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The asymptomatic progression of chemotherapy-induced cardiotoxicity poses a significant risk to breast cancer patients. In the present single-center cohort study, a predictive model for evaluating the risk of cardiotoxicity during or by the end of chemotherapy was designed. The risk-prediction nomogram was delineated and assessed. In total, 34 patients out of 120 developed asymptomatic cardiotoxicity (28.3%). Of six explored biomarkers, only B-type natriuretic peptide showed a reliable pattern of incremental increase, revealing statistical significance between cardiotoxicity "+" and "-" groups by visit 4 or by the 9th month of monitoring (p 0.006). The following predictors were included in the model: age, hypertension, diabetes mellitus, baseline glomerular filtration rate, 6 min walk test measured at visit 4, BNP values at visit 4, left ventricular ejection fraction levels at visit 4, a total dose of radiotherapy received, and anthracycline cumulative doses. The model's AUC was 0.72 (95% CI 0.59; 0.86), evidencing the satisfactory predictive ability of the model; sensitivity 100% (95% CI 90.36; 100.0) at a specificity of 66.67% (95% CI 50.33; 79.79); PPV 54.1% [95% CI 47.13; 60.91]; PVN 100% [95% CI 94.64; 100.00]. The calibration plot showed satisfactory agreement between predicted and actual chances (p = 0.98). The designed model can be applied in settings lacking speckle tracking echocardiography.
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The prognosis of cancer treatment depends on, among other aspects, the cardiotoxicity of chemotherapy. This research aims to create a feasible algorithm for the early diagnosis of antitumor therapy cardiotoxicity in breast cancer patients. The paper represents a protocol for a prospective cohort study with N 120 eligible participants admitted for treatment with anthracyclines and/or trastuzumab. These patients will be allocated into four risk groups regarding potential cardiotoxic complications. Patients will be examined five times every three months for six biomarkers,: cardiac troponin I (cTnI), brain natriuretic peptide (BNP), C-reactive protein (CRP), myeloperoxidase (MPO), galectin-3 (Gal-3), and D-dimer, simultaneously with echocardiographic methods, including speckle tracking. The adjusted relative risk (aOR) of interrupting an entire course of chemotherapy due to cardiotoxic events will be assessed using multiple analyses of proportional Cox risks. The Cox model will also assess associations between baseline biomarker values and time to cardiotoxic events. Moreover, partly conditional survival models will be applied to determine associations between repeated assessments of changes in biomarkers from baseline and time to cancer therapy-related cardiac dysfunction. All models will be adjusted for cancer therapy regimen, baseline LVEF, groups at risk, baseline biomarker values, and age. The decision-tree and principal component analysis (PCA) methods will also be applied. Thus, feasible patterns will be detected.
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This retrospective cohort study focused on colposcopic accuracy for the diagnosis of cervical premalignant lesions using cytology and histology, as well as HPV data not included in current cervical screening practices in Kazakhstan. Colposcopy performance was assessed using the modified Reid index in women aged 18-63 years. In total, 1,129 colposcopic-HPV-cytology triple samples and 94 histology findings were collected. The sensitivity of colposcopy was 81.6% with specificity 72.6% for LSIL but fell to 56.6% with specificity 88.3% for CIN2+ vs. 89.6% and 74.5% for cytology at CIN2+, respectively. The ORs for high-grade lesion occurrence within each colposcopy group at viral load rising vs. ORs for HPV-negative women were 3.4; 5.3; and 39.7, respectively (p < 0.0001). Total attributive agreement between the colposcopy and histology findings reached 55.3%, κ 0.47 ± 0.06 vs. 0.62 ± 0.08 for cytology, and 0.34 ± 0.13 and 0.58 ± 0.1, for specialists, respectively. Outcomes obtained for colposcopy alone failed to show satisfactory reliability. Globally adopted primary HPV screening would be the best option despite the related costs.
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OBJECTIVE: to assess the current state of gastric cancer (GC) incidence and its five-year survival across Aktobe region of western Kazakhstan from 2009 to 2018 by presenting key indicators and analyzing the most significant features. METHODS: Rough incidence rates (per 100,000) and average annual percent changes (aAPCs) were estimated for each age group at diagnosis with respect to gender, ethnicity, residence, the disease stages, tumor subsite, and histology type using linear regression analysis, including the prognostic index for 2019-2020. Overall five-year survival rates were estimated by the Kaplan-Meier method. RESULTS: Overall GC incidence increased from 19.2 to 29.3, and averaged 25.8 (R2 0.65) with aAPC of 3.2%, with a potential to further rise (30.4 by 2020, p<0.001). Non-cardia location (17.8, p<0.001, aAPC 6.4%) and intestinal type of the tumor (17.0, p<0.001, aAPC 7.35%) were predominant. The observed overall five-year survival rate was 28.4% (95% CI 24.5;32.3) with a median survival time of 8.0 months (95% CI 6.6;9.4). Groups aged 40-49 and ≥70 had the lowest rates (24.4% and 22.1%, respectively, log-rank p 0.008), but the youngest individuals (18-39 years) showed the shortest median survival time, 5.0 months after diagnosis at the survival rate of 29.4%. Resectional surgery contributed significantly to the median survival time, 23.0 months vs. 6.0 in non-operated patients (log-rank p<0.001). CONCLUSION: GC in Aktobe region was featured by growing incidence and unsatisfactory five-year survival rates. Indigenous males of 60-69 years old with intestinal histology type, as well as the youngest patients irrespective of their gender, ethnicity, and other characteristics were recognized as high risk groups. Besides, relatively high aAPC 5.1% in the youngest revealed their further expected vulnerability. Further research is suggested to focus on risk factors, including gene expression profiling, to find out an accessible preventive strategy.
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Mortalidad/tendencias , Sistema de Registros/estadística & datos numéricos , Neoplasias Gástricas/mortalidad , Adolescente , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Kazajstán/epidemiología , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Neoplasias Gástricas/epidemiología , Neoplasias Gástricas/patología , Neoplasias Gástricas/cirugía , Tasa de Supervivencia , Factores de Tiempo , Adulto JovenRESUMEN
High-risk human papillomavirus strains are widely known to be the causative agents responsible for cervical cancer development. Aggregated damage caused by papillomaviruses solely is estimated in at least 5% of all malignancies of the human body and 16% in cancers that affect the female genital area. Enhanced understanding of the complex issue on how the high extent of carcinogenicity is eventually formed due to the infection by the Papoviridae family would contribute to enhancing current prevention strategies not only towards cervical cancer, but also other HPV associated cancers. This review article is aimed at presenting the key points in two directions: the current cervical cancer prevention and related aspects of HPV behavior. Virtually all applied technologies related to HPV diagnostics and screening programs, such as HPV tests, colposcopy-based tests (VIA/VILI), conventional and liquid-based cytology, currently available are presented. Issues of availability, advantages, and drawbacks of the screening programs, as well as vaccination strategies, are also reviewed in the article based on the analyzed sources. The current point of view regarding HPV is discussed with emphasis on the most problematic aspect of the HPV family concerning the observed increasing number of highly carcinogenic types. Present trends in HPV infection diagnostics throughout the human fluids and tissues are also reported, including the latest novelties in this field, such as HPV assay/self-sample device combinations. Besides, a brief outline of the related prevention issues in Kazakhstan, the leading country of Central Asia, is presented. Kazakhstan, as one of the post-soviet middle-income countries, may serve as an example of the current situation in those terrains, concerning the implementation of globally accepted cervical cancer prevention strategies. Along with positive achievements, such as the development of a nationwide screening program, a range of drawbacks is also analyzed and discussed.
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Papillomaviridae , Infecciones por Papillomavirus , Vacunas contra Papillomavirus , Neoplasias del Cuello Uterino , Colposcopía , Detección Precoz del Cáncer , Femenino , Humanos , Tamizaje Masivo , Infecciones por Papillomavirus/diagnóstico , Infecciones por Papillomavirus/prevención & control , Infecciones por Papillomavirus/virología , Embarazo , Prevalencia , Neoplasias del Cuello Uterino/prevención & controlRESUMEN
Abstract Introduction The study is aimed to outline the vector of colorectal cancer incidence in the industrial Aktobe province of western Kazakhstan through the first decade of the screening implementation, 2009-2018. Methods Rough incidence rates and annual percent changes were estimated for each age group at diagnosis, ethnicities, gender, residences, the disease stages and anatomic subsites (total N 1128) via regression analysis. Results Within 2009-2018 colorectal cancer rates increased from 14.74 to 23.19, with annual percent changes of 4.69%. The most significant growth was traced in men compared to women, up to 28.39 by 2018, with annual percent changes 6.64% vs. 2.64% (p = 0.0009). Annual percent changes in Kazakhs reached 8.7%, whereas Slavic groups showed decline in the incidence, annual percent changes −4.3% (p = 0.002). Declining in rates was also observed in urban population compared to rural one, annual percent changes −3.3% vs. 17.6%, respectively. Patients aged 60-69 made 31% of all cases and showed the largest annual percent changes 9.37% (p = 0.002). Patients at Stage II made 61% of all observations, but general trend evidenced sharp growth in the group of Stage I (annual percent changes 28.91%, p < 0.0001). Conclusion Overall, during the last decade colorectal cancer incidence increased 1.5 fold with expected further rise. However, the increment of Stage I portion by 2018 vs. advanced stages at diagnosis and the trend to decrease in rates among urban population inspire a definite assurance in potential efficiency of the screening program in long run. The next researches on colorectal cancer should include scenarios to reveal the role of disadvantaged environment in the region and consuming unhealthy ultra-processed food.
Resumo Introdução O objetivo do estudo é delinear o vetor da incidência do câncer colorretal na província industrial de Aktobe, no oeste do Cazaquistão, durante a primeira década da implementação do rastreamento, 2009‒2018. Métodos Taxas de incidência brutas e alterações percentuais anuais foram estimadas para cada faixa etária ao diagnóstico, etnias, sexo, residências, estágios da doença e localizações anatômicas (N total de 1.128) através da análise de regressão. Resultados Entre 2009‒2018, as taxas de câncer colorretal aumentaram de 14,74 para 23,19, com alteração percentual anual de 4,69%. O crescimento mais significativo foi evidenciado em homens em comparação com as mulheres, até 28,39 em 2018, com alterações percentuais anuais de 6,64% contra 2,64% (p = 0,0009). Alterações percentuais anuais nos cazaques atingiu 8,7%, enquanto os grupos eslavos mostraram declínio na incidência, alterações percentuais anuais -4,3% (p = 0.002). O declínio nas taxas também foi observado na população urbana em comparação com a rural, alterações percentuais anuais -3,3% vs. 17,6%, respectivamente. Pacientes com idade entre 60‒69 anos eram 31% de todos os casos e apresentaram as maiores alterações percentuais anuais 9,37% (p = 0,002). Os pacientes no Estágio II eram 61% de todas as observações, mas a tendência geral evidenciou crescimento acentuado no grupo do Estágio I (alterações percentuais anuais 28.91%; p < 0,0001). Conclusão No geral, durante a última década, a incidência de câncer colorretal aumentou 1,5 vezes com expectativa de maior aumento. No entanto, o incremento da porção do Estágio I em 2018 em comparação com os estágios avançados no momento do diagnóstico e a tendência de diminuição nas taxas entre a população urbana inspira uma garantia definitiva de eficiência potencial do programa de rastreamento em longo prazo. As próximas pesquisas sobre o câncer colorretal devem incluir cenários para revelar o papel do ambiente desfavorecido na região e o consumo de alimentos ultraprocessados não saudáveis.
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Adulto Joven , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/epidemiología , Incidencia , Estudios RetrospectivosRESUMEN
OBJECTIVE: To assess the effectiveness of the current cervical cancer screening tools in Western Kazakhstan. METHODS: Smears taken through (i) conventional cytology using azur-eosin staining and (ii) liquid-based cytology (LBC) 'Cell Scan' in the general female population and in women first diagnosed with cervical cancer were collected throughout the region. ROC-analysis with curve construction and weighted Cohen's κ calculation were applied. A total of 494 cytological pairs were collected, including 94 sets with histology findings. RESULTS: The conventional (azur-eosin staining) technique contained 0.2% non-informative material and LBC 'Cell Scan' had 5.9%. Area under the curve was 0.95 for the conventional technique and 0.92 for 'Cell Scan' (p > 0.05). The conventional smears showed κ 0.62, sensitivity 90.4% at specificity 90.0% for CIN2+, while LBC 'Cell Scan' smears showed κ 0.47, sensitivity 83.3% at specificity 92.5%. CONCLUSIONS: In this analysis it was not possible to prove that the LBC 'Cell Scan' technique was superior to its predecessor, azur-eosin staining. These findings highlight the need to modify the current screening programme according to updated international scientific evidence on effective screening design, such as the use of HPV DNA testing with Pap smear triage in women aged 30 or older. Further research, and a Health Technology Assessment, are necessary if we wish to establish a national standardized screening programme using the available technology appropriately.
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Colorantes Azulados , Detección Precoz del Cáncer/métodos , Prueba de Papanicolaou/métodos , Neoplasias del Cuello Uterino/diagnóstico , Frotis Vaginal/métodos , Adolescente , Adulto , Área Bajo la Curva , Técnicas Citológicas/métodos , Eosina Amarillenta-(YS) , Femenino , Colorantes Fluorescentes , Humanos , Kazajstán , Persona de Mediana Edad , Curva ROC , Coloración y Etiquetado , Adulto JovenRESUMEN
Objective: to detect the HPV types distribution both in general female population and in women with first diagnosed cervical cancer, including viral load in both groups. Methods: Qualitative detection and quantification of HPV was performed by PCR-Real time method based on the Russian equipment and test systems ("DNA-Technology" LLC, Russia). The DNA of low-risk (HPV 6, 11, 44) and possibly / potentially / high carcinogenic risk (HPV 16, 18, 26, 31, 33 , 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68, 73, 82), a total of 21 types, were detected. Results: During the period of 2014-2017 total 1,166 clinically healthy women were tested for HPV, as well as 73 women diagnosed with CaCx. Overall prevalence of HPV in female population was determined as 25.0% (95% CI 22.3;27.7, p = 0.05). Top-5 leading HPV types: 16 (26.4%); 31 (10.1%); 51 (9.4%); 52 (9.0%); 6 (7.9%). Average viral load was 5.5±3.8 (CI 95% 5.1;5.9). In women diagnosed with CaCx ranking was as follows 16 (54.1%), 31 (11.2%), 18 / 58 (5.1% each), 33 / 45 (4.1% each). Type 16 appeared to be one of the most significant risk factors of the CaCx development (p=0.00007, phi 0.35, Pierson's X 2 15.9). Average viral load in patients with CaCx was 6.9±4.0 (95% CI 6.1;7.7). A reliable relationship between the cancer staging and the viral load was found (p = 0.043, n = 73). Domination of type 16 calls for urgent need the transition to HPV primary screening and resumption of immunization program discontinued in 2014. The study is registered in ISRCTN registry, No. ISRCTN71514910 (01.02.2018).