ABSTRACT
Background: Ovarian cancer is the 8th most common cancer among women in Lebanon. Despite new advances in the treatment of these tumors, their prognosis remains very poor. The histology of ovarian tumors and their stage at the time of diagnosis are the two most relevant prognostic factors. Epithelial tumors, including serous, mucinous, endometrioid, clear-cell, Brenner and seromucinous tumors, account for the vast majority of ovarian tumors. Germ cell tumors and tumors of the sexual cord are respectively the second and third subgroups of ovarian tumors. In Lebanon, there are no data concerning borderline and malignant ovarian tumors
Aim: We report the epidemiological and histological characteristics of borderline and malignant ovarian tumors in a Lebanese tertiary hospital
Material and Methods: This is a retrospective study evaluating the characteristics of borderline and malignant ovarian tumors diagnosed in 19 years [from 1999 to 2017] at the pathology laboratory of Hotel-Dieu de France, Saint Joseph University Hospital in Beirut, Lebanon. The data were extracted from the computerized registers of the laboratory. Statistical analysis was performed using SPSS 24.0
Results: Atotal of 996 ovarian lesions were found. Of these, 529 [53.1percent] were epithelial [342 [64.7percent] serous, 107 [20.2percent] mucinous, 23 [4.3percent] endometrioid, 18 [3.4percent] undifferentiated carcinoma, 15 [2.8percent] seromucinous, 12 [2.3percent] clear cell and 12 [2.5percent] Brenner]; 285 [28.6percent] were germinal [including 245 [86.0percent] mature teratomas, 12 [4.9percent] dysgerminomas and 7 [2.5percent] immature teratomas]; 83 [8.3percent] were stromal tumors of the sexual cord. Of the 529 epithelial tumors, 261 [49.3percent] were benign [60percent were serous cystadenomas], 46 [8.7percent] were borderline [26 serous, 18 mucinous and 2 serous] and 222 [42.0percent] were malignant [of which 139 [62.6percent] were high grade serous carcinomas, 19 [8.6percent] endometrioid, 18 undifferentiated, 12 low-grade serous and 12 clear cell]. Mean age for malignant epithelial tumors and borderline epithelial tumors were 54.3 years and 39.7 years respectively
Conclusion: Our data are compatible with those published in Western countries. Many studies will be launched on the basis of this database, including the evaluation of somatic and germinal ovarian panel mutations in high-grade ovarian serous carcinoma and in those with borderline tumor sequencing
ABSTRACT
Introduction: In terms of frequency, colorectal cancer is the 3rd cancer in Lebanon with 1093 incidences registered in 2015. However, to this date not a single screening campaign has been organized in the country. Fecal immunochemical test [FIT] is a technique being more and more advised in screening. This being said, we found it useful to organize a screening campaign using FIT in order to determine the prevalence of colorectal cancer in a population of 3000 healthy Lebanese in order to extract useful data
Material and Methods: Healthy Lebanese adults of average risk of developing colorectal cancer between 45 and 80 years old. Procedure: 3000 sampling tubes were distributed. Numerous presentations were done to explain the screening modalities and its importance. In order to preserve the sample quality, patients were asked to return the tubes within 3 days of doing the test. Once the hemoglobin quantification has been done at the medical genetics unit [UGM] of Saint-Joseph University, patients with stool hemoglobin of more than 80ng/ml were contacted and answered few questions then were asked to undergo a colonoscopy. Follow-up is still ongoing as well as sampling kits distribution
Results o Out of the 3000 distributed tests, 705 were returned [23.5 percent]. 528 were presented with enough data to be studied and out of them 459 answered the inclusion criteria. The cohort median for age was 56 years old [45-80]. Sex ratio F/M 2.3, among them 4 percent had personal cancer history, 14 percent had familial history of colorectal cancer and 20 percent underwent colonoscopies at least once in their life. Out of the 459 patients, 278 [60.5 percent] showed 0 ng/ml, 137 [29.8 percent] showed 1 to 79 ng/ml, 3 [0.6 percent] showed 80 to 99 ng/ml meaning they are at intermediate risk, 33 [7.1 percent] showed 100 to 800 ng/ml considered as a positive value and finally 8 [1.7 percent] showed over range values. Among the 44 positive patients we contacted 41, directly or by their referent physician. Out of the 8 [18 percent] colonoscopies results received so far, 5 had hemorrhoids causing false positive results. One had ulcerative ileitis. For the remaining 2, tubular adenomas of low grade were discovered, while for one of them a carcinoma was discovered
Conclusion: While it was hard for us to quantify people for whom a free FIT was proposed, the low restitution rate among those who accepted to undergo the test shows the urgent necessity of establishing sensitization and screening campaigns. This takes a particular dimension knowing that some patients with positive FIT refused further investigations
ABSTRACT
Background: Loco-regional renal cell carcinoma [RCC] accounts for 15 to 20 percent of patients with RCC, with a risk of post-surgical relapse of 40 percent [1,2]. Following the adoption of tyrosine kinase inhibitors [TKIs] as the first-line treatment of metastatic RCC, multiple studies evaluated Sunitinib [3,4] and Pazopanib [5] in the adjuvant setting of high-risk resected RCC. However, these studies have yielded inconclusive results, and there are currently no meta-analyses combining the results of all trials evaluating TKIs in the adjuvant setting of high-risk RCC. The aim was to perform a meta-analysis to evaluate and compare the possible benefit of Sunitinib and Pazopanib on diseasefree survival [DFS] in the adjuvant setting of high-risk RCC
Methods: This meta-analysis included all the phase 3 randomized controlled trials [ASSURE 3, S-TRAC 4 and PROTECT 5] evaluating Sunitinib and Pazopanib in the adjuvant setting of high-risk RCC. A random-effects model was preferentially used to pool the data using the inverse variance method and a subgroup analysis including Sunitinib and Pazopanib subgroups was used in order to account for heterogeneity and allow comparison of the two subgroups. Two variations of the same analysis were undertaken as sensitivity analyses : first with a fixed-effects model, second while excluding the results of the ASSURE study. The primary outcome was the comparison of disease-free survival [DFS] between TKIs and placebo. Hazard ratios were reported along with their 95 percent confidence intervals [95 percentCI]
Results: A total of 3447 patients from the three trials were included in the analysis. There was a tendency for a significant overall effect of both TKIs on DFS; however, this tendency only reached the threshold for statistical significance in the fixed-effects model [HR = 0.91; 95 percentCI = 0.83-0.99; p = 0.03] but not in the random-effects model [HR = 0.85; 95 percentCI = 0.72-1.01; p = 0.06, Figure 1]. Significant between-study overall heterogeneity was observed [p = 0.07; I2 = 58 percent] and the subgroup analysis showed that this was largely due to the heterogeneity within the Sunitinib subgroup [p = 0.05; I2 = 73 percent, Figure 1]. Moreover, a sensitivity analysis excluding the ASSURE study led to results which were markedly more homogeneous [p = 0.48; I2 = 0 percent]. While the test for overall effect was found to be significant in the Pazopanib subgroup [HR = 0.80; 95 percentCI = 0.65-0.98; p = 0.03] but not in the Sunitinib subgroup [HR = 0.90; 95 percentCI = 0.67-1.19; p = 0.45], there was no significant difference between the subgroup effects [p = 0.51; I2 =0 percent; Figure 1]
Conclusion: Our analysis showed that Pazopanib and Sunitinib could still have a potential role in the armamentarium of adjuvant treatment in high-risk RCC. However, it failed to demonstrate a significant difference between these agents in this setting
ABSTRACT
Aim: The administration of total parenteral nutrition [TPN] in terminally ill cancer patients is aggressive with a relatively high risk of complications. In this paper, we investigated the use of TPN in Lebanese cancer patients at end of life. To our knowledge, this is the first study describing TPN administration to Middle Eastern patients with advanced cancer
Methods: We conducted this observational study at Hotel-Dieu de France University Hospital, Lebanon. Eligible cases included all cancer patients that died at our institution between the 1st of January and the 31st of December 2014. The patients and tumors characteristics as well as the management plan were retrieved from the hospital records
Results: Our study enrolled 129 cancer patients at end of life among which 39 percent had received TPN: 28 percent during the last 6 weeks and 34 percent during the last 3 months. The mean duration of TPN administration was 33 days [range: 1 to 211]. The mean duration between the end of TPN administration and death was 37 days [range: 0 to 315]. TPN administration correlated negatively to hyperlipidemia [OR = 0.33; 95 percent CI [0.12 - 0.87]] and to the presence of three cardiovascular risk factors [OR = 0.28; 95 percent CI [0.10 - 0.80]]. On the other hand, it correlated positively to gastrointestinal tumors [OR = 3.9; 95 percent CI [1.3 - 11.7]] and to imaging studies during the last month of life [OR = 3.4; 95 percent CI [1.3 - 9.0]]. In the multivariate analysis, only hyperlipidemia was found to be a significant determinant of the TPN administration [p = 0.010; ORa= 0.29 [0.11 - 0.74]
Conclusion: The prevalent use of TPN at end of life underlines a difficulty in adopting a palliative care approach in our population. This is truly applicable in Middle Eastern populations that seem to refuse a patient-centered supportive care approach
ABSTRACT
Introduction: Localized form of gastric cancer is currently treated, independently of genetic profiles, by surgical resection with perioperative chemotherapy, radiotherapy and/or targeted therapy. Next-generation sequencing (NGS) recently provided new information regarding gene mutations related to gastric cancer pathogenesis. This information can determine new therapeutic pathways to successfully treat gastric cancer depending on its molecular profiling. Ramucirumab is a humanized monoclonal antibody directed against vascular endothelial growth factor receptor 2. Ramucirumab is approved in second-line therapy for advanced or metastatic gastric cancer as a single agent or combined with chemotherapy in molecularly unselected patients. Some studies determined prognostic value of plasma biomarkers and cytokines in patients treated with Ramucirumab (RAINBOW trial). Other studies have shown no relationship between Ramucirumab therapy and VEGFR-2 mutation (REGARD trial). However, no studies have shown significant survival benefit for certain genetic profiles in patients treated with Ramucirumab therapy. The aim of this study is to assess the value of certain molecular profiles in predicting response to Ramucirumab therapy in advanced or metastatic gastric cancer
Methods: This is a retrospective study to determine molecular profiles for gastric cancer that predict outcomes of treatment with Ramucirumab. Patients' molecular profiling will be studied using NGS. Included patients are those with advanced or metastatic gastric cancer treated with second-line Ramucirumab therapy combined with Paclitaxel. Patient characteristics are collected retrospectively from medical records including tumor localization, size, stage, type of surgery, definitive histological subtype, number of lymph nodes resected. Type and response to first line chemotherapy as well as overall survival (OS) and disease free survival (DFS) are acquired for all patients
Results o Kaplan-Meier curves for DFS and OS will be compared between subjects with different somatic mutations using log-rank test. Multivariate Cox regression models for DFS and OS with mutated somatic genes as independent variables were computed. Any predictive factor for response to Ramucirumab, especially molecular, will be reported
Conclusion o Molecular characteristics of advanced gastric cancer patients will be analyzed to define any predictive value for response to Ramucirumab in second-line based therapy
ABSTRACT
El incremento de los cánceres incidentales del riñón podría significar un aumento de la cirugía conservadora en el tratamiento del cáncer renal. Se analiza una serie constituida por 15 casos de la cirugía conservadora en el tratamiento de cánceres renales durante 11 años. Corresponde a alrededor del 8 por ciento del total de operaciones por cáncer renal en ese período. En once oportunidades debió realizarse este tipo de intervenciones por tumores bilaterales sincrónicos (9 casos) o monorrenos reales o funcionales (2 casos). Solo 4 pacientes fueron sometidos a cirugía conservador por tumor unilateral pequeño. Del total de tumores renales incidentales Grado I de Robson (18 casos), candidatos a cirugía parcial, solo se realizó ésta en el 22 por ciento dadas las características de localización y tamaño del tumor. El tiempo de seguimiento para los 15 pacientes varió entre 4 y 119 meses. La sobrevida actuarial es del 93 por ciento. Se discuten las indicaciones, ventajas e inconvenientes de este tipo de tratamiento de los cánceres renales a la luz del claro incremento de los tumores incidentales renales