Advanced EOC patients benefit from a user-friendly procedure that combines the prognostic advantages of IP chemotherapy with prompt administration. A hypothesis-generating study of advanced EOC is being undertaken to inform future clinical trials evaluating the contrasting effects of single-dose NIPEC versus HIPEC.
A key objective of this study was to determine the incidence of synchronous peritoneal metastases (PM) from extraperitoneal primary tumors, evaluate the subsequent treatment strategies employed, and ultimately analyze survival rates. The Netherlands Cancer Registry (NCR) provided the data for a cohort of all patients diagnosed with PM in 2017 and 2018, which were subsequently screened to determine eligibility. The five primary extraperitoneal sources of PM—lung, breast, urinary tract cancers, kidney cancer, and malignant melanoma—were the focus of further analyses. The log-rank test was employed to examine the survival impact of primary tumor sites. A total of 480 patients received a diagnosis of synchronous peritoneal mesothelioma, stemming from extraperitoneal sites. The prevalence of PM with extraperitoneal origins varied from 1% to 11%, with the highest proportion seen in patients with lung cancer. From the patient group, 234 (representing 49% of the patient population) experienced tumor-focused treatment, while 246 (51%) did not. Patients with PM exhibiting lung, breast, urinary tract, kidney, and melanoma cancers displayed varying survival times: 16 months, 157 months, 54 months, 34 months, and 21 months, respectively. This difference in survival was statistically highly significant (p < 0.0001). A noteworthy, albeit small, cohort of extraperitoneal cancer patients in this study experienced PM. In patients diagnosed with PM, the documented survival period varied from 16 to 157 months. Among patients with PM, only half received tumor-focused treatment, resulting in a 12-month survival time for those who did not receive this type of therapy. These discoveries underscore the importance of developing new diagnostic tools that can enable earlier detection of PM, with the potential to lead to a more effective treatment strategy.
We performed a groundbreaking classification and differentiation of colorectal cancer in a cohort of NCI patients, employing supervised machine learning algorithms, focusing on anatomical laterality and multi-omics stratification, in a first-of-its-kind approach. An integrative multi-omics analysis reveals distinct clustering patterns in left and right colorectal cancers, exhibiting separate methylomic signatures and distinct transcriptomic and genomic profiles. Consistent with augmented hypermethylation in right-sided colorectal cancer (CRC), novel multi-omics data demonstrate the presence of epigenetic biomarkers, immune-related pathway signatures, and lymphocytic infiltration. These observations open up new therapeutic prospects. In contrast, the left CRC multi-omic signature reveals a pattern associated with angiogenesis, cadherins, and epithelial-mesenchymal transition (EMT). An integrated molecular signature, arising from multi-omics data, unveils complex biological phenomena.
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The study has determined that certain genes have had their copy numbers modified. Overall survival analysis demonstrates the presence of genomic biomarkers.
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The study encompassed 852 LCRC cases.
In 170 RCRC cases, a significant survival advantage is predicted. Our study effectively illustrates machine learning's capacity for robust and competent translational bridging of research and clinic.
Supplementary materials for the online version are available at the provided URL: 101007/s13193-023-01760-6.
Accessible at 101007/s13193-023-01760-6, there is additional material associated with the online version.
The peritoneum is the source of the rare and aggressive malignancy, primary peritoneal mesothelioma (PM), which is categorized as diffuse malignant peritoneum mesothelioma (DMPM) and borderline variants. Well-differentiated papillary peritoneal mesothelioma (WDPPM), alongside multicystic peritoneal mesothelioma (MCPM), are distinct types of peritoneal mesothelioma. Conventional DMPM cases are more prevalent than the borderline variants, which account for a smaller percentage, 3-5%, of peritoneal mesothelioma diagnoses. This review article examines the pathogenesis, clinical presentation, natural history, and management of these less common PM variants. MCPM and WDPPM are key components in a multifaceted system. Under the microscope, MCPM typically presents with small cysts composed of mesothelial epithelium. These cysts contain clear fluid and are populated by benign, bland cuboidal cells lacking cellular atypia, yet demonstrating an increased mitotic rate. A distinguishing feature of WDPPM is its papillary component, which comprises myxoid, plump cores and a single layer of unassuming mesothelial cells. Chronic abdominal pain, chronic pelvic inflammatory disease, pelvic masses, and infertility can both be symptoms or incidental findings of the common variants. These diseases are sluggish in their advancement when untreated, raising major concerns regarding the malignant transformation potential of both variants and their propensity for frequent recurrence. In light of the current data, it is strongly recommended that MCPM and WDPPM patients receive a full cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy, featuring cisplatin and doxorubicin. For the purpose of producing a substantial dataset and developing sturdy guidelines, cooperative multi-institutional research endeavors are imperative.
This study aimed to chronicle the clinical trajectory and survival-impacting factors in patients with an initial AGC recurrence, who were treated with cytoreductive surgery, potentially combined with HIPEC. The study's second objective was to investigate the distribution of the disease within the peritoneal cavity, categorized by the peritoneal carcinomatosis index (PCI) and the characteristics of peritoneal deposits. This retrospective, multi-institutional study of adult granulosa cell tumor patients experiencing peritoneal recurrence investigated the use of CRS, either with or without HIPEC, as a treatment strategy. Relevant clinical and demographic data were meticulously recorded. mediator complex To assess the elements influencing recurrence following CRSHIPEC, a multivariable logistic regression analysis was conducted. An analysis of the disease's distribution at initial recurrence was conducted, complemented by an investigation into factors impacting survival and subsequent recurrences. For this study, 30 consecutive patients with recurrent adult granulosa cell tumors of the ovary who received CRSHIPEC treatment were selected, spanning the period from January 2013 through December 2021. After a median follow-up of 55 months, the investigation continued, encompassing follow-up durations from 12 months to 96 months [12-96 months]. Both the median rPFS and rOS measurements failed to attain their respective medians. Inavolisib mouse HIPEC, with a p-value of 0.0015, was the sole independent predictor of a longer rPFS. The initial recurrence of adult granulosa cell tumors allows for the performance of CRS, with or without HIPEC, while maintaining acceptable morbidity. Further research using a larger patient database is crucial to examine the impact of HIPEC, patterns of peritoneal dissemination, and how other predictive factors affect treatment results.
The prognosis for diffuse malignant peritoneal mesothelioma (DMPM) was positively influenced by the locoregional approach utilizing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Multiple protocols for HIPEC, a multiparametric treatment, are presented and analyzed in this study. A PRISMA-compliant systematic review of medical literature was performed. The keywords 'malignant peritoneal mesothelioma' and 'HIPEC' were used to develop a search strategy across three databases. Studies were considered eligible if they meticulously detailed the HIPEC regimen and its associated outcomes, if they compared different regimens, or if they adhered to national/international guidelines. Evidence evaluation was conducted using the GRADE framework. genetic phylogeny This review's analysis encompassed twenty-eight studies, including one meta-analysis, eighteen cohort-outcome reports, four retrospective comparisons of HIPEC treatment protocols, and five guidelines. Among the identified HIPEC regimens, six were analyzed. Four employed a single drug (cisplatin, mitomycin-C, carboplatin, or oxaliplatin). Two combined two drugs (cisplatin-doxorubicin or cisplatin-mitomycin-C). Cisplatin, with a maximum dosage of 250 mg/m2 infused over 90 minutes, played a crucial role, its toxicity effectively managed by concurrent intravenous administration of sodium thiosulfate. Bi-drug regimens, as demonstrated in comparative studies, often resulted in improved long-term cancer outcomes. Cisplatin at 50 mg/m2 alongside doxorubicin at 15 mg/m2 proved both safe and more effective in these studies. Within the context of international guidelines, this late protocol stood out as the most broadly applied and endorsed method in three out of four cases. Cisplatin's efficacy as the leading drug in hyperthermic intraperitoneal chemotherapy (HIPEC) for diffuse peritoneal mesothelioma (DPM) patients remained undeniable. In most instances, a 90-minute treatment protocol included both this substance and doxorubicin. To optimize the selection of HIPEC regimens, a harmonization of protocols and further comparative studies are necessary.
Significant advancements have been made in the treatment of advanced epithelial ovarian cancer (EOC), reflecting a progressive evolution. The emergence of platinum-based chemotherapy and hyperthermic intraperitoneal chemotherapy (HIPEC) has redefined the approach to care, demonstrating a significant improvement in long-term survival. Our analysis of advanced EOC patients in this study sought to reveal care patterns. A retrospective analysis of 250 advanced EOC patients, sourced from our prospectively maintained computerized database in the Department of Surgical Oncology at a tertiary care referral center, spanned the period from 2013 to 2020.