Level 1 evidence supports use of neoadjuvant platinum chemotherapy (NAC) for muscle invasive bladder cancer, but little is known about prospective efficacy and safety of NAC in HG UTUC. This multisite phase II trial investigated NAC prior to nephroureterectomy and lymph node dissection (NU).METHODS: Patients (pts) with HG UTUC planned for NU were eligible, with treatment arm of 4 NAC cycles assigned by baseline creatinine clearance (CrCl), CrCl >50 received accelerated (a)MVAC (methotrexate 30 mg/m2, vinblastine 3 mg/m2, doxorubicin 30 mg/m2, cisplatin 70 mg/m2 with pegfilgrastim q14 days). CrCl !30 and 50 received carboplatin AUC 5 D1 and gemcitabine 1000 mg/m2 days 1, 8 (GC). Primary endpoint was pathologic complete response (pCR) rate (ypT0N0). On each arm, a pCR rate of 18% was of interest vs. a null of 4%. Success was defined as at least 3 pCRs among 28 pts (10.7%). Accrual goal was 30 pts per arm.RESULTS: From April 2015-May 2017, 30 patients were enrolled to the aMVAC cohort. Six enrolled to the GC cohort which closed for poor accrual in January 2018. On aMVAC arm 1 pt had renal cell ca. 3/29 eligible pts (23 M 6F), median age 65(40-84), median PS 0, achieved ypT0N0 at NU (10.3%, 90% CI [2.9 e 24.6]). Including pt with clinical CR on preoperative imaging without lymph node dissection at NU (ypT0Nx), the pCR rate was 4/29 (14%, 90% CI [4.9 e 28.8]), (table). The median number of chemotherapy cycles was 4 (1-4), 79% of patients completed treatment. One pt on aMVAC arm with cycle 1 Gr4 sepsis deferred further NAC and NU. Grade 3-4 toxicity rate was 23% on aMVAC arm, no G5 events.CONCLUSIONS: aMVAC NAC demonstrated pre-defined activity with 14% pCR, above null 4%, with no new safety concerns in pts with HG UTUC and CrCl >50. Rate of ypT1 over 60% may be of clinical interest. Slow accrual in the CrCl 50 arm suggests novel trials are warranted. A follow up immunotherapy-chemotherapy combination trial in UTUC is planned through ECOG-ACRIN.
IntroductionSince patients with type 2 diabetes are frequently misdiagnosed, provided inappropriate management, or poorly controlled, it is important to comprehend the wide range of clinical signs and symptoms associated with diabetes. Therefore, this study evaluated the overall clinical manifestations of patients with type 2 diabetes patients with respect to gender.
MethodsThis was a multicenter, cross-sectional study that was conducted at various hospitals, using a nonprobability sampling technique. The duration of the study was about six months, from January 1, 2022 to June 30, 2022. The study included 590 type 2 diabetes patients, ranging in age from 35 to 70 years. Age, gender, socioeconomic status, health status, co-morbidities, and diabetes symptoms were documented. A chi-square was applied to determine the association between overall symptoms associated with type 2 diabetes and gender. An independent t-test was applied to determine the significance level between means of demographic parameters.
ResultsThe study findings showed that out of 590 patients with diabetes, 310 (52.5%) were males and 280 (47.5%) were females. The male and female mean ages were 57.46±14.93 and 50.38±14.85 years, respectively, with a statistically significant gender difference (p<0.001). The prevalence of renal manifestation in type 2 patients with diabetes revealed a significant relationship (p<0.05) for both genders. The prevalence of ocular manifestations revealed a significant relationship with both genders (p<0.05) in terms of distortion and blurred vision. The prevalence of ocular manifestations revealed a significant relationship observed with both genders (p<0.05) in terms of shortness of breath, dyspnea severity, and severity of chest pain.
ConclusionThis study concluded that women with type 2 diabetes mellitus have a significantly higher frequency of muscular pain, urinary symptoms, neurological symptoms, and dermatological manifestations than men. In contrast, respiratory symptoms were significantly more pronounced in males than in females. The presence of comorbidities such as dyslipidemia significantly increased the probability of developing type 2 diabetes in both genders.
Objective
To estimate whether flow cytometric indices provide independent measures of prognosis or predict response to prophylactic progestogens in endometrial cancer.
Design
Endometrial tumour specimens were retrieved and analysed by flow cytometry from 257 women who had been randomly allocated in a previous trial to receive prophylactic progestogen in addition to conventional therapy for endometrial carcinoma.
Setting
Fourteen district and two teaching hospitals in West Yorkshire.
Subjects
Women developing primary endometrial cancer between 1975 and 1983.
Main outcome measures
Tumour ploidy status and proliferative indices and the relation of these to tumour stage and grade, to prognosis and to response to progestogens.
Results
Ploidy status and proliferative indices were related to tumour stage, grade and patient survival but were not independent predictors of survival. They did not predict patients who would respond to progestogens although there was a nonsignificant trend towards patients with diploid tumours surviving longer after progestogen treatment.
Conclusions
Flow cytometry adds little to established prognostic indicators for endometrial cancer.
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