Which patients are not included in the English Cancer Waiting Times monitoring dataset, 2009-2013? Implications for use of the data in research.

BACKGROUND: Cancer waiting time targets are routinely monitored in England, but the Cancer Waiting Times monitoring dataset (CWT) does not include all eligible patients, introducing scope for bias. METHODS: Data from adults diagnosed in England (2009-2013) with colorectal, lung, or ovarian cancer were linked from CWT to cancer registry, mortality, and Hospital Episode Statistics data. We present demographic characteristics and net survival for patients who were and were not included in CWT. RESULTS: A CWT record was found for 82% of colorectal, 76% of lung, and 77% of ovarian cancer patients. Patients not recorded in CWT were more likely to be in the youngest or oldest age groups, have more comorbidities, have been diagnosed through emergency presentation, have late or missing stage, and have much poorer survival. CONCLUSIONS: Researchers and policy-makers should be aware of the limitations in the completeness and representativeness of CWT, and draw conclusions with appropriate caution

Platinum(II) Complexes of Nonsymmetrical NCN-Coordinating Ligands: Unimolecular and Excimeric Luminescence Properties and Comparison with Symmetrical Analogues

A series of seven new platinum(II) complexes PtLnCl have been prepared, where Ln is an NCN-coordinating ligand comprising a benzene ring 1,3-disubstituted with two different azaheterocycles. In PtL1–5Cl, one heterocycle is a simple pyridine ring, while the other is an isoquinoline, a quinoline, a pyrimidine (L1, L2, L3), or a p-CF3- or p-OMe-substituted pyridine (L4 and L5). PtL6Cl incorporates both a p-CF3 and a p-OMe-substituted pyridine. The synthesis of the requisite proligands HLn is achieved using Pd-catalyzed cross-coupling methodology. The molecular structures of six of the Pt(II) complexes have been determined by X-ray diffraction. All the complexes are brightly luminescent in deoxygenated solution at room temperature. The absorption and emission properties are compared with those of the corresponding symmetrical complexes featuring two identical heterocycles, PtLnsymCl, and of the parent Pt(dpyb)Cl containing two unsubstituted pyridines [dpybH = 1,3-di(2-pyridyl)benzene]. While the absorption spectra of the nonsymmetrical complexes show features of both PtLnsymCl and Pt(dpyb)Cl, the emission generally resembles that of whichever of the corresponding symmetrical complexes has the lower-energy emission. PtL1Cl differs in that─at room temperature but not at 77 K─it displays emission bands that can be attributed to excited states involving both the pyridine and the isoquinoline rings, despite the latter being unequivocally lower in energy. This unusual behavior is attributed to thermally activated repopulation of the former excited state from the latter, facilitated by the very long-lived nature of the isoquinoline-based excited state. At elevated concentrations, all the complexes show an additional red-shifted emission band attributable to excimers. For PtL1Cl, the excimer strikingly dominates the emission spectra at all but the lowest concentrations (<10–5 M). Trends in the energies of the excimers and their propensity to form are compared with those of the symmetrical analogues

A novel methodology for in vivo endoscopic phenotyping of colorectal cancer based on real-time analysis of the mucosal lipidome: a prospective observational study of the iKnife

Background: This pilot study assessed the diagnostic accuracy of rapid evaporative ionization mass spectrometry (REIMS) in colorectal cancer (CRC) and colonic adenomas. Methods: Patients undergoing elective surgical resection for CRC were recruited at St. Mary’s Hospital London and The Royal Marsden Hospital, UK. Ex vivo analysis was performed using a standard electrosurgery handpiece with aspiration of the electrosurgical aerosol to a Xevo G2-S iKnife QTof mass spectrometer (Waters Corporation). Histological examination was performed for validation purposes. Multivariate analysis was performed using principal component analysis and linear discriminant analysis in Matlab 2015a (Mathworks, Natick, MA). A modified REIMS endoscopic snare was developed (Medwork) and used prospectively in five patients to assess its feasibility during hot snare polypectomy. Results: Twenty-eight patients were recruited (12 males, median age 71, range 35–89). REIMS was able to reliably distinguish between cancer and normal adjacent mucosa (NAM) (AUC 0.96) and between NAM and adenoma (AUC 0.99). It had an overall accuracy of 94.4 % for the detection of cancer versus adenoma and an adenoma sensitivity of 78.6 % and specificity of 97.3 % (AUC 0.99) versus cancer. Long-chain phosphatidylserines (e.g., PS 22:0) and bacterial phosphatidylglycerols were over-expressed on cancer samples, while NAM was defined by raised plasmalogens and triacylglycerols expression and adenomas demonstrated an over-expression of ceramides. REIMS was able to classify samples according to tumor differentiation, tumor budding, lymphovascular invasion, extramural vascular invasion and lymph node micrometastases (AUC’s 0.88, 0.87, 0.83, 0.81 and 0.81, respectively). During endoscopic deployment, colonoscopic REIMS was able to detect target lipid species such as ceramides during hot snare polypectomy. Conclusion: REIMS demonstrates high diagnostic accuracy for tumor type and for established histological features of poor prognostic outcome in CRC based on a multivariate analysis of the mucosal lipidome. REIMS could augment endoscopic and imaging technologies for precision phenotyping of colorectal cancer