Characteristics of Incident Testicular Cancer in Lebanon - 1990-2015 Single Institutional Experience

Background: Despite the fact that testicular cancer is a major health issue with its increasing incidence, very few studies have described its characteristics in the Middle East, particularly in Lebanon. Materials and Methods: We report in this paper a retrospective pilot study of the characteristics of testicular cancer in Lebanon. The demographic, epidemiologic and survival characteristics of 178 patients diagnosed between 1990 and 2015 at an oncology clinic affiliated to Hotel Dieu de France Hospital were analyzed. Results: The mean age at diagnosis was 32 10 years. The most prevalent testicular tumor was the germ cell type (GCT) (95.2%) of which non-seminomatous tumors (NST) were the commonest (64.7%). Most of our patients were diagnosed at an early stage. Lymph node spread affected most commonly the retroperitoneal region and distant visceral metastases occurred in 14.6%. All patients underwent orchiectomy with 67% receiving adjuvant treatment, mainly chemotherapy. After a median follow up of 2,248 days (75.9 months) 16 patients were reported dead. Two, five and ten-year overall survival rates were 96%, 94% and 89% respectively. The median overall survival rate was not reached. Conclusions: Despite being part of the developing world, demographic, epidemiologic and survival analyses of testicular cancer reported in our study are in line with those reported from developed countries and would allow us to extrapolate management plans from these populations.     

Postoperative Chemotherapy in Resected Gastric Cancer: Results of a Single Center Experience

Abstract

Gastric cancer remains a major health problem despite its decline in incidence in Western countries. Although radical surgery represents the primary curative option for gastric cancer patients, most of them relapse and die due to their disease despite an R0 resection. At present the routine use of postoperative adjuvant therapy to reduce disease recurrence is still considered an investigational approach. Out of a total of 275 patients (stage IB through IV M0 AJCC/UICC) who underwent surgery for gastric cancer at our Surgery Unit between 1993 and 2001, 156 were eligible for adjuvant chemotherapy, of whom only 52 accepted to undergo this treatment. This group of patients was retrospectively compared with a control group (1:2) and overall survival was assessed using hazard ratio and Kaplan-Meier estimates. Five-year survival was 40% in the chemotherapy group and 37.8% in the group which underwent surgery alone. Indeed, chemotherapy did not reduce the risk of death (HR 0.87, 95% CI = 0.57-1.34, p=0.54). Serosal involvement and the invasion of more than 6 lymph nodes were the main independent prognostic factors identified by multivariate analysis. The current study did not show a clear advantage of chemotherapy over surgery alone. However, our results can help to define strategies for future clinical trials with the use of new regimens based on more effective and less toxic drugs.     

Type Distribution of Lymphomas in Lebanon: Five-Year Single Institution Experience

Background: Lymphomas represent the fifth most frequent cancer in Lebanon. However, little is knownconcerning epidemiologic characteristics and distribution of lymphoid neoplasms according to the 2008 WHOclassification. Materials and Methods: We conducted a retrospective study of lymphoma cases diagnosed from2008 till 2012 at Hôtel-Dieu de France University Hospital. Results: A total of 502 new cases of lymphoma werediagnosed at our institution during a five year period: 119 cases (24%) were Hodgkin lymphomas (HL) and 383cases (76%) were non-Hodgkin lymphomas (NHL). HLs were equally distributed in both sexes with a meanage at diagnosis of 30 years. Among NHL, 87% (332 cases) were B cell lymphomas, 9% (34 cases) were T celllymphomas and 4%(17 cases) were classified as precursor lymphoid neoplasms. Among B cell lymphomas,44% (147 cases) were diffuse large B cell lymphomas (DLBCL), 20% (65 cases) follicular lymphomas and 8%(27 cases) mantle cell lymphomas. DLBCL were equally distributed in both sexes with a mean age of 58 years.Follicular lymphomas were characterized by a male predominance (57%) and a mean age of 60 years. Mantlecell lymphomas showed a pronounced male predominance (85%) with a mean age of 60 years in men and 70years in women. Some 72% of patients having T cell lymphomas were men, with a mean age of 57 years in menand 45 years in women, while 65% of patients having precursor lymphoid neoplasms were women with a meanage of 22 years in women and 30 years in men. Conclusions: The lymphoma subtype distribution in Lebanon isunique when compared to other countries from around the world. In fact, Hodgkin and follicular lymphomasare more frequent than in most Far Eastern, European and American countries, while T-cell lymphomas andDLBCL are less frequent.     

Risk of Lymph Node Metastases from Early Gastric Cancer in Relation to Depth of Invasion: Experience in a Single Institution

Background: An accurate assessment of potential lymph node metastasis is important for the appropriate treatment of early gastric cancers. Therefore, this study analyzed predictive factors associated with lymph node metastasis and identified differences between mucosal and submucosal gastric cancers. Materials and Methods: A total of 518 early gastric cancer patients who underwent radical gastrectomy were reviewed in this study. Clinicopathological features were analyzed to identify predictive factors for lymph node metastasis. Results: The rate of lymph node metastasis in early gastric cancer was 15.3% overall, 3.3% for mucosal cancer, and 23.5% for submucosal cancer. Using univariate analysis, risk factors for lymph node metastasis were identified as tumor location, tumor size, depth of tumor invasion, histological type and lymphovascular invasion. Multivariate analysis revealed that tumor size >2 cm, submucosal invasion, undifferentiated tumors and lymphovascular invasion were independent risk factors for lymph node metastasis. When the carcinomas were confined to the mucosal layer, tumor size showed a significant correlation with lymph node metastasis. On the other hand, histological type and lymphovascular invasion were associated with lymph node metastasis in submucosal carcinomas. Conclusions: Tumor size >2 cm, submucosal tumor, undifferentiated tumor and lymphovascular invasion are predictive factors for lymph node metastasis in early gastric cancer. Risk factors are quite different depending on depth of tumor invasion. Endoscopic treatment might be possible in highly selective cases.     

Gastric Carcinoma: 5 Year Experience of a Single Institute

Puropse: Gastric cancer (GC) is the most common cause of cancer death registered in cancer institute. Background ‍clinical information is important for cancer prevention and therefore we here present characteristics and outcome ‍of GC patients, more than half coming from northern parts of Iran. ‍Materials and Methods: we retrospectively studied records patients with pathologic diagnosis of GC referred to ‍the Medical Oncology Department of the Cancer Institute from 1998 to 2003. ‍Results: Four hundred and thirteen patients were registered with GC with the average age of 58 and a male to ‍female ratio of 3/1. Tumor stage based on AJCC was stage 2(12.5%),stage 3(22%),stage 4(63%) and 2% unknown. ‍Most common site of involvement was cardia (43%). Median survival time of all patients (with or without treatment) ‍was 10 months overall. Gastrectomy was performed for 214 patients(39% with positive surgical margins), and 175 ‍of the gastrectomised patients received chemotherapy. Median survival with surgery only was 7 months but 20 ‍months with both surgery and chemotherapy. Only 21 patients received neoadjuvant chemotherapy. Median survival ‍of patients who had response to preoperative chemotherapy was 30 months. By multivariate analysis lower extent of ‍disease (p=0.0024), free surgical margin (p=0.0017), and chemotherapy (p=0.001) were associated with better ‍prognosis. ‍Conclusions: Only curative resection with free margins was associated with a survival benefit in this study. More ‍than 80% of patients were diagnosed in locally advanced or metastatic stage of disease and even with neoadjuvant ‍chemotherapy and salvage surgery the outcome was poor. Clearly more efforts need to be given to early detection of ‍lesions to allow a better cure rate.     

Clinicopathological Characteristics of Iranian Patients with Lung Cancer a Single Institute Experience

Background Lung cancer has long been a leading cause of cancer related death in both women and men worldwide. The focus of this study was to review clinicopathological features of Iranian patients diagnosed with lung cancer. Materials and Methods Clinicopathological data of 1353 primary lung cancer patients diagnosed during 17 years (1997-2014) in the National Institute of Tuberculosis and Lung Disease (NRITLD), Tehran, Iran, were retrospectively reviewed. Results The median age of patients was 60 (mean 58.95 years, range 16- 99) and adenocarcinoma was the most prevalent pathology (45.2%). Male/female ratio was 3.22 and 57.2% of patients were smokers (men 70.3%, women 15%). The majority (85.3%) were referred in advanced stages (stage IIIB and IV). Conclusions Although some of our ndings are in concordance with other studies in lung cancer but there are some discrepancies particularly in terms of smoking status and median age of Iranian patients. Further clinical and epidemiological studies are warranted to elucidate etiologic and factors other than smoking contributing to development of lung cancer such as environmental exposures or genetic predisposition.     

Choroid Plexus Papillomas: A Single Institutional Experience

OBJECTIVE: To determine the long-term outcome of resected choroid plexus papillomas (CPPs). METHODS: Medical records and histologic specimens were reviewed for 41 patients (19 male, 22 female; median age, 36 years; range, 6 months to 74 years) with CPP seen between 1974 and 2000. Tumor locations were as follows: 76%, fourth ventricle; 17%, lateral ventricle, and 7%, third ventricle. Fifty-six percent had a gross total resection (GTR) and 44% had a subtotal resection (STR). Median follow-up was 6.5 years. RESULTS: Five-year local control, distant brain control, and overall survival were 84%, 92%, and 97%, respectively. Comparison of GTR and STR at 5 years showed a significant increase in local control (100% vs. 68%; P = 0.04) but not in overall survival (100% vs. 94%). Even after STR, only 50% of patients required a subsequent resection for recurrence. Addition of radiation therapy to initial STR did not seem to influence outcomes. At first relapse, GTR was accomplished in 1 patient, and only STR was accomplished in the others. Addition of radiation therapy to STR in our study led to disease control in half the patients treated, and STR alone led to disease control in only a quarter of the patients. Second relapses were treated palliatively with radiation therapy. CONCLUSIONS: Surgical resection is the treatment of choice for CPPs. After initial STR, reoperations for recurrence are required only half the time. Therefore, there seems to be no role for radiation therapy after initial STR. For STRs at first relapse, local control outcome is poor.     

Colorectal Cancer in Sweden a Descriptive Epidemiologic Study

In a register-based 19-year follow-up we studied the incidence rate of colorectal cancer in the Swedish 1960 census population. A total of 53 377 cases were identified: 28 003 men and 25 374 women. A U-shaped distribution of tumors in the large bowel was observed, with a minimum in the descending colon. Other findings were 1) An incidence gap between elderly men and women increasing with age and with distal direction in the large bowel; 2) An increase in the incidence of colorectal cancer with population density; 3) A higher incidence of colorectal cancer in the southwestern region than in the northern region and 4) A lower incidence of colon cancer among blue than among white collar workers and a lower incidence of colorectal cancer among never married men than among other men.     

Unique Features of Gastric Cancer in Young Patients: Experience from a General Hospital in Nepal

Background: Gastric cancer, the fifth most common malignancy in the world, usually affects older individuals but can occur in younger age groups. In this study we compared the clinicopathological profile of young patients of gastric cancer with that of older patients. Materials and Methods: It is a prospective study of gastric cancer patients treated over three year period (January 2012 to December 2014). Data of patients were obtained from the medical record. Clinical and pathological characters of younger patients (age 40 years or less) were compared with older patients (age more than 40 years). Results: There were total of 152 patients treated during the study period. Twenty patients (13.2%) were less than 40 years of age and 132 (86.8%) were older. The male to female ratio in younger patients was 1:1.5 whereas in older patients it was 1:0.6. In the younger age group 14 patients (70%) had poorly differentiated adenocarcinoma in contrast to 45% in the older age group (<0.01). Some 55% of younger and 42% of older patients had stage IV disease at presentation and curative surgery was not possible. Palliative surgery for gastric outlet obstruction or bleeding from the tumor was performed on 25% and 21% respectively. Conclusions: Gastric cancer in young people aged less than 40 years has unique characters like female predominance, unfavorable tumor biology, and advanced stage at presentation. There should be a high index of suspicion of gastric cancer even in young patients.     

Characteristics of Patients With Second Primary Lung Cancer Following Breast Cancer: A Retrospective Descriptive Study

BackgroundBreast cancer (BC) is the most common noncutaneous malignancy in women and survivors are at an increased risk for secondary malignancy with lung cancer (LC) being the most common. There are few studies that have explored the clinicopathological specifics of LC in BC survivors.MethodsIn this single-institution, retrospective study, we identified BC survivors who subsequently developed LC, examined their breast and LC clinical and pathological characteristics and compared them to the general BC and LC population as published in the literature.ResultsIn our study, we found the following associations that could be meaningful: an association between receiving radiation (RT) and LC (including a statistically significant P = .03 chance of ipsilateral LC after BC treatment with RT), a higher incidence and amount of smoking and LC, high BRCA positivity (78.9%) in the few patients who had germline testing, and a higher incidence of EGFR mutations in NSCLC after BC (60.9%) as well as an earlier stage of NSCLC disease.ConclusionTreatments such as RT, genetic factors such as BRCA mutations, and tobacco use may increase the risk of developing LC amongst BC survivors. Exploring this further can potentially lead to better risk stratification through modified low-dose CT chest screening protocols to catch LCs earlier and ultimately improve outcomes. Past studies have shown that BC survivors who are subsequently diagnosed with NSCLC may have improved OS compared with primary NSCLC and our study showed a high incidence of EGFR mutated NSCLC, which also suggest both improved prognosis and a different molecular profile of NSCLC, which warrants further investigation. Lastly, BC survivors who subsequently are diagnosed with NSCLC had earlier stage disease in our study, perhaps a result of surveillance, highlighting the importance of close monitoring of BC survivors.     

Histologic Distribution of Pulmonary Tumors in Lebanon: A 5-Year Single Institution Experience

Background: To compare the current histologic distribution of lung cancer in Lebanon to the worldwidetrends, according to the 2004 WHO Classification. Materials and Methods: 1,760 patients with a pulmonarypathology examination at Hotel-Dieu de France University Hospital between July 2009 and July 2014 wereincluded. Results: Some 676 out of the total investigated patients (38.4%) had a lung tumor. In 665 (98.4%) thetumors were malignant, with a mean age at diagnosis of 63.8 years and a male/female (M/F) sex ratio of 1.7:1.Among the malignant tumors, 86.2% were epithelial tumors with a mean age at diagnosis of 64.8 years and anM/F sex ratio of 1.9. Other malignant tumors consisted of metastatic tumors (10.2%), lymphoproliferative tumors(2.1%) and mesenchymal tumors (1.5%). Most common carcinoma subtypes were adenocarcinoma (48.0%),squamous cell carcinoma (23.0%) and small cell carcinoma (13.3%). Carcinoid tumors were the only carcinomasubtype with an M/F sex ratio below 1 (0.7). Salivary gland tumors were the carcinoma with lowest mean ageat diagnosis (45.5 years). Conclusions: The histologic distribution of lung tumors in Lebanon is similar to thatin developed countries. We believe this resemblance is due to common smoking habits, known to be responsiblefor the increase of lung adenocarcinoma at the expense of other subtypes.     

Prevalence of Abnormal Pap Smears: A Descriptive Study from a Cancer Center in a Low-Prevalence Community

Background and aims: Cervical cancer is the fourth most common cancer in women worldwide and the 13th in Jordan. The cervical smear (Pap smear) is a simple approach to detect pre-cancerous cervical lesions. The aim of this study was to evaluate the prevalence of abnormal cervical smears in women seen at the Early Detection/Community Outreach clinic of King Hussein Cancer Center (KHCC). Materials and Methods: In this retrospective study, reports of routine cervical Pap smears performed in the pathology department at KHCC from January 2007 to December 2016, were reviewed. During this period, a total of 5,529 routine smears were assessed for epithelial abnormalities and histopathological grading. Results: A total of 210 (3.8%) abnormal Pap smears were found, with atypical squamous cell of undetermined significance (ASC-US) reported in 110 (52.4%) cases, atypical glandular cells of undermined significance (AGUS) in 58 (27.6%), low grade squamous intra-epithelial lesion (LSIL) in 27 (12.9%) and high grade intra-epithelial lesion (HSIL) in 13 (6.2%). Only single cases of ASC-H and squamous cell carcinoma were reported. The available biopsies showed benign findings in 70.1% of cases, low grade squamous intraepithelial lesions in 11.5% and high grade squamous intraepithelial lesions in 18.4%. Conclusions: The low epithelial cell abnormality (EPCA) prevalence illustrated in this study argues against introduction of population-based HPV testing and vaccination. It calls for a more cost-effective measures in a country with limited resources, where a more widely available Pap-smear testing might suffice.     

Sociological Transition and Breast Cancer in the Arab World: the Experience of Lebanon

Background: Breast cancer is the leading cause of cancer death among females in Lebanon. This study aimed at analyzing its epidemiology in the country over time. Methods: Data were extracted from the Lebanese National Cancer Registry (NCR) for the years 2004 through 2010. Age-standardized and age-specific incidence rates for cancers per 100,000 population were calculated. Results: Breast cancer ranked first, accounting for an average of 37.6% of all new female cancer cases in Lebanon during the period of 2004-2010. Breast cancer was found to have been increasing faster than other hormone-related women’s cancers (i.e. of the ovaries and corpus uteri). The breast cancer age-standardized incidence rates (world population) (ASRw) increased steadily from 2004 (71.0) to 2010 (105.9), making the burden comparable to that in developed countries, reflecting the influence of sociological and reproductive patterns transitioning from regional norms to global trends. The age-specific incidence rates for breast cancer rose steeply from around age 35-39 years, to reach a first peak in the age group 45-49 years, and then dropped slightly between 50 and 64 years to rise again thereafter and reach a second peak in the 75+ age group. Five-year age-specific rates among Lebanese women between 35 and 49 years were among the highest observed worldwide in 2008. Conclusion: Breast cancer is continuously on the rise in Lebanon. The findings of this study support the national screening recommendation of starting breast cancer screening at the age of 40 years. It is mandatory to conduct an in-depth analysis of contributing factors and develop consequently a comprehensive National Breast Cancer Control strategy.     

Survival Following Non Surgical Treatments for Oral Cancer: a Single Institutional Result

Aim: To report the results of radiotherapy with or without chemotherapy in the patients with oral cancer.Methods: Over the 2003-2009 periods, a total number of 69 patients with squamous cell carcinoma of the oralcavity that refused surgery or had unresectable tumor were enrolled in this study. A total dose of 60 to 70 Gy(2 Gy per day) was given to the primary tumor and clinically positive nodes. In the patients with locoregionallyadvanced disease (57 patients with T3, T4 lesions and/ or N+) induction chemotherapy following by concomitantchemoradiation was used. Induction chemotherapy consisted of 3 cycles of Cisplatin and 5-Flourouracil withor without Docetaxel. Weekly cisplatin was used in concomitant protocol. Kaplan-Meier method was used tocalculate overall survival. Log-rank test and Cox regression model were used for comparison purposes. Results:Median follow-up was 32 months. The mean age of the patients was 59.2 years. The overall response rate afterinduction chemotherapy was 68.4%. Actuarial overall survival rates after 2 and 3 years were 38% and 26%,respectively. Clinical stage emerged as the only independent predictor of survival. Conclusion: Outcome of thepatients with oral cancer is poor. Presenting with an advanced stage lesion contributed to this result. The roleof chemotherapy in advanced cases remains to be defined.     

Percutaneous Microwave Ablation Under CT Guidance for Hepatocellular Carcinoma: a Single Institutional Experience

Background

Microwave ablation (MWA) is an emerging treatment for treatment of patients with hepatocellular carcinoma (HCC) not amenable of surgical resection.

Patients and Methods

We searched for patients diagnosed as having small-, medium-, and large HCCs treated with MWA under CT guidance between 2010 and 2014. The main outcomes of interest were rates of complete ablation, complications, and overall survival. Rates of complete ablation were compared with Chi-square test, and estimated survival rates were calculated by means of Kaplan-Meier method.

Results

Thirty-two patients with 45 HCC nodules received MWA. Seventeen (37.8%) nodules were <3 cm (small), 15 (33.3%) between 3 and 5 cm (medium), and 13 (28.9%) > 5 cm (large). Complete ablation was obtained in 94.1% of small tumors, 80% of medium tumors, and 53.8% of large tumors (p = 0.03). Two patients had HCC located in risk area (paracardiac position). Minor complications occurred after seven procedures (15.5%). Estimated median survival was 37 months (95% confidence interval 11.97–62.02). One-year OS was 82.7%, 2-year survival 68.9%, and 3-year survival 55.2%.

Conclusion

MWA is a versatile ablative method that can be applied in HCC at various stages, and also in lesions located in risk areas.

     

Survival Outcomes Associated With Female Primary Urethral Carcinoma: Review of a Single Institutional Experience

Background

Primary urethral carcinoma (PUC) is rare, and standard treatment recommendations are lacking. We examined the variation in treatments and survival outcomes of female PUC at a single, tertiary referral cancer center.

Patient Experience After Receiving a Diagnosis of Gastric Cancer in the USA

Purpose

This study investigated the patient perspective during cancer treatment and throughout the survivorship period and to understand how the patient experience may be related to choices for the treatment of gastric cancer.

Methods

Eligible patients in the Vector Oncology electronic medical records database were ≥18 years of age, diagnosed with gastric cancer, and received active treatment. Quality of life (QOL) was collected using the Patient Care Monitor (PCM). Time to deterioration in QOL and overall survival were measured, adjusting for demographic and baseline clinical characteristics. Logistic regression model and classification and regression trees (CART) were used to identify factors associated with treatment choice.

Results

There were 776 patients in this study, of whom 301 (38.8%) reported QOL data. Most patients reported problems on all PCM subscales; problems were more common during the treatment period. Median time to deterioration of PCM subscales ranged from 42 days for treatment side effects to 331 days for impaired performance. Median survival was low: 6.9 and 5.5 months from the start of first- and second-line therapy, respectively. The choices made between therapeutic options were primarily associated with the site at which the oncologist practiced.

Conclusions

Patients with gastric cancer report a considerable number of concerns on all subscales of the PCM, particularly during active treatment periods. The treatment heterogeneity and relative lack of clinical and symptom- or QOL-related factors associated with treatment choice suggest a gap in evidence that must be filled.