Association of Mediterranean Diet Adherence with Disease Progression Characteristics, Lifestyle Factors and Overall Survival in Gastric Cancer Patients

© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/BACKGROUND: The Mediterranean diet (MD) exerts a protective effect against cancer development and progression; however, the evaluation of its impact on gastric cancer still remains quite scarce. The present study aims to evaluate the association of MD adherence during the lifespan with disease progression characteristics, lifestyle factors and overall survival in gastric carcinoma patients. METHODS: This is an observational, cross-sectional study conducted on 186 gastric cancer patients followed up for a median time interval of 57 months or until death due to cancer disease. Tumor histopathological characteristics were retrieved from patients' medical records, while validated questionnaires assessing, immediately after the time of diagnosis, health-related quality of life, physical activity levels, sleep quality, depression, anxiety and MD adherence during the lifespan were used. RESULTS: Higher MD adherence during the lifespan was significantly associated with younger patients (p = 0.0106), regular smoking (p < 0.0001), abnormal BMI status (p < 0.0001), intestinal-type gastric carcinoma (p = 0.0111), high tumor histopathological grade (p < 0.0001) and earlier disease stage (p < 0.0001). Moreover, patients with elevated MD adherence during their lifespan showed significantly better health-related quality of life (p < 0.0001), higher physical activity levels (p < 0.0001), more adequate sleep quality (p < 0.0001) and lower prevalence of depression (p = 0.0003) and anxiety (p = 0.0006) compared to those with reduced MD adherence. In multiple regression analysis, elevated MD compliance during the lifespan was independently correlated with longer overall patient survival after adjustment for several confounders (Cox regression analysis, p = 0.0001). CONCLUSIONS: Higher MD adherence during the lifespan was associated with less advanced tumor histopathology characteristics and favorable mental and physical lifestyle factors. Moreover, higher MD adherence during the lifespan was also independently correlated with longer overall survival in gastric carcinoma patients. Thus, adopting a healthy dietary pattern like the MD during the lifespan may act as a preventive agent in combination with a healthy lifestyle against gastric cancer development and progression.Peer reviewe

Drug Eluding Stents for Malignant Airway Obstruction: A Critical Review of the Literature

Lung cancer being the most prevalent malignancy in men and the 3rd most frequent in women is still associated with dismal prognosis due to advanced disease at the time of diagnosis. Novel targeted therapies are already on the market and several others are under investigation. However non-specific cytotoxic agents still remain the cornerstone of treatment for many patients. Central airways stenosis or obstruction may often complicate and decrease quality of life and survival of these patients. Interventional pulmonology modalities (mainly debulking and stent placement) can alleviate symptoms related to airways stenosis and improve the quality of life of patients. Mitomycin C and sirolimus have been observed to assist a successful stent placement by reducing granuloma tissue formation. Additionally, these drugs enhance the normal tissue ability against cancer cell infiltration. In this mini review we will concentrate on mitomycin C and sirolimus and their use in stent placement

Smoking habits as an independent factor of lung cancer and respiratory diseases development

Smoking habit is held responsible for several respiratory and metabolic diseases. Respiratory diseases such as chronic obstructive disease pulmonary disease (COPD) and disease exacerbation of asthma, cystic fibrosis, interstitial lung disease and bronchiectasis has been observed to be induced by smoking. Lung parenchyma damage such as emphysema occurs due to smoking habit. The aim of this study was to investigate the smoking habit as independent factor responsible for the expression of respiratory diseases and lung cancer. Moreover, the analysis of the results included questions such as how various diseases associated with smoking, with duration of smoking habit, the dependence of the respondents, the degree of preparedness, their age and the number of cigarettes packets per day consumed. We also investigated whether the gender of the respondents related to their degree of readiness while preparedness related to years of smoking. The tool for collecting research data was a questionnaire while questions were selected based on previous research on the subject of smoking habits. All subjects who answered the questionnaire aged 18-75 years and were patients visiting the office of the county welfare of city of Serres and the anti-smoking clinic of city of Serres for examination. The final size of the sample for the questionnaires was formed in 1542 smokers and 180 non-smokers. A statistically significant correlation was found between smoking and disease genital cancers, lung cancer, COPD, asthma, digestive problems, diabetes and transient respiratory problems. A statistically significant correlation was also found between smoking and diseases like lung cancer, COPD, coronary artery disease, arterial hypertension, dyslipidemia, diabetes and neurological problems. In addition, statistically significant correlation was found between the number of packets and diseases of genital cancer and lung cancer, COPD, coronary artery disease, arterial hypertension, arrhythmias, blood problems, problems of urinal and digestive system, diabetes mellitus, transient respiratory and neurological problems. A statistically significant correlation was found between the extra dependency and disease COPD, transient respiratory problems and lung cancer, while there is no statistically significant correlation between age of respondents and the degree of readiness to quit smoking. There is a statistically significant correlation between the gender of the respondents and their level of readiness. In particular the majority of women are not so determined to quit smoking (54.3%) while the majority of men are very determined to quit (54.1%). Finally, there is a statistically significant correlation between the degree of preparedness and years of smoking. Specifically those who appear to be very determined to quit smoke on average more years (25.54 years) versus those that are not very determined to quit (24.18 years).H καπνισματική συνήθεια είναι υπεύθυνη για πολλές αναπνευστικές και μεταβολικές ασθένειες όπως χρόνια αποφρακτική νόσος (ΧΑΠ) και επιδείνωση της νόσου του άσθματος, της κυστικής ίνωσης, διάμεση πνευμονοπάθεια και βρογχεκτασίες. Βλάβη του πνευμονικού παρεγχύματος, όπως το εμφύσημα συμβαίνει λόγω της συνήθειας του καπνίσματος. Στόχος της παρούσας έρευνας ήταν η διερεύνηση της καπνισματικής συνήθειας ως ανεξάρτητου παράγοντα εκδήλωσης αναπνευστικών παθήσεων και καρκίνου του πνεύμονα. Επιπλέον, με την ανάλυση των αποτελεσμάτων διερευνήθηκαν ερωτήματα όπως με ποιο τρόπο σχετίζεται η εμφάνιση των διαφόρων νόσων με το κάπνισμα, και με τα έτη καπνίσματος και με τον αριθμό των πακέτων ανά ημέρα, με τον βαθμό εξάρτησης των ερωτώμενων, με τον βαθμό ετοιμότητας τους, με την ηλικία τους. Επίσης διερευνήθηκε κατά πόσο το φύλο των ερωτώμενων σχετίζεται με τον βαθμό ετοιμότητας τους και ο βαθμός ετοιμότητας σχετίζεται με τα έτη του καπνίσματος. Επιλέχθηκε το ερωτηματολόγιο, ως το εργαλείο συλλογής των δεδομένων της έρευνας ενώ οι ερωτήσεις του επιλέχθηκαν με βάση προηγούμενες έρευνες στο θέμα των καπνισματικών συνηθειών. Εισήλθαν στην μελέτη όλα τα άτομα, ηλικίας 18-75 ετών, που προσήλθαν για εξέταση στο ιατρείο κοινωνικής μέριμνας του νομού Σερρών και το αντικαπνιστικό ιατρείο του δήμου Σερρών. Το τελικό μέγεθος του δείγματος όσον αφορά τα ερωτηματολόγια διαμορφώθηκε στους 1542 καπνίζοντες και 180 μη καπνίζοντες. Στατιστικά σημαντική συσχέτιση βρέθηκε μεταξύ του καπνίσματος και των νόσων: καρκίνος των γεννητικών οργάνων, καρκίνος των πνευμόνων, ΧΑΠ, άσθμα, προβλήματα του πεπτικού συστήματος, σακχαρώδης διαβήτης και παροδικά αναπνευστικά προβλήματα. Στατιστικά σημαντική συσχέτιση βρέθηκε επίσης μεταξύ των ετών καπνίσματος και των νόσων: καρκίνος των πνευμόνων, ΧΑΠ, στεφανιαία νόσος, Α/Υ, δυσλιπιδαιμίες, σακχαρώδης διαβήτης και νευρολογικά προβλήματα. Επιπροσθέτως, στατιστικά σημαντική συσχέτιση βρέθηκε μεταξύ του αριθμού των πακέτων και των νόσων καρκίνος των γεννητικών οργάνων και καρκίνος των πνευμόνων, ΧΑΠ, στεφανιαία νόσος, Α/Υ, αρρυθμίες, αιματολογικά προβλήματα, προβλήματα του ουροπεπτικού συστήματος, σακχαρώδης διαβήτης, παροδικά αναπνευστικά προβλήματα και νευρολογικά προβλήματα. Στατιστικά σημαντική συσχέτιση βρέθηκε επιπλέον μεταξύ του βαθμού εξάρτησης και των νόσων ΧΑΠ, παροδικά αναπνευστικά προβλήματα και καρκίνος των πνευμόνων ενώ δεν υπάρχει στατιστικά σημαντική συσχέτιση μεταξύ της ηλικίας των ερωτώμενων και του βαθμού ετοιμότητας τους να διακόψουν το κάπνισμα. Υπάρχει στατιστικά σημαντική συσχέτιση μεταξύ του φύλου των ερωτώμενων και του βαθμού ετοιμότητας τους. Συγκεκριμένα το μεγαλύτερο ποσοστό των γυναικών δεν είναι τόσο αποφασισμένες να διακόψουν το κάπνισμα (54.3%) ενώ το μεγαλύτερο ποσοστό των ανδρών είναι πολύ αποφασισμένο να διακόψει το κάπνισμα (54.1%). Τέλος, υπάρχει στατιστικά σημαντική συσχέτιση μεταξύ του βαθμού ετοιμότητας και των ετών καπνίσματος. Συγκεκριμένα αυτοί που εμφανίζονται ως πολύ αποφασισμένοι να διακόψουν το κάπνισμα καπνίζουν κατά μέσο όρο περισσότερα χρόνια (25.54 έτη) έναντι αυτών που δεν είναι πολύ αποφασισμένοι να το διακόψουν (24.18 έτη)

Clinical Approach to Immunotherapy-induced Type 1 Diabetes Mellitus: A Case of Pembrolizumab Associated Insulin-dependent Diabetes in a Patient with NSCLC

As the introduction of immune checkpoint inhibitors in the treatment of various cancers is now proven to be already acquired knowledge, so does a new challenge arise for clinicians; the understanding, diagnosis, and management of the rarest adverse effects of immunotherapy. We present a case of type-1 diabetes Mellitus (T1DM) in a patient with non-small cell lung carcinoma (NSCLC) treated with pembrolizumab. Following ten cycles of treatment, our patient was diagnosed with T1DM after being admitted for diabetic ketoacidosis and stayed hospitalized in the ICU. Later, they continued treatment with insulin, having shown disease response to pembrolizumab, and resumed immunotherapy while on insulin. Immunotherapy-induced T1DM can sometimes occur with PD1/PD-L1 blockage therapies. It has a rapid onset, is characterized by insulin deficiency due to the autoimmune destruction of beta-cells, and usually presents itself with diabetic ketoacidosis. Unlike most of the other adverse effects of immunotherapy, glucocorticoids don&rsquo;t seem to be of therapeutic value, and insulin substitution is required. Regular glucose monitoring can be key to early diagnosis and prevention of hospitalization.&nbsp

The impact of bisphosphonate therapy on survival of lung cancer patients with bone metastasis

SUMMARY. INTRODUCTION: Bone metastases occur in 20% to 40% of patients with lung cancer. Recent studies (most in vitro) demonstrate an anti-proliferative effect of third-generation biphosphonates (BPs) on lung tumours which may, indirectly, have an impact on the survival. OBJECTIVES: This was a study of the effects of treatment with BPs on the course and survival of lung cancer patients with bone metastases. PATIENTS AND METHODS: For the study 108 male patients with lung cancer (stage IV) were recruited consecutively. Of these, 55/108 patients with positive bone scan experienced bone pain and received Nitrogen BPs (NBPs), specifically zoledronic acid (ZOL), 4 mg i.v. every 21 days (Group A). The other 53 patients received no NBPs, of which 30/53 had a positive bone scan (Group B) and 23/53 a negative bone scan (Group C). All patients were treated with combination chemotherapy consisting of Docitaxel 100 mg/m2 and Carboplatin AUC = 6. RESULTS: Group A had a statistically significantly longer mean survival and time to progression than Groups B and C (p<0.001). A statistically significant positive correlation was found between the number of cycles of therapy with NBPs and total patient survival (p<0.01, Pearson Correlation) and time to progression (p<0.01). Regarding the pain effect in relation to baseline, no significant difference was observed between the two groups of patients (with and without NBPs) with positive bone scan (p>0.05). CONCLUSION: The addition of NBPs to the treatment regime appears to increase overall survival in lung cancer patients with bone metastases. Further studies are needed to support the potential usefulness of NBPs as an independent therapeutic agent against lung cancer. Pneumon 2009; 22(1):25–3

“Liquid elbows” due to afatinib administration

Non-small cell lung cancer adenocarcinoma in the past decade has targeted therapies as the cornerstone for therapy. In specific patients with epidermal growth factor receptor mutation have three different therapy approaches with the tyrosine kinase inhibitors: erlotinib, gefitinib and afatinib. Nowadays we can use tyrosine kinase inhibitors as second line treatment for squamous cell carcinoma. We present a case with a patient with squamous cell carcinoma receiving afatinib tyrosine kinase inhibitor who presented elbow bursitis or olecranon bursitis in both elbows

Galactorrhea, mastodynia and gynecomastia as the first manifestation of lung adenocarcinoma. A case report

Gynecomastia with mastodynia and galactorrhea as a paraneoplastic syndrome due to lung cancer with complete response after surgical excision is rare. A 62-year-old Caucasian male presented with mastodynia, galactorrhea and right breast enlargement. Chest x-ray revealed a left upper lobe tumor. The patient had high levels of serum beta-human chorionic gonadotropin (b-HCG) and prolactine. Complete staging was negative for metastases. A typical left upper lobectomy with radical mediastinal lymph node dissection was performed. Pathology report was consistent with a poorly differentiated adenocarcinoma (T2N1M0). Immunohistochemically, multinucleate cells and occasional mononucleate tumor cells showed positivity for human chorionic gonadotropin. The patient received adjuvant chemotherapy with cisplatin - navelbine. One year later physical examination showed regression of both gynecomastia and mastodynia and there was no nipple discharge, while he is free from local or distant metastatic disease and the b-HCG level is normal (1,59 mIU/ml). This case represents a very rare, first manifestation of lung cancer. Galactorrhea, mastodynia and gynecomastia were the initial symptoms, which totally resolved following the successful surgical resection and adjuvant chemotherapy. In this case, prolactin and b-HCG are useful biomarkers during follow up for checking local or distal recurrence of the disease

Possible adverse effects of immunotherapy in non-small cell lung cancer; treatment and follow-up of three cases

In the past decade novel agents are on the market for non-small cell lung cancer adenocarcinoma based on pharmacogenomics. The epidermal growth factor receptor mutation, anaplastic lymphoma kinase and programmed death-ligand 1 investigation is necessary in the everyday clinical practice for the oncologic patient. Immunotherapy is nowadays the novel therapy for advanced stage non-small cell lung cancer with two agents nivolumab and pembrolizumab. In the current case series we will present adverse effects from our centers and comment on the treatment and follow-up of the patients