इंटीग्रेटिव ऑन्कोलॉजी जर्नल

Purpose: Recently, higher expression of chemokine receptors in patients with various cancer types has been observed and indicated to have prognostic significance in the clinical progression of cancers. Former research has determined that CXCR7, as a member of chemokine receptor C-X-C family, empowers greater affinity with chemokine CXCL12 than CXCR4. The present study investigated the correlation of clinical characteristics and CXCR7 expression in cancers using meta-analysis. Methods: A comprehensive search on Pubmed and Web of Science identified CXCR7-related clinical studies. Methodological quality of these studies was evaluated and all the data were extracted, calculated and analyzed. This meta-analysis was carried out with Stata 12.0. Results: Fifteen eligible studies consisting of 1780 participants were included. The results showed that CXCR7 significantly relates to tumor occurrence (pooled RR=3.12, 95% CI: 1.71-5.70, P=0.000), tumor grades (pooled RR=1.41, 95% CI: 1.14-1.75, P=0.002), tumor stages (pooled RR=1.51, 95% CI: 1.26-1.82, P=0.000) and lymph node metastasis (pooled RR=1.49, 95% CI: 1.14-1.94, P=0.000), respectively. Conclusion: Highly expressed chemokine receptor CXCR7 potentially increases tumor occurrence risk. Higher CXCR7 expression is associated with poorer prognosis, advanced stages, differentiation grades and poor lymph node metastasis in patients with various cancers. Thus, highly expressed CXCR7 could be a potential biomarker in the prognosis of cancers.

Introduction and objectives: The incidence of multiple myeloma (MM) increases with age. There is a clear decrease in overall survival (OS) in older patients. The purpose of this study was to investigate prognostic factors of MM in this population. Materials and methods: This is an analytic prospective single-center study conducted over 27 months including MM elderly patients treated with weekly subcutaneous bortezomib alone or associated with another chemotherapy. Results: Our work has included 45 patients (median age 84.3 years). Most of them (77.7%) had a PS ≥ 2, 75.6% were undernourished and 57, 1% had a Mini Mental State Examination (MMSE)<26. Haematological grade 3 toxicities were observed in 11% of patients. After 17 months mean follow-up, the median of OS was 18.6 months. In univariate analysis, significant predictors for OS were instrumental activities of daily living (IADL) ≥ 2 (p = 0.003), activities of daily living (ADL)<5 (p = 0.005), the body mass index (BMI)<21 (p = 0.03) and using hospitalization at home unit for bortezomib injections (p = 0.01). In multivariate analysis, significant predictors for OS were ADL<5 (p = 0.005), using hospitalization at home unit (p = 0.007) and IADL ≥ 2 (p = 0.05) Conclusion: In our work, weekly subcutaneous bortezomib was well tolerated. We have shown that functional decline, malnutrition and hospitalization at home unit are predictors of OS. These results lead us to reflect on the need to include these factors in the choice of treatment in elderly patients with MM.

Patients with a solitary bone metastasis have a different prognosis according to primary tumor histotype. Surgeon has to consider this parameter when performing operations. A good prognosis means a long survivorship, high functional demands, long lasting treatment and, overall, a quick rehabilitation program. The study is on 36 patients with solitary bone metastasis from different Histotypes (Breast cancer, Kidney Cancer and Thyroid Cancer) which have been treated by resection and prostheses. Clinical findings demonstrated that resections and prosthetic reconstructions are the gold standard to help surgeon to obtain the best results. Adjuvant systemic or local therapy may help when feasible.

Sarcomas of the foot are conventionally treated with amputation. However, limb salvage procedures are possible in cases of specific histological patterns. We report a rare case of a huge myxoid liposarcoma of the dorsal and plantar aspect of the forefoot.
A 47 years-old woman was admitted to our Institution complaining of a painless huge mass of the dorsal and plantar aspect of the left forefoot. Following the patient’s medical history remarking a previous myxoid liposarcoma, this finding was interpreted as a local recurrence. The mass was explored through radiographic, magnetic resonance imaging and bone scan assessments. An incisional biopsy was performed, and a myxoid liposarcoma was ultimately diagnosed.
A limb salvage procedure was performed in association with coverage plastic surgery. Postoperative stay was uneventfully. Forty days after surgery the patient underwent a cycle of radiotherapy. At 10 year follow-up the patient had a good functionality without signs of local recurrence nor metastatic spread.

Background: Clinical epidemiology studies of breast cancer in India have reported younger age at detection, presentation at a later stage with a greater proportion of Triple Negative Breast Cancer (TNBC). The aim of this study was to examine the standard clinic-pathological variables in the hormone-receptor based sub-types for patterns indicative of intrinsic differences from that reported in Western, Caucasian women.
Methods: Clinico-pathological variables from 645 patients who were diagnosed with breast cancer during 2012 at the regional cancer were retrospectively analyzed for clinical and immunohistochemistry details.
Results: The median age at first diagnosis is 48 years which is decade earlier than that reported in Western case-series, 65% were lymph-node positive, and 33% of all cases were Triple negative Breast Cancers. Sub-type specific examination of tumor size and lymph-node (LN) status showed the HER2 positive tumors to have the highest proportion of tumors that were pT4 and 75% were LN positive. Conversely, despite 92% of TNBCs being grade 3, 40% of them were LN negative.
Conclusion: We confirm the three cardinal clinical epidemiological features reported by other Indian centres. The clinical behavior of the HER2 positive and TNBC sub-types are no different from that reported in Western caseseries suggesting that these aspects are innate and conserved.

Introduction: The Nutrition Risk in Critically ill (NUTRIC) score is a specific tool for assessing the nutritional risk in the Intensive Care Unit (ICU). Under these conditions, it is extremely important to monitor Enteral Nutrition Therapy and identify main barriers in the control of energy-protein deficit.
Objective: To identify main barriers to control the energy-protein deficit in critically ill patients at nutritional risk, on enteral nutrition (EN) and on mechanical ventilation (MV).
Methods: Prospective, observational, descriptive study was conducted in an ICU in 2015. Patients >19 years of age on MV and underwent EN for >72 hours. The data collected were NUTRIC score, Subjective Global Assessment (SGA), Cachexia Syndrome, APACHE II, SOFA, ICU time, MV and EN times and main barriers for pausing EN. The protein-calorie deficit was compiled into total days of EN.
Results: Total of 62 patients, 22 were excluded, 40 analyzed. The scores were NUTRIC 7 (+0.7), APACHE 26 (+5.2), SOFA 11.5 (+2.2), Body Mass Index 23.2 (+6.2) kg/m², 47% malnourished (SGA B+C), 70% cachexia syndrome and mortality rate of 52.5%. Among these patients, 77.5% underwent early EN and percentage of volume prescribed infused was 89%. It was observed total deficit of -296 (+339) calories and -28 (IQ -58:-2.95) g/protein. Main barriers for pausing EN were extubation 38%, hemodynamic instability 29%, tracheostomy, diarrhea and vomiting, both 6.5%. There was a statistically significant difference between calorie (p<0.003) and protein (p<0.002) deficits in the subgroups of adult patients compared to malnourished elderly patients with cachexia syndrome: -358.9 (+305) calories and -33 (+14.24) g/protein; -91.6 (+190) calories and -18.8 (+7.96) g/protein, respectively.
Conclusion: The main barriers in control of energy-protein deficit in critical oncologic patient at nutritional risk on EN and on MV were extubation and hemodynamic instability.