In developing countries, breast cancer is diagnosed at a much younger age. In this study we investigate the dichotomies between older and young breast cancer patients in our region. The study involved two cohorts; older patients (≥ 65 years, n = 553) and younger ones (≤ 40 years, n = 417). Statistical models were used to investigate the associations between age groups, clinical characteristics and treatment outcomes. Compared to younger patients, older patients were more likely to present with advanced-stage disease (20.6% vs. 15.1%, p = .028). However, among those with non-metastatic disease, younger patients tended to have more aggressive pathological features, including positive axillary lymph nodes (73.2% vs. 55.6%, p < .001), T-3/4 (28.2% vs. 13.8%, p < .001) and HER2-positive disease (29.3% vs. 16.3%, p < .001). The 5-year overall survival (OS) rate was significantly better for the younger (72.1%) compared to the older (67.6%), p = .035. However, no significant difference was observed in disease-free survival (DFS) between the two groups.In conclusion, younger patients with breast cancer present with worse clinical and pathological features, albeit a better OS rate. The difference in DFS between the two groups was not insignificant, suggesting that older women were more likely to die from non-cancer related causes.

Purpose: Though less than 5% of patients with breast cancer present with De Novo Metastasis (dnMBC) in Western societies, this percentage may reach 30% in developing countries. In this study, we present survival outcomes of patients diagnosed with dnMBC treated at a tertiary center in a developing country. Patients and Methods: Using hospital-based database, consecutive patients with dnMBC diagnosed between 2013 and 2017 were identified. Demographic data, tumor characteristics, types of treatment, and survival data were retrospectively collected. Results: A total of 435 patients were included; median age (range) at time of diagnosis was 51 (24– 85) years. Most of the tumors expressed hormone receptors (81% Estrogen Receptor positive, 77% Progesterone Receptor positive). Human epidermal growth factor receptor-2 (HER2) overexpression was reported in 134 (30.9%) patients, while only 24 (5.5%) had Triple Negative (TN) disease. Bone, lung and liver were the most common sites of metastasis involved in 70.6%, 36.1%, and 32.0%, respectively. The median Overall Survival (OS) for all patients was 38 months, and 5-year OS was 32.6%. On univariate analysis, high tumor grade, advanced T-stage, TN-disease and metastasis to multiple sites, but not HER2 status, were associated with poor OS. On multivariate analysis, high tumor grade (Hazard Ratio =1.6, p=0.002), advanced T-stage (Hazard Ratio=1.6, p=0.003), and triple negative status (Hazard Ratio= 2.1, p=0.008) predicted poor OS. Conclusion: The overall survival of patients with dnMBC remains poor. Better understanding of the disease behavior and factors affecting survival is required for optimal utilization of available regimens and new drugs to hopefully improve patients’ outcomes.

Background/Objectives: To explore the prognostic potential of gross tumor volume (GTV)-based delta-radiomic features from CT simulation scans in patients with locally advanced unresectable vulvar cancer. Methods: A total of 21 patients (between 2019 and 2024) undergoing definitive radiotherapy were included, with baseline and post-phase I (after 25 fractions) CT simulation scans analyzed. Radiomic features (n = 107) were extracted from GTVs using PyRadiomics, and delta features were calculated as the relative change between scans. A multi-step selection pipeline (univariable Cox screening (p < 0.10), correlation filtering, and Lasso–Cox) was applied for each endpoint: local control (LC), regional control, distant metastasis-free survival, progression-free survival, and overall survival (OS). Model discrimination was assessed via 500-iteration bootstrapped concordance index (C-index), and calibration was plotted at 24 months. Results: Median follow-up was 50.0 months. The 2-year LC and OS rates were 56.2% and 55.9%, respectively. Final multivariable models retained a sole texture Δ feature for LC (HR = 2.62, 95% CI = 1.05–6.52, p = 0.039; C-index = 0.748) and six Δ features for OS (C-index = 0.864). No features were retained for other endpoints. For LC, increased run-length non-uniformity after phase I predicted poorer control. For OS, increased texture/shape complexity predicted worse survival, whereas increased uniformity predicted better survival. Conclusions: CT-based delta-radiomic features, particularly shape and texture metrics, may predict LC and OS in unresectable vulvar cancer. Despite the small sample size, these findings highlight the potential for delta-radiomics as a noninvasive biomarker for risk stratification. Validation in larger cohorts and exploring potential in adaptive radiotherapy are warranted.

Background: Distant metastasis at the time of diagnosis of breast cancer is found in approximately 6% of new cases and much more in developing countries. Due to distinct biologic and molecular characteristics, de novo Metastatic Breast Cancer (dnMBC) is inherently different from recurrent metastatic breast cancer (rMBC). Data on de novo metastatic breast cancer is limited due to the heterogeneity of the disease and the lack of distinction between rMBC and dnMBC in most of the published literature. In this study, we aim to review the survival outcomes of patients diagnosed with dnMBC treated at a tertiary cancer center in a developing country and to identify factors that affect their outcome. Methods: Using hospital-based database, consecutive patients with pathologically proven dnMBC diagnosed between 2013 and 2017 inclusive were identified. Retrospective chart review was performed to collect demographic data, tumor characteristics, types of treatment, and dates of death/last follow-up. Overall survival (OS) was defined as the time from diagnosis to death from any cause or last follow-up. Survival was estimated using the Kaplan-Meier method and compared between subgroups using log-rank tests. Multivariate analysis was performed using cox regression method. Results: 435 patients (3 males) were included in the analysis. Median age (range) at time of diagnosis was 51 (24- 85) years, and 99 (22.8%) were younger than 40 years. Predominant histology was invasive ductal carcinoma (IDC) in 372 (75.2%) patients, followed by invasive lobular carcinoma (ILC) in 37 (8.5%) patients. Poor prognostic features of the primary tumor were present in majority of patients, including: high grade (n=201, 46%), advanced T-stage (T3/T4) (n=205, 47.2%), and lymph node involvement (n=322, 74%). Most of the tumors expressed hormone receptors (81% ER+, 77% PR+). HER-2neu overexpression was reported in 134 (30.9%) patients while only 24 (5.5%) had triple negative (TN) disease. The most common sites of distant metastases were bone (n=307, 70.6%) followed by lung (n=157, 36.1%) and liver (n=139, 32%). The median OS for all patients was 38 months, and 5-year OS was 32.6%. On univariate analysis, factors associated with poor OS were: GIII (5-year OS: 45.8% in GI and II vs 19.1% in GIII), log rank p<0.001), advanced T-stage (5-year OS: 47% for T1/T2 vs 26.5% for T3/T4 tumors, log rank p<0.001), TN status (5-year OS 0 % in TN vs 35% in non-TN, log rank p<0.001), and metastasis to multiple sites (5-year OS: 50% for metastasis to a single site vs 24% for multiple sites (log rank p<0.001). No difference in OS was observed based on HER-2neu overexpression. On multivariate analysis, high tumor grade (Hazard ratio (HR) =1.6, p=0.002), advanced T-stage (HR=1.6, p=0.003) and triple negative status (HR= 2.1, p=0.008) predicted poor OS. Conclusions: The overall survival of patients with dnMBC remains poor. Better understanding of the disease behaviour and factors affecting survival is required for optimal utilization of available regimens and new drugs to hopefully improve patients’ outcomes. Citation Format: Hanan Almasri, Ayah Erjan, Hebah Abudawaba, Khaled Ashouri, Sara Mheid, Anoud Alnsour, Hikmat Abdel-Razeq. De novo metastatic breast cancer; clinical characteristics and treatment outcomes in a developing country [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-07-27.

Purpose: To explore the prognostic potential of gross tumor volume (GTV)–based delta-radiomic features from CT simulation scans in patients with locally advanced unresectable vulvar cancer. Methods: A total of 21 patients (between 2019–2024) undergoing definitive radiotherapy were included, with baseline and post–phase-I (after 25 fractions) CT simulation scans analyzed. Radiomic features (n = 107) were extracted from GTVs using PyRadiomics, and delta features were calculated as the relative change between scans. A multi-step selection pipeline (univariable Cox screening (p < 0.10), correlation filtering and Lasso-Cox) was applied for each endpoint: local control (LC), regional control, distant metastasis–free survival, progression-free survival, and overall survival (OS). Model discrimination was assessed via 500-iteration bootstrapped concordance index (C-index), and calibration was plotted at 24 months. Results: Median follow-up was 50.0 months. The 2-year LC and OS rates were 56.2% and 55.9%, respectively. Final multivariable models retained a sole texture Δ feature for LC (HR = 2.62, 95% CI = 1.05–6.52, p = 0.039; C-index = 0.748) and six Δ features for OS (C-index = 0.864). No features were retained for other endpoints. For LC, increased run-length non-uniformity after phase I predicted poorer control. For OS, increased texture/shape complexity predicted worse survival, whereas increased uniformity predicted better survival. Conclusion: CT-based delta-radiomic features, particularly shape and texture metrics, may predict LC and OS in unresectable vulvar cancer. Despite the small sample size, these findings highlight the potential for delta-radiomics as a noninvasive biomarker for risk stratification. Validation in larger cohorts and exploring potential in adaptive radiotherapy are warranted.