Delhi State Cancer Institute

Abstract Background Data on multinational 90-day mortality and morbidity rates after surgery for gastric cancer is limited in the literature. This study aimed to understand the 90-day mortality and morbidity outcomes according to GASTRODATA Registry for elective gastric cancer surgery patients and identify risk factors. Method We conducted an international prospective study on ≥18 years patients undergoing elective surgery for gastric cancer with curative intent from 01 April 2022 to 30 September 2022. Known metastatic disease, concurrent secondary cancers, gastrointestinal stromal tumour (GIST) and Siewert type I/II oesophagogastric junction malignancies were excluded. Univariate and multivariate logistic regression was used to identify variables associated to 90-day outcome. Results 380 collaborators from 47 countries submitted data on 1538 patients. Mean age was 64.2 years and 58.5% were males. 90-day morbidity rate was 38.2% (n=587) and mortality rate was 2.9% (n=45). Pre-operative higher CCI or ASA score, pre-operative weight loss >10%, and surgical determinants such as type of gastric resection, positive specimen margin, number of harvested lymph nodes, longer surgery duration and post operative pathological IV staging (p value<0.05) were identified as predictors of postoperative severe complications and mortality. Conclusion Elective gastric cancer surgery has a 90-day morbidity of 38.2% and 90-day mortality of 2.9%, globally. This study identified several factors associated with higher morbidity and exemplified the importance of a unified language on surgical morbidity, pre-habilitation and ongoing audits to enhance patient outcomes.

Sweet syndrome is a rare, etiologically unknown dermatosis that can be idiopathic or associated with certain clinical conditions. Among these conditions are infections, autoimmune diseases, inflammatory bowel diseases, vaccinations, the use of medications, and neoplasias. Hematological neoplasias, particularly acute myeloid leukemia, are the most commonly described; however, the condition may also be related to solid tumors, being those of the genitourinary tract the most associated with the syndrome. Drug-induced Sweet syndrome has also been reported; however, it is rarely seen. We report a case of 59 years old male patient with a diagnosis of carcinoma urinary bladder, who developed skin eruption after infusion of the first cycle of chemotherapy (gemcitabine and cisplatin) and resolved after treatment with steroids. The diagnosis of Sweet syndrome was confirmed only after skin biopsy, cultures and laboratory investigations. Malignancy as the cause of skin eruptions was eliminated by the fact that it occurred only after infusion of chemotherapy and the tumor was still there in the bladder, and skin eruptions did not occur after stopping steroids.

The present study aimed to describe the clinical characteristics and outcomes of patients with malignant and non-malignant disorders who underwent hematopoietic stem cell transplantation at largest public Hospital (SMS Hospital) of Rajasthan, India.

Radical surgery for cervical cancer has inherent benefits, and as upfront or post neoadjuvant chemotherapy (NACT), is extendable to locally advanced cancer cervix (LACC), with postoperative radiotherapy (PORT) for high-risk factors. Objective of the study was to compare the effectiveness and survival between non-PORT and PORT in high-risk early stages. Radical hysterectomies conducted between January 2014 and December 2017 were evaluated and followed till December 2019. Clinical, surgical-pathologic characteristics, and oncological outcomes were compared between non-PORT and PORT groups. A similar comparison was made between alive and dead patients within each group. The impact of PORT was assessed. Of 178 radical surgeries, early-LACC constituted 70%. Most (37%) of the patients belonged to stage 1b2, while stage 2b formed 5%. Mean age of patients was 46.5 years; 69% were below 50 years of age. Abnormal bleeding (41%) was the predominant symptom, followed by postcoital (20%) and postmenopausal bleeding (12%). Upfront surgeries formed 70.2%, and the average waiting period was 1.93 months (range: 1-10 months). PORT patients were 97 (54.5%) in number and the remaining formed the non-PORT group. Mean follow-up was 34 months, with 118 (66%) alive patients. Significant adverse prognostic factors were tumors >4 cm (44.4% patients), positive margins (10%), lymphatic vascular space invasion (LVSI; 42%), malignant nodes (33%), multiple metastatic nodes averaging seven (range: 3-11), and delayed (>6 months) presentation, but not deep stromal invasion (77% patients) and positive parametrium (8.4% patients). PORT overcame the adverse effects of tumors >4 cm, multiple metastatic nodes, positive margins, and LVSI. Total recurrences (25%) were balanced for both groups, but recurrences within 2 years were significantly more for PORT. Two-year overall survival (78%) and recurrence-free survival (72%), median overall survival (21 months), and median recurrence-free interval (19 months) were significantly better for PORT, with the complication rates being similar. PORT had significantly better oncological outcomes compared to non-PORT. Multimodal management is worthwhile.

Abstract: BACKGROUND: Breast cancer is one of the most common cancers among females all over the world, with high prevalence rate in developed and developing countries alike. Since the last decade, breast cancer made a huge jump and became the most common cancer among women in India, in cities, as well as in rural areas, thereby posing a grave public health threat that demands increasing attention. OBJECTIVES: To study socioeconomic and demographic profile of patients with breast cancer attending a tertiary cancer care center in North India. MATERIALS AND METHODS: This was a retrospective study made up of 213 patients registered in a cancer care center of Delhi over a period of 1 year. Study subjects were histopathologically confirmed cases of breast cancer. The data were collected by employing pretested, structured questionnaire including information such as age, income, religion, occupation, education, and residence after taking prior consent from patients and concerned authorities from the institution. RESULTS: More than half of the patients were in the 41–60-year-old category. One hundred and seventy-nine patients out of the total 213 hailed from Delhi and Uttar Pradesh, implying that the institute mostly caters to the patients hailing from Northern Indian states. Laborers and people from lower socioeconomic class made the greater part of the patient sample size, and cases of distant metastasis were also found mostly in the people from lower socioeconomic class. CONCLUSION: Factors such as low levels of literacy, financial constraints, rural residence, and lack of awareness were associated with higher incidence and late presentation of breast cancer.

High mortality has been observed in the cancer population affected with COVID-19 during this pandemic. We undertook this study to determine the characteristics and outcomes of cancer patients with COVID-19 and assessed the factors predicting outcome. Patients of all age groups with a proven history of malignancy and a recent diagnosis of SARS-CoV-2 infection based on nasal/nasopharyngeal reverse transcriptase (RT)-PCR tests were included. Demographic, clinical and laboratory variables were compared between survivors and non-survivors groups, with respect to observed mortality. Between May 11 and August 10, 2020, 134 patients were included from the three centres and observed mortality was 17.1 per cent. The median age was 53 yr (interquartile range 39-61 yr) and thirty four patients (25%) were asymptomatic. Solid tumours accounted for 69.1 per cent and breast cancer was the most common tumour type (20%). One hundred and five patients (70.5%) had received chemotherapy within the past four weeks and 25 patients (19.3%) had neutropenia at presentation. On multivariate analysis, age [odds ratio (OR) 7.99 (95% confidence interval [CI] 1.18-54.00); P=0.033], haemoglobin [OR 6.28 (95% CI 1.07-37.04); P=0.042] neutrophil-lymphocyte ratio [OR 12.02 (95% CI 2.08-69.51); P=0.005] and baseline serum albumin [OR 18.52 (95% CI 2.80-122.27); P=0.002], were associated with higher mortality. Recent chemotherapy, haematological tumours type and baseline neutropenia did not affect the outcome. Higher mortality in moderate and severe infections was associated with baseline organ dysfunction and elderly age. Significant proportion of patients were asymptomatic and might remain undetected.

The digital revolution can help developing countries to overcome the problem of limited healthcare infrastructure in developing nations such as India. The COVID-19 pandemic has shown the urgency of integration of digital technologies into healthcare infrastructure. In order to solve the issue of lack of trained healthcare professionals at public health centres (PHCs), researchers are trying to build tools which can help to tag pulmonary ailment within a fraction of second. Such tagging will help the medical community to utilize their time more efficiently. In this work, we have tried to assess the “lung health” of patients suffering from a variety of pulmonary diseases including COVID-19, tuberculosis and pneumonia by applying Earth Mover’s Distance algorithm to the X-ray images of the patients. The lung X-ray images of patients suffering from pneumonia, TB and COVID-19 and healthy persons are pooled together from various datasets. Our preliminary data based upon 100 random images depicting each type of lung disease such as COVID-19, tuberculosis and pneumonia revealed that patients suffering from tuberculosis have the highest severity as per the values obtained from the EMD scale.

Small-cell lung cancer (SCLC) is a subtype of lung cancer, accounting for approximately 15% of lung cancers, with early metastasis, high recurrence and poor prognosis. The underlying molecular mechanisms are still unclear and further research is required. The aim of the present study was to identify SCLC-specific biomarkers by evaluating the differential expression of mRNA and microRNA (miRNA) profiling of tissue from patients with SCLC and to compare the normal lung tissue. A non-coding RNA sequence dataset (GSE19945) and transcriptome sequencing dataset (GSE6044) were downloaded from the Gene Expression Omnibus (GEO) database. Using the R limma software package and the GEO2R tool of the GEO, we identified 445 differentially expressed genes (DEGs) and 128 differentially expressed miRNAs (DEmiRNAs). The GO function was significantly enriched for 26 terms, and the Kyoto Encyclopedia of Genes and Genomes (KEGG) database had fifteen enrichment pathways, mainly related to DNA replication, cell cycle, and oocyte meiosis mismatch repair. Cytoscape software was used to generate the protein-protein interaction (PPI) networks to identify the molecular mechanisms of key signalling pathways and cellular activities in SCLC. Using miRNAWalk, we identified 598 target genes of the 13, 80 miRNAs and constructed miRNA target networks. In total, there were eighteen overlapping genes regulated by 28 miRNAs between target genes of the DEmiRNAs and DEGs. The identified hub genes are important because they may be used as biomarkers for prognosis, diagnosis and therapeutic target for SCLC.

Aim: This retrospective study was conducted to evaluate the pattern of recurrence in head and neck squamous cell carcinoma (HNSCC) patients who received a definitive chemo-radiotherapy. Materials and Methods: In this retrospective study, the data of 308 head and neck patients from January 2015 to March 2015 were analyzed. Only patients who received definitive chemo-radiotherapy were included in the study. The pattern of recurrence was stratified based on age, gender, site involved, histopathological differentiation, stage, habitual risk factors, and treatments received. Results: The mean age of the patients was 51.6 years. No association in the pattern of recurrence based on age, gender, or histopathologic differentiation was found. Patients with habitual risk factors (smoking, tobacco chewing, and alcohol) showed the poorest response to chemo-radiotherapy and unresolved residual disease. Among the primary sites involved, oral cavity patients showed the poorest response with maximum cases of residual disease. In addition, patients with advanced stage remained with residual disease and have a maximum recurrence, and the difference was statistically significant. All the patients who received neoadjuvant chemo-radiation (NACT-RT) as compared to chemo-radiation (CT-RT) had residual disease. According to the pattern of recurrence, the local recurrence was the most common followed by regional and then local and regional, but the distance recurrence was the lowest. Conclusion: Of the patients who have received definitive chemo-radiotherapy, more than half of HNSCC had residual disease. Of the patients with no residual disease, about half of them had recurrence at follow-up. However, no association in the pattern of recurrence was found based on gender or histopathologic differentiation. Patients who have multiple habitual risk factors showed the worst outcome as compared to the patients who have a single habitual risk factor. Patients with multiple habitual risk factors have maximum cases of residual disease and maximum cases of recurrence. Among the habitual risk factors, tobacco chewing was the worst habitual risk factor for refractory residual disease and recurrence. Based on the sites, the patients with carcinoma of the oral cavity showed the worst outcome in terms of residual disease, which is followed by hypopharynx, oropharynx, and then larynx carcinoma, but the rate of recurrence does not depend on the site involved. Advanced-stage patients had a poor response and with maximum cases of recurrence. A combination of chemotherapy with radiation showed better results as compared to the radiation alone in terms of response and recurrence. As to the site of recurrence, the local recurrence was the most common, followed by regional and then distance recurrence. This study indicated that HNSCC is locally aggressive, and local failures are the most common.