Serum vascular cell adhesion molecule-1 (VCAM1) level is elevated in colorectal cancer regardless of the tumor stage

Purpose: Vascular cell adhesion molecule-1 (VCAM1) is a transmembrane glycoprotein, which is expressed on endothelium and plays role in inflammation. It is over-expressed on colorectal cancer (CRC) cells and plays role in metastasis development and angiogenesis. We aimed to compare serum VCAM1 levels of CRC patients with heathy controls and evaluate its relationship with clinicopathological parameters, treatment response and overall survival (OS).Methods: The study enrolled 111 patients with histopathologically confirmed CRC followed-up in our clinic and 30 sex- and age-matched healthy controls. Pre-treatment serum VCAM1 levels were determined by the solid-phase sandwich ELISA method.Results: Metastatic disease was present in 57 patients. Forty percent of 40 metastatic patients receiving systemic therapy had partial or complete response. The median serum VCAM1 level was significantly higher in CRC patients than controls (p<0.001). In addition, serum VCAM1 level was significantly higher in diabetic CRC patients than those without diabetes (p = 0.03). There was no significant relationship between VCAM1 and other clinicopathological parameters including stage and response to systemic therapy. The median follow-up period was 12 (±8.2) months. Twenty patients were dead at the time of analysis. The presence of metastasis (p < 0.001) and elevated CEA level (p < 0.001) were factors affecting OS significantly. However, serum VCAM1 did not have a significant impact on OS (p = 0.55).Conclusion: Serum VCAM1 level is significantly elevated in CRC patients regardless of the tumor stage. However, it has no prognostic or predictive role for response to systemic therapy

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Adrenocortical carcinoma: clinicopathological features, prognostic factors and outcome.

Objective: The purpose of this study was to investigate the clinicopathological characteristics and treatment outcomes of patients with adrenocortical carcinoma (AC). Methods: Twenty-four patients (10 females and 14 males) diagnosed with AC between 1998 and 2009 were evaluated. Clinical features and outcomes were reviewed. Results: Median age was 46.5 years. One (4%) patient was classified as stage I, 10 (42%) were classified as stage II, 8 (33%) were classified as stage III and 5 (21%) were classified as stage IV. Tumor sizes ranged from 3 to 22 cm with a mean diameter of 11 cm. Five patients were locally inoperable at initial diagnosis. In addition to surgery, 2 of 19 patients were treated with an adjuvant cisplatin plus etoposide regimen. Sixteen patients were treated with chemotherapy after recurrence. Median survival time was 18 months. The 1-and 5-year overall survival estimates were 73 and 48%, respectively. Mean survival times for male and female patients were 58 and 12 months, respectively (p = 0.046). Early T stage (p = 0.04), lymph node negativity (p < 0.001), the absence of distant metastases (p < 0.001) and early stage (p < 0.001) were cor-related with overall survival. Conclusion: AC is a rare disease with a poor prognosis. There are correlations between gender, stage and survival. Copyright (C) 2013 S. Karger AG, Base

Dramatic response to single-agent atezolizumab in a patient with MSI-H serous ovarian cancer

What is known and objective: Patients with ovarian cancer have not benefited substantially from immunotherapy. We report a case of ovarian cancer, however, that responded well to the programmed cell death-ligand 1 inhibitor atezolizumab

"Door to Treatment" Outcomes of Cancer Patients during the COVID-19 Pandemic

Background: The novel coronavirus disease 2019 has become a worldwide threat. We aimed to explore reflections of these unexpected changes to newly diagnosed cancer patients. Method: We searched the 2 months after the index case of our country. The first admission day and the first day of intravenous treatment of newly diagnosed patients were recorded. Results: In the 60 days measured during the pandemic, the total number of patients on polyclinics was 159/weekdays, and the total applied chemotherapy cycles were 276/week. For comparison, the total numbers in the previous year were 267/weekday and 363/week for polyclinic and applied chemotherapy cycles, respectively. The total number of newly admitted patients in 2020 was 283. For comparison, the number of new patients in the same 60-day period in 2019 was 495. Patients who were admitted for adjuvant treatment required a median of 8 days for the first course, those who were admitted for neoadjuvant treatment required 12 days, and metastatic patients required 14 days; there were no significant differences between treatment types (p = 0.233). However, the median treatment time was 11.5 and 17 days, in 2020 and in 2019, respectively. A significant difference was observed between the 2 groups (p < 0.001). Conclusion: The effective shift of workers and accurate regulations have not resulted in apparent delays in patient care. While a decrease in the number of patients has detected, faster healthcare service was introduced to newly diagnosed patients. The reason for the decrease in the number of patients should be investigated with new studies

Factors Associated with Late Toxicity in Nasopharyngeal Carcinoma Patients Treated with Radio-Chemotherapy

Objective: To quantify late toxicity in patients treated with intensive chemotherapy (ChT) and radiotherapy (RT) for nasopharyngeal carcinoma (NPC) and to investigate factors associated with it. Material and Methods: We retrospectively reviewed the treatment outcome in terms of moderate-severe late toxicity (MSLT) in 44 NPC patients diagnosed between 2001 and 2007. All the patients were treated with conformal RT and cisplatin containing ChT. Twenty-eight (63.6%) patients among 44 received only multidrug neoadjuvant ChT, while the remaining 16 (36.4%) patients received additional concomitant cisplatin during RT. MSLT was evaluated according to RTOG/EORTC scoring system and defined as grade 3-5 late toxicity. The median follow-up of these 44 patients was 38 months (range, 12-84 months). Statistical analyses were performed with Kaplan-Meier method and a multiple Cox's regression model. Results: The hazard probability of developing MSLT at 5 years was 49%. In univariate analyses; gender, age, histopathology, T stage, N stage and ChT schema did not have significant impact on treatment outcome in terms of MSLT. Total radiation dose to the neck, which appeared to have a paradoxical effect on late toxicity in univariate analysis turned to be insignificant in multivariate analysis. Treatment response was found to be the only prognostic factor in multiple Cox's regression analysis, which had an impact on MSLT in NPC patients. Probability of MSLT among the 12 NPC patients with less than complete response to the treatment was higher than 32 patients with complete response to the treatment (85.7% and 35.2% at 5 years, respectively; p=0.0254). Conclusion: Late toxicity in NPC patients is treatment related. Poor tumour control can be a triggering factor for development of late toxicity. Long lasting residual disease following treatment is an interesting phenomenon in NPC patients, which appears to be related with MSLT and has to be further investigated in prospective studies