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2014
Zeeneldin AA, Ramadan H, El Gammal MM, Saber MM, Elgamal D, Sherisher MA. Gastric carcinoma at Tanta Cancer Center: a comparative retrospective clinico-pathological study of the elderly versus the non-elderly. J Egypt Natl Canc Inst. 2014;26(3):127-37. Abstractn/a

BACKGROUND AND AIMS: To study the clinico-pathological features, treatments and outcomes of gastric carcinoma (GC) in the elderly (⩾65 years) and the non-elderly Egyptian patients.

METHODS: This retrospective cohort study included 168 patients with histologically confirmed GC treated at Tanta Cancer Center between 2003 and 2007.

RESULTS: Compared to the non-elderly, elderly patients had significantly higher proportion of tumors involving the cardia (p=0.034) and of adenocarcinoma NOS histology (p=0.032). Treatments were largely comparable in the two groups. Response to palliative chemotherapy was achieved in 44.4% of the elderly and 25.5% of the non-elderly patients (p=0.417). The median overall survival (OS), disease-free survival (DFS) and progression-free survival (PFS) were 6, 17 and 3 months, respectively. The median OS was 4 months in the elderly compared to 9 months in the non-elderly (p=0.005). The median DFS was 4 months in the elderly compared to 20 months in the non-elderly (p=0.004). The median PFS was 2 months in the elderly compared to 3 months in the non-elderly (p=0.685). In multivariate analysis, poor performance status was an independent predictor of poor OS, DFS and PFS. Non-curative or no surgery and lack of chemotherapy use were independent predictors of poor OS. Age was an independent predictor of poor DFS.

CONCLUSIONS: Compared to the non-elderly, GC in the elderly has similar clinico-pathological characteristics and exhibits comparable outcomes with the same treatment options. Treatments should be tailored to each patient.

Zeeneldin A, Diyaa A, Moneer M, Elgammal M, Buhoush W. Review of 40-year MD theses in medical oncology. J Egypt Natl Canc Inst. 2014;26(3):109-18. Abstractn/a

BACKGROUND AND OBJECTIVE: It is almost 40 years since the foundation of the Medical Oncology (MO) Department. We aimed to appraise the clinical research to fulfill the Medical Doctorate (MD) degree in MO at the National Cancer Institute, Cairo University (NCI, CU).

METHODS: This review included 62 MD theses containing 66 studies. They were reviewed regarding aims, type of study, clinical trial phase, design and methodology, statistical tests, results, limitations, consent and IRB approval. Theses were grouped into 3 periods: 1970-1989, 1990-1999 and 2000-2008.

RESULTS: Almost 76% of the studies were interventional and 24% were observational. Informed consent and Institutional Review Board approval were mentioned in 18 and 2 studies, respectively. While all studies mentioned the aims, none, clearly mentioned the research question. Outcomes were mainly efficacy followed by safety. Study design was inadequately considered, especially in 70's-80's period (p=0.038). Median sample size and study duration were almost stable through the three periods (p=0.441, 0.354, respectively). Most of the studies used both descriptive and analytical statistical methods. In a descending order, researched cancers were lymphoma, breast, leukemia, liver, urinary bladder, lung and colorectal. The commonest stages researched were IV and III. The number of studies focused on assessing biomarkers, biomarkers plus drugs/procedures, drugs and procedures are 20, 20, 16 and 6, respectively.

CONCLUSION: With time, research within MD theses in MO increased quantitatively and qualitatively. Improvements were noticeable in documentation of study design.

Zeeneldin AA, Eid SM, Darweesh AD, Moneer MM, Saadeldin M. Tamoxifen compared to best supportive care in advanced hepatocelluar carcinoma: A retrospective matched-cohort study. J Egypt Natl Canc Inst. 2014;26(1):1-7. Abstractn/a

BACKGROUND: Hepatocelluar carcinoma (HCC) is a common cancer worldwide as well as in Egypt with hepatitis B and C, alcohol and aflatoxins being the commonest risk factors. Tamoxifen was initially reported to confer a marginal survival benefit in advanced HCC. However, later reports declined any benefit.

OBJECTIVE: To study the impact of tamoxifen on overall survival (OS) compared to best supportive care (BSC) in Egyptian patients with advanced HCC.

METHODS: This retrospective matched-cohort study was conducted at Tanta Cancer Center (TCC), Egypt where 116 advanced HCC cases treated with tamoxifen were compared to TNM stage and Child-Pugh class matched 116 HCC cases who received BSC.

RESULTS: The median OS in the tamoxifen group was 9.3 months (95% confidence interval [CI], 6.7-11.9 months) compared to 8.7 months (95%CI, 6.8-10.6) in the BSC group (p=0.758). With univariate analyses, it was shown that absence of fatigue, Child-Pugh class A, single tumors, less advanced tumors (T2), and absence of metastases (M0), had significantly better OS than their counterparts. Multivariate analysis showed that absence of fatigue, Child-Pugh class A and T2 tumors were independent prognostic factors affecting OS. Tamoxifen produced partial response and clinical stabilization in one% and 16% of cases, respectively. The median PFS with tamoxifen was 7.2 months (95%CI, 5.2-9.5).

CONCLUSIONS: Tamoxifen did not show any OS advantage in Egyptian patients with advanced HCC. Use of this drug is discouraged.

Saber MM, Zeeneldin AA, El Gammal MM, Salem SE, Darweesh AD, Abdelaziz AA, et al. Treatment outcomes of female germ cell tumors: the Egyptian National Cancer Institute experience. J Egypt Natl Canc Inst. 2014;26(2):103-8. Abstractn/a

INTRODUCTION: Female germ cell tumors (GCTS) are rare tumors that carry a good prognosis.

AIM: To report the experience of the Egyptian National Cancer Institute (ENCI) in managing female GCTs.

METHODS: This retrospective study included 19 females with ovarian GCTs presenting to the ENCI between 2006 and 2010.

RESULTS: The median age was 23years. Ovaries were the primary site in all patients. Dysgerminoma and teratoma were the predominant pathologies followed by mixed GCT in females. Unilateral ovariectomy or ovarian tumorectomy were the classic surgical procedures with R0 resection being feasible in most cases. Surveillance was adopted in six patients with stage I disease. Chemotherapy was administered in 63% of ovarian GCTs with BEP being the commonest regimen with reasonable tolerability and good response rates. The median OS and EFS were not reached. The projected 5-year OS rate was 93.8%. Both OS and EFS were better in patients responding to chemotherapy than non-responders (p<0.002). Stage of disease did not significantly affect OS or EFS.

CONCLUSIONS: Female GCTs rarely affect Egyptian females. They have good prognosis.

Zeeneldin AA, Taha FM. Qatar biomedical and cancer publications in PubMed between 2000 and 2012. Qatar Med J. 2014;2014(1):31-7. Abstractn/a

BACKGROUND: The aim of this work was to analyse the past trends of biomedical and cancer publications from Qatar listed on PubMed for the years 2000-2012. These findings were then compared with the corresponding global number of publications.

METHODS: PubMed was searched for cancer publications, clinical trials, publications on humans or other species. Searching for "Qatar*" in the "Affiliation" field yielded the lowest number of publications; searching for "Qatar*" in the "Affiliation" or in "Title/Abstract" yielded a moderate number of results and searching for "Qatar*" in the "Affiliation" or "Title/Abstract" or "Text Word" fields yielded the highest number of publications. The annual percentage change (APC) from one year to the next was calculated for the population and each type of publication. Information on the population of Qatar was gathered from the website of Qatar Statistics Authority to determine the correlation of papers published per 1000 population.

RESULTS: The number of publications retrieved from PubMed was not particularly different for each variation of search carried out. However, the most representative number of publications was retrieved upon searching for "Qatar*" in the "Affiliation" or in "Title/Abstract" fields. Between the years 2000 and 2012, the total number of biomedical publications from Qatar increased 24 times with an average APC of 33.4%, which was found to be more than the APC of the population in Qatar which averaged at 9%. The number of biomedical publications per 1000 population increased from 0.02 in 2000 to 0.15% in 2012. Most publications retrieved were humans studies and occasionally were for other animal species. Cancer publications in Qatar represented 16.9% of the total publications and the number of cancer publications per 1000 population increased from 0% in 2000 to 0.02% in 2012. Publications classified as clinical trials represented 4.6% of Qatar biomedical publications. Publication of cancer clinical trials were very rare (0.4%).

CONCLUSIONS: Despite the obvious increase in Qatar biomedical and cancer publications in PubMed, the absolute numbers were relatively small. While strategies are in place, leaders of Qatar biomedical research need to consider increasing cancer research and clinical trials to meet the country's needs. Linking research output to researchers, research facilities and research funding is needed.

2013
Zeeneldin AA, Saber MM, Seif El-Din IA, Frag SA. Small intestinal cancers among adults in an Egyptian district: a clinicopathological study using a population-based cancer registry. J Egypt Natl Canc Inst. 2013;25(3):107-14. Abstractn/a

BACKGROUND: Small intestinal cancers (SICs) are very rare all over the world and little is known about them in Egypt.

METHODS: This a retrospective study. Between 2000 and 2002, 30 cases with SICs were identified in the Gharbiah population based cancer registry (GPBCR); 17 cases of whom were treated at Tanta Cancer Center (TCC).

RESULTS: The median age was 51 years with female predominance. The duodenum was the commonest site (43%) followed by the ileum then the jejunum. Adenocarcinoma (AC), carcinoids, gastrointestinal stromal tumors (GISTs), lymphoma and sarcoma represented 50%, 10%, 17%, 13% and 10% respectively. Abdominal pain was the commonest symptom and localized disease was the commonest presentation. Surgery, chemotherapy and radiotherapy were employed in 65%, 35% and 0% of patients, respectively. The median overall survival and progression free survival (OS, PFS) were 18 and 15 months (95% CI: 10.4-25.6 and 3.6-26.4), respectively. AC had inferior OS and PFS to other histologies (p = 0.08 and 0.12, respectively). Also, duodenum subsite was inferior in OS and PFS to other sites (p = 0.25 and 0.35, respectively).

CONCLUSIONS: SICs in Gharbiah, Egypt are characterized by predominance of female gender and adenocarcinoma histology. One year survival is 64% with a poor outcome for adenocarcinoma and duodenal subsite.

Zeeneldin AA, Salem SE, Tabashy RH, Ibrahim AA, Alieldin NH. Transarterial chemoembolization for the treatment of hepatocellular carcinoma: a single center experience including 221 patients. J Egypt Natl Canc Inst. 2013;25(3):143-50. Abstractn/a

BACKGROUND: Hepatocelluar carcinoma (HCC) is a major health problem in Egypt as well as in many countries. Transarterial chemoemoblization (TACE) is a treatment modality applicable to locally advanced HCC beyond surgery or ablative therapies and is associated with survival improvements. The aim of this study was to assess the outcomes of TACE in our center over the past four years.

METHODS: This is a retrospective cohort study that included 221 patients with locally advanced HCC treated with TACE in a single center between the years 2007 and 2010. The median age was 57 years with male predominance. Liver cirrhosis, viral hepatitis and Bilharziasis were encountered in 64%, 31% and 8% of patients, respectively. Abdominal pain was the most common presenting symptom (67%). Most cases were diagnosed based on radiology (57%) with a TNM stage I or II (73%) and a median AFP value of 150 ng/mL.

RESULTS: 221 patients received 440 cycles of TACE with a median of 2 cycles per patient. Cisplatin and doxorubicin (50mg per cycle, each) were the most commonly used drugs. Impaired liver function was the most common toxicity. Liver cell failure occurred in 17% of patients. An objective tumor response was achieved in 44% of cases. The median overall survival (OS) was 16 months (95% CI, 13-19 months) and the median progression free survival (PFS) was 6 months (95% CI, 4.3-7.8 months). Responding patients, Child-Pugh class A and patients receiving standard doses of chemotherapy had a significantly better OS than their counterparts. Only Child-Pugh class A was associated with significantly longer PFS (p < 0.001).

CONCLUSION: TACE produces reasonable responses and fair survival rates in locally advanced HCC but with noticeable toxicities. Proper patients' selection and prompt liver support are mandates for improving TACE outcomes.

Zeeneldin AA, Ramadan M, Gaber AA, Taha FM. Clinico-pathological features of breast carcinoma in elderly Egyptian patients: a comparison with the non-elderly using population-based data. J Egypt Natl Canc Inst. 2013;25(1):5-11. Abstractn/a

BACKGROUND: Breast cancer (BC) is a major worldwide health care problem that mostly afflicts the elderly population in the more developed countries. It is not known how common is breast cancer among elderly Egyptian patients and whether this differs from the disease in younger patients.

AIMS: To study the clinico-pathological features of BC in elderly Egyptian patients (⩾65years of age) among the population of an Egyptian Governorate, Gharbiah, and to compare these features with those of younger patients (<65years).

METHODS: This is a cross sectional study that compares elderly BC (EBC) and the non-elderly BC (NEBC) using the information from the Gharbiah Population-based Cancer registry (GPCR) during the years 1999-2007.

RESULTS: Out of 6078 BCs, 12% were EBCs and 88% were NEBCs. Between 1999 and 2007, the crude incidence rate (CIR, per 100,000 populations) of EBC increased from 47 to 71 and that of NEBC increased from 16 to 17. Compared to NEBC patients, EBC patients were more likely to have a positive family history and present with a distant disease and less likely to present with a localized disease. EBCs were more likely to have lung metastases and less likely to have liver metastases. Histology, grade, hormone and HER-2 receptor statuses were comparable in both groups. Apart from hormonal therapies, the elderly were less likely to receive surgery, radiotherapy or chemotherapy.

CONCLUSION: EBC patients in Egypt present with advanced disease and are less likely to receive surgery, radiotherapy or chemotherapy compared to NEBC patients.

Zeeneldin AA. Adherence of non-pharmaceutically sponsored oncology trial protocols to the International Conference on Harmonization (ICH) guidelines in an academic institution outside the ICH jurisdictions and the impact of IRB implementation on this adherence. J Egypt Natl Canc Inst. 2013;25(2):71-8. Abstractn/a

PURPOSE: To assess adherence of non-pharmaceutically sponsored trials (non-PSTs) to ICH protocol structure guidelines and to estimate the effect of implementing Institutional Review Board's (IRB) review on this adherence.

METHODS: This is a retrospective exploratory study where 60 non-PST clinical trial protocols (CTPs) were reviewed and halved to IRB-reviewed CTPs (IRCTPs) and non-IRB-reviewed CTPs (non-IRCTPs). Adherence score (AS) was calculated as the number of fulfilled items or sub-items divided by their total number.

RESULTS: Three adherence patterns were encountered: (1) items consistently present in both groups e.g. general and background information, objectives, inclusion criteria and intervention details, (2) items consistently absent in both groups and included contact information of investigators and trial sites, product accountability, randomization codes' management, interim analyses and many other statistical aspects, and (3) items variably present in both groups where the effect of IRB was verifiable. Trial site details, potential benefits, discontinuation and exclusion criteria, and follow up for adverse events were more encountered in IRCTPs than non-IRCTPs. Withdrawal criteria and monitoring of treatment compliance showed a reverse pattern (p<0.05 for all). The total AS, administrative AS and ethics AS for IRCTPs was 43%, 22% and 70% compared to 38%, 16% and 33% for non-IRCTPs (p<0.003, <0.001, 0.004), respectively. The scientific AS was 54% for both groups (p=0.87).

CONCLUSIONS: IRB-implementation at NCI-Egypt improved ethical and administrative sections of academic protocols. However, this improvement is modest and needs further actions including adoption of protocol templates. Scientific sections were as good after IRB-implementation as they were before that.

Saber MM, Zeeneldin AA, Samra MO, Farag SA. Primary gastrointestinal lymphoma in an Egyptian district: a study using a population-based cancer registry. J Egypt Natl Canc Inst. 2013;25(2):95-101. Abstractn/a

INTRODUCTION: Gastrointestinal lymphoma (GIL) is the most common extranodal form of non-Hodgkin's lymphoma (NHL) with geographical and age variation of its various subtypes.

AIM: To study GIL in Gharbiah, Egypt and to recognize the treatments employed and their outcomes including survival.

METHODS: This is a retrospective study. Between 2000 and 2002, 40 adult patients with GIL were identified in the Gharbiah population based cancer registry (GPBCR); 26 cases of whom were treated at Tanta Cancer Center (TCC).

RESULTS: GIL in Gharbiah, Egypt represented 6.2% of all GIT cancers. The median age was 47 years with slight male predominance. The commonest primary site was the stomach followed by the colon/rectum then the small intestine (67.5%, 25% and 7.5%, respectively). The commonest histological subtypes were the diffuse large B-cell (41.5%) followed by marginal zone B-cell (39%). The commonest symptoms were abdominal pains followed by vomiting. Only 18% of GILs were surgically resected. Most patients (77%) received chemotherapy with a 60% complete response (CR) rate. Once in CR, relapses are occasional. The median overall survival (OS) and progression free survival (PFS) were 31 and 14 months (95% CI, 13.2-48.7 and 6.4-21.6 months, respectively). Gastric primary site and diffuse large B cell subtype carry a non-significant worse OS and PFS than those of other sites and subtypes.

CONCLUSIONS: GILs in Gharbiah, Egypt are characterized by predominance of male gender, gastric site and marginal zone histology. Survival is worse for gastric and diffuse large B-cell GILs compared to other sites and histologies.

Zeeneldin AA, Ramadan M, Elmashad N, Fakhr I, Diaa A, Mosaad E. Breast cancer laterality among Egyptian patients and its association with treatments and survival. J Egypt Natl Canc Inst. 2013;25(4):199-207. Abstractn/a

BACKGROUND AND AIM: Breast cancers (BCs) involve the left side (LS) more than the right side (RS). Among the Egyptians, neither BC laterality nor its association with demographic factors, tumor locations, treatments and outcomes were previously reported.

PATIENTS AND METHODS: Laterality was analyzed among 5459 BCs from the Gharbiah population-based cancer registry covering >5% of the Egyptian population. Cox proportional model was used to assess the independent effect of stage, ER, and laterality on overall survival (OS).

RESULTS: In Egypt, BCs involve LS more than RS with LS-to-RS ratio (LRR) of 1.16. LS predominance was evident among men and women and both younger (< 45 years) and older patients. HER2 over-expression and ductal cancers were significantly more in RSBCs while lobular cancers were significantly more in LSBCs. There were no significant differences in localization within the breast between LSBCs and RSBCs (p = 0.51). LS predominance was noticed across all subgroups except in patients with HER2 positive tumors (LRR = 0.63; p = 0.02). OS was significantly better in stage II and ER positive tumors than stage III and ER negative tumors. Despite OS of LSBCs being generally lower than RSBCs, this was not statistically significant. The significant impact of stage on OS was lost in LSBCs.

CONCLUSIONS: Among Egyptian patients, the left breast is at greater risk of cancer than the right one. Despite right-sided tumors seemed more aggressive, Left-sided ones tend to confer worse survival than right-sided tumors.

Elzawahry HM, Saber MM, Mokhtar NM, Zeeneldin AA, Ismail YM, Alieldin NH. Role of Ki67 in predicting resistance to adjuvant tamoxifen in postmenopausal breast cancer patients. J Egypt Natl Canc Inst. 2013;25(4):181-91. Abstractn/a

INTRODUCTION: Breast cancer (BC) is a major health problem in Egypt and worldwide. Its prognosis depends not only on tumor stage but also on tumor biology.

AIM: To correlate the expression of Ki67 with the clinical outcomes of early hormone-receptor positive postmenopausal BC patients who are receiving tamoxifen.

METHODS: This cohort study included 70 patients. They were followed up for a minimum of 2 years. Ki67 was assessed on paraffin-embedded blocks using immunohistochemistry methods.

RESULTS: The median Ki67 value was 22.5% (IQR, 10%-50%). Ki67 was significantly higher in patients with HER2 positive tumors compared to HER2 negative tumors. After a median follow up period of 53 months, 22 patients (31%) developed disease recurrence either loco-regional or distant in 5.7% and 30%, respectively. Recurrent patients had significantly higher tumor stage, nodal stage and Ki67 values compared to non-recurrent cases. The 2-, 3- and 5-year overall survival (OS) and disease-free survival (DFS) rates were 100% & 91%, 98% & 84% and 77% & 59%, respectively. DFS was significantly worse with higher TNM stage, lower ER expression and higher Ki67 values. OS was significantly worse in patients with Ki67 values ≥ 30%. Ki67 ≥ 30% was an independent predictor of recurrence, poor DFS and OS.

CONCLUSION: High Ki67 expression is predictive of poor prognosis and of resistance to adjuvant tamoxifen therapy in postmenopausal BC. We recommend considering Ki67 as one of the risk factors that guide adjuvant treatment decisions.

Saad I, Abdelaziz S, Zeeneldin A, Eltoni A, Loay I. Assessment of axillary nodal status post neoadjuvant chemotherapy in breast cancer: rationale and predictors. Cairo: Cairo; 2013.
Saber MM, Zeeneldin AA, Samra MO, Farag S. Primary Gastrointestinal Lymphoma in an Egyptian District: a Study Using a Population-Based Cancer Registry. Journal of the Egyptian National Cancer Institute. 2013.
Zeeneldin AA. Research Profile of the Egyptian National Cancer Insitute (ENCI) on the PubMed. Meditreanen Oncology Journal. 2013. Abstract<p>n/a</p>

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Zeeneldin AA, Eid SM, Diaa A, Moneer M, Saadeldin M. Tamoxifen compared to best supportive care in advanced hepatocelluar carcinoma: a retrospective matched-cohort study. Journal of the Egyptian National Cancer Institute. 2013.
Zeeneldin A, Eid S, Tabashi R, Ibrahin A, Alieldin N. Transarterial Chemoembolization for the Treatment of Hepatocelluar Carcinoma: A Single Center Experience including 221 Patients. Journal of the Egyptian National Cancer Institute. 2013.
Elzawahry HM, Saber MM, Mokhtar NM, Zeeneldin AA, Ismail YM, Alieldin NH. Role of Ki67 in predicting resistance to adjuvant tamoxifen in postmenopausal breast cancer patients. Journal of the Egyptian National Cancer Institute. 2013. Abstractn/a
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Zeeneldin AA, Saber MM, El-Din IS, Frag SA. Small intestinal cancers among adults in an Egyptian district: A clinicopathological study using a population-based cancer registry. Journal of the Egyptian National Cancer Institute. 2013. Abstractn/a
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2012
Zeeneldin AA, Gaber AA, Taha FM. Does fasting during Ramadan trigger non-adherence to oral hormonal therapy in breast cancer patients? J Egypt Natl Canc Inst. 2012;24(3):133-7. Abstractn/a

PURPOSE: To estimate the effect of fasting during Ramadan (the ninth lunar month) on adherence to oral hormonal therapies (OHT) among breast cancer (BC) patients.

PATIENTS AND METHODS: During Ramadan 2010, 139 BC patients were interviewed at the Egyptian National Cancer Institute. They were asked about fasting as well as intake of OHT in Ramadan and in the preceding month.

RESULTS: The median age was 50years and most patients were postmenopausal with good performance status and non-metastatic disease. The median number of fasting days was 18% and 93% of patients were fasting 80% or more of Ramadan. Tamoxifen and aromatase inhibitors were used in 64% and 36%, respectively. Adherence to OHT during Ramadan and its preceding month were 94.2% and 95.7%, respectively (p=0.77). In univariate analysis, non-adherence prior to Ramadan and shorter duration of OHT were predictors of non-adherence during Ramadan (P<0.001, 0.003, respectively). Fasting, age, performance status, presence of metastases and type of hormonal therapy were not good predictors of adherence.

CONCLUSIONS: While most of patients receiving OHT for BC are fasting during Ramadan, this does not negatively impact compliance with treatment.

Zeeneldin AA, Taha FM. Fasting among Muslim cancer patients during the holy month of Ramadan. Ann Saudi Med. 2012;32(3):243-9. Abstractn/a

BACKGROUND AND OBJECTIVE: Muslims constitute more than 20% of the world's population and have a significant share of its cancer cases. Many Muslim cancer patients witness the fasting month of Ramadan but we do not know which individuals elect to fast.

DESIGN AND SETTING: Cross-sectional study conducted among Muslim cancer patients at the National Cancer Institute (NCI), Egypt, during Ramadan, Hijri 1430 (the month of fasting) August-September 2009.

SUBJECTS AND METHODS: One-hundred and two patients being treated at the NCI were interviewed. The most common diagnoses were breast cancer (31%), acute leukemia (24%), colorectal cancer (7%), non-Hodgkin lymphoma (5%), bladder cancer (4%), lung cancer (4%), and laryngeal cancer (4%). The two sexes were equally represented and so were metastatic and nonmetastatic diseases. The outpatient:inpatient ratio was 3:1. Treatments being received by these patients included chemotherapy, radiotherapy, hormonal therapy, and nonspecific therapy in 42%, 31%, 10%, and 17%, respectively. Other concomitant diseases were present in 22% of the patients.

RESULTS: While 40% of patients did not fast at all during Ramadan, 36% and 24% were partial and complete fasters, respectively. Female patients, those with performance status (PS) 0 to 1, those whose disease was a nonmetastatic solid tumor, and those receiving non-intravenous chemotherapy as outpatients were more likely to be fasting than their corresponding counterparts. Being a female, having PS 0 to 1, and receiving treatment as an outpatient were the only factors that were significant on multivariate analysis. Only 46% of patients sought the treating oncologist advice on whether they could fast.

CONCLUSIONS: Most cancer patients fast during Ramadan, but only half of them discuss the issue with their oncologists. We hope that our study stimulates more research on this topic.

Mohammad MA, Zeeneldin AA, Abd Elmageed ZY, Khalil EH, Mahdy SM, Sharada HM, et al. Clinical relevance of cyclooxygenase-2 and matrix metalloproteinases (MMP-2 and MT1-MMP) in human breast cancer tissue. Mol Cell Biochem. 2012;366(1-2):269-75. Abstractn/a

Breast cancer (BC) is the most common neoplasm among women in most developed countries, including Egypt. Elevated levels of certain proteins in human BC are associated with unfavorable prognosis and progressive stages of the disease. The aim of our study was to evaluate the protein expression profile and prognostic significance of cyclooxygenase-2 (COX-2), matrix metalloproteinase-2 (MMP-2), MMP-9 and membrane type 1-MMP (MT1-MMP) and their interaction in operable BC patients. The protein expression of COX-2, MMP-2 and MT1-MMP were evaluated by western blot technique, whereas enzymatic activity of MMP-2 and MMP-9 was determined by zymography in 47 breast cancer patients as well as normal adjacent tissues. Also, the correlation between these proteins and age, tumor size, LN stage, TNM stage, estrogen receptor, progesterone receptor, disease-free survival, and overall survival (OS) has been investigated. As compared to adjacent normal tissues, COX-2, MMP-2 and MT1-MMP were over-expressed in 43, 64, and 60 % of tumor tissues, respectively. In the same pattern, the activity of MMP-2 (62 %) and MMP-9 (45 %) was elevated in BC tissues. Multivariate analysis showed a positive correlation between the protein expression of COX-2, MMP-2, and MT1-MMP and the activity of MMP-2 and MMP-9 in BC patients. However, the enzymatic activity showed no correlation with clinicopathological features. This study confirms the preclinical evidence that COX-2 increased the expression of MT1-MMP, which in turn activates MMP-2. The lack of correlation with clinicopathological features, OS or disease-free survival ascertains the complexity of tumor progression and metastasis with many pro- and counter regulatory factors.

Zeeneldin AA, Taha FM, Moneer M. Past and future trends in cancer and biomedical research: a comparison between Egypt and the world using PubMed-indexed publications. BMC Res Notes. 2012;5:349. Abstractn/a

BACKGROUND: PubMed is a free web literature search service that contains almost 21 millions of abstracts and publications with almost 5 million user queries daily. The purposes of the study were to compare trends in PubMed-indexed cancer and biomedical publications from Egypt to that of the world and to predict future publication volumes.

METHODS: The PubMed was searched for the biomedical publications between 1991 and 2010 (publications dates). Affiliation was then limited to Egypt. Further limitation was applied to cancer, human and animal publications. Poisson regression model was used for prediction of future number of publications between 2011 and 2020.

RESULTS: Cancer publications contributed 23% to biomedical publications both for Egypt and the world. Egyptian biomedical and cancer publications contributed about 0.13% to their world counterparts. This contribution was more than doubled over the study period. Egyptian and world's publications increased from year to year with rapid rise starting the year 2003. Egyptian as well as world's human cancer publications showed the highest increases. Egyptian publications had some peculiarities; they showed some drop at the years 1994 and 2002 and apart from the decline in the animal: human ratio with time, all Egyptian publications in the period 1991-2000 were significantly more than those in 2001-2010 (P < 0.05 for all). By 2020, Egyptian biomedical and cancer publications will increase by 158.7% and 280% relative to 2010 to constitute 0.34% and 0.17% of total PubMed publications, respectively.

CONCLUSIONS: The Egyptian contribution to world's biomedical and cancer publications needs significant improvements through research strategic planning, setting national research priorities, adequate funding and researchers' training.

Ismail Y, Elzawahry H, Saber MA, Mokhtar N, Zeeneldin A. the Role of Ki67 and p53 in resistance to adjuvant hormonal treatment in early Breast cancer. Cairo: Cairo; 2012.
Mohammad MA, Zeeneldin AA, Elmageed ZA, Khalil EH, Mahdy SM, Sharada HM, et al. Clinical relevance of cyclooxygenase-2 and matrix metalloproteinases (MMP-2 and MT1-MMP) in human breast cancer tissue. Molecular and cellular biochemistry. 2012;366(1-2):269-75. Abstractn/a
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Zeeneldin AA, Ramadan M, Gaber AA, Taha FM. Clinico-pathological features of breast carcinoma in elderly Egyptian patients: A comparison with the non-elderly using population-based data. Journal of the Egyptian National Cancer Institute. 2012. Abstractn/a
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Zeeneldin AA, Saber MM, El-din IS, Farag SA. Colorectal carcinoma in gharbiah district, Egypt: Comparison between the elderly and non-elderly. Journal of Solid Tumors. 2012;2(3):p13. Abstractn/a
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Zeeneldin AA, Gaber AA, Taha FM. Does fasting during Ramadan trigger non-adherence to oral hormonal therapy in breast cancer patients? Journal of the Egyptian National Cancer Institute. 2012. Abstractn/a
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Zeeneldin AA, Taha FM. Fasting among Muslim cancer patients during the holy month of Ramadan. Annals of Saudi medicine. 2012;32(3):243. Abstractn/a
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Zeeneldin AA, Saadeldin MR. Tamoxifen in advanced hepatocellular carcinoma: a retrospective cohort study. Mediterranean Oncology Journal. 2012;2(2):43-9. Abstractn/a
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2011
Elshafiey MM, Zeeneldin AA, Elsebai HI, Moneer M, Mohamed DB, Gouda I, et al. Epidemiology and management of breast carcinoma in Egyptian males: experience of a single Cancer Institute. J Egypt Natl Canc Inst. 2011;23(3):115-22. Abstractn/a

OBJECTIVE: To assess the epidemiological and clinico-pathological features, surgical and reconstructive techniques, adjuvant treatments and clinical outcome of breast carcinoma in males (BCM) at the Egyptian National Cancer Institute (NCI).

PATIENTS AND METHODS: Thirty-two males with breast carcinoma presented to NCI between January 2000 and December 2002. They were evaluated by complete history, physical examination, laboratory and radiological investigations.

RESULTS: Median age was 59 years. Left sided and retroareolar breast lumps were the commonest presentations. Grade II tumors positive for hormone receptors were very common. Stages I, II, III and IV of the disease were encountered in 6.2%, 34.4%, 34.4% and 25.0% of patients, respectively. Curative surgery was done in 22 patients; they received adjuvant hormonal therapy, chemotherapy and radiotherapy in 22, 16 and 10 patients, respectively. Eight metastatic patients were treated with palliative measures. Surgery was done in 25 patients; the most common procedure was modified radical mastectomy (40.6%). Primary closure was feasible in 17 patients (68%), local flaps were needed in 4 cases (16%), while myocutaneous flap was done in 3 cases (12%). The commonest complication was the development of seroma (9 cases). The overall survival (OS) at 5 years was 65.4%. The disease free survival (DFS) at 5 years was 53.9%. Stage and curative surgery significantly affected OS, while type of surgery was the only variable significantly affecting DFS.

CONCLUSION: Male breast carcinoma occurs at older ages than females, usually in advanced stage. This necessitates directing attention of males and awareness on the prevalence and risk factors for this disease.

Elshafiey MM, Zeeneldin AA, Elsebai HI, Moneer M, Mohamed DB, Gouda I, et al. Epidemiology and management of breast carcinoma in Egyptian males: Experience of a single Cancer Institute. Journal of the Egyptian National Cancer Institute. 2011;23(3):115-22. Abstractn/a
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2010
Zekri JM, Ibrahim E, Al-Gahmi AM, Zeeneldin AA, Elkhodary TR, Gaballa HE, et al. A matched case-control study of Triple negative vs. HER-2 positive (irrespective of hormonal status) breast cancer: two subtypes with high risk features and poor outcome. Gulf J Oncolog. 2010;(7):14-20. Abstractn/a

Genetic profile studies of breast cancer identified a number of biologically different subtypes. These genetic subtypes are often surrogated by estrogen receptors (ER), progesterone receptors (PR) and HER2 status as measured by immunohistochemistry (IHC). Triple negative (TN) subtype is recognized to have high risk features and poor outcome. Over expression of the HER2 is also recognized as a poor outcome marker. The characteristics and outcome of HER2 positive tumours (irrespective of hormonal status) (HER2 HR+/-) identified by IHC have not addressed in the era of surrogate genetic subtyping. Therefore, we retrospectively compared the risk features and clinical outcome of patients with TN against these with HER2 HR+/- tumours.

Zekri JM, Ibrahim E, Ben Sadiq B, Al-Gahmi AM, Zeeneldin AA, Elkhodary TR, et al. A matched group study of triple negative versus HER-2 positive (irrespective of hormonal status) breast cancer: two subtypes with high-risk features and poor outcome. Ecancermedicalscience. 2010;4:167. Abstractn/a

INTRODUCTION: Genetic profile studies of breast cancer identified a number of biologically different subtypes. These genetic subtypes are often surrogated by oestrogen receptors (ERs), progesterone receptors (PR) and HER2 status as measured by immunohistochemistry (IHC). Triple negative (TN) subtype is recognized to have high-risk features and poor outcome. Over-expression of the HER2 is also recognized as poor outcome marker. The characteristics and outcome of HER2 positive tumours (irrespective of hormonal status) (HER2 HR+/-) identified by IHC have not addressed in the era of surrogate genetic subtyping. Therefore, we retrospectively compared the risk features and clinical outcome of patients with TN against these with HER2 HR+/- tumours.

PATIENTS AND METHODS: Forty patients with HER2 HR+/- tumours were matched for age and stage to 40 patients with TN tumours. Clinical and pathological data were collected retrospectively. All patients were managed in a single institution.

RESULTS: Tumour grade and stage and rate of pathologically involved lymph nodes were similar in both groups. There was a trend of more lymphovascular invasion in HER2 HR+/- than TN patients (40% vs. 27.5%. p=0.07). Relapse and death rates were not statistically different (p=0.469 and p=1.0, respectively). Median relapse free survival was 38 months for TN and not reached for HER2 HR+/- patients (Log rank; p=0.757). Median overall survival was not reached in both groups. Multivariate analysis did not identify TN or HER2 HR+/- status to have any differential impact on RFS.

CONCLUSION: HER2 HR+/- tumours exhibit high risk, presenting features and relatively poor clinical outcome possibly not very different from the increasingly recognized TN tumour.

Farag S, Saber MA, Seifeldin I, Zeeneldin A. Gastrointestinal tract Cancers in Egyptian Patients; Comparison between the elderly and non-elderly. Cairo: Cairo; 2010.
Zekri JM, Ibrahim E, Sadiq BB, Al-Gahmi AM, Zeeneldin AA, Elkhodary TR, et al. A Matched Group Study of Triple Negative vs. HER-2 Positive (irrespective of hormonal status) Breast Cancer: Two Subtypes with High Risk Features and Poor Outcome. Ecancermedicalscience. 2010. Abstract<p>n/a</p>

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Sallam Y, Nassar H, Zeeneldin A, Gaber A, Abodeef W. The prognostic significance of ki67 nuclear proliferation antigen and p53 tumour suppressor gene overexpression in aggressive B-cell lymphoma. The Medical journal of Cairo University.. 2010.
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