The establishment of a dedicated Musculoskeletal Oncology Unit within a healthcare system requires meticulous planning, coordination, and collaboration among diverse medical professionals. A multidisciplinary team approach is essential for delivering comprehensive, patient-centered care to individuals diagnosed with musculoskeletal malignancies. Integrating orthopaedic oncology into existing oncology services enhances clinical care, addressing the needs of patients with musculoskeletal tumours and providing supportive/palliative care for skeletal lesions from other primary tumours. Core members of a successful unit typically include orthopaedic surgeons, medical and radiation oncologists, radiologists, pathologists, physical therapists, and specialized nursing staff. Additionally, integrating supportive disciplines such as nutritionists, social workers, and palliative care specialists is crucial for addressing the multifaceted needs of patients. Reconstruction and rehabilitation are vital for restoring patient function. Establishing an MSK Oncology Unit within an existing oncology framework optimizes the use of shared diagnostic services like radiology, onco-pathology, nuclear imaging, and therapeutic services, providing a cost-effective model. The Department of Orthopaedic Oncology requires team members who can provide care in the operating theatre, surgical ward, and emergency departments. Given the complexity of bone and soft tissue tumour surgeries, access to surgical intensive care and blood bank support is essential. Coordinating diverse professionals presents challenges due to differing expertise and priorities, but a cohesive multidisciplinary team can yield transformative benefits. Moreover, advancements in medical technology-such as modular operating theatres, navigation equipment, 3D imaging techniques, and custom implant manufacturing-are shaping the future of personalized care in Musculoskeletal Oncology. This article summarizes our experience in establishing a MSK Oncology Unit at a tertiary cancer care level, asserting that the concept of a free-standing orthopaedic oncologist is a myth, as the foundation of this department is rooted in teamwork.
The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.
This study evaluates the surgical approach, role of trans-arterial angioembolization (TAE) and long-term outcomes of patients presenting with solitary fibrous tumors (SFT) to a tertiary thoracic surgical unit in India. This is a retrospective study of thoracic SFTs operated between 1 August 2008 and 31 March 2024 from our center. The clinical, radiological, and histo-pathological features, surgical outcomes, and follow-up status were retrieved from the surgical database and electronic medical records and evaluated. A total of 34 patients underwent surgical excision during the abovementioned period. The median tumor volume calculated from preoperative computed tomography images was 765.8 cm3 (range from 13 to 3740 cm3). Preoperative TAE was employed in 15 patients, all of whom had tumors larger than 10 cm in the largest dimension. Complete microscopic tumor (R0) resection was achieved in all cases. Major surgical morbidity with Clavien-Dindo grade 3 or more was seen in 11.8% (4/34) and perioperative mortality was 5.8% (2/34). Four recurrences were observed, with a disease-free interval ranging from 13 to 73 months, and no local recurrences were observed. All failures were systemic failures in the lung and had dismal outcomes despite salvage treatment. The 5-year disease-free survival and overall survival were 77% and 82%, respectively. Surgical extirpation with negative margins is the cornerstone of treatment for thoracic SFTs. Preoperative TAE is useful in the management of SFTs of 10 cm or more in size. Recurrences are late systemic failures occurring in non-low risk Demicco group patients and have poor outcomes.
The incidence of breast cancer is rising alarmingly in the Indian subcontinent, with the steepest increase observed in women in their 20 s and 30 s. While lifestyle westernization is often cited as a cause, its relevance to younger women remains unexplored. This study aims to evaluate the prevalence of established and suspected risk factors for breast cancer among Indian women aged ≤ 40 years. A case-control study was conducted from September 2019 to April 2022 at the Department of Surgery, UCMS & GTB Hospital, Delhi. The study included 272 biopsy-proven breast cancer patients (≤ 40 ± 2 years) and 300 age-matched controls. Data were collected via a standardized questionnaire addressing clinical history, lifestyle, and risk factor profile. Logistic regression was used to determine associations, with a significance threshold of p < 0.05. The mean age of cases was 37.39 ± 5.31 years. There was a low prevalence of traditional risk factors across both groups. Only breastfeeding (protective, p = 0.038) and family history of breast cancer (OR = 2.79, p ≈ 0.05) showed statistically significant differences. Other factors, including early menarche, nulliparity, delayed pregnancy, and benign breast disease, did not differ significantly. Traditional risk factors do not adequately explain the rising incidence of breast cancer in young Indian women. The assumption that westernized lifestyles are primarily responsible may be overly simplistic. Further research into environmental, dietary, and occupational exposures is warranted.
Frozen section remains the most reliable method used for provisional intraoperative diagnosis of ovarian cancer, despite various imaging modalities. Its results enable the surgeon in decision-making between a fertility-sparing or an extended surgery. The study aims to calculate the diagnostic accuracy of frozen section in patients with ovarian masses, also, to calculate the sensitivity, specificity, NPV, and PPV of intraoperative frozen section for benign, borderline, and malignant ovarian masses, considering histopathology as the gold standard. The retrospective study was conducted at a tertiary care center in India. Patients who underwent surgery for ovarian masses followed by frozen section (FS) were studied. Study data of 185 patients Jan 2020 to June 2024 was obtained from the hospital computerized database. Data collected included basic and clinical characteristics. Patients with a diagnosis of ovarian tumors by clinical examination or imaging with consultation for intraoperative ovarian tumors frozen section were included in the study, and cases of incomplete medical records were excluded. Accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of intraoperative frozen and permanent sections were evaluated. A significant agreement was seen between FS and final histopathology with a kappa value of 0.899 and P-value < 0.001. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for benign were 98.4%, 98.9%, 97.8%, 97.8%, and 98.9%; for borderline, they were 94%, 85.7%, 95%, 69.2%, and 98.1%; and for malignant pathology, they were 95.6%, 90.3%, 99.1%, 98.5%, and 94.0% respectively. Our study concludes that the utility of intraoperative FS analysis is an excellent tool in the management of ovarian masses. Thus, FS, by providing nearly accurate diagnosis, facilitates informed surgical decision-making and thereby improves patient care outcomes.
The distorted anatomy of the porta hepatis can significantly complicate the process of portal dissection. In cases of large hepatoblastomas, the distortion of portal structures becomes pronounced, making it particularly difficult to manage inflow control effectively. This anatomical alteration not only complicates dissection but also heightens the risk of displacing nearby biliary structures. Such displacement increases the likelihood of inadvertent injuries to the bile ducts, which may require additional surgical interventions, such as hepaticojejunostomy, to restore biliary drainage. Furthermore, complex liver resections frequently result in an increased rate of morbidity, underscoring the importance of meticulous surgical technique. To minimize the risk of preventable duct injuries and the subsequent complications they can cause, it is crucial to adopt strategies that enhance identification and preserve the integrity of the biliary anatomy. This image vignette demonstrates a straightforward yet effective technique for duct cannulation. By employing this maneuver, surgeons can achieve better visualization and delineation of the ductal anatomy, ultimately reducing the likelihood of accidental injuries during surgery. This careful approach is key to improving surgical outcomes and minimizing postoperative complications.
Lung cancer remains a leading cause of cancer mortality in India, yet its genomic landscape remains understudied. To address this gap, we performed whole-exome sequencing (WES) on tumor and matched blood samples from 47 lung cancer patients [adenocarcinoma (ADC): 30; squamous cell carcinoma (SqCC): 10; and small cell lung cancer (SCLC): 7] to comprehensively analyze somatic mutations across all protein-coding genes. Our analysis revealed novel and recurrent alterations, with MUC4 being the most recurrently mutated gene, and TP53 emerging as the most frequently mutated across subtypes. Shared mutations included MUC4, MUC16, TP53, KMT2C, CDC27, and UBXN11, the latter not previously associated with lung cancer. ADC exhibited the highest mutational diversity, particularly in RTK/MAPK pathway genes (EGFR, KRAS, BRAF, ERBB2, PIK3CG). Notably, EGFR mutations were identified in 26.7% of ADC cases, including exon 19 deletions (5 cases), exon 21 missense mutations (2 cases), and exon 20 insertions (3 cases) and a novel EGFR exon 20 duplication (p.Ser768_Asp770dup). SqCC showed frequent mutations in KMT2D, ARID2, and FBXW7, suggesting a role for epigenetic dysregulation. One SqCC case harbored a rare EGFR p.Glu866Gly mutation. SCLC was enriched for TP53 (43%) and RB1 (14%) mutations, along with alterations in FAT4 and LRP1B. Importantly, therapeutically actionable mutations were identified in 91.5% patients, including those with NCCN-recommended (25.5%) and FDA-approved off-label drug targets (68.1%). These findings underscore the value of WES in uncovering clinically relevant mutations and support the integration of genomic profiling into precision oncology strategies for Indian lung cancer patients. The online version contains supplementary material available at 10.1007/s13193-025-02359-9.
The Enhanced Recovery After Surgery (ERAS®) protocols are designed to maximize postoperative recovery and reduce complications. Despite extensive research on ERAS®, its implementation in bone and soft tissue surgeries is under investigated. The study aimed to assess the percentage compliance with individual components of the ERAS® pathway, determine the average overall compliance among patients, and compare postoperative complications across varying levels of compliance. In 300 patients with bone and soft tissue cancer surgeries from December 2021 to May 2023, we measured 20 ERAS® components for compliance including preoperative, perioperative, and postoperative items. We computed compliance percentages and postoperative results like postoperative length of stay, postoperative complications as per Clavien-Dindo (CD) class of complications, and readmission rates. The overall compliance rate with ERAS® protocols was 84.5% (81.8% in bone tumour groups and 82.2% in soft tissue groups). A significant correlation was observed between higher compliance and better outcomes. Patients with higher compliance had a shorter median hospitalstay of 7 days compared to 10 days for those with lower compliance (p < 0.001). Additionally, 70.3% of patients mobilized with limb physiotherapy within 24 h of surgery, and 98.7% received multimodal analgesia. Majority (81.7%) of the patients experienced minor complications (CD class I-II), and 5.6% experienced major complications (CD class III-V). Higher ERAS® compliance was associated with shorter hospital stays and fewer complications, suggesting its potential of better postoperative outcomes in bone and soft tissue cancer surgeries. Further studies stratifying patients by surgical complexity are needed to confirm these findings. Clinical Trial Registry Number: CTRI/2021/11/038241.
Gnathic osteosarcomas (OS) are a rare subset of osteosarcomas, primarily localized to the mandible and maxilla. These tumors are characterized by their distinct clinical behavior, including locally aggressive behavior but a lower tendency for metastasis and differential response to adjuvant therapy, compared to other osteosarcomas of other body parts. The present study was conducted to describe the clinicopathological features of osteosarcomas of the jaws, with an emphasis on immunohistochemical characterization. A retrospective study was done in the electronic database and department archives to retrieve all the cases of osteosarcomas reported in the department from 2007 to 2024, totally 14 cases were identified and paraffin blocks were obtained. All 14 cases were resorted to immunohistochemistry against the markers Ki67, MDM2, and SATB2 using standard operating protocol. The results were documented in an Excel sheet. The mean age of the patients included in the study was 32 years, and a slight female predilection was observed. Histopathologically, the osteoblastic variant was the most common subtype observed. The Ki-67 proliferation index ranged from 20 to 50%. MDM2 expression score of 3 was observed in 70% of the cases, and SATB2 expression was positive in all cases included. In the present study, no metastasis was noted; however, a single case showed recurrence within 6 months of surgery. Osteosarcomas of the jaws are a group of rare subset of locally aggressive bone tumors, showing high proliferative index but demonstrate a lower metastatic potential. SATB2 is a sensitive marker, while MDM2 may have a limited role in high-grade osteosarcoma, in contrast to low-grade osteosarcoma. More studies with a higher sample size are warranted to assess if these markers are correlated with targeted therapies.
Breast carcinoma is the most common malignancy in women and ranks first among malignant tumors throughout the world. Timely diagnosis of breast lesions is life saving for women. Fine needle aspiration cytology (FNAC) is an important part of triple approach for diagnosing the breast lesions. It is a simple, rapid, highly sensitive, specific, inexpensive method and is used as a first line diagnostic approach for evaluation of breast lesions and for deciding the treatment. A 3-year retrospective study was carried out from Jan 2021-Dec 2023 in the department of pathology at a tertiary care hospital in Ganganagar among 141 patients who presented with a breast lump. All breast lump cases were evaluated with FNAC and categorized according to IAC Yokohama classification, and histopathological diagnosis was also retrieved and correlated in all cases wherever available. The associated risk of malignancy (ROM) was also calculated for each category. The. aims are (1) to diagnose and categorize any palpable breast lump on cytology by IAC Yokohama reporting system and ( 2) to correlate the cytological diagnosis with histopathological findings. The present study includes 141 cases, of which 107 cases were benign, and 34 cases were malignant. Out of these 141 cases, 108 cases underwent surgical exploration and were correlated with histopathology. The sensitivity, specificity, positive predictive value, and negative predictive value of these cases were 95%, 98.5%, 97.4%, and 97%, respectively. Risk of malignancy was calculated for each cytological category which was maximum for C5 (100%) and C1 (100%), followed by C4 (80%), C3 (25%), and the ROM was (0%) for C2 category. FNAC serves as a rapid, reliable, and preliminary tool for evaluation of breast lumps, and the results show a high degree of correlation with the histopathological report.
Papillary thyroid cancer (PTC) is the most prevalent form of differentiated thyroid carcinoma, known for its high survival rate and propensity for metastasizing to regional lymph nodes. Despite its generally favorable prognosis, the spread of PTC to cervical lymph nodes poses significant challenges in management and treatment.We aimed to investigate the anatomical relationship between intralobar localization of thyroid tumors and cervical lymph node metastases. The clinicopathological data of patients who presented to our hospital were retrospectively analyzed. A total of 103 patients (34 males, 69 females) diagnosed with papillary thyroid cancer and regional lymph node metastases at the time of diagnosis were included. Patients were categorized into four groups based on tumor localization: group 1 (right lobe), group 2 (left lobe), group 3 (isthmus), and group 4 (bilobar involvement). Tumor localization and cervical lymph node metastases (levels I-VII) were evaluated based on postoperative pathology, preoperative ultrasonography, and contrast-enhanced computed tomography (CT) findings. Fine-needle aspiration cytology (FNAC) was performed for suspicious lymph nodes. There was no difference between the groups in terms of tumor sizes. A statistically significant difference was found between ipsilateral metastases of the tumors in the lobes (p < 0.001). No significant difference was found between the metastasis rates to the central region lymph nodes among groups. The metastases to the right cervical level III of the tumors located in the upper half of the right lobe were significantly higher than the other regions. Preoperative regional lymph node staging in thyroid carcinoma is crucial for determining the extent of surgery. Our study supports applying more selective lymph node dissection, especially for the central and ipsilateral cervical region. The risk of contralateral cervical metastasis is low for routine comprehensive surgery.
Treatment outcomes for rectal cancer have improved significantly over the last few decades. Concerns regarding the morbidity of treatment have led to nuances like total neoadjuvant therapy and nonoperative management. The primary objective was to determine the predictive factors associated with pathological complete response in locally advanced carcinoma rectum undergoing neoadjuvant chemoradiation. The secondary objectives were to estimate the incidence of pCR and cCR in the study population, and to determine the concordance rate of cCR with pCR. We included 84 patients diagnosed with nonmetastatic rectal cancer who underwent neoadjuvant long-course chemoradiation (CTRT) and radical surgery during September 2018 to March 2020 at the institute. The clinicopathological and treatment details were collected. Rates of clinical (cCR) and pathological complete response (pCR) were analyzed and compared with baseline and histopathological characteristics. Of 84 patients who underwent radical surgery following CTRT, 23 (27.4%) and 16 (19%) had cCR and pCR, respectively. Mean duration for completion of CTRT and interval to surgery were 35.33 days and 57.86 days, respectively. The majority were stage 3 (96.4%), low-middle rectal (95.4%), and moderately differentiated (69%) cancers. Even though cCR was a significant predictor of pCR (p = .01), the rate of non pCR in the cCR group was 43.5% while 4.9% of the non cCR had pCR in the postoperative pathological specimen. Pre-treatment CEA level and neutrophil: lymphocyte ratio, differentiation of tumor, tumor infiltrating lymphocyte response were found to have a statistical significant association with pCR. The rate of cCR and pCR was 27.4% and 19% respectively in our population. The tumor location, T4 and N2 stages, in contrary to the existing literature, do not predict a pCR. With the low rate of pCR and significant discordance between cCR and pCR, stringent selection strategies are mandatory before contemplating a nonoperative management.
Oesophageal cancer (EC) is extremely aggressive in nature. Despite intensive multimodality treatment, survival is poor at the expense of high treatment-related morbidity. Meghalaya has the highest incidence of EC in India. Outcome of treatment for EC is dismal, and the compliance to the treatment is very low. This study strives to look for the compliance of patients to multimodality treatment at a tertiary hospital in Northeast India. This is an analysis of a prospectively maintained database (Ethics Committee approved) of all patients diagnosed with EC and advised management by the Multidisciplinary Team (MDT) at a tertiary health care centre at North East India between 31st January, 2023 and 31st December, 2024. The socio demographic, clinical, and treatment related details were recorded. The compliance to the treatment plan was assessed, with changes in the final treatment noted. Descriptive and analytical statistics were used. A total of 106 patients with EC were planned for curative (69.8%) and palliative (30.2%) treatment. The commonest ethnic background was Khasi-Jaintia tribe (88.6%%). Only 20.0% (12) of the patients who were advised neoadjuvant chemotherapy-surgery (NACT-Sx) or neoadjuvant chemoradiation-surgery (NACTRT-Sx) were able to complete the planned treatment. It was seen that 41(55.4%) patients receiving curative management were noncompliant. Patients belonging to urban region has higher odds of adherence to NACT-Sx [OR (95% CI): 1.400 (0.342-5.734)], NACTRT-Sx [OR (95% CI): 1.200 (0.304-4.743)], chemoradiation [OR (95% CI): 1.112 (0.983-1.842)], and palliative therapy [OR (95% CI): 1.015 (0.971-1.984)] than rural region. Compliance to multimodality treatment of EC at the study centre is poor. Further studies are recommended to find out the reason of low compliance to multimodality treatment.
This study aimed to evaluate the outcomes of pelvic exenteration (PE) in patients with recurrent or persistent cervical cancer, with emphasis on whether modern advancements-timely diagnosis, surgical refinement, and multidisciplinary perioperative care-have addressed traditional concerns regarding morbidity, quality of life, and survival. This was a retrospective study conducted at a tertiary cancer center from January 2021 to December 2023. In total, 25 patients who underwent PE for recurrent (60%) or persistent (40%) cervical cancer were included. All patients were evaluated with PET-CT and pelvic MRI for operability. Tissue diagnosis was confirmed using TRUS, TVS, EUA, or cystoscopic biopsy. Surgical outcomes, complications, margin status, survivals, and quality of life were assessed using EORTC QLQ-C30 and Stoma-QOL tools. Median age was 58 years. Total PE was performed in 56%, anterior in 40%, and posterior in 4%; 28% were robotic. R0 resection was achieved in 100%. Major complications occurred in 8%, with no perioperative mortality. Mean operative time was 6.4 h and mean blood loss was 650 ml. At a median follow-up of 18.5 months, 76% of patients were alive and 72% were disease free. Median DFS and OS were 18.5 months. QoL improved significantly over time, with global health scores increasing from 69.5 to 80.8, and stoma-related QoL indices from 77.7 to 83.3%. With modern advances, PE offers a curative option with acceptable morbidity and improved quality of life. It should be actively considered in eligible patients rather than deferred in favor of palliative systemic therapies.
Increased microvessel density (MVD) can be associated with tumor progression and poor prognosis in epithelial ovarian tumors. This study investigated the association of MVD with subtypes and staging of epithelial ovarian tumors. This cohort study reviewed the medical profiles of 121 patients with epithelial ovarian tumors (98 malignant and 23 borderline) referred to Imam Hossein Hospital, affiliated with Shahid Beheshti University of Medical Sciences, between 2019 and 2024. The World Health Organization (WHO 2020) classification of tumors was used to assess histological subtypes. Immunohistochemically staining was performed with anti-cluster of differentiation (CD31) antibody. The analySIS program was used to examine the images to assess MVD (vessels/mm2). Multivariate analysis was used to assess the association of MVD with tumor type, subtypes, and tumor stage. Based on histological findings, 75 (62%) were serous type, 17 (14%) endometrioid, 27 (22.3%) mucinous type, and 2 (1.7%) clear cell. In terms of histological grade, 53 (54.1) were high grade, and 45 (45.9%) were low grade. Multivariate analysis showed that MVD was significantly associated with malignant tumor type (ORadjusted 1.61; 95% CI 1.11, 2.12; P 0.001), endometrioid tumor subtype versus serous and mucinous subtype (ORadjusted 1.46; 95% CI 1.05, 1.87; P 0.009), and tumor stage > II (ORadjusted 2.01; 95% CI 1.09, 2.93; P 0.004). Our study showed that higher MVD was associated with the malignant type of tumor. The median MVD was higher in the endometrioid subtype than in the serous subtype.
Cervical cancer is one of the most common gynecological malignancies worldwide. Tumor angiogenesis is a hallmark of cancer, and vascular endothelial growth factor (VEGF) is a potent angiogenic marker. Targeted therapy against VEGF in cervical carcinoma has been found to be effective and prompted us to explore other markers having a role in angiogenesis. B7-H3, an immune checkpoint molecule, is known to promote tumor progression and angiogenesis. However, the relationship between B7-H3 and angiogenesis in cervical carcinoma remains unclear. Hence, we planned to evaluate and compare the immunohistochemical expression of B7-H3 and VEGF in cervical squamous cell carcinoma. This was a retrospective study conducted on 30 histologically diagnosed cervical squamous cell carcinoma cases. Immunohistochemistry for B7-H3 and VEGF was performed in all cases. The H-score for both markers was calculated by multiplying the intensity score with the percentage cell positivity. Data was analyzed using SPSS v 20.0 software. B7-H3 and vascular endothelial growth factor immunopositivity were found in 90% and 96.6% of cervical squamous cell carcinoma cases, respectively. A statistically significant positive correlation was obtained between the H-score of B7-H3 and VEGF (p = 0.000; τ = 0.601). However, the immunoexpression of B7-H3/VEGF had no statistically significant correlation with age, tumor grade, pathological tumor stage, and lymph node metastasis. In view of the immunoregulatory role of B7-H3 and its role in tumor angiogenesis, B7-H3-based targeted therapy might prove to be of utility for treatments and better prognostic outcomes in cervical squamous cell carcinomas.
Oral squamous cell carcinoma (OSCC) is one of the most prevalent cancers in India. Significant research over the last 10 years has revealed that the inflammatory tumour microenvironment is crucial to the development of OSCC. Macrophages account for 30-50% with subtypes M1 and M2, hence called as tumour-associated macrophages (TAMs). It was a laboratory-based observational study conducted on 88 histologically proven cases of OSCC to determine the immunohistochemical expression of TAMs and to find its association with lymph node metastasis and TNM staging. Screening for lymph node metastasis, grading and TNM staging were done according to the new AJCC staging criteria followed by immunohistochemical staining of the same using CD68 and CD163. The mean age observed was 48.5 years with a female preponderance. Strong cytoplasmic positivity for CD68 was noted in 21.5% of cases whereas strong membranous positivity for CD163 was noted in 70% of cases. 43.18% of cases had nodal involvement. 5.6%, 17%, 34% and 43.4% of cases belonged to TNM stages I, II, III and IV respectively. CD68 positivity score was higher in node negative cases. Increased CD163 TAMs score was linked to lymph node positivity (p = 0.003) and higher TNM stages (p = 0.014). When assessing OSCC, the important role of the tumour microenvironment must be taken into account. TAMs show promise as a marker for tumour aggressiveness and as possible targets for immunotherapy.
According to GLOBOCAN 2022 estimates, lung cancer is the leading cause of cancer morbidity and mortality in 2022. 5 year survival rate is dismal for the disease, despite advances in therapeutic modalities. Current research into lung cancer therapy is largely focused on molecular advancements. Our study was focused on finding association between the HLA expression in lung carcinoma patients, in northern region of India. It contributes data for basic molecular understanding of pathogenesis in lung cancer patients. This study was conducted in the Department of Pathology and Department of Pulmonary critical care and sleep medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi. A total of 35 lung cancer cases and 35 healthy controls were taken over a period of 18 months and results were compared. In our study the mean age of presentation for lung carcinoma patients was 52.29 years HLA-A11 (p value = 0.028) and HLA-B51 (p value = 0.035), were under expressed in the patients as compared to control group, and HLA-DRB1*15 (p value = 0.037) was over expressed in the patients as compared to control group. However, no statistically significant result was seen in co-relation to the clinical staging. The results of this small sample study provide data for a completely new population and might help to guide in understanding the role of HLA in lung carcinoma patients for future studies.
With increasing use of neoadjuvant chemotherapy (NAC) in breast cancer, it is important to standardize the assessment of tumor response to systemic therapy by pathologists. The Residual Cancer Burden (RCB) quantifies residual disease after NAC. In a series of 185 patients treated by NAC, we assessed the prognostic value of the Residual Cancer Burden (RCB) index. We analyzed the association between RCB index and disease-free survival (DFS), after stratification by BC subtypes. One hundred eighty-five. patients were included (luminal (n = 65, 35.1%), TNBC (n = 75, 40.5%), HER2-positive (n = 45, 24.32%)). After a median follow-up of 49.6 months (9.2-72 months), 23 patients experienced relapse in our study. Among 112 patients with residual disease, RCB index repartition was as follows: RCB-I: n = 23 (12.4%), RCB-II: n = 72 (39.5%), and RCB-III: n = 17 (9.1%). Among pre-NAC parameters, RCB class was not significantly different apart from hormone and HER2 receptor status (p < 0.001). Higher RCB class was significantly correlated with the presence of nodal involvement (p < 0.001). Increasing RCB was associated with an increased risk of relapse. Five-year disease-free survival was good in the RCB-0 and RCB-I groups (58.4 months (95% C.I [56.9-60.4]) and 58 months (95% C.I [56.6-61.0]) respectively)), whereas the prognosis was intermediate in RCB-II patients 54 months (95% C.I [52.0-57.6]) and poor in RCB-III patients 47 months (95% C.I [39.5-54.7])). RCB index displays high prognostic performances to stratify survival outcome of patients. Based on the RCB score, you can accurately identify high-risk patients and calibrate further adjuvant therapy and individualize follow-up strategies. The study demonstrated the simplicity and ease of reciprocation of RCB measurement and supports incorporating it within standardized pathology reporting guidelines.
Despite implementation of the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD), screening coverage for oral, breast and cervical cancers remains below 2%. Screening quality is inadequately addressed and delays in diagnosis and treatment initiation continue to persist. This multisite implementation research aims to improve district-level coverage and quality of screening, early diagnosis and timeliness of treatment initiation through a model co-developed within the NP-NCD context. The study will be conducted in three phases across seven districts in diverse regions of India. In phase I (formative), the current status, barriers and facilitators of cancer screening, diagnosis and treatment initiation under NP-NCD will be assessed. In phase II (optimisation), a model (package of implementation strategies) will be co-developed and iteratively optimised with multistakeholder engagement at the subdistrict level to improve screening coverage and quality and strengthen the referral system for early diagnosis and treatment initiation. In phase III (scale-up and evaluation), the model will be implemented at the district level and evaluated for improvements in screening, early diagnosis and treatment initiation. A convergent mixed-methods design will be used, incorporating household surveys, facility assessments and stakeholder interviews. Implementation Research Logic Model will guide planning, execution and evaluation in the present study. Determinants of screening coverage and quality, early diagnosis and treatment initiation will be assessed using the Consolidated Framework for Implementation Research. Implementation strategies for the model will be finalised using the Expert Recommendations for Implementing Change framework. Implementation and service outcomes will be evaluated using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework. Ethical approval has been obtained from all study sites. The study findings will be disseminated at the state, national and global levels through meetings and conferences and submitted to a peer-reviewed journal for publication. CTRI/2025/08/092672.