Mohammad Faheem

Impact of Age, Tumor Size, Lymph Node Metastasis, Stage, Receptor Status and Menopausal Status on Overall Survival of Breast Cancer Patients in Pakistan

BACKGROUND Survival of breast cancer patients depends on a number of factors which are not only prognostic but are also predictive. A number of studies have been carried out worldwide to find out prognostic and predictive significance of different clinicopathological and molecular variables in breast cancer. This study was carried out at Nuclear Medicine, Oncology and Radiotherapy Institute (NORI), Islamabad, to find out the impact of different factors on overall survival of breast cancer patients coming from Northern Pakistan. MATERIALS AND METHODS This observational retrospective study was carried out in the Oncology Department of NORI Hospital. A total of 2,666 patients were included. Data were entered into SPSS 20. Multinomial logistic regression analysis was performed to determine associations of different variables with overall survival. P values <0.05 were considered significant. RESULTS The mean age of the patients was 47.6 years, 49.5% being postmenopausal. Some 1,708 were ER positive and 1,615 were PR positive, while Her 2 neu oncogene positivity was found in 683. A total of 1,237 presented with skin involvement and 426 had chest wall involvement. Some 1,663 had > 5cm tumors. Lymph node involvement was detected in 2,131. Overall survival was less than 5 years in 669 patients, only 324 surviving for more than 10 years, and in the remainder overall survival was in the range of 5-10 years. CONCLUSIONS Tumor size, lymph node metastases, receptor status, her 2 neu positivity, skin involvement, and chest wall involvement have significant effects whereas age and menopausal status have no significant effect on overall survival of breast cancer patients in Pakistan.

Estrogen receptor, progesterone receptor, and Her 2 Neu positivity and its association with tumour characteristics and menopausal status in a breast cancer cohort from northern Pakistan

Objectives: To measure the frequency of estrogen receptor (ER), progesterone receptor (PR), and Her 2 Neu positivity and to study their association with tumour characteristics and menopausal status in a breast cancer cohort from Northern Pakistan. Methodology: Patients attending NORI with histopathologically proven diagnosis of invasive ductal carcinoma of the breast were included after providing informed consent. Age, menopausal status, and tumour size were recorded. The presence or absence of nodal involvement (including site and number), distant metastases, sites of metastases, skin involvement, chest wall involvement, recurrent disease, and bilateral breast cancer were noted along with ER, PR, and Her 2 Neu status. Mean ± standard deviations were calculated for continuous variables like age. Frequency and percentage were calculated for categorical variables like ER, PR, and Her 2 Neu status. Association of ER, PR, and Her 2 Neu status with menopausal status and tumour-related characteristics were sought employing t test, x2 square test, and ANOVA wherever appropriate. P value >0.05 was considered significant. Results: There were 1226 patients included in the study. Mean patient age was 48.04 ± 11.97 years, and 743 (60.6%) patients were premenopausal. ER, PR, and Her 2 Neu were found positive in 763 (62.2%), 738 (60.1%), and 478 (38.9%) patients, respectively. Significant association (P < 0.05) was found between ER, PR positivity, and Her 2 Neu over expression with menopausal status, tumour size, involvement of skin, chest wall and lymph nodes and the presence of distant metastases. However, no significant association was detected between ER, PR, Her 2 Neu and recurrent disease. Conclusions: The frequency of expression of hormonal receptors in breast cancer patients from Northern Pakistan is the same as reported in the literature although overexpression of Her 2 Neu is a little higher in our population. There is an inverse relationship between hormonal receptors expression and Her 2 Neu expression. Postmenopausal women have a higher incidence of ER and PR positivity and Her 2 Neu negativity. ER and PR negativity and Her 2 Neu positivity are associated with more advanced disease and poor outcome.

Human papillomavirus infection in females with normal cervical cytology: Genotyping and phylogenetic analysis among women in Punjab, Pakistan

BACKGROUND Globally, cervical cancer is the fourth most common cancer in women and the seventh most common cancer overall, accounting for an estimated 300 000 annual deaths. Human papillomavirus (HPV) is the second most common cause of cervical cancer worldwide. HPV screening is not a common practice in Pakistan. The aim of this study was to determine the prevalence of HPV and HPV types in women with a normal cytology of the cervix living in the upper and lower regions of Punjab, Pakistan, and to analyze the risk factors for HPV in this region. METHODS PCR analysis was performed for 1011 female patients with a normal cytology of the cervix from various districts of Punjab Province, Pakistan. Risk factors for the acquisition of HPV were studied. High-risk HPV types (HPV16 and HPV18) were detected using the Abbott Real Time HR HPV test. To determine the genotype, partial L1 region sequences of HPV-positive samples were subjected to sequencing using MY/09/MY11 primers, and a phylogenetic tree was constructed using CLC software. RESULTS The study found a 4.74% prevalence of HPV, with the most frequent HPV type found being the low-risk HPV6 (in 25% of infected individuals), followed by HPV55 (22.9%), HPV11 (20.8%), and high-risk types HPV45 (12.5%), HPV33 (8.33%), HPV18 (6.25%), and HPV16 (4.16%). Phylogenetic analysis of all HPV types in this study showed 80-99% nucleotide identity with types related to the same species. The sequences were clustered with China, India, Mexico, Iran, Slovenia, and Germany, showing the diversity in origin of the various genotypes prevalent in Pakistan. CONCLUSIONS In this population with a normal cervical cytology, the prevalence of high-risk HPV types was very low. The major prevalent HPV genotype in Punjab Province of Pakistan was the low-risk HPV type 6, followed by HPV type 55. Sequencing of the partial L1 region suggested that the region was highly conserved in all reported sequences. This study highlights the need to conduct robust epidemiological studies in the region and to develop regular HPV screening so that the situation does not reach an alarming stage resulting in cervical cancer.

Clinical characteristics and long-term outcome of patients with differentiated carcinoma of thyroid with bone metastases: a retrospective study

Background: Bone is the second most frequent target of distant metastases in patients with differentiated thyroid cancer (DTC). However, there is a controversy regarding the longterm outcome of the breast cancer patients wtih bone metastases. This study therefore was designed with the objective of assessing the clinical characteristics related to the long-term outcome and prognosis of patients with bone metastases. Methods: We reviewed the medical records of 360 patients of differentiated thyroid cancer followed at our institute from 2007 to 2012. A total of 57 patients were found to have bone metastases, who we analyzed with regard to their basic demographic data, clinical characteristics, treatment and clinical outcomes. Results: The incidence of bone metastases from thyroid carcinoma was 15.8%. The mean age at the diagnosis of bone metastases was 47±18 years (range 16 to 80 years); 46% patients were below 40 years of age and 53.8% of the patients were above 40 years of age. 15.3% were males and 84.6% were females. Histopathologic subtypes included papillary (38%), and follicular (45.6%). Multiple bone sites were involved in 50% of the patients with 29% of the patients with single bone site involvement; and 20.8% of the patients had metastases to other body organs. All patients underwent near-total thyroidectomy followed by aggressive radioiodine therapy. Number of 131I doses received ranged from 3 to 12 with a mean of 6.6. Mean dose of 131I per patient was 48914 MBq ± 20424 (Range: 18130 - 76960). Baseline thyroglobulin (TG) level ranged from 380ng/ml to 17300ng/ml with a mean value of 2250±5644 ng/ml. 60% of the patients showed a declining trend in TG over time, whilst 23% of the patients showed a rising trend; 6.2% of the patients had normal TG/ATG (antithyroglobulin) values throughout the course of disease. 10.4% of the patients had static TG levels. 64% of the patients with bone metastases showed 5-year survival. Conclusion: Multiple bone metastases represent a frequent complication of DTC especially of follicular thyroid cancer. In our population it is more common in females and in patients above 40 years of age. Overall survival rate is very good in the patients with bone metastasis if they are managed aggressively with total thyroidectomy and repeated radioactive iodine.

Corrigendum to “Metastatic hepatoid carcinoma of ovarian origin - A case report from Northern Pakistan” [Gynecol. Oncol. Rep. 21 (2017) 24–27]

[This corrects the article DOI: 10.1016/j.gore.2017.05.007.].

Metastatic hepatoid carcinoma of ovarian origin - a case report from northern Pakistan

Highlights • Hepatoid carcinoma of the ovary is rapidly progressing rare epithelial ovarian tumor.• The term ‘hepatoid’ refers to the morphological resemblance with hepatocellular carcinoma.• Final diagnosis is made via positive staining for alpha fetoprotein along with immunohistochemistry• Combination chemotherapy can be considered superior over the targeted agents while treating this tumor.