=1.7, p =0.02) and mildly promoted gross extrathyroidal extension (ETE) (OR=1.4, p =0.06). However, associations didn't emerge in the characteristics mentioned above with CLT when patients were ≥55 years old. The prognostic value of CLT in high-risk recurrence was evident only in patients aged 35-44 years. (OR=2.4, 95%CI:1.2-5.4, p =0.02). Greater lesion size independently promoted gross ETE, no matter patients were aged above 55 years or not. Besides, its prognostic value of high-risk recurrence was significant throughout all age groups. Conclusion: These findings revealed that CLT coexistence might be the unfavorable factor of PTC prognosis in young and middle-aged (<55 years) patients, and its role in recurrence risk stratification was presented only in the specific age (35-44 years).