613 Background: Pertuzumab, a HER2-targeting monoclonal antibody, significantly improves outcomes for patients with HER2-positive breast cancer (HER2+ BC) in different settings in combination with another HER2-agents with/without chemotherapy. BCD-178 is a biosimilar of the originator pertuzumab (OP). Preclinical and phase I clinical studies have demonstrated its equivalence to OP. The phase III PREFER trial compared the efficacy and safety of BCD-178 and OP as neoadjuvant and adjuvant therapy in HER2+ BC. Methods: The study hypothesized that neoadjuvant therapy containing BCD-178 would yield a pathological complete response (pCR) rate equivalent to that of therapy containing OP in women aged 18–75 years with stage II–III HER2+, hormone receptor-negative invasive BC and a primary tumor > 2 cm. Patients were randomized 1:1 to receive neoadjuvant therapy with either BCD-178 or OP, combined with trastuzumab and chemotherapy (TCHP regimen). The primary endpoint was the pCR rate (ypT0/is, ypN0) assessed by central independent review. Safety was monitored throughout, with adverse events (AEs) graded by CTCAE v5.0. Immunogenicity and pharmacokinetics were also evaluated (NCT05802225). Results: Of 398 randomized patients, 201 received BCD-178 and 197 received OP. The median age was 53 years; over one-third of patients in each group had stage IIIB/IIIC disease. pCR rates were 75.0% with BCD-178 and 72.2% with OP (risk ratio [RR] 2.7, 95% CI: -6.0 to 11.6). The 95% CI for the between-group difference in pCR rate fell within the predefined equivalence margins, confirming equivalent efficacy. The safety profiles were comparable. The most common AEs (≥10%) were diarrhea and anemia. Immunogenicity was low and similar between groups: binding antibodies were detected in 1.6% (BCD-178) vs. 1.1% (OP) of patients, and neutralizing antibodies in 1.1% in both groups. The concentration-time profiles and pharmacokinetic profiles (Cmin, Ceoi) were also comparable. Conclusions: In patients with HER2+, hormone receptor-negative locally advanced breast cancer, the biosimilar BCD-178 demonstrated equivalent efficacy, safety, immunogenicity, and pharmacokinetics to the originator pertuzumab within a neoadjuvant TCHP regimen. Clinical trial information: NCT05802225 .

Background Oral squamous cell carcinoma (SCC) is the leading cause of cancer in Pakistani males. With 17,000 new cases and 10,000 deaths caused by oral SCC annually, it is imperative to maintain an accurate record to highlight regional distribution, cause of mortality, quality of life, prevention strategies, and issues like under-reporting. Objectives This study aims to determine the quality of data entered at our institute’s registry (Aga Khan University Hospital; AKUH) and to identify the challenges faced while managing this registry. Methods The study includes all patients in our database who presented to AKUH from 2018–2020 and were diagnosed with primary oral SCC. Inclusion criteria for cancer sites was based on The International Classification of Diseases for Oncology ICD-0-3 guidelines. Variables from each patient in the CNExT database were selected and the data was analyzed for completeness, validity, and timeliness. Results In our study, 71% of cases were > 40 years of age with 82% being male. 59% had a history of smokeless tobacco use. Cheek mucosa was the most common site (55%) followed by the ventral surface of the tongue (19%), lower gum (7%) & others (21%). Out of the 200 cases, 59% were clinically staged as IVA, 13% as stage II, and 12.5% as stage III. 96% of patients underwent surgical excision while 63% and 57.5% received radiation and chemotherapy respectively. Disease-free survival was < 1 year for 21% of cases and 1–2 years for 25%. Recurrence was reported in 24% of cases. In addition, patients presenting with T4 disease and ENE positivity recurred earlier. 72% were lost to follow-up. The data was 100% complete with 98.5% validity but 0% timeliness, which reflected the backlog due to resource constraints. Conclusion Cancer registry data quality for HNSCC in LMIC can vary significantly, however, it provides a basis to quantify the cancer burden. Managing data quality has several limitations which can be addressed by capacity-building and bridging cancer registries through national and international collaborations. These initiatives can help improve data quality and enhance cancer control and healthcare planning in LMICs.

Lung cancer varies between Caucasians and Asians. There have been differences recorded in the epidemiology, genomics, standard therapies and outcomes, with variations according to the geography and ethnicity which affect the decision for optimal treatment of the patients. To better understand the profile of lung cancer in Southeast Asia, with a focus on India, we have comprehensively reviewed the available data, and discuss the challenges and the way forward. A substantial proportion of patients with lung cancer in Southeast Asia are neversmokers, and adenocarcinoma is the common histopathologic subtype, found in approximately a third of the patients. EGFR mutations are noted in 23-30% of patients, and ALK rearrangements are noted in 5-7%. Therapies are similar to global standards, although access to newer modalities and molecules is a challenge. Collaborative research, political will with various policy changes and patient advocacy are urgently needed. Copyright (c) 2024 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/).

BACKGROUND: In the absence of population based cancer registries, hospital records can only highlight the importance of collection and analysis of data to address the burden of cancer among children. For this purpose, a hospital-based registry’s pediatric cancer data (individuals aged 0-18 at diagnosis) from 2010 to 2019 was compiled and analyzed at AKUH in Karachi, Pakistan. METHODS: A paper-based system is used to record all interactions with patients at the hospital. A dedicated team of Cancer Registrars transcribe this data onto a US based registry software; CNExT. Registry data was extracted through software generated reports and compiled for analysis. RESULTS: The total number of children presented at our center was 2,694, out of which 1,673 were males while 1,021 were females. Top 5 sites were bone marrow (n=887), central nervous system (n=481), lymphoid tumors (n=294) bone (n=255) and soft tissues (n=145). All other sites contributed to 632 cases, 23.5% of the total patient population. Furthermore, 806 patients were aged 0-4, 627 were aged 5-9, 684 were aged 10-14 while 966 patients were 15-19 years old.. A consistent increase of 210% was noted during the 10-year period. CONCLUSION: Our database analysis shows that the top cancer sites are consistent with other databases around the world. Increase in numbers may reflect awareness and referral pattern emphasizing the need for capacity building at the national level to accommodate patients locally so families don’t have to travel over provincial and international borders to receive treatment.

Background and aim: Docetaxel, oxaliplatin, leucovorin and 5-fluorouracil (FLOT) may improve overall survival (OS) in patients with locally advanced gastric and gastroesophageal cancer. Our study aims to determine the pathological response in these patients with the FLOT chemotherapy in the Neoadjuvant setting. This is the first study conducted in our country. Methods: We conducted a retrospective cross-sectional study from March 2018 to December 2020. After ethical review committee approval, all patients who fulfilled the inclusion criteria and received treatment at our tertiary care center were included in the study. SPSS version 22 was used for data analysis. Frequencies and percentages were calculated for categorical. Values were presented as mean +/- standard deviation (SD) for continuous variables. The chi-square test was used to determine the difference between categorical variables. A p-value of <= 0.05 was considered the level of significance. Kaplan-Meier curves were used to calculate survival analysis. Results: Out of 41, 35 patients with locally advanced resectable gastric or gastroesophageal adenocarcinoma were included in our study analysis. The entire cohort had a male predominance, with a mean age of 59. All patients received neoadjuvant FLOT. Pathological treatment response achieved was 77%, of which 66% had partial and 11% had complete response. There is a significant association of pathological response with age, gender, stage, grade, co-morbid and number of chemotherapy cycles received (p-value =<0.05). The OS was 80% with the mean OS was 2.6 years (31 months). Conclusion: Our study shows comparable response rates to other studies conducted internationally. Our findings confirm that FLOT is an effective and well-tolerated perioperative regimen with reasonable response rates in the Pakistani population. A more extensive longitudinal study would ensure these preliminary results in the local patient population.

A consensus meeting of national experts from all major national hepatobiliary centres in the country was held on May 26, 2023, at the Pakistan Kidney and Liver Institute & Research Centre (PKLI & RC) after initial consultations with the experts. The Pakistan Society for the Study of Liver Diseases (PSSLD) and PKLI & RC jointly organised this meeting. This effort was based on a comprehensive literature review to establish national practice guidelines for hilar cholangiocarcinoma (hCCA). The consensus was that hCCA is a complex disease and requires a multidisciplinary team approach to best manage these patients. This coordinated effort can minimise delays and give patients a chance for curative treatment and effective palliation. The diagnostic and staging workup includes high-quality computed tomography, magnetic resonance imaging, and magnetic resonance cholangiopancreatography. Brush cytology or biopsy utilizing endoscopic retrograde cholangiopancreatography is a mainstay for diagnosis. However, histopathologic confirmation is not always required before resection. Endoscopic ultrasound with fine needle aspiration of regional lymph nodes and positron emission tomography scan are valuable adjuncts for staging. The only curative treatment is the surgical resection of the biliary tree based on the Bismuth-Corlette classification. Selected patients with unresectable hCCA can be considered for liver transplantation. Adjuvant chemotherapy should be offered to patients with a high risk of recurrence. The use of preoperative biliary drainage and the need for portal vein embolisation should be based on local multidisciplinary discussions. Patients with acute cholangitis can be drained with endoscopic or percutaneous biliary drainage. Palliative chemotherapy with cisplatin and gemcitabine has shown improved survival in patients with irresectable and recurrent hCCA.

Abstract Objective Despite quality of life (QoL) being recognized as an important outcome in neuro-oncology, there is a lack of research from Pakistan where sociocultural differences may influence QoL. This study aimed to measure the QoL in patients with primary brain tumors (PBTs) and assess its association with mental health outcomes and social support. Results Our study included a total of 250 patients, with a median age of 42 years (range 33–54 years). The commonest brain tumors were glioma (46.8%) and meningioma (21.2). The mean global QoL of the sample was 75.73 ± 14.9. The majority of patients had high social support (97.6%) and were not depressed (90%) or anxious (91.6%). On multivariable linear regression, global QoL was inversely associated with no or low income (beta coefficients: −8.75 to −11.84), having hypertension (−5.53), currently using a urine catheter (−13.55), having low social support (−28.16) suffering from mild (−15.31) or symptomatic (−23.84) depression, or mild anxiety (−13.22).

Background: Squamous cell carcinoma of the head and neck have been characterized using various prognostic parameters. These include advanced age, lifestyle habits such as smoking, higher tumor stage at presentation & presence of metastasis. Many patients are diagnosed with head and neck cancers annually in Pakistan, but limited data is available for the prognosis of these patients. This study aims to investigate a new biomarker by estimating the mean level of pretreatment neutrophil to lymphocyte ratio (NLR) in patients with Squamous cell carcinoma of the head & neck.Methods: We conducted a cross-sectional study using non-probability consecutive sampling techniques for 222 biopsy-proven cases of head & neck squamous cell carcinoma. Clinical & pathological variables were analyzed, including the patient's profile and tumor characteristics. The NLR of each patient before treatment was calculated using the absolute neutrophil count divided by the absolute lymphocyte count in preoperative blood samples. An independent sample t-test was used to assess the mean difference. A p-value less than or equal to 0.05 was taken as statistically significant.Results: Of 222 patients, a male predominance was seen in the entire cohort. A median pre-treatment NLR of 3.19 (2.47-4.97) was identified, and patients were classified into high and low NLRs based on this value. Data analysis revealed a statistically significant increase in NLR among patients with nodal metastasis. In addition, patients with NLR above the median cutoff value of 3.19 demonstrated that there was a significant increase in NLR values with high tumor (T) and nodal (N) classifications with a p-value of 0.001 and 0.003, respectively.Conclusion: Pretreatment neutrophil to lymphocyte ratio may be associated with increased nodal involvement. It may serve as a useful prognostic predictor for patients with squamous cell car-cinomas of the head and neck. Identifying high-risk patients in the pretreatment phase with the help of such biomarkers will also facilitate early inclusion in clinical trials.

PDF file, 591K, Supplementary Figure 4. KCN1 inhibits the growth of pre-established human glioblastoma s.c. xenografts. Supplementary Figure 5. Effect of KCN1 treatment on mice weight. Supplementary Figure 6. Chronic systemic KCN1 administration shows little effect on major organs, except liver. Supplementary Figure 7. Effect of KCN1 on the survival of mice with orthotopic (intracranial) brain tumor models. Supplementary Figure 8. Permeability coefficients (PC) of KCN1 calculated from the transfer across monolayers of brain endothelial cells.

OBJECTIVE:To collect and analyse epidemiologic data of all malignancies by age group and gender for the Karachi population to estimate the cancer incidence of 5-years (2017-2021) and identify major risk factors for setting priorities towards cancer control programs. STUDY DESIGN:Observational study. Place and Duration of the Study: Karachi Cancer Registry (KCR) Secretariat, Pakistan Health Research Council (PHRC), JPMC, Karachi, from 2017-2021. METHODOLOGY:Cancer data of seven tertiary care hospitals of Karachi submitted to KCR during the study period were analysed including age, gender, date of first contact, primary site and ICD coding. All the data was cleaned, merged, and analysed. All patients 0-14 years were classified as 'children', all aged 15-19 years were classified as 'adolescents', and those age 20-years and above as 'adults'. Age standardised incidence rates (ASIR) were determined for both genders. RESULTS:During the last five years (2017-2021), a total of 65,886 malignant cases were received. The distributions seen amongst males and females were 33,510 (51%) and 32,376 (49%), respectively with 60,145 (91.3%) tumours found in adults (≥20 years), 4844 (7.3%) in children, and 897 (1.4%) in adolescents. The three most common tumour sites were oral, liver, and colorectal in males; breast, oral and ovary in females; bone, brain and connective tissue in adolescents; and leukaemia, brain and bone in children. The overall ASIR (%) in males was 89.20 for adults, 9.19 for children, and 1.61 for adolescents. The overall ASIR (%) in females was 93.44 for adults, 5.45 for children, and 1.11 for adolescents. CONCLUSION:Oral cancer, a largely preventable cancer is the leading cancer in males while breast cancer is the leading cancer in females followed by oral cancer. In adolescents and children, the incidence closely matches most of the world. KEY WORDS:Karachi, Cancer registry, Oral cancer, Breast cancer, Age-standerdised ratio.

Introduction The disease course of head and neck (H&N) cancer can severely impair patients’ quality of life (QoL). In Pakistan, a South Asian lower-middle-income country (LMIC), psychosocial factors may impact QoL. We aimed to assess QoL and associated factors amongst patients with H&N cancer in Pakistan. Methods An analytical cross-sectional study was conducted amongst adult (≥ 18 years) patients with H&N cancer who were ≥ 4 weeks post-initiation of treatment. The survey assessed QoL (European Organization for Research and Treatment of Cancer Quality of Life Questionnaires), anxiety and depression (Hospital Anxiety and Depression Scale), and social support (Enriched Social Support Instrument). Multivariable linear regression was performed for analysis. Results A total of 250 patients (mean age: 51.6 years) were included. The majority of patients were married (87%) and living with multigenerational/extended family households (53%). On multivariable linear regression, ongoing cancer treatment (beta coefficient: -13.93), having a tracheostomy (-10.02), and receiving adjuvant chemoradiotherapy (-8.17) were significantly associated with poorer global QoL. Additionally, poorer QoL was associated with depression (-24.37) and anxiety (-13.34). However, having more household family members was associated with better global QoL (0.34). Conclusion The QoL of patients with H&N cancer in Pakistan is affected by both the nature of cancer treatment as well as sociocultural factors such the number of household family members. Given that poorer QoL is associated with worse mental health outcomes, there is a need to develop and implement psychosocial interventions to improve the QoL of patients with H&N cancer in Pakistan, particularly during active treatment.

Limited knowledge is available on the incidence of febrile neutropenia (FN) in intermediate-risk patients and the rationale for use of granulocyte colony-stimulating factor (G-CSF) in these patients. We aimed to estimate the rate at which patients associated with intermediate risk (10–20

IntroductionBrain tumor is a devastating and often fatal diagnosis; quality of life and patient well-being are important goals of treatment. This study addresses the gap in culture-specific literature exploring the needs and coping strategies of brain tumor patients within an LMIC setting.MethodologyA qualitative approach was undertaken using an exploratory descriptive study design. In-depth interviews were conducted to capture the perspective of 250 brain tumor patients at a private tertiary center followed by extensive content analysis to identify major themes and sub-themes across responses.ResultsThe analysis identified three major themes: (i) Factors affecting the lives of brain tumor survivors (BTSs) and their impact (ii) What works to improve QoL according to the survivors’ perspectives, and (iii) Coping tactics & fostering healthy relationships. The need for financial navigation strategies improved patient-physician relationships, and reinforcing positive coping strategies were emphasized.ConclusionIn our population, family support and spiritual connection played an important role in helping patients mitigate the psychosocial burden of illness. However, financial concerns were pervasive and need to be addressed for better overall well-being.

The pervasive stigma about the transgender community is deeply rooted around the globe in all spheres of public life. Health, as a fundamental human right, was enshrined in the Universal Declaration of Human Rights in 1948, Article 25 ( 1 Universal Declaration of Human Rights. 2021; Available at: https://www.un.org/en/about-us/universal-declaration-of-human-rights. Access date: April 15th, 2022. Google Scholar ). However, even after more than 70 years, communities such as transgenders, face the worst form of discrimination while seeking healthcare. Less than 1% of the population of the United States identifies themselves as transgender. This is likely under-reported to avoid social stigma and exclusion ( 2 Deutsch MB Radix A Wesp L. Breast cancer screening, management, and a review of case study literature in transgender populations. Semin Reprod Med. 2017; 35: 434-441https://doi.org/10.1055/s-0037-1606103 Crossref PubMed Scopus (38) Google Scholar ). A member of the transgender community says, "There isn't a trans moment… It's just a presence where there was an absence. We deserve so much more." — Hari Nef, The New Yorker, 2016 ( 3 Team, K. Inspirational transgender quotes: powerful words of support, acceptance, and love. 2021; Available at: https://kidadl.com/articles/inspirational-transgender-quotes-powerful-words-of-support-acceptance-and-love. Google Scholar ).

INTRODUCTION AND IMPORTANCE:Primary cardiac sarcoma is a rare malignancy with a poor prognosis because of diagnostic delay, therapeutic difficulties, and high metastatic potential. The therapeutic approach includes surgery, chemotherapy, and radiation therapy, alone or in combination. However, there is a lack of evidence to guide the treatment.CASE PRESENTATION:We present a case of primary cardiac sarcoma. Our patient was presented in the department of emergency medicine (ED) in our institute with shortness of breath on exertion associated with orthopnea. Based on the history and cardiovascular examination, he underwent an echocardiogram, which revealed a sizeable echogenic density in the right ventricular outflow tract. He underwent surgical resection of the cardiac mass via median sternotomy and total cardiopulmonary bypass approach. The patient was eventually diagnosed with primary cardiac sarcoma, confirmed by tissue biopsy after surgical intervention.CLINICAL DISCUSSION:Through this report, we highlight the rarity of primary cardiac sarcomas, the importance of multidisciplinary tumor board (MDT) discussion and provide evidence of surgical excision being the treatment of choice, followed by systemic chemotherapy in selected cases.CONCLUSION:Cardiac sarcoma is a rare but highly malignant tumor with a poor prognosis. However, early diagnosis and surgical resection of a primary cardiac sarcoma can significantly increase the patient's survival and quality of life. Therefore, physicians should keep a high suspicion of a patient with clinical features suggestive of cardiac sarcoma, and echocardiography should be the diagnostic modality of choice in such patients.

Background Breast cancer is the most common malignancy in women, affecting over 1.5 million women every year, which accounts for the highest number of cancer-related deaths in women globally. Hereditary breast cancer (HBC), an important subset of breast cancer, accounts for 5–10% of total cases. However, in Low Middle-Income Countries (LMICs), the population-specific risk of HBC in different ethnicities and the correlation with certain clinical characteristics remain unexplored. Methods Retrospective chart review of patients who visited the HBC clinic and proceeded with multi-gene panel testing from May 2017 to April 2020. Descriptive and inferential statistics were used to analyze clinical characteristics of patients. Fisher’s exact, Pearson’s chi-squared tests and Logistic regression analysis were used for categorical variables and Wilcoxon rank-sum test were used for quantitative variables. For comparison between two independent groups, Mann-Whitney test was performed. Results were considered significant at a p value of < 0.05. Results Out of 273 patients, 22% tested positive, 37% had a VUS and 41% had a negative genetic test result. Fifty-five percent of the positive patients had pathogenic variants in either BRCA1 or BRCA2 , while the remaining positive results were attributed to other genes. Patients with a positive result had a younger age at diagnosis compared to those having a VUS and a negative result; median age 37.5 years, IQR (Interquartile range) (31.5–48). Additionally, patients with triple negative breast cancer (TNBC) were almost 3 times more likely to have a positive result (OR = 2.79, CI = 1.42–5.48 p = 0.003). Of all patients with positive results, 25% of patients had a negative family history of breast and/or related cancers. Conclusions In our HBC clinic, we observed that our rate of positive results is comparable, yet at the higher end of the range which is reported in other populations. The importance of expanded, multi-gene panel testing is highlighted by the fact that almost half of the patients had pathogenic or likely pathogenic variants in genes other than BRCA1/2 , and that our test positivity rate would have only been 12.8% if only BRCA1/2 testing was done. As the database expands and protocol-driven referrals are made across the country, our insight about the genetic architecture of HBC in our population will continue to increase.

Objective: To determine recurrence-free survival, patterns of loco-regional and systemic recurrence in patients with pancreatic adenocarcinoma. Methods: We conducted a retrospective Study at the Department of Oncology in a tertiary care Hospital, Karachi Pakistan from January 2013 to December 2019. We studied the sample size of 67 adults of 18 to 70 years of age, diagnosed with adenocarcinoma of the pancreas and treated primarily with curative intent. All patients received complete treatment for the primary disease in our institution and data was extracted retrospectively from the hospital's medical record. Records were reviewed for recurrence of disease and patterns of loco regional and systemic recurrence. SPSS version 23 was used to analyze the data. Results: Out of 67 patients with pancreatic adenocarcinoma, 65 patients (97%) had a complete clinical and radiological response on the follow up scans performed at three months after the completion of curative treatment. However 2 (3%) patients had disease recurrence/residual disease on first follow up scan. Subsequent follow ups showed cancer recurrence was observed in 60 (89.5%) patients, out of which 10 (14.9%) had loco regional while 7 (10.5 %) had systemic only recurrence. Most of the patients (n= 43; 64.1%) had systemic as well loco regional recurrences. The most frequent site of distant metastasis was the liver (66 %). The median recurrence free survival was 09 months (IQR= 8, 15). Conclusion: This retrospective analysis highlights the patterns of recurrence after curative treatment of pancreatic ductal adenocarcinoma and indicates high recurrence rates which is expected for an aggressive disease like pancreatic carcinoma. By better understanding the patterns of recurrence, it can help in identifying subsets of patients with high risk of recurrence as well as in managing such patients more effectively. Keywords: Pancreatic Adenocarcinoma, clinical outcomes, recurrence, metastasis, progression- free survival.

Background and Aim:Diffuse large B-cell lymphoma (DLBCL) has been classified using various parameters, including the site of origin. Studies have reported conflicting outcomes when DLBLC patients were stratified according to the site of origin. This study aimed to investigate the response rate and survival outcomes in nodal versus extranodal DLBCL and compare the results to a region-matched study covering the 1988 - 2005 period.Methods:A single-center retrospective cohort study was conducted on all patients diagnosed with DLBCL and treated in a tertiary care hospital in Pakistan during 2014 - 2019. We calculated the mean and median for continuous variables and frequency and percentages for all categorical variables. Progression-free survival (PFS) and overall survival (OS) were calculated using Kaplan-Meier survival curves. A Cox proportional hazards model was used to determine the hazard ratio (HR) for OS.Results:Of the 118 patients, 49 patients (41.5%) had nodal disease and 69 patients (58.5%) were diagnosed with extranodal DLBCL. The majority of patients in the nodal and extranodal cohorts presented with Stages III and IV disease (73.4% and 62.3%, respectively). A complete response to (immuno) chemotherapy was achieved in 71.4% of nodal DLBCL patients and 65.2% of extranodal DLBCL patients. The 5-year PFS and median PFS in the entire cohort were 0.8% and 17 m, respectively. The PFS and median PFS in the nodal and extranodal DLBCL cohort were 0% and 1.4%, respectively, and 15 m and 19 m, respectively. The 5-year OS and median OS in the entire cohort were 16.1% and 19 m, respectively. The OS and median OS in the nodal and extranodal DLBCL cohort were 8.2% and 21.7%, respectively, and 19 m and 21 m, respectively. Multivariable linear regression revealed that the ABC phenotype (nodal, HR = 1.37, 95% CI = 1.37 - 3.20; extranodal, HR = 1.65, 95% CI = 1.46 - 3.17; GBC as reference) and double and triple hit DLBCL (nodal, HR = 1.29, 95% CI = 1.19 - 2.81; extranodal, HR = 1.87, 95% CI = 1.28 - 2.43; and non-expressors as reference) are independent negative predictors of OS.Conclusions:DLBCL incidence in the Karachi region has remained comparable but patient composition in the extranodal DLBCL cohort has shifted to predominantly advanced stage. Nodal and extranodal DLBCL were associated with similar PFS and OS profiles and first- and second-line treatment responses. Cell of origin and antigen expression status was independent negative predictors of OS, disfavoring the ABC phenotype and lesions with c-MYC and BCL2 and/or BCL6 overexpression.Relevance for Patients:DLBCL is an aggressive type of non-Hodgkin's lymphoma, however; patients respond well to standard systemic chemotherapy. Extranodal type of DLBCL patients tend to have more residual disease after first-line systemic chemotherapy, but physicians should keep in mind that the subsequent line treatment mitigates its negative impact on survival.

Abstract Background We translated and validated the Urdu version of the European Organization for Research and Treatment of Cancer Quality of Life (QoL) Questionnaire’s Head and Neck (H&N) Cancer Module (EORTC QLQ-H&N35) and assessed its convergent and discriminant validity by examining correlations of QoL with depression, anxiety, and resilience. Methods We translated the EORTC QLQ-H&N35 according to EORTC instructions. Patients at a tertiary care hospital in Pakistan completed a survey consisting of Urdu versions of EORTC QLQ-C30 (core QoL tool), QLQ-H&N35, Hospital Anxiety and Depression Scale, and Wagnild and Young Resilience Scale (RS-14). Content validity, convergent validity, discriminant validity, and reliability (using Cronbach’s alpha) of the EORTC QLQ-H&N35 were assessed. Results Our sample comprised 250 patients with H&N cancer, most commonly oral (82%). The Urdu translations were comprehensible for all patients. The Cronbach alpha for QLQ-H&N35 multi-item domains ranged from 0.75 to 0.98 (acceptable to excellent), barring “Senses Problems”, which was less than the generally acceptable level (0.50). The patient-reported content validity index (CVI) scores for relevance and clarity of the Urdu version of the QLQ-H&N35 were 0.93 and 0.92, respectively (both excellent). Our results revealed weak bidirectional correlations of the QLQ-H&N35 with resilience, depression, and anxiety, showing good discriminant validity. A weak-to-moderate but significant negative correlation (r: − 0.185 to − 0.613; p < 0.01) was seen between the QLQ-H&N35 and the global QoL measure of the QLQ-30. Conclusion Our Urdu translation of the EORTC QLQ-H&N35 demonstrated validity comparable to previous studies, with good discriminant construct validity when measured against resilience, depression, and anxiety. An issue of concern is the poor internal consistency of the “Senses Problems” domain. Nevertheless, the Urdu translation produced in this study serves as a valid and reliable measure to measure QoL in H&N cancer in clinical or research settings in Pakistan.

Background: GBM is the most common and aggressive primary malignant brain tumor. Despite multimodality approach in the treatment of brain tumor, survival of the patients with GBM remains poor. The median survival of glioblastoma patients is 12 months. However, 35% of the patients survives for more than 3 years and are referred to as long-term survivors. When disease progression occurs 6-month progression-free survival (PFS) is usually lower than 15%.