A study of human epidermal growth factor receptor 2 overexpression by immunohistochemistry in patients with gastric adenocarcinoma.

Gastric cancer is one of the leading causes of cancer-related deaths across the world and in the Middle East. Human epidermal growth factor receptor 2 (HER2) overexpression has been observed in gastric cancers. Trastuzumab, a recombinant monoclonal antibody targeting HER2 protein, is being used for treatment of metastatic gastric cancer. To study the frequency and association of HER2 overexpression with age, gender, histopathological subtype and grade of differentiation in patients with gastric adenocarcinoma from Basra, Iraq. This cross-sectional single-center study collected demographic (age, gender), histopathological (histological subtype, grade of differentiation) and immunohistochemical (HER2 overexpression status) data from 100 consenting adult patients (male: 56) with histopathologically confirmed gastric adenocarcinoma from samples obtained through endoscopy or surgery. HER2 overexpression (ToGA score 3+) was observed in 6/100 (6%) of patients, with another 6 showing 'equivocal' HER2 expression (2+). Out of 20 patients with moderately differentiated gastric cancer, 4 (20%) showed HER2 overexpression (p=0.008). Other factors considered (age, gender, histological subtype) did not show statistically significant correlation with HER2 overexpression. More females showed HER2 overexpression than males (4 vs. 2), and more patients with intestinal type gastric cancer showed HER2 overexpression than diffuse gastric cancer (5 vs. 1), but the difference was not statistically significant in both variables. HER2 overexpression was 6% in this population; statistically significant correlation was found with histological grade. Statistically non-significant correlations were observed between HER2 overexpression and gender, age, and histological subtype.

Epidemiology of Different Types of Cancers Reported in Basra, Iraq.

OBJECTIVES: This study aimed to report the incidence and pattern of various types of cancers and their distribution across various demographic groups in Basra, Iraq. METHODS: Cancer cases recorded during 2017 at the Basra Cancer Control Centre, the Department of Pathology and Forensic Medicine, the Basra Oncology and Hematology Centre, the Basra Children's Hospital and at private laboratories were included in the study. Patients' records were analysed for information related to age, gender, residence and type of cancer. Incidences for different geographical regions and distribution of incidences across age groups were recorded as percentages. The mean age was recorded for patients of different genders and age groups. Incidence rates per 100,000 were calculated for different types of cancer. RESULTS: A total of 2,163 cancer cases were identified of which 2,020 were in adults (93.4%) and 143 were in children (6.6%). Among adults, most cancers were found in females (59%). Patients' mean age at diagnosis was 51.4 ± 19.6 years for adults and 6.4 ± 4.23 years for children. Cancer incidence rates per 100,000 people increased with age. Breast cancer was the most frequent cancer type found in adult females, with an incidence rate of 60.64 per 100,000 people. The most common types of cancer found in adult males were urinary bladder and lung and bronchus cancers; leukaemia was the most common cancer in children. CONCLUSION: The findings from this study can be used for predicting cancer epidemiology in Basra, Iraq, and to identify subsets of the population at high risk of cancer incidence. This information will help healthcare providers to adequately respond to the demands of diagnosis, treatment and palliative care for such patients.

Comprehensive review into the challenges of gastrointestinal tumors in the Gulf and Levant countries.

Although gastrointestinal stromal tumors (GISTs) are rare, with an incidence of 1/100000 per year, they are the most common sarcomas in the peritoneal cavity. Despite considerable progress in the diagnosis and treatment of GIST, about half of all patients are estimated to experience recurrence. With only two drugs, sunitinib and regorafenib, approved by the Food and Drug Administration, selecting treatment options after imatinib failure and coordinating multidisciplinary care remain challenging. In addition, physicians across the Middle East face some additional and unique challenges such as lack of published local data from clinical trials, national disease registries and regional scientific research, limited access to treatment, lack of standardization of care, and limited access to mutational analysis. Although global guidelines set a framework for the management of GIST, there are no standard local guidelines to guide clinical practice in a resource-limited environment. Therefore, a group of 11 experienced medical oncologists from across the Gulf and Levant region, part of the Rare Tumors Gastrointestinal Group, met over a period of one year to conduct a narrative review of the management of GIST and to describe regional challenges and gaps in patient management as an essential step to proposing local clinical practice recommendations.

Impact of Comorbidities on Survival Among Patients with Chronic Myeloid Leukaemia Using the Charlson Comorbidity Index: Retrospective study from Basra, Iraq.

OBJECTIVES: In chronic diseases, comorbidities are known to have a strong negative association with overall survival (OS). This study aimed to use the Charlson Comorbidity Index (CCI) to examine the effect of comorbidities on OS among patients with chronic myeloid leukaemia (CML) treated with tyrosine kinase inhibitors. METHODS: This retrospective study was conducted between January 2006 and October 2016 and included 247 CML patients treated at the Basra Oncology & Haematology Centre, Basra, Iraq. Information from hospital records was used to calculate CCI scores and patients were divided into groups based on scores of 2-3 (CCI1 group) or ≥4 (CCI2 group). The OS was calculated using Kaplan-Meier curves. RESULTS: There were 177 (71.7%) patients in the CCI1 group and 70 (28.3%) in the CCI2 group. Overall, patients in the CCI1 group were significantly younger compared to those in the CCI2 group (median age: 35 versus 60 years; P <0.001); however, the gender distribution was similar in both groups (male-to-female ratio of 1:1.06 versus 1:1.18, respectively; P = 0.683). Diabetes mellitus was the most common comorbidity (17%), followed by hypertension (12%) and gastrointestinal diseases (6%). There were no significant differences in mortality between the groups (9.6% versus 8.6%; P = 0.801). In total, 69.6% of all deaths were related to CML progression rather than to the presence of comorbidities. CONCLUSION: No significant correlation was found between CCI score and OS among CML patients in Basra. However, larger long-term prospective studies are needed to evaluate associations with median age at diagnosis and disease severity and to develop region-specific prognostic scales.

Breast Cancer in Basra Oncology Center: A Clinico- Epidemiological Analysis

Background: Breast cancer is the most common cancer affecting women, and the leading cause of cancer-related deaths. Objective: This study was performed to evaluate clinico-epidemiological features of breast cancer from Iraq during a five-year period. Methodology: This is a retrospective descriptive study. Medical notes and histopathological reports of patients with confirmed diagnosis of breast cancer between January 2011 and December 2015 were reviewed for age, gender, site, laterality, histopathological type, grade of differentiation and TNM stage at diagnosis. Results: A total of 1,000 patients were included in the study. Mean age at diagnosis was 50 years (range 22-85 years), and females constituted 99.2% of cases. Most cases (98.7%) were unilateral and most common (85.5%) histological subtype was invasive ductal carcinoma. Majority of the cases (58%) were moderately differentiated (grade II), wherein 45% belonged to stage II in TNM system, and nearly half (49%) of patients had locally advanced or metastatic cancer. Conclusion: Breast cancer presents at least a decade earlier and at a more advanced stage in Iraqi women when compared to the Western World. Steps for early detection are essential for initiation of prompt therapy and reduction of mortality.