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1.
Technol Cancer Res Treat ; 20: 15330338211035037, 2021.
Article in English | MEDLINE | ID: covidwho-1484272

ABSTRACT

BACKGROUND: Oncotype Dx (ODx) is a genomic assay which estimates the risk of distant recurrence and predicts adjuvant chemotherapy benefit in early stage breast cancer patients. Most ODx data is derived from excisional specimens. AIM: We assess the utility of ODx on core needle biopsies (CNB) and measure its impact on neoadjuvant treatment decisions, particularly in patients with clinically complicated situations. METHODS: Consecutive ODx results on breast CNBs with invasive carcinoma from 2012-2020 at 3 tertiary care hospitals with dedicated Breast Health Centers were reviewed. Clinical indications to perform ODx on CNB were recorded through a review of patients' electronic medical records. Clinicopathologic features, surgical or oncologic modalities and follow-up data were recorded. RESULTS: Three distinct clinical indications for performing ODx on CNB in 85 ER+ invasive breast carcinomas were identified: 1) Excisions with insufficient tissue to perform ODx, 2) adjudicate neoadjuvant therapy versus primary surgical resection, and 3) select neoadjuvant chemotherapy (NAC) versus neoadjuvant endocrine therapy (NET). Primary surgery was selected in patients with low score RS (<18), and NET was preferred in patients with intermediate or high RS (>18). NET was preferred over NAC in patients with low RS (<18). CONCLUSION: This study shows that CNB ODx RS helps guide treatment decisions in a neoadjuvant setting along with other contributing factors such as the presence of pathogenic mutations, node positivity, patient age, and comorbidities. The use of ODx on CNB is furthermore valuable in the midst of the COVID-19 pandemic for early breast cancer patients to administer effective therapy in a timely manner.


Subject(s)
Breast Neoplasms, Male/diagnosis , Breast Neoplasms/diagnosis , Carcinoma, Ductal, Breast/diagnosis , Neoplasm Recurrence, Local , Adult , Aged , Aged, 80 and over , Biomarkers, Tumor/genetics , Biopsy, Large-Core Needle , Breast Neoplasms/pathology , Breast Neoplasms, Male/pathology , Carcinoma , Carcinoma, Ductal, Breast/pathology , Combined Modality Therapy , Electronic Health Records , Female , Gene Expression Profiling/methods , Genomics , Hormones/therapeutic use , Humans , Male , Medical Oncology , Middle Aged , Neoadjuvant Therapy , Neoplasm Invasiveness , Retrospective Studies , Treatment Outcome
2.
Andrologia ; 53(6): e14061, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1276536

ABSTRACT

Testicular cancer, in particular testicular germ cell tumours, is the most common malignancy in young adult men. Defining prognosis and the best therapeutic strategy is challenging since accurate staging could be controversial. We report an unusual case of seminoma with pagetoid spread into the rete testis and, unexpectedly, also within the epithelium of the vas deferens, up to the margin of excision of the spermatic cord. Focussing on the extremely rare pathological finding and the challenge in defining the stage and the best post-surgical management, we would like to raise some issues about the knowledge gap on this topic.


Subject(s)
Neoplasms, Germ Cell and Embryonal , Seminoma , Testicular Neoplasms , Humans , Male , Neoplasm Invasiveness , Seminoma/surgery , Testicular Neoplasms/surgery , Vas Deferens , Young Adult
3.
Int J Clin Pract ; 75(9): e14490, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1266327

ABSTRACT

PURPOSE: To evaluate the impact of delay in cystoscopic surveillance on recurrence and progression rates in non-muscle-invasive bladder cancer (NMIBC). MATERIALS AND METHODS: A total of 407 patients from four high-volume centres with NMIBC that applied for follow-up cystoscopy were included in our study prospectively. Patients' demographics and previous tumour characteristics, the presence of tumour in follow-up cystoscopy, the pathology results of the latest transurethral resection of bladder tumour (if tumour was detected) and the delay in cystoscopy time were recorded. Our primary outcomes were tumour recurrences detected by follow-up cystoscopy and progression. Multivariate logistic regression analysis was performed using the possible factors identified with univariate analyses (P values ≤ .2). RESULTS: A total of 105 patients (25.8%) had tumour recurrence in follow-up cystoscopy, and 20 (5.1%) of these patients had disease progression according to grade or stage. In multivariate analysis, the number of recurrences (OR: 1.307, P < .001) and the cystoscopy delay time (62-147 days, OR: 2.424, P = .002; >147 days, OR: 4.883, P < .001) were significant risk factors for tumour recurrence on follow-up cystoscopy; the number of recurrences (OR: 1.255, P = .024) and cystoscopy delay time (>90 days, OR: 6.704, P = .002) were significant risk factors for tumour progression. CONCLUSIONS: This study showed that a 2-5 months of delay in follow-up cystoscopy increases the risk of recurrence by 2.4-fold, and delay in cystoscopy for more than 3 months increases the probability of progression by 6.7-fold. We suggest that cystoscopic surveillance should be done during the COVID-19 pandemic according to the schedule set by relevant guidelines.


Subject(s)
COVID-19 , Urinary Bladder Neoplasms , Cystoscopy , Humans , Neoplasm Invasiveness , Neoplasm Recurrence, Local , Pandemics , SARS-CoV-2 , Urinary Bladder Neoplasms/epidemiology , Urinary Bladder Neoplasms/surgery
4.
IUBMB Life ; 73(6): 843-854, 2021 06.
Article in English | MEDLINE | ID: covidwho-1219298

ABSTRACT

The 78 kDa glucose-regulated protein (GRP78) is an endoplasmic reticulum (ER)-resident molecular chaperone. GRP78 is a member of the 70 kDa heat shock family of proteins involved in correcting and clearing misfolded proteins in the ER. In response to cellular stress, GRP78 escapes from the ER and moves to the plasma membrane where it (a) functions as a receptor for many ligands, and (b) behaves as an autoantigen for autoantibodies that contribute to human disease and cancer. Cell surface GRP78 (csGRP78) associates with the major histocompatibility complex class I (MHC-I), and is the port of entry for several viruses, including the predictive binding of the novel SARS-CoV-2. Furthermore, csGRP78 is found in association with partners as diverse as the teratocarcinoma-derived growth factor 1 (Cripto), the melanocortin-4 receptor (MC4R) and the DnaJ-like protein MTJ-1. CsGRP78 also serves as a receptor for a large variety of ligands including activated α2 -macroglobulin (α2 M*), plasminogen kringle 5 (K5), microplasminogen, the voltage-dependent anion channel (VDAC), tissue factor (TF), and the prostate apoptosis response-4 protein (Par-4). In this review, we discuss the mechanisms involved in the translocation of GRP78 from the ER to the cell surface, and the role of secreted GRP78 and its autoantibodies in cancer and neurological disorders.


Subject(s)
Autoimmune Diseases of the Nervous System/immunology , COVID-19/transmission , Heat-Shock Proteins/physiology , Neoplasm Proteins/physiology , Nerve Tissue Proteins/physiology , Receptors, Cell Surface/physiology , Receptors, Virus/physiology , SARS-CoV-2/metabolism , Spike Glycoprotein, Coronavirus/metabolism , Autoantibodies/immunology , Autoantigens/immunology , Autoimmune Diseases of the Nervous System/metabolism , Cell Survival , Endoplasmic Reticulum Stress/physiology , Exosomes , GPI-Linked Proteins/metabolism , Heat-Shock Proteins/chemistry , Heat-Shock Proteins/immunology , Humans , Ligands , Neoplasm Invasiveness , Neoplasm Proteins/immunology , Nerve Tissue Proteins/immunology , Protein Domains , Protein Transport , Signal Transduction , Tumor Microenvironment , Unfolded Protein Response/physiology , Virus Internalization
8.
Clin Genitourin Cancer ; 19(1): 41-46.e1, 2021 02.
Article in English | MEDLINE | ID: covidwho-926856

ABSTRACT

INTRODUCTION: During the coronavirus disease 2019 (COVID-19) pandemic, providers and patients must engage in shared decision making to ensure that the benefit of early intervention for muscle-invasive bladder cancer exceeds the risk of contracting COVID-19 in the clinical setting. It is unknown whether treatment delays for patients eligible for curative chemoradiation (CRT) compromise long-term outcomes. PATIENTS AND METHODS: We used the National Cancer Data Base to investigate whether there is an association between a ≥ 90-day delay from transurethral resection of bladder tumor (TURBT) in initiating CRT and overall survival. We included patients with cT2-4N0M0 muscle-invasive bladder cancer from 2004 to 2015 who underwent TURBT and curative-intent concurrent CRT. Patients were grouped on the basis of timing of CRT: ≤ 89 days after TURBT (earlier) vs. ≥ 90 and < 180 days after TURBT (delayed). RESULTS: A total of 1387 (87.5%) received earlier CRT (median, 45 days after TURBT; interquartile range, 34-59 days), and 197 (12.5%) received delayed CRT (median, 111 days after TURBT; interquartile range, 98-130 days). Median overall survival was 29.0 months (95% CI, 26.0-32.0) versus 27.0 months (95% CI, 19.75-34.24) for earlier and delayed CRT (P = .94). On multivariable analysis, delayed CRT was not associated with an overall survival difference (hazard ratio, 1.05; 95% CI, 0.87-1.27; P = .60). CONCLUSION: Although these results are limited and require validation, short, strategic treatment delays during a pandemic can be considered on the basis of clinician judgment.


Subject(s)
COVID-19/prevention & control , Chemoradiotherapy, Adjuvant/standards , Decision Making, Shared , Time-to-Treatment/standards , Urinary Bladder Neoplasms/therapy , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/transmission , Chemoradiotherapy, Adjuvant/statistics & numerical data , Cystectomy , Female , Follow-Up Studies , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Neoplasm Invasiveness , Pandemics/prevention & control , Time Factors , Time-to-Treatment/statistics & numerical data , Treatment Outcome , Urinary Bladder Neoplasms/mortality , Urinary Bladder Neoplasms/pathology , Young Adult
9.
Arch Bronconeumol (Engl Ed) ; 56(10): 674-676, 2020 Oct.
Article in English, Spanish | MEDLINE | ID: covidwho-614755
10.
Head Neck ; 42(6): 1179-1186, 2020 06.
Article in English | MEDLINE | ID: covidwho-380347

ABSTRACT

BACKGROUND: The novel coronavirus 2019 (COVID-19) pandemic has changed health care, challenged by resource constraints and fears of transmission. We report the surgical practice pattern changes in a Head and Neck Surgery department of a tertiary cancer care center and discuss the issues surrounding multidisciplinary care during the pandemic. METHODS: We report data regarding outpatient visits, multidisciplinary treatment planning conference, surgical caseload, and modifications of oncologic therapy during this pandemic and compared this data to the same interval last year. RESULTS: We found a 46.7% decrease in outpatient visits and a 46.8% decrease in surgical caseload, compared to 2019. We discuss the factors involved in the decision-making process and perioperative considerations. CONCLUSIONS: Surgical practice patterns in head and neck oncologic surgery will continue to change with the evolving pandemic. Despite constraints, we strive to prioritize and balance the oncologic and safety needs of patients with head and neck cancer in the face of COVID-19.


Subject(s)
Coronavirus Infections/epidemiology , Head and Neck Neoplasms/surgery , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Practice Patterns, Physicians'/organization & administration , Surgical Oncology/organization & administration , COVID-19 , Coronavirus Infections/prevention & control , Delivery of Health Care , Female , Head and Neck Neoplasms/mortality , Head and Neck Neoplasms/pathology , Humans , Male , Neoplasm Invasiveness/pathology , Neoplasm Staging , Pneumonia, Viral/prevention & control , Program Evaluation , Reference Values , Survival Analysis , Tertiary Care Centers/organization & administration , United States
11.
Head Neck ; 42(6): 1173-1178, 2020 06.
Article in English | MEDLINE | ID: covidwho-116849

ABSTRACT

BACKGROUND: The coronavirus infection is rapidly spreading, putting a strain on health care services across the globe. Patients with oral cancer are susceptible often immunosuppressed due to the disease and/or the treatment received. METHODS: We performed a simulation of the currently available data using a multistate and hazards model to provide an objective model for counseling and decision making for health care workers. RESULTS: Stage IV patients with oral cancer who did not receive treatment had progression of disease and an increased mortality rate compared to patients who receive treatment but did not contract COVID-19. The patients who received treatment and got affected with COVID-19 had a far worse impact and higher mortality rate than all other groups. CONCLUSION: Isolation and deferring treatment for stage IV patients with oral cancer, so as to avoid hospital visits and contraction of COVID-19, is an advisable strategy based on this model.


Subject(s)
Cause of Death , Clinical Decision-Making/methods , Coronavirus Infections/epidemiology , Mouth Neoplasms/pathology , Mouth Neoplasms/surgery , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , COVID-19 , Computer Simulation , Coronavirus Infections/prevention & control , Disease Management , Disease-Free Survival , Female , Humans , Male , Mouth Neoplasms/mortality , Neoplasm Invasiveness/pathology , Neoplasm Staging , Patient Selection , Pneumonia, Viral/prevention & control , Proportional Hazards Models , Risk Assessment , Survival Analysis , United States
12.
Breast Cancer Res Treat ; 181(3): 487-497, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-116756

ABSTRACT

The COVID-19 pandemic presents clinicians a unique set of challenges in managing breast cancer (BC) patients. As hospital resources and staff become more limited during the COVID-19 pandemic, it becomes critically important to define which BC patients require more urgent care and which patients can wait for treatment until the pandemic is over. In this Special Communication, we use expert opinion of representatives from multiple cancer care organizations to categorize BC patients into priority levels (A, B, C) for urgency of care across all specialties. Additionally, we provide treatment recommendations for each of these patient scenarios. Priority A patients have conditions that are immediately life threatening or symptomatic requiring urgent treatment. Priority B patients have conditions that do not require immediate treatment but should start treatment before the pandemic is over. Priority C patients have conditions that can be safely deferred until the pandemic is over. The implementation of these recommendations for patient triage, which are based on the highest level available evidence, must be adapted to current availability of hospital resources and severity of the COVID-19 pandemic in each region of the country. Additionally, the risk of disease progression and worse outcomes for patients need to be weighed against the risk of patient and staff exposure to SARS CoV-2 (virus associated with the COVID-19 pandemic). Physicians should use these recommendations to prioritize care for their BC patients and adapt treatment recommendations to the local context at their hospital.


Subject(s)
Breast Neoplasms/classification , Breast Neoplasms/therapy , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Betacoronavirus/isolation & purification , Breast Neoplasms/diagnosis , Breast Neoplasms/pathology , COVID-19 , Coronavirus Infections/virology , Female , Health Resources , Humans , Neoplasm Invasiveness , Pandemics , Pneumonia, Viral/virology , SARS-CoV-2 , Telemedicine , Triage
13.
Eur Urol ; 78(1): 1-3, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-116508

ABSTRACT

Non-muscle-invasive bladder cancer patients with COVID-19 are more likely to develop acute respiratory distress syndrome. Thus, several adjustments to the use of intravesical instillations of bacillus Calmette-Guérin should be made during the current pandemic to limit the risk of contamination.


Subject(s)
BCG Vaccine/administration & dosage , Betacoronavirus , Coronavirus Infections/complications , Pandemics , Pneumonia, Viral/complications , Urinary Bladder Neoplasms/drug therapy , Adjuvants, Immunologic/administration & dosage , Administration, Intravesical , Aged , COVID-19 , Coronavirus Infections/epidemiology , Disease Progression , Drug Administration Schedule , Female , Humans , Male , Neoplasm Invasiveness , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Urinary Bladder Neoplasms/complications , Urinary Bladder Neoplasms/pathology
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