فهرست مطالب

Cancer Management - Volume:9 Issue: 6, 2017
  • Volume:9 Issue: 6, 2017
  • تاریخ انتشار: 1395/11/07
  • تعداد عناوین: 10
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  • Zahra Taherian-Esfahani, Atieh Abedin-Do, Elahe Nikpayam, Behnoosh Tasharofi, Akram Ghahghaei Nezamabadi, Soudeh Ghafouri-Fard* Page 3
    Context: Ovarian cancer is the most fatal gynecological malignancy with no effective screening strategy for early detection. As most cases are being detected in advance stages, conventional therapies are not beneficial for the majority of patients. Cancer-testis antigens (CTAs) are a group of tumor associated antigens with specific expression pattern in cancers which potentiate them for application as cancer biomarkers and targets for immunotherapy.
    Evidence Acquisition: We performed a computerized search of the MEDLINE/PUBMED databases with key words: ovarian cancer, cancer-testis antigen, biomarker and immunotherapy.
    Results
    Thirty five CTAs have been shown to be expressed in ovarian cancer. At least 13 of them have been shown to elicit immune responses in different studies. The pattern of expression for some of them may facilitate molecular classification of different histologic classes of ovarian cancer. In addition, some CTAs such as NY-ESO-1 and MAGE have been used as targets for immunotherapeutic approaches with promising results.
    Conclusions
    The expression pattern of CTAs in ovarian cancer and the preliminary results of clinical trials indicate that CTAs can be used as targets for immunotherapy of ovarian cancer patients.
    Keywords: Cancer, Testis Antigen, Ovarian Cancer, Biomarker, Immunotherapy
  • Sayed Hossein Davoodi, Yasaman Jamshidi-Naeini, Saeideh Esmaeili, Sara Sohrabvandi, Amir M. Mortazavian* Page 4
    Background
    Although iron is essential for all cells, it could be potentially hazardous. This is mostly due to iron participation in oxidation-reduction reactions. In terms of cancer risk, the role of both iron deficiency and overload can be studied in two directions, protective or therapeutic effects, and carcinogenic effects.
    Materials And Methods
    PubMed, Science direct, Ovid, Proquest, Medline, and Google scholar databases were used to obtain articles identified by using the key words “Iron”, “Iron deficiency”, “Iron overload”, “Cancer”, and “Neoplasm” without any time limit. The relevance of studies was identified by reviewing the titles and the abstracts. 185 articles published in English, including experimental, observational, molecular and cellular studies were reviewed.
    Results and
    Conclusion
    Considering the dual nature of iron, maintaining an optimal iron level in the body is important. This can be achieved when regulatory mechanisms of body iron level work properly and the amount of iron input is within the physiological range. Current evidence generally supports this possibility that higher animal-derived (heme) iron may increase the risk of some cancers. The release of iron or nitrosyl heme from iron complexes during some processing of meat may increase production of cancer promoter lipoperoxides. On the other hand, use of iron chelation or iron mediated oxidative assault for the treatment or prevention of cancer appears to be promising; but further research is required. Considering this background, this article reviews the literature and evidence, focusing on the role of iron overload and deficiency in developing and treatment of various cancers.
    Keywords: Iron, Overload, Deficiency, Neoplasms
  • Gohar Mohammadi, Mohammad Esmaeil Akbari *, Yadollah Mehrabi, Ali Ghanbari Motlagh Page 5
    Introduction
    Cancer Registry is one of the important components of health information systems in developing countries. Continuous monitoring of data quality can have a crucial role in controlling cancers. This study aimed to assess the quality of cancer registry data in terms of completeness of coverage and validity.
    Methods
    Data were collected from three main sources, including Pathology registry, Hospital and national death registries in five provinces in Iran during March 2008-March 2011. We used two source capture-recapture method for estimate of cancer registry coverage and measures of validity were percentage of death certificate only (DCO%), histological verified cases (MV%); cancer incidence in childhood based on sex and age group, percentage of cancer in the elderly (80 years or above) and mortality-to-incidence ratio (M:I).We compared them to international standards.
    Results
    The overall completeness was estimated at 54.2% and 32.4% under reporting for stomach cancer in a period of three years (2008 - 2010). MV% and percentage of unknown primary site of the tumor were 68.7%, and 5% respectively. The mortality-to-incidence ratio for men and women was 37.6% and 28.2%, and percentage of cancer in the elderly was 10.9% in 2010 year. The age-specific rate in girls and boys in age groups of 5 - 9 and 10 - 14 years was lower than minimum of the recommended international standards.
    Conclusions
    The results of this study showed data quality of cancer registry is relatively low in terms of the completeness and validity. Cancer registries should pay great attention to the quality of their data. In addition to technical measures in data processing, continuous evaluation of their quality in order to achieve the set goals is essential.
    Keywords: Cancer Registry, Iran, Quality Assessment, Completeness, Validity
  • Hadi Raeisi Shahraki, Mansooreh Jaberipoor, Najaf Zare*, Ahmad Hosseini Page 6
    Background
    Genetic expression has been frequently considered as an efficient method for early diagnosis of cancer. In this study, we examined the simultaneous effect of 22 genes on contribution to bladder cancer.
    Objectives
    Since these 22 genes are known as the most important risk factors in many cancers, we aimed to investigate them as potential effective genes in bladder cancer.
    Methods
    The data consist of 25 patients with bladder cancer (the case group) and 23 matched healthy individuals as a control group. Univariate analysis was performed and differences between two groups were analyzed through the independent T-test. A multivariate gene expression model was implemented using the least absolute shrinkage and selection operator (LASSO) and Adaptive LASSO regression. Standard error of coefficients was obtained using the bootstrap method. We used two methods for classification and compared areas under the curve (AUC), using receiver operating characteristic (ROC) curve.
    Results
    Independent T-test showed that 11 genes had a significant difference between the two groups. Also multivariate analysis using the LASSO revealed that 12 genes have a significant effect on bladder cancer and adaptive lasso regression represented SDF1, CTLA-4, Her2 and IL-23 genes as the most effective genes. The AUC for LASSO and Adaptive LASSO were 0.71 and 0.89, respectively which was statistically significant (P = 0.009). Our multivariable results for SDF1, CTLA-4 and IL-23 confirm the findings of many studies in this field.
    Conclusions
    Among all genes were examined, SDF1, CTLA-4, Her2 and IL-23 which were selected by the two methods has the greatest contribution to bladder cancer.
    Keywords: Adaptive LASSO, Bladder Cancer, Gene Expression, LASSO
  • Arezoo Chouhdari, Parvin Yavari *, Mohammad-Amin Pourhoseingholi, Mohammad-Reza Zali Page 7
    Background
    First-degree relatives (FDRs) of people diagnosed with colorectal cancer (CRC) have a two- to three-fold increased risk of developing disease. Colonoscopy screening test can be effective in prevention and early treatment.
    Objectives
    The purpose of this study was to determine the rate of participation in colonoscopy screening test and related factors in first degree relatives.
    Methods
    200 FDRs of CRC cases were interviewed by the researchers. A reliable and valid questionnaire about undergoing colonoscopy screening test and barriers was filled via phone. To report qualitative data results, we used percent and proportion. Full (bytotal variables) and final (Forward LR) multiple logistic regression analysis were used to make a model which was executed using spss19.
    Results
    In total, 59% FDRs had undergone colonoscopy screening test to the time of interview. Major reasons for not participating were fear of pain (23%), concerns about complications and test positive result (21.5%), lack of health insurance (21.5%), not believing in the test effectiveness (17%), no need because of healthy feeling (13%), embarrassment (12%) and distrust to service provider skills (10%). Results of multiple logistic regression analysis indicated there is statistical significance between participating colonoscopy screening and variables “not affected with hypertension (95%CI: 0.4 - 2.04, OR = 3.7), believe in test effectiveness in FDRs (95%CI: 1.8 - 16.9, OR = 5.6), also age of diagnosis ≥ 50 in CRC cases (95%CI: 1.7 - 2.3, OR = 2)”. Finally, age below 50 (95%CI: 1.1 - 5.1, OR = 2.4), not being alive person affected by CRC (95%CI: 1.2 - 5.8, OR = 3.3), monthly family income ≥ 10 million Rials (95%CI: 1.08 - 4.7, OR = 2.2) and belief in effectiveness of the test (95%CI: 2.61 - 12.55, OR = 5.7) were predictor factors to participate.
    Conclusion
    Future Interventions should focus on fostering positive attitudes, overcoming barriers, enhancing social and health insurance support and following medical recommendation consecutive to performing colonoscopy screening test.
    Keywords: Colorectal Cancer, Colonoscopy, Screening, First Degree Relatives
  • Yousef Moradi, Mehdi Jafari, Shahla Chaichian *, Sorour Khateri, Abdolrasool Akbarian, Bahram Moazzami, Kamyar Mansori, Yaghob Mahmodi, Saeed Samie Page 8
    Background
    Cancer is a major cause of morbidity and mortality, among which ovarian cancer has a high incidence and case fatality. Gaining insight into the epidemiology and trends of ovarian cancer can be very influential in cancer screening and treatments programming. This study aimed to investigate the trends in the incidence of ovarian cancer in Iran, because this issue has been neglected so far.
    Methods
    This study is a re-analysis of existing data from the cancer data recording system in Iran during the years 2003 to 2009. The incidence rates reported were standardized according to the world health organization (WHO) and the trend in the incidence of this disease was determined by STATA software and the significance of the morbidity trend diagram was also derived via WINPEPI software.
    Results
    The statistics of cancer registry center shows an increasing trend of ovarian cancer from 2003 to 2008, while it decreased from 2008 to 2009. During this period, 6078 cases of ovarian cancer were registered in Iran, increasing from 591 cases in 2003 to 1077 in 2009, which shows an approximately 2-fold increase in the incidence of registered cases. During these seven years, the highest incidence rate was seen in Markazi province with 6.33 per 100,000 persons and the least in Kohkiloye-va-Boyerahmad province with zero incidence. Almost all provinces, except a few, had increasing incidence of ovarian cancer.
    Conclusions
    According to the results of the study, the incidence of ovarian cancer is increasing in Iran, especially in the central and northwestern regions of the country. This increase may be due to changing the patterns of risk factors for this disease, such as changes in lifestyle in the population, which will lead to changes in the incidence of the disease. Hence, due to the increase in incidence of this cancer, it is recommended to implement screening and early detection programs in high risk areas and populations.
    Keywords: Ovarian Cancer, Incidence, Epidemiology, Iran
  • Mohammad Esmaeil Akbari, Atieh Akbari, Nahid Nafissi, Zeinab Shormeij, Soheila Sayad, Marzieh Rohani Rasaf, Leyla Shojaee* Page 9
    Background
    Breast cancer treatment success depends upon prolonging survival with effective treatment, and constant monitoring of recurrence. Survival rate can well be improved by better understanding of prognostic factors, preventive measures, and effective treatments together with follow-up and post-treatment care.
    Objectives
    This study is aimed to know prognostic factors effective in recurrence and death in Iranian breast cancer patients.
    Methods
    This is a retrospective study conducted by reviewing data acquired from 1604 female breast cancer patients who were admitted to Cancer Research Center at Shahid Beheshti University of Medical Sciences between October, 1982 and March, 2014. During the follow-up, after diagnosis, 313 patients experienced recurrence then were classified into two groups: early recurrence, less than 1 year and late recurrence after 5 years. We analyzed prognostic factors of recurrence in each groups and evaluated effective factors of death in this patients.
    Results
    Median age of patients at diagnosis was 50 years. Median follow up time was 4.33 years (range: 0.005-24.9 years). Of these patients, 210 (67.09 %) and 76 (24.28%), developed distant and loco -regional recurrence. Among 313 patients, 62 (21/60%) and 69 (24/04%) had early and late recurrence. In the univariate analysis, tumor grade, stage of disease, ER and PR status, axillary lymph node involvement and lymph vascular invasion were the prognostic factors affecting recurrence in patients, but in the multivariate analysis, ER/PR status was the most important independent prognostic factor affecting the early recurrence and stage of disease were prognostic factors in late recurrence. In all of the recurrent patients, 56.86% (178 individuals) survived and 43.13% (135 individuals) died at the end of follow-up period. The most important factors of death were histologic grade, disease free survival time, site of recurrence and age of disease.
    Conclusions
    Biologic marker, estrogen and progesterone receptors status, had most influence in early recurrence, unlike late recurrence, stage of disease had a more important role. However, lymph vascular invasion has been an effective factor either in early or late recurrence. As a result of studying effective factors in death of these patients, recurrence site, DFS, pathologic grade and patients’ age at the time of recurrence came to be effective. Knowing more about affecting factors on recurrence and the death of patients with recurrence, one can try to enhance survival and quality of life in patients by adopting more effective treatments.
    Keywords: Breast Cancer, Recurrence, Metastasis, Risk Factor, Prognosis
  • Sushmita Pathy*, Soumyajit Roy, Prabhat Singh Malik, Bidhu Kalyan Mohanti, Vinod Raina Page 10
    Objectives
    To evaluate treatment compliance, toxicity and survival in geriatric patients (≥65 years) with locally advanced non-small cell lung cancer (LA-NSCLC).
    Methods
    Departmental archive was collected for the details of demographics, treatment and outcome in elderly patients with LA-NSCLC (2008 - 2013) (n = 96). Both progression-free survival (PFS) and overall survival (OS) were evaluated using Kaplan-Meier method. Acute and late morbidity were scored using common terminology criteria for adverse events version 4, radiation therapy and oncology group late morbidity scoring system.
    Results
    Overall treatment completion rate was 65%. The rates of acute grade ≥ 3 hematologic and non-hematologic toxicities were 20% and 17% respectively. Overall rate of late toxicity was 12.5%. The median PFS and OS values were 7.4 months and 10.54 months, respectively. Patients with multiple comorbidities, poor socio-economic background and serum albumin level (
    Conclusions
    Curative multi-modality therapy in elderly patients with LA-NSCLC is a challenging task. They are susceptible to poor compliance, treatment-associated toxicities and poor survival.
    Keywords: Geriatric Patients, Locally Advanced NSCLC, Toxicity, Compliance, Survival
  • Masoud Nazem, Behrouz Kaleydari, Mohsen Kolahdouzan*, Valiollah Kashi Page 11
    Background
    One of the first steps to determine the thyroid nodules nature is fine needle aspiration. Almost 15% of the nodules are reported as atypia of unknown significance/follicular lesion of unknown significance (AUS/FLUS), with no clear nature of benign or malignant cells.
    Objectives
    This study aimed to evaluate the diagnostic value of repeated FNA in patients with AUS/FLUS undergoing thyroidectomy.
    Methods
    This cross-sectional study was conducted on 50 patients candidate for thyroid surgery due to both FNA report (AUS/FLUS) and clinical/ ultrasound findings from 2013 - 2014 in a referral surgery centre. First, a new FNA sample was taken from the lesion during surgery and was sent for cytopatholgy. Then, permanent pathology results (as gold standard method of diagnosis) and repeated FNA reports were analyzed and compared. The data were analyzed using SPSS Ver. 17, with P values less than 0.05 being considered significant.
    Results
    The obtained results revealed that repeated FNA had sensitivity of 61.9%, specificity of 100%. It had 0% false positive and 38.1% false negative results. In our study the malignancy rate in repeated FNA was 26%. Also, according to the results, the positive and negative predictive values were 100% and 46.7% respectively, and the accuracy was reported as 71.4%.
    Conclusions
    Repeated FNA for AUS/FLUS has low sensitivity and negative predictive value despite 100% specificity and positive predictive value. Also, the prevalence of “undetermined” reports in repeated FNA for such lesions is high. It is recommended that repeating FNA for AUS/FLUS may have a limited role in decision making for managing patients with this type of thyroid nodules.
    Keywords: AUS, FLUS, Thyroid Nodules, FNA
  • Mojtaba Javaherzadeh, Babak Sabet*, Ali Solouki, Ahmad Javanmard, Ali Shekarchizadeh Page 12
    Background
    Nowadays, esophageal cancer is among the most malignant cancers with high mortality and morbidity. Although reasonable progress in radiotherapy and chemotherapy has been made, still esophagectomy is the main treatment for the disease. Using esophagectomy induces a durable palliation and provides possible cure.
    Objectives
    This study aimed to assess the three-month and three-year survival rates and complications of transthoracic surgery in patients with esophageal cancer.
    Methods
    In a longitudinal case series study was performed in three years, 34 patients with esophagus cancer, operated using trans-thoracic approach were assessed for short- and long-term survival rates and complications.
    Results
    Immediately after the surgery, anastomotic leakage was seen in 17.6% and vocal cord paresis in 26.6% of cases; in next days, the vocal cord paresis decreased to 11.8%. Hospital mortality rate was 20.6% and the rate of malignancy recurrence in long-term follow-up was 8.8%. Long-term morality rate was 39.0%. There was microscopic residue in 20.5% and macroscopic residue in 6.0% of the patients. Three-month and three-year survival rates were 76% and 61%, respectively.
    Conclusions
    The achieved three-month and three-year survival rate were reasonable in comparison to other studies. Although the rate of vocal cord paresis after the surgery was about two times more than previous studies, most of the cases were temporary paresis and resolved in coming days.
    Keywords: Esophageal Cancer, Survival, Trans, Thoracic Esophagectomy, Complications