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    • DALYs as a tool for measuring the

    2019-04-22

    DALYs, as a tool for measuring the burden of breast cancer, is useful for public health and for burden of disease analyses. DALYs can add useful available information for monitoring services and conducting health-related economic analyses for cost-effective planning in the country. As noted earlier, there was an increase in DALYs between 1990 and 2010 for the age group 50–69 from 439.3 to 767.2 per 100,000 population per year due to population growth, with a small measure of increase due to aging. There was no substantial change in age-specific prevalence, probably because of the high number of new cases of breast cancer among younger females. The WHO report in 2014 stated that most of the regional and country-level differences in YLDs due to breast cancer might be due to some exceptional countries with statistically higher or lower YLD rates compared to the global mean. YLD rates were highest in Yemen, one of the countries in the North Africa/Middle Eastern region where there is a wide and overlapping range of uncertainty observed in data calculation for breast cancer and other types of diseases. These findings suggest that the different parameters used in this study expressed the importance of analyzing the burden of the disease using different epidemiological approaches with higher weights. They also suggest that these parameters should be used to show the burden of the specific disease, rather than the classical approach where the focus is to study mortality more than disability. This method will also allow for an increased precision in the measurement of disease such as breast cancer, and comparisons with other populations might be easier, either at the same rank of the human development index or even higher.
    Conclusion
    Conflict of interest
    Introduction
    Case report
    Discussion Lymphoepithelioma-like cholangiocarcinoma is histologically characterized by large undifferentiated p2x7 receptor with vesicular nuclei, prominent nucleoli, indistinct cell borders, and dense lymphoplasma cell infiltrations. In reviewing the English literature, only 27 cases of LELCC were reported. Clinical characteristics and pathologic features are summarized in Table 1. In reported cases of all 27 patients, a female-predominant (16/27) trend is observed. The median study participant age was 57, and about 70% (19/27) of the cases were positive with EBER in situ hybridization. Interestingly, the geographical distribution of reported cases was similar to nasopharyngeal carcinoma, with 69% (20/29) of the cases arising from east and southeast parts of Asia. How EBV infection contributes to carcinogenesis of LELCC needs further investigation. Epstein–Barr virus DNA in serum/plasma has been reported as a prognostic marker for nasopharyngeal carcinoma. The presence of Epstein–Barr nuclear antigen 1 (EBNA-1) DNA in peripheral blood is a risk factor for patients with nasopharyngeal carcinoma developing distant metastasis as well as a lower survival rate. Furthermore, pretreatment plasma EBV DNA copy number and their clearance rates are also significant predictors for treatment outcome in patients with nasopharyngeal cancer. Whether EBV DNA in peripheral blood level can be used as a prognostic factor in patients with LELCC is not well-defined. To our knowledge, we were the first researchers to report elevated serum EBV DNA in patients with LELCC. In this case report, we demonstrated elevated EBV DNA level in a patient with advanced LELCC, and clearance after initial chemotherapy. The purpose of our study was to confirm whether peripheral blood EBV DNA level might correlate with disease progression in patients LELCC associated with EBV. Additionally, we further intended to assess EBV DNA titer in patients with LELCC associated with EBV. The outcome of early LELCC is reported to be better than classical intra-hepatic cholangiocarcinoma (IHCC). Chan et al reported a seven-patient case series with surgically resected stage I LELCC, which demonstrated better overall survival and disease-free survival compared to randomly selected stage I IHCC. However, the clinical outcome and optimal treatment of advanced LELCC remains unknown. We reported the first Asian patient with advanced LELCC treated with systemic chemotherapy. Gemcitabine, a nucleoside analog, was reported to have an objective response rate of 0–30% as a single-agent, and 21–35% as combination therapy with cisplatin in treating bile duct cancer. In patients with nasopharyngeal carcinoma, gemcitabine also has an objective response rate of 28–48% as a single-agent, and 64–92% as combination therapy with cisplatin. In this case, we opted for combination therapy of cisplatin and gemcitabine for this patient based on the literature reports. However, the result was quite dismal despite initial EBV DNA response after one cycle of cisplatin and gemcitabine.