AbstractIntroduction: Muscle-invasive bladder cancer is common in Egypt. Trimodality chemoradiation post transurethral resection of bladder tumor proved high benefits. Our aim is to show our institute’s experience in using gemcitabine concurrent with radiotherapy post-TURB in an old frail group of patients diagnosed with MIBC regarding efficacy and tolerability. Materials and Methods: This prospective study included 47 patients diagnosed with de novo MIBC in the period between October 2016 and October 2020. Eligible patients underwent maximal TURBT followed by radiation therapy with 65 GY in two phases concomitant weekly gemcitabine (100 mg/m2). Results: The median age was 65.9 years. Males were more common (80.9%) than females. The Median follow-up was 24 months. A complete response was achieved in 34 patients (72.3%). Salvage cystectomy was done for 3 patients who did not achieve CR. chemotherapy was given to another 5 patients of those who did not achieve CR (gemcitabine plus cisplatin /carboplatin). While 5 patients refused any further treatment, only for follow-up regimens. Survival: Median PFS and OS were 40 months and 42 months, respectively. Three-year progression-free survival (PFS) and overall survival (OS) were 66.6% and 75.4%, respectively. Conclusion: Chemoradiation with low dose Gemcitabine is well tolerated and effective post-TURT. It provides an alternative organ-preserving strategy in invasive TCC for old fragile patients.

Background: Contradictory reports regarding the role of the androgen receptor (AR) in breast cancer (BC).The current study aimed to evaluate the prognostic and predictive value of AR expression in postmenopausal luminal BC and response to tamoxifen (TAM) versus aromatase inhibitors (AIs).Methods: A retrospective study included postmenopausal female patients with luminal BC treated with TAM or AI from February 2015 to December 2020.Results: Eighty percent of the patients had AR expression. Low grade, small tumor size, less involvement of lymph nodes, hormone receptor positive, low ki67, and her-2-ve were associated with AR +ve (p 0.001). Compared to 21.4% and 23.2% of AR-ve patients, only 16.2% of AR+ve patients experienced relapses and 10.5% died. The OS improvement for AR+ve patients was statistically significant (79.3 vs. 82.0 p 0.014), but the difference in DFS between AR-ve and AR+ve patients was not significant (74.5 vs. 75.6 p 0.11). In AR-ve patients, there was no significant difference between the TAM and AI groups in terms of DFS or OS (73.4 vs. 74.2, p 0.9; 78.2 vs. 78.9, p 0.84, respectively), but AR+ve patients, there was a statistically significant difference in DFS and a trend toward improved OS (71.2 vs. 77.7, p 0.04; 78.7 vs. 83.7, p 0.06, respectively)Conclusion: AR expression is associated with favorable pathological characteristics and a better survival outcome. Although our results showed improvement in DFS in patients who received AI in adjuvant settings, we still need more data to consider AR as a routine predictive marker in this scenario.

Background: Studies have been carried out to highlight the connection between the Neutrophil–Lymphocyte Ratio (NLR) and the prognosis of pancreatic cancer, still with controversial findings. This study retrospectively examined the relation between NLR and response to treatment, time to treatment failure (TTF), and overall survival (OS) among patients with advanced pancreatic cancer.Subjects and methods: This observational retrospective cohort study was carried out on 80 patients diagnosed with advanced pancreatic cancer treated with first-line chemotherapy. The NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count. We evaluated the TTF and OS in all cases.Results: Using the 1-year survival as a time point to create the receiver operating characteristics (ROC) curve, the optimal cut-off value for baseline NLR was found to be 2.05 with an area under the curve (AUC) of 0.906. Patients with NLR ≤2.05 revealed a significantly longer OS (mean: 11.347 months) than patients with NLR >2.05 (mean: 6.707 months) with a significant p-value of <0.001. NLR had a sensitivity of 81.2% and specificity of 84.4% at a threshold value of 2.05 in predicting mortality. For patients with NLR ≤2.05, the average TTF was longer (7.075 months) compared with those with NLR >2.05 (6.670 months) but with no significant difference (P >0.05). Conclusion: NLR could serve as a valuable prognostic and predictive biomarker in advanced pancreatic cancer, aiding treatment decision-making and patient management.

Abstract: Objective: to assess the utility of 18FDG-PET/CT in the detection of bone marrow (BM) infiltration and the prediction of therapy outcomes in patients with diffuse large B-cell lymphoma (DLBCL). Method: This retrospective study included 111 patients with pathologically confirmed DLBCL. They underwent 18FDG-PET/CT imaging twice at initial staging and 2 to 12 months following completion of the recommended therapy. Results: 18FDG-PET/CT is more accurate than BMB for the identification of BM infiltration and exhibited 100% sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), and accuracy for BM infiltration detection. Patients with avid 18FDG BM uptake has a bad prognosis compared to those with no BM FDG uptake, as it is significantly associated with lower rates of complete metabolic response (CMR) (66% vs. 85.9%; p = 0.019), a higher relapse rate (38.7% vs. 9.1%; p = 0.001), lower four-year relapse-free survival (RFS) (37.4% vs. 90.3%; p = 0.001), a lower five-year overall survival (OS) rate (0% vs. 77.1%; p = 0.034), and a higher death rate (21.3% vs. 6.2%; p = 0.018). Also, patients with axial, multifocal, and diffuse FDG BM uptake have a bad prognosis and lower RFS and OS rates. Conclusion: 18FDG PET/CT imaging provides whole-body mapping for detecting BM infiltration with high SN, SP, and accuracy; it can replace routine BMB in the staging of DLBCL. Avid 18FDG BM uptake is a poor prognostic sign associated with a higher relapse rate and lower rates of CMR and OS.

BACKGROUND:Definite treatment for glioma is not exist, and with increased drug resistance, more effort should be paid to identify new prognostic biomarkers and molecular targets for therapy for glioma patients.AIM:The current study aimed to evaluate the immunohistochemical (IHC) expression of MTAP and A-Kinase Interacting Protein 1 (AKIP1) in astrocytoma and to investigate their association with the clinicopathological characters of these cases.METHODS:Totally 66 cases of astrocytoma patients involved in this study. Cases underwent tumor resection and tissue sections were stained with MTAP, AKIP1 and IDH1 by IHC and evaluated in different grades of astrocytoma and their association with survival and response to therapy was investigated.RESULTS:High AKIP1 expression was positively correlated with treatment resistance and progressive disease. Positive IDH and retained MTAP expressions had shown better treatment response rather than negative IDH and lost MTAP. High AKIP, negative IDH and loss of MTAP expressions were significantly associated with poor survival outcome.CONCLUSION:Irrespective to grade and IDH status, the loss of MTAP immunoreactivity and high AKIP1 expression are predictive factors in astrocytoma, and they may be used as a biomarker for guiding astrocytoma management and prognosis surveillance.

BACKGROUND: The basis of cancer management is understanding its underlying molecular abnormalities. To improve survival of ovarian cancer patients, new therapeutic targets and prognostic markers are needed. SMYD3 and CDK9 are two markers that play important role in epigenetic regulation and promotion of oncogenic process. They have to be under investigation to be used as target for therapy. Objective: evaluation the diagnostic and prognostic value of the immunohistochemical expression of SMYD3 and CDK9 in serous ovarian carcinoma (SOC). Methods: 50 cases of SOC and 50 benign ovarian lesions cases were included in this study. The morphological classification was assessed according to the World Health Organization criteria. Immunohistochemistry (IHC) for CDK9 and SMYD3 was performed. Results: SMYD3 and CDK9 was highly expressed in cancer compared with benign lesions (p <0.001 and <0.05 respectively). High CDK9 and SMYD3 expression were significantly associated with vascular invasion and advanced stage disease (p <0.001 for both). Patients who exhibited high SMYD3 and CKD9 expression showed poor treatment response, drug resistance and higher frequency of relapse and mortality. Conclusions: The immunohistochemical staining of SMYD3 and CDK9 is higher in serous ovarian carcinoma compared with benign ovarian lesions and represents a worse prognostic factor.

Background: There is an ongoing need for targeted therapy and systemic treatment protocols for papillary thyroid carcinoma (PTC) patients. Yes activated protein-1 (YAP-1) has been found to control many targets of Hippo pathway. Annexin family is a huge family playing many roles in cellular processes. Annexin A10 (ANXA10) is a member of annexin family. Uncoordinated-5D (UNC5D), a recently discovered Unc5 family member which is found in normal tissues and downregulated in cancer cell lines and tissues. Aim of the study was to assess the expression of YAP-1, ANXA10, and UNC5D in PTC and in non-neoplastic tissues of thyroid gland using immunohistochemistry to evaluate their clinical significance and prognostic values in PTC patients.Method: In the present prospective study, we took samples from 60 patients with PTC and 30 samples from non-neoplastic thyroid tissues for YAP-1, ANXA10, and UNC5D immunohistochemistry. All the patients were followed up for assessment of the prognostic, clinical, and pathological of their expression.Results: Upregulation of YAP-1 and ANXA10 in addition to downregulation of UNC5D was found in PTC tissues more than non-neoplastic thyroid tissues. In PTC tissues, there were positive associations between high YAP-1 and ANXA10 expression, low UNC5D expression, tumor size (P = 0.022, 0.011, 0.014), presence of lymph node metastases (P = 0.005, < 0.001, 0.008), and inferior disease-free survival rate (P = 0.003, 0.01, 0.03).Conclusion: Upregulation of YAP-1 and ANXA10 expression and downregulation of UNC5D was associated with bad clincopathological criteria, disease progression, high incidence of disease recurrence, and poor survival.

Introduction: In Egypt, bladder cancer (BC) represents about 8.7% of cancers in both sexes. In Egyptian men, it ac-counts for over 30% of all cancers, which makes it the second most fre-quent cancer. The standard curative treatment for patients with muscle -in-vasive bladder cancer (MIBC) has been radical cystectomy (RC) with urinary diversion and pelvic lym phadenec-tomy. Concomitant chemoradiation therapy (CCRT) in MIBC appears to produce results that are comparable to those of RC.Material and methods: Between Jan-uary 2018 and March 2021, 34 BC -diagnosed patients, who refused RC, were enrolled. They received trans -urethral resection of the bladder tu-mour (TURBT) followed by 3 cycles of neoadjuvant chemotherapy (NACT) with gemcitabine, cisplatin, and CCRT. Concomitant chemoradiation therapy with cisplatin, as a chemosensitizer, was administered to patients who experienced a complete response (CR) and a partial response (PR) symbolscript 50%.Results: Following NACT, CCRT was given to 27 patients (79.45%) who had either a PR > 50% or CR. Seven patients (20.5%) showed PR below 50%, stable disease, or progressive disease; 4 of them underwent RC followed by postoperative radiation. The average follow-up period was 46 months (range: 6-52 months). Twenty-three patients (67.6%) were still alive at the last check-up. Disease-free survival and 3-year over-all survival were 70.8% and 65.1%, respectively.Conclusions: Bladder preservation provides survival rates comparable to those of MIBC patients, but with a higher quality of life. The findings show good survival rates without metastasis; nevertheless, more mul-ticentre trials with larger sample sizes and longer follow-up periods are re-quired to confirm these findings.

Background For various types of cancer in oncologic patients, the clinical features of pulmonary embolism (PE) are unknown. The purpose of the study is to identify pulmonary embolism incidence and type among oncologic patients along with evaluating any associated clinical variables. Patients and methods A prospective cohort study was conducted on 540 patients who had various types of cancers and attended to a 1-day care unit of oncology in King Fahd Hospital, Kingdom of Saudi Arabia. Chest CT with contrast and CT pulmonary angiography was applied when indicated. Results This study was conducted on 540 patients who have different types of cancers; among them, 24 (4.44%) developed PE. Pulmonary embolism was reported in 50% of patients who had seminoma and germ cell tumor, while in cancer larynx, it was represented in 33.4% of them. Moreover, PE was less common among patients who had cancer colon, prostate, and breast (6.68%, 4.7%, and 2.54%, respectively). Seven patients with PE (1.3%) were diagnosed incidentally during cancer staging, while 17 patients (3.14%) had symptomatic PE. Eighty-four percent of the PE cases were diagnosed within the first 6 months of cancer diagnosis, while 4/24 (16%) of the PE cases were diagnosed throughout patient follow-up within the first year of diagnosis. Chest pain and dyspnea were the common presentations in confirmed PE either symptomatic or incidental group. Conclusions Low-risk PE was the most frequent degree; massive and sub-massive PE was uncommon in oncologic patients. Dyspnea and chest discomfort are concerning signs of PE in cancer. Meticulous care during the first 6 months for cancer patients to pick up pulmonary embolism is recommended.

AbstractBackground: Malignant pleural effusions (MPEs) can occur due to practically any type of cancer. MPEs frequently impairs quality of life. There are numerous techniques for managing MPEs; each drains the pleural space and relieves respiratory symptoms. Pleurodesis is described as the formation of a symphysis between two layers of pleura in order to avoid the recurrence of effusions. Numerous chemical compounds are being investigated for use in pleurodesis. Aim of work: The purpose of this research was to examine the medical pleurodesis results performed with three different chemical agents in order to determine the most effective one with the fewest side effects. Patients and Methods: This study enrolled 60 patients from Medical Oncology department at Zagazig university Hospitals, Egypt between January 2021 and January 2022. All patients were with MPEs. We enlisted 60 patients, separated them into three groups of 20 each, and had them undergo medical pleurodesis with three different chemical agents in comparison: povidone-iodine, doxycycline, and bleomycin. Sex, age, side of the effusion, treatment outcome (success and failure), and adverse effects were analyzed. Results: After pleurodesis, the findings were evaluated, and final success rates were 80% for povidone-iodine, 75% for bleomycin, and 65% for doxycycline. Conclusions: When utilized appropriately, povidone-iodine, doxycycline, and bleomycin are practically similarly efficient and safe sclerosing agents. While the povidone-iodine and doxycycline are similarly efficient and secure as bleomycin as chemical agents for pleurodesis in cases of MPEs, they are less costly and more commonly available.Keywords: pleurodesis, malignant, effusion, doxycycline, bleomycin, povidone-iodine.

Introduction:We aimed to evaluate the outcome of treatment with docetaxel plus androgen deprivation therapy (ADT) in newly diagnosed patients with metastatic high tumor burden hormone-sensitive prostate cancer (mHSPC) and correlated the outcome with hemoglobin, albumin, lymphocyte and platelets (HALP) score. Material and methods:Six cycles of docetaxel plus ADT were given to 50 patients with high burden mHSPC. Baseline HALP score was calculated and disease outcome was tabulated; moreover, the prognostic impact of the HALP score in response to treatment and survival was calculated. Results:We found a significant association between high HALP score and response to treatment where a higher rate of complete response occurred in patients with a high HALP score than in patients with a low HALP score (53.8% vs. 5.4% respectively, p-value = 0.001). Patients with ≥ 12-month-duration castration-resistant prostate cancer (CRPC) had a significantly higher HALP score compared to patients with a lower HALP score (84.6% vs. 35.1% respectively, p-value = 0.002); 18-month-duration CRPC-free survival was significantly greater in patients with higher HALP score than patients with a lower HALP score (23.1% and 5.4% respectively, p-value < 0.001). Patients with a high HALP score had insignificantly higher mean overall survival than patients with a low HALP score (mean: 22.91 and 20.66 months respectively, p-value = 0.230). Conclusions:Our results confirmed the benefits of treatment with docetaxel plus ADT in high-burden mHSPC with accepted tolerance. HALP score was found to be an independent predictive factor for benefit from therapy; we can apply it as an easy way to stratify patients for appropriate selection of treatment for better tolerance and outcome.

Background The prevalence rate of breast carcinoma (BC) among multiple ethnic populations required more explanations to understand the pathogenesis mechanisms for the development of this type of cancer. The principal purpose of this work is to validate the correlation of the CCND1 (c.723G > A; rs9344) variant with an increased risk of breast carcinoma. Methods This retrospective case-controlled study was designed appertaining to 200 women including 100 BC patients and 100 unrelated cancer-free controls. The amplification of genomic DNA was genotyped utilizing the PCR-RFLP technique. Results The frequencies of the CCND1 (c.723G > A; rs9344) variant revealed a significant association with increased risk of breast carcinoma under different genetic models including allelic (OR = 2.84, P-value < 0.001), recessive (OR = 4.83, P-value < 0.001), and dominant (OR = 3.19, P-value < 0.001) models. Conclusions Our findings concluded that the genetic biomarker of the CCND1 (c.723G > A; rs9344) variant is correlated with an elevated risk of breast carcinoma among Egyptian women.

Introduction:Endometrial carcinoma is now considered a common female gynecologic cancer with increasing incidence, with 13-25% of patients being still liable to recurrence and metastasis, which needs further studies to detect novel targets and new therapies. The aim of the study was evaluate tissue expression of RON, ROR1 and SUSD2 in endometrial carcinoma and atypical endometrial hyperplasia using immunohistochemistry and correlate their expression with clinical, pathological and prognostic parameters of patients.Material and methods:We included samples from 100 patients with endometrial carcinoma. Sections from paraffin blocks were stained with RON, ROR1 and SUSD2 using immunohistochemistry. Correlations between marker expression, clinicopathological features and prognostic samples were evaluated.Results:Upregulation of RON and ROR1 and downregulation of SUSD2 expression were found in endometrial carcinoma more than atypical endometrial hyperplasia (p < 0.001). High RON and ROR1 expression levels were significantly associated with high grade (p < 0.001), presence of lymph node metastases (p = 0.003), distant metastases (p = 0.009), advanced International Federation of Gynecology and Obstetrics stage (p = 0.002), poor response to therapy (p = 0.046), and lower recurrence-free survival (RFS) rate (p = 0.002), progression-free survival (PFS) rate (p = 0.008), distant metastasis-free survival (DMFS) rate (p = 0.019) and overall survival rate (p < 0.001). Low SUSD2 expression was significantly associated with older patient age (p = 0.002), large tumor size (p = 0.003), high grade (p = 0.005), presence of adnexal invasion (p = 0.023), presence of lympho-vascular invasion (p = 0.021), extent of myometrial invasion (p = 0.002), lower RFS rate (p = 0.008), lower PFS rate (p = 0.023), and lower DMFS rate (p < 0.001).Conclusions:Upregulation of RON and ROR1 and downregulation of SUSD2 lead to promotion of endometrial cancer cell proliferation, migration, epithelial-mesenchymal transition, and invasion.