Purpose:
The aim of this study was to evaluate the demographic characteristics, clinical and pathological factors, and the outcome of cancer and COVID-19 patients in Mexico.
Patients and methods:
A ...prospective, multicentric study was performed through a digital platform to have a national registry of patients with cancer and positive SARS-CoV-2 test results through reverse transcription quantitative polymerase chain reaction (RT-qPCR). We performed the analysis through a multivariate logistic regression model and Cox proportional hazard model.
Results:
From May to December 2020, 599 patients were registered with an average age of 56 years with 59.3% female; 27.2% had hypertension. The most frequent diagnoses were breast cancer (30.4%), lymphoma (14.7%), and colorectal cancer (14.0%); 72.1% of patients had active cancer and 23.5% of patients (141/599) were deceased, the majority of which were men (51.7%). This study found that the prognostic factors that reduced the odds of death were gender (OR = 0.42, p = 0.031) and oxygen saturation (OR = 0.90, p = 0.0001); meanwhile, poor ECOG (OR = 5.4, p = 0.0001), active disease (OR = 3.9, p = 0.041), dyspnea (OR = 2.5, p = 0.027), and nausea (OR = 4.0, p = 0.028) increased the odds of death. In the meantime, the factors that reduce survival time were age (HR = 1.36, p = 0.035), COPD (HR = 8.30, p = 0.004), having palliative treatment (HR = 10.70, p = 0.002), and active cancer without treatment (HR = 8.68, p = 0.008).
Conclusion:
Mortality in cancer patients with COVID-19 is determined by prognostic factors whose identification is necessary. In our cancer population, we have observed that being female, younger, non-COPD, with non-active cancer, good performance status, and high oxygen levels reduce the probability of death.
Neurofibromatosis type 1 (NF1) is a complex, multisystem disorder that is characterized, among other features, by a higher risk of developing benign and malignant tumors. Despite NF1 being one of the ...most common autosomal dominant genetic disorders, data from adult individuals in several world regions remain elusive, including Hispanics.
The present is a retrospective cohort study conducted among adult patients with a confirmed diagnosis of NF1 who attended a single cancer-reference center, the Instituto Nacional de Cancerología in Mexico City from 2001 to 2021. Data were extracted from electronic health records and collected in an anonymous database by an NF1-expert physician in order to obtain demographic characteristics and detailed information regarding the development of tumors among this patient subgroup. All patients with malignant tumors or with benign tumors, which severely affected their quality of life, were included in this study.
Patient records were reviewed from 2001 to 2021. A total of
= 29 patients met the criteria, with a higher proportion of female compared with male subjects
= 22 (75.9%) vs.
= 7 (24.1%). Patients had a mean age at diagnosis of tumors of 32.2 years (
= 11.2 years). In terms of malignant neoplasms, the most frequent malignant tumor presented by patients in this cohort was malignant peripheral nerve sheath tumors (
= 7, 24.1%), this was followed by breast cancer (
= 4, 13.8% among all patients, 18.2% among female patients). Other tumors also identified in this cohort included melanoma, gastrointestinal stromal tumors, and rectal cancer.
In Mexico, patients diagnosed with NF1 develop diverse tumors as adults. As described in other studies, the most frequent malignant tumor in this patient population is the malignant peripheral nerve sheath tumor. Further studies are required to increase the scarce information available for adult Hispanics with NF1.
Obesity has been associated with an increased risk of biologically aggressive variants in breast cancer. Women with obesity often have tumors diagnosed at later stages of the disease, associated with ...a poorer prognosis and a different response to treatment. Human cell lines have been derived from specific subtypes of breast cancer and have served to define the cell physiology of corresponding breast cancer subtypes. However, there are no current cell lines for breast cancer specifically derived from patients with different BMIs. The availability of those breast cancer cell lines should allow to describe and unravel functional alterations linked to these comorbidities.
Cell cultures were established from tumor explants. Once generated, the triple negative subtype in a patient with obesity and a patient with a normal BMI were chosen for comparison. For cellular characterization, the following assays were conducted: proliferation assays, chemo - sensitivity assays for doxorubicin and paclitaxel, wound healing motility assays, matrix invasion assays, breast cancer cell growth to estradiol by chronic exposure to leptin, induction of endothelial permeability and tumorigenic potential in athymic mice with normo - versus hypercaloric diets with an evaluation of the epithelium - mesenchymal transformation proteins.
Two different cell lines, were established from patients with breast cancer: DSG-BC1, with a BMI of 21.9 kg/m2 and DSG-BC2, with a BMI of 31.5 kg/m2. In vitro, these two cell lines show differential growth rates, motility, chemosensitivity, vascular permeability, response to leptin with an activation of the JAK2/STAT3/AKT signaling pathway. In vivo, they displayed distinct tumorigenic potential. In particular, DSG-BC2, presented higher tumorigenicity when implanted in mice fed with a hypercaloric diet.
To our knowledge, these primary cultures are the first in vitro representation of both breast cancer and obesity. DSG - BC2 presented a more aggressive in vivo and in vitro phenotype. These results support the hypothesis that breast cancer generated in an obese metabolic state may represent a contrasting variant within the same disease. This new model will allow both further comprehension, functional studies and the analysis of altered molecular mechanisms under the comorbidity of obesity and breast cancer.
Oncologic patients with covid 19: A mexican endeavor Daniela Shveid-Gerson; Alejandro Noguez-Ramos; Diana A. Villegas-Osorno ...
Revista medica del hospital general de mexico s.s.a,
10/2021, Letnik:
84, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Introduction: The coronavirus disease 2019 (COVID-19) pandemic is a worldwide challenge. There are few reports regarding its behavior in cancer patients. Materials and methods: Retrospective study ...including cancer patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the ABC Medical Center in Mexico City. We include general and oncological variables. We analyzed clinical features and treatment of COVID-19 and its outcomes such as hospitalization and death. Results: We report 86 patients with cancer and SARS-CoV-2 infection. The vast majority of patients 80 (93.1%) had a solid tumor while the most frequent primary tumor was breast 40 (46.5%) and lung 8 (9.3%). The clinical stage of patients was I in 22.1%, II in 16.3%, III in 31.4%, and IV in 24.4%. Antibiotics were used in 37 patients (43%) and corticosteroids in 32 (37.2%). Discussion: During disease evolution, 11 (12.8%) patients were hospitalized and 6 (7.0%) died. Variables of significant association with hospitalization include gender (men, odds ratio OR 5.6), previous cardiac disease (OR 25.1), and hematologic malignancy (OR 8.1). Associations with higher mortality rates were gender (men, OR 15), clinical Stage III/IV cancer (OR 11.3), type 2 diabetes mellitus (OR 14.7), previous cardiac disease (OR 19.2), and targeted therapy (OR 9.0). Conclusions: We found lower hospitalization and mortality rates compared to what had been previously reported both in Mexico around the globe. Men and patients with previous cardiac disease had a significant higher risk of hospitalization and death. Hematologic malignancies (lymphoma) were associated with higher hospitalization. Clinical Stage III/IV, targeted therapy, and type 2 diabetes mellitus showed a statistically significant association with mortality risk.
Introduction: The Coronavirus disease (COVID-19) pandemic is a worldwide challenge. There are few useful tools to predict patient outcomes. Identification of biomarkers able to predict progression of ...the disease could improve the treatment of these patients. Objective: The objective of the study was to identify biomarkers of disease progression among patients with severe COVID-19 pneumonia. Materials and methods: A retrospective cohort study was conducted among severe COVID-19 pneumonia patients hospitalized in the American British Cowdray Medical Center in Mexico City. Disease progression was defined as use of vasoactive amines, need of non-invasive or invasive mechanical ventilation or death. Studied biomarkers included neutrophil/lymphocyte index, lymphocyte/platelet Ratio, C reactive protein, procalcitonin, D Dimer, lactic dehydrogenase (LDH), ferritin, 25–OH–Vitamin D, and interleukin 6. Results: We report 46 patients with severe COVID-19 pneumonia. Mean age was 51 years, the majority of whom 30 (65%) male. Median hospitalization was 9 days. 23 (50%) of patients presented disease progression. Ferritin and LDH were strongly associated with disease progression among our cohort. In addition, age was associated with worst prognosis with a relative risk 4.5 (1.2-16.9, p = 0.003). Conclusions: Age, ferritin, and LDH were associated with disease progression among patients with severe COVID-19 pneumonia.
Opinion statement
Over the years, there have been significant advances in systemic treatments for metastatic pancreatic neuroendocrine tumors (panNETs). Despite these advancements, uncertainty ...remains regarding how to best sequence available therapies. For well-differentiated and metastatic panNETs that are somatostatin receptor (SSTR) avid on functional imaging, first-line therapy typically consists of somatostatin analogs (SSAs), given their favorable toxicity profile and overall low burden for patients. When progression of disease is observed on an SSA, multiple treatment options are available, including the targeted agents everolimus and sunitinib, peptide receptor radionuclide therapy (PRRT), as well as chemotherapy, with the latter often preferred for those panNETs of heavy tumor burden, higher grade, and/or more aggressive behavior clinically and/or radiographically. Here, we review panNET classification, currently available systemic treatments, therapy sequencing, and areas of active investigation to further our treatments for the disease.
e13647
Background: The risk of developing COVID-19 in patients with cancer has increased, directly influenced by age and the magnitude of comorbidities. In this population, the estimated mortality is ...10.9%. With this, the urgent need for patients with cancer to get vaccinated against SARS COV 2 has generated an international response. With the ongoing vaccination campaign, experts in nuclear medicine have observed an increment in lymph node uptake in PET CT with 18 FDG. Increased uptake in lymph nodes in patients with a neoplastic diagnosis on PET CT 18 FDG must be closely followed and well-studied to differentiate disease progression from an inflammatory, fleeting reaction. Methods: Amongst the inclusion criteria were patients over 18 years of age with solid tumors, including lymphomas, who were on active oncologic treatment with chemotherapy, immune therapy, radiotherapy or under surveillance between April 2021 and July 2021 who underwent a PET CT scan and had at least one dose of a COVID 19 vaccine, and a prior PET CT to the vaccine for comparison. Patients were excluded who showed evidence of progression or disease recurrence of the primary tumor. We evaluated lymph node size and metabolism measured by SUV max in the PET CT scan prior to being vaccinated and posterior to, as well as patients’ clinical characteristics. Results: A total of 92 patients who met inclusion criteria were included in the study. Amongst those, 54.3% were women, the median age was 68 years (27 - 95 years), the most common neoplastic diagnoses were breast cancer (19.6%), gastrointestinal tumors (17.4%), urothelial tumors (9.8%), lymphomas (9.8%) and ovarian cancer (8.7%). 52.2% of patients were under surveillance and 47.8% were under active treatment. 79% of patients had at least 2 vaccine doses. 59% had received Pfizer vaccines and the measurable adenopathies were axillary in 32.7% and mediastinal in 27%. The medium size of the measured lymph nodes prior to receiving the vaccine was 2.86 mm with an SUV max of 1.24, while after vaccination were 6.01 and 2.27 respectively. A Kruskal Wallis test was conducted to compare median results according to histopathologic reports, with no statistical difference. A Mann Whitney U test was conducted to compare breast cancer to other cancer histologies, where a statistical difference was found for SUV max, p = 0.003 and size with p = 0.033. Conclusions: This work details significant differences between lymph node size and SUV max in oncologic patients pre and post vaccination for COVID 19, showing a statistical difference in patients with breast cancer. This increment in lymph node uptake in patients with a neoplastic diagnosis PET CT 18 FDG must be closely followed and well-studied to differentiate disease progression from an inflammatory reaction.
Oncologic patients with covid 19: A mexican endeavor Daniela Shveid-Gerson; Alejandro Noguez-Ramos; Diana A. Villegas-Osorno ...
Revista medica del hospital general de mexico s.s.a,
10/2021, Letnik:
84, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Introduction: The coronavirus disease 2019 (COVID-19) pandemic is a worldwide challenge. There are few reports regarding its behavior in cancer patients. Materials and methods: Retrospective study ...including cancer patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the ABC Medical Center in Mexico City. We include general and oncological variables. We analyzed clinical features and treatment of COVID-19 and its outcomes such as hospitalization and death. Results: We report 86 patients with cancer and SARS-CoV-2 infection. The vast majority of patients 80 (93.1%) had a solid tumor while the most frequent primary tumor was breast 40 (46.5%) and lung 8 (9.3%). The clinical stage of patients was I in 22.1%, II in 16.3%, III in 31.4%, and IV in 24.4%. Antibiotics were used in 37 patients (43%) and corticosteroids in 32 (37.2%). Discussion: During disease evolution, 11 (12.8%) patients were hospitalized and 6 (7.0%) died. Variables of significant association with hospitalization include gender (men, odds ratio OR 5.6), previous cardiac disease (OR 25.1), and hematologic malignancy (OR 8.1). Associations with higher mortality rates were gender (men, OR 15), clinical Stage III/IV cancer (OR 11.3), type 2 diabetes mellitus (OR 14.7), previous cardiac disease (OR 19.2), and targeted therapy (OR 9.0). Conclusions: We found lower hospitalization and mortality rates compared to what had been previously reported both in Mexico around the globe. Men and patients with previous cardiac disease had a significant higher risk of hospitalization and death. Hematologic malignancies (lymphoma) were associated with higher hospitalization. Clinical Stage III/IV, targeted therapy, and type 2 diabetes mellitus showed a statistically significant association with mortality risk.
Introduction: The Coronavirus disease (COVID-19) pandemic is a worldwide challenge. There are few useful tools to predict patient outcomes. Identification of biomarkers able to predict progression of ...the disease could improve the treatment of these patients. Objective: The objective of the study was to identify biomarkers of disease progression among patients with severe COVID-19 pneumonia. Materials and methods: A retrospective cohort study was conducted among severe COVID-19 pneumonia patients hospitalized in the American British Cowdray Medical Center in Mexico City. Disease progression was defined as use of vasoactive amines, need of non-invasive or invasive mechanical ventilation or death. Studied biomarkers included neutrophil/lymphocyte index, lymphocyte/platelet Ratio, C reactive protein, procalcitonin, D Dimer, lactic dehydrogenase (LDH), ferritin, 25–OH–Vitamin D, and interleukin 6. Results: We report 46 patients with severe COVID-19 pneumonia. Mean age was 51 years, the majority of whom 30 (65%) male. Median hospitalization was 9 days. 23 (50%) of patients presented disease progression. Ferritin and LDH were strongly associated with disease progression among our cohort. In addition, age was associated with worst prognosis with a relative risk 4.5 (1.2-16.9, p = 0.003). Conclusions: Age, ferritin, and LDH were associated with disease progression among patients with severe COVID-19 pneumonia.