Introduction
Hepatocellular carcinoma (HCC) accounts for approximately 90% of primary liver cancer and can be caused by well-known risk factors, including infection with hepatitis B and C viruses, ...alcohol intake, and metabolic syndrome. The overall prognosis remains poor with a median survival of 1 year for symptomatic advanced-stage cases treated with systemic therapies.
Case description
In July 2020, a 73-year-old male patient presented at our institution with mild abdominal pain and an attack of intense cold. After a radiological workup, the diagnosis of HCC located in the caudate lobe was established. The patient underwent atypical caudate lobe resection, and pathology confirmed the diagnosis of grade 3 HCC. Postoperative MRI showed a new metastasis in the 6th liver segment 1.3 cm in diameter, and a PVT progression which now affected the whole right lobe. The patient was started on sorafenib and demonstrated a complete response which still lasts for more than two years.
Conclusion
We present a rare case of a patient who demonstrated a complete response to sorafenib treatment in advanced HCC with unfavorable prognostic factors.
Background Li-Fraumeni is a rare autosomal dominant cancer predisposition syndrome. The basis is a germline mutation of TP53 gene which encodes tumor suppressor protein resulting in early onset of ...tumors, most often breast cancer, soft tissue sarcomas, brain tumors, adrenocortical carcinomas, and leukemia. Case report We present a case of a young woman with a positive family history for cancer diagnosed with malignant solitary fibrous tumor and luminal B-like invasive breast cancer. Breast cancer and sarcomas account for the majority of tumors associated with Li-Fraumeni syndrome, yet solitary fibrous tumor is a rare clinical entity with no established guidelines for treatment. Even though both primary tumors were successfully resected, the sarcoma relapsed in the form of lung metastases. The NGS analysis revealed single nucleotide variant (c.1101-1G>A) in TP53 gene, affecting the acceptor splice site at intron 10. Until now, only one case of this genetic variant has been documented with conflicting interpretations of pathogenicity. Conclusions The knowledge of TP53 mutation status is essential since the management of these patients requires different approach to avoid excessive toxicity due to the risk of developing secondary malignancy. Using the clinical criteria to screen for affected individuals facilitates appropriate early genetic counseling of patients and their families. Following the American College of Medical Genetics criteria, we believe that the reported single nucleotide variant (c.1101-1G>A) in TP53 gene should be considered pathogenic. Keywords: TP53, Li-Fraumeni syndrome, Invasive breast cancer, Malignant solitary fibrous tumor, Splice-site mutation
We have studied human life expectancy in Croatia with the median derivative power function model; the median age of death was 76 and 81 years for men and women respectively. Cummulative mortality ...increases at a constant rate after the age 60 y and 65 y for men and women, respectively (r2 = 0.99 and 0.98). Individual life span is a stochastic (random) event within the deterministic frame of cumulative mortality.
Bolesnici s malignim bolestima izloženi virusu SARS-CoV-2 mogu biti pod povišenim rizikom od razvoja teže kliničke slike COVID-19. To se prvenstveno odnosi na bolesnike koji su u aktivnom onkološkom ...liječenju i primaju kemoterapiju, radioterapiju ili druge oblike specifičnog liječenja. Prema dosadašnjim spoznajama, i sama dijagnoza maligne bolesti dovedena je u vezu s povećanim rizikom od razvoja težeg oblika i smrti od COVID-19. Nadalje, onkološki bolesnici mogu imati atipičnu prezentaciju bolesti, a s druge strane komplikacije liječenja mogu oponašati COVID-19, primjerice pneumonitis i febrilno stanje s neutropenijom. Štoviše, limfopenija koja je česta kod zaraze, može već biti prisutna kao posljedica kemoterapije. S obzirom na navedeno, kliničke aktivnosti prilagođene su uvjetima pandemije. Preporuke za liječnike i bolesnike uključuju smanjenje izloženosti bolesnika i medicinskog osoblja, korištenje telemedicine, odgodu ambulantnih pregleda koji nisu hitni te prilagodba intenziteta i načina aplikacije terapije kada je to dozvoljeno.
One of the main features of wasting in cancer is an involuntary weight loss which is most pronounced in gastrointestinal tract tumors and leads to worse clinical outcomes. The aim of this study is to ...analyze the frequency of body weight loss (FBWL) as an additional prognostic factor in the treatment of patients with metastatic colorectal cancer (mCRC).
In this observational, single-center study, data were retrieved for 236 patients treated for mCRC. FBWL was defined as a percent of change in weight divided by weeks of therapy. Patients were stratified into two groups according to the median of FBWL which equaled to the loss of 0.05%/week. Patients who lost >0.05%/week (N = 116) had shorter progression-free survival (PFS) in the first-line treatment, then the ones who lost <0.05%/week (N = 120); 28.3 vs 46.3 weeks, respectively. Cox regression model showed that FBWL and sidedness were significant predictors of PFS, while age, sex and ECOG were not. Significantly more patients with stable weight were also eligible for second-line treatment. In conclusion, stabilization of body weight is important and independent predictor of longer PFS in first-line therapy of patients with mCRC.
There are no recommended biomarkers to identify patients with refractory metastatic colorectal cancer (mCRC) who would benefit the most from trifluridine/tipiracil (TTP). The exploratory analysis of ...the RECOURSE trial revealed that patients with low tumor burden and indolent disease derive greater benefit in terms of both progression-free survival (PFS) and overall survival (OS). Nevertheless, the final answer on the TTP real impact on the well-being of patients with late-stage mCRC will come from real-world data.
The aim of this retrospective exploratory study was to investigate the effectiveness of TTP in mCRC with regard to the duration of standard treatment and other influencing variables. The study included 260 patients from the three largest Croatian oncology centers who began treatment with TTP in the third or fourth line between 2018 and 2020.
The median OS and PFS for the entire cohort were 6.53 and 2.50 months, respectively. Patients with more aggressive disease, defined as those whose time to progression on the first two lines of standard therapy was less than 18 months, had significantly shorter PFS (2.40 vs. 2.57 months, hazard ratio HR 1.34, 95% confidence interval CI: 1.03-1.84). There was also a tendency toward shorter OS (6.10 vs. 6.30 months, HR 1.32, 95% CI: 0.99-1.78) but without statistical significance. Patients with ECOG PS 0, without liver metastases, and with RAS mutation had both longer OS and PFS. No influence was detected from other variables including age, sex, primary tumor location, and tumor burden.
With regard to the results of the previously conducted trials, the study concludes that indolent disease, good general condition, and absence of liver metastases are positive predictive factors for TTP treatment.
Short-term biological indicator of urinary Mg and Ca excretion helps us to assess human body Mg and Ca nutritional status. In this study, we used the long-term biological indicator tissue of hair to ...assess Mg and Ca human body nutritional status.
Hair Mg and Ca were analyzed in 1073 healthy white adult Caucasians 734 women (♀) and 339 men (♂) consuming common mid-European diet, with the ICP MS. The log transformed data on hair magnesium and calcium were analyzed with median derivatives bioassay.
The median values (μg·g–1) were ♀Mg 137.2 and ♂Mg 47.1, and ♀Ca 1721.4 and ♂Ca 492.0, respectively. The linear (adequate) reference ranges of the sigmoid saturation curve for magnesium were ♀Mg 29.7–270.6 and ♂Mg 20.5–90.2, whereas these ranges for calcium were ♀Ca 487.7–4426.8 and ♂Ca 261.1–816.4. The magnesium to calcium (Mg/Ca) ratio in women appears fairly constant along the sigmoid linear segment range (about 0.067), and in difference to the constantly increasing Mg/Ca ratio in men - from 0.078 at the start of the linear segment to 0.096 at the median and 0.1105 before leveling at the top of the curve.
Women tend to accumulate much more Ca in their hair than men. The results suggest how hair Mg concentration should not be below 29.7 and 20.5 or above 270.6 and 90.2 μg·g–1 in women and men, respectively. Similarly, Ca hair concentrations should be not below 487.7 and 261.1 and higher than 4456.8 and 816.4 in women and men, respectively. The possible health effects of the observed sex related metabolic difference between men and women remains to be elucidated.
The authors received no specific funding for this work.
Pancreatic cancer is one of the most lethal malignancies with a rise in mortality rates. FOLFIRINOX and nab-paclitaxel plus gemcitabine demonstrated a survival benefit compared to gemcitabine alone. ...Both protocols are now considered the standard of first-line treatment with no significant difference between them, primarily based on observational studies. Although new therapeutic options have emerged recently, the prognosis remains poor. We conducted a retrospective single-center study on 139 patients treated for metastatic pancreatic adenocarcinoma (mPDAC) with gemcitabine monotherapy (Gem) or nab-paclitaxel + gemcitabine (Nab-P/Gem) in the first line. The aim of our study was to evaluate the effectiveness in terms of overall survival (OS) and progression-free survival (PFS) as well as the influence of patient and disease characteristics on outcomes. Nab-P/Gem resulted in OS of 13.87 months compared to 8.5 months in patients receiving Gem. The same trend was achieved in PFS, 5.37 versus 2.80 months, respectively, but without reaching statistical significance. Furthermore, the 6-month survival in the Nab-P/Gem group was also higher, 78.1% versus 47.8%. In terms of survival, the group of elderly patients, patients of poorer performance, with higher metastatic burden and liver involvement, benefited the most from combination therapy. In our analysis ECOG performance status (p.s.), previous primary tumor surgery, and liver involvement were found to be independent prognostic factors. The addition of nab-paclitaxel to gemcitabine resulted in a significant improvement in the OS of patients with mPDAC. Subgroup analysis demonstrated that patients with some unfavorable prognostic factors benefited the most.
Iodine and selenium are two essential trace elements intimately associated with the thyroid gland function. The aim of this study was to assess the combined hair iodine and selenium frequency ...distribution in the hair to assess their nutritional status and their mutual ratio.
Hair was collected in 1073 healthy adult subjects (339 men and 729 women) living in Zagreb, CROATIA. Hair samples were analyzed for Se and I by the ICP-MS at the CBM, Moscow, RUSSIA, an internationally ISO certified analytical laboratory. I and Se were detected in all the 1073 hair samples. The frequency distribution of hair I and Se was statisticaly analyzed with the median derivative bioassay method of the log transformed data.
The adequate nutritional status of iodine and selenium in the hair is shown by the linear response interval on ther sigmoid curves. The adequate nutritional status was associated with the hair iodine and selenium (μg·g–1) of men (M) and women (W), respectively. Iodine was M 0.506 W 9.482, and selenium M 0.346 and W 0.269, Over the same linear (adequate) interval of the responsive sigmoid curve of the combined iodine and selenium dietary intake (I&Se) the adequate dietary interval was (μg·g–1) 0.209–2.433 (r2 0.90); their combined ratio was also constant at (log μg·g–1) 0.740 within the ±2% difference between men and women.
Iodine and selenium deposition into the hair are closely entangled over the adequate interval of their dietary intake. The iodine to selenium mutual ratio should be also kept constant to provide the most optimal nutrition environment for the thyroid gland function. Single element supplementation should be always viewed on how it may affect the rest of the elements in our body.
Institute for Research and Development of Sustainable Eco Systems, 10,000 Zagreb, Croatia.
Molybdenum is the essential trace element in human nutrition since it is a part of a pterin coenzyme which is essential for the activity of various oxidases. High doses of Mo are neurotoxic to the ...human brain. The safe adequate intake of Mo is set at 75–200 μg·g–1, but there is no available long-term biological indicator tissue to assess the Mo nutritional status. The aim of this study was to assess human Mo nutritional status with a median derivatives bioassay.
We analyzed frequency distribution of hair Mo (HMo) in a prospective, observational, cross sectional and exploratory epidemiological study of 1073 apparently healthy adults (339 men, M and 734 women, W) from Zagreb, CROATIA. Whole blood Mo (WBMo) was assessed in a population subsample of 143 W and 91 M. Both hair and whole blood, a long- and short-term biological indicator, respectively were analyzed for Mo with the ICP MS at the Center for Biotic Medicine, Moscow, Russia: an ISO certified bioelement (electrolytes, trace- and ultra-trace elements) analytical laboratory. Hair Mo natural frequency distribution was analyzed with the aid of median derivatives bioassay logistic sigmoid curve for men and women separately. The range of values below the linear segment of the sigmoid curve (the adequate Mo intake) was considered to reflect Mo deficiency, whereas the values above that linear range indicate Mo dietary excess. The adequate linear range may be further subdivided into marginal (subclinical), true adequate, and ample region with a 30:60:10 ratio, respectively.
The linear segment of the hair Mo deposition was distinctly different (ng·g–1) and higher in M (34–75) than W (27–57) with the observed median ♀/♂ ratio 0.82. The marginal (subclinical) interval ranges are M 34–46.3, W 27–36). However, there were no difference in the WBMo confidence intervals between M (455–1380) and W (480–1145); the Median ♀/♂ observed ratio is 0.93.
Adequate human population Mo nutritional status may be accurately assessed by analyzing hair Mo frequency distribution with the median derivatives bioassay. Apparently, there is gender dependent delay of Mo hair saturation in the men hair. For the first time it was possible to differentiate the subclinical levels of sparsely adequate dietary Mo.
Institute for Research and Development of Sustainable Eco Systems, 10,000 Zagreb, Croatia.
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