Comparison of the effects of perioperative and adjuvant chemotherapy on outcomes of operable gastric cancer: A retrospective cohort experience from a tertiary cancer center.

OBJECTIVE: To compare the overall survival and disease-free survival rates with perioperative or adjuvant chemotherapy regimens in operable gastric cancer cases. METHODS: The retrospective, observational study was conducted at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised date from January 2015 to December 2020 of operable gastric cancer patients who had perioperative or adjuvant chemotherapy. Overall survival and disease-free survival were evaluated. Data was analysed using SPSS 23. RESULTS: Of the 108 patients in the aga range 27-80 years, 71(65.74%) were males. The overall median age was 49.50 years (interquartile range: 28 years). There were 69(63.88%) patients on perioperative and 39(36.12%) on adjuvant chemotherapy. The probability of 2- and 3-year overall survival was 68.20% and 57.32% in the perioperative group, and 51.09% and 45.43%, respectively, in the adjuvant group. The probability of 2- and 3-year disease-free survival was 55.45% and 49.30% in the perioperative group, while 2-year disease-free survival was 38.39% in the adjuvant group which had no patient reaching the 3-year mark. The median overall survival for the perioperative group was 49.29 months (interquartile range: 44.50 months) and for the adjuvant group it was 28.23 months (interquartile range: 25.00months) (p=0.07). The median disease-free survival was 35.46 months (interquartile range: 38.50 months) for the perioperative group and 10.19 months (interquartile range: 14.00months) for adjuvant group (p=0.16). The difference between the groups was not significant (p>0.05), but there was a trend suggestive of the superiority of perioperative chemotherapy over adjuvant chemotherapy. CONCLUSIONS: In operable gastric cancer cases, the difference between the groups was not significant, but there was a trend suggestive of the superiority of perioperative chemotherapy over adjuvant chemotherapy with respect to overall survival and disease-free survival.

The Clinicopathologic Characteristics and Outcomes of Gastroentero-pancreatic Neuroendocrine Tumors - Experience from A Tertiary Cancer Center.

OBJECTIVE: Gastroentero-pancreatic neuroendocrine tumor (GEP NETs) are a heterogeneous group of tumors with variable behaviors. Our aim was to study the baseline characteristics and outcomes of GEP-NETs and to establish the impact of tumor grade and resectability on the survival. METHODS: A single center retrospective review of patients registered at SKMCH &RC Pakistan with the diagnosis of GEP-NETs was carried out from the Hospital Information System. The baseline characteristics of 134 diagnosed patients from January 2006 to August 2020 were analyzed. Overall survival (OS) and Disease Free Survival (DFS) was calculated using Kaplan-Meier curve. The impact of tumor grade and resectability was seen on the OS and DFS. Data was analyzed through SPSS version 23. Categorical parameters were computed using ChiSquare test, keeping p-value =0.05 significant. RESULT: A large majority had Grade 1 disease (59%) along with localized stage at presentation (73.1%) as compared to Grade 2 (23.9%) and Grade 3 (17.1%) disease with metastatic stage at presentation (26.9%). The 5 year OS according to tumor grade was, 88%, 57% and 0% in low, intermediate and high grade respectively. The 5-year OS was 94%, 79% and 43% in the completele, incomplete and in unresectable disease group, respectively. CONCLUSION: GEP-NETs are rare tumors with good outcomes in Grade I and II and poor outcomes in grade III Neuroendocrine Carcinomas (NEC). Tumor grade and complete surgery of the primary tumor are important predictors of response outcomes and prognosis.

Comparison of three standard neoadjuvant chemotherapy regimens based on pathological tumor response in breast cancer patients.

We compared the efficacy of different neoadjuvant chemotherapy regimens and pathological factors related to higher pCR in localized breast cancer. This comparative retrospective study included 313 patients with breast carcinoma who received neoadjuvant therapy from January 2017 till July 31, 2019 at our institute. Patients were grouped in 3 different categories according to the treatment arms. In Arm A, patients received dose-dense AC [4 Cycles] followed by dose dense paclitaxel [4 Cycles]. In Arm B, 2 weekly dose dense AC [4 Cycles] followed-by paclitaxel every week [12 Cycles], while Arm C received 3 weekly AC [4 Cycles] and 3 weekly paclitaxel [4 Cycles]. pCR was seen in 135(43.1%) patients with the highest pCR in arm B i-e 33(55%), followed by 39(43.3%) in arm A, and 63(38.6%) in arm C. Triple-negative patients had the highest percentage of pCR 38 (65.5%). HER2 positive patients who received neoadjuvant Trastuzumab also had increased pCR rate of 21 (61.7%). ER/PR positive, HER2 negative patients had the lowest pCR 56 (33.5%). Dose dense AC [4 cycles] followed-by weekly Paclitaxel [12 cycles] is the most effective neoadjuvant therapy regimen for breast cancer patients, particularly if they were also triple negative and HER2 positive receiving Trastuzumab.