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Chen J, Ln H. A review of prognostic factors in squamous cell carcinoma of the vulva: Evidence from the last decade. Semin Diagn Pathol 2024; 41:140-153. [PMID: 32988675 DOI: 10.1053/j.semdp.2020.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 12/24/2022]
Abstract
Squamous cell carcinoma of the vulva is a rare gynecologic cancer that is associated with significant patient morbidity and mortality, particularly for recurrent disease. This review summarizes the evidence and continued challenges, regarding the traditional clinicopathologic factors used to prognosticate vulvar squamous cell carcinoma. Articles published within the last 10 years (2010-2020) were identified. Relevant articles concerning the following fifteen prognostic factors were reviewed: HPV/p16 status, vulvar intraepithelial neoplasia, patient age, tumor stage, tumor grade, tumor size, depth of invasion, stromal changes, histologic patterns of invasion, lymphovascular space invasion (LVSI), perineural invasion, lymph node metastases, tumour focality, margin status and lichen sclerosus (LS). The relationship between each prognostic factor and progression-free survival (PFS) and overall survival (OS), including hazard ratios, 95% confidence intervals and p-values, were extracted.
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Affiliation(s)
- Julia Chen
- Medical Undergraduate Program, Faculty of Medicine, University of British Columbia, BC, Canada
| | - Hoang Ln
- Department of Pathology, Vancouver General Hospital and University of British Columbia, BC, Canada; Genetic Pathology Evaluation Center (GPEC), BC, Canada.
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2
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The Prognostic Value of the Fibrinogen-Albumin-Ratio Index (FARI) in Patients with Advanced Vulvar Cancer. J Pers Med 2022; 12:jpm12111882. [PMID: 36579608 PMCID: PMC9694316 DOI: 10.3390/jpm12111882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/18/2022] [Accepted: 11/06/2022] [Indexed: 11/12/2022] Open
Abstract
The present study aims to evaluate the pretherapeutic Fibrinogen-Albumin-Ratio Index (FARI), as currently reliable biomarkers to predict therapy response and prognosis of patients with advanced vulvar cancer are missing. Data of 124 consecutive patients, who underwent primary resection for vulvar cancer ≥ pT1b, were retrospectively analyzed. Associations between the FARI and disease recurrence were assessed fitting receiver operating characteristics (ROC) and binary logistic regression models; univariate and multivariable Cox regression models for disease-specific survival (DSS) and progression-free survival (PFS) were performed. A pretherapeutic low FARI cut at its median (<9.67) is significantly associated with younger age (65.5 vs. 74.0 years) and higher risk of recurrence (52.4% vs. 26.2%). The ROC analysis calculates the area under the curve (AUC) of the FARI for a PFS < 6 months of 0.700 and for a DSS < 12 months of 0.706, outperforming fibrinogen and albumin alone. The FARI remained independently predictive for PFS (HR 0.84, 95% CI [0.99−1.03], p = 0.009) and DSS (HR 0.82, 95% CI [0.70−0.99], p = 0.019), also in multivariable survival analysis. Despite the FARI’s promising predictive and prognostic value, however, further elucidation of its precise mode of action is warranted before clinical application as it appears to rely only on subtle changes of fibrinogen levels.
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3
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Julia CJ, Hoang LN. A review of prognostic factors in squamous cell carcinoma of the vulva: Evidence from the last decade. Semin Diagn Pathol 2020; 38:37-49. [PMID: 33246713 DOI: 10.1053/j.semdp.2020.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/03/2020] [Indexed: 12/24/2022]
Abstract
Squamous cell carcinoma of the vulva is a rare gynecologic cancer that is associated with significant patient morbidity and mortality, particularly for recurrent disease. This review summarizes the evidence and continued challenges, regarding the traditional clinicopathologic factors used to prognosticate vulvar squamous cell carcinoma. Articles published within the last 10 years (2010-2020) were identified. Relevant articles concerning the following fifteen prognostic factors were reviewed: HPV/p16 status, vulvar intraepithelial neoplasia, patient age, tumor stage, tumor grade, tumor size, depth of invasion, stromal changes, histologic patterns of invasion, lymphovascular space invasion (LVSI), perineural invasion, lymph node metastases, tumour focality, margin status and lichen sclerosus (LS). The relationship between each prognostic factor and progression-free survival (PFS) and overall survival (OS), including hazard ratios, 95% confidence intervals and p-values, were extracted.
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Affiliation(s)
- Chen J Julia
- Medical Undergraduate Program, Faculty of Medicine, University of British Columbia, BC, Canada
| | - L N Hoang
- Department of Pathology, Vancouver General Hospital and University of British Columbia, 1215 - 910 West 10th Avenue, Vancouver BC, Canada; Genetic Pathology Evaluation Center (GPEC), BC, Canada.
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4
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Bekos C, Polterauer S, Seebacher V, Bartl T, Joura E, Reinthaller A, Sturdza A, Horvat R, Schwameis R, Grimm C. Pre-operative hypoalbuminemia is associated with complication rate and overall survival in patients with vulvar cancer undergoing surgery. Arch Gynecol Obstet 2019; 300:1015-1022. [PMID: 31468203 PMCID: PMC6759670 DOI: 10.1007/s00404-019-05278-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 08/19/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Hypoalbuminemia, a known marker for malnutrition, has been associated with an increased risk for perioperative morbidity and poor prognosis in patients with solid tumors. The aim of this study was to investigate the prognostic and predictive value of pre-treatment serum albumin levels for survival and postoperative complications in patients with vulvar cancer undergoing surgery. METHODS Within in this retrospective study, we assessed data of 103 consecutive patients with vulvar cancer undergoing primary surgery into this study. Pre-treatment serum albumin levels were correlated with clinico-pathological parameters and complications. We performed univariate log-rank test and multivariable Cox regression models to evaluate the association between pre-treatment serum albumin and survival. RESULTS We found hypoalbuminemia (< 35 mg/dl) in 9 of 103 (8.7%) patients. No difference in tumor characteristics was observed between patients with hypoalbuminemia and normal serum albumin levels. Difference in postoperative complications (55.6% and 37.8% of patients with hypoalbuminemia and normal serum albumin levels, respectively) was not statistically significant (p = 0.345). Shorter overall survival (OS) was observed in patients with hypoalbuminemia (5-year OS rate 17.1%) when compared to patients with normal serum albumin levels (5-year OS rate 58.6%, p = 0.004). In multivariable analysis, age (p = 0.017), FIGO stage (p = 0.011) and serum albumin levels (p = 0.013) were independently associated with OS. CONCLUSION Pre-treatment hypoalbuminemia is an independent prognostic biomarker for OS in patients with vulvar cancer. We did not find an association between pre-treatment hypoalbuminemia and a higher risk for postoperative complications.
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Affiliation(s)
- Christine Bekos
- Department of Gynaecology and Obstetrics, Gynecologic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Stephan Polterauer
- Department of Gynaecology and Obstetrics, Gynecologic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
- Karl Landsteiner Institute for General Gynecology and Experimental Gynecologic Oncology, Vienna, Austria.
| | - Veronika Seebacher
- Department of Gynaecology and Obstetrics, Gynecologic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Thomas Bartl
- Department of Gynaecology and Obstetrics, Gynecologic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Elmar Joura
- Department of Gynaecology and Obstetrics, Gynecologic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Alexander Reinthaller
- Department of Gynaecology and Obstetrics, Gynecologic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Karl Landsteiner Institute for General Gynecology and Experimental Gynecologic Oncology, Vienna, Austria
| | - Alina Sturdza
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Reinhard Horvat
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Richard Schwameis
- Department of Gynaecology and Obstetrics, Gynecologic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Christoph Grimm
- Department of Gynaecology and Obstetrics, Gynecologic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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Schwameis R, Postl M, Bekos C, Hefler L, Reinthaller A, Seebacher V, Grimm C, Polterauer S, Helmy-Bader S. Prognostic value of serum creatine level in patients with vulvar cancer. Sci Rep 2019; 9:11129. [PMID: 31366905 PMCID: PMC6668438 DOI: 10.1038/s41598-019-47560-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 07/17/2019] [Indexed: 12/12/2022] Open
Abstract
Vulvar cancer is a rare malignancy with poor prognosis that generally occurs in elderly patients. The individual prognosis is difficult to assess. Serum creatinine levels are frequently elevated in elderly patients. Recent evidence have shown shown that - besides indicating kidney impairment - serum creatinine levels may be used to predict the survival in cancer patients. Several studies observed an association between elevated serum creatinine levels and poor prognosis in patients with solid tumors. In this retrospective cohort study, serum creatinine levels were evaluated in 170 patients with invasive vulvar cancer. Serum creatinine levels were correlated to established clinicopathologic factors. Univariate and multivariate survival analysis were performed. Elevated serum creatinine levels (>1.2 mg/dl) were significantly associated with both poor disease specific and overall survival. Three year overall survival rates were 74.8% and 32.5% for patients with serum creatinine levels of ≤ and >1.2 mg/dl, respectively. In a multivariate survival model, serum creatinine levels were significantly associated with overall survival independent of tumor stage and patients' age. In conclusion, pretherapeutic serum creatinine levels may be useful as an independent prognostic parameter in patients with vulvar cancer.
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Affiliation(s)
- Richard Schwameis
- Gynecologic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Magdalena Postl
- Gynecologic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Christine Bekos
- Gynecologic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Lukas Hefler
- Department of Gynecology, Ordensklinikum Linz, Seilerstätte 4, 4020, Linz, Austria
- Karl Landsteiner Institute for Gynecologic Surgery and Oncology, Seilerstaette 4, 4020, Linz, Austria
| | - Alexander Reinthaller
- Gynecologic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Karl Landsteiner Institute for General Gynecology and Experimental Gynecologic Oncology, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Veronika Seebacher
- Gynecologic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Christoph Grimm
- Gynecologic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Stephan Polterauer
- Gynecologic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Karl Landsteiner Institute for General Gynecology and Experimental Gynecologic Oncology, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Samir Helmy-Bader
- Gynecologic Cancer Unit, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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Bekos C, Grimm C, Brodowicz T, Petru E, Hefler L, Reimer D, Koch H, Reinthaller A, Polterauer S, Polterauer M. Prognostic role of plasma fibrinogen in patients with uterine leiomyosarcoma - a multicenter study. Sci Rep 2017; 7:14474. [PMID: 29101329 PMCID: PMC5670177 DOI: 10.1038/s41598-017-13934-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 10/03/2017] [Indexed: 02/07/2023] Open
Abstract
Fibrinogen has an important pathophysiological role in tumor cell progression and development of metastases in different types of cancer. The present study aimed to evaluate the role of pre-treatment fibrinogen plasma concentrations as a biomarker for tumor biology and prognosis in patients with uterine leiomyosarcoma (ULMS). Clinical data of patients with ULMS were assessed in this multi-center study Pre-therapeutic fibrinogen plasma concentrations were evaluated. We investigated the association between fibrinogen plasma levels and clinico-pathological parameters and performed univariate and multivariable survival analyses. In total, 70 women with ULMS were included into the analysis. Mean (SD) pre-treatment fibrinogen plasma levels were 480.2 (172.3) mg/dL. Patients with advanced tumor stage, increased tumor size and higher histological grading had higher fibrinogen levels (p = 0.02, p = 0.013, and p = 0.029, respectively). In ULMS patients with increased fibrinogen levels 5-year overall survival (OS) rates were 25.0% compared to 52.9% in ULMS patients with normal fibrinogen, respectively. Univariate survival analyses revealed that elevated fibrinogen plasma levels (p = 0.030), advanced tumor stage (p < 0.001) and undifferentiated histology (p = 0.003) showed association with unfavorable OS. In multivariable analysis, histological grade (p = 0.03) and tumor stage (0.02) were independently associated with survival. Elevated fibrinogen plasma levels were associated with aggressive tumor biology and poor prognosis in women with ULMS. Fibrinogen might be useful as a novel biomarker in ULMS.
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Affiliation(s)
- Christine Bekos
- Department of General Gynaecology and Gynaecological Oncology, Gynecologic Cancer Unit - Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Christoph Grimm
- Department of General Gynaecology and Gynaecological Oncology, Gynecologic Cancer Unit - Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Thomas Brodowicz
- Clinical Division of Oncology, Department of Medicine 1, Comprehensive Cancer Center - Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Edgar Petru
- Department of Obstetrics and Gynaecology of the Medical University of Graz, Graz, Austria
| | - Lukas Hefler
- Department of Gynaecology, Barmherzige Schwestern Hospital Linz, Linz, Austria
| | - Daniel Reimer
- Department of Obstetrics and Gynaecology of the Medical University of Innsbruck, Tirol, Austria
| | - Horst Koch
- Department of Obstetrics and Gynaecology of the Medical University of Salzburg, Salzburg, Austria
| | - Alexander Reinthaller
- Department of General Gynaecology and Gynaecological Oncology, Gynecologic Cancer Unit - Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Karl Landsteiner Institute for General Gynecology and Experimental Gynecologic Oncology, Vienna, Austria
| | - Stephan Polterauer
- Department of General Gynaecology and Gynaecological Oncology, Gynecologic Cancer Unit - Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. .,Karl Landsteiner Institute for General Gynecology and Experimental Gynecologic Oncology, Vienna, Austria.
| | - Mariella Polterauer
- Department of General Gynaecology and Gynaecological Oncology, Gynecologic Cancer Unit - Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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Kang HJ, Bae K, Kim JH, Cho CK, Yoo HS. Correlation Between Natural Killer Cell Activity and Systemic Inflammatory Markers for Heterogeneous Cancer Patients Treated With Wheel Balance Cancer Therapy. Integr Cancer Ther 2017; 17:322-331. [PMID: 28714337 PMCID: PMC6041908 DOI: 10.1177/1534735417717789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background and Objective: Natural killer (NK) cells are known to
have an effect on the prevention of tumorigenesis for the initial cancer, as
well as the metastatic cancer. For the past several years, the relationship
between cancer and inflammation has been actively studied in preclinical and
clinical settings, but there are no reports on alterations in and correlation
for NK cell activity (NKA) and systemic inflammatory markers. Accordingly, this
study aimed to measure correlation between NKA and the levels of other systemic
inflammatory markers in patients with gastric, breast, and pancreatic cancer who
received Wheel Balance Cancer Therapy (WBCT). Methods: Forty-two
electronic charts of patients with gastric, breast, and pancreatic cancer
treated with WBCT from February 1, 2015 to September 30, 2015, were reviewed
retrospectively. These charts were statistically analyzed, looking for
alterations of and correlation for NKA and the expressions of systemic
inflammatory markers. Results: Patients with a NKA of under 300
pg/mL at admission showed significantly higher erythrocyte sedimentation rate
(ESR) and neutrophil-to-lymphocyte ratio (NLR) values and decreasing NLR values
due to WBCT than patients with an NKA greater than 300 pg/mL. As a result of the
correlation analysis between NKA and the levels of the systemic inflammatory
markers, NKA showed significant negative correlation with NLR, ESR, and
fibrinogen values. Conclusions: Negative correlation was identified
between NKA and NLR, NKA and ESR, and NKA and fibrinogen in patients with
heterogeneous cancer patients.
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Affiliation(s)
- Hwi-Joong Kang
- 1 Dunsan Korean Medical Hospital of Daejeon University, Daejeon, South Korea
| | - Kyeore Bae
- 1 Dunsan Korean Medical Hospital of Daejeon University, Daejeon, South Korea
| | - Jee-Hye Kim
- 1 Dunsan Korean Medical Hospital of Daejeon University, Daejeon, South Korea
| | - Chong-Kwan Cho
- 1 Dunsan Korean Medical Hospital of Daejeon University, Daejeon, South Korea
| | - Hwa-Seung Yoo
- 1 Dunsan Korean Medical Hospital of Daejeon University, Daejeon, South Korea
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Perisanidis C, Psyrri A, Cohen EE, Engelmann J, Heinze G, Perisanidis B, Stift A, Filipits M, Kornek G, Nkenke E. Prognostic role of pretreatment plasma fibrinogen in patients with solid tumors: A systematic review and meta-analysis. Cancer Treat Rev 2016; 41:960-70. [PMID: 26604093 DOI: 10.1016/j.ctrv.2015.10.002] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 10/06/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Plasma fibrinogen may be involved in several stages of cancer progression. Clinical studies have demonstrated that pretreatment plasma fibrinogen is associated with poor survival in various cancers. The aim of this meta-analysis was to examine the prognostic effect of circulating fibrinogen in solid tumors. MATERIALS AND METHODS We searched Medline, EMBASE, Cochrane Database of Systematic Reviews, and meeting proceedings to identify studies assessing the effect of pretreatment plasma fibrinogen on survival of cancer patients. Pooled multivariable-adjusted hazard ratios (HRs) for overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS) were estimated using random-effects models. RESULTS Data from 52 observational studies and 15,371 patients were summarized. An elevated baseline plasma fibrinogen was significantly associated with worse OS (pooled HR = 1.69; 95% CI = 1.48–1.92). The highest negative effect of elevated plasma fibrinogen on OS was demonstrated in renal cell carcinoma (pooled HR = 2.22), followed by head and neck cancer (pooled HR = 2.02), and colorectal cancer (pooled HR = 1.89). The adverse prognostic impact of high plasma fibrinogen remained in both non-metastatic and metastatic disease and patients of different ethnicity. Patients with high baseline fibrinogen had a significantly shorter DFS (pooled HR = 1.52) and CSS (pooled HR = 2.50). CONCLUSIONS An elevated pretreatment plasma fibrinogen significantly correlates with decreased survival in patients with solid tumors. Future clinical trials are warranted to determine whether plasma fibrinogen could be incorporated in cancer staging systems and whether fibrinogen-lowering therapies have a favorable effect on disease recurrence and mortality.
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Uccella S, Cromi A, Vigetti D, Cimetti L, Deleonibus S, Casarin J, Passi A, Riva C, Ghezzi F. Endometrial cancer cells can express fibrinogen: Immunohistochemistry and RT-PCR analysis. J OBSTET GYNAECOL 2015; 36:353-8. [DOI: 10.3109/01443615.2015.1065231] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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10
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Evasion and interactions of the humoral innate immune response in pathogen invasion, autoimmune disease, and cancer. Clin Immunol 2015; 160:244-54. [PMID: 26145788 DOI: 10.1016/j.clim.2015.06.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 06/22/2015] [Accepted: 06/26/2015] [Indexed: 02/07/2023]
Abstract
The humoral innate immune system is composed of three major branches, complement, coagulation, and natural antibodies. To persist in the host, pathogens, such as bacteria, viruses, and cancers must evade parts of the innate humoral immune system. Disruptions in the humoral innate immune system also play a role in the development of autoimmune diseases. This review will examine how Gram positive bacteria, viruses, cancer, and the autoimmune conditions systemic lupus erythematosus and anti-phospholipid syndrome, interact with these immune system components. Through examining evasion techniques it becomes clear that an interplay between these three systems exists. By exploring the interplay and the evasion/disruption of the humoral innate immune system, we can develop a better understanding of pathogenic infections, cancer, and autoimmune disease development.
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11
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Ghanim B, Hoda MA, Klikovits T, Winter MP, Alimohammadi A, Grusch M, Dome B, Arns M, Schenk P, Jakopovic M, Samarzija M, Brcic L, Filipits M, Laszlo V, Klepetko W, Berger W, Hegedus B. Circulating fibrinogen is a prognostic and predictive biomarker in malignant pleural mesothelioma. Br J Cancer 2014; 110:984-90. [PMID: 24434429 PMCID: PMC3929892 DOI: 10.1038/bjc.2013.815] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 12/05/2013] [Accepted: 12/10/2013] [Indexed: 02/07/2023] Open
Abstract
Background: To investigate the clinical utility of pretreatment plasma fibrinogen levels in malignant pleural mesothelioma (MPM) patients. Methods: A retrospective multicenter study was performed in histologically proven MPM patients. All fibrinogen levels were measured at the time of diagnosis and clinical data were retrospectively collected after approval of the corresponding ethics committees. Results: In total, 176 MPM patients (mean age: 63.5 years±10.4 years, 38 females and 138 males) were analysed. Most patients (n=154, 87.5%) had elevated (⩾390 mg dl−1) plasma fibrinogen levels. When patients were grouped by median fibrinogen, patients with low level (⩽627 mg dl−1) had significantly longer overall survival (OS) (19.1 months, confidence interval (CI) 14.5–23.7 months) when compared with those with high level (OS 8.5; CI 6.2–10.7 months). In multivariate survival analyses, fibrinogen was found to be an independent prognostic factor (hazard ratio 1.81, CI 1.23–2.65). Most interestingly, fibrinogen (cutoff 75th percentile per 750 mg dl−1) proved to be a predictive biomarker indicating treatment benefit achieved by surgery within multimodality therapy (interaction term: P=0.034). Accordingly, only patients below the 75th percentile benefit from surgery within multimodality therapy (31.3 vs 5.3 months OS). Conclusions: Fibrinogen is a novel independent prognostic biomarker in MPM. Most importantly, fibrinogen predicted treatment benefit achieved by surgery within multimodality therapy.
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Affiliation(s)
- B Ghanim
- 1] Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna 1090, Vienna, Austria [2] Institute of Cancer Research, Department of Internal Medicine I, Medical University of Vienna 1090, Vienna, Austria
| | - M A Hoda
- 1] Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna 1090, Vienna, Austria [2] Institute of Cancer Research, Department of Internal Medicine I, Medical University of Vienna 1090, Vienna, Austria
| | - T Klikovits
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna 1090, Vienna, Austria
| | - M-P Winter
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna 1090, Vienna, Austria
| | - A Alimohammadi
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna 1090, Vienna, Austria
| | - M Grusch
- Institute of Cancer Research, Department of Internal Medicine I, Medical University of Vienna 1090, Vienna, Austria
| | - B Dome
- 1] Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna 1090, Vienna, Austria [2] National Koranyi Institute of Pulmonology, Budapest 1121, Hungary [3] Department of Thoracic Surgery, National Institute of Oncology, Budapest, Hungary
| | - M Arns
- Department of Pulmonology, LKH Hochegg, 2803 Vienna, Austria
| | - P Schenk
- Department of Pulmonology, LKH Hochegg, 2803 Vienna, Austria
| | - M Jakopovic
- University of Zagreb, School of Medicine, Department for Respiratory Diseases Jordanovac, University Hospital Center, Zagreb 10000, Croatia
| | - M Samarzija
- University of Zagreb, School of Medicine, Department for Respiratory Diseases Jordanovac, University Hospital Center, Zagreb 10000, Croatia
| | - L Brcic
- University of Zagreb, School of Medicine, Institute of Pathology, Zagreb 10000, Croatia
| | - M Filipits
- Institute of Cancer Research, Department of Internal Medicine I, Medical University of Vienna 1090, Vienna, Austria
| | - V Laszlo
- 1] Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna 1090, Vienna, Austria [2] Department of Biological Physics, Eötvös University, Budapest 1117, Hungary
| | - W Klepetko
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna 1090, Vienna, Austria
| | - W Berger
- Institute of Cancer Research, Department of Internal Medicine I, Medical University of Vienna 1090, Vienna, Austria
| | - B Hegedus
- 1] Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna 1090, Vienna, Austria [2] Institute of Cancer Research, Department of Internal Medicine I, Medical University of Vienna 1090, Vienna, Austria [3] MTA-SE Molecular Oncology Research Group, Hungarian Academy of Sciences, Budapest 1091, Hungary
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12
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Ertas IE, Gungorduk K, Akman L, Ozdemir A, Terek MC, Ozsaran A, Sanci M, Dikmen Y. Can preoperative neutrophil:lymphocyte and platelet:lymphocyte ratios be used as predictive markers for lymph node metastasis in squamous cell carcinoma of the vulva? Eur J Obstet Gynecol Reprod Biol 2013; 171:138-42. [PMID: 23992992 DOI: 10.1016/j.ejogrb.2013.08.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 07/27/2013] [Accepted: 08/10/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine whether the neutrophil:lymphocyte ratio (NLR) and platelet:lymphocyte ratio (PLR) before complete surgical staging provide information on lymph node metastasis in vulvar squamous cell carcinoma (SCC). STUDY DESIGN All patients with vulvar SCC who underwent complete surgical staging at two institutions between 1 January 2005 and 31 December 2011 were identified retrospectively from patient databases. Receiver operating characteristic (ROC) curve analysis was used to evaluate cut-off, sensitivity, and specificity values for preoperative NLR and PLR to predict lymph node metastasis. RESULTS Data from 64 women with adequate information were analyzed. Lymph node involvement was detected in 19 (29.7%) patients. NLR and PLR were higher in the lymph node--positive group than in the--negative group (p < 0.001). The best cut-off values for predicting lymph node metastasis were 2.81 for the NLR, with 84.5% sensitivity and 89.5% specificity, and 139.5 for the PLR, with 68.9% sensitivity and 89.5% specificity. Forty of the 64 (62.5%) patients had NLRs ≤ 2.81 and 24 (37.5%) had NLRs >2.81. Lymph node involvement was more common in the NLR >2.81 group [60.7% vs. 5.6%; relative risk RR = 10.9, 95% confidence interval CI = 2.7-43.4; p < 0.001]. Mean tumor sizes were 4.2 ± 2.3 cm in the NLR >2.81 group and 2.1 ± 1.2 cm in the NLR ≤ 2.81 group (p = 0.001). The rate of lymph node involvement was higher in the PLR >139.5 group than in the PLR ≤ 139.5 group (54.8% vs. 6.1%; RR = 9.0, 95% CI = 2.2-35.9; p<0.001). CONCLUSION Preoperative NLR and PLR are directly associated with nodal involvement status of vulvar SCC. These markers are simple, readily obtained and calculated, and easy to integrate into the surgical work-up of patients with vulvar SCC, at no extra cost.
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Affiliation(s)
- Ibrahim Egemen Ertas
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey.
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