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Nguyen KH, Joo H, Manuel S, Chen LM, Chen LL. Incorporating low haemoglobin into a risk prediction model for conversion in minimally invasive gynaecologic oncology surgeries. J OBSTET GYNAECOL 2024; 44:2349960. [PMID: 38783693 DOI: 10.1080/01443615.2024.2349960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/24/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND A well-known complication of laparoscopic management of gynaecologic masses and cancers is the need to perform an intraoperative conversion to laparotomy. The purpose of this study was to identify novel patient risk factors for conversion from minimally invasive to open surgeries for gynaecologic oncology operations. METHODS This was a retrospective cohort study of 1356 patients ≥18 years of age who underwent surgeries for gynaecologic masses or malignancies between February 2015 and May 2020 at a single academic medical centre. Multivariable logistic regression was used to study the effects of older age, higher body mass index (BMI), higher American Society of Anaesthesiologist (ASA) physical status, and lower preoperative haemoglobin (Hb) on odds of converting from minimally invasive to open surgery. Receiver operating characteristic (ROC) curve analysis assessed the discriminatory ability of a risk prediction model for conversion. RESULTS A total of 704 planned minimally invasive surgeries were included with an overall conversion rate of 6.1% (43/704). Preoperative Hb was lowest for conversion cases, compared to minimally invasive and open cases (11.6 ± 1.9 vs 12.8 ± 1.5 vs 11.8 ± 1.9 g/dL, p<.001). Patients with preoperative Hb <10 g/dL had an adjusted odds ratio (OR) of 3.94 (CI: 1.65-9.41, p=.002) for conversion while patients with BMI ≥30 kg/m2 had an adjusted OR of 2.86 (CI: 1.50-5.46, p=.001) for conversion. ROC curve analysis using predictive variables of age >50 years, BMI ≥30 kg/m2, ASA physical status >2, and preoperative haemoglobin <10 g/dL resulted in an area under the ROC curve of 0.71. Patients with 2 or more risk factors were at highest risk of requiring an intraoperative conversion (12.0%). CONCLUSIONS Lower preoperative haemoglobin is a novel risk factor for conversion from minimally invasive to open gynaecologic oncology surgeries and stratifying patients based on conversion risk may be helpful for preoperative planning.
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Węgierek-Ciuk A, Lankoff A, Lisowska H, Kędzierawski P, Akuwudike P, Lundholm L, Wojcik A. Cisplatin Reduces the Frequencies of Radiotherapy-Induced Micronuclei in Peripheral Blood Lymphocytes of Patients with Gynaecological Cancer: Possible Implications for the Risk of Second Malignant Neoplasms. Cells 2021; 10:2709. [PMID: 34685687 PMCID: PMC8534481 DOI: 10.3390/cells10102709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/06/2021] [Accepted: 10/06/2021] [Indexed: 01/22/2023] Open
Abstract
Gynaecologic cancers are common among women and treatment includes surgery, radiotherapy or chemotherapy, where the last two methods induce DNA damage in non-targeted cells like peripheral blood lymphocytes (PBL). Damaged normal cells can transform leading to second malignant neoplasms (SMN) but the level of risk and impact of risk modifiers is not well defined. We investigated how radiotherapy alone or in combination with chemotherapy induce DNA damage in PBL of cervix and endometrial cancer patients during therapy. Blood samples were collected from nine endometrial cancer patients (treatment with radiotherapy + chemotherapy-RC) and nine cervical cancer patients (treatment with radiotherapy alone-R) before radiotherapy, 3 weeks after onset of radiotherapy and at the end of radiotherapy. Half of each blood sample was irradiated ex vivo with 2 Gy of gamma radiation in order to check how therapy influenced the sensitivity of PBL to radiation. Analysed endpoints were micronucleus (MN) frequencies, apoptosis frequencies and cell proliferation index. The results were characterised by strong individual variation, especially the MN frequencies and proliferation index. On average, despite higher total dose and larger fields, therapy alone induced the same level of MN in PBL of RC patients as compared to R. This result was accompanied by a higher level of apoptosis and stronger inhibition of cell proliferation in RC patients. The ex vivo dose induced fewer MN, more apoptosis and more strongly inhibited proliferation of PBL of RC as compared to R patients. These results are interpreted as evidence for a sensitizing effect of chemotherapy on radiation cytotoxicity. The possible implications for the risk of second malignant neoplasms are discussed.
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Yoo J, Jung Y, Ahn JH, Choi YJ, Lee KH, Hur S. Incidence and clinical course of septic shock in neutropenic patients during chemotherapy for gynecological cancers. J Gynecol Oncol 2020; 31:e62. [PMID: 32808493 PMCID: PMC7440980 DOI: 10.3802/jgo.2020.31.e62] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/01/2020] [Accepted: 04/10/2020] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To identify the incidence and clinical course of septic shock combined with neutropenia during chemotherapy in gynecological cancer patients. METHODS We retrospectively reviewed the medical records of all gynecological cancer patients who received intravenous chemotherapy between March 2009 and March 2018. Patients diagnosed with neutropenic septic shock (NSS) during the course of chemotherapy were identified. We calculated the overall incidence and mortality rate of NSS, and analyzed risk factors and clinical course. RESULTS A total of 1,009 patients received 10,239 cycles of chemotherapy during the study period. Among these, 30 (3.0%) patients had 32 NSS events, of which 12 (1.2%) died. With respect to patient age during the first course of chemotherapy, the incidence of NSS after the age of 50 was significantly higher than that in patients under 50 (3.9% vs. 1.4%, p=0.034). As the number of chemotherapy courses increased, the incidence of NSS increased, and linear-by-linear association analysis showed a positive correlation (p=0.004). NSS events occurred on average 7.8 days after the last cycle of chemotherapy, and the median duration of vasopressor administration was 23.3 hours. The median age (64.0 vs. 56.5, p=0.017) and peak heart rate (149.5 min-1 vs. 123.5 min-1, p=0.015) were significantly higher in the group of patients who subsequently died of NSS than in those who survived. CONCLUSION The overall incidence of NSS in gynecological cancer patients receiving chemotherapy was 3.0%, which is higher than previously estimated. Peak heart rate during NSS events may be an indicator for predicting survival.
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Wang Q, Peng H, Qi X, Wu M, Zhao X. Targeted therapies in gynecological cancers: a comprehensive review of clinical evidence. Signal Transduct Target Ther 2020; 5:137. [PMID: 32728057 PMCID: PMC7391668 DOI: 10.1038/s41392-020-0199-6] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/12/2020] [Accepted: 05/20/2020] [Indexed: 12/11/2022] Open
Abstract
Advanced and recurrent gynecological cancers are associated with poor prognosis and lack of effective treatment. The developments of the molecular mechanisms on cancer progression provide insight into novel targeted therapies, which are emerging as groundbreaking and promising cancer treatment strategies. In gynecologic malignancies, potential therapeutic targeted agents include antiangiogenic agents, poly (ADP-ribose) polymerase (PARP) inhibitors, tumor-intrinsic signaling pathway inhibitors, selective estrogen receptor downregulators, and immune checkpoint inhibitors. In this article, we provide a comprehensive review of the clinical evidence of targeted agents in gynecological cancers and discuss the future implication.
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Franza L, Costantini B, Corrado G, Spanu T, Covino M, Ojetti V, Quagliozzi L, Biscione A, Taccari F, Fagotti A, Scambia G, Tamburrini E. Risk factors for bloodstream infections in gynecological cancer. Int J Gynecol Cancer 2020; 30:245-251. [PMID: 31915135 DOI: 10.1136/ijgc-2019-000861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/29/2019] [Accepted: 10/31/2019] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Infections are a threat to frail patients as they have a higher risk of developing serious complications from bloodstream pathogens. The aim of this study was to determine which factors can predict or diagnose bloodstream infections in patients with an underlying gynecologic malignancy. MATERIALS AND METHODS Between July 2016 and December 2017, 68 patients visiting the emergency room with an underlying gynecologic malignancy were evaluated. Variables concerning underlying disease, invasive procedures, and laboratory and clinical parameters were analyzed. Patients were divided into three groups based on their blood and urine specimens (positive blood specimens, positive urine specimens, and no positive specimens; patients who had both positive blood and urine specimens were included in the group of positive blood specimens). Risk factors for surgical site infections, recent (<30 days) surgery, and chemotherapy were studied separately. RESULTS 68 patients were included in the analysis. Mean age was 55.6 years (standard deviation 14.1). 44% of patients had ovarian cancer, 35% cervical cancer, 12% endometrial cancer, and 9% had other cancer types. In total, 96% of all patients had undergone surgery. Patients who had been treated with chemotherapy were at a higher risk of developing bloodstream infection (P=0.04; odds ratio (OR)=7.9). C reactive protein, bilirubin, and oxygen saturation (SO2) were significantly different between patients with an underlying infection and those who had none. Only C reactive protein maintained its significance in a linear model, with a cut-off of 180 mg/L (linear regression, P=0.03; OR=4). CONCLUSIONS Chemotherapy is a risk factor for the development of bloodstream infections in patients with an underlying gynecologic malignancy; C reactive protein could be a useful tool in making this diagnosis.
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Abdel Aziz MT, Abdel Aziz Wassef M, Kamel M, el Zein M, el Hassan H. Clinical Evaluation of Serum Aminoterminal Propeptide of Type III Procollagen as Tumor Marker in Gynecologic Malignancies. TUMORI JOURNAL 2018; 79:219-23. [PMID: 8236508 DOI: 10.1177/030089169307900313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims The aim of this study was to determine the possible usefulness of the assay of the aminoterminal propeptide of type III procollagen and fibronectin in detecting connective tissue changes associated with gynecologic malignancies. Study Design Serum aminoterminal propeptide of type III procollagen and plasma fibronectin were measured in 36 women with gynecologic malignancies, 20 women with benign gynecologic tumors and 10 healthy women serving as controls. Results A significant serum propeptide was significantly high In the group with gynecologic malignancies and normal in the benign tumor group. The serum propeptide levels were related to of disease stage and presence of ascites in patients with ovarian carcinoma but not in those with cervical or endometrial carcinoma. In the follow-up study, a favorable clinical response was associated with normalizing propeptide levels whereas in rapidly progressive disease the levels fell initially but rose again. In partial response with ultimate progression, the propeptide concentration decreased but remained clearly above the normal range. No difference in plasma fibronectin was found among the malignant tumor, benign tumor and control groups. Conclusions The present study indicates that the aminoterminal propeptide of type III procollagen could serve as an additional, non specific marker to follow the clinical behavior of gynecologic malignancies and consequently of connective tissue metabolism reflecting tumor matrix interaction.
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Rella C, Coviello M, De Frenza N, Falco G, Chiuri E, Colavito P, Quaranata M, De Leonardis A. Plasma D-Dimer Measurement as a Marker of Gynecologic Tumors: Comparison with CA 125. TUMORI JOURNAL 2018; 79:347-51. [PMID: 8116080 DOI: 10.1177/030089169307900513] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Fibrin is formed and degraded Intra-abdominally in ovarian cancer, and the cross-linked fibrin degradation product, D-dimer (D-D), has been found in increased concentrations In the plasma of these patients. Methods D-dimer and Ca 125 levels were determined simultaneously in 110 patients with gynecologic neoplasms. D-dimer and Ca 125 assays were performed using the Dimertest Stripwell EIA Kit (Ortho) and CA 125-11 EIA assay (Roche), respectively. Results D-dimer plasma and Ca 125 serum levels were significantly higher in patients with ovarian cancer (mean ± SE = 894.2 ± 173.7 ng/ml and 760.5 ± 292.7 U/ml, respectively) than in those with uterine cancer (mean DD ± SE = 109.7 ± 23.5 ng/ml and mean Ca 125 ± SE = 50.0 ± 23.1 U/ml) or those with benign disease (mean D-D ± SE = 70.5 ± 5.5 ng/ml and mean Ca 125 ± SE = 6.6 ± 2.8 U/ml). The levels of both markers Increased with regard to ovarian cancer disease status. Mean D-D ± SE was 90.0 ± 22.8 ng/ml and mean Ca 125 ± SE was 2.1 ±1.2 U/ml in patients with complete remission; mean D-D ± SE was 143.3 ± 33.5 ng/ml and mean Ca 125 ± SE was 26.2 ± 13.6 U/ml in patients with partial remission. In active disease, both markers had very high levels: D-D mean ± SE = 1021.6 ± 173.0 ng/ml and Ca 125 mean ± SE = 1154.7 ± 458.1 U/ml. In all groups of ovarian cancer patients, D-dimer sensitivity was better than that of Ca 125. In advanced ovarian cancer patients, the D-dimer concentration in ascites was up to 100 fold that in plasma. Conclusions Our results suggest that D-dimer can serve as a sensitive indicator to monitor the extent and course of the disease in ovarian cancer patients. The patient follow-up is ongoing to establish the predictive value of D-dimer measurement with respect to prognosis.
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Yan L, Gu Y, Luan T, Miao M, Jiang L, Liu Y, Li P, Zeng X. Associations between serum vitamin D and the risk of female reproductive tumors: A meta-analysis with trial sequential analysis. Medicine (Baltimore) 2018; 97:e0360. [PMID: 29642181 PMCID: PMC5908580 DOI: 10.1097/md.0000000000010360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 02/06/2018] [Accepted: 03/15/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Female reproductive tumors are common with high morbidity and mortality worldwide; however, the association between gynecological tumors and serum vitamin D is controversial. The aim of this meta-analysis was to evaluate the relationship between insufficiency of serum vitamin D and the occurrence of benign and malignant gynecological tumors. METHODS Studies from inception to June 2017 were searched in the electronic databases: National Library of Medicine (PubMed), Web of Science (Clerivate), and Cochrane Database of Systematic Reviews (Cochrane Library, CDSR) by 2 investigators independently. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. STATA 12.0 Software and Trial Sequential Analysis (TSA) software were applied for data analyses. RESULTS Overall, 8 studies (including 2391 patients and 5798 patients with and without female reproductive tumors, respectively) were eligible for the present meta-analysis. In the subsequent meta-analysis, the occurrence of vitamin D deficiency in the case and control groups were 52.36% and 48.70%, respectively; women with female reproductive benign and malignant tumors were 55.57% and 50.59%, respectively. Although, no conclusive association was found between vitamin D deficiency and female reproductive tumors (OR, 1.05; 95% CI, 0.85-1.31); vitamin D deficiency may be a risk factor of malignant female reproductive neoplasm, as shown by the pooled OR (95% CI):1.17 (1.02-1.33). Furthermore, based on the OR values, association of vitamin D insufficiency with disease type, study location, number of patients, and methods for detecting CLA was observed. Similar results in the sensitivity analysis were observed. TSA showed that the cumulative Z-curve crossed the traditional boundary line, rather than crossing the trial sequential monitoring boundary. However, the cumulative information failed to reach the required information size. CONCLUSIONS Currently, vitamin D deficiency appears to be a common issue in females, and there may be an urgent need to improve the level of vitamin D. Furthermore, vitamin D deficiency may be a non-negligible risk factor of malignant female reproductive neoplasm. Undoubtedly, more trials are required in the future according to TSA.
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Salman T, el-Ahmady O, Sawsan MR, Nahed MH. The clinical value of serum TPS in gynecological malignancies. Int J Biol Markers 2018; 10:81-6. [PMID: 7561243 DOI: 10.1177/172460089501000203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study included 75 cases; 39 with gynecological cancer of different types, stages, and grades (14 ovarian, 11 endometrial, 9 cervical, and 5 vulvovaginal); 23 patients with benign gynecological diseases and 13 normal healthy controls. Serum TPS was estimated using the ELISA kit supplied by Beki Diagnostic AB, Bromma, Sweden. The results of the present study revealed that serum TPS was significantly elevated in cancer patients followed by those with benign diseases. When the cutoff values were adjusted to 137 and 101 U/L, we obtained sensitivities of 56.4% and 82.1% at specifities of 100% and 85%, respectively. The benign diseases group had false positive rates of 13% and 34.8%, respectively. When considering tumor site, vulvo vaginal cancer showed the highest sensitivity (80%) followed by cervical (66.7%), ovarian (50%), and lastly endometrial cancer (45.5%). Serial measurement of TPS was shown to be of important value in the post-surgical follow-up of cancer patients.
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Wang HP, Wu HY, Wang Y, Wang L. Combined detection of tumor markers and serum inflammatory factors in the diagnosis and treatment of gynecologic oncology. J BIOL REG HOMEOS AG 2017; 31:691-695. [PMID: 28956419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In recent years, gynecologic cancer has become the third leading cause of death for women world-wide. Serum tumor markers and inflammatory factors have been shown to be useful in the diagnosis of gynecological tumors. Therefore, the clinical value of the combined detection of tumor markers and serum inflammatory factors in the diagnosis of gynecologic oncology was studied. One hundred patients with gynecological tumors admitted to our hospital were selected as the tumor group, and 50 healthy volunteers were selected as the control group. According to clinical diagnosis, the tumor group was divided into a malignant tumor group and a benign tumor group. The levels of CA199, CA125, and CEA in each serum were measured by the Elecsys2010 automatic electrochemiluminescence immunoassay system. The levels of serum TNF-α and IL-17 were determined by enzyme-linked immunosorbent assay (ELISA). Our results showed that, when compared with the control group, the levels of CA199, CA125, CEA, TNF-α, and IL-17 in serum of the benign tumor group were significantly increased (P<0.001), and were further increased in the malignant tumor group. Moreover, the positive detection rates of combined detection of CA199, CA125, CEA, TNF-α, and IL-17 for malignant and benign tumors were significantly higher than that of single detection (P<0.05), and the positive detection rate of combined detection of malignant tumors was significantly higher than that of benign tumors (P<0.05). These results indicate that the combined detection of inflammatory factors and tumor markers has a high clinical value in the diagnosis and treatment of gynecological tumors and is worth adopting.
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Graul A, Latif N, Zhang X, Dean LT, Morgan M, Giuntoli R, Burger R, Kim S, Schmitz K, Ko E. Incidence of Venous Thromboembolism by Type of Gynecologic Malignancy and Surgical Modality in the National Surgical Quality Improvement Program. Int J Gynecol Cancer 2017; 27:581-587. [PMID: 28187092 PMCID: PMC5539959 DOI: 10.1097/igc.0000000000000912] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Women with gynecologic cancer are at higher risk of venous thromboembolism (VTE) due to malignancy, pelvic surgery, increased age, and frequently comorbidities. The rate of VTE among different gynecologic cancers and relative to benign gynecologic surgeries has not been reported in a nationally representative cohort. METHODS Using the American College of Surgeons National Surgical Quality Improvement Program database, gynecologic surgeries were identified retrospectively from 2006 to 2012. Clinical characteristics, surgical procedures, and 30-day postoperative complications were abstracted. Multivariable logistic regression models were performed. RESULTS Of all gynecologic surgeries (n = 104,368), 11,427 were performed for malignancy: 2.7% (n = 2800) for ovarian cancer, 6.8% (n = 7114) for uterine cancer, 1.0% (n = 1026) for cervical cancer, and 0.5%(n = 487) for vulvar cancer. 202 (1.8%) patients experienced a VTE. Ovarian cancer had a deep venous thrombosis and pulmonary embolism rates of 1.6% and 1.5% compared with uterine cancer, 0.8% and 0.8%, respectively. Ovarian cancer patients were 1.8 (95% confidence interval [CI], 1.19-2.65) times more likely to have a deep venous thrombosis and 1.7 (95% CI, 1.11-2.51) times more likely to have a pulmonary embolism than patients with uterine cancer. Compared with all gynecologic cancer surgeries, ovarian cancer patients were 1.5 times more likely to have a VTE (95% CI, 1.10-2.16). Patients undergoing minimally invasive surgery were 64% less likely to have a VTE regardless of malignancy site; however, if they had disseminated disease, they remained at higher risk of VTE (odds ratio, 5.96; P = 0.027). CONCLUSIONS Of gynecologic cancer surgeries, ovarian cancer patients had the highest rate of VTE. Venous thromboembolism rates were lower in those who had minimally invasive surgery but remained higher in those with disseminated disease.
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Sun Y, Meng H, Jin Y, Shi X, Wu Y, Fan D, Wang X, Jia X, Dai H. Serum lipid profile in gynecologic tumors: a retrospective clinical study of 1,550 patients. EUR J GYNAECOL ONCOL 2016; 37:348-352. [PMID: 27352562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND The study was performed to characterize and compare the serum lipid profile in gynecologic cancers and benign diseases. MATERIALS AND METHODS A total of 1,550 age-matched females were included in this study: 760 patients with gynecologic cancers and 790 patients with benign diseases. Serum levels of triglycerides (TG), high density lipoprotein cholesterol (HDL-c), low density lipoprotein cholesterol (LDL-c), total cholesterol (TC), and lipoprotein (a) were measured. RESULTS Compared to gynecologic benign disease group, gynecologic cancer group was associated with higher level of TG (p = 0.0002), as well as lower level of HDL-c (p < 0.0001), LDL-c (p = 0.004) and TC (p = 0.003). Compared to benign ovarian tumor group, ovarian cancer group had significantly lower levels of HDL-c (p < 0.0001), LDL-c (p = 0.0009), and TC (p < 0.0001), as well as a trend of higher level of lipoprotein (a) (p = 0.10). Compared to endometriosis group, endometrial cancer group showed higher levels of TG (p < 0.0001) and lower levels of HDL-c (p = 0.002). There was no significant difference in any lipid parameters between cervical cancer group and uterine leiomyomas group. CONCLUSION In conclusion, compared with benign diseases, gynecologic cancers are associated with a disordered lipid profile characterized by higher TG and lipoprotein (a) levels, and lower HDL-c, LDL-c, and TC levels. The association is most conspicuous in ovarian cancers. Endometrial cancer is accompanied by alterations only in TG and HDL-c levels, while cervical cancer does not appear to be associated with disordered lipid profile.
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Pereira E, Camacho-Vanegas O, Anand S, Sebra R, Catalina Camacho S, Garnar-Wortzel L, Nair N, Moshier E, Wooten M, Uzilov A, Chen R, Prasad-Hayes M, Zakashansky K, Beddoe AM, Schadt E, Dottino P, Martignetti JA. Personalized Circulating Tumor DNA Biomarkers Dynamically Predict Treatment Response and Survival In Gynecologic Cancers. PLoS One 2015. [PMID: 26717006 DOI: 10.1371/journal.pone.0145754] [] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND High-grade serous ovarian and endometrial cancers are the most lethal female reproductive tract malignancies worldwide. In part, failure to treat these two aggressive cancers successfully centers on the fact that while the majority of patients are diagnosed based on current surveillance strategies as having a complete clinical response to their primary therapy, nearly half will develop disease recurrence within 18 months and the majority will die from disease recurrence within 5 years. Moreover, no currently used biomarkers or imaging studies can predict outcome following initial treatment. Circulating tumor DNA (ctDNA) represents a theoretically powerful biomarker for detecting otherwise occult disease. We therefore explored the use of personalized ctDNA markers as both a surveillance and prognostic biomarker in gynecologic cancers and compared this to current FDA-approved surveillance tools. METHODS AND FINDINGS Tumor and serum samples were collected at time of surgery and then throughout treatment course for 44 patients with gynecologic cancers, representing 22 ovarian cancer cases, 17 uterine cancer cases, one peritoneal, three fallopian tube, and one patient with synchronous fallopian tube and uterine cancer. Patient/tumor-specific mutations were identified using whole-exome and targeted gene sequencing and ctDNA levels quantified using droplet digital PCR. CtDNA was detected in 93.8% of patients for whom probes were designed and levels were highly correlated with CA-125 serum and computed tomography (CT) scanning results. In six patients, ctDNA detected the presence of cancer even when CT scanning was negative and, on average, had a predictive lead time of seven months over CT imaging. Most notably, undetectable levels of ctDNA at six months following initial treatment was associated with markedly improved progression free and overall survival. CONCLUSIONS Detection of residual disease in gynecologic, and indeed all cancers, represents a diagnostic dilemma and a potential critical inflection point in precision medicine. This study suggests that the use of personalized ctDNA biomarkers in gynecologic cancers can identify the presence of residual tumor while also more dynamically predicting response to treatment relative to currently used serum and imaging studies. Of particular interest, ctDNA was an independent predictor of survival in patients with ovarian and endometrial cancers. Earlier recognition of disease persistence and/or recurrence and the ability to stratify into better and worse outcome groups through ctDNA surveillance may open the window for improved survival and quality and life in these cancers.
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MESH Headings
- Adult
- Aged
- Biomarkers, Tumor/blood
- Biomarkers, Tumor/genetics
- Breast Neoplasms/blood
- Breast Neoplasms/drug therapy
- Breast Neoplasms/genetics
- Breast Neoplasms/mortality
- CA-125 Antigen/blood
- DNA, Neoplasm/blood
- DNA, Neoplasm/genetics
- Endometrial Neoplasms/blood
- Endometrial Neoplasms/drug therapy
- Endometrial Neoplasms/genetics
- Endometrial Neoplasms/mortality
- Exome/genetics
- Female
- Genital Neoplasms, Female/blood
- Genital Neoplasms, Female/drug therapy
- Genital Neoplasms, Female/genetics
- Genital Neoplasms, Female/mortality
- Humans
- Middle Aged
- Mutation/genetics
- Neoplasm Recurrence, Local/blood
- Neoplasm Recurrence, Local/genetics
- Ovarian Neoplasms/blood
- Ovarian Neoplasms/drug therapy
- Ovarian Neoplasms/mortality
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Haug H, Lüthgens M, Schlegel G, Peter G. Cancer testing in a large German hospital with special reference to immunoglobulin E (IgE) and amino acid patterns in cancer patients. ANTIBIOTICS AND CHEMOTHERAPY 2015; 22:85-97. [PMID: 74975 DOI: 10.1159/000401154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Check JH, Sarumi M, DiAntonio A, Hunter K, Simpkins G, Duroseau M. Serum levels of the progesterone induced blocking factor do not precipitously rise in women with gynecologic cancer in contrast to women exposed to progesterone. CLIN EXP OBSTET GYN 2015; 42:563-567. [PMID: 26524797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE To determine if an immunomodulatory protein (progesterone induced blocking factor [PIBF]) that is progesterone induced and found in higher concentration during pregnancy is similarly found with increased levels in women with gynecologic cancers. MATERIALS AND METHODS A newly developed enzyme linked immunoabsorbent assay (ELISA) assay was used to measure PIBF in the sera of six women with various gynecologic cancers and compare them to five controls (three with benign tumors and two having gynecologic procedures for non-tumors. RESULTS The PIBF levels in women with gynecologic cancer did not rise precipitously as historical controls of women or men exposed to progesterone. The two highest PIBF levels of the 11 subjects were in women with gynecologic cancer. CONCLUSIONS The data suggest that if PIBF helps cancer cells to evade immune surveillance, it probably operates through an intracytoplasmic presence. If an increase in sera PIBF could have been detected in women with gynecologic cancer, then this ELISA test could have been used to detect tumor recurrence. Future studies may concentrate on evaluating intracytoplasmic PIBF to possibly help determine which tumors may respond to progesterone antagonist receptors.
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Wu MM, Chen HC, Chen CL, You SL, Cheng WF, Chen CA, Lee TC, Chen CJ. A prospective study of gynecological cancer risk in relation to adiposity factors: cumulative incidence and association with plasma adipokine levels. PLoS One 2014; 9:e104630. [PMID: 25115836 PMCID: PMC4130554 DOI: 10.1371/journal.pone.0104630] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 07/11/2014] [Indexed: 12/19/2022] Open
Abstract
Background Associations of obesity and obesity-related metabolic factors (adiposity factors) with uterine corpus cancer (UCC) and ovarian cancer (OVC) risk have been described. Still, a cause-effect relationship and the underlying mediators remain unclear, particularly for low-incidence populations. We aimed to prospectively determine whether adiposity factors could predict the development of UCC and OVC in Taiwanese women. To explore the biological mediators linking adiposity factors to cancer risk, we examined the association of two adipokines, leptin and adiponectin, with the gynecological cancers. Methods Totally, 11,258 women, aged 30–65, were recruited into the Community-Based Cancer Screening Program (CBCSP) study during 1991–1993, and were followed for UCC and OVC cases until December 31, 2011. Cox proportional hazard models were used to estimate hazard ratios (HRs). Adiposity factors and risk covariates were assessed at recruitment. Newly-developed cancer cases were determined from data in the government’s National Cancer Registry and Death Certification System. For adipokienes study, a nested case-control study was conducted within the cohort. Baseline plasma samples of 40 incident gynecological cancer cases and 240 age-menopause-matched controls were assayed for adipokines levels. Findings There were 38 and 30 incident cases of UCC and OVC, respectively, diagnosed during a median 19.9 years of follow-up. Multivariate analysis showed that alcohol intake (HR = 16.00, 95% = 4.83–53.00), high triglyceride levels (HR = 2.58, 95% = 1.28–5.17), and years of endogenous estrogen exposure per 5-year increment (HR = 1.91, 95% = 1.08–3.38) were associated with increased UCC risk. High body mass index (BMI≥27 kg/m2, HR = 2.90, 95% = 1.30–6.46) was associated with increased OVC risk. Analysis further showed an independent effect of adipokines on UCC and OVC risk after adjustment of the risk covariates. Conclusion We provided evidence that alcohol intake, high triglyceride levels and long endogenous estrogen exposure increase UCC risk, whereas obesity positively predicts OVC risk. Circulating adipokines may mediate the link of adiposity factors to gynecological cancer risk.
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Morimoto A, Ueda Y, Yokoi T, Tokizawa Y, Yoshino K, Fujita M, Kimura T, Kobayashi E, Matsuzaki S, Egawa-Takata T, Sawada K, Tsutsui T, Kimura T. Perioperative venous thromboembolism in patients with gynecological malignancies: a lesson from four years of recent clinical experience. Anticancer Res 2014; 34:3589-3595. [PMID: 24982374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM To analyze clinical characteristics of venous thromboembolisms (VTE) in gynecological malignancies, and to find a cost-effective prophylaxis procedure for post-operative VTE. PATIENTS AND METHODS We analyzed clinical characteristics of 751 patients who underwent definitive surgery for gynecologic malignancies, and cost-effectiveness of VTE prophylaxis. RESULTS VTE was diagnosed preoperatively in 4.5% of ovarian cancer cases, more frequently than any other type (p<0.005). Older age and greater length of operation were independent risk factors for postoperative VTE. To prevent eight VTEs in 738 malignant cases, which occurred during day 2 to 10, $617,783, $726,185, or $994,222 were necessary for continuous VTE prophylaxis, using either unfractionated heparin (UFH), low-molecular weight heparin or fondaparinux, respectively. CONCLUSION A strategy which might be cost-effective for post-surgical management of gynecological malignances is use of UFH three times combined with graduated compression stockings and intermittent pneumatic compression, thorough SpO2 monitoring, and perioperative measurements of the circumference of both sides of thighs and calves.
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Schmeler KM, Wilson GL, Cain K, Munsell MF, Ramirez PT, Soliman PT, Nick AM, Frumovitz M, Coleman RL, Kroll MH, Levenback CF. Venous thromboembolism (VTE) rates following the implementation of extended duration prophylaxis for patients undergoing surgery for gynecologic malignancies. Gynecol Oncol 2013; 128:204-8. [PMID: 23200912 PMCID: PMC3826112 DOI: 10.1016/j.ygyno.2012.11.027] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 11/16/2012] [Accepted: 11/17/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare the incidence of venous thromboembolism (VTE) before and after the implementation of standardized extended duration prophylaxis guidelines in women undergoing laparotomy for gynecologic cancer. METHODS In October 2009, departmental practice guidelines were implemented for VTE prevention. Patients undergoing laparotomy for gynecologic cancer were started on low molecular weight heparin (LMWH) within 24h of surgery and it was continued for a total of 28 days postoperatively. The incidence of VTE diagnosed within 30 and 90 days of surgery was determined and compared to a historic cohort of patients who underwent surgery prior to implementation of the guidelines. RESULTS The incidence of VTE within 30 days of surgery decreased from 2.7% (8/300) to 0.6% (2/334) following implementation of VTE prevention guidelines (78% reduction, p=0.040). However, when the pre and post-guideline implementation groups were compared for the development of VTE within 90 days of surgery, there was no significant difference (11/300 (3.7%) vs. 10/334 (3.0%) respectively, p=0.619). The median time between surgery and VTE diagnosis was 12 days in the pre-guideline implementation group, compared with 57 days in the post-guideline implementation group (p=0.012). CONCLUSION Patients receiving extended duration LMWH were found to have significantly lower rates of VTE within 30 days of surgery when compared with similar patients who did not receive extended duration LMWH. However, this effect was not sustained when the groups were compared for VTE diagnosis within 90 days of surgery. Additional study is needed to further reduce long-term VTE rates in this high-risk population.
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Han SN, Lotgerink A, Gziri MM, Van Calsteren K, Hanssens M, Amant F. Physiologic variations of serum tumor markers in gynecological malignancies during pregnancy: a systematic review. BMC Med 2012; 10:86. [PMID: 22873292 PMCID: PMC3425318 DOI: 10.1186/1741-7015-10-86] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 08/08/2012] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Recent insights provide support for the treatment of cancer during pregnancy, a coincidence that poses both mother and fetus at risk. Our aim was to critically review studies on the physiologic variations during pregnancy, the most common tumor markers used in diagnosis and follow-up of gynecological cancers. METHODS We conducted a systematic review of six tumor markers during normal pregnancy: carbohydrate antigen (CA) 15-3 (breast cancer); squamous cell carcinoma antigen (cervical cancer); and CA 125, anti-Müllerian hormone, inhibin B and lactate dehydrogenase (ovarian cancer). RESULTS For CA 15-3, 3.3% to 20.0% of all measurements were above the cut-off (maximum 56 U/mL in the third trimester). Squamous cell carcinoma antigen values were above cut-off in 3.1% and 10.5% of the measurements (maximum 4.3 µg/L in the third trimester). Up to 35% of CA 125 levels were above cut-off: levels were highest in the first trimester, with a maximum value up to 550 U/mL. Inhibin B, anti-Müllerian hormone and lactate dehydrogenase levels were not elevated in maternal serum during normal pregnancy. CONCLUSION During normal pregnancy, tumor markers including CA 15.3, squamous cell carcinoma antigen and CA 125 can be elevated; inhibin B, anti-Müllerian hormone and lactate dehydrogenase levels remain below normal cut-off values. Knowledge of physiological variations during pregnancy can be clinically important when managing gynecological cancers in pregnant patients.
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Ohno S, Takano F, Ohta Y, Kyo S, Myojo S, Dohi S, Sugiyama H, Ohta T, Inoue M. Frequency of myeloid dendritic cells can predict the efficacy of Wilms' tumor 1 peptide vaccination. Anticancer Res 2011; 31:2447-2452. [PMID: 21873158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND The object of this study was to investigate the clinical predictive capability of peripheral myeloid dendritic cells (DCs) in Wilms' tumor 1 (WT1) vaccine therapy for patients with gynaecological cancer. PATIENTS AND METHODS Six patients with WT1/human leukocyte antigen (HLA)-A*2402-positive gynaecological cancer were included in this study. The patients received intradermal injections of a modified 9-mer WT1 peptide every week for 12 weeks. Peripheral blood samples were obtained at 0, 4, 8 and 12 weeks after the initial vaccination. Circulating DCs were detected by flow cytometry. RESULTS The frequencies of CD14(+)CD16(+)CD33(+)CD85(+) myeloid DCs were significantly higher in the therapeutically effective group than in therapeutically inert group (p<0.05). CONCLUSION These results suggested that myeloid DCs, which should be associated with inducing cytotoxic T-cells, provided additional prognostic information in the use of cancer peptide vaccine.
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Stuklov NI, Levakov SA, Kozinets GI. [A new approach to studying anemia in patients with gynecological diseases and gynecological neoplasms]. Klin Lab Diagn 2010:39-41. [PMID: 20734689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The authors have used a coefficient that characterizes the functional activity of red blood cells. Evidence is provided for the significance of the coefficient, by comparing the groups of gynecological and gynecological cancer patients.
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Arteaga-Gómez AC, Aranda-Flores C, Márquez-Acosta G, Colín-Valenzuela A. [Adnexal tumor and pregnancy: diagnosis and treatment]. GINECOLOGIA Y OBSTETRICIA DE MEXICO 2010; 78:160-167. [PMID: 20939220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND The finding of adnexal masses during pregnancy is an exceptional event. Its reported incidence is less than 5% and most cases resolve spontaneously as the pregnancy progresses. OBJECTIVE Describe a case series of patients with adnexal mass and pregnancy. MATERIAL AND METHODS We retrospectively reviewed the medical records of patients who had diagnosis of pregnancy and adnexal over a period of five years. RESULTS The incidence was 0.22%. The mean age was 26 +/- 7.3 years, mean gestational age was 17 +/- 6.6 weeks. The diagnosis was established by ultrasound (USG) in 95% of cases, 48% had cystic characteristics, the mean diameter of the tumor was 99 +/- 42 mm. Cistectomy was performed during pregnancy or trans-cesarean section in 30% and 58% of patients respectably. The mean tumor size was 118 mm (range 2 a 40 mm), weight 1,370 g (range 10 a 5,800 g). The most frequent histological diagnosis were serous cyst (40%), mature teratoma (28%), mucinous (6%), malignancy (4%). There were not complications related to the surgical procedure. CONCLUSIONS The USG constitute a safe method for the diagnosis, but the image method with the highest positive predictive value is the MRI. Tumor markers (CA-125, AFP, GCH-B,DHL, ACE), are not useful during pregnancy. If the tumor doesn't achieve surgical criteria the recommended follow up is clinical observation and USG. If surgery is decided, it should be performed between 16 a 23 weeks of pregnancy, and it's recommended to send the tumor to histological diagnosis, in case of malignancy the surgery will continue according to the tumor stage. The time and delivery route will be decided by the obstetrician.
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Grammatikakis IE, Botsis DC, Grigoriou OV, Dalamanga AN, Creatsas GC. Fibronectin plasma levels in gynecological cancers. JOURNAL OF B.U.ON. : OFFICIAL JOURNAL OF THE BALKAN UNION OF ONCOLOGY 2010; 15:122-126. [PMID: 20414938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
PURPOSE Fibronectin (FBN) is involved in the motility and migration of malignant cells. The purpose of this study was to investigate FBN plasma levels in gynecological cancers patients and in healthy women. METHODS The study took place between 1998 and 2003. One hundred women with histologically diagnosed cancer of gynecological organs (cervix, ovary, endometrium, breast) formed the study group (group A), whereas the control group (group B) consisted of 100 healthy women. FBN plasma levels were measured with the radial immunodiffusion method. RESULTS The average age of group A patients was 42.08 years (range 33-77), and of group B it was 41.1 years (range 32-65). Both groups were compared with the Student's-t test. The median plasma value of FBN in all gynecological malignancies was 258.4 mg/l (standard deviation/SD 163.9, p=0.0066, t-statistics: 2.768, (t95): 1.984, 95% CI: 225.4-290.9). The plasma levels were significantly elevated when compared to the control group (median=213 mg/l). The distribution of values showed a statistically important "tail" in high plasma levels (FBN >400 mg/l). Plasma levels of FBN were more increased in breast and cervical malignancies when compared to ovarian and endometrial cancers. CONCLUSION FBN plasma levels were significantly increased in the total of group A patients, but not significantly increased in the endometrial and ovarian subgroup. Whether or not FBN could reliably be a marker for gynecological cancers should be confirmed in studies with larger number of patients.
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van den Akker PAJ, Aalders AL, Snijders MPLM, Kluivers KB, Samlal RAK, Vollebergh JHA, Massuger LFAG. Evaluation of the Risk of Malignancy Index in daily clinical management of adnexal masses. Gynecol Oncol 2009; 116:384-8. [PMID: 19959215 DOI: 10.1016/j.ygyno.2009.11.014] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 10/28/2009] [Accepted: 11/08/2009] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To verify the effectiveness of the Risk of Malignancy Index in the discrimination between non-invasive (benign and borderline) lesions and invasive malignant adnexal masses in daily clinical practice. METHODS This prospective observational study was conducted in a multicentre cooperation of 11 hospitals. A total of 548 women with adnexal masses were included. Ultrasound characteristics, menopausal status and serum CA 125 level were registered preoperatively, and combined into the RMI afterwards. Final diagnosis was based on routine histopathologic examination. The decision to have patients operated by or with a gynecologic oncologist was based on the clinical impression of the gynecologist in the local hospital, based on physical examination, testing of serum samples, and ultrasound examination. This was compared with the hypothetical situation in which the RMI would have been applied as method of selection. RESULTS An RMI of 200 achieved a sensitivity of 81% and specificity of 85% in the detection of ovarian cancer. Positive and negative predictive values were 48% and 96% respectively. In current practice, 64% of ovarian cancer patients were operated by a gynecologic oncologist. This percentage would have increased to 80% if the RMI with a cutoff value of 200 would have been used as method of selection. CONCLUSIONS In our study population, introduction of the RMI would improve the management of adnexal masses, with a higher percentage of ovarian cancer patients that are operated by a gynecologic oncologist. At the same time, referral of patients with non-invasive (benign and borderline) lesions would be reduced.
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Celik JB, Gezginç K, Ozçelik K, Celik C. The role of immunonutrition in gynecologic oncologic surgery. EUR J GYNAECOL ONCOL 2009; 30:418-421. [PMID: 19761135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND This study assesses the effect of immunonutrition on biochemical and hematological parameters, incidence of infection, postoperative complications, mortality rate and length of hospital stay. MATERIAL AND METHODS A total of 50 patients operated on for gynecological malignancies were randomly assigned to two groups, each receiving two days preoperative and seven days postoperative enteral nutrition after intestinal movements started. The patients in group 1 were given 1000 kcal/d immun-enhancing enteral nutrition (IEN). The patients in group 2 received 1000 kcal/d standard enteral nutrition. The nutritional (albumin, prealbumin), immunologic (CRP, white blood cell (WBC) count, lymphocyte population) parameters, length of hospital stay (LOS) and clinical outcomes were examined. RESULTS The two groups did not differ in terms of demographic data, nutritional status, surgical status, mortality rate (p > 0.05). WBC count, lymphocyte population, CRP levels were significantly higher in group 1 compared with group 2 in the postoperative period (p < 0.05). Pulmonary and urinary tract infection rates were similar in both groups (p > 0.05) but wound infection, and LOS rate were significantly lower in group 1 than group 2 (p < 0.05). CONCLUSION Perioperative immunonutrition proved to be safe and useful in increasing the immunologic response. It may decrease postoperative complications and LOS in patients undergoing surgery for gynecological malignancy.
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