Objective Our prospective study aims to define the correlation of EGFR(epidermal growth factor receptor) mutations with major histological subtypes of lung adenocarcinoma from resected and non-resected specimens, according to the WHO 2015 classification, in Moroccan North East Population. Methods Epidermal growth factor receptor mutations of 150 primary lung adenocarcinoma were performed using Real-Time PCR or SANGER sequencing. SPSS 21 was used to assess the relationship between histological subtypes of lung adenocarcinoma and EGFR mutation status. Results 25 mutations were detected in the series of 150 lung adenocarcinomas, most of which were found in cases with papillary, acinar, patterns than without these patterns and more frequently occurred in the cases without solid pattern than with this pattern. A significant correlation was observed between EGFR mutation and acinar (P = 0,024), papillary pattern (P = 0,003) and, negative association with a solid pattern (P < 0,001). In females, EGFR mutations were significantly correlated with the acinar pattern (P = 0,02), whereas in males with the papillary pattern (P = 0,01). Association between the histologic component and exon 19 deletions and exon 21 mutations were also evaluated and, we found a significant correlation between the papillary major pattern with exon 19 mutations (P = 0,004) and, ex21 with the acinar component (P = 0,03). Conclusion An analysis of resected and non-resected lung ADC specimens in 150 Moroccan Northeast patients, revealed that acinar and papillary patterns may predict the presence of a mutation in the EGFR gene. While the solid major pattern may indicate a low mutation rate of the EGFR gene.
Breast cancer is a serious worldwide public health problem and is currently the most common cancer overall. Its endocrine therapy is related to the expression of the steroid hormones, estrogen receptor (ER), and progesterone receptor (PR). Breast cancers can be presented under multiple profiles of steroid hormones: ER(−)/PR(+), ER(+)/PR(−), double-positive/negative ER, and PR. 2–8% of all breast cancers express only PR (ER−/PR+) which is an abnormal phenotype, with less known about their behaviors and outcomes. Our study was performed on a large and well-characterized database of primary breast cancer from 2012 to 2019, up to 1159 cases. These cases were divided according to ER and PR expression, as we put all of our focus on ER-negative/PR-positive group, more specifically ER−/PR+/HER2+ and ER−/PR+/HER2− gene expressions, to highlight their features and find a pattern that links HR (hormone receptors) profiles and breast cancer subtypes. Out of the informative cases, 94 patients (8%) had ER−/PR+ breast cancers, while 676 (58.4%) had ER+/PR+, 88 (7.6%) had ER+/PR−, and 164 (14.2%) had ER−/PR− tumors. The ER−/PR+ group was statistically correlated with a high risk of recurrence and death in midway between the double-negative and double-positive HR. According to HER2 status, a low DFS was observed in patients ER−/PR+/HER2−, which is closer to the DFS of TNBC cases but worse than ER+/PR any. On the other side, the ER−/PR+/HER2+ showed also a poorer DFS closer to the HER2+ subgroup in between TNBC and ER+/PR any. The clinicopathological features of the ER−/PR+/HER2− and ER−/PR+ HER2+ have distinguished the patients into two groups with a difference in some clinicopathological characteristics: both groups had closer OS estimation, which was worse than ER−/PR any and better than TNBC and HER2. The ER−/PR+/HER2− seems to increase the risk of recurrence than ER−/PR+/HER2+ when compared to ER+/PR any. On the other hand, the ER−/PR+/HER2+ seems to increase the risk of death more than ER−/PR+/HER2− in comparison with ER+/PR any. Our results support that ER−/PR+ tumors really exist and are rare and clinically and biologically distinct subtypes of breast cancer. In addition, our analysis, which was based on dividing the groups according to HER2 expression, has revealed the existence of two distinct groups; this gave the ER−/PR+ subgroup a heterogeneity characterization. Moreover, this breast cancer subtype should not be treated as a luminal tumor but rather according to the HER2 expression status.
Background: Breast cancer is a major public health problem worldwide. It's the most common cause of death from cancer in women, it considers a heterogeneous disease, shows variable morphological and biological features, they have different clinical behavior, and prognoses, and respond to therapy differently despite similarities in histological types, grade, and stage. The classication aims for an accurate diagnosis and prediction of behavior, however, histological classication isn't enough in this era of personalized medicine, this results in « overtreatment » of many patients, so, molecular proling allows tumors to be dened by the expression pattern or genomic alteration of thousands of genes. A Methods: retrospective, descriptive and analytic study was performed among 1040 women with invasive breast carcinoma, which was diagnosed in the department of surgical pathology at University Hospital Center of Hassan 2 of Fez in Morocco, during a period ranging from 2012 to 2019. The prevalence of different molecular subtypes of breast carcinoma was estimated, in addition, clinicopathological features such as age, tumor size, tumor grade, lymph node involvement, hormonal receptors prole, and HER2 status have been compared. The mean age of diagnosis was Results: 49.5 years (DS12,5 years, 17-88 years), among these, 637 (55%) were under 50 years. NOS invasive breast carcinoma was the histological type the most common in 1030 (89%), with an SBR II in 60% of cases. The Mean tumor size was 2.8cm. Axillary lymph nodes (LN) were metastatic in 60% of cases. 76% of cases showed positive staining for estrogen receptors, 75,5% for progesterone receptors, and 18,5% for HER2/neu. Luminal A subtype was found in 22% of patients while Luminal B was present in 62,5% of patients, HER2 enriched in 5%, and triple-negative (TN) in 10,5 % of cases. There is signicant difference between the 4 subclasses by age (P=0.02), SBR grading (p<0,0001), tumor size (p=0,05), lymph node metastasis (0,0001). There are more young women in HER2 enriched and luminal B subtypes than in luminal A and TN subtypes, while the rate of older women is increased in luminal A subtypes. The proportion of patients with histological grade III in the TN subtype and HER2 subtype, is signicantly increased (P<0.0001) while grade I is signicantly increased in the luminal A subtype. LN metastasis in the luminal B and Her2 cancers are more signicant than in luminal A and TN. Disease-free survival (DFS) among older women above 50 years is signicantly greater among young women under 40 years ( p=0,021). Regarding SBR grading, and DFS, we found that survival was signicantly highest for patients with grade I, followed by those with grade II and then grade III (P<0.0001). According to molecular subtypes, we noted that DFS was signicantly highest for patients with luminal-A subtype, followed by those with luminal B subtype, then HER2 and TN cancers (P<0.0001). The Conclusion: present study shows the particularities of women breast carcinoma in our countryo, through our results, we found that BC is diagnosed at a younger age, a decade earlier than in developed countries, and we found a predominance of luminal B subtype in contrary with others studies suggesting that there are clinico-biological differences, as well as disparities in the expression proling in our population. This highlights the importance of early screening and the need to improve women's awareness of breast cancer in our region and additional research is needed to understand these results in hopes of adopting more effective therapies.
The aim of our study was to assess the overall survival rates for colorectal patients in Morocco and to identify strong prognostic factors using a novel approach combining survival random forest and the Cox model. Covariate selection was performed using the variable importance based on permutation and partial dependence plots were displayed to explore in depth the relationship between the estimated partial effect of a given predictor and survival rates. The predictive performance was measured by two metrics, the Concordance Index (C-index) and the Brier Score (BS). Overall survival rates at 1, 2 and 3 years were, respectively, 87% (SE = 0.02; CI-95% = 0.84–0.91), 77% (SE = 0.02; CI-95% = 0.73–0.82) and 60% (SE = 0.03; CI-95% = 0.54–0.66). In the Cox model after adjustment for all covariates, sex, tumor differentiation had no significant effect on prognosis, but rather tumor site had a significant effect. The variable importance obtained from RSF strengthens that surgery, stage, insurance, residency, and age were the most important prognostic factors. The discriminative capacity of the Cox PH and RSF was, respectively, 0.771 and 0.798 for the C-index, while the accuracy of the Cox PH and RSF was, respectively, 0.257 and 0.207 for the Brier Score. This shows that RSF had both better discriminative capacity and predictive accuracy. Our results show that patients who are older than 70, living in rural areas, without health insurance, at a distant stage and who have not had surgery constitute a subgroup of patients with poor prognosis.
Background Moroccan incidence of cancer is increasing with the lengthening of life expectancy. Data regarding elderly Moroccan cancer patients are lacking. In the context of our project aiming to develop an adapted version of the Comprehensive Geriatric Assessment CGA to the Moroccan population, we launched the first Moroccan multicenter transverse study to explore the characteristics of elderly Moroccan cancer patients.Methods The study was conducted in nine Moroccan medical oncology departments. Patients were enrolled over 4 months. Inclusion criteria were patients aged 65 years or over with verified solid cancer. The questionnaire included four sections: socio-demographic and economic data, clinical data, vulnerability and EORTC-QLQ C30. We explored the entire included population. Then, we compared the results according to age (65–70 years old and ≥ 71 years old) and sex. We also explored the correlation between G8 scores and the ability to practice religion as an indicator of fitness level.Results In total, 164 patients were enrolled. The mean age was 73.18 ± 6.01 years. The majority of patients were married, lived with their children and received their financial income from them. Fifteen percent of families asked to hide the diagnosis from the patient. Breast (23%), colorectal (15.9%) and lung (14%) cancers were the most frequent, and 83.5% had an abnormal G8. The majority of the patients were independent for basic daily activities. Female patients had poorer social and economic conditions. Abnormal G8 was correlated with religious practice and quality of life scores.Conclusion This is the first multicenter prospective study designed to collect data on the lifestyle and clinical profiles of elderly Moroccan cancer patients as an Arab and Muslim population. Our study shows that it is a well-cared-for population with strong social ties. However, there is deep economic vulnerability, especially among women, requiring urgent care. Religious practice is an important daily activity for our elderly patients and should be included in the Moroccan CGA.
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