Background: Multidisciplinary care in quality-assured specialized Brest Centre (BC) is nowadays considered optimal management of breast cancer and is associated with better patient outcomes. Modern ...breast cancer surgery should provide optimal oncological outcomes and preserve the quality of life. European Society of Breast Cancer Specialists (EUSOMA) set up the minimum requirements for a specialized BC and a set of 15 mandatory quality indicator (Q.I.) benchmarks for BC certification purposes. Six Q.I. are intended for breast cancer surgery quality assessment.
Methods: In BC of Clinical Hospital Centre Rijeka, data were collected retrospectively for 2019 and prospectively thereafter in a clinical register, encrypted according to the EUSOMA instructions and uploaded into collective EUSOMA database. Following database validation, all Q.I. were calculated for our BC for 3 consecutive years. In addition, a comprehensive on-site audit was performed in 2021 for all services included in breast cancer management in Rijeka.
Results: All mandatory surgical Q.I. were above the EUSOMA benchmarks in all 3 years. Non-compliance with EUSOMA recommendations were reported as major, minor, recommendations and observations. For BC surgical department, no major or minor non-conformities were reported. At the national level, mastectomy rates were above the permitted EUSOMA benchmark in 4 consecutive years.
Conclusion: We have voluntarily initiated and performed quality control of our BC. The certificate obtained is a confirmation of the high quality of care. Concerning the mastectomy rate in Croatia, other centres should consider quality evaluation to determine the status of detected suboptimal surgical management.
Prema definiciji onkološka kirurgija je kirurgija kojoj je cilj liječenje maligne bolesti i otklanjanje smetnji koje su posljedica maligne bolesti kirurškim odstranjenjem primarnog tumora ili ...metastaze. Ona je još uvijek najučinkovitija metoda liječenja raka. U kirurgiji tumora zahvate možemo podijeliti na kurativne i palijativne. Kurativni kirurški zahvati su oni kojima se odstranjuje cijeli tumor s ciljem izlječenja bolesti. Palijativni kirurški zahvati u onkoloških pacijenata su oni kojima se otklanjaju komplikacije koje su posljedica maligne bolesti sa svrhom poboljšanja kvalitete života pacijenata. Primjenom preoperativnih kemoterapijskih i radioterapijskih protokola moguće je izazvati smanjenje tumorske mase i redukciju stadija bolesti, te na taj način inoperabilni tumor učiniti operabilnim. Sam princip onkološke kirurgije zasniva se na težnji da se što bolji terapijski učinak postigne sa što manje agresivnim zahvatom i minimalno invazivnom metodom.
: Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine disorders in women's reproductive period of life. The presence of nonalcoholic fatty liver disease NAFLD, one of the leading ...causes of chronic liver disease in the Western world, is increased in women with PCOS. This review aims to present current knowledge in epidemiology, pathophysiology, diagnostics, and treatment of NAFLD in PCOS with an emphasis on the molecular basis of development of NAFLD in PCOS women.
: Authors investigated the available data on PCOS and NAFLD by a MEDLINE and Pub Med search during the years 1990-2021 using a combination of keywords such as "PCOS", "NAFLD", "steatohepatitis", "insulin resistance", "hyperandrogenaemia", "inflammation", "adipose tissue", and "obesity". Peer-reviewed articles regarding NAFLD and PCOS were included in this manuscript. Additional articles were identified from the references of relevant papers.
: PCOS and NAFLD are multifactorial diseases, The development of NAFLD in PCOS women is linked to insulin resistance, hyperandrogenemia, obesity, adipose tissue dysfunction, and inflammation. There is the possible role of the gut microbiome, mitochondrial dysfunction, and endocannabinoid system in the maintenance of NAFLD in PCOS women.
: There is a need for further investigation about the mechanism of the development of NAFLD in PCOS women. New data about the molecular basis of development of NAFLD in PCOS integrated with epidemiological and clinical information could influence the evolution of new diagnostic and therapeutic approaches of NAFLD in PCOS.
One of the most powerful prognostic indicators in patients (pts) with multiple myeloma (MM), along with International Staging System (ISS) and recently adapted Revised ISS score (R-ISS), is ...achievement of complete remission (CR)
The aim of study was to analyze prognostic significance of Response-adjusted ISS (RaISS) in transplant ineligible MM pts
The study included 257 newly diagnosed, transplant ineligible MM pts, diagnosed during period 2012-2020 (129 male; 128 female, mean age 66 yrs, range 35-85 yrs). The IgG MM existed in 155pts (60.3%), IgA in 50 (19.5%), BJ in 43 (16.7%), IgD in 3 (1.2%) and IgM in 1pt (0.4%). According to the clinical stage (CS, Durie-Salmon), III CS was present in 207pts (80.5%); II in 38pts (14.8%); and I CS in 10pts (3.9%). Renal impairment was present in 82pts (31.9%) and elevated LDH in 58pts (22.6%). The ISS score 1 had 55pts (21.4%), ISS2 65pts (25.3%) and 137pts (53.3%) had ISS3. According to the Revised ISS (R-ISS) score, R-ISS1 was found in 40pts (15.6%), R-ISS2 in 164pts (63.8%), while R-ISS3 was present in 53pts (20.6%). Treatment with triple thalidomide (Thal) based chemotherapy (HT) was applied in 129pts (50.2%) with standard risk features (R-ISS1), while bortezomib (Bz) based triplets were applied in 95pts (37%) with high risk features (R-ISS2 and R-ISS3). Standard HT was applied in 33pts (12.9%).
Considering RaISS score, the group of pts treated with Thal-based HT consisted of: 15pts (11.6%) with low risk (RaISS 0-1); 65pts (50.4%) with intermediate risk (RaISS 2-3); and high risk (RaISS 4) in 49pts (40.3%). There was significant difference in PFS (Log Rank 7.197; p=0.027), and, even more pronounced, in OS (log Rank 22.192; p=0.000) between low risk pts (RaISS 0-1), and intermediate or high risk pts (RaISS 2-3; RaISS 4), treated with Thal-based HT. The distribution according the RaISS score in patients treated with Bz-based combos was as follows: low risk - 11pts (11.6%); intermediate - risk 36pts (37.9%); high risk- 48pts (50.5%). Although there was no difference in PFS (Log Rank 3.307; p=0.191), pts of low risk, with RaISS score 0-1, had significantly longer OS (Log Rank 13.894; p=0.001) in comparison to the pts of intermediate and high risk (RaISS ≥2), treated with Bz-based triplets. There was no difference in PFS (Log Rank 0.008; p=0.930) or OS (Log Rank 0.502; p=0.479) between pts with RaISS 4, and pts with R-ISS 3 (Log Rank 0.008; p=0.930) treated with Thal-based HT. Likewise, no difference was found considering PFS (Log Rank 0.168; p=0.682) and OS (Log Rank 0.923; p=0.337) in patients treated with Bz-based triplets with RaISS 4 in comparison to the pts with R-ISS3.
RaISS score is simple and powerful prognostic index, indicating necessity of tailored treatment in accordance to the R-ISS score with final goal to overcome high-risk features in patients with multiple myeloma.
Up to 60% of patients with aggressive B-cell lymphoma who receive chimeric antigen receptor (CAR) T-cell therapy experience treatment failure and subsequently have a poor prognosis. Allogeneic ...hematopoietic stem cell transplantation (alloHSCT) remains a potentially curative approach for patients in this situation. Induction of a deep response prior to alloHSCT is crucial for long-term outcomes, but the optimal bridging strategy following relapse after CAR T-cell therapy has not yet been established. Polatuzumab vedotin, an antibody drug conjugate targeting CD79b, is a novel treatment option for use in combination with rituximab and bendamustine (Pola-BR) in relapsed or refractory disease. Patients: We report two heavily pretreated patients with primary refractory diffuse large B-cell lymphoma (DLBCL) and primary mediastinal B-cell lymphoma (PMBCL) respectively who relapsed after therapy with CAR T-cells with both nodal and extranodal manifestations of the disease. After application of three courses of Pola-BR both patients achieved a complete metabolic remission. Both patients underwent alloHSCT from a human leukocyte antigen (HLA)-mismatched donor following conditioning with busulfan and fludarabine and are disease free 362 days and 195 days after alloHSCT respectively. We conclude that Pola-BR can be an effective bridging therapy before alloHSCT of patients relapsing after CAR T-cell therapy. Further studies will be necessary to define the depth and durability of remission of this salvage regimen before alloHSCT.
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