IASO General Hospital

Abstract Background Identifying pathogenic/likely pathogenic variants in high-risk cancer genes is key to cancer risk management.Prophylactic surgeries like RRM and RRSO are guideline-recommended options. This study aims to provide real-world evidence on their clinical implementation. Methods Between 2020 and 2025, 203 women referred for genetic testing at Genekor Medical S.A., were detected with P/LP variants in cancer susceptibility genes, for which risk-reducing surgical options are either recommended or considered for discussion. Referring clinicians were invited to complete a questionnaire to assess whether prophylactic surgical options had been discussed, if the patients had agreed to undergo such procedures, and whether the surgeries have already been performed or postponed. Results Among the individuals referred for genetic testing, 168(83%) were referred following a cancer diagnosis, while 35(17%) were unaffected individuals referred due to a family history. 153 individuals (76%) harbored BRCA1/2, 31(15%) harbored PALB2, PTEN, TP53 and 19 (9%) harbored BRIP1,RAD51C, RAD51D P/LP variants. RRSO was discussed with 78/153 (51%) of BRCA1/2 carriers and agreed in 60/78 (77%) cases. Addition of hysterectomy to RRSO was discussed in 16/78 (21%) of cases and agreed in 10/16 (63%). RRM was discussed with 113/203 (56%) of patients and agreed in 73/113(65%). In PALB2, PTEN, TP53 carriers, RRM was discussed in 21/31 (68%) cases, and accepted in 9/21 (43%), while in 5 cases both RRM/RRSO were discussed with 3 women agreeing. Finally, for 19 BRIP1,RAD51C, RAD51D carriers, in 9 cases the physician discussed RRSO as an option, with the examinees agreeing in 7 of them and in 5 cases RRM was discussed with agreement to proceed in 2 of them. In all cases, 22 individuals although agreed to proceed with RRM and/or RRSO, decided to postpone the procedure. Conclusions This study highlights the high awareness and acceptance of surgical management demonstrating the adherence to the recommendations. Age under 35 years and receiving therapy at the time of genetic testing were significant factors in lowering risk reduction RRSO and hysterectomy performance rates. Stage IV cancer was the main reason for not discussing surgical intervention. Citation Format: K. Papazisis, M. Paraskeva, S. Giassas, M. Skondra, R. Iosifidou, C. Tolis, G. Kesisis, E. Zairi, V. Venizelos, C. Markopoulos, I. Natsiopoulos, E. Bleka, I. Xanthakis, A. Ananiadis, D. Matheos, D. Stefanou, A. Adamidis, A. Meintani, G. Kapetsis, D. Bouzarelou, E. Papadopoulou, G. Nasioulas. High-risk cancer susceptibility genes mutation carriers’ compliance with surgical risk reduction for breast and ovarian cancer [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS3-05-05.

Radical prostatectomy is the standard of care for the treatment of early, clinically localized prostate cancer (PC). In addition to known clinical prognosticators, perioperative conditions and the type of anesthesia may affect clinical outcomes through several mechanisms that favor a tumor-propagating state, including activation of the sympathetic system, increased opioid requirements, and inflammation. In this review, we provide an overview of the impact of the perioperative period on PC prognosis and patient outcomes. A non-systematic literature review was conducted to investigate the possible association between neuraxial anesthesia and outcomes after radical prostatectomy (RP) for prostate cancer. The following keywords were used: “cancer recurrence” OR “cancer prognosis” OR “metastasis” AND “neuraxial anesthesia” AND “prostate cancer”. Eligible studies were summarized in the form of a narrative review. In the era of limited use of ERAS protocols, the implementation of neuraxial anesthesia was found to reduce mortality after RP for primary prostate cancer when compared to general anesthesia. Although there was no significant association between anesthetic technique and radiological or biochemical-free survival, regional anesthesia may have an impact on short-term survival in patients with severe comorbidities, involving pulmonary complications and thrombosis. The effect of anesthetic technique on PC patient outcomes remains elusive, although preliminary retrospective evidence suggests a possible positive effect of neuraxial anesthesia on patient outcomes. As the perioperative period is considered a vulnerable timeframe for these patients, the role of the leadership dyad of surgeon and onco-anesthesiologist is crucial.

Objective: Investigate a possible association between the serum uric acid and fibrinogen levels and the atheromatosis of the carotid arteries of hypertensive patients Design and method: We studied 1296 hypertensive patients of median age: 61 (51-69) years, without any known cardiovascular disease and with mean office systolic/diastolic arterial blood pressure (S/DBPo): 145.5±19.55/89.8±12.5 mmHg, mean office heart rate (HRo): 74.4±9.9 bpm, median (BMI): 27.5 (25-30) kg/m2 a The levels of serum uric acid (SUA), fibrinogen were recorded and eGFR was also calculated according MDRD formula Equation. All patients underwent a carotid ultrasound test. Intima-media thickness was measured (IMT) and the presence of atheromatus plaqueThe study population was separated in two groups, according the IMT value and the existence or not of atheromatous plaque. Group A: IMT> 0.9 mm or/and existence of atheromatous plaque (72,1%) Group B:IMT< 0.9 mm and without any atheromatous plaque (27,9%) (t-test between the two groupsp<0.001). ANOVA statistic method Results: Significantly more patients in the total study population had carotid atheromatous plaques (72,1% vs 27,9% p<0.001) without any statistically significant differences in the prevalence of atheromatous plaques between male and female (Pearson chi –Square NS (0,274). There were significantly higher levels of SUA in Group A vs Group B (5,4±1,6 vs 5,0±1,6 mg/dl p=0.001) as also between the male and female population (SUA men: 5,9±1,5 vs 5,8±1,4 by groups NS, women: 4,9±1,6 vs 4,3±1,4 p <0.001). As far as the fibrinogen levels are concerned, there were significantly higher levels in groupA vs group B (361,6±99,7vs 332,7±84,6 mg/dl p=0.001), in the sex-specific association of fibrinogen and increased carotid intima-media thickness or the existence of carotid plaque(fibrinogen men:341,5±91,4 vs 321,7±77,5 by groups NS, women: fibrinogen 377,3±103,2 vs 341,7±89,3 p =0.002), the significance remained only in women. There was also a significant correlation between SUA and fibrinogen (r=0.206, p<0,001), a significant regression between SUA and fibrinogen (p<0,001) Conclusions: In hypertensives treated or not, with high proportion of carotid atheromatosis, the existence of IMT, was associated with higher SUA and fibrinogen levels, in women, indicating their importance in the atheromatous status of hypertensive patients

To contribute to the refinement of future physical activity (PA) guidelines, which have remained mostly generic until now, we performed an umbrella review of meta-analyses for PA in cancer survivors. Medline and Scopus databases were searched in January 2024 for systematic reviews and meta-analyses on the association/effect of any type of PA in every cancer type and for any studied outcome. Statistically significant meta-analyses were categorized into four evidence groups (strong, highly suggestive, suggestive, weak) using pre-established grading criteria. A total of 102 publications reporting 740 meta-analytic associations were identified, including breast (n = 427), prostate (n = 104), hematological (n = 58), colorectal (n = 79) and lung (n = 54) cancer survivors. Overall, 401 (54 %) associations were nominally statistically significant, of which 16 were categorised as strong, 10 as highly suggestive, and 93 as suggestive evidence. In breast cancer, there was strong or highly suggestive evidence that post-diagnosis PA is associated with lower all-cause mortality, recurrence, cancer-related fatigue, depression, and higher mental health, body strength, aerobic capacity, and weight loss. In prostate cancer, strong evidence was identified for the positive association of PA with cardiovascular fitness, quality of life and fatigue amelioration. In colorectal cancer, strong and highly suggestive evidence supported the association of PA with lower all-cause mortality. In lung cancer, strong evidence supported the association of preoperative combination of breathing exercise and PA with reduced length of hospital stay. This grading of the entirety of the available evidence can facilitate robust introduction of targeted exercise prescription in oncology care as standard practice.

Background:Systemic sclerosis (SSc) is a chronic systemic disease with skin and internal organ manifestations often difficult to treat. SSc patients often complain to their doctors about memory and attention difficulties, as well as about the “tip of the tongue” phenomenon. Cognitive worsening during this chronic disease seems to be underestimated.Objectives:This study aims to review the cognitive function of SSc patients systematically.Methods:This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was performed in PubMed, Scopus, and ScienceDirect for English articles published from inception to 2024. The combinations of keywords used were: “systemic sclerosis”, “cognitive function”, “cognitive impairment” and “neuropsychological impairment”. There was no limitation in age, gender, nationality, and severity of disease. Studies with perceived cognitive function, qualitative studies, and reviews were not chosen for the review.Results:A total of 4 quantitative studies with 113 SSc patients who underwent neuropsychological evaluation were included[1-4]. Neuropsychological assessments utilized in the studies were the Mini-Mental State Examination, Wechsler Deterioration Index, Symbol Digit Modalities Test, Wisconsin Card Sorting Test, Wechsler Memory Scale 3rd Edition Digit Span subtest, the Stroop ColorWord Interference Test, California Verbal Learning Test, and Benton Facial Recognition Test. Results unveiled significant deficits in verbal fluency and memory tasks, attention and information processing speed, global and complex attention, visuospatial functions, and dysexecutive syndrome.Conclusion:Although data are limited, there are significant cognitive deficits in patients with SSc and appear to impair the quality of life of these patients.REFERENCES:[1] Aligianni SΙ, et al. Low cognitive functioning and depressive symptoms in patients with rheumatoid arthritis and systemic sclerosis: a clinical study. BMC psychiatry. 2023;23(1).[2] Khedr EM, El Fetoh NA, Gamal RM, Elzohri MH, Azoz NMA, Furst DE. Evaluation of cognitive function in systemic sclerosis patients: a pilot study. Clinical rheumatology. 2020;39(5):1551-9.[3] Sakr BR, Rabea RE, Aboulfotooh AM, Kishk NA. Neurosonological and cognitive screening for evaluation of systemic sclerosis patients. Clinical rheumatology. 2019;38(7):1905-16.[4] Yilmaz N, Mollahasanoglu A, Gurvit H, Can M, Tuncer N, Inanc N, et al. Dysexecutive syndrome: a specific pattern of cognitive impairment in systemic sclerosis. Cognitive and behavioral neurology: official journal of the Society for Behavioral and Cognitive Neurology. 2012;25(2):57-62.Acknowledgements:NIL.Disclosure of Interests:None declared.

Knowledge of the morphology of the suprascapular notch is clinically beneficial in patients withsuspected suprascapular nerve compression or palsy. Several classification systems have been proposed for the morphological classification of the suprascapular notch and its severalanatomical variations. The purpose of this study was to evaluate the inter- and intraobserver reliability of four different classification systems for suprascapular notch typing analysing shoulder computed tomography (CT) scans. Shoulder CT scans from 109 subjects (71.5% males) were examined by three raters of various experience levels, one senior, one experienced, and one junior orthopaedic surgeon. The CT scans were evaluated quantitatively and qualitatively and the suprascapular notch was classified according to four classification systems at two separate timepoints, four weeks apart. To determine consistency among the same or different raters, the Kappa statistic was performed and intrarater reliability for each rater between the first and the second evaluation was assessed using Cohen's kappa. Reliability across all raters at each timepoint was assessed using the Fleiss kappa. Agreement was almost perfect for all the classification systems and amongst all raters, regardless of their experience level. There were no significant differences between the raters on any of the evaluations. The overall interobserver agreement for all classifications was almost perfect. The four suprascapular notch classification systems are reliable, and the rater's experience level has no impact on the evaluation.