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Background Reports have described the prognostic relevance of microRNAs (miRNAs) in patients treated for pancreatic ductal adenocarcinoma (PDAC). However, many of these include small numbers of patients. To increase statistical power and improve translation, we performed a systematic review and meta-analysis to determine a pooled conclusion. We examined the impact of miRNAs on overall survival (OS) and disease-free survival (DFS) in PDAC. Methods Eligible studies were identified and quality assessed using multiple search strategies (last search December 2014). Data were collected from studies correlating clinical outcomes with dysregulated tumoural or blood miRNAs. Studies were pooled, and combined hazard ratios (HRs) with 95% confidence intervals (CIs) were used to estimate strength of the associations. Results Twenty studies involving 1525 patients treated for PDAC were included. After correcting for publication bias, OS was significantly shortened in patients with high tumoural miR-21 (adjusted HR = 2.48; 1.96–3.14). This result persisted when only studies adjusting for adjuvant chemotherapy were combined (adjusted HR = 2.72; 1.91–3.89). High miR-21 also predicted reduced DFS (adjusted HR = 3.08; 1.78–5.33). Similarly, we found significant adjusted HRs for poor OS for high miR-155, high miR-203, and low miR-34a; and unadjusted HRs for high miR-222 and high miR-10b. The small number of studies, limited number of miRNAs and paucity of multivariate analyses are the limitations of our study. Conclusions This is the first rigorous pooled analysis assessing miRNAs as prognostic biomarkers in PDAC. Tumoural miR-21 overexpression emerged as an important predictor of poor prognosis after PDAC resection independent of other clinicopathologic factors, including adjuvant chemotherapy use. [ABSTRACT FROM AUTHOR]

Abstract: Background and objectives: Since the introduction of highly active antiretroviral therapy (HAART), non-AIDS defining malignancies including colorectal cancer (CRC) have emerged as major health concerns for people living with HIV. Methods: From a prospective database of 11,112 HIV seropositive individuals, we identified 11 patients with CRC. Clinicopathological details on the presentation, treatment and outcomes were collected. Results: All were male with a median age of 50years (range 36–67) and median duration of HIV infection of 7.2years (range 0–21). Five had metastatic disease at presentation, including 1 patient with a small cell cancer of the rectum. Patients were treated along conventional lines for CRC with concomitant HAART and opportunistic infection prophylaxis. During treatment, median CD4 cell counts fell from 357/mm3 at CRC diagnosis to 199/mm3, although no opportunistic infections were recorded. Three patients have died and the 5-year overall survival measured 65% (95% confidence interval 32–98%). Conclusions: Treatment for CRC reduces cellular immunity and potentially puts HIV patients at risk of opportunistic infections; knowledge of HIV status prior to starting treatment is essential. This risk may be reduced by concomitant HAART and prophylaxis. Clinicians managing CRC should consider screening patients for HIV before starting chemotherapy or radiotherapy. [Copyright &y& Elsevier]

Abstract: Background: Peritoneal metastases are now a significant cause of morbidity and mortality in patients with advanced breast cancer. There are few published data regarding the prognosis, clinical characteristics and management of individuals with peritoneal metastases from breast cancer. Methods: The electronic database at Imperial College Healthcare NHS Trust (Charing Cross Hospital) was searched for the terms ‘breast’, ‘cancer’ or ‘tumour’, ‘peritoneal’ and ‘ascites’ from 2000 to 2008. Those with confirmed peritoneal disease from breast cancer, as described on ultrasound or staging CT reports with a clinico-pathologic confirmed diagnosis, were included. Results: A total of 1628 patients were screened and initially 168 patients were identified. A subsequent total of 44 individuals (2.7% of the cohort) were defined as having breast cancer with peritoneal secondaries and were included in the analysis. Of these, the majority (77%) had invasive ductal carcinomas (IDCs). While the median survival from the diagnosis of metastatic breast cancer measured 20.5 months (range 0.1–125 months), the median survival of patients with peritoneal disease was 1.56 months (range 0.2–27 months). Conclusions: These data demonstrate that the median survival of patients with peritoneal breast cancer metastasis is surprisingly poor, with only a minority surviving more than 6 months. A specific association with invasive lobular carcinoma (ILC) was not observed. The dismal outcome of these individuals, despite further active therapy, merits their inclusion into clinical trials designed specifically for this group of patients. [Copyright &y& Elsevier]

Abstract: Background: Percutaneous vertebroplasty appears beneficial for patients with acute compression fractures of multiple aetiologies including myeloma, osteoporosis and trauma. There are few reports on its use in the setting of metastatic solid malignancy. Methods: We identified all individuals who had undergone percutaneous vertebroplasty at our institution since 2004 and focused on those with metastatic solid malignancies. Their clinical characteristics and outcomes were investigated. Results: From 136 cases that underwent percutaneous vertebroplasties, 19 were performed mainly in breast, prostate, lung and renal cancers. Of these 19 cases, 10 patients (53%) were treated for solitary lesions, 3 (16%) were injected at two levels and the remaining 6 cases (31%) underwent cement injection at three levels. The majority of individuals (84%) reported short- and long-term symptomatic improvements. At a median follow-up of one year, six patients have died. Conclusions: Percutaneous vertebroplasty appears as an effective palliative procedure in patients with compression fractures secondary to metastatic solid malignancy. Its use can be successfully combined with other treatment modalities (radiotherapy and chemotherapy). [Copyright &y& Elsevier]