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  1. Win TT, Razy N, Hamid S, Ubramanian AB, Ramalinggam G
    Turk Patoloji Derg, 2014;30(3):220-4.
    PMID: 24715558 DOI: 10.5146/tjpath.2013.01220
    Teratoma of the neck is a rare extra-gonadal teratoma. Although it can be seen in adult, most of the cases present in fetal life or early childhood. Grading and classification of teratoma is important for management and prognosis. Decision making between mature and immature teratoma is sometime challenging if it is not composed of extensive unusual neuroectodermal tissue component. We reported a rare case of huge congenital mature cystic teratoma composted of various neuroectodermal tissues in an 8-month-old boy; it was located at the lateral neck and mimicked congenital cystic hygroma. A literature review was done to grade and classify the tumour.
  2. Win TT, Sitiasma H, Zeehaida M
    Trop Biomed, 2011 Apr;28(1):64-7.
    PMID: 21602770
    Infections and mTalignancies are common causes of pleural effusion. Among infectious causes, hyperinfection syndrome of Strongyloides stercoralis may occur in immunosuppressive patient. A 62-year-old man, known case of Non-Hodgkin lymphoma (NHL) was presented with recurrent NHL stage IV and had undergone salvage chemotherapy. Patient subsequently developed pneumonia with bilateral pleural effusion and ascites. We reported rhabditiform larvae of S. stercoralis in pleural fluid of both lungs without infiltration by lymphoma cells. Stool for microscopic examination also revealed rhabditiform larvae of S. stercoralis. This patient was a known case of NHL receiving chemotherapy resulting in immunosuppression state. Although S. stercoralis infection is not very common compared to other parasitic infections, it is common in immunosuppressive patients and may present with hyperinfection. Therefore, awareness of this parasite should be kept in mind in immunosuppressive patients.
  3. Abdul Hafidz MI, Zulkifli KK, Win TT, Mat Zin AA, Mustaffa N
    Med J Malaysia, 2021 05;76(3):318-325.
    PMID: 34031329
    INTRODUCTION: Microscopic colitis (MC) is a well-recognised cause of chronic diarrhoea in Western countries. It is classically associated with normal endoscopic findings and a higher prevalence among patients with autoimmune disease. Local information regarding this disease remains scarce. We identified patients diagnosed with MC over a five-year period, and then proceeded to analyse the clinical characteristics of these cases.

    MATERIALS AND METHODS: A retrospective study was conducted by identifying all histologically confirmed colitis cases diagnosed at Hospital Universiti Sains Malaysia from January 2015 until December 2019. Clinicodemographic data was retrieved from case notes of patients.

    RESULTS: Of the 299 cases with histological colitis, 23 (7.7%) were initially identified as MC. Two cases had incomplete data, while two others were excluded as the diagnoses were revised to inflammatory bowel disease. An incidence of 14 MC cases/1000 case-year was obtained using the 21 MC cases seen within the five-year period. MC subtypes for the 19 analysed cases i.e., lymphocytic colitis and collagenous colitis accounted for 13 (68.4%) and 6 (31.6%) cases, respectively. Eleven patients (57.9%) were females (M:F ratio 1:1.5) with a median age of 51 years. Only nine (47.3%) presented with diarrhoea; one subject (5.4%) had an autoimmune condition (Hashimoto thyroiditis). Normal endoscopic findings were found in 89.5% of patients.

    CONCLUSION: Approximately half of the subjects in our study who had histologically confirmed MC did not present with diarrhoea. Adequate biopsy samples despite normal colonoscopy findings are important in order to not miss the diagnosis of MC.

  4. Htet H, Win TT, Wong ST, Shamsudin NH, Kandasami P
    Med J Malaysia, 2023 Sep;78(5):616-620.
    PMID: 37775488
    INTRODUCTION: Gastric cancer (GC) is one of the leading causes of all new cancer cases globally. Although it is no longer reported in the top 10th most common cancer in Malaysia, geographical distribution and ethnic influences still obviously exist.

    MATERIALS AND METHODS: This is a retrospective analysis of histopathological records in a public tertiary health care centre in Malaysia. The computerised laboratory information system from the histopathology department of the hospital was retrieved for the period of 2005-2018. Descriptive analysis was done using Microsoft Excel.

    RESULTS: There was a total of 233 histologically confirmed GC cases. The burden of GC was observed to be an increasing trend from 2016 onwards. Among them, 64% were male and 36% were female. The youngest age of diagnosis was 19, while the oldest one was 93. Malaysian Chinese were found to have the highest incidences (41.63%), followed by Malays (32.19%) and Malaysian Indians (23.61%). All cases were of adenocarcinoma cell types and were found to have poorly differentiated in majority at the time of diagnosis.

    CONCLUSION: Although this report only represents one tertiary health care centre in Malaysia, the Indian Enigma was still observed, as stated in other literatures. Over time, the incidence of GC in Malays has increased. Consideration of lifestyle modifications, health education and Helicobacter pylori eradication in various nations' National Health Insurance plans, are encouraged as prevention is always better than treatment or cure, including the cost load.

  5. Win TT, Kamaludin Z, Husin A
    Malays J Pathol, 2016 Aug;38(2):153-7.
    PMID: 27568673 MyJurnal
    Primary mediastinal large B-cell lymphoma (PMLBL) is an uncommon non-Hodgkin lymphoma with a distinct clinicopathological entity in the WHO classification of lymphoid malignancies. It is known to originate from B-cells of the thymus. It mimics thymic neoplasms and other lymphomas clinically and histopathologically. We reported a 33-year-old obese man who presented with shortness of breath off and on for 4 years. Radiologically, there was a huge anterior mediastinal mass. Tru-cut biopsy was initially diagnosed as type-A thymoma. Histopathological examination of the excised specimen revealed PMLBL with stromal fibrosis and sclerosis which created a diagnostic difficulty. The neoplastic cells varied from medium-sized to large pleomorphic cells, including mononuclear cells with centroblastic and immunoblastic features as well as bi-lobed Reed Sternberg (RS)-like cells and horse-shoe like hallmark cells. Some interlacing spindle cells and epithelioid cells were also present. Immunohistochemically, tumour cells expressed diffuse positivity for LCA, CD20, CD79a, CD23, Bcl2, MUM-1 and heterogenous positivity for CD30 and EMA, and were negative for CD10, CD15 and ALK. Ki67 scoring was very high. Tumour cells infiltrated into peri-thymic fat and pericardium. No malignant cells were detected in the pleural fluid and there was no bone marrow infiltration. The patient showed partial response to 6 cycles of RICE chemotherapy, and was planned for second line chemotherapy using hyper-CVAD regimen followed by autologous stem cell transplantation. This case illustrates the importance of thorough sampling and immunohistochemistry in differentiating PMLBL from its differential diagnoses.
  6. Win TT, Yusuf Y, Jaafar H
    Malays J Med Sci, 2013 Mar;20(2):10-6.
    PMID: 23983572 MyJurnal
    Many studies on the role of apoptosis in cancer development and management have been undertaken. Apoptotic activity depends partly on the balance between anti-apoptotic (Bcl-2) and pro-apoptotic (Bax) activities. This study compared Bcl-2 and Bax expression in the tumour cells and endothelial cells of tumour blood vessels in soft tissue sarcoma, and examined the association of these with tumour characteristics.
  7. Win TT, Jaafar H, Yusuf Y
    South Asian J Cancer, 2014 Jul;3(3):171-4.
    PMID: 25136525 DOI: 10.4103/2278-330X.136799
    Angiogenesis and apoptosis play an essential role in tumor development and progression. Previous studies on apoptosis and angiogenesis of soft-tissue sarcoma (STS) were done separately. This is the first study of the relationship between apoptotic and angiogenic activity. Correlation of expression of anti-apoptotic protein (Bcl-2) and pro-apoptotic protein (Bax) in the tumor cells (TCs) with their expression in endothelial cell (EC) of the tumor blood vessels in STS were also carried out.
  8. Toh YS, Yeoh SL, Yap IKS, Teh CSJ, Win TT, Thong KL, et al.
    Med Microbiol Immunol, 2019 Dec;208(6):793-809.
    PMID: 31263955 DOI: 10.1007/s00430-019-00628-3
    Cholera is an acute diarrheal illness caused by the Gram-negative bacterium Vibrio cholerae. The pathogen is known for its ability to form biofilm that confers protection against harsh environmental condition and as part of the colonisation process during infection. Coaggregation is a process that facilitates the formation of biofilm. In a preliminary in vitro study, high coaggregation index and biofilm production were found between V. cholerae with human commensals namely Escherichia coli and Enterobacter cloacae. Building upon these results, the effects of coaggregation were further evaluated using adult BALB/c mouse model. The animal study showed no significant differences in mortality and fluid accumulation ratio between treatment groups infected with V. cholerae alone and those infected with coaggregation partnership (V. cholerae with E. coli or V. cholerae with E. cloacae). However, mild inflammation was detected in both partnering pairs. Higher density of V. cholerae was recovered from faecal samples of mice co-infected with E. coli and V. cholerae in comparison with other groups at 24 h post-infection. This partnership also elicited slightly higher levels of interleukin-5 (IL-5) and interleukin-10 (IL-10). Nonetheless, the involvement of autoinducer-2 (AI-2) as the signalling molecules in quorum sensing system is not evident in this study. Since E. coli is one of the common commensals, our result may suggest the involvement of commensals in cholera development.
  9. Bo MS, Cheah WL, Lwin S, Moe Nwe T, Win TT, Aung M
    J Nutr Metab, 2018;2018:7027624.
    PMID: 30116641 DOI: 10.1155/2018/7027624
    Background: Atherogenic index of plasma (AIP) was found to be one of the strongest markers in predicting the cardiovascular disease (CVD) risk. This study was to determine the AIP and its relationship with other CVD risk factors.

    Materials and Methods: This cross-sectional study was done among 349 staff of a public university in Sarawak. Data were collected using questionnaire, blood sampling, and anthropometric and blood pressure measurement. Data were analyzed using IBM SPSS version 20.

    Results: A total of 349 respondents participated with majority females (66.8%), aged 38.5 ± 7.82 years. Nearly 80% of the respondents were overweight and obese, 87.1% with high and very high body fat, and 46.9% with abnormal visceral fat. For AIP category, 8.9% were found to be in intermediate and 16.4% were at high risk. Elevated lipid profile showed that total cholesterol (TC) is 15.5%, low density lipoprotein (LDL) is 16.1%, and triglyceride (TG) is 10.6%. AIP was significantly correlated with body mass index (r=0.25), visceral fat (r=0.37), TC (r=0.22), LDL (0.24), HDL (r=-0.72), TG (r=0.84), glucose (r=0.32), systolic blood pressure (r=0.22), and diastolic blood pressure (r=0.28).

    Conclusion: It indicated that AIP is associated with other CVD risk factors. Modification of lifestyle is strongly recommended.

  10. Win TT, Aye SN, Lau Chui Fern J, Ong Fei C
    J Gastrointestin Liver Dis, 2020 Jun 03;29(2):191-198.
    PMID: 32530986 DOI: 10.15403/jgld-818
    BACKGROUND AND AIMS: The latest meta-analysis on the role of aspirin on various cancers was published in early 2018. By including the latest and updated primary observational studies, we aimed to conduct this systematic review and meta-analysis to synthesize stronger evidence on the role of aspirin in reducing gastric cancer (GC) risk.

    METHODS: The PubMed, Scopus, and MEDLINE databases were systematically searched up to December 2019 to identify relevant studies. Random-effects model was used to calculate summary ORs and 95%CI for I 2 >50%. If the heterogeneity is not significant, the fixed-effects model was used. Overall analysis of the studies, inverse variance weighting after transforming the estimates of each study into log OR and its standard error were used.

    RESULTS: 21 studies were included in this meta-analysis. Results showed that aspirin significantly reduced the GC risk (OR=0.64, 95%CI=0.54-0.76) with substantial heterogeneity (I 2 =96%). Effect of GC risk reduction in low dose (OR=0.80, 95%CI=0.59-1.09) is slightly greater than high dose aspirin (OR=1.08, 95%CI=0.77-1.52). Protective effect of aspirin uses >5 years (OR=0.67, 95%CI=0.34-1.31) was greater than <5 years (OR=1.01, 95%CI=0.72-1.43) Conclusion: In conclusion, this meta-analysis showed that low dose aspirin with longer duration of more than 5 years were associated with a statistically significant reduction in GC risk. However, due to possible confounding variables and bias, these results should be cautiously treated.

  11. Win TT, Nik Mahmood NMZ, Ma SO, Ismail M
    Iran J Pathol, 2016;11(5):478-482.
    PMID: 28974971
    Clear cell carcinoma of ovary is uncommon ovarian tumour that arises from surface epithelium of ovary. It has well-known association with ovarian endometriosis. We report here the first case of bilateral clear cell carcinoma of ovaries in a 40-year-old woman with a 17-year history of bilateral ovarian endometriosis. In addition, during the longstanding duration of the endometriosis, the patient was treated with hormonal therapy, including oestrogen. It represents the first report of such bilateral involvement in the background of ovarian endometriosis. This should prompt clinicians to be aware that prolonged hormonal treatment of endometriosis may precipitate bilateral malignancy of the ovary.
  12. Win TT, Othman NH, Mohamad I
    Indian J Pathol Microbiol, 2017 Apr-Jun;60(2):167-171.
    PMID: 28631629 DOI: 10.4103/IJPM.IJPM_457_16
    INTRODUCTION: Poorly differentiated thyroid carcinoma (PDTC) is a rare aggressive malignancy of thyroid follicular cells and has unique features in morphology and behavior. This study was aimed to describe the experience of a tertiary medical center with PDTC within a 10-year period.

    MATERIALS AND METHODS: This is a descriptive retrospective study of eight cases of PDTC among 418 various thyroid carcinomas. All cases of PDTC were retrieved along with the clinicopathological information.

    RESULTS: Only eight cases (1.9%) of PDTC were diagnosed among 418 thyroid carcinomas. Mean age was 48.12 with 3:5 (male:female) and tumor size ranged 3-12 cm. PDTC were diagnosed coexisting with one or more other pathologies; nodular hyperplasia (four cases), papillary carcinoma (one case), follicular carcinoma (three cases), and Hashimoto thyroiditis (two cases); with ≥60% PDTC component. Six cases associated with high-grade features died within 3 years after diagnosis.

    DISCUSSION: Mean age in this study was younger including a 20-year-old girl. Younger age was associated with better prognosis. Most of the cases had underlying benign thyroid lesions and differentiated thyroid carcinoma. Most of the PDTC had poor prognosis associated with PDTC component ≥60%, tumor necrosis, high mitotic count, lymph node involvement, vascular invasion and distant metastasis; and these cases died within 3 years after diagnosis.

    CONCLUSION: Although treatment of PDTC remains surgery followed by radioiodine therapy, correct histopathological diagnosis is important for clinicians and oncologists to predict the prognosis. All thyroid carcinoma should be sampled thoroughly not to miss small foci of PDTC component.
  13. Win TT, Aye SN, Abdul Hamad NS, Tuan Sharif SE
    Indian J Cancer, 2021 1 7;58(2):262-266.
    PMID: 33402586 DOI: 10.4103/ijc.IJC_528_19
    The primary retroperitoneal serous adenocarcinoma (PRSAC) is a rare malignant tumor of the retroperitoneum. It shares the same pathological and biological behavior with ovarian serous carcinoma. Most of the cases develop as peritoneal adenocarcinoma and rarely occur in the retroperitoneum. It is reported as serous surface papillary carcinoma of the peritoneum and extraovarian peritoneal serous papillary carcinoma. We present a case of PRSAC in a 60-year-old woman. Only 11 cases of PRSAC have been reported from 1983 to 2019. Histopathological features with immunohistochemical expressions are important to diagnose PRSAC. The outcome and survival mainly depend on the possibility of surgical resection. Molecular genetics of PRSAC should also be studied in relation with its ovarian counterpart.
  14. Win TT, Tuan Sharif SE, Mat Zin AA
    MyJurnal
    Intraoperative frozen section (FS) is an important tool in the management of neoplastic and non-neoplastic central nervous system (CNS) lesions. Although the final pathological diagnosis is based on the findings in paraffin tissue sessions, interpreting FS of CNS lesion is to assist the neurosurgeon in making the accurate judgment regarding the nature of the lesion and tissue adequacy. This study was to evaluate the agreement between FS and paraffin sections (PS) results; and to highlight the possible causes of error in discrepancy between FS and PS. Materials & Methods:This is a retrospective study of 85 cases of FS. H&E stained sections of both FS and PS of all these cases were reviewed with their histopathological reports. FS and PS results were compared. Possible causes of errors were reviewed and recorded.Results:Out of 85 cases; 76 cases (89.4%) showed no discrepancy, 2 cases (2.4%) minor discrepancy and 7 cases (8.2%) discrepancy. Sensitivity and specificity of FS were 90.1% and 85.7% respectively. Positive predictive value was 97.0% and negative predictive value was 63.1%. The false positive rate was 14.2% and false negative rate was 36.8%. The overall accuracy of FS was 89.4%. Conclusion:Our results showed high accuracy and specificity of FS. Therefore, FS is still useful, an effective tool for neurosurgeon although there are some challenges for histopathologists in reporting FS. The commonest discrepancy was seen between reactive gliosis and low-grade glioma. Over-diagnosis or under-diagnosis of FS can be reduced by closed cooperation among pathologist, neurosurgeon and radiologist.
  15. Lim RBT, Cheung ONY, Tham DKT, La HH, Win TT, Chan R, et al.
    Global Health, 2018 04 16;14(1):36.
    PMID: 29661249 DOI: 10.1186/s12992-018-0358-5
    BACKGROUND: There is an increasing global movement of foreign female entertainment workers (FEWs), a hard-to-reach population vulnerable to HIV/STIs. This paper described the needs assessment phase before intervention implementation where the socio-organisation, sexual risk behaviours and access to health services of foreign FEWs in Singapore were explored. We also highlighted how qualitative inquiry, census enumeration technique and community-based engagement approaches were used to gain access and to develop a culturally appropriate STI prevention intervention.

    METHODS: In-depth interviews, observations, informal conversational interviews, mystery client and critical incident technique were used. We estimated the size of FEW population using the census enumeration technique. The findings were used to inform intervention development and implementation.

    RESULTS: We estimated 376 Vietnamese and 330 Thai FEWs in 2 geographical sites where they operated in Singapore. Their reasons for non-condom use included misconceptions on the transmission and consequences of STI/HIV, low risk perception of contracting HIV/STI from paid/casual partner, lack of skills to negotiate or to persuade partner to use condom, unavailability of condoms in entertainment establishments and fear of the police using condom as circumstantial evidence. They faced difficulties in accessing health services due to fear of identity exposure, stigmatisation, cost and language differences. To develop the intervention, we involved FEWs and peer educators, and ensured that the intervention was non-stigmatising and met their needs. To foster their participation, we used culturally-responsive recruitment strategies, and ensured that the trial was anonymous and acceptable to the FEWs. These strategies were effective as we achieved a participation rate of 90.3%, a follow-up rate of 70.5% for the comparison and 66.8% for the intervention group. The interventions group reported a significant increase in consistent condom use with a reduction in STI incidence compared to no significant change in the comparison group.

    CONCLUSIONS: The qualitative inquiry approaches to gain access, to foster participation and to develop a culturally appropriate intervention, along with the census enumeration technique application to estimate the FEW population sizes has led to successful intervention implementation as well as safer sexual behaviour and STI incidence reduction.

    TRIAL REGISTRATION: ClinicalTrials.gov, NCT02780986 . Registered 23 May 2016 (retrospectively registered).

  16. Hanifi N, Halim AS, Aleas CF, Singh J, Marzuki M, Win TT, et al.
    Exp Clin Transplant, 2015 Jun;13(3):273-8.
    PMID: 26086837
    Skin grafting has been evolving as an important application in reconstructive surgery. Mixed reports about the survival of allogeneic and xenogeneic keratinocytes require further substantiation to determine the role of these cells in wound healing.
  17. Abdul Kadir A, Abdul Kadir A, Abd Hamid R, Mat Jais AM, Omar J, Sadagatullah AN, et al.
    Biomed Res Int, 2019;2019:6979585.
    PMID: 31355276 DOI: 10.1155/2019/6979585
    Objectives: The objective of the study is to evaluate the chondroprotective activity of Channa striatus (Channa) and glucosamine sulphate (glucosamine) on histomorphometric examinations, serum biomarker, and inflammatory mediators in experimental osteoarthritis (OA) rabbit model.

    Design: Anterior cruciate ligament transection (ACLT) was performed to induce OA in thirty-three male New Zealand white rabbits and were randomly divided into three groups: Channa, glucosamine, and control group. The control group received drinking water and the Channa and glucosamine groups were orally administered with 51.4 mg/kg of Channa extract and 77.5 mg/kg of glucosamine sulphate in drinking water, respectively, for eight weeks and then sacrificed. The articular cartilage was evaluated macroscopically and histologically using semiquantitative and quantitative methods. Serum cartilage oligomeric matric protein (COMP), cyclooxygenase 2 (COX-2) enzyme, and prostaglandin E2 (PGE2) were also determined.

    Results: Macroscopic analysis revealed that Channa group have a significantly lower severity grade of total macroscopic score compared to the control (p < 0.001) and glucosamine (p < 0.05) groups. Semiquantitative histology scoring showed that both Channa and glucosamine groups had lower severity grading of total histology score compared to the control group (p < 0.001). In comparison with the control, Channa group had lower histopathological changes in three compartments of the joint compared to glucosamine group which had lower histological scoring in two compartments only. The cartilage thickness, area, and roughness of both Channa (p < 0.05) and glucosamine (p < 0.05) groups were superior compared to the control group. However, the Channa group demonstrated significantly less cartilage roughness compared to the glucosamine group (p < 0.05). Serum COMP levels were lower in both Channa (p < 0.05) and glucosamine (p < 0.05) groups compared to the control group.

    Conclusion: Both oral administration of Channa extract and glucosamine exhibited chondroprotective action on an ACLT OA-induced rabbit model. However, Channa was superior to glucosamine in maintaining the structure of the cartilage.

  18. Abdul Rahman WF, Md Hashim MN, Win TT, Bakrin IH
    BMJ Case Rep, 2013;2013.
    PMID: 23749834 DOI: 10.1136/bcr-2013-010001
    Solid variant of papillary thyroid carcinoma (PTC) is a rare, poorly characterised variant and predominantly reported in children with a history of radiation exposure. This variant has a high propensity for extra-thyroidal extension and cervical lymph node metastases. A 14-year-old Malay girl who had no history of radiation exposure, presented with multiple cervical lymphadenopathy and it was clinically suspicious for tuberculosis or lymphoma. An incisional biopsy revealed a metastatic PTC. The patient underwent total thyroidectomy with bilateral lateral neck dissection and histopathology report was solid variant of PTC. Whole-body I(131) scan was performed which revealed an intense tracer uptake in the neck. She was planned for radioactive iodine ablation and now on regular follow-up for monitoring of possible tumour metastasis.
  19. Sharmni Vishnu K, Win TT, Aye SN, Basavaraj AK
    BMC Cancer, 2022 Nov 05;22(1):1139.
    PMID: 36335316 DOI: 10.1186/s12885-022-10225-y
    BACKGROUND: Triple negative breast cancer (TNBC) is clinically aggressive breast cancer with a poor prognosis. Approximately 20% of TNBC has been found to express programmed death ligand 1 (PD-L1), making it a potential therapeutic target. As a PD-L1 inhibitor, atezolizumab is a recently approved immunotherapeutic drug for TNBC, this meta-analysis (MA) was aimed to review the randomized controlled trial studies (RCTs) of combined atezolizumab and nab-paclitaxel in the treatment of TNBC and synthesize the evidence-based results on its effectiveness and safety.

    METHOD: We searched PubMed, Embase, EBSCOhost and ClinicalTrials.gov for the eligible RCTs which compared the efficacy and safety of combined atezolizumab and nab-paclitaxel with nab-paclitaxel alone. The outcomes analyzed included overall survival (OS), progression-free survival (PFS), objective response rate (ORR) and treatment-related adverse effects (AEs).

    RESULTS: A total of six RCTs were included in this MA. For efficacy, although OS was not significantly prolonged with combined atezolizumab and nab-paclitaxel (HR 0.90, 95% CI [0.79, 1.01], p=0.08), this combination therapy significantly improved PFS (HR 0.72, 95% CI [0.59, 0.87], p=0.0006) and ORR (RR 1.25, 95% CI [0.79, 1.01] p<0.00001). For safety, any AEs, haematological, gastrointestinal, and liver AEs showed no statistically significant differences between the atezolizumab and nab-paclitaxel combination group and nab-paclitaxel alone group. However, serious AEs, high grade, dermatological, pulmonary, endocrine, and neurological AEs were significantly lower with nab-paclitaxel alone compared to atezolizumab and nab-paclitaxel combined (p-value range from <0.00001 to 0,02).

    CONCLUSION: Atezolizumab combined with nab-paclitaxel was associated with improved outcomes in the treatment of TNBC; however, this combination resulted in more toxicity compared to nab-paclitaxel alone. While nab-paclitaxel alone produced chemotherapy-related AEs, the combination of atezolizumab with nab-paclitaxel produced AEs, especially immune-related AEs such as haematological, pulmonary, endocrine, and neurological AEs.

    TRIAL REGISTRATION: This research work of systematic review has been registered on PROSPERO (Registration number: CRD42022297952).

  20. Mohamad Pakarul Razy NH, Wan Abdul Rahman WF, Win TT
    Asian Pac J Cancer Prev, 2019 Jan 25;20(1):277-282.
    PMID: 30678450
    Introduction: Vascular endothelial growth factor (VEGF) is an angiogenic factor that plays an important role in
    thyroid cancer. VEGF is known to have high affinity to VEGF receptors such as VEGFR-1 (Flt-1) and VEGFR-2 (KDR).
    Papillary thyroid carcinoma (PTC) is the most common thyroid cancer and studies showed the increasing incidence of
    PTC arising in nodular hyperplasia. Targeted therapy on these growth factors and receptors are used in management
    of both differentiated and undifferentiated thyroid carcinoma. This study aims to determine the expression of VEGF
    and VEGF receptors (VEGFR) in thyroid nodular hyperplasia and PTC. Methods: A cross-sectional study based on
    paraffinized archival tissue blocks of 113 nodular hyperplasias and 67 PTC from the thyroidectomy specimens in
    the year of 2003 to 2014. The tissue sections were then stained by immunohistochemistry for VEGF, VEGFR-1 and
    VEGFR-2. The lymph node involvement and extrathyroid extension also were determined. Results: The mean age of
    PTC patients was 44.7±15.8 years and nodular hyperplasia were 42.2±13.6 years. There was a statistical difference
    of VEGFR-1 (p=0.028) and VEGFR-2 (p=0.003) expression between nodular hyperplasia and PTC. However, no
    significant difference of VEGF expression (p=0.576) between both diseases. Co-expression of VEGF and VEGFR-1
    was significant in both nodular hyperplasia (p=0.016) and PTC (p=0.03), meanwhile no relevant relationship for VEGF
    and VEGFR-2 expression (p>0.05). No significant association (p>0.05) between lymph node status and extrathyroid
    extension with age groups, gender, VEGF and VEGFR expression. Conclusions: VEGF, VEGFR-1 and VEGFR-2
    showed overexpression in both nodular hyperplasia and PTC. The expression of VEGFR-1 and VEGFR-2 are more
    significant in PTC with relevant co-expression of VEGF and VEGFR-1. Therefore, the inhibition of VEGFR offers a
    promising prospect for tumour management in thyroid carcinoma.
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