Middle East Journal of Cancer
Volume:14 Issue: 4, Oct 2023

Breast cancer (BC) is the most prevalent neoplasm in females globally, with an increasing incidence trend almost in all regions. Previous studies have indicated that non-alcoholic fatty liver disease (NAFLD) may be an emerging risk factor for extrahepatic cancers, including BC. This systematic review and meta-analysis study aimed to determine the association between NAFLD and the development of BC.

Data were systematically collected without time limitation until 21 April 2022, from the following electronic databases: PubMed, Scopus, Embase, Web of Science, and Google Scholar. The association between NAFLD and BC with odds ratio (OR) was calculated with a 95% confidence interval (CI) and presented via forest plots. Hazard ratios along with incidence rate ratios in the cohort studies transformed into OR.

According to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) and the inclusion criteria herein, 11 eligible studies were obtained from various countries. The pooled OR of NAFLD as a risk of developing BC, using a random-effects model, was estimated at 1.61 (95% CI: 1.30-2.00) (Q-value: 51.35, I2 = 80.52%, P < 0.0001). Multivariate meta-regression analysis showed that the publication year-, country-, detection method-, study design-, and body mass index-adjusted status did not cause heterogeneity. The Egger's regression (P = 0.32) and the symmetry in the funnel plot showed no publication bias in the studies.

The present research revealed that NAFLD had a significant association with BC, independent of traditional risk factors.

Breast and gynecological cancers are the most common malignancies in females. Early-stage detection and treatment could significantly reduce the mortality rate in patients. However, common treatments such as chemotherapy and radiotherapy fail after a while and lead to recurrence and drug resistance in cancer cells. The recent use of nanotechnology has enabled the development of novel approaches for diagnosing and treating oncological diseases. Chitosan-based polymer nanoparticles (CHPNPs) with unique properties such as non-toxicity, biocompatibility, and anti-carcinogenic effects are promising tools for the clinical development of targeted delivery systems. So far, various methods have been applied to use these nanoparticles in the diagnosis and treatment of various cancers. Identifying the most practical methods is one of the most important challenges in achieving effective treatments. A review of these studies can provide better horizons to realize effective treatment. In this review, we evaluate and discuss the use of CHPNPs from published literature to assess diagnostic and therapeutic strategies in breast and gynecological cancers, including ovarian and uterine neoplasms, as well as their advantages and challenges.

Early detection of breast cancer (BC) is extremely important as late diagnosis has been associated with a high rate of mortality. Immunogenic proteins and autoantibodies have been considered as favorable targets for early detection and targeted therapy in cancer. Accordingly, the present study aimed to identify the immunogenic antigens in both early and advanced stages of BC via a serologic proteome analysis (SERPA) approach.

This is a case-control study wherein we separated the proteins from BC tissues in the early stages (n = 10) and advanced stages (n = 10) utilizing two-dimensional electrophoresis (2DE) and then transferred them onto a Polyvinylidene Difluoride (PVDF) membrane. To explore the tumor antigens reacting with antibodies, two-dimensional (2D) blots of tumor tissues in the early and advanced stages were separately probed with the sera from the same patients. Afterwards, we identified antibody-reactive proteins via liquid chromatography with tandem mass spectrometry (LC-MS/MS).

Fibrinogen beta chain (FGB), protein deglycase DJ-1(PARK7), and peroxiredoxin-2 (PRDX2) were the highly reactive antigens identified in the earlystage patients. In addition, RuvB-like1 (RUVBL1) and triose phosphate isomerase (TPI) were recognized as the immune reactive proteins in the late-stage patients.

The results herein revealed that the immune-proteome pattern of BC patients changes along with tumor progression from primary to advanced stages. Moreover, immunogenic proteins seemed to stimulate the humoral immune system to produce autoantibodies in the initiation phase of BC; these autoantibodies could be employed as complementary factors for early detection of BC. The findings are however preliminary, and further studies with a larger sample size are required for verification and validation of previous findings.

One cause of tumor relapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the alteration of the graft-versus-tumor effect of early reconstituting natural killer (NK) cells due to overexpression of the NKG2A inhibitory receptor. This study aims to determine the effect of Monalizumab, an anti- NKG2A receptor, on the effector functions of reconstituting NK cells after allo-HSCT. In this prospective cohort study, 18 patients with hematological malignancies were divided into three groups: dose 1 group (0.1 mg/kg, n = 5), dose 2 group (0.5 mg/kg, n = 8), and dose 3 group (1 mg/kg, n = 5), and followed up for six months. Blood samples were taken directly before the administration of Monalizumab and at different time points post-treatment. Reconstituting NK cells were phenotypically and functionally assessed by flow cytometry. Our results showed a more pronounced increase in the expression of activating NK receptors (NKG2D, NKp30, NKp46) on the reconstituting CD56dim NK cells of patients receiving 1 mg/kg of Monalizumab compared with other participants. Additionally, we observed that patients treated with dose 3 of Monalizumab had the highest levels of degranulation compared with other patients and controls. Moreover, we noticed that CD56dim NK cells of dose 2- and dose 3-related patients produced significant levels of perforin, interferon gamma (IFN-γ), and tumor necrosis factor alpha (TNF-α) in response to K562 stimulation post-Monalizumab treatment compared with controls and dose 1-treated patients. We suggest that using Monalizumab improves the phenotype and cytotoxicity of reconstituting NK cells after allo-HSCT.

WHO has reported 34,189 (8.6%) colorectal carcinoma cases out of 396,914 total cancer cases in Indonesia. Accumulated gene mutation and the environment can affect cell regulation, growth, and differentiation, impacting the methylation of tumor suppressor genes. Carcinoembryonic antigen (CEA) is a biomarker used to detect the presence of colorectal carcinoma. Moreover, the E-cadherin gene has an essential role in tissue homeostasis, the adhesion between cells at embryogenesis, tissue morphogenesis, differentiation, and carcinogenesis stages. During instability and dysfunction in its regulation, the E-cadherin gene induces tumor progression. This study aimed to compare the level of CEA and E-cadherin expression in metastatic and non-metastatic sample groups. The present study is descriptive with a quantitative approach using ANOVA one-way, unpaired t-test, and Pearson correlation analysis for the measurement and comparison of the CEA level and relative gene expression value from the reverse transcription-quantitative polymerase chain reaction analysis. The obtained results suggested increasing CEA level and decreasing Ecadherin expression on the metastatic sample. Statistically, E-cadherin proven to show a negative r value or correlation value of CEA, even though it has a significant P-value. In other parameters, alanine transaminase and aspartate aminotransferase indicated a positive r-value and a significant P-value. These findings indicated the potential clinical benefit of E-cadherin in detecting tumor progressivity, supported by other significant parameters, such as alanine transaminase and aspartate aminotransferase. Furthermore, E-cadherin was found beneficial in diagnosing the colorectal carcinoma with liver metastasis. Nonetheless, further research is needed to determine the role of E-cadherin regulation in colorectal cancer metastasis.

This study aimed to evaluate serum vitamin D levels in patients with oral lichen planus (OLP) and oral squamous cell carcinoma (OSCC) in comparison to healthy controls in an Iranian population.
A cross-sectional study was conducted, which included 69 patients with OLP, 40 patients with OSCC, and 60 healthy controls. Serum vitamin D levels were measured using the ELISA method. The data were analyzed using Mann-Whitney and T-tests, and statistical significance was set at P < 0.05.
The study found that 17.9% of OLP patients, 27.25% of OSCC patients, and 25% of the control group had normal vitamin D levels. The mean vitamin D level in OLP patients (17.00 ± 14.16 ng/mL) was significantly lower than that in the control group (22.99 ± 14.46 ng/mL) (P = 0.003). However, in OSCC patients, the mean vitamin D level (24.63 ± 16.19 ng/mL) was not significantly different from that of the control group.
The study revealed a high rate of vitamin D deficiency and insufficiency in OLP, OSCC, and control group patients. Vitamin D deficiency was more common in patients with OLP. Vitamin D deficiency may potentially increase the risk of OLP and OSCC development and progression.

Patients with multiple myeloma (MM) have compromised immune systems due to the nature of the malignancy and anticancer treatments. This study aims to report the effects of Bortezomib-containing chemotherapy regimens on the severity and mortality of MM patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-COV-2).
This retrospective cohort study enrolled MM patients presenting with coronavirus disease 2019 (COVID-19) infection referred to Omid Hospital. Patients were divided into two groups based on whether they received any chemotherapy regimens containing Bortezomib within the last 90 days of admission or not. Clinical and laboratory characteristics, severity, and outcomes of both groups were reported and compared.
Among 48 patients with MM diagnosed with COVID-19 (63% male; median age 66), 33 received chemotherapy. The most common symptoms were fever, cough, and dyspnea, and there was no significant difference between the groups. Only D-dimer had a significant difference in laboratory tests (P = 0.03) and was higher in the chemotherapy group. There was no significant relationship between chemotherapy and severity (risk ratio (RR) = 1.17; 95% confidence interval (CI): 0.37 to 3.71; P = 0.79) or chemotherapy and mortality (RR= 1.00; 95% CI: 0.39 to 2.61; P = 0.99), even after adjusting for baseline C-reactive protein and white blood cell counts.
Our study showed that receiving Bortezomib-containing chemotherapy regimens did not worsen the symptoms and prognosis of MM patients infected with COVID-19. However, further studies with larger sample sizes and longer follow-up times are needed to provide better evidence on this subject.

Glioblastoma, not otherwise specified (NOS), is the most common primary malignant brain tumor. The TRAF3IP2 gene is an upstream regulator responsible for activating multiple proinflammatory pathways that could influence tumor size, angiogenesis, aggressiveness, and metastasis. In the present study, we aimed to investigate and assess the TRAF3IP2 gene expression in brain tumor tissue of patients with glioblastoma, NOS and compare it with non-neoplastic brain tissue. In this case-control study, biopsies were obtained from 15 surgically glioblastoma, NOS removed block samples and 15 non-neoplastic brain tissue samples containing normal white and gray matter as controls. Ribonucleic acid (RNA) was isolated and reverse-transcribed to complementary DNA (cDNA). Quantitative polymerase chain reaction (qPCR) was then carried out to measure TRAF3IP2 gene expression. We evaluated data from 30 cases, divided into two groups: case (N = 15) and control (N = 15). Based on our data, the expression of the TRAF3IP2 gene was 6.95 ± 0.65 times higher in glioblastoma multiforme tissue compared with controls (P < 0.05). We also found no significant difference in TRAF3IP2 gene expression between genders (P = 0.452), and there was no significant correlation between TRAF3IP2 gene expression and age (P = 0.745). The expression of the TRAF3IP2 gene was almost seven times higher in glioblastoma, NOS brain tissue compared with normal brain samples. This finding could have significant clinical and therapeutic implications.

Pancreatic cancer is characterized by its generally poor prognosis and ranks seventh worldwide in cancer-related mortality. We previously conducted a prospective study on the use of modified GTX regimen (a combination of gemcitabine, docetaxel, and capecitabine), which has appreciable activity and is well-tolerated, in this setting. We compared the efficacy of GTX regimen versus Gemcitabine-nabpaclitaxel (GmAb) as second-line chemotherapy in advanced pancreatic cancer patients receiving first-line therapy with FOLFIRINOX. This retrospective chart review aimed to collect and record data corresponding to patients diagnosed with advanced pancreatic cancer at the American University of Beirut Medical Center who received FOLFIRINOX as first-line chemotherapy and who then had GTX or GmAb as second-line treatment between 2013 and 2019. We measured the progression-free survival, overall survival, and toxicity of GTX versus GmAb as second-line treatment for pancreatic adenocarcinoma at AUBMC. The median overall survival for the GmAb group was around 52 months, which is greater than that of the GTX group, which was 25 months. 26.7% of patients who received GTX required dose reduction starting from cycle one, while only 3.1% of those who received GmAb required dose reduction from cycle one. 38.7% of patients who received GmAb did not have anemia throughout the course of treatment, while the majority of patients who received GTX, 93.3%, had grade I anemia. Our data show that GmAb is a possibly better second-line treatment option than GTX with better tolerance to the dose, less anemia, and a better survival profile. More studies are needed with a larger sample size and a prospective design to prove such a possible difference between the two regimens.

Preoperative marking of impalpable breast lesions is crucial for limiting false negative results and reducing the size of the resected breast tissue, thus improving cosmesis. The aim of this study was to evaluate wire localization versus intralesional methylene blue marking for surgical excision of impalpable breast lesions regarding the success of localization, cost, and limitations of both techniques. This prospective cohort study included 50 patients with impalpable breast lesions or an area of suspicious microcalcification who were scheduled for surgical excision in the period between June 2020 and December 2021. Patients were randomly allocated into two groups: group I included 25 patients for surgical excision after preoperative ultrasound-guided methylene blue marking. Group II included 25 patients scheduled for surgical excision after preoperative guide wire localization under radiological guidance. Localization by methylene blue injection has been associated with significantly shorter time of operation with mean duration (P = 0.018) and much reduced cost in comparison with guide wire (P < 0.001). Postoperative pain, reactions, ecchymosis, accuracy of localization, margin status, and patient satisfaction did not vary significantly between both groups. Localization by methylene blue injection is not only equally successful to guide wire in locating and identifying impalpable breast lesions for surgical excision, but also is significantly less costly and associated with a shorter duration of operation.

Prostate cancer remains one of the most common and lethal cancers among men worldwide. This study aimed to investigate the characteristics, prognostic factors, and outcomes of patients with prostate cancer who were treated and followed up in Shiraz, southern Iran over the past 12 years. This retrospective medical chart review was performed on 872 patients with prostate cancer who were treated and followed up in the Radiation Oncology Department of Shiraz University of Medical Sciences. The survival analysis was conducted for the patients, and the receiver operating characteristic (ROC) curve analysis was performed for the prostate-specific antigen (PSA) level. The median age of the patients at presentation was 69 years (range 35-91 years). In terms of local treatments, 28% of the patients underwent prostatectomy, and 23% were treated with transurethral resection of the prostate. The remaining 49% of patients were treated with non-surgical therapies. Patients between 55 and 75 years had the longest survival duration. The shortest survival was observed in the third Gleason group and those over 75 years old, while the first Gleason group and patients younger than 55 years had the longest survival duration. Hypoalbuminemia had no effect on the survival duration. A PSA level of 33.8 ng/dl was the most suitable cutoff point to predict bone metastasis, and patients with a PSA level of more than 33.8 ng/dl had significantly less survival duration than the others. More aggressive treatment and shorter follow-up intervals are recommended for patients with an initial PSA level of more than 33.8 and those younger than 55 years old.

Mature teratoma is a common tumor that can undergo malignant transformation, either in ovarian or extragonadal sites. While adenocarcinoma superimposed on sacrococcygeal teratoma is rare, mucinous variants have been reported in only five cases. Here, we present a case of a young girl with disseminated metastasis of mucinous carcinoma, initially of unknown primary origin. Further investigation by a dedicated multidisciplinary team (MDT) revealed a focus of mucinous carcinoma (intestinal type) in a sacrococcygeal teratoma incompletely resected five years earlier. The patient is currently undergoing second-line chemotherapy after experiencing side-effects on the first-line regimen. Pathologists, gynecologic oncologists, and surgical oncologists should exercise caution when dealing with locally aggressive teratomas, thoroughly searching for malignant components and conducting short-term follow-up.