Nevin Manimala

Asian Pac J Cancer Prev. 2021 Feb 1;22(2):573-579. doi: 10.31557/APJCP.2021.22.2.573.

ABSTRACT

OBJECTIVES: To evaluate the expression of miR-126-3p and its potential as a biomarker for cholangiocarcinoma (CCA) and to better understand the prognosis, comorbidities, and lifestyle habits associated with the disease.

METHODS: Fifty-nine individuals were distributed into either the study group (38 CCA patients) or the control group (21 individuals without liver diseases). Total RNA was extracted, cDNA synthesis was performed, and miR-126-3p expression was assessed using real-time PCR. For statistical analysis, alpha error was set at 5%.

RESULTS: MiR-126-3p was found to be underexpressed in the study group relative to the controls (0.42; P=0.001). Additionally, marked underexpression was found in the study group in when associated with smoking (0.28; P=0.0001), alcoholism (0.19; P=0.0001), hypertension (0.29; P=000.1), and diabetes (0.12; P=0.0003) relative to the controls. No association was found between miR-126-3p expression and tumor subtypes (iCCA=0.42; pCCA=0.45; dCCA=0.72; P=0.9155). A total of 67% of dCCA patients were event-free at 16 months of follow up, while both pCCA and iCCA exhibited event-free survival rates of 25%, though there was no significant difference between these subgroups (P=0.273).

CONCLUSION: The underexpression of mir-126-3p is associated with cholangiocarcinoma and can be potentiated by alcoholism, hypertension, diabetes, and smoking, the latter of which is an independent risk factor for this cancer. Furthermore, dCCA patients exhibit higher survival rates relative to patients with pCCA and iCCA.<br />.

PMID:33639676 | DOI:10.31557/APJCP.2021.22.2.573

Asian Pac J Cancer Prev. 2021 Feb 1;22(2):559-564. doi: 10.31557/APJCP.2021.22.2.559.

ABSTRACT

BACKGROUND: Estimation of JAK2V617F mutational load in Polycythemia Vera (PV) helps to determine the severity of the disease phenotype, the risk of thrombotic events, progression to post-PV myelofibrosis and survival. Amplification Refractory Mutation Screening (ARMS) PCR or Allele Specific (AS) PCR is a simple easy method with a reasonable sensitivity for screening of zygosity.The purpose of this study was to see the frequency of disease burden and phenotypic characteristics in Pakistani patients diagnosed with JAK2V617F mutation positive PV.

MATERIALS AND METHODS: A cross-sectional study using non probability consecutive sampling was conducted at Hematology Department, Liaquat National Hospital Karachi from October 2018 to July 2019.Adult newly diagnosed JAK2V617F positive PV patients of either gender were included. Patients’ demographics, clinical characteristics and baseline CBC were noted. JAK2V617F zygosity was qualitatively analyzed by ARMS-PCR technique. Age and gender were stratified to see to see the result of qualitative and quantitative effect modifiers on these patients using Chi Square and fisher exact test as appropriate while mean comparison was done by independent t-test and one way ANOVAtest. P value of ≤0.05 was considered as significant.

RESULTS: Fifty one patients were included in the study with an average age of 59.60±14.29years.90.2% of patients had hypertension.All patients tested positive for heterozygous state. Significant association of gender was found with smoking (p=0.001) while age was significantly linked with hypertension (p-0.033).

CONCLUSION: JAK2V617F positive PV patients are mainly heterozygous males showing significant association with smoking and hypertension. ARMS-PCR is a robust technique to determine zygosity which can be used for screening purposes.<br />.

PMID:33639674 | DOI:10.31557/APJCP.2021.22.2.559

Asian Pac J Cancer Prev. 2021 Feb 1;22(2):537-546. doi: 10.31557/APJCP.2021.22.2.537.

ABSTRACT

BACKGROUND: Obtaining the right image dataset for the medical image research systematically is a tedious task. Anatomy segmentation is the key step before extracting the radiomic features from these images.

OBJECTIVE: The purpose of the study was to segment the 3D colon from CT images and to measure the smaller polyps using image processing techniques. This require huge number of samples for statistical analysis. Our objective was to systematically classify and arrange the dataset based on the parameters of interest so that the empirical testing becomes easier in medical image research.

MATERIALS AND METHODS: This paper discusses a systematic approach of data collection and analysis before using it for empirical testing. In this research the image were considered from National Cancer Institute (NCI). TCIA from NCI has a vast collection of diagnostic quality images for the research community. These datasets were classified before empirical testing of the research objectives. The images in the TCIA collection were acquired as per the standard protocol defined by the American College of Radiology. Patients in the age group of 50-80 years were involved in various clinical trials (multicenter). The dataset collection has more than 10 billion of DICOM images of various anatomies. In this study, the number of samples considered for empirical testing was 300 (n) acquired from both supine and prone positions. The datasets were classified based on the parameters of interest. The classified dataset makes the dataset selection easier during empirical testing. The images were validated for the data completeness as per the DICOM standard of the 2020b version. A case study of CT Colonography dataset is discussed.

CONCLUSION: With this systematic approach of data collection and classification, analysis will be become more easier during empirical testing.<br />.

PMID:33639671 | DOI:10.31557/APJCP.2021.22.2.537

Asian Pac J Cancer Prev. 2021 Feb 1;22(2):523-530. doi: 10.31557/APJCP.2021.22.2.523.

ABSTRACT

BACKGROUND: Early diagnosis of a brain tumor is important for improving the treatment possibilities. Manually segmenting the tumor from the volumetric data is time-consuming, and the visualization of the tumor is rather challenging.

METHODS: This paper proposes a user-guided brain tumour segmentation from MRI (Magnetic Resonance Imaging) images developed using Medical Imaging Interaction Toolkit (MITK) and printing the segmented object using the 3D printer for tumour quantification. The proposed method includes segmenting the tumour interactively using connected threshold method, then printing the physical object from the segmented volume of interest. Then the distance between two voxels was measured using electronic callipers on the 3D volume in a specific direction. And next, the same distance was measured in the same direction on the 3D printed object.

RESULTS: The technique was tested with n=5 samples (20 readings) of brain MRI images from RIDER Neuro MRI dataset of National Cancer Institute. MITK provides various tools that enable image visualization, registration, and contouring. We were able to achieve the same measurements using both the approaches and this has been tested statistically with paired t-test method. Through this and the observer’s opinion, the accuracy of the segmentation was proved.

CONCLUSION: When the difference in measurement of tumor volume through the electronic calipers and with 3D printed object equates to zero, proves that the segmentation technique is accurate. This helps to delineate the tumor more accurately during radio therapy.

PMID:33639669 | DOI:10.31557/APJCP.2021.22.2.523

Asian Pac J Cancer Prev. 2021 Feb 1;22(2):499-508. doi: 10.31557/APJCP.2021.22.2.499.

ABSTRACT

BACKGROUND: A study investigating associations between various socioeconomic factors and standardized mortality ratios (SMR) of each type of cancer among municipalities in Japan has not been conducted using the data of the past decade. Herein, we investigated the predictors of a recent trend of municipal SMRs of cancer using the Vital Statistics in Japan and revealed the change in the SMRs depending on the identified predictors.

METHODS: Data on cancer mortality for each municipality in 2010 and 2019 were used. We calculated empirical Bayes SMR (EBSMR) for each municipality by type of cancer and sex and then fitted a multiple linear regression model using possible predictors in 2010 as explanatory variables and the EBSMR in 2019 as the outcome variable. We also classified municipalities into quintiles based on the values of an identified predictor in 2010, and SMRs of each type of cancer in 2010 and 2019 were calculated for each quintile.

RESULTS: The total population was positively associated with EMSMRs of multiple cancer types, whereas educational level was negatively associated with EMSMRs of multiple cancer types. In addition, SMRs of municipalities with the lowest educational level deteriorated from 2010 to 2019 for many cancer types among men and women, and the difference between municipalities with the highest and lowest educational level for the SMR of cancer in all sites widened in 2019 for men. On the other hand, the SMR of municipalities with the highest educational level or the largest total population tended to be higher than municipalities with lower counterparts in both 2010 and 2019 for women.

CONCLUSION: There was a difference in the trend of the SMRs of multiple types of cancer depending on municipal educational level, whereas municipalities with larger population or educational level continued to have higher SMRs of cancer in all sites for women.<br />.

PMID:33639666 | DOI:10.31557/APJCP.2021.22.2.499

Asian Pac J Cancer Prev. 2021 Feb 1;22(2):491-497. doi: 10.31557/APJCP.2021.22.2.491.

ABSTRACT

OBJECTIVE: To explore the treatment outcomes of locally advanced cervical cancer (LACC) patients with pelvic lymph node enlargement (PLNE) or stage IIIC1 when compared with no PLNE and unknown PLN status (UNK).

MATERIALS AND METHODS: Retrospective cohort study was designed by matching with the ratio of 1:4:4 for patients with PLNE, no PLNE and UNK between 2003 and 2017. The main factor which was used to match was clinical staging.

RESULTS: All 360 LACC patients who treated as concurrent chemoradiation therapy (CCRT) were composed of 40 with PLNE, 160 with no PLNE and 160 with UNK. The majority of tumor histology (78.9%) was squamous cell carcinoma and 51.1% were diagnosed in stage IIB. Five-year progression free survival rates of patients with PLNE, no PLNE and UNK were 42.7%, 64.5% and 59.0%, respectively (P = 0.191), and corresponding with 5-year overall survival rates of 57.0%, 66.0% and 61.9% (P = 0.608). Patients with PLNE had local recurrence (LR) at 22.5%, compared with no PLNE at 11.3% and UNK at 11.9%. The most common site of LR for patients with PLNE was PLN with odds ratio of 19.7 when using no PLNE as reference (P < 0.001). There was no statistically significant difference between distant metastasis rates in PLN statuses of patients with PLNE, no PLNE and UNK at 20.6%, 30.0% and 26.3%, respectively. Conclusions: LACC patients with PLNE had a trend of poorer survival rates than patients with no PLNE, while treatment outcomes of patients with UNK were not inferior to no PLNE.<br />.

PMID:33639665 | DOI:10.31557/APJCP.2021.22.2.491

Asian Pac J Cancer Prev. 2021 Feb 1;22(2):477-483. doi: 10.31557/APJCP.2021.22.2.477.

ABSTRACT

OBJECTIVE: To investigate the oral psychosomatic disorders (PSDs) in family caregivers (FCs) of oral cancer (OC) patients and to evaluate the correlation between these oral PSDs to severity of depression anxiety and stress.

METHODS: A total of 50 participants were included each in first degree relative (FDR), second degree relative (SDR) and control group. All the participants completed DASS-21 questionnaire and were subjected to thorough clinical history and oral examination.

RESULTS: All the FCs reported statistically significant higher mean levels of depression, anxiety and stress compared to controls (p˂0.001). A significantly greater number of FCs (40.00%) reported oral PSDs than control group (12.00%). Most prevalent oral PSD in FCs was aphthous stomatitis followed by oral lichen planus, bruxism, burning mouth syndrome and myofascial pain dysfunction syndrome. Moreover, there was a preponderance of these diseases in FDR (60.86%) compared to SDR (26.08%). FCs with moderate to very severe depression, anxiety and stress showed higher prevalence of these oral PSDs compared to the ones with mild depression, anxiety and stress.

CONCLUSION: The observations of higher prevalence of oral PSDs in FCs with psychological alterations can enhance healthcare professionals’ awareness to better understand FCs’ oral healthcare needs.<br />.

PMID:33639663 | DOI:10.31557/APJCP.2021.22.2.477

Asian Pac J Cancer Prev. 2021 Feb 1;22(2):437-445. doi: 10.31557/APJCP.2021.22.2.437.

ABSTRACT

BACKGROUND: While many past studies have constructed projections of future lung cancer rates, little is known about their consistency with the corresponding observed data for the time period covered by the projections. The aim of this study was to assess the agreement between previously published lung cancer incidence and/or mortality rate projections and observed rates.

METHODS: Published studies were included in the current study if they projected future lung cancer rates for at least 10 years beyond the period for which rates were used to obtain the projections, and if more recent observed rates for comparison covered a minimum of 10 years from the beginning of the projection period. Projected lung cancer incidence and/or mortality rates from these included studies were extracted from the publications. Observed rates were obtained from cancer registries or the World Health Organization’s Mortality Database. Agreement between projected and observed rates was assessed and the relative difference (RD) for each projected rate was calculated as the percentage difference between the projected and observed rates.

RESULTS: A total of 59 projections reported in 14 studies were included. Nine studies provided projections for 20 years or more. RDs were higher for those projections in which the lung cancer rates peaked during the projection period, and RDs increased substantially with the length of the projection period. When lung cancer rates peaked during the projection period, methods incorporating smoking data were generally more successful at predicting the trend reversal than those which did not incorporate smoking data. Mean RDs for 15-year projections comparing methods with or without smoking data were 12.7% versus 48.0% for males and 8.2% versus 42.3% for females.

CONCLUSIONS: The agreement between projected and observed lung cancer rates is dependent on the trends in the observed rates and characteristics of the population, particularly trends in smoking.

PMID:33639658 | DOI:10.31557/APJCP.2021.22.2.437

Asian Pac J Cancer Prev. 2021 Feb 1;22(2):365-370. doi: 10.31557/APJCP.2021.22.2.365.

ABSTRACT

BACKGROUND: Despite approvals of immune checkpoint inhibitors in both small cell and non-small cell lung cancers, the role of immunotherapy in large cell neuroendocrine carcinoma (LCNEC) in lung is undefined.

METHODS: Using the National Cancer Database (NCDB), Stage IV lung LCNEC cases diagnosed from 2014 to 2016 were analyzed. Information regarding cancer treatment was limited to first course of therapy, including surgery for primary lesion, radiation, chemotherapy, and immunotherapy. Survival analysis was performed using Kaplan-Meier curves and Log-rank tests. Cox proportional hazard model was used for multivariate analysis.

RESULTS: Among 661 eligible cases, 37 patients were treated with immunotherapy. No significant association between use of immunotherapy and clinical demographics was observed except for use of chemotherapy (p=0.0008). Chemotherapy was administered in 34 (92%) and 406 (65%) in immunotherapy and non-immunotherapy groups, respectively. Use of immunotherapy was associated with improved overall survival (Log-rank p=0.0018). Landmark analysis in the immunotherapy group showed 12 and 18-month survivals of 34.0% and 29.1%, respectively, whereas those in the non-immunotherapy group were 24.1% and 15.0%, respectively. Multivariate analysis demonstrated that female sex (HR=0.79, p=0.0063), liver metastases (HR=0.75, p=.0392), surgery (HR= 0.50, p <0.0001) use of chemotherapy (HR= 0.44, p <0.0001), and use of immunotherapy (HR=0.64, p=0.0164) had statistical significance. Propensity score matching in overall survival analysis showed a nonsignificant trend (p=0.0733) in favor of immunotherapy treatment.

CONCLUSION: This retrospective study using NCDB suggests that use of immunotherapy may improve survival of LCNEC patients.

PMID:33639649 | DOI:10.31557/APJCP.2021.22.2.365