Medicina
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Multicenter Study Observational Study
Who Are Suitable Patients for Omitting Breast Surgery as an Exceptional Responder in Selected Molecular Subtypes of Breast Cancer After Neoadjuvant Systemic Treatment?
Background and Objectives: Among breast cancer molecular types, HER2 positive and triple negative (TN) subtypes have the highest likelihood of pathological complete response (pCR), which is a surrogate marker for reduced recurrence and improved patient survival after neoadjuvant systemic treatment (NST). Preoperative pathological identification of these exceptional responders is a new era. Therefore, we aimed to determine the accuracy of trucut biopsy in identifying the exceptional responders in selected molecular subtypes of breast cancer patients. ⋯ The remaining 3 patients had residual disease. Conclusions: Along with thorough patient selection, post-chemo radiological assessment and the reliable biopsy technique are the key points in accurately predicting response to neoadjuvant treatment. If an image-guided core biopsy confirms elimination of tumour tissue at the marked tumour area with a radiological complete response on MRI after NST in breast cancer patients with selected molecular subtypes, these may be suitable patients as exceptional responders in whom we can omit breast surgery.
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Multicenter Study
HALP Score in Predicting Response to Treatment in Patients with Early-Stage Gastric Cancer: A Multi-Centred Retrospective Cohort Study.
Background and Objectives: The HALP (Haemoglobin, Albumin, Lymphocyte and Platelet) score is used to predict the prognosis of different types of cancer. This study aimed to investigate the role of the HALP score in predicting pathological response in early-stage gastric cancer patients. Materials and Methods: This retrospective cohort study was conducted on 118 patients diagnosed with early-stage gastric cancer and subjected to perioperative (FLOT) treatment between 2018 and 2023. ⋯ In the Fagan nomogram, when the HALP score was ≥28.9, our pathological response probability estimate (post-test response probability) was found to increase to 64.8% (Positive Likelihood Ratio = 3, Negative Likelihood Ratio = 0.53). In patients with HALP scores ≥ 28.9 and <28.9, progression rates were 16.7% and 47.8%, respectively (p < 0.001), and median survival times were 45.4 and 30.6 months (p < 0.001). Conclusions: The HALP score is a useful and easily accessible score for determining pathological responses in patients with locally advanced gastric cancer.
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Multicenter Study Observational Study
Real-World Clinical Utility of a Methylated DNA Biomarker Assay on Samples Collected with a Swallowable Capsule-Balloon for Detection of Barrett's Esophagus (BE).
Background: Barrett's Esophagus (BE) is the only known precursor for esophageal adenocarcinoma (EAC). Patients with multiple risk factors for BE/EAC are recommended for screening; however, few eligible patients undergo evaluation by endoscopy. EsoGuard® (EG) is a commercially available biomarker assay used to analyze esophageal cells collected non-endoscopically with EsoCheck® (EC) for the qualitative detection of BE/EAC. ⋯ Among the EG-positive patients, the overall compliance with follow-up EGD was 85.4%. Conclusions: Combining EC non-endoscopic esophageal cell collection with the EG biomarker assay is effective in guiding provider decision-making for the detection of BE and EAC. Patients with positive EG results demonstrate high compliance with recommended follow-up EGD.
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Multicenter Study
Relative Frequency of Primary Salivary Gland Tumors: Multicenter Study of 796 Cases from Riyadh, Saudi Arabia.
Background and Objectives: Salivary gland tumors (SGTs) are diverse lesions with varying morphological and clinical characteristics. Limited data exist on the distribution of SGTs in Saudi Arabia. We aimed to fill this gap by examining the distribution of SGTs across four tertiary hospitals in Riyadh. ⋯ Additionally, 36 (4.5%) mesenchymal and 30 (3.8%) hematolymphoid non-epithelial SGTs were reported. Conclusions: This multicenter study is the largest of its kind in Saudi Arabia, identifying pleomorphic adenoma and mucoepidermoid carcinoma as the most commonly reported benign and malignant tumors, respectively. These findings offer valuable insights into the understanding of salivary gland tumors globally.
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Multicenter Study Observational Study
Effectiveness and Predictors of Long-Term Treatment Response to Tofacitinib in Rheumatoid Arthritis Cohort: General Analysis and Focus on High-Cardiovascular-Risk Subgroup-A Multicenter Study.
Background and Objectives: The treatment landscape for Rheumatoid Arthritis (RA) has evolved significantly with the introduction of Janus kinase inhibitors (JAKi), such as Tofacitinib (TOFA), which offer a new therapeutic option for patients who have failed or are intolerant to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). Safety concerns, particularly related to cardiovascular and cancer risks, prompted a need for additional investigation in real-world clinical settings. This study aimed to evaluate the long-term effectiveness and predictors of response to TOFA in two subpopulations of RA patients, categorized by differing cardiovascular risk profiles. ⋯ Despite safety concerns related to cardiovascular risk, TOFA remained an effective treatment option across patient subgroups, with no significant differences in remission or LDA rates based on cardiovascular risk profiles. Age appeared to negatively impact treatment response, highlighting the role of immunosenescence in RA management. These findings support the use of TOFA as a personalized therapeutic option for RA, emphasizing the need for careful evaluation of cardiovascular and age-related risks in clinical decision-making.