scholarly journals Cholangiocarcinoma: Biology, Clinical Management, and Pharmacological Perspectives

2014 ◽  
Vol 2014 ◽  
pp. 1-13 ◽  
Author(s):  
Rocio I. R. Macias
Keyword(s):  
Clinical Management ◽  
Imaging Techniques ◽  
Therapeutic Option ◽  
Tumor Biology ◽  
Survival Rates ◽  
Staging System ◽  
Biliary Tree ◽  
System Management ◽  
Recent Past ◽  
Standard Chemotherapy

Cholangiocarcinoma (CCA), or tumor of the biliary tree, is a rare and heterogeneous group of malignancies associated with a very poor prognosis. Depending on their localization along the biliary tree, CCAs are classified as intrahepatic, perihilar, and distal, and these subtypes are now considered different entities that differ in tumor biology, the staging system, management, and prognosis. When diagnosed, an evaluation by a multidisciplinary team is essential; the team must decide on the best therapeutic option. Surgical resection of tumors with negative margins is the best option for all subtypes of CCA, although this is only achieved in less than 50% of cases. Five-year survival rates have increased in the recent past owing to improvements in imaging techniques, which permits resectability to be predicted more accurately, and in surgery. Chemotherapy and radiotherapy are relatively ineffective in treating nonoperable tumors and the resistance of CCA to these therapies is a major problem. Although the combination of gemcitabine plus platinum derivatives is the pharmacological treatment most widely used, to date there is no standard chemotherapy, and new combinations with targeted drugs are currently being tested in ongoing clinical trials. This review summarizes the biology, clinical management, and pharmacological perspectives of these complex tumors.

Molecular Mechanisms Underlying the Functions of Cellular Markers Associated with the Phenotype of Cancer Stem Cells

2019 ◽  
Vol 14 (5) ◽  
pp. 405-420 ◽  
Author(s):  
Eduardo Alvarado-Ortiz ◽  
Miguel Á. Sarabia-Sánchez ◽  
Alejandro García-Carrancá
Keyword(s):  
Stem Cells ◽  
Cancer Stem Cells ◽  
Molecular Mechanisms ◽  
Tumor Biology ◽  
Molecular Tools ◽  
Recent Past ◽  
Functional Roles ◽  
Cellular Population ◽  
Cellular Markers ◽  
A Minor

Cancer Stem Cells (CSC) generally constitute a minor cellular population within tumors that exhibits some capacities of normal Stem Cells (SC). The existence of CSC, able to self-renew and differentiate, influences central aspects of tumor biology, in part because they can continue tumor growth, give rise to metastasis, and acquire drug and radioresistance, which open new avenues for therapeutics. It is well known that SC constantly interacts with their niche, which includes mesenchymal cells, extracellular ligands, and the Extra Cellular Matrix (ECM). These interactions regularly lead to homeostasis and maintenance of SC characteristics. However, the exact participation of each of these components for CSC maintenance is not clear, as they appear to be context- or cell-specific. In the recent past, surface cellular markers have been fundamental molecular tools for identifying CSC and distinguishing them from other tumor cells. Importantly, some of these cellular markers have been shown to possess functional roles that affect central aspects of CSC. Likewise, some of these markers can participate in regulating the interaction of CSC with their niche, particularly the ECM. We focused this review on the molecular mechanisms of surface cellular markers commonly employed to identify CSC, highlighting the signaling pathways and mechanisms involved in CSC-ECM interactions, through each of the cellular markers commonly used in the study of CSC, such as CD44, CD133, CD49f, CD24, CXCR4, and LGR5. Their presence does not necessarily implicate them in CSC biology.

scholarly journals Surgical Advances in Osteosarcoma

Cancers ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 388
Author(s):  
Marcus J. Brookes ◽  
Corey D. Chan ◽  
Bence Baljer ◽  
Sachin Wimalagunaratna ◽  
Timothy P. Crowley ◽  
...  
Keyword(s):  
Fluorescent Dyes ◽  
Imaging Techniques ◽  
Intraoperative Imaging ◽  
Survival Rates ◽  
Computer Navigation ◽  
Bone Cancer ◽  
Technical Difficulty ◽  
Implant Design ◽  
Patient Specific ◽  
Patient Specific Instruments

Osteosarcoma (OS) is the most common primary bone cancer in children and, unfortunately, is associated with poor survival rates. OS most commonly arises around the knee joint, and was traditionally treated with amputation until surgeons began to favour limb-preserving surgery in the 1990s. Whilst improving functional outcomes, this was not without problems, such as implant failure and limb length discrepancies. OS can also arise in areas such as the pelvis, spine, head, and neck, which creates additional technical difficulty given the anatomical complexity of the areas. We reviewed the literature and summarised the recent advances in OS surgery. Improvements have been made in many areas; developments in pre-operative imaging technology have allowed improved planning, whilst the ongoing development of intraoperative imaging techniques, such as fluorescent dyes, offer the possibility of improved surgical margins. Technological developments, such as computer navigation, patient specific instruments, and improved implant design similarly provide the opportunity to improve patient outcomes. Going forward, there are a number of promising avenues currently being pursued, such as targeted fluorescent dyes, robotics, and augmented reality, which bring the prospect of improving these outcomes further.

scholarly journals Inter-relationships between Gender, Frailty and 10-Year Survival in Older Italian Adults: an observational longitudinal study

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Graziamaria Corbi ◽  
Francesco Cacciatore ◽  
Klara Komici ◽  
Giuseppe Rengo ◽  
Dino Franco Vitale ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Cox Model ◽  
Survival Rates ◽  
Staging System ◽  
Female Gender ◽  
Term Survival ◽  
Fractional Polynomial ◽  
The Impact

AbstractAim of the present study was to assess the impact of gender on the relationship between long-term mortality and clinical frailty. In an observational, longitudinal study on 10-year mortality, we examined 1284 subjects. The Frailty Staging System was used to assess frailty. The Cox model was employed to assess variables independently associated with survival using a backward stepwise algorithm. To investigate the possible interactions between gender and the selected variables, an extension of the multivariable fractional polynomial algorithm was adopted. Women were more likely to be older, have a higher disability, present with more comorbidities, consume more drugs, be frail and have a higher rate of survival at the follow-up than were men. At the Cox multivariate analysis only age (HR 2.26), female gender (HR 0.43), and number of drugs (HR 1.57) were significant and independent factors associated with all-cause mortality. In the survival analyses, only frailty (vs no frailty) showed significant interaction with gender (p < 0.001, HR = 1.92). While the presence of frailty reduced the survival rate in women, no effect was observed in men. Importantly, frail women showed higher survival rates than did both frail and no frail men. The main finding of the present study is that gender shapes up the association between frailty and long-term survival rates.

scholarly journals Concomitant Chemoradiation in Locally Advanced Laryngeal Cancer

2010 ◽  
Vol 1 (3) ◽  
pp. 153-160
Author(s):  
Arif Jamshed ◽  
Raza Hussain ◽  
Sarah Jamshed ◽  
Aamir Ali Syed ◽  
Asif Loya ◽  
...  
Keyword(s):  
Laryngeal Cancer ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Survival Rates ◽  
Staging System ◽  
Nodal Disease ◽  
Free Survival ◽  
Concomitant Chemoradiation ◽  
Ajcc Staging System ◽  
Ajcc Staging

Abstract Introduction Despite the acceptance of concomitant chemoradiation (CRT) as an alternative to total laryngectomy (TL) in locally advanced laryngeal cancer (LALC), laryngeal preservation is sparingly recommended in developing countries. We report on prognostic factors and survival in T3/T4 laryngeal cancer treated with concomitant CRT at Shaukat Khanum Memorial Cancer Hospital and Research Center (SKMCH and RC) to provide comparison with other geographic locations. Material and Methods During the period November 2003-April 2009, 101 patients with biopsy proven untreated LALC underwent concurrent CRT treatment at SKMCH and RC. According to AJCC staging system (6th edition) 41 had T3 and 60 patients had T4 disease. Radiation dose to the larynx was 70 Gy in 35 fractions with concomitant cisplatin. Induction chemotherapy was given to 42 patients. Thirty-one patients required tracheotomy either before or during concomitant CRT. Results Actuarial overall survival and laryngectomy free survival (LFS) for the whole group at 5 years were 54% (95% CI; 48-60) and 47% (95% CI; 42-52) respectively. Median LFS was 4.17 years. On univariate analysis patients with T4 tumors (p = 0.04), positive neck nodal disease (p = 0.02), supraglottic site (p = 0.02) and tracheotomy (0.009) had a significantly inferior LFS. Multivariate analysis showed tracheotomy to be the only factor significantly (p = 0.03) related to a higher risk of failure for LFS. Conclusion Survival rates for LALC treated with concomitant CRT in our institution are acceptable. Our study supports the use of TL in patients with compromised airways that require tracheotomy as outcome with concomitant CRT is poor.

scholarly journals Risk classification as the basis for clinical staging of diffuse large- cell lymphoma derived from 10-year survival data

Blood ◽  
1989 ◽  
Vol 74 (2) ◽  
pp. 551-557 ◽  
Author(s):  
WS Velasquez ◽  
S Jagannath ◽  
SL Tucker ◽  
LM Fuller ◽  
LB North ◽  
...  
Keyword(s):  
Survival Data ◽  
Risk Model ◽  
Survival Rates ◽  
Staging System ◽  
Large Cell ◽  
Risk Groups ◽  
Lactic Dehydrogenase ◽  
Tumor Burden ◽  
Clinical Staging ◽  
Ann Arbor

Two hundred and fifty previously untreated adult patients with diffuse large-cell lymphomas were treated with a chemotherapy combination of cyclophosphamide, adriamycin, vincristine, prednisone, and low-dose bleomycin (CHOP-Bleo) with or without radiotherapy between 1974 and 1984. The 10-year survival rates for patients with Ann Arbor stages II, III, or IV disease of 55%, 42%, and 40%, respectively, were not significantly different. However, the survival rate of 76% for patients with stage I disease was clearly better. Factors more indicative of prognosis than stage, as found by univariant analysis, were tumor burden, serum lactic dehydrogenase level (LDH), age, and constitutional symptoms. From these, a multivariant analysis selected tumor burden, LDH level, and age as major independent factors for predicting survival (P less than .001). A prognostic risk model constructed on the basis of tumor burden and LDH levels identified four distinct risk groups (A, B, C, D) with 10-year survival rates of 85%, 66%, and 43% for A, B, and C. No patient in group D survived 10 years. These risk groups also had a strong correlation with complete remission rates and with relapse rates. Thus this model proved more effective for identifying patient populations according to their expected responses, durations of remission, and survivals than the Ann Arbor staging system. Detailed information supporting the use of this system for predicting prognosis and for treatment selection for patients with diffuse large-cell lymphomas is provided.

scholarly journals Stenting of the esophagus in the course of the malignant dysphagia in elderly patients

2020 ◽  
Vol 05 (02) ◽  
pp. 1-1
Author(s):  
Janusz Włodarczyk ◽  
◽  
Alicja Włodarczyk ◽  
Keyword(s):  
Lung Cancer ◽  
Esophageal Cancer ◽  
Elderly Patients ◽  
Clinical Management ◽  
Survival Rates ◽  
Palliative Therapy ◽  
Esophageal Stenosis ◽  
Safe Procedure ◽  
Malignant Dysphagia ◽  
Esophageal Stenting

Esophageal cancer is a disease with difficult clinical management, and palliative therapy is the only predominant treatment. This retrospective study analyses the results of clinical management of elderly patients (>75 years of age) who were treated with esophageal stenting for malignant dysphagia due to primary esophageal cancer, including squamous cell carcinoma (SCC), esophageal adenocarcinoma (EAC), as well as secondary esophageal malignant strictures due to non-small cell lung cancer (NSCLC). Patients with esophago-respiratory fistula (ERF) were also included in the study. This study included 166 patients aged 75–88 (mean age, 78) years. Nine (5.4%) patients had upper malignant esophageal stenosis, 48 (28.1%) had the middle, 43 (25.9%) in the lower part of the esophagus, 49 (29.5%) patients had EAC-related stenosis, and 17 (10.2%) patients reported lung cancer-related esophageal stenosis. Dysphagia was rated at 2.8 (range, 2–3) before stenting and at 1.2 (range, 1–2) after the stenting procedure. Seven (4%) patients experienced stenting migration, 12 (7.2%) had granulation tissue overgrowth and prosthesis obstruction, two (1.2%) developed respiratory failure, and one (0.6%) patient died. Twelve (7.2%) patients were treated for ERF with double-stenting, and three (1.8%) patients developed a secondary fistula after the stent implantation. The mean survival of patients with esophageal cancer and ERF was 101.8 days and 62.5 days, respectively. Esophageal stenting has proven a safe procedure in patients over 75 years of age. It has a low rate of stenting obstruction and migration. Patients with ERF are a particularly difficult group to treat, show very poor outcomes and short survival rates.

Peritoneal dialysis in very low and extremely low birthweight infants: A pooled analysis

2021 ◽  
pp. 089686082110598
Author(s):  
Ioannis Bellos ◽  
Vasilios Karageorgiou
Keyword(s):  
Peritoneal Dialysis ◽  
Low Birthweight ◽  
Therapeutic Option ◽  
Survival Rates ◽  
Kidney Injury ◽  
Pooled Analysis ◽  
Hazard Ratio ◽  
Preterm Neonates ◽  
Kidney Replacement Therapy ◽  
Extremely Low Birthweight

Background: Peritoneal dialysis (PD) represents an important therapeutic option in neonatal acute kidney injury (AKI), although evidence regarding its effects in preterm neonates remains unclear. The present study aims to evaluate the feasibility of PD in very low birthweight (VLBW) and extremely low birthweight (ELBW) infants and clarify the association of catheter choice with clinical outcomes. Methods: Medline, Scopus, Web of Science, Clinicaltrials.gov and CENTRAL databases were systematically searched from inception to 15 January 2021. Studies reporting individual participant data of VLBW and ELBW infants treated with PD were selected. Results: Overall, 20 studies were included comprising 101 patients. Catheter-related complications were significantly more frequent among ELBW infants (odds ratio: 5.18, 95% confidence intervals (CI): 1.23–29.09). After inverse probability treatment weighting, compared to drainage catheters, death risk was significantly lower with the use of PD (hazard ratio: 0.42, 95% CI: 0.19–0.90) but not vascular catheters (hazard ratio: 0.58, 95% CI: 0.28–1.20). Similarly, kidney function loss was significantly lower only with the implementation of PD catheters (hazard ratio: 0.44, 95% CI: 0.21–0.94). Conclusions: PD is a feasible kidney replacement therapy modality in VLBW and ELBW infants with AKI. The use of drainage catheters may be linked to significantly worse kidney recovery and overall survival rates, compared to PD catheters. Future cohorts should confirm the most appropriate catheter type and contribute to the standardisation of PD procedures.

Impact of race and socioeconomic status on breast cancer outcomes within the AJCC staging system.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18565-e18565
Author(s):  
Olga Kantor ◽  
Monica L. Wang ◽  
Kimberly Bertrand ◽  
Mariana Chavez-MacGregor ◽  
Rachel A. Freedman ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Socioeconomic Status ◽  
Proportional Hazards ◽  
Census Data ◽  
Tumor Biology ◽  
Staging System ◽  
Cox Proportional Hazards ◽  
Cancer Outcomes ◽  
Black Race ◽  
Breast Cancer Outcomes

e18565 Background: The persistent racial and socioeconomic status (SES) disparities in breast cancer outcomes are partially attributed to propensity towards more aggressive cancers or presentation at higher stages among these groups. Chronic stressors related to race and SES are another major mechanism underlying these inequities. This study aims to examine the effect of race and SES within the AJCC 8th-edition staging system, which incorporates anatomic extent of disease and tumor biology. Methods: The SEER breast cancer database linked with county-level census data was used to identify patients with invasive breast cancer from 2010-2015. The database includes a composite SES-index which was analyzed in quintiles. Cox proportional-hazards regression was used to estimate disease-specific survival (DSS). Results: 259,852 patients were included: 176,369 (67.9%) non-Hispanic white, 28,510 (11.0%) Black, 29,737 (11.4%) Hispanic, and 22,887 (8.8%) Asian. Black race, lower SES, public insurance, lower education, and increased poverty were associated with decreased DSS. Adjusted survival analysis for patient, SES, tumor, and treatment characteristics demonstrated that patients of black race had inferior DSS within each stage. Fully adjusted models also showed patients residing in lower SES counties had inferior DSS [Table]. Conclusions: Racial and SES disparities in breast cancer-specific mortality were evident across all stages of disease. Future efforts to improve breast cancer outcomes should systematically assess and address racial and socioeconomic factors as fundamental drivers of inequitable outcomes. Adjusted 5-year DSS Estimates, Stratified by Race and SES.[Table: see text]

A Study on Automatic Segmentation and Classification of Skin Lesions in Dermoscopic Images

2015 ◽  
Vol 6 (4) ◽  
pp. 51-61
Author(s):  
Ebtihal Abdullah Al-Mansour ◽  
Arfan Jaffar
Keyword(s):  
Skin Cancer ◽  
Imaging Techniques ◽  
Automatic Segmentation ◽  
Survival Rates ◽  
Skin Lesions ◽  
Incidence Rates ◽  
Automated System ◽  
Final State ◽  
Survey Paper ◽  
Real Scenario

Malignant Melanoma is one of the rare and the deadliest form of skin cancer if left untreated. Death rate due to this cancer is three times more than all other skin-related malignancies combined. Incidence rates of melanoma have been increasing, especially among young adults, but survival rates are high if detected early. There is a need for an automated system to assess a patient's risk of melanoma using digital dermoscopy, that is, a skin imaging technique widely used for pigmented skin lesion inspection. Although many automated and semi-automated methods are available to diagnose skin cancer but each has its own limitations and there is no final, state-of-the art technique to date which is able to be implemented in real scenario. This survey paper is based on techniques used to segment the skin cancer, analysis of their merits and demerits and their applications on advanced imaging techniques.

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