The number of genes suggested to play a role in cancer biology is rapidly increasing. To be able to test a large number of molecular parameters in sufficiently large series of primary tumours, a tissue microarray (TMA) approach has been developed where samples from up to 1000 tumours can be simultaneously analysed on one glass slide. Because of the small size of the individual arrayed tissue samples (diameter 0.6 mm), the question arises of whether these specimens are representative of their donor tumours. To investigate how representative are the results obtained on TMAs, a set of 2317 bladder tumours that had been previously analysed for histological grade and Ki67 labelling index (LI) was used to construct four replica TMAs from different areas of each tumour. Clinical follow-up information was available from 1092 patients. The histological grade and the Ki67 LI were determined for every arrayed tumour sample (4x2317 analyses each). Despite discrepancies in individual cases, the grade and Ki67 information obtained on minute arrayed samples were highly similar to the data obtained on large sections (p<0.0001). Most importantly, every individual association between grade or Ki67 LI and tumour stage or prognosis (recurrence, progression, tumour-specific survival) that was observed in large section analysis could be fully reproduced on all four replica TMAs. These results show that intra-tumour heterogeneity does not significantly affect the ability to detect clinico-pathological correlations on TMAs, probably because of the large number of tumours that can be included in TMA studies. TMAs are a powerful tool for rapid identification of the biological or clinical significance of molecular alterations in bladder cancer and other tumour types.
Children, adolescent and young adult (CAYA) males with cancer are at an increased risk for infertility, if their treatment adversely impacts reproductive organ function. Future fertility is a primary concern of patients and their families. Variations in clinical practice are barriers to the timely implementation of fertility preserving interventions. The PanCareLIFE consortium in collaboration with the International Late Effects of Childhood Cancer Guideline Harmonization Group (IGHG) reviewed the current literature and developed a clinical practice guideline (CPG) for fertility preservation in male CAYA cancer patients diagnosed before age 25 years, including guidance on risk assessment and available fertility preservation methods. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to grade the evidence and recommendations. Recognizing the need for global consensus, this CPG used existing evidence and international expertise to develop transparent, easy-touse and rigorously-developed recommendations that can facilitate the care of CAYA males with cancer at risk of fertility impairment and enhance their quality of life.
Parents of long-term CCS reported lower household income and higher risk-of-poverty than control parents. Support strategies may be developed to mitigate parents' risk-of-poverty in the long term, particularly among parents with lower education.
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