Search

Background: Millions of dead cases are reported every year due to sepsis. Sepsis has been estimated in 1-2 % of hospitalized patients especially leukemic patients. The diagnosis of sepsis remains a clinical challenge. Many studies suggest that presepsin plays a role in diagnosing sepsis, but the results remain controversial. Objective: To evaluate the potential of presepsin as an early biochemical marker of sepsis in adult acute leukemic patients and to assess the correlation between severity of sepsis and level of presepsin. Comparing between presepsin & CRP in diagnosing bacterial infection in critically ill adult leukemic patients. Patients and Methods: This study was conducted on 24 patients having acute leukemia after receiving chemotherapy and 24 controls at Medical Oncology and Clinical Pathology Departments, Zagazig University Hospitals during the period from June 2018 to August 2019. Results: There was statistically significant difference between patients and control regarding presepsin levels. The highest levels of presepsin were in patients with septic shock followed by severe sepsis, sepsis, SIRS then control group. There was statistically significant difference between types of sepsis and presepsin (P value = 0.000). There was statistically significant positive correlation between CRP and presepsin (r = 0.658). AT cut off value of 440 the clinical sensitivity of presepsin was 82.5% and its clinical specificity was 90%, AUC was 0.89. On comparing these results with the normal cut off value of CRP level (6), the clinical sensitivity and specificity were 90% & 61% respectively and AUC was 0.70. Conclusion: Presepsin can be used as a better indicator to the degree of severity of sepsis than CRP in septic adult leukemic patients.

Hepatocellular carcinoma (HCC) is a major health problem. HCC burden has been increasing in Egypt in the past 10 years. Most HCC cases are diagnosed at an advanced stage with limited treatment options. Sorafenib is the standard therapy for advanced HCC, but the effectiveness is not satisfied. Metformin may decrease the risk of HCC development in diabetic patients, reduces tumor invasion, and augments sensitivity to sorafenib; however, safety and efficacy of combined treatment are still unclear. As HCC is characterized by high vascularity, and vascular endothelial growth factor (VEGF) plays an important role in vascularization, many studies questioned if VEGF and HIF-1 α could offer information about HCC response to sorafenib. We conducted this study to assess the benefits from adding metformin to HCC treatment, and appraise the role of VEGF and HIF-1 α in HCC prognosis.This was a prospective, randomized study in which 80 advanced measurable patients consecutively treated with sorafenib plus metformin (arm A) or sorafenib alone (arm B), prognostic value of plasma, and tissue levels of VEGF and HIF-1 α were evaluated.We enrolled 61 men and 19 women with a median age of 60 years (range 49-68 years). Fifty-seven patients had Child-Pugh A while 23 had early B, the most common etiology of liver disease was hepatitis C (86%). Sixty percent of patients were diabetic. No significant difference was detected between arm A and arm B regarding response to treatment (p = 0.5), time to disease progression (p = 0.3), or overall survival (p = 0.6). Low VEGF and HIF-1 α plasma levels were significantly associated with better treatment response (p 0.001 for both), and higher OS (p 0.001). Patients with high expressions of VEGF and HIF in HCC tissue had significantly poor treatment outcome (p 0.001, p = 0.03, respectively), and poor OS (p 0.001, p 0.001, respectively).No superior efficacy of adding metformin to sorafenib in HCC treatment. VEGF and HIF-1 α had promising prognostic value in HCC.

Background: chromosome 17 abnormalities are non-random cytogenetic events that occur in hematological and myeloid malignancies. Their prognostic impact is mostly related to alteration of tumor suppressor gene p53 by deletion or mutation. The aim of this study is to detect the frequency and types of chromosome 17 abnormalities and their prognostic effect in myeloid malignancies patients.Methods: the study included 50 patients of newly diagnosed myeloid malignancies divided into three groups: group 1 included 28 AML patients, group 2 included 7 MDS patients and group 3 included 15 CML patients. All studied patients groups were subjected to history taking, clinical examination, routine laboratory investigations, conventional cytogenetic analysis and FISH for detection of chromosome 17 abnormalities. Results: Chromosome 17 abnormalities were positive in 52% of myeloid malignancies patients; structural abnormalities were more frequent (40%) than numerical abnormalities (12%). Chromosome 17 abnormalities was detected in 67.9% of AML patients, 28.6% of MDS patients, and in 33.3% of CML patients.Conclusion: Chromosome 17 abnormalities were frequent cytogenetic events that occur in various myeloid neoplasms and have poor prognostic impact related to alteration of tumor suppressor gene (p53).

Background: High levels of MCL-1 and BCL-2 proteins have been found in Chronic Lymphocytic Leukemia (CLL), and inversely correlated with response to treatment. BCL-2/Bax ratio is the main director of apoptosis in CLL. The study aimed to clarify the prognostic role of MCL-1, BCL-2 and BCL-2/ Bax ratio in B-CLL. Patients & method: Estimation of MCL-1, BCL-2 and Bax expressions by a flow cytometry in 45 B-CLL patients and the prognostic value of these markers were correlated with other well-known established prognostic markers and treatment response. Results: MCL-1 was expressed in 60% of cases while BCL-2 was expressed in 82.2% of cases. MCL-1 expression was significantly high in male gender, short lymphocyte doubling time (LDT), and high expression of CD 38 (p β2M, CD38 expression), low ZAP-70 expression, splenomegaly and higher Rai stage were significantly increased in patients with high expression of BCL-2 (p β2M, high C-D38 expression, low ZAP-70 expression, the poor cytogenetic and splenomegaly in patients with high expression of BCL-2/ Bax ratio (p < 0.001). Among the 39 patients who started treatment when indicated responding patients had statistically significant lower BCL-2/Bax ratio than non-responding patients, although their lower mean of MCL-1 and BCL2 expressions values were insignificant. In conclusion: MCL-1, BCL-2 expressions and BCL-2/Bax ratio could be useful potential predictive and prognostic markers in B-CLL.

Background: One of the barriers to cancer care is the inadequate communication with patients and their families. InEgypt, it is believed that culture is against the honest disclosure of cancer diagnosis. So, the majority of cancer patientsare usually unaware of their diagnosis.Aim: To study cancer diagnosis awareness among a group of Egyptian patients and the factors contributing to their unawareness. Methods: The study included 119 cancer patients from two cancer centers; one in Cairo and the other in Sharkia. Patients were asked about their illness and who answered as having cancer/tumor” or mentioned the name of cancer considered aware. Results: The majority of our patients (100/119, 84%) were aware of their cancer diagnosis. Their answer was “cancer” in 31%, “tumor” in 60% and the name of cancer in 9%. While, a nority (19 /119, 16%), were unaware of their cancer diagnosis. They were more likely to be less educated, older in age, males, unmarried, and from Sharkia. None of the studied variables associated significantly with awareness. Conclusions: The results of this study suggest that most cancer patients in Egypt are aware of their diagnosis. This may be due to a change in the Egyptian cultural attitude towards truth telling and a shift in the approach of care from paternalistic to patient-centred.

Introduction : Abiraterone Acetate (AA) improves outcome of patients with castrate resistant prostate cancer (CRPC) and is currently recommended for chemo-naA¯ve patients and after progression on chemotherapy. We reviewed our initial experience with the use of AA in these patients. Patients and Methods : Forty six consecutive CRPC patients were treated with AA 1000 mg/day and prednisolone 5 mg twice daily in 2 cancer centres in England and Saudi Arabia. Treatment was continued until disease progression or unacceptable toxicity. Patients achieving prostate specific antigen decline (PSA) ≥ 50% were considered as marker responders. Results : Median age was 76 (52-91) years. 28 and 18 patients received AA in pre-chemotherapy and post-chemotherapy setting respectively. PSA marker response was achieved in 56.1% (23/41) assessable patients. Objective radiological response rate was seen in 31.6% (6/19) and stable disease in 15.8% (3/19) assessable patients. After a median follow up of 20 months, median time to PSA progression was 12 months (95% CI: 9.5-14.5) and median overall survival was not reached (mean = 21 months, 95% CI: 18-24.5). Toxicity was assessed in 18 patients. All grades adverse events of special interest were hypokalaemia (22%) and hypertension (11%). Conclusion : In daily clinical practice, AA is an effective treatment for patients with CRPC. It produces meaningful marker and objective responses, marker progression free survival and OS that are comparable to those reported in clinical trials. Monitoring of blood pressure and serum potassium is recommended.

Aim: Colorectal carcinoma (CRC) is the commonest and most deathly malignant gastrointestinal tumors. Carcinogenic process starts in a group of cancer cells, called cancer stem cells (CSCs) having the ability to start and maintain tumor growth and invasion. In order to detect and remove colon CSCs, a selective biomarker "LGR5 (leucine-rich-repeat-containing G-protein-coupled receptor 5)" might be required. At the same time, an abnormal expression of TPX2 (targeting protein for xenopus kinesin-like protein 2) has been found to be related to the development and progression of tumors. We aimed to evaluate the immunohistochemical expressions of LGR5 and TPX2 in CRC in a trial to clarify their relations to proliferation and metastasis of CRC, and hence its prognosis. Methods: Immunohistochemical staining of both LGR5 and TPX2 was assessed in sections from sixty paraffin blocks of CRC . The relationships between their levels of expressions with the clinicopathological parameters and patient outcome were statistically analyzed. Results: The immunoexpression of LGR5 in CRC was signifi­cantly positively correlated with location of the tumor, grade, stage, local recurrence, lymph node and distant metastasis (p

Background: Bladder cancer is the second most common malignancy among Egyptian males. Patients and methods: To investigate the factors affecting survival in Egyptian patients suffering from urinary bladder cancer, we analyzed the geographical patterns of 564 bladder cancers patients from Oncology Departments of Ain Shams University, Mansoura University, Zagazig University and Damietta oncology centerover a period of 7 years between January 2006 and September 2013. Results: Among the included 564 patients, Males represented 72.5% of the patients. While, 27.5% were female with a male to female ratio of 2.6, 227 patients presented with non-metastatic and 337 patients with metastatic urinary bladder cancer. Grade III was found in 36% of our patients and 60% of them had stage IV. Mean DFS was (9.15 ± 0.5) and (4.4 ± 0.1) while, mean OS was (13.5 ± 0.7) and (7.5 ± 0.15) months for non-metastatic, and metastatic patients, respectively. In univariate analysis, patients with no bilharzial infection, Non-SCC, responding patients had significant better DFS and OS vs. patients with bilharzial infection, SCC, non-responding patients (respectively, p=0.001 for all). In multivariate analysis, response (OS and PFS), SCC (OS and PFS) and bilharzias is (OS and PFS) where found to be highly statistically significant (Cox regression, P

We conducted this prospective study which included 28 de novo CD20-positive DLBCL patients to assess the clinical outcome, treatment response, and hepatic toxicity in DLBCL patients who received rituximab-CHOP as a first line treatment in relation to HCV infection status. We included 7 patients with positive HCV infection (group A) and 21 patients with negative HCV infection (group B). HCV infection was not a significant risk factor for prognosis (1-year event-free survival rates, 71.4% versus 81%, P=0.53; overall survival rates, 85.7% versus 90.5%, P=0.72, for groups A and B, resp.). CR rate was 71.4% (5/7) in group A and 76.2% (16/21) in group B (P=0.8). Of the 7 patients who were HCV positive, 2 (28.6%) had enzyme flare (grade 2), compared with 1 of the 21 (4.8%) patients who were HCV negative (P=0.15). Two (28.6%) of the 7 positive HCV infection patients had viral reactivation (≥1 log10 IU/mL increase in the viral load). No patient required discontinuation of immunochemotherapy owing to hepatotoxicity in either group. In conclusion, HCV infection might not influence the clinical course in DLBCL patients who receive rituximab-CHOP. Close monitoring of hepatic function and viral load is recommended.

Background: According to the literature, vitamin D (Vit D) deficiency is a risk factor for breast cancer developing with lack of information on its direct prognostic effects in breast cancer. Patients and methods: A total of 168 women with proven breast cancer diagnosed in Zagazig university hospitals- Egypt were enrolled in this study. Serum level of 25 (OH) Vit D was measured in stored blood just after diagnosis. Vit D levels were classified into three groups: deficient: 30 ng/ml. Clinical-pathological data and disease outcome were accessed to examine prognostic effect of vitamin D in breast cancer. Results: Median age was 51.5 (26-77) years, Metastasis was present in 13.1% of the cases. The median serum level of 25(OH) Vit D was 20 (5-98) ng/ml; it was deficient in 36.9% of patients, insufficient in 32.1% of patients, and sufficient in 31% of patients. Serum level of 25 (OH) VitD levels decreased significantly with increasing body mass index (BMI) (P=0.00), also the relations of 25 (OH) Vit D level with the number of positive lymph nodes, tumor size, tumor stage and KI 67 level were statistically significant (p= 0.01, p=0.011, p=0.002, p= 0.001 respectively). The level of 25 (OH) vitamin D was significantly low in metastatic patients (p=0.01). For those non -metastatic BC patients; there was no statistically significant difference in mean Disease-Free Survival (DFS) times across the 3 categories of serum Vitamin D (p=0.13), also for metastatic patients, serum vit D level didn’t affect the median PFS (p=0.98). The mean OS of the 3 different categories of serum vit D (sufficient, insufficient and deficient) were 45.8 months, 39.7 months and 39 months respectively (p=0.047). Univariate analysis, showed that OS was significantly affected by age, BMI, grade, stage, molecular type and vit D levels (p=0.014, p=0.002, p=0.002, p

Background: Gastric adenocarcinoma (GAC) is a serious disease with poor outcome. Discovering novel molecular targeted therapies is a recent point of research to improve prognosis. One of the newly discovered targets is the receptor tyrosine kinases (RTKs); it is a member of trans-membrane receptors which had important roles in proliferation and apoptosis. RTKs were found to have different expression patterns in several malignancies. HER2 neu which is a member of HER family is a proto-oncogene that is formed of four receptor tyrosine kinases. Erythropoietinproducing hepatocellular (Eph) molecules are major RTKs members and one of those molecules is EphA2 which has many different functions in cancer as tumor initiation, progression, angiogenesis and spread. We aimed to explore the expression patterns of both HER2 neu and EphA2 in GAC patients using immunohistochemistry, and to correlate their expressions with clinico-pathological factors and prognosis of our patients Methods: HER2 neu and EphA2 expressions were assessed in sections from forty blocks of paraffin which were diagnosed as GAC. Then we analyzed the correlations between their expressions and disease outcome of GAC patients. Results: HER2 neu and EphA2 positive expressions in GAC were positively correlated with tumor grade and stage (p

Background. The most common malignant tumor of the urinary bladder is transitional cell carcinoma (TCC). Neural precursor cell-expressed developmentally downregulated protein 9 (NEDD9) is found to be a cell adhesion mediator. P38 Mitogen-Activated Protein Kinase is a serine/threonine kinases member which can mediate carcinogenesis through intracellular signaling. Methods. To assess their prognostic role; NEDD9 and p38 protein were evaluated in sections from 50 paraffin blocks of TCC. Results. The high expressions of NEDD9 and p38 protein were significantly associated with grade, stage, distant metastasis (p<0.001), number of tumors, lymph node metastasis, and tumor size (p<0.001, 0.002; 0.018, p=0.041 and Conclusion. NEDD9 and p38 protein expressions were poor prognostic markers of TCC.

Graphical abstract Malignant lymphomas and HCV infection have a dual relationship., B-cell NHL is strongly associated with HCV that was proved in the last 2 decades. The most common HCV infection related B-NHL subtypes include MZL and DLBCL lymphomas. HCV-positive NHL patients usually present with older age at diagnosis, higher LDH, and more extranodal disease. The standard chemo-immunotherapy tolerance is generally good. Antiviral treatment achieves virological and hematological remission in HCV associated indolent lymphoma. More aggressive lymphoma requires combination of antiviral treatment and chemotherapy. New generation of HCV antiviral drugs is safe and is highly efficacious. Regimens including DAAs appear promising options as they can reduce the HCV-associated NHL incidence by dramatically lowering the HCV chronic carriers.

PurposeTo evaluate the role of FSE STIR whole body MRI in diagnosis and initial staging of malignant lymphoma, and can FSE STIR whole body MRI replace conventional staging procedures including computed tomography and bone marrow biopsy in initial staging of lymphoma.Materials and methodsTwenty one newly diagnosed histologically proven lymphoma patients underwent whole body MR imaging and conventional staging procedures including computed tomography and bone marrow biopsy for initial staging of lymphoma using Modified Ann Arbor staging system. Both methods evaluated positive involvement by lymphoma to the nodal and extra-nodal sites including parenchymal organs, serosal cavities and bone marrow. The numbers of involved nodal and extra-nodal sites detected by both methods were compared, then agreement and disagreement between whole-body MRI and conventional procedures regarding lesions detection and staging according to the Ann Arbor staging system were calculated, along with binomial exact 95% confidence intervals (CIs).ResultsTwenty one patients had a total of 145 abnormalities. One hundred and twenty four were correctly diagnosed by conventional staging procedures, however, FSE STIR whole body MRI correctly diagnosed all the 144 abnormalities with 1 false negative and 3 false positive abnormalities with a total of detected abnormalities of 147 lesions. FSE STIR whole body MRI was significantly more accurate than conventional staging procedures in the diagnosis of positive lymphoma lesions [(99.3%; 95% CI: 95.6–100.0%) versus (85.5%; 95% CI: 78.5–90.6%)]. FSE STIR whole body MRI correctly staged 20 out of 21 patients, Kappa test 0.93 (P

Background: The aim of this study was to investigate the prognostic role of mammalian target of Rapamycin (mTOR) and C-X-C chemokine receptor type 4 (CXCR4) in diffuse large-B-cell lymphoma (DLBCL) patients. Patients and methods: This retrospective study was collected data from 64 de novo DLBCL patients, who received standardized R-CHOP therapy at two oncology centers. CXCR4 and mTOR expressions were assessed by immunohistochemistry. Results: Out of the 64 DLBCL patients, 40 patients were positive for CXCR4 (62.5%) and 35 patients for mTOR (54.7%) expressions. CXCR4 expression was positively correlated with mTOR expression (r = 0.7; p < .001). While mTOR expression was significantly associated with high lactate dehydrogenase level ( p = .03) and number of extranodal sites one or more ( p =.02), CXCR4 expression was significantly associated with high IPI score ( p < .001) and ECOG PS ( p = .005). Furthermore, the expression levels of mTOR and CXCR4 were significantly associated with older ages and poor response to treatment ( p = .04

Background: Bladder cancer is one of the most common cancers worldwide. Gene expression profiling using microarray technologies improves the understanding of cancer biology. The aim of this study was to determine the gene expression profile in Egyptian bladder cancer patients. Materials and Methods: Samples from 29 human bladder cancers and adjacent non-neoplastic tissues were analyzed by cDNA microarray, with hierarchical clustering and multidimensional analysis. Results: Five hundred and sixteen genes were differentially expressed of which SOS1, HDAC2, PLXNC1, GTSE1, ULK2, IRS2, ABCA12, TOP3A, HES1, and SRP68 genes were involved in 33 different pathways. The most frequently detected genes were: SOS1 in 20 different pathways; HDAC2 in 5 different pathways; IRS2 in 3 different pathways. There were 388 down-regulated genes. PLCB2 was involved in 11 different pathways, MDM2 in 9 pathways, FZD4 in 5 pathways, p15 and FGF12 in 4 pathways, POLE2 in 3 pathways, and MCM4 and POLR2E in 2 pathways. Thirty genes showed significant differences between transitional cell cancer (TCC) and squamous cell cancer (SCC) samples. Unsupervised cluster analysis of DNA microarray data revealed a clear distinction between low and high grade tumors. In addition 26 genes showed significant differences between low and high tumor stages, including fragile histidine triad, Ras and sialyltransferase 8 (alpha) and 16 showed significant differences between low and high tumor grades, like methionine adenosyl transferase II, beta. Conclusions: The present study identified some genes, that can be used as molecular biomarkers or target genes in Egyptian bladder cancer patients.

The treatment of advanced renal cell carcinoma (RCC) has advanced significantly over the last two decades. This multicenter study was designed with the primary objective to evaluate the efficacy and safety of sorafenib as first-line treatment in patients with advanced or metastatic RCC in the Middle East, who were considered to be ineligible for other approved first-line therapies. A total of 75 eligible patients from 8 centers in the Middle East were included in this study. The patients comprised 48 men and 27 women, with a median age of 52 years (range, 19–78 years). A total of 50 patients had clear cell carcinoma, 17 had papillary carcinoma and 8 had other pathological subtypes. At enrollment, 55 of the 75 patients had undergone previous nephrectomy. A total of 67 patients presented with metastatic disease, while 8 patients had regional residual lesions or local recurrence. The patients were treated with 400 mg oral sorafenib twice daily on a continuous basis as a single agent. Treatment was discontinued upon disease progression, prohibitive toxicity, surgical complications, loss to follow-up, or refusal to continue therapy. The median treatment duration was 21 weeks (range, 1–137 weeks). Sorafenib was tolerated by the majority of the patients. Grade 3/4 hand-foot syndrome occurred in 17 patients; diarrhea, elevated liver enzymes and fatigue were observed in 3 patients each; and grade 3/4 vomiting, hypertension and anemia, in 1 patient each. Of the 75 patients included in this study, 60 were evaluable for response. One patient achieved a complete response for 91 weeks and 6 patients exhibited a partial response (median duration of 23 weeks) with an overall response rate of 11.7%. Disease stabilization occurred in 37 patients (61.7%). Thus, disease control was achieved in 44 of the 60 patientrs (73%). At a median follow-up period of 53.5 weeks (range, 8.5–192 weeks), an intention-to-treat analysis demonstrated a median time-to-disease progression of 25.7 weeks, with a median overall survival of 54.8 weeks. In conclusion, sorafenib was found to be tolerable and effective as first-line therapy in patients with advanced RCC.

Background: Hematogons (HGs) are normal bone marrow cells; that may reflect the quality of the bone marrow response to chemotherapy. Many studies have focused on the role of HGs in acute leukemia. Methods: A total of 65 patients with nonpromyelocytic AML, in first complete remission were enrolled in this study, and four color flow cytometry was used to quantify Hematogones. We identify the HGs detectable group as those who had more than or equal to 0.01% HGs in bone marrow aspirated sample. Results: HGs were detectable in 25 patients' marrow samples, and they were significantly associated with cytogenetic risk (p=0.01). After a median followup of 17.6 months, patients with detectable HGs had better DFS and OS than those with undetectable levels (p=0.013 and

4537 Background: Bladder carcinoma is still one of the foremost oncologic problems in Egypt. In previous single-arm and double-arm phase II studies, prolonged infusion of low dose gemcitabine and cisplatin proved to be an effective treatment for such patients with advanced disease. Methods: To compare efficacy and safety of both prolonged infusion and standard gemcitabine-cisplatin combination, we updated the data and duplicated the number of patients of our previously published phase II randomized study to 120 untreated patients with stage III/IV bladder cancer. Patients were randomized to receive either gemcitabine (250 mg/m2) 6-hour infusion on days 1 and 8, and cisplatin (70 mg/ m2) on day 2 every 21-day cycle (Arm1) or gemcitabine (1,250 mg/ m2) 30-min infusion on days 1 and 8, and cisplatin (70 mg/ m2) on day 2 every 21-day cycle (Arm 2). Results: The 92 males and 28 females had a median age of 62 years (range 40-85 years). A total of 87 patients had transitional cell, 28 had squamous cell, and 5 had undifferentiated cell carcinoma. Among the 105 evaluable patients (52patients in arm1 and 53patients in arm 2), complete response rate was achieved in 13.5% (7/52 patients of arm 1) and 5.7% (3/53 patients of arm 2). Eighteen patients in arm 1 (34.6%) and 17 patients (32.1%) in arm 2 had partial response on therapy. Thus the overall response rate of patients in arm1 and arm 2 was 48% (25/52 patients) and 37.7% (20/53patients), respectively (p = 0.26). No significant difference in median time to disease progression (26 months versus 24 months, p =0.4), median survival (12 months versus 16 months, p =0.8), and 1-year survival (49.9 % versus 54.7%, p = 0.8) was detected between arms 1 and 2, respectively. No treatment- related deaths occurred. Main hematologic and nonhematologic toxicities were similar in both arms with no statistically significant differences. Conclusions: In the treatment of advanced bladder cancer, gemcitabine in low dose and prolonged infusion in combination with cisplatin is not inferior to high-dose short infusion gemcitabine and cisplatin in terms of overall survival, time to disease progression, and response rates with favorable toxicity profile and less financial costs.

e19039Background: The clinical outcome and hepatic toxicity occurrence of diffuse large B-cell lymphoma (DLBCL) patients with hepatitis C virus (HCV) infection in the rituximab era remains controve...

The medical records of deceased patients were reviewed to describe the pattern of cancer deaths in a newly established Saudi tertiary care hospital. During eleven months, 87 patients died of cancer. The majority (80 patients, 92%) died of incurable cancer; among which 53% did not receive any systemic anti-cancer therapy (SAT) and 43% received SAT with palliative intent. Younger age (< 65 years), relatively chemosensitive tumours and initial presentation in a potentially curable stage were associated with higher prevalence of palliative SAT administration (p = 0.009, 0.019 and 0.001, respectively). The last palliative SAT was administered during the last two months of life in 66% and during the last two weeks in 14%. During the last admission, 54% of patients were admitted through emergency room, 50% stayed >14 days and 14% died in intensive care unit or emergency room. The results demonstrate that palliative care is a realistic treatment for the majority of patients in our setting and that a significant proportion of these patients receive aggressive care at the end-of-life. There is a need to establish an integrative palliative care program to improve the quality-of-life of dying cancer patients in our region and to minimize the aggressiveness of end-of-life care.

Objective: The data available regarding the epithelial-mesenchymal transition (EMT) markers are little. This study aimed to evaluate the immunohistochemical expression of EMT markers; MYb-like, Swirm and Mpn domain-containing protein-1 (MYSM-1) and Twist-1 in renal cell carcinoma (RCC), in a trial to find their role in the prognosis of such type of cancer. Methods: Immunoexpressions of MYb-like, Swirm and Mpn domaincontaining protein-1 (MYSM-1) and Twist-1 were assessed in tissue specimens of 50 patients with RCC, and correlated with other clinicopathological features. The findings and their correlations were statistically determined. Results: Low expression of MYSM-1 was negatively correlated with size of the tumor, primary tumor (pT) stage, Fuhrman grade (P < 0.001), age (P = 0.002), and lymph node metastases (P = 0.010). Immunoexpression of MYSM-1 was significantly correlated with distant metastases (P = 0.004), overall survival (OS) (P < 0.001), and local recurrence (P = 0.001). High expression of Twist-1 was positively correlated with pT stage, Fuhrman grade, lymph node, distant metastases, age (P < 0.001), clinical stage (P = 0.002), the presence of sarcomatous change (P = 0.004), and tumor size (P = 0.008). Immunoexpression of Twist-1 was significantly correlated with distant metastases (P = 0.009), OS (P < 0.001), and local recurrence (P = 0.003). Conclusion: Overexpression of Twist-1 is an indication of poor prognosis in patients with RCC, whereas that of MYSM-1 is a marker of good prognosis.

e14629 Background: The prognosis of young colorectal cancer (CRC) patients was addressed by several studies with contradictory results. The aim of the present study is to evaluate clinico-pathologi...

4572 Background: Bladder carcinoma is the foremost oncological problem in Egypt, being the most common malignant tumor among Egyptian males. The gene expression profile in Egyptian bladder cancer m...

Objective To detect the diagnostic efficiency of ultrasound elastography in differentiation between benign and malignant enlarged cervical lymph nodes. Patient and methods This study included 27 patients, ranging in age from 21 to 70 years. Enlarged cervical lymph nodes were defined in this study as those nodes having short axis measuring more than 8 mm. Approval was taken from our hospital institutional review board and an informed consent was obtained from each patient before participating in the study. All patients were subjected to B-mode ultrasound and ultrasound elastography. Results B-mode score had the highest sensitivity in this study (sensitivity = 100%) and the least specificity and positive predictive value. Ultrasound Elastography (UE) and strain ration (SR) showed higher specificity (75%) and PPV (81.3% and 82.4% respectively). There was a statistical significant difference between the diagnostic performance of ES and B-mode score ( p = 0.034), and a nearly significant difference between SR and B-mode score ( p = 0.059). ROC curve analysis for SR measurements (cutoff value ⩾1.62) showed sensitivity = 93.3%, specificity = 75% and overall accuracy = 85.2%. However, no statistically significant difference was shown between the performance of ES and SR ( p = 0.317). Conclusion Hardness on more than 50% of the node surface and SR > 1.62 are fair to good indicators of malignancy.