Gujarat Cancer Research Institute

The gut microbiome (GM) has emerged as a significant determinant of cancer biology, which influences carcinogenesis, therapeutic efficacy and toxicity associated with treatment. Dysbiosis contributes to the initiation and progress of tumors due to long-term inflammatory reaction, generation of genotoxins, and immune system evasion in tumors such as colorectal, gastric, pancreatic, hepatic cancers, and prostate tumors. Microbial diversity and the growth of specific taxa that include Faecalibacterium prausnitzii, Bifidobacterium longum, Akkermansia muciniphila, and others have been positively correlated with efficacy of immune checkpoint inhibitors (ICIs) in the GM. These effects are mediated by microbial metabolites, namely, short-chain fatty acids and menaquinone (vitamin K2) through immunomodulation and toxicity control. Conversely, bacterial dysbiosis and pathological taxa induced by antibiotics complicate the cure of infection and lead to immune-related adverse events (irAEs). Future interventions such as transplantation of fecal microbiota, next-generation probiotics and engineered biotherapeutics have the potential to restore the ICI responsiveness and decrease the toxicity. To implement microbiome-based biomarkers and therapeutics in precision oncology, the existing issues of standardization, causality, and clinical translation should be solved. The GM represents a new frontier in cancer treatment, combining immunology, metabolism and microbial ecology to further the personalized medicine. This narrative review synthesizes molecular and clinical findings regarding the influence of the GM on carcinogenesis, immunotherapy efficacy, resistance, and toxicity, while also delineating translational initiatives for the integration of microbiome-based biomarkers and therapies into precision oncology.

Abstract Background Patients with thrombocytopenia undergoing percutaneous coronary intervention (PCI) are at an elevated risk of bleeding and adverse cardiovascular events due to dual-antiplatelet therapy (DAPT). Limited data exist on the safety of DAPT in this subset of patients. Methods This single-centre prospective cohort study was conducted at SMS Medical College, Jaipur, India, over 12 months (March 2024–March 2025). A total of 368 patients with baseline (pre-PCI) thrombocytopenia who underwent elective or emergency PCI while on DAPT were enrolled. DAPT comprised aspirin plus a P2Y12 inhibitor: clopidogrel in 317 patients (86.1%), ticagrelor in 48 (13.0%), and prasugrel in 3 (0.8%), with the choice based on clinician discretion; the distribution did not differ significantly across thrombocytopenia grades (p = 0.204). DAPT was generally maintained for 6–12 months per institutional protocol, without a standardized de-escalation strategy. Thrombocytopenia was classified based on pre-procedural platelet counts as mild (100,000–150,000/mm³; n = 237, 64.4%), moderate (50,000–100,000/mm³; n = 104, 28.2%), or severe (30,000–50,000/mm³; n = 27, 7.3%). The primary outcomes were major adverse cardiovascular events (MACE), defined as a composite of total death, myocardial infarction (MI), coronary revascularization, stroke, and hospitalization due to heart failure; and bleeding events assessed using Bleeding Academic Research Consortium (BARC) criteria. Secondary outcomes included in-hospital mortality, stent thrombosis, target vessel revascularization, and post-PCI MI. Follow-up was conducted at 1, 2, and 6 months post-PCI. Multivariate logistic regression was used to adjust for confounders across three sequential models (demographics; clinical variables; procedural outcomes). Results Severe thrombocytopenia independently predicted higher risks for MACE (HR: 2.30, CI: 1.89–2.81) and bleeding (HR: 2.88, CI: 2.37–3.49) across all models. Mild thrombocytopenia showed no significant risk after adjustment for confounders. Patients with moderate thrombocytopenia demonstrated consistent risks for both outcomes. Smoking and history of PCI/MI significantly correlated with thrombocytopenia severity (p < 0.01). Conclusion Moderate and severe thrombocytopenia are independently associated with increased risks of bleeding and cardiovascular events in patients on DAPT post-PCI. These observational findings support the incorporation of thrombocytopenia severity into existing risk stratification frameworks; however, as this study did not evaluate alternative management strategies, prospective randomized trials are needed to determine whether modified antiplatelet regimens can improve outcomes in this high-risk population.

Background The Peritoneal Cancer Index recorded at laparotomy is based on visual and palpable inspection of peritoneal surfaces for disease. This study aimed to analyze interobserver variation in assigning the lesion score (LS) and morphologic term (MT) to characterize peritoneal lesions (PL) and predict the probability of malignancy (POM) among surgeons with expertise in cytoreductive surgery (CRS) for peritoneal malignancies. Methods The study selected 80 intraoperative images of PLs depicting different morphologic appearances of PLs arising from different primary tumors in various peritoneal regions. In the study, 50 expert peritoneal malignancy surgeons were asked to assign an LS to the region in question, select the MT or MTs to describe the PL, and predict the POM. Information on the presence of disease on histopathology was not provided at this point. Inter-observer reliability was evaluated using Krippendorff's alpha (alpha). A consensus was reached if any option received more than 75% of the votes. Results The study participants comprised 41 (82%) of 50 experts. Consensus on LS was achieved for 18 images (22.5%), with low agreement (alpha = 0.174). For MTs, a consensus was reached for 21 images (26.5%; alpha = 0.0902, denoting low and unreliable agreement. Of these 21 images, the MT used was "tumor nodule" for 90.4% of the images (p < 0.001). The POM was accurately predicted in 52.5% of the cases (alpha = 0.155). Administration of neoadjuvant chemotherapy had no impact on the surgeons' assessment of the three parameters. Conclusions Even the most experienced CRS surgeons showed high interobserver variation and unreliable agreement in the description and accurate characterization of PLs on pictorial records. A Delphi consensus to standardize the MT used and scoring of PL could reduce discordance.

ABSTRACT:Vulvar cancer has an incidence of 2-3 per 100,000 women and accounts for 5% of all female genital tract (FGT) malignancies. About 90% of them are squamous cell carcinoma (SCC). Primary malignant glandular tumors of the vulva (PMGTV) are rare, diverse tumors with different prognoses and differentials. We present three cases of PMGTV diagnosed at our institution over 11 years (2013-2023) in the present study. Hospital intranet and medical records provided required clinical, histopathology, and immunohistochemistry (IHC) data. There were only three reported cases of PMGTV. The most common presentation was a painful mass growing rapidly. Most of the tumors were high-grade, and IHC was required for a definite diagnosis. A spectrum of variable entities was diagnosed, namely, adenoid cystic carcinoma (ADC), adenocarcinoma intestinal type, and adenocarcinoma of mammary gland type (AMGT). PMGTVs are rare entities and resemble morphologically and immunophenotypically tumors of other systemic sites, making exclusion of any primary malignancy mandatory. A large panel of immunohistochemistry is needed to typify them. Due to the rarity of the disease, no definite treatment guidelines are present.

Objective: Bladder paragangliomas (PUB) are extremely rare. The incidence is <0.06% of all bladder tumors and <1% of all pheochromocytomas. The importance of accurate diagnosis is crucial for effective patient treatment. Material and Methods: This study encompassed 9 cases of bladder paragangliomas, identified over a duration of 6 years. Analyses of the epidemiological features, symptoms, imaging, laboratory tests, treatments, pathology, immunohistochemistry (IHC), and follow-up outcomes were executed. Results: Among the 9 cases of PUB, 5 were female and 4 male, with ages ranging from 24 to 73 years. The most common presenting symptom was painless gross hematuria (67%), followed by micturition attack (22%), and hypertension (11%). Radiologically, the tumors were well circumscribed, solitary, and broad-based. Most patients underwent transurethral resection of the bladder tumor (TURBT). The characteristic Zell Ballen pattern of tumor cells, separated by a delicate fibrovascular network and supported by small sustentacular cells, was evident on microscopy. All tumors were classified as T2, per the 8th edition American Joint Committee on Cancer Staging System (AJCC) staging system. Based on histmorphology, various differentials were considered. On IHC, tumor cells were immunoreactive for synaptophysin, chromogranin, with S100 highlighting sustentacular cells, thereby confirming the diagnosis of PUB. MIB1 ranged from 1-10%. Two patients were lost to follow-up. Duration of follow-up ranged from 3 months to 78 months (6.5 years). All the patients were disease and symptom-free at the follow-up. Conclusion: PUB is a rare condition. Characteristic clinical presentation, histologic features, and application of immunohistochemistry are all important to differentiate this tumor from other bladder tumors, ensuring patients receive the appropriate treatment.