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Thull T, Kempton D. Ovarian cancer: A review for primary care providers. JAAPA 2024; 37:32-36. [PMID: 38916368 DOI: 10.1097/01.jaa.0000000000000042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
ABSTRACT Ovarian cancer is the second most common gynecologic cancer in the United States and the deadliest gynecologic cancer worldwide, with a 5-year survival rate of less than 50%. Because of its vague symptoms, more than half of patients present with advanced disease and metastasis. This article reviews the epidemiology, pathogenesis, risk factors, screening, presentation, and diagnosis of ovarian cancer, in addition to providing an overview of the standard approach to treatment and novel targeted biologic therapies.
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Affiliation(s)
- Tessa Thull
- Tessa Thull practices in psychiatry in Cincinnati, Ohio. Danielle Kempton is director and clinical professor in the Doctor of Medical Science program at Northern Arizona University in Phoenix, Ariz. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Vaishnavi Nalla S, Jayapradha P, Lalruatmawii, Nandheeswari K, Naxine P, Vigneshwaran G, Rohilla G, Dubey I, Kushwaha S. Irisin as an emerging target in the regulation of reproductive functions in health and disease. Gen Comp Endocrinol 2024; 353:114529. [PMID: 38643847 DOI: 10.1016/j.ygcen.2024.114529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/22/2023] [Accepted: 04/18/2024] [Indexed: 04/23/2024]
Abstract
Germ cells are highly conserved in the gonads, nurtured to either develop into a gamete or self-renew into a stem cell reserve. Preserving the germ cell pool and protecting the reproductive organs is essential for maintaining an individual's fertility. Several factors, including a sedentary lifestyle, pollutants, hormonal disruption, drugs, and a disease condition, have been shown to impair normal reproductive function. Irisin has recently been identified as an adipomyokine involved in modulating physiological functions based on the body's metabolic status. It is being studied for its role in various functions, including fertility. Findings show the localization of irisin in various parts of the reproductive axis, with the highest levels observed during puberty and pregnancy. This raises questions about its role and function in reproduction. Studies support irisin's role in protecting against disease-induced reproductive abnormalities and infertility. Therefore, the current review focuses on how irisin influences spermatogenesis and ovarian follicular development and plays a significant role in indirectly preserving the germ cell pool by protecting the gonads against oxidative stress and inflammation.
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Affiliation(s)
- Sree Vaishnavi Nalla
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Raebareli (NIPER-R), Transit Campus, Bijnor-Sisendi Road, Sarojini Nagar, Near CRPF Base Camp, Lucknow (UP) 226002, India
| | - P Jayapradha
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Raebareli (NIPER-R), Transit Campus, Bijnor-Sisendi Road, Sarojini Nagar, Near CRPF Base Camp, Lucknow (UP) 226002, India
| | - Lalruatmawii
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Raebareli (NIPER-R), Transit Campus, Bijnor-Sisendi Road, Sarojini Nagar, Near CRPF Base Camp, Lucknow (UP) 226002, India
| | - K Nandheeswari
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Raebareli (NIPER-R), Transit Campus, Bijnor-Sisendi Road, Sarojini Nagar, Near CRPF Base Camp, Lucknow (UP) 226002, India
| | - Pratik Naxine
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Raebareli (NIPER-R), Transit Campus, Bijnor-Sisendi Road, Sarojini Nagar, Near CRPF Base Camp, Lucknow (UP) 226002, India
| | - G Vigneshwaran
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Raebareli (NIPER-R), Transit Campus, Bijnor-Sisendi Road, Sarojini Nagar, Near CRPF Base Camp, Lucknow (UP) 226002, India
| | - Gaurav Rohilla
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Raebareli (NIPER-R), Transit Campus, Bijnor-Sisendi Road, Sarojini Nagar, Near CRPF Base Camp, Lucknow (UP) 226002, India
| | - Itishree Dubey
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Raebareli (NIPER-R), Transit Campus, Bijnor-Sisendi Road, Sarojini Nagar, Near CRPF Base Camp, Lucknow (UP) 226002, India
| | - Sapana Kushwaha
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Raebareli (NIPER-R), Transit Campus, Bijnor-Sisendi Road, Sarojini Nagar, Near CRPF Base Camp, Lucknow (UP) 226002, India.
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Pasamba EC, Orda MA, Villanueva BHA, Tsai PW, Tayo LL. Transcriptomic Analysis of Hub Genes Reveals Associated Inflammatory Pathways in Estrogen-Dependent Gynecological Diseases. BIOLOGY 2024; 13:397. [PMID: 38927277 PMCID: PMC11201105 DOI: 10.3390/biology13060397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/26/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024]
Abstract
Gynecological diseases are triggered by aberrant molecular pathways that alter gene expression, hormonal balance, and cellular signaling pathways, which may lead to long-term physiological consequences. This study was able to identify highly preserved modules and key hub genes that are mainly associated with gynecological diseases, represented by endometriosis (EM), ovarian cancer (OC), cervical cancer (CC), and endometrial cancer (EC), through the weighted gene co-expression network analysis (WGCNA) of microarray datasets sourced from the Gene Expression Omnibus (GEO) database. Five highly preserved modules were observed across the EM (GSE51981), OC (GSE63885), CC (GSE63514), and EC (GSE17025) datasets. The functional annotation and pathway enrichment analysis revealed that the highly preserved modules were heavily involved in several inflammatory pathways that are associated with transcription dysregulation, such as NF-kB signaling, JAK-STAT signaling, MAPK-ERK signaling, and mTOR signaling pathways. Furthermore, the results also include pathways that are relevant in gynecological disease prognosis through viral infections. Mutations in the ESR1 gene that encodes for ERα, which were shown to also affect signaling pathways involved in inflammation, further indicate its importance in gynecological disease prognosis. Potential drugs were screened through the Drug Repurposing Encyclopedia (DRE) based on the up-and downregulated hub genes, wherein a bacterial ribosomal subunit inhibitor and a benzodiazepine receptor agonist were the top candidates. Other drug candidates include a dihydrofolate reductase inhibitor, glucocorticoid receptor agonists, cholinergic receptor agonists, selective serotonin reuptake inhibitors, sterol demethylase inhibitors, a bacterial antifolate, and serotonin receptor antagonist drugs which have known anti-inflammatory effects, demonstrating that the gene network highlights specific inflammatory pathways as a therapeutic avenue in designing drug candidates for gynecological diseases.
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Affiliation(s)
- Elaine C. Pasamba
- School of Graduate Studies, Mapúa University, Manila City 1002, Philippines; (E.C.P.); (M.A.O.); (B.H.A.V.)
- School of Chemical, Biological, and Materials Engineering and Sciences, Mapúa University, Manila City 1002, Philippines
| | - Marco A. Orda
- School of Graduate Studies, Mapúa University, Manila City 1002, Philippines; (E.C.P.); (M.A.O.); (B.H.A.V.)
- School of Chemical, Biological, and Materials Engineering and Sciences, Mapúa University, Manila City 1002, Philippines
| | - Brian Harvey Avanceña Villanueva
- School of Graduate Studies, Mapúa University, Manila City 1002, Philippines; (E.C.P.); (M.A.O.); (B.H.A.V.)
- School of Chemical, Biological, and Materials Engineering and Sciences, Mapúa University, Manila City 1002, Philippines
| | - Po-Wei Tsai
- Department of Food Science, National Taiwan Ocean University, Keelung 20224, Taiwan;
| | - Lemmuel L. Tayo
- School of Graduate Studies, Mapúa University, Manila City 1002, Philippines; (E.C.P.); (M.A.O.); (B.H.A.V.)
- School of Chemical, Biological, and Materials Engineering and Sciences, Mapúa University, Manila City 1002, Philippines
- Department of Biology, School of Health Sciences, Mapúa University, Makati City 1203, Philippines
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Webb PM, Jordan SJ. Global epidemiology of epithelial ovarian cancer. Nat Rev Clin Oncol 2024; 21:389-400. [PMID: 38548868 DOI: 10.1038/s41571-024-00881-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/26/2024]
Abstract
Globally, ovarian cancer is the eighth most common cancer in women, accounting for an estimated 3.7% of cases and 4.7% of cancer deaths in 2020. Until the early 2000s, age-standardized incidence was highest in northern Europe and North America, but this trend has changed; incidence is now declining in these regions and increasing in parts of eastern Europe and Asia. Ovarian cancer is a very heterogeneous disease and, even among the most common type, namely epithelial ovarian cancer, five major clinically and genetically distinct histotypes exist. Most high-grade serous ovarian carcinomas are now recognized to originate in the fimbrial ends of the fallopian tube. This knowledge has led to more cancers being coded as fallopian tube in origin, which probably explains some of the apparent declines in ovarian cancer incidence, particularly in high-income countries; however, it also suggests that opportunistic salpingectomy offers an important opportunity for prevention. The five histotypes share several reproductive and hormonal risk factors, although differences also exist. In this Review, we summarize the epidemiology of this complex disease, comparing the different histotypes, and consider the potential for prevention. We also discuss how changes in the prevalence of risk and protective factors might have contributed to the observed changes in incidence and what this might mean for incidence in the future.
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Affiliation(s)
- Penelope M Webb
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
- School of Public Health, The University of Queensland, Herston, Queensland, Australia.
| | - Susan J Jordan
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
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Zheng G, Faber MT, Wang J, Baandrup L, Hertzum-Larsen R, Sundström K, Kjær SK. Low-dose aspirin use and risk of ovarian cancer: a combined analysis from two nationwide studies in Denmark and Sweden. Br J Cancer 2024; 130:1279-1285. [PMID: 38347096 PMCID: PMC11014981 DOI: 10.1038/s41416-024-02609-7] [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: 08/03/2023] [Revised: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Studies on association between low-dose aspirin use and ovarian cancer risk were mostly based on self-reported medication use and few had large enough sample size to investigate the potential modification effect by ovarian cancer risk factors. METHODS In these two nationwide nested case-control studies among the Danish and Swedish female population, 11,874 women with ovarian cancer (30-84 years old) (Denmark: 7328 diagnosed in 2000-2019, Sweden: 4546 diagnosed in 2010-2018) were randomly age- matched with 473,960 female controls (293,120 from Denmark, and 181,840 from Sweden). We used conditional logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI) and combined the estimates based the fixed-effect assumption. Effect modification by inflammation-related risk factors and by indication (cardiovascular disease, CVD) were also investigated. RESULTS Ever use of low-dose aspirin was not strongly associated with the overall risk of ovarian cancer (OR = 0.97; 95%CI: 0.92-1.03). However, the association differed according to parity (nulliparous: OR = 0.80, 95%CI: 0.70-0.92; parous: OR = 1.00, 95%CI: 0.94-1.07; p-interaction = 0.0024), and according to history of CVD (no CVD: OR = 0.91, 95%CI: 0.82-1.00; ever CVD: OR = 1.05, 95%CI: 0.97-1.13; p-interaction =0.0204). CONCLUSIONS Low-dose aspirin use was associated with a decreased ovarian cancer risk especially in nulliparous women and in women without CVD diagnosis.
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Affiliation(s)
- Guoqiao Zheng
- Unit of Virus, Lifestyle and Genes, Danish Cancer Institute, Copenhagen, Denmark.
| | - Mette Tuxen Faber
- Unit of Virus, Lifestyle and Genes, Danish Cancer Institute, Copenhagen, Denmark
| | - Jiangrong Wang
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Louise Baandrup
- Unit of Virus, Lifestyle and Genes, Danish Cancer Institute, Copenhagen, Denmark
| | | | - Karin Sundström
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Susanne K Kjær
- Unit of Virus, Lifestyle and Genes, Danish Cancer Institute, Copenhagen, Denmark
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Wilczyński J, Paradowska E, Wilczyński M. High-Grade Serous Ovarian Cancer-A Risk Factor Puzzle and Screening Fugitive. Biomedicines 2024; 12:229. [PMID: 38275400 PMCID: PMC10813374 DOI: 10.3390/biomedicines12010229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 01/14/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
High-grade serous ovarian cancer (HGSOC) is the most lethal tumor of the female genital tract. Despite extensive studies and the identification of some precursor lesions like serous tubal intraepithelial cancer (STIC) or the deviated mutational status of the patients (BRCA germinal mutation), the pathophysiology of HGSOC and the existence of particular risk factors is still a puzzle. Moreover, a lack of screening programs results in delayed diagnosis, which is accompanied by a secondary chemo-resistance of the tumor and usually results in a high recurrence rate after the primary therapy. Therefore, there is an urgent need to identify the substantial risk factors for both predisposed and low-risk populations of women, as well as to create an economically and clinically justified screening program. This paper reviews the classic and novel risk factors for HGSOC and methods of diagnosis and prediction, including serum biomarkers, the liquid biopsy of circulating tumor cells or circulating tumor DNA, epigenetic markers, exosomes, and genomic and proteomic biomarkers. The novel future complex approach to ovarian cancer diagnosis should be devised based on these findings, and the general outcome of such an approach is proposed and discussed in the paper.
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Affiliation(s)
- Jacek Wilczyński
- Department of Gynecological Surgery and Gynecological Oncology, Medical University of Lodz, 4 Kosciuszki Str., 90-419 Lodz, Poland
| | - Edyta Paradowska
- Laboratory of Virology, Institute of Medical Biology of the Polish Academy of Sciences, 106 Lodowa Str., 93-232 Lodz, Poland;
| | - Miłosz Wilczyński
- Department of Surgical, Endoscopic and Gynecological Oncology, Polish Mother’s Health Center—Research Institute, 281/289 Rzgowska Str., 93-338 Lodz, Poland;
- Department of Surgical and Endoscopic Gynecology, Medical University of Lodz, 4 Kosciuszki Str., 90-419 Lodz, Poland
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Jonsson S, Jonsson H, Lundin E, Häggström C, Idahl A. Pelvic inflammatory disease and risk of epithelial ovarian cancer: a national population-based case-control study in Sweden. Am J Obstet Gynecol 2024; 230:75.e1-75.e15. [PMID: 37778677 DOI: 10.1016/j.ajog.2023.09.094] [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: 05/11/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Epithelial ovarian cancer is an insidious disease, and women are often diagnosed when the disease is beyond curative treatment. Accordingly, identifying modifiable risk factors is of paramount importance. Inflammation predisposes an individual to cancer in various organs, but whether pelvic inflammatory disease is associated with an increased risk of epithelial ovarian cancer has not been fully determined. OBJECTIVE This study aimed to investigate a possible association between clinically verified pelvic inflammatory disease and the risk of epithelial ovarian cancer. STUDY DESIGN In this national population-based case-control study, all women in Sweden diagnosed with epithelial ovarian cancer between 1999 and 2020 and 10 controls for each were identified, matched for age and residential district. Using several Swedish nationwide registers, data on previous pelvic inflammatory disease and potential confounding factors (age, parity, educational level, and previous gynecologic surgery) were retrieved. Adjusted odds ratios and 95% confidence intervals were estimated using conditional logistic regression. Histotype-specific analyses were performed for the subgroup of women diagnosed with epithelial ovarian cancer between 2015 and 2020. Moreover, hormonal contraceptives and menopausal hormone therapy were adjusted in addition to the aforementioned confounders. RESULTS This study included 15,072 women with epithelial ovarian cancer and 141,322 controls. Most women (9102 [60.4%]) had serous carcinoma. In a subgroup of cases diagnosed between 2015 and 2020, high-grade serous carcinoma (2319 [60.0%]) was identified. A total of 168 cases (1.1%) and 1270 controls (0.9%) were diagnosed with pelvic inflammatory disease. Previous pelvic inflammatory disease was associated with an increased risk of epithelial ovarian cancer (adjusted odds ratio, 1.39; 95% confidence interval, 1.17-1.66) and serous carcinoma (adjusted odds ratio, 1.46; 95% confidence interval, 1.18-1.80) for the entire study population. For the subgroup of women diagnosed in 2015-2020, pelvic inflammatory disease was associated with high-grade serous carcinoma (adjusted odds ratio, 1.43; 95% confidence interval, 1.01-2.04). The odds ratios of the other histotypes were as follows: endometrioid (adjusted odds ratio, 0.13; 95% confidence interval, 0.02-1.06), mucinous (adjusted odds ratio, 1.55; 95% confidence interval, 0.56-4.29), and clear cell carcinoma (adjusted odds ratio, 2.30; 95% confidence interval, 0.90-5.86). A dose-response relationship was observed between the number of pelvic inflammatory disease episodes and the risk of epithelial ovarian cancer (Ptrend<.001). CONCLUSION A history of pelvic inflammatory disease is associated with an increased risk of epithelial ovarian cancer and a dose-response relationship is evident. Histotype-specific analyses show an association with increased risk of serous epithelial ovarian cancer and high-grade serous carcinoma and potentially also with clear cell carcinoma, but there is no significant association with other histotypes. Infection and inflammation of the upper reproductive tract might have serious long-term consequences, including epithelial ovarian cancer.
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Affiliation(s)
- Sarah Jonsson
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden.
| | - Håkan Jonsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Eva Lundin
- Pathology Unit, Department of Medical Biosciences, Umeå University, Umeå, Sweden
| | - Christel Häggström
- Department of Public Health and Clinical Medicine, Registry Centre North, Umeå University, Umeå, Sweden
| | - Annika Idahl
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
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Gharbia N, Halouani A, Tekaya F, Slama SB, Triki A, Amor AB. Infected, giant borderline ovarian tumor: A case report. Int J Surg Case Rep 2023; 111:108873. [PMID: 37801963 PMCID: PMC10558306 DOI: 10.1016/j.ijscr.2023.108873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 10/08/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Gigantic borderline ovarian cancer, also known as giant borderline ovarian tumor, is a rare subtype of borderline ovarian cancer. This type of ovarian cyst can be associated to various complication, including superinfection. CASE PRESENTATION We present the case of a 30-year-old woman who sought medical attention due to chronic abdominal pain and a rapid increase in abdominal girth over the past four months. Pelvic ultrasound and pelvic magnetic resonance imaging (MRI) revealed an abdominal-pelvic mass of 27 ∗ 12 cm. The tumoral markers were elevated. During her hospitalization, she developed a fever along with abdominal pain and biological inflammatory syndrome. Surgical intervention a 30-cm-long solid cystic mass located on the right ovary, accompanied by moderate ascites. The surgical procedure included a right adnexectomy, omentectomy, and appendicectomy, with cytology performed. Postoperative antibiotics were administered, and the patient showed favorable clinical and biological progress. The anatomopathological examination confirmed a 35-cm borderline mucinous tumor with signs of infection. CLINICAL DISCUSSION Giant borderline ovarian tumor is characterized by the presence of an ovarian mass measuring at least 10 cm in diameter. Infectious complications are rare, and their clinical features usually mimic those of a peritonitis. Treatment is based on antibiotics and chirurgical removal of the tumor based on the FIGO classification along with peritoneal biopsies and cytology. CONCLUSION This study explores the diagnosis, treatment, and prognosis of infected giant borderline ovarian tumors.
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Affiliation(s)
- Nourallah Gharbia
- Department of Gynecology and Obstetrics, University Hospital Center Mongi Slim, Tunis, Tunisia; Research laboratory LR18SP05, Tunis, Tunisia.
| | - Ahmed Halouani
- Department of Gynecology and Obstetrics, University Hospital Center Mongi Slim, Tunis, Tunisia; Research laboratory LR18SP05, Tunis, Tunisia
| | - Fatma Tekaya
- Department of Gynecology and Obstetrics, University Hospital Center Mongi Slim, Tunis, Tunisia
| | - Sana Ben Slama
- Department of Anatomical Pathology, University Hospital Center Mongi Slim, Tunis, Tunisia
| | - Amel Triki
- Department of Gynecology and Obstetrics, University Hospital Center Mongi Slim, Tunis, Tunisia
| | - Anissa Ben Amor
- Department of Gynecology and Obstetrics, University Hospital Center Mongi Slim, Tunis, Tunisia; Research laboratory LR18SP05, Tunis, Tunisia
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Syed Khaja AS, Zafar M, Alshammari AMA, Alharbi S, Alghaithi AMS, Alshahri B, Saleem M, Parveen N, Mohammed G. Assessment of Knowledge and Attitude Toward Pelvic Inflammatory Disease Among Women in Saudi Arabia. Cureus 2023; 15:e45013. [PMID: 37829952 PMCID: PMC10565605 DOI: 10.7759/cureus.45013] [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] [Accepted: 09/05/2023] [Indexed: 10/14/2023] Open
Abstract
Purpose Pelvic inflammatory disease (PID) is a serious infection of the female reproductive system that can lead to long-term complications such as infertility, chronic pelvic pain, and ectopic pregnancy. PID is also associated with an increased risk of HIV infection and other sexually transmitted infections (STIs). Early diagnosis and treatment of PID is crucial to prevent complications. Despite the severe consequences of PID, many women are unaware of the risks associated with this condition. This lack of awareness can lead to delayed diagnosis and treatment, increasing the risk of complications. This study explores women's knowledge and attitudes regarding PID. Methods A cross-sectional survey was conducted using a bilingual, community-based questionnaire, circulated using different social media platforms. A total of 239 participants were selected through convenient non-probability sampling from the public in the Kingdom of Saudi Arabia. The collected data was analyzed using SPSS Statistics version 26 (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp.). The chi-square test was applied to determine the differences between knowledge and attitude levels with participants' socio-demographic characteristics. A p-value <0.005 was considered statistically significant. Results Appropriate PID knowledge level was found only in 32% of the respondents and was significantly associated with the respondents' family history of the PID (p=0.025). A positive attitude toward PID/STI was also observed only in 36% of the study participants, which was significantly associated with the respondents' age (p˂0.001), marital status (p˂0.001), occupation (p˂ 0.001), past medical/surgical history (p=0.006), and family history of the PID (p˂0.009). Conclusion The present study reported average levels of appropriate knowledge and attitudes toward PID among female respondents, which could be further improved by increasing PID/STI awareness programs.
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Affiliation(s)
| | - Mubashir Zafar
- Department of Family and Community Medicine, University of Hail College of Medicine, Hail, SAU
| | | | - Saqer Alharbi
- Department of Pathology, University of Hail College of Medicine, Hail, SAU
| | | | - Badr Alshahri
- Department of Pathology, University of Hail College of Medicine, Hail, SAU
| | - Mohd Saleem
- Department of Pathology, University of Hail College of Medicine, Hail, SAU
| | - Nuzhat Parveen
- Department of Obstetrics and Gynecology, University of Hail College of Medicine, Hail, SAU
| | - Ghorashy Mohammed
- Department of Pathology, University of Hail College of Medicine, Hail, SAU
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Torres W, Pérez JL, Díaz MP, D’Marco L, Checa-Ros A, Carrasquero R, Angarita L, Gómez Y, Chacín M, Ramírez P, Villasmil N, Durán-Agüero S, Cano C, Bermúdez V. The Role of Specialized Pro-Resolving Lipid Mediators in Inflammation-Induced Carcinogenesis. Int J Mol Sci 2023; 24:12623. [PMID: 37628804 PMCID: PMC10454572 DOI: 10.3390/ijms241612623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/10/2023] [Accepted: 04/15/2023] [Indexed: 08/27/2023] Open
Abstract
Cancer is a process involving cell mutation, increased proliferation, invasion, and metastasis. Over the years, this condition has represented one of the most concerning health problems worldwide due to its significant morbidity and mortality. At present, the incidence of cancer continues to grow exponentially. Thus, it is imperative to open new avenues in cancer research to understand the molecular changes driving DNA transformation, cell-to-cell interaction derangements, and immune system surveillance decay. In this regard, evidence supports the relationship between chronic inflammation and cancer. In light of this, a group of bioactive lipids derived from polyunsaturated fatty acids (PUFAs) may have a position as novel anti-inflammatory molecules known as the specialized pro-resolving mediators (SPMs), a group of pro-resolutive inflammation agents that could improve the anti-tumor immunity. These molecules have the potential role of chemopreventive and therapeutic agents for various cancer types, and their effects have been documented in the scientific literature. Thus, this review objective centers around understanding the effect of SPMs on carcinogenesis and their potential therapeutic effect.
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Affiliation(s)
- Wheeler Torres
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo 4004, Venezuela
| | - José Luis Pérez
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo 4004, Venezuela
| | - María P. Díaz
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo 4004, Venezuela
| | - Luis D’Marco
- Grupo de Investigación en Enfermedades Cardiorrenales y Metabólicas, Departamento de Medicina y Cirugía, Facultad de Ciencias de la Salud, Universidad Cardenal Herrera-CEU, CEU Universities, 46115 Valencia, Spain
| | - Ana Checa-Ros
- Grupo de Investigación en Enfermedades Cardiorrenales y Metabólicas, Departamento de Medicina y Cirugía, Facultad de Ciencias de la Salud, Universidad Cardenal Herrera-CEU, CEU Universities, 46115 Valencia, Spain
| | - Rubén Carrasquero
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo 4004, Venezuela
| | - Lissé Angarita
- Escuela de Nutrición y Dietética, Facultad de Medicina, Universidad Andres Bello, Concepción 4260000, Chile
| | - Yosselin Gómez
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo 4004, Venezuela
| | - Maricarmen Chacín
- Facultad de Ciencias de la Salud, Universidad Simón Bolívar, Barranquilla 080022, Colombia
| | - Paola Ramírez
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo 4004, Venezuela
| | - Nelson Villasmil
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo 4004, Venezuela
| | - Samuel Durán-Agüero
- Facultad de Ciencias Para el Cuidado de la Salud, Universidad San Sebastián, Los Leones 8420524, Chile
| | - Clímaco Cano
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo 4004, Venezuela
| | - Valmore Bermúdez
- Facultad de Ciencias de la Salud, Universidad Simón Bolívar, Barranquilla 080022, Colombia
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Pankowska KA, Będkowska GE, Chociej-Stypułkowska J, Rusak M, Dąbrowska M, Osada J. Crosstalk of Immune Cells and Platelets in an Ovarian Cancer Microenvironment and Their Prognostic Significance. Int J Mol Sci 2023; 24:ijms24119279. [PMID: 37298230 DOI: 10.3390/ijms24119279] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/17/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Ovarian cancer (OC) is one of the deadliest gynecological cancers, largely due to the fast development of metastasis and drug resistance. The immune system is a critical component of the OC tumor microenvironment (TME) and immune cells such as T cells, NK cells, and dendritic cells (DC) play a key role in anti-tumor immunity. However, OC tumor cells are well known for evading immune surveillance by modulating the immune response through various mechanisms. Recruiting immune-suppressive cells such as regulatory T cells (Treg cells), macrophages, or myeloid-derived suppressor cells (MDSC) inhibit the anti-tumor immune response and promote the development and progression of OC. Platelets are also involved in immune evasion by interaction with tumor cells or through the secretion of a variety of growth factors and cytokines to promote tumor growth and angiogenesis. In this review, we discuss the role and contribution of immune cells and platelets in TME. Furthermore, we discuss their potential prognostic significance to help in the early detection of OC and to predict disease outcome.
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Affiliation(s)
- Katarzyna Aneta Pankowska
- Department of Haematological Diagnostics, Medical University of Bialystok, Waszyngtona 15A Street, 15-269 Bialystok, Poland
| | - Grażyna Ewa Będkowska
- Department of Haematological Diagnostics, Medical University of Bialystok, Waszyngtona 15A Street, 15-269 Bialystok, Poland
| | - Joanna Chociej-Stypułkowska
- Department of Haematological Diagnostics, Medical University of Bialystok, Waszyngtona 15A Street, 15-269 Bialystok, Poland
| | - Małgorzata Rusak
- Department of Haematological Diagnostics, Medical University of Bialystok, Waszyngtona 15A Street, 15-269 Bialystok, Poland
| | - Milena Dąbrowska
- Department of Haematological Diagnostics, Medical University of Bialystok, Waszyngtona 15A Street, 15-269 Bialystok, Poland
| | - Joanna Osada
- Department of Haematological Diagnostics, Medical University of Bialystok, Waszyngtona 15A Street, 15-269 Bialystok, Poland
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The Female Reproductive Tract Microbiome and Cancerogenesis: A Review Story of Bacteria, Hormones, and Disease. Diagnostics (Basel) 2023; 13:diagnostics13050877. [PMID: 36900020 PMCID: PMC10000484 DOI: 10.3390/diagnostics13050877] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/07/2023] [Accepted: 02/18/2023] [Indexed: 03/02/2023] Open
Abstract
The microbiota is the complex community of microorganisms that populate a particular environment in the human body, whereas the microbiome is defined by the entire habitat-microorganisms and their environment. The most abundant and, therefore, the most studied microbiome is that of the gastrointestinal tract. However, the microbiome of the female reproductive tract is an interesting research avenue, and this article explores its role in disease development. The vagina is the reproductive organ that hosts the largest number of bacteria, with a healthy profile represented mainly by Lactobacillus spp. On the other hand, the female upper reproductive tract (uterus, Fallopian tubes, ovaries) contains only a very small number of bacteria. Previously considered sterile, recent studies have shown the presence of a small microbiota here, but there are still debates on whether this is a physiologic or pathologic occurrence. Of particular note is that estrogen levels significantly influence the composition of the microbiota of the female reproductive tract. More and more studies show a link between the microbiome of the female reproductive tract and the development of gynecological cancers. This article reviews some of these findings.
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Xu S, Gao X, Qiu J, Hong F, Gao F, Wang X, Zhang S. TIPE2 acts as a tumor suppressor and correlates with tumor microenvironment immunity in epithelial ovarian cancer. Aging (Albany NY) 2023; 15:1052-1073. [PMID: 36801818 PMCID: PMC10008487 DOI: 10.18632/aging.204529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/11/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND Epithelial ovarian cancer (EOC) is one of the deadliest gynecologic cancers. The etiology of EOC has still not been elucidated thoroughly. Tumor necrosis factor-α-induced protein 8-like2 (TNFAIP8L2, TIPE2), an important regulator of inflammation and immune homeostasis, plays a critical role in the progression of various cancers. This study aims to investigate the role of TIPE2 in EOC. METHODS Expression of TIPE2 protein and mRNA in EOC tissues and cell lines was examined using Western blot and quantitative real-time PCR (qRT-PCR). The functions of TIPE2 in EOC were investigated by cell proliferation assay, colony assay, transwell assay, and apoptosis analysis in vitro. To further investigate the regulatory mechanisms of TIPE2 in EOC, RNA-seq and western blot were performed. Finally, the CIBERSORT algorithm and databases including Tumor Immune Single-cell Hub (TISCH), Tumor Immune Estimation Resource (TIMER), Tumor-Immune System Interaction (TISIDB), and The Gene Expression Profiling Interactive Analysis (GEPIA) were used to elucidate its potential role in regulating tumor immune infiltration in the tumor microenvironment (TME). RESULTS TIPE2 expression was shown to be considerably lower in both EOC samples and cell lines. Overexpression of TIPE2 suppressed EOC cell proliferation, colony formation, and motility in vitro. Mechanistically, TIPE2 suppressed EOC by blocking the PI3K/Akt signaling pathway, according to bioinformatics analysis and western blot in TIPE2 overexpression EOC cell lines, and the anti-oncogenic potentials of TIPE2 in EOC cells could be partially abrogated by the PI3K agonist, 740Y-P. Finally, TIPE2 expression was positively associated with various immune cells and possibly involved in the regulation of macrophage polarization in ovarian cancer. CONCLUSIONS We detail the regulatory mechanism of TIPE2 in EOC carcinogenesis, as well as how it correlates with immune infiltration, emphasizing its potential as a therapeutic target in ovarian cancer.
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Affiliation(s)
- Shuai Xu
- Department of Obstetrics and Gynecology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China.,Department of Obstetrics and Gynecology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250033, Shandong, China
| | - Xiaolin Gao
- Department of Obstetrics and Gynecology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250033, Shandong, China
| | - Jianqing Qiu
- Department of Obstetrics and Gynecology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250033, Shandong, China
| | - Fanzhen Hong
- Department of Obstetrics and Gynecology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250033, Shandong, China
| | - Fufeng Gao
- Department of Gynecological Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, Shandong, China
| | - Xia Wang
- Laboratory of Translational Gastroenterology, Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250033, Shandong, China
| | - Shiqian Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China
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Shah HK, Banerjee BD, Thakur GK, Guleria K. Organochlorine pesticides induce epithelial as well as inflammatory mediators following exposure to human ovarian surface epithelial cells: An in vitro study. J Biochem Mol Toxicol 2022; 36:e23191. [PMID: 35946146 DOI: 10.1002/jbt.23191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 05/12/2022] [Accepted: 07/25/2022] [Indexed: 11/10/2022]
Abstract
Although studies have suggested organochlorine pesticides (OCPs) exposure increased the risk of epithelial ovarian cancer, the mechanisms underlying its potential tumorigenic effects in the human ovary are not well understood. In this study, we investigated the impact of dichlorodiphenyldichloroethylene (DDE), endosulfan, and heptachlor exposure on epithelial cadherin (E-cadherin) and proinflammatory mediators in human ovary surface epithelial (HOSE) cells. We found that DDE, endosulfan, and heptachlor exposure resulted in epithelial differentiation accompanied by upregulation of E-cadherin expression and overexpression of proinflammatory cytokines (TNFα, IL-1β, and IL-6) in HOSE cells. The epithelial differentiation may accelerate HOSE cells to inclusion body formation, a common site for ovarian cancer initiation and persistent exposure to OCPs creates a chronic inflammatory microenvironment that may promote the neoplastic transformation of HOSE cells within the inclusion cyst.
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Affiliation(s)
- Harendra K Shah
- Department of Biochemistry, Environmental Biochemistry and Molecular Biology Laboratory, University College of Medical Sciences and G.T.B. Hospital (University of Delhi), Delhi, India
| | - Basu D Banerjee
- Department of Biochemistry, Environmental Biochemistry and Molecular Biology Laboratory, University College of Medical Sciences and G.T.B. Hospital (University of Delhi), Delhi, India
| | - Gaurav K Thakur
- Department of Biochemistry, Environmental Biochemistry and Molecular Biology Laboratory, University College of Medical Sciences and G.T.B. Hospital (University of Delhi), Delhi, India
| | - Kiran Guleria
- Department of Obstetrics and Gynecology, University College of Medical Sciences and G.T.B. Hospital (University of Delhi), Delhi, India
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Guo J, Feng H, Gu X. Association Between Benign Ovarian Tumors and Ovarian Cancer Risk: A Meta-Analysis of Ten Epidemiological Studies. Front Oncol 2022; 12:895618. [PMID: 35646702 PMCID: PMC9133501 DOI: 10.3389/fonc.2022.895618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/18/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundEpidemiological evidence on the relationship between benign ovarian tumors and ovarian cancer risk has been controversial; therefore, this systematic review and meta-analysis evaluated this association.MethodsThe PubMed and Web of Knowledge databases were searched for eligible studies published up to April 30, 2020. The study-specific risk estimates were pooled using a random-effects model.ResultsTen articles (two cohorts, seven case-control studies, and one pooled analysis of eight case-control studies) with 10331 ovarian cancer patients were included. Benign ovarian tumors were associated with an increased risk of ovarian cancer (pooled relative risk [RR]=1.39, 95% confidence interval [CI]: 1.01–1.90), with high heterogeneity among studies. The pooled RR was 2.02 (95%CI: 1.32–3.11) for two cohort studies, which was higher than the pooled result of eight case-control studies (pooled RR: 1.15; 95%CI: 0.92–1.44). When stratifying by histological type, the pooled RRs were 1.53 (95% CI: 0.37–6.29) and 3.62 (95%CI: 0.81–16.20) for serous and mucinous tumors, respectively. The pooled RRs were 1.61 (95%CI: 0.65–3.95) and 1.54 (95%CI: 1.29–1.84) for the associations of ovarian cyst with invasive and borderline cancers, respectively.ConclusionsBenign ovarian tumors were associated with an increased risk of ovarian cancer. Due to the high heterogeneity among the studies and the risks of bias, more studies are warranted to confirm these findings.
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Affiliation(s)
- Jiao Guo
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Haoshen Feng
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xi Gu
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Xi Gu,
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Curry K, Chandler R, Kostas-Polston EA, Alexander I, Orsega S, Johnson-Mallard V. Recommendations for managing sexually transmitted infections: Incorporating the 2021 guidelines. Nurse Pract 2022; 47:10-18. [PMID: 35349512 DOI: 10.1097/01.npr.0000822528.27483.b2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Sexually transmitted infections (STIs) are common and costly, with about 26 million STIs occurring each year in the US. Guidelines for the prevention and management of STIs are updated periodically. In 2021, the CDC updated its guidelines for the treatment of STIs. This article provides information on the most recent updates on managing STIs to help advanced practice nurses in their practice.
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Irisin Activates M1 Macrophage and Suppresses Th2-Type Immune Response in Rats with Pelvic Inflammatory Disease. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:5215915. [PMID: 35186099 PMCID: PMC8853798 DOI: 10.1155/2022/5215915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/13/2022] [Accepted: 01/20/2022] [Indexed: 11/29/2022]
Abstract
Objective To investigate the mechanism of irisin to treat rats with acute pelvic inflammatory disease (APID). Methods Female rats were established as APID. Firstly, the content of IL-6, IL-8, TNF-α, and NF-kB was tested in rats' serum by enzyme linked immunosorbent assay (ELISA). Interferon-γ (IFN-γ) and IL-4 in the supernatant of pelvic homogenates were also detected. The mRNA expression of the inducible nitric oxide synthase (iNOS), TNF-α, chemokine ligand 1 (CXCL1), arginase-1(Arg1), and chitinase-3-like-3 (Chi313) genes in the pelvic cavity was detected by quantitative reverse transcription polymerase chain reaction (RT-qPCR). IFN-γ and IL-4 secreted by spleen CD4+T cells and CD8+T cells were counted by flow cytometry, and the ratio of IFN-γ/IL-4 in CD4+T cells and CD8+T cells in the spleen was also detected by flow cytometry. Results Irisin reduced the levels of IL-6, IL-8, TNF-α, and NF-kB in serum. Compared with the APID group, the expression level of IL-4 in the APID + Irisin group was reduced in the homogenate. At the same time, Irisin promotes the activation of M1 macrophages in the uterus, ovaries, and uterine tubes of rats with APID. Irisin also inhibited Th2-type immune response. Conclusions Irisin activates M1 macrophage and suppresses Th2-type immune response in APID rats.
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Brieger KK, Phung MT, Mukherjee B, Bakulski KM, Anton-Culver H, Bandera EV, Bowtell DDL, Cramer DW, deFazio A, Doherty JA, Fereday S, Fortner RT, Gentry-Maharaj A, Goode EL, Goodman MT, Harris HR, Matsuo K, Menon U, Modugno F, Moysich KB, Qin B, Ramus SJ, Risch HA, Rossing MA, Schildkraut JM, Trabert B, Vierkant RA, Winham SJ, Wentzensen N, Wu AH, Ziogas A, Khoja L, Cho KR, McLean K, Richardson J, Grout B, Chase A, Deurloo CM, Odunsi K, Nelson BH, Brenton JD, Terry KL, Pharoah PDP, Berchuck A, Hanley GE, Webb PM, Pike MC, Pearce CL. High Prediagnosis Inflammation-Related Risk Score Associated with Decreased Ovarian Cancer Survival. Cancer Epidemiol Biomarkers Prev 2022; 31:443-452. [PMID: 34789471 PMCID: PMC9281656 DOI: 10.1158/1055-9965.epi-21-0977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/16/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND There is suggestive evidence that inflammation is related to ovarian cancer survival. However, more research is needed to identify inflammation-related factors that are associated with ovarian cancer survival and to determine their combined effects. METHODS This analysis used pooled data on 8,147 women with invasive epithelial ovarian cancer from the Ovarian Cancer Association Consortium. The prediagnosis inflammation-related exposures of interest included alcohol use; aspirin use; other nonsteroidal anti-inflammatory drug use; body mass index; environmental tobacco smoke exposure; history of pelvic inflammatory disease, polycystic ovarian syndrome, and endometriosis; menopausal hormone therapy use; physical inactivity; smoking status; and talc use. Using Cox proportional hazards models, the relationship between each exposure and survival was assessed in 50% of the data. A weighted inflammation-related risk score (IRRS) was developed, and its association with survival was assessed using Cox proportional hazards models in the remaining 50% of the data. RESULTS There was a statistically significant trend of increasing risk of death per quartile of the IRRS [HR = 1.09; 95% confidence interval (CI), 1.03-1.14]. Women in the upper quartile of the IRRS had a 31% higher death rate compared with the lowest quartile (95% CI, 1.11-1.54). CONCLUSIONS A higher prediagnosis IRRS was associated with an increased mortality risk after an ovarian cancer diagnosis. Further investigation is warranted to evaluate whether postdiagnosis exposures are also associated with survival. IMPACT Given that pre- and postdiagnosis exposures are often correlated and many are modifiable, our study results can ultimately motivate the development of behavioral recommendations to enhance survival among patients with ovarian cancer.
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Affiliation(s)
- Katharine K. Brieger
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Minh Tung Phung
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Bhramar Mukherjee
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Kelly M. Bakulski
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Hoda Anton-Culver
- Department of Medicine, University of California Irvine, Irvine, CA, USA
| | - Elisa V. Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - David D. L. Bowtell
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia
| | - Daniel W. Cramer
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Anna deFazio
- Centre for Cancer Research, The Westmead Institute for Medical Research, and The University of Sydney, New South Wales, Australia
- Department of Gynaecological Oncology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Jennifer A. Doherty
- Huntsman Cancer Institute, Department of Population Health Sciences. University of Utah. Salt Lake City, UT, USA
| | - Sian Fereday
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia
| | - Renée T. Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Ellen L. Goode
- Department of Quantitative Health Sciences, Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
| | - Marc T. Goodman
- Samuel Oschin Comprehensive Cancer Institute, Cancer Prevention and Genetics Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Community and Population Health Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Holly R. Harris
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA
| | - Keitaro Matsuo
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
- Department of Cancer Epidemiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Usha Menon
- MRC Clinical Trials Unit, Institute of Clinical Trials & Methodology, UCL, London, UK
| | - Francesmary Modugno
- Women’s Cancer Research Center. Magee-Women’s Research Institute and Hillman Cancer Center, Pittsburgh, PA, USA
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburg, PA, USA
| | - Kirsten B. Moysich
- Division of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center. Buffalo, NY, USA
| | - Bo Qin
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Susan J. Ramus
- School of Women’s and Children’s Health, Faculty of Medicine, University of NSW Sydney, Sydney, New South Wales, Australia
- The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Harvey A. Risch
- Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Mary Anne Rossing
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA
| | | | - Britton Trabert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Robert A. Vierkant
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Stacey J. Winham
- Department of Quantitative Health Sciences, Division of Computational Biology, Mayo Clinic, Rochester, MN, USA
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Anna H. Wu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Argyrios Ziogas
- Department of Medicine, University of California Irvine, Irvine, CA, USA
| | - Lilah Khoja
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Kathleen R. Cho
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Karen McLean
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jean Richardson
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | | | | | - Kunle Odunsi
- Department of Gynecological Oncology, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Brad H. Nelson
- Deeley Research Centre, British Columbia Cancer Agency, Victoria, British Columbia, Canada
| | - James D. Brenton
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Kathryn L. Terry
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Paul D. P. Pharoah
- Centre for Cancer Genetic Epidemiology, Department of Oncology. University of Cambridge, Cambridge, UK
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Andrew Berchuck
- Division of Gynecologic Oncology, Duke University School of Medicine, Durham, NC, USA
| | - Gillian E. Hanley
- University of British Columbia Faculty of Medicine, Department of Obstetrics & Gynecology, Vancouver, Canada
| | - Penelope M. Webb
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Malcolm C. Pike
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Celeste Leigh Pearce
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
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Huang H, Wu K, Chen L, Lin X. Study on the Application of Systemic Inflammation Response Index and Platelet-Lymphocyte Ratio in Ovarian Malignant Tumors. Int J Gen Med 2021; 14:10015-10022. [PMID: 34955651 PMCID: PMC8694276 DOI: 10.2147/ijgm.s346610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/09/2021] [Indexed: 12/12/2022] Open
Abstract
Objective We aimed to evaluate whether the systemic inflammatory response index (SIRI) and platelet lymphocyte ratio (PLR) are associated with ovarian malignancy and their diagnostic value. Design: This retrospective study compared SIRI, PLR, cancer antigen 125 (CA125), cancer antigen 153 (CA153), cancer antigen 199 (CA199), A carcinoma embryonic antigen (CEA) and alpha fetal protein (AFP) of the two groups in Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University from January 2018 to December 2020, divided into two groups based on pathological results, including 85 with ovarian malignancy who met the study criteria and 85 patients with benign ovarian tumors were randomly selected as control group. Results 1) SIRI and PLR in benign ovarian tumor group were lower than those in ovarian malignancy group; 2) SIRI and PLR in ovarian malignant tumor low stage group were lower than those in the high stage group; 3) In ovarian malignancies, SIRI and PLR were positively associated with CA125 (the correlation coefficient r = 0.251, p = 0.021; r = 0.251, p = 0.020;) but showed no correlation with CA153. Conclusion The study shows that SIRI and PLR are both convenient and associated with ovarian malignancy. SIRI and PLR can be used to help the differentiation of benign and malignant ovarian tumors and can also be used in the markers of ovarian malignant tumors roughly staging.
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Affiliation(s)
- Huifang Huang
- Intensive Care Unit, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Kunhai Wu
- Blood Transfusion Department, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Lufei Chen
- Blood Transfusion Department, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Xiaomei Lin
- Intensive Care Unit, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
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Greydanus DE, Cabral MD, Patel DR. Pelvic inflammatory disease in the adolescent and young adult: An update. Dis Mon 2021; 68:101287. [PMID: 34521505 DOI: 10.1016/j.disamonth.2021.101287] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Pelvic inflammatory disease (PID) is an infection of the female upper genital tract that is typically polymicrobial with classic core involvement of Neisseria gonorrhoeae and/or Chlamydia trachomatis, though other endogenous flora from the vagino-cervical areas can be involved as well. It is often a sexually transmitted disease but other etiologic routes are also noted. A variety of risk factors have been identified including adolescence, young adulthood, adolescent cervical ectropion, multiple sexual partners, immature immune system, history of previous PID, risky contraceptive practices and others. An early diagnosis and prompt treatment are necessary to reduce risks of PID complications such as chronic pelvic pain, ectopic pregnancy and infertility. Current management principles of PID are also reviewed. It is important for clinicians to screen sexually active females for common sexually transmitted infections such as Chlamydia trachomatis and provide safer sex education to their adolescent and young adult patients. Clinicians should provide comprehensive management to persons with PID and utilize established guidelines such as those from the US Centers for Disease Control and Prevention (CDC).
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Affiliation(s)
- Donald E Greydanus
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, Michigan, 49008, United States of America.
| | - Maria Demma Cabral
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, Michigan, 49008, United States of America.
| | - Dilip R Patel
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, Michigan, 49008, United States of America.
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Uslu Yuvaci H, Cinar N, Yalnizoglu Caka S, Topal S, Peksen S, Saglam N, Cevrioglu AS. Effects of antepartum education on worries about labor and mode of delivery. J Psychosom Obstet Gynaecol 2021; 42:228-234. [PMID: 32050831 DOI: 10.1080/0167482x.2020.1725465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
AIM This study evaluated the effects of antenatal education, which was provided in a pregnancy education class, on pregnant women's concerns about labor and the mode of delivery. MATERIALS AND METHODS Primigravid pregnant women (n = 144) were enrolled into the study between May 2017 and November 2018. Pregnant women received standard education on nutrition during pregnancy, exercise, methods of coping with pain, and breastfeeding. The participants completed the "Introductory Information Form" and "Oxford Worries about Labour Scale" to collect data. RESULTS A statistically significant difference was found between the participants' pain, distress, uncertainty, and interventions in the pre-education, post-education, and postpartum periods and mean total score on the Oxford scale (p<.05). However, education had no significant effect on the mode of delivery (p>.05). CONCLUSION Education provided during pregnancy significantly decreased women's worries about labor, but it did not lead to a significant difference in the modes of delivery.
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Affiliation(s)
- Hilal Uslu Yuvaci
- Department of Obstetrics and Gynecology, University of Sakarya School of Medicine, Sakarya, Turkey
| | - Nursan Cinar
- School of Health Sciences, Sakarya University, Sakarya, Turkey
| | | | - Sumeyra Topal
- School of Health Sciences, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Sultan Peksen
- Department of Obstetrics and Gynecology, Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Nuran Saglam
- Department of Obstetrics and Gynecology, Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Arif Serhan Cevrioglu
- Department of Obstetrics and Gynecology, University of Sakarya School of Medicine, Sakarya, Turkey
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Different Influences of Endometriosis and Pelvic Inflammatory Disease on the Occurrence of Ovarian Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168754. [PMID: 34444500 PMCID: PMC8394785 DOI: 10.3390/ijerph18168754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 11/17/2022]
Abstract
To compare the rate and risk of ovarian cancer in patients with endometriosis or pelvic inflammatory disease (PID). A nationwide population cohort research compared the risk of ovarian cancer in 135,236 age-matched comparison females, 114,726 PID patients, and 20,510 endometriosis patients out of 982,495 females between 1 January 2002 and 31 December 2014 and ended on the date of confirmation of ovarian cancer, death, or 31 December 2014. In order to reduce the unbalanced characteristics, propensity score matching (PSM) was performed for 20,478 females in each subgroup. The incidence rate (per 100,000 person–years) of ovarian cancer was 8.74 (95% CI, 7.16–10.66) in comparison, 9.26 (7.54–11.39) in PID, and 28.73 (21.07–39.16) in endometriosis cohorts. The adjusted hazard ratio (aHR) of ovarian cancer was 1.17 (p = 0.296) in PID and 3.12 (p < 0.001) in endometriosis cohorts, compared with the comparison cohort in full cohort, using the multiple Cox regression model. The aHR of ovarian cancer was 0.83 (p = 0.650) in PID and 3.03 (p = 0.001) in endometriosis cohorts, compared with the comparison cohort after performing PSM. In the full cohort and PSM population, the cumulative incidence rate of ovarian cancer was significantly higher in patients with endometriosis than in those with PID or in the comparison cohort (p < 0.001 and p < 0.001). In conclusion, after considering the differences in the impacts of exposure to endometriosis or PID, patients with endometriosis were more likely to develop ovarian cancer.
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Paavonen J, Turzanski Fortner R, Lehtinen M, Idahl A. Chlamydia trachomatis, Pelvic Inflammatory Disease, and Epithelial Ovarian Cancer. J Infect Dis 2021; 224:S121-S127. [PMID: 34396414 DOI: 10.1093/infdis/jiab017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Epidemiologic, clinical, molecular and translational research findings support an interrelationship between Chlamydia trachomatis, pelvic inflammatory disease (PID), and epithelial ovarian cancer (EOC). Overall, the link between C. trachomatis, PID, and EOC seems to be relatively weak, although nondifferential misclassification bias may have attenuated the results. The predominant tubal origin of EOC and the role of chronic inflammation in tumorigenesis suggest that the association is biologically plausible. Thus, C. trachomatis and PID may represent potential risk factors or risk markers for EOC. However, many steps in this chain of events are still poorly understood and need to be addressed in future studies. Research gaps include time of exposure in relation to the long-term consequences and lag time to EOC. Data of differential risk for EOC between chlamydial and nonchlamydial PID is also needed. Another major research gap has been the absence of high-performance biomarkers for C. trachomatis, PID, and EOC, as well as EOC precursors. Biomarkers for C. trachomatis and PID leading to increased risk of EOC should be developed. If the association is confirmed, C. trachomatis and PID prevention efforts may play a role in reducing the burden of EOC.
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Affiliation(s)
- Jorma Paavonen
- Professor Emeritus, University of Helsinki, Helsinki, Finland
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24
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Sasamoto N, Babic A, Vitonis AF, Titus L, Cramer DW, Trabert B, Tworoger SS, Terry KL. Common Analgesic Use for Menstrual Pain and Ovarian Cancer Risk. Cancer Prev Res (Phila) 2021; 14:795-802. [PMID: 34244153 PMCID: PMC8344407 DOI: 10.1158/1940-6207.capr-21-0090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/15/2021] [Accepted: 05/18/2021] [Indexed: 01/08/2023]
Abstract
Menstrual pain has been associated with increased ovarian cancer risk, presumably through increased inflammation, which is known to play a critical role in ovarian carcinogenesis. Analgesic medications are frequently used to treat menstrual pain, some of which lower ovarian cancer risk. In this study, we examined the association between analgesic use for menstrual pain during the premenopausal period and ovarian cancer risk among women with history of menstrual pain. We used data from the New England Case-Control Study, including 1,187 epithelial ovarian cancer cases and 1,225 population-based controls enrolled between 1998 and 2008 with detailed information on analgesic use for their menstrual pain. We used unconditional logistic regression to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for the association between analgesic use (i.e., aspirin, ibuprofen, acetaminophen) for menstrual pain and ovarian cancer risk. We further conducted a stratified analysis by intensity of menstrual pain (mild/moderate, severe). Among women with menstrual pain during their 20s and 30s, ever use of analgesics for menstrual pain was not significantly associated with ovarian cancer risk. However, among women with severe menstrual pain, ever use of aspirin or acetaminophen for menstrual pain was inversely associated with risk (OR, 0.41; 95% CI, 0.18-0.94 and OR, 0.43; 95% CI, 0.21-0.88 compared with never users, respectively). No significant association was observed between analgesic use and ovarian cancer risk among women with mild/moderate menstrual pain (P interaction ≤ 0.03). Our results suggest that use of aspirin or acetaminophen for severe menstrual pain may be associated with lower risk of ovarian cancer. PREVENTION RELEVANCE: This study investigates whether analgesic use specifically for menstrual pain during the premenopausal period influences ovarian cancer risk. Our results suggest use of aspirin or acetaminophen for severe menstrual pain may be associated with lower risk of ovarian cancer among women with severe menstrual pain.
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Affiliation(s)
- Naoko Sasamoto
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Ana Babic
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Allison F Vitonis
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Linda Titus
- Public Health, Muskie School of Public Service, University of Southern Maine, Portland, Maine
| | - Daniel W Cramer
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Britton Trabert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Shelley S Tworoger
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Kathryn L Terry
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Chang CYY, Lin KYH, Huang CC, Lin WC. Association of pelvic inflammatory disease (PID) with ovarian cancer: a nationwide population-based retrospective cohort study from Taiwan. BMC WOMENS HEALTH 2021; 21:274. [PMID: 34320962 PMCID: PMC8320223 DOI: 10.1186/s12905-021-01413-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 07/17/2021] [Indexed: 01/07/2023]
Abstract
Background Pelvic inflammatory disease (PID) is an important health issue for women. Infection and inflammation play an important role in carcinogenesis and PID has been reported to be associated with ovarian cancer in some small scale studies. Aim We sought to determine whether PID is associated with an elevated risk of ovarian cancer in Asian women. Methods Using data from Taiwan’s National Health Insurance Research Database (NHIRD), our retrospective cohort study included women diagnosed with PID (cases) between the years of 2000 till 2012. Each case was matched with two women without PID (controls) by age and the year of first entry into the database. Both study cohorts were followed-up until the first event of ovarian cancer, withdrawal from the NHI program, death, or the end of the study period (December 31, 2012). Cox proportional hazards regression models were used to estimate crude and adjusted hazard ratios (HRs and aHRs) with their corresponding 95% confidence intervals (95% CIs) for the association of PID and ovarian cancer risk, with and without adjusting for potential confounders. Results During an approximate 10 years of follow-up, cases were significantly more likely than controls to develop ovarian cancer (incidence rates of 0.27 and 0.16 per 1,000 person-years, respectively; P < 0.001). Women with a history of PID had a 1.49-fold elevated risk for ovarian cancer (aHR, 1.49; 95% CI, 1.21–1.84; P < 0.001). Conclusion Our study evidence supports the contention that PID increases the risk of developing ovarian cancer among Taiwanese women. Gynecologists should undertake careful assessments and closely follow patients with PID, who are at long-term risk of developing ovarian cancer. Our findings need further verification in other international cohorts. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01413-2.
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Affiliation(s)
- Cherry Yin-Yi Chang
- Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan.,Department of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung, 404, Taiwan
| | - Kent Yu-Hsien Lin
- Department of Obstetrics and Gynaecology, Women and Children's Health, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Chien-Chu Huang
- Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan. .,Graduate Institution of Biomeidcal Sciences, China Medical University, No. 2, Yuh-Der Road, Taichung, 404, Taiwan.
| | - Wu-Chou Lin
- Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan. .,Department of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung, 404, Taiwan.
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26
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Qi Y, Wang M, Yang Y, Zeng Z, Zhou Y. Analysis of Factors Influencing Relapse and Pregnancy in Patients with Borderline Ovarian Tumors. J Cancer 2021; 12:5275-5285. [PMID: 34335944 PMCID: PMC8317534 DOI: 10.7150/jca.56387] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 05/23/2021] [Indexed: 11/18/2022] Open
Abstract
Objective: This retrospective study analyzed the factors affecting recurrence in patients after surgery with borderline ovarian tumors and postoperative recurrence and pregnancy after fertility-sparing surgery (FSS), to provide guidance for clinical treatment of borderline ovarian tumors and propose a therapeutic strategy for fertility protection. Methods: A total of 415 patients with borderline ovarian tumors were initially operated on in the gynecology ward of Shengjing Hospital Affiliated with China Medical University from September 1, 2013, to September 1, 2019. Central pathology review and prospective follow-up were carried out. The clinical and pathological data were consulted through the medical record query system of our hospital. The recurrence and pregnancy of the patients were investigated through telephone follow-up and outpatient and inpatient medical records. The influence of clinical and pathological variables on recurrence and pregnancy were evaluated using univariate/multivariate analyses. Results: In this study, 415 patients were collected, of which 21 lost follow-up, and a total of 394 eligible patients were included in the analysis. Among these patients, 25 patients relapsed with a recurrence rate of 6.3% and there were 196 patients with fertility-sparing surgery, of the 63 patients attempting to conceive, 35 were able to attain pregnancy with a pregnancy rate of 55.6%. All patients survived until the follow-up deadline. In univariate and multivariate analyses, FSS, FIGO stage, and micropapillary pattern were independent risk factors for recurrence of BOTs. FIGO stage, micropapillary pattern were independent risk factors for recurrence of BOTs with FSS. The risk of recurrence was not related to omentectomy nor postoperative chemotherapy. While omentectomy and chemotherapy had an impact on the pregnancy rate (P <0.05) and the pregnancy rate of patients without omentectomy or chemotherapy was higher. Conclusion: Omentectomy did not affect recurrence and it is not recommended as a routine operation. Adjuvant chemotherapy does not reduce the recurrence rate. While omentectomy and chemotherapy had an impact on the pregnancy rate, and both of them should be carried out more carefully in patients with fertility requirements.
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Affiliation(s)
- Ya Qi
- Department of Gynecology and Obstetrics, Shengjing Hospital Affiliated of China Medical University, Shenyang, Liaoning, China
| | - Min Wang
- Department of Gynecology and Obstetrics, Shengjing Hospital Affiliated of China Medical University, Shenyang, Liaoning, China
| | - Yuwei Yang
- Department of Gynecology and Obstetrics, Shengjing Hospital Affiliated of China Medical University, Shenyang, Liaoning, China
| | - Zhi Zeng
- Department of Gynecology and Obstetrics, Shengjing Hospital Affiliated of China Medical University, Shenyang, Liaoning, China
| | - Yingying Zhou
- Department of Gynecology and Obstetrics, Shengjing Hospital Affiliated of China Medical University, Shenyang, Liaoning, China
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27
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Brunham RC, Paavonen J. Reproductive system infections in women: upper genital tract, fetal, neonatal and infant syndromes. Pathog Dis 2021; 78:5848195. [PMID: 32463429 DOI: 10.1093/femspd/ftaa023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/26/2020] [Indexed: 02/03/2023] Open
Abstract
Lower genital tract infection and bloodborne spread of infection are the two principal modes for infection of the upper genital tract or for infection of the fetus, neonate or infant. Treponema pallidum and human immunodeficiency virus (HIV) are the two most common bloodborne pathogens that infect the fetus, neonate or infant. Most infections of the upper genital tract, however, spread along epithelial surfaces from the vagina or cervix to the upper genital tract or chorioamnion, fetus, neonate or infant. These infections are caused by either pathogens associated with a dysbiotic vaginal microbiome or those that are sexually transmitted. The clinical syndromes that these pathogens produce in the lower genital tract were discussed in part one of this review. We now discuss the syndromes and pathogens that affect the upper genital tract of both non-pregnant and pregnant women as well as fetus, neonate and infant.
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Affiliation(s)
- Robert C Brunham
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada V5Z 4R4
| | - Jorma Paavonen
- Department of Obstetrics and Gynecology, 00014 University of Helsinki, Helsinki, Finland
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28
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Rahbar A, Pantalone MR, Religa P, Rådestad AF, Söderberg-Naucler C. Evidence of human cytomegalovirus infection and expression of 5-lipoxygenase in borderline ovarian tumors. J Med Virol 2021; 93:4023-4027. [PMID: 33174621 DOI: 10.1002/jmv.26664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/05/2020] [Accepted: 11/07/2020] [Indexed: 11/10/2022]
Abstract
Borderline ovarian tumors (BOTs) belong to a group of tumors that are distinctly different from ovarian carcinomas. There is an increased risk of BOTs in patients with pelvic inflammatory disease. Human cytomegalovirus (HCMV) has been detected in ovarian cancer tissue specimens. This virus favors the inflammatory milieu by inducing expression of the potent inflammatory factor 5-lipoxygenase (5LO), which stimulates cellular viability, cellular proliferation and activates antiapoptotic signaling pathways. Here, we aimed to examine presence of HCMV and 5LO in BOTs. Expression levels of HCMV proteins (IE and pp65) and 5LO were examined in paraffin embedded BOT tissue sections by immunohistochemistry staining and HCMV immunoglobulin M and immunoglobulin G (IgG) levels were determined by serology in blood samples obtained from 15 patients with BOTs identified in a prospective study at Karolinska University Hospital. Extensive expression of HCMV-IE, pp65, and 5LO were detected in 87%, 40%, and 90% of examined BOT tissue sections, respectively. HCMV-IgG prevalence and antibody levels were significantly higher in patients with BOT compared to age matched healthy women (83.3% vs. 65,6%, respectively, p = .01). Whether HCMV can induce inflammation and affect the pathogenesis of BOTs should therefore be further investigated.
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Affiliation(s)
- Afsar Rahbar
- Microbial Pathogens Unit, Department of Medicine Solna, BioClinicum, Karolinska Institute, Stockholm, Sweden
- Division of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Mattia Russel Pantalone
- Microbial Pathogens Unit, Department of Medicine Solna, BioClinicum, Karolinska Institute, Stockholm, Sweden
- Division of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Piotr Religa
- Microbial Pathogens Unit, Department of Medicine Solna, BioClinicum, Karolinska Institute, Stockholm, Sweden
- Division of Neurology, Karolinska University Hospital, Stockholm, Sweden
- Polish Academy of Sciences, Magdalenka, Poland
| | - Angelique Flöter Rådestad
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Hereditary Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Cecilia Söderberg-Naucler
- Microbial Pathogens Unit, Department of Medicine Solna, BioClinicum, Karolinska Institute, Stockholm, Sweden
- Division of Neurology, Karolinska University Hospital, Stockholm, Sweden
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Wang X, Shi W, Shi X, Lin H, Qian X. The effect of adjuvant treatment in chronic pelvic inflammation by Fukejing capsules and its influence on hemorheology and inflammatory factors. Am J Transl Res 2021; 13:3480-3486. [PMID: 34017525 PMCID: PMC8129380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 12/26/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES This study investigated and analyzed the therapeutic effect of Fukejing capsules combined with ceftriaxone sodium and metronidazole in treating chronic pelvic inflammation and its influence on hemorheology and inflammatory factors. METHODS 137 patients with chronic pelvic inflammation admitted to our hospital from March 2018 to April 2020 were selected as the research subjects, and randomly classified into observation group (n=70) and control group (n=67) based on the random number table. The control-group were treated with ceftriaxone sodium and metronidazole, while the observation-group received Fukejing capsules based on the medication taken by the control group. The clinical efficacy, changes of hemorheology indexes and inflammatory factors of the two groups were compared. RESULTS The overall response rate of the observation group was critically higher than that of the control group (P<0.05). The hemorheology indicators of plasma viscosity, the blood viscosity at low and high shear rate of the two groups of patients in post-treatment were notably lower than those in pre-treatment (P<0.05), and the indexes of the observation group in post-treatment were remarkably lower than that of the control group (P<0.05). The two groups' degree of serum TNF-α, IL-6 and CRP in post-treatment were critically lower than in pre-treatment (P<0.05), and the indicators of the observation group in post-treatment were dramatically lower than that of the control group (P<0.05). CONCLUSION The treatment of Fukejing capsules combined with ceftriaxone sodium and metronidazole is effective in the chronic pelvic inflammation. It can efficiently reduce the blood viscosity of patients and cut down the inflammatory response of the body, which is worthy of clinical promotion.
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Affiliation(s)
- Xuefang Wang
- Department of Obstetrics and Gynecology, Wuwei People’s HospitalWuwei 733000, Gansu, China
| | - Wenyao Shi
- Department of Obstetrics and Gynecology, Yueqing Maternal and Child Care Service HospitalYueqing 325600, Zhejiang, China
| | - Xiaohua Shi
- Department of Obstetrics and Gynecology, Yueqing Maternal and Child Care Service HospitalYueqing 325600, Zhejiang, China
| | - Haiping Lin
- Department of Clinical Laboratory, Yueqing Maternal and Child Care Service HospitalYueqing 325600, Zhejiang, China
| | - Xiaoquan Qian
- Department of Obstetrics and Gynecology, Yueqing Maternal and Child Care Service HospitalYueqing 325600, Zhejiang, China
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Sipos A, Ujlaki G, Mikó E, Maka E, Szabó J, Uray K, Krasznai Z, Bai P. The role of the microbiome in ovarian cancer: mechanistic insights into oncobiosis and to bacterial metabolite signaling. Mol Med 2021; 27:33. [PMID: 33794773 PMCID: PMC8017782 DOI: 10.1186/s10020-021-00295-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/22/2021] [Indexed: 02/07/2023] Open
Abstract
Ovarian cancer is characterized by dysbiosis, referred to as oncobiosis in neoplastic diseases. In ovarian cancer, oncobiosis was identified in numerous compartments, including the tumor tissue itself, the upper and lower female genital tract, serum, peritoneum, and the intestines. Colonization was linked to Gram-negative bacteria with high inflammatory potential. Local inflammation probably participates in the initiation and continuation of carcinogenesis. Furthermore, local bacterial colonies in the peritoneum may facilitate metastasis formation in ovarian cancer. Vaginal infections (e.g. Neisseria gonorrhoeae or Chlamydia trachomatis) increase the risk of developing ovarian cancer. Bacterial metabolites, produced by the healthy eubiome or the oncobiome, may exert autocrine, paracrine, and hormone-like effects, as was evidenced in breast cancer or pancreas adenocarcinoma. We discuss the possible involvement of lipopolysaccharides, lysophosphatides and tryptophan metabolites, as well as, short-chain fatty acids, secondary bile acids and polyamines in the carcinogenesis of ovarian cancer. We discuss the applicability of nutrients, antibiotics, and probiotics to harness the microbiome and support ovarian cancer therapy. The oncobiome and the most likely bacterial metabolites play vital roles in mediating the effectiveness of chemotherapy. Finally, we discuss the potential of oncobiotic changes as biomarkers for the diagnosis of ovarian cancer and microbial metabolites as possible adjuvant agents in therapy.
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Affiliation(s)
- Adrienn Sipos
- Department of Medical Chemistry, Faculty of Medicine, University of Debrecen, Debrecen, 4032, Hungary
| | - Gyula Ujlaki
- Department of Medical Chemistry, Faculty of Medicine, University of Debrecen, Debrecen, 4032, Hungary
| | - Edit Mikó
- Department of Medical Chemistry, Faculty of Medicine, University of Debrecen, Debrecen, 4032, Hungary
| | - Eszter Maka
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Debrecen, Egyetem tér 1, Debrecen, 4032, Hungary
| | - Judit Szabó
- Department of Medical Microbiology, Faculty of Medicine, University of Debrecen, Debrecen, 4032, Hungary
| | - Karen Uray
- Department of Medical Chemistry, Faculty of Medicine, University of Debrecen, Debrecen, 4032, Hungary
| | - Zoárd Krasznai
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Debrecen, Egyetem tér 1, Debrecen, 4032, Hungary
| | - Péter Bai
- Department of Medical Chemistry, Faculty of Medicine, University of Debrecen, Debrecen, 4032, Hungary.
- MTA-DE Lendület Laboratory of Cellular Metabolism, Debrecen, 4032, Hungary.
- Research Center for Molecular Medicine, Faculty of Medicine, University of Debrecen, Debrecen, 4032, Hungary.
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Potential Impact of Human Cytomegalovirus Infection on Immunity to Ovarian Tumours and Cancer Progression. Biomedicines 2021; 9:biomedicines9040351. [PMID: 33808294 PMCID: PMC8065684 DOI: 10.3390/biomedicines9040351] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 02/07/2023] Open
Abstract
Ovarian cancer (OC) is one of the most common, and life-threatening gynaecological cancer affecting females. Almost 75% of all OC cases are diagnosed at late stages, where the 5-year survival rate is less than 30%. The aetiology of the disease is still unclear, and there are currently no screening method nor effective treatment strategies for the advanced disease. A growing body of evidence shows that human cytomegalovirus (HCMV) infecting more than 50% of the world population, may play a role in inducing carcinogenesis through its immunomodulatory activities. In healthy subjects, the primary HCMV infection is essentially asymptomatic. The virus then establishes a life-long chronic latency primarily in the hematopoietic progenitor cells in the bone marrow, with periodic reactivation from latency that is often characterized by high levels of circulating pro-inflammatory cytokines. Currently, infection-induced chronic inflammation is considered as an essential process for OC progression and metastasis. In line with this observation, few recent studies have identified high expressions of HCMV proteins on OC tissue biopsies that were associated with poor survival outcomes. Active HCMV infection in the OC tumour microenvironment may thus directly contribute to OC progression. In this review, we highlight the potential impact of HCMV infection-induced immunomodulatory effects on host immune responses to OC that may promote OC progression.
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Falconer H, Yin L, Salehi S, Altman D. Association between pelvic inflammatory disease and subsequent salpingectomy on the risk for ovarian cancer. Eur J Cancer 2021; 145:38-43. [PMID: 33418235 DOI: 10.1016/j.ejca.2020.11.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/23/2020] [Accepted: 11/26/2020] [Indexed: 11/29/2022]
Abstract
AIM Salpingectomy is associated with a lower risk for ovarian cancer, suggesting that the fallopian tubes constitute the origin of the disease. It is unclear whether the observed effect is mediated by pelvic inflammatory disease (PID); a major indication for salpingectomy and implicated in the aetiology of ovarian cancer. METHODS In this population-based cohort study, we used nationwide registry-based data on women exposed for PID with and without subsequent salpingectomy (n = 97,912) compared with the unexposed population (n = 5,429,174) between 1973 and 2010. The effect of hormone treatment was considered in a subanalysis. RESULTS Of the exposed women, 9538 women underwent salpingectomy during the study period. There was a significant association between PID and ovarian cancer (hazard ratio [HR] 1.44, 95% confidence interval [CI] 1.31-1.59), whereas an inverse association was observed for exposed women with subsequent salpingectomy (HR 0.55, 95% CI 0.36-0.83). Salpingectomy performed on other indications (n = 24,895) was associated with a lower incidence of ovarian cancer (HR 0.72, 95% CI 0.56-0.93). No effect modification was observed for the use of oral contraceptives or hormonal replacement therapy. CONCLUSION Salpingectomy is associated with a lower incidence of ovarian cancer regardless of indication.
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Affiliation(s)
- Henrik Falconer
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden.
| | - Li Yin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sahar Salehi
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Daniel Altman
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
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Spaan M, van den Belt-Dusebout AW, Lambalk CB, van Boven HH, Schats R, Kortman M, Broekmans FJM, Laven JSE, van Santbrink EJP, Braat DDM, van der Westerlaken LAJ, Cohlen BJ, Cantineau AEP, Smeenk JMJ, van Rumste MM, Goddijn M, van Golde RJT, Meeuwissen PAM, Hamilton CJCM, Ouwens GM, Gerritsma MA, Schaapveld M, Burger CW, van Leeuwen FE. Long-Term Risk of Ovarian Cancer and Borderline Tumors After Assisted Reproductive Technology. J Natl Cancer Inst 2020; 113:699-709. [PMID: 33769500 DOI: 10.1093/jnci/djaa163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/11/2020] [Accepted: 09/25/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Long-term effects of assisted reproductive technology (ART) on ovarian tumor risk are unknown. METHODS This nationwide cohort study comprises 30 625 women who received ovarian stimulation for ART in 1983-2000 and 9988 subfertile women not treated with ART. Incident invasive and borderline ovarian tumors were ascertained through linkage with the Netherlands Cancer Registry and the Dutch Pathology Registry until July 2018. Ovarian tumor risk in ART-treated women was compared with risks in the general population and the subfertile non-ART group. Statistical tests were 2-sided. RESULTS After a median follow-up of 24 years, 158 invasive and 100 borderline ovarian tumors were observed. Ovarian cancer risk in the ART group was increased compared with the general population (standardized incidence ratio [SIR] = 1.43, 95% confidence interval [CI] = 1.18 to 1.71) but not when compared with the non-ART group (age- and parity-adjusted hazard ratio [HR] = 1.02, 95% CI = 0.70 to 1.50). Risk decreased with higher parity and with a larger number of successful ART cycles (resulting in childbirth, Ptrend = .001) but was not associated with the number of unsuccessful ART cycles. Borderline ovarian tumor risk was increased in ART-treated women compared with the general population (SIR = 2.20, 95% CI = 1.66 to 2.86) and with non-ART women (HR = 1.84, 95% CI = 1.08 to 3.14). Risk did not increase with more ART cycles or longer follow-up time. CONCLUSIONS Increased ovarian cancer risk in ART-treated women compared with the general population is likely explained by nulliparity rather than ART treatment. The increased risk of borderline ovarian tumors after ART must be interpreted with caution because no dose-response relationship was observed.
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Affiliation(s)
- Mandy Spaan
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Cornelis B Lambalk
- Department of Obstetrics & Gynecology, Amsterdam University Medical Center (UMC) Location, VU University Medical Center, Amsterdam, the Netherlands
| | - Hester H van Boven
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Roel Schats
- Department of Obstetrics & Gynecology, Amsterdam University Medical Center (UMC) Location, VU University Medical Center, Amsterdam, the Netherlands
| | - Marian Kortman
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frank J M Broekmans
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joop S E Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Didi D M Braat
- Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | | | - Ben J Cohlen
- Department of Obstetrics and Gynecology, Isala Clinics, Zwolle, the Netherlands
| | - Astrid E P Cantineau
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University Groningen, Groningen, the Netherlands
| | - Jesper M J Smeenk
- Department of Obstetrics and Gynecology, St Elisabeth Hospital, Tilburg, the Netherlands
| | - Minouche M van Rumste
- Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, the Netherlands
| | - Mariëtte Goddijn
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Amsterdam UMC Location, Academic Medical Center, Amsterdam, the Netherlands
| | - Ron J T van Golde
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Paul A M Meeuwissen
- Department of Obstetrics and Gynecology, Admiraal de Ruyter Hospital, Vlissingen, the Netherlands
| | - Carl J C M Hamilton
- Department of Obstetrics and Gynecology, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, the Netherlands
| | - Gabriële M Ouwens
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Miranda A Gerritsma
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Michael Schaapveld
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Curt W Burger
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Flora E van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
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Idahl A, Le Cornet C, González Maldonado S, Waterboer T, Bender N, Tjønneland A, Hansen L, Boutron-Ruault MC, Fournier A, Kvaskoff M, Boeing H, Trichopoulou A, Valanou E, Peppa E, Palli D, Agnoli C, Mattiello A, Tumino R, Sacerdote C, Onland-Moret NC, Gram IT, Weiderpass E, Quirós JR, Duell EJ, Sánchez MJ, Chirlaque MD, Barricarte A, Gil L, Brändstedt J, Riesbeck K, Lundin E, Khaw KT, Perez-Cornago A, Gunter MJ, Dossus L, Kaaks R, Fortner RT. Serologic markers of Chlamydia trachomatis and other sexually transmitted infections and subsequent ovarian cancer risk: Results from the EPIC cohort. Int J Cancer 2020; 147:2042-2052. [PMID: 32243586 DOI: 10.1002/ijc.32999] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/23/2020] [Accepted: 02/19/2020] [Indexed: 12/19/2022]
Abstract
A substantial proportion of epithelial ovarian cancer (EOC) arises in the fallopian tube and other epithelia of the upper genital tract; these epithelia may incur damage and neoplastic transformation after sexually transmitted infections (STI) and pelvic inflammatory disease. We investigated the hypothesis that past STI infection, particularly Chlamydia trachomatis, is associated with higher EOC risk in a nested case-control study within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort including 791 cases and 1669 matched controls. Serum antibodies against C. trachomatis, Mycoplasma genitalium, herpes simplex virus type 2 (HSV-2) and human papillomavirus (HPV) 16, 18 and 45 were assessed using multiplex fluorescent bead-based serology. Conditional logistic regression was used to estimate relative risks (RR) and 95% confidence intervals (CI) comparing women with positive vs. negative serology. A total of 40% of the study population was seropositive to at least one STI. Positive serology to C. trachomatis Pgp3 antibodies was not associated with EOC risk overall, but with higher risk of the mucinous histotype (RR = 2.30 [95% CI = 1.22-4.32]). Positive serology for chlamydia heat shock protein 60 (cHSP60-1) was associated with higher risk of EOC overall (1.36 [1.13-1.64]) and with the serous subtype (1.44 [1.12-1.85]). None of the other evaluated STIs were associated with EOC risk overall; however, HSV-2 was associated with higher risk of endometrioid EOC (2.35 [1.24-4.43]). The findings of our study suggest a potential role of C. trachomatis in the carcinogenesis of serous and mucinous EOC, while HSV-2 might promote the development of endometrioid disease.
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Affiliation(s)
- Annika Idahl
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Charlotte Le Cornet
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Tim Waterboer
- Infections and Cancer Epidemiology, Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Noemi Bender
- Infections and Cancer Epidemiology, Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Diet, Genes and Environment (DGE), Copenhagen, Germany
| | - Louise Hansen
- Danish Cancer Society Research Center, Diet, Genes and Environment (DGE), Copenhagen, Germany
| | - Marie-Christine Boutron-Ruault
- CESP, Faculté de Médecine, Université Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Agnès Fournier
- CESP, Faculté de Médecine, Université Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Marina Kvaskoff
- CESP, Faculté de Médecine, Université Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition (DIfE) Potsdam-Rehbrücke, Nuthetal, Germany
| | | | | | | | - Domenico Palli
- Institute for Cancer Research, Prevention and Clinical Network - ISPRO, Cancer Risk Factors and Life-Style Epidemiology Unit, Florence, Italy
| | - Claudia Agnoli
- Istituto Nazionale dei Tumori di Milano Via Venezian, Epidemiology and Prevention Unit Fondazione IRCCS, Milan, Italy
| | - Amalia Mattiello
- Dipartimento di Medicina Clinica e Chirurgia, Federico II university, Naples, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, "Civic - M.P. Arezzo" Hospital, ASP, Ragusa, Italy
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città Della Salute e Della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy
| | - N Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, YOUth onderzoek - Universiteit Utrecht, Utrecht, The Netherlands
| | - Inger T Gram
- Faculty of Health Sciences, Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | | | - Jose R Quirós
- J.S. Información Sanitaria, Dirección General de Salud Pública, Consejería de Sanidad, Oviedo, Spain
| | - Eric J Duell
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - Maria-Jose Sánchez
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.GRANADA. Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Maria-Dolores Chirlaque
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain
| | - Aurelio Barricarte
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Navarra Public Health Institute, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA) Pamplona, Spain
| | - Leire Gil
- Public Health Division of Gipuzkoa, Research institute of BioDonostia, San Sebastian, Spain
| | - Jenny Brändstedt
- Department of Clinical Sciences, Lund University, Division of Surgery, Skåne University Hospital, Lund, Sweden
- Division of Surgery, Skåne University Hospital, Lund, Sweden
| | - Kristian Riesbeck
- Clinical Microbiology, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Eva Lundin
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Aurora Perez-Cornago
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Marc J Gunter
- International Agency for Research on Cancer, Lyon, France
| | - Laure Dossus
- International Agency for Research on Cancer, Lyon, France
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Renée T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Irvin S, Clarke MA, Trabert B, Wentzensen N. Systematic review and meta-analysis of studies assessing the relationship between statin use and risk of ovarian cancer. Cancer Causes Control 2020; 31:869-879. [PMID: 32685996 DOI: 10.1007/s10552-020-01327-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 07/07/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE The link between lipid-stabilizing medications and epithelial ovarian carcinogenesis is incompletely understood. Statins may reduce ovarian cancer risk, but results are inconclusive. METHODS We conducted a systematic review and meta-analysis of studies reporting associations between statin use and ovarian cancer risk in PubMed. Summary risk ratios (RRs) and confidence intervals (CIs) were calculated. Subgroup analyses by cancer histotype, statin class (lipo- or hydrophilic) and duration of statin use were conducted. Use of individual statins in populations was assessed to determine population-specific differences in statin types. RESULTS Nine studies with 435,237 total women were included (1 randomized controlled trial (RCT); 4 prospective; 4 case-control). Statin use was associated with a reduced risk of ovarian cancer (RR 0.87, 95% CI 0.74-1.03) and risk was significantly reduced in populations with low pravastatin use (RR 0.83, 95% CI 0.70-0.99). Risk estimates varied by statin class (3 studies; lipophilic: RR 0.88, 95% CI 0.69-1.12; hydrophilic: RR 1.06, 95% CI 0.72-1.57) and cancer histotype (3 studies; serous: RR 0.95, 95% CI 0.69-1.30; clear cell: RR 1.17, 95% CI 0.74-1.86). Long-term use was associated with a reduced risk of ovarian cancer (RR 0.77, 95% CI 0.54-1.10) that further reduced when pravastatin use was low (RR 0.68, 95% CI 0.46-1.01). Between-study heterogeneity was high overall and in subgroups (I2 > 60%). CONCLUSION Statins may be associated with a reduced risk of ovarian cancer, but the effect likely differs by individual statin, duration of use and cancer histotype. Additional well-powered studies are needed to elucidate important subgroup effects.
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Affiliation(s)
- Sarah Irvin
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA.
| | - Megan A Clarke
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA
| | - Britton Trabert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA
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36
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Sun Y, Xu J, Jia X. The Diagnosis, Treatment, Prognosis and Molecular Pathology of Borderline Ovarian Tumors: Current Status and Perspectives. Cancer Manag Res 2020; 12:3651-3659. [PMID: 32547202 PMCID: PMC7246309 DOI: 10.2147/cmar.s250394] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/24/2020] [Indexed: 11/24/2022] Open
Abstract
Borderline ovarian tumors (BOTs) are a type of low malignant potential tumor that is typically associated with better outcomes than ovarian cancer. Indeed, its 10-year survival rate is as high as 95%. However, there is a small subset of patients who experience relapse and eventually die. It has been shown that the prognosis of BOTs was based on pathological diagnosis, the age at diagnosis, pre-operative carbohydrate antigen 125 level, invasive implants, and micropapillary patterns. Now the molecular-targeted therapy and molecular-genetic diagnosis have developed into a form of precision medicine. Recent studies on extensive molecular characterizations and molecular pathological mechanisms of BOTs have helped us understand the genomic landscapes of BOTs, and therefore BOTs could be reclassified into biologically and clinically more accurate and effective subtypes. The purpose of this review is to summarize current status for the diagnosis and treatment of BOTs and to describe the research progress on molecular pathologies, with a goal of providing a theoretical perspective for the diagnosis and treatment of BOTs.
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Affiliation(s)
- Yu Sun
- Department of Gynecology, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing 210004, People's Republic of China
| | - Juan Xu
- Department of Gynecology, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing 210004, People's Republic of China
| | - Xuemei Jia
- Department of Gynecology, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing 210004, People's Republic of China
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37
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Piao J, Lee EJ, Lee M. Association between pelvic inflammatory disease and risk of ovarian cancer: An updated meta-analysis. Gynecol Oncol 2020; 157:542-548. [DOI: 10.1016/j.ygyno.2020.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/28/2020] [Accepted: 02/01/2020] [Indexed: 10/25/2022]
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Guo M, Xu C, Chen YZ, Sun QW, Zhao XY, Liu X, Yang Y, Hu YY, Li FF, Liu SL. Associations of CXCL1 gene 5'UTR variations with ovarian cancer. J Ovarian Res 2020; 13:43. [PMID: 32326946 PMCID: PMC7181480 DOI: 10.1186/s13048-020-00640-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 03/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are about 2.4 hundred thousand new cases and 1.5 hundred thousand deaths of ovarian cancer (OC) annually in the world. Chronic inflammation is a risk factor for OC. C-X-C motif chemokine ligand 1 (CXCL1) defects may facilitate inflammation and transactivate EGFR in ovarian cancer, but the precise haplotypes associated with the potential diseases remained largely unknown. In this work, we characterized CXCL1 gene variations to elucidate their possible associations with OC. METHODS We analyzed the CXCL1 gene for 300 OC patients with 400 healthy participants as controls. The statistical analyses and Hardy-Weinberg equilibrium tests of the patients and control populations were conducted using the SPSS software (version 19.0) and Plink (version 1.9). RESULTS The variants rs11547681, rs201090116, rs199791199, rs181868085, rs4074 and rs1814092 within or near the CXCL1 gene were characterized. The genetic heterozygosity of rs11547681 and rs4074 was very high. Statistical analysis showed that the variant rs11547681 in the gene was closely associated with the risk of OC in the Chinese Han population, although this variant was not associated with FIGO stages or pathological grades of the patients. CONCLUSIONS Rs11547681 in CXCL1 gene was associated with the risk of OC in the Chinese Han population.
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Affiliation(s)
- Man Guo
- Genomics Research Center, College of Pharmacy (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China), Harbin Medical University, Harbin, China.,Department of Gynaecology and Obstetrics of the Second Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Chao Xu
- Genomics Research Center, College of Pharmacy (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China), Harbin Medical University, Harbin, China.,Department of Colorectal Surgery of the Second Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Yan-Zhe Chen
- Genomics Research Center, College of Pharmacy (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China), Harbin Medical University, Harbin, China
| | - Qi-Wen Sun
- Genomics Research Center, College of Pharmacy (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China), Harbin Medical University, Harbin, China
| | - Xin-Ying Zhao
- Department of Blood Dialysis, Heilongjiang Agricultural Reclamation Bureau General Hospital, Harbin, China
| | - Xin Liu
- Fifth Hospital Gynecology the City of Xiamen, Xiamen, Fujian, China
| | - Yi Yang
- Genomics Research Center, College of Pharmacy (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China), Harbin Medical University, Harbin, China
| | - Yi-Yan Hu
- Genomics Research Center, College of Pharmacy (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China), Harbin Medical University, Harbin, China
| | - Fei-Feng Li
- Genomics Research Center, College of Pharmacy (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China), Harbin Medical University, Harbin, China. .,Translational Medicine Research and Cooperation Center of Northern China, Heilongjiang Academy of Medical Sciences, Hegang, Heilongjiang, China.
| | - Shu-Lin Liu
- Genomics Research Center, College of Pharmacy (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China), Harbin Medical University, Harbin, China. .,Translational Medicine Research and Cooperation Center of Northern China, Heilongjiang Academy of Medical Sciences, Hegang, Heilongjiang, China. .,Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Canada.
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39
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Ouldamer L, Body G, Daraï E, Bendifallah S. [Borderline Ovarian Tumours: CNGOF Guidelines for Clinical Practice - Epidemiological Aspects and Risk Factors]. ACTA ACUST UNITED AC 2020; 48:239-247. [PMID: 32004787 DOI: 10.1016/j.gofs.2020.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The incidence (rate/100,000) of BOT gradually increases with age from 15-19 years of age and peaks at nearly 4.5 cases/100,000 for the 55-59 year age group (NP3). In the presence of a benign ovarian mass, the standardized risk ratio of serous and mucinous BOT is 1.69, (95% CI 1.39-2.03) and 1.75, (95% CI 1.45-2.10), respectively (NP2). At diagnosis, a median age of diagnosis of OFA is 46 years, unilateral forms (79.7% of cases) are predominant compared to cancers (45.3%) (<0.001) and FIGO I stages represent nearly 63.7% of cases (NP3). The 5-year survival rates for FIGO I, II, III, IV stages are: 99.7% (95% CI: 96.2-100%), 99.6% (95% CI: 92.6-100%), 95.3% (95% CI: 91.8-97.4%), 77.1% (95% CI: 58.0-88.3%), respectively (NP3). Survivors at 5 years for serous and mucinous tumours are 99.7% (95% CI: 99.2-99.9%), 98.5% (95% CI: 96.9-99.3%), respectively (NP3). An epidemiological association exists between personal BOT risk and: (1) a familial history of BOT/certain cancers (pancreas, lung, bone, leukemia) (NP3), (2) a personal history of benign ovarian cyst (NP2), (3) a personal history of pelvic inflammatory disease (IGH), (4) the use of intrauterine device levonorgestrel (NP3), (5) the use of oral contraceptive pills (NP3), (6) multiparity (NP3), (7) hormone replacement therapy (NP3), (8) high consumption of coumestrol (NP4), (9) medical treatment of infertility with progesterone (NP3), (10) non-steroidal anti-inflammatory drug (NSAID). An epidemiological association exists between previous/actual tabacco consumption and the risk of mucinous ovarian BOT (NP2). Relative risk (RR) varies between 2.2 and 2.7, however the relationship is not necessarily a causal one. An epidemiological association exists between overweight/obesity and the risk of serous BOT (NP2). RR varies between 1.2 to 1.8. The high Vitamin D was inversely associated to the risk of serous BOT (NP4). The risk of mucinous BOT was lowered with paracetamol use (OR=0.77; 95% CI: 0.60-0.98) (NP3). However, the relationship between these factors and BOT is not necessarily a causal one and no screening modality can be proposed in the general population (gradeC).
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Affiliation(s)
- L Ouldamer
- Département de gynécologie, centre hospitalier régional universitaire de Tours, hôpital Bretonneau, 37044 Tours, France; Unité Inserm 1069, 10, boulevard Tonnellé, 37044 Tours, France
| | - G Body
- Département de gynécologie, centre hospitalier régional universitaire de Tours, hôpital Bretonneau, 37044 Tours, France; Unité Inserm 1069, 10, boulevard Tonnellé, 37044 Tours, France
| | - E Daraï
- Département de gynécologie et d'obstétrique et médecine de la reproduction, Sorbonne université, hôpital universitaire Tenon, Assistance publique-hôpitaux de Paris (AP-HP), 4, rue de la Chine, 75020 Paris, France; UMR_S938, centre de recherche de Saint-Antoine, université Sorbonne, 75006 Paris, France
| | - S Bendifallah
- Département de gynécologie et d'obstétrique et médecine de la reproduction, Sorbonne université, hôpital universitaire Tenon, Assistance publique-hôpitaux de Paris (AP-HP), 4, rue de la Chine, 75020 Paris, France; UMR_S938, centre de recherche de Saint-Antoine, université Sorbonne, 75006 Paris, France.
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40
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Stewart LM, Stewart CJR, Spilsbury K, Cohen PA, Jordan S. Association between pelvic inflammatory disease, infertility, ectopic pregnancy and the development of ovarian serous borderline tumor, mucinous borderline tumor and low-grade serous carcinoma. Gynecol Oncol 2020; 156:611-615. [PMID: 31983516 DOI: 10.1016/j.ygyno.2020.01.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/14/2020] [Accepted: 01/16/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Risk factors for ovarian borderline tumors and low-grade serous carcinoma (LGSC) are poorly understood. The aim of this study was to examine the association between infertility, pelvic inflammatory disease (PID), endometriosis, ectopic pregnancy, hysterectomy, tubal ligation and parity and the risk of serous borderline tumor (SBT), mucinous borderline tumor (MBT) and LGSC. METHODS This was a population-based cohort study using linked administrative and hospital data. Participants were 441,382 women born between 1945 and 1975 who had been admitted to hospital in Western Australia between 1 January 1980 and 30 June 2014. We used Cox regression to estimate hazard ratios (HRs). RESULTS We observed an increased rate of SBT associated with infertility, PID and ectopic pregnancy (HRs and 95% CIs were, respectively, 1.98 (1.20-3.26); 1.95 (1.22-3.10) and 2.44 (1.20-4.96)). We did not detect an association between any of the factors under study and the rate of MBT. A diagnosis of PID was associated with an increased rate of LGSC (HR 2.90, 95% CI 1.21-6.94). CONCLUSIONS The association with PID supports the hypothesis that inflammatory processes within the upper gynaecological tract and/or peritoneum may predispose to the development of SBT and LGSC.
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Affiliation(s)
- L M Stewart
- Health Research and Data Analytics Hub and PHRN Centre for Data Linkage, Curtin University, Bentley, Western Australia, Australia; Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia.
| | - C J R Stewart
- Department of Pathology, King Edward Memorial Hospital and School of Women's and Infants' Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - K Spilsbury
- Health Research and Data Analytics Hub and PHRN Centre for Data Linkage, Curtin University, Bentley, Western Australia, Australia; Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - P A Cohen
- Division of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, Western Australia, Australia; Department of Gynaecological Oncology, King Edward Memorial Hospital for Women, Subiaco, Western Australia, Australia; Department of Gynaecological Oncology, St John of God Hospital Bendat Family Comprehensive Cancer Centre, Subiaco, Western Australia, Australia
| | - S Jordan
- School of Public Health, The University of Queensland, Brisbane, Australia; Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
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Guleria S, Jensen A, Toender A, Kjaer SK. Risk of epithelial ovarian cancer among women with benign ovarian tumors: a follow-up study. Cancer Causes Control 2019; 31:25-31. [PMID: 31673820 DOI: 10.1007/s10552-019-01245-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/18/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE The importance of benign ovarian tumors as precursors or risk markers for ovarian cancer is not fully understood. Studies on the association between benign ovarian tumors and ovarian cancer have provided inconclusive results. We examined the overall and histological type-specific risk of ovarian cancer among 158,221 Danish women diagnosed with a benign ovarian tumor during 1978-2016. METHODS The study cohort was linked to the Danish Cancer Register to identify all cases of epithelial ovarian cancer, and standardized incidence ratios (SIR) with 95% confidence intervals (CI) were calculated. RESULTS After excluding the first year of follow-up, women with benign ovarian tumors did not have an increased risk for overall epithelial ovarian cancer (SIR 1.02; 95% CI 0.93-1.11), as compared with women in the general population. However, we found an increased risk for mucinous ovarian cancer (SIR 2.06; 95% CI 1.67-2.52); both solid and cystic benign ovarian tumors were associated with an increased risk. The risk for mucinous ovarian cancer was increased irrespective of the age at benign ovarian tumors diagnosis and persisted for up to 20 years after the benign ovarian tumor diagnosis. No clear associations for other histological types of ovarian cancer were observed, except for an increased risk for serous ovarian cancer among women diagnosed with benign ovarian tumors at an young age. CONCLUSIONS Benign ovarian tumors may be associated with long-term increased risk for mucinous ovarian cancer.
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Affiliation(s)
- Sonia Guleria
- Danish Cancer Society Research Center, Virus, Lifestyle and Genes, Copenhagen, Denmark
| | - Allan Jensen
- Danish Cancer Society Research Center, Virus, Lifestyle and Genes, Copenhagen, Denmark.
| | - Anita Toender
- National Centre for Register-Based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark.,Centre for Integrated Register-Based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| | - Susanne K Kjaer
- Danish Cancer Society Research Center, Virus, Lifestyle and Genes, Copenhagen, Denmark.,Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Koninckx PR, Ussia A, Tahlak M, Adamyan L, Wattiez A, Martin DC, Gomel V. Infection as a potential cofactor in the genetic-epigenetic pathophysiology of endometriosis: a systematic review. Facts Views Vis Obgyn 2019; 11:209-216. [PMID: 32082526 PMCID: PMC7020943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The genetic-epigenetic theory postulates that endometriosis is triggered by a cumulative set of genetic-epigenetic (GE) incidents. Pelvic and upper genital tract infection might induce GE incidents and thus play a role in the pathogenesis of endometriosis. Thus, this article aims to review the association of endometriosis with upper genital tract and pelvic infections. METHODS Pubmed, Scopus and Google Scholar were searched for 'endometriosis AND (infection OR PID OR bacteria OR viruses OR microbiome OR microbiota)', for 'reproductive microbiome' and for 'reproductive microbiome AND endometriosis', respectively. All 384 articles, the first 120 'best match' articles in PubMed for 'reproductive microbiome' and the first 160 hits in Google Scholar for 'reproductive microbiome AND endomytriosis' were hand searched for data describing an association between endometriosis and bacterial, viral or other infections. All 31 articles found were included in this manuscript. RESULTS Women with endometriosis have a significantly increased risk of lower genital tract infection, chronic endometritis, severe PID and surgical site infections after hysterectomy. They have more colony forming units of Gardnerella, Streptococcus, Enterococci and Escherichia coli in the endometrium. In the cervix Atopobium is absent, but Gardnerella, Streptococcus, Escherichia, Shigella, and Ureoplasma are increased. They have higher concentrations of Escherichia Coli and higher concentrations of bacterial endotoxins in menstrual blood. A Shigella/Escherichia dominant stool microbiome is more frequent. The peritoneal fluid of women with endometriosis contains higher concentrations of bacterial endotoxins and an increased incidence of mollicutes and of HPV viruses. Endometriosis lesions have a specific bacterial colonisation with more frequently mollicutes (54%) and both high and medium-risk HPV infections (11%). They contain DNA with 96% homology with Shigella. In mice transplanted endometrium changes the gut microbiome while the gut microbiome influences the growth of these endometriosis lesions. CONCLUSIONS Endometriosis is associated with more upper genital tract and peritoneal infections. These infections might be co-factors causing GE incidents and influencing endometriosis growth.
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Affiliation(s)
- PR Koninckx
- Latifa Hospital, Dubai, United Arab Emirates;,KU, Leuven, Belgium;,Gruppo Italo-Belga, Villa Del Rosario, Rome, Italy;,University of Oxford-Hon Consultant, Oxford,UK
| | - A Ussia
- Gruppo Italo-Belga, Villa Del Rosario, Rome, Italy;,Università Cattolica, Roma Italy
| | - M Tahlak
- Latifa Hospital, Dubai, United Arab Emirates
| | - L Adamyan
- Department of Operative Gynecology, V. I. Kulakov Research Centre for Obstetrics, Gynecology, and Perinatology, Russian Federation,Department of Reproductive Medicine and Surgery, Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A Wattiez
- Latifa Hospital, Dubai, United Arab Emirates;,Department of Obstetrics and Gynaecology, University of Strasbourg, France
| | - DC Martin
- School of Medicine, University of Tennessee Health Science Centre, Memphis Tennessee, USA;,Virginia Commonwealth University, Richmond, Virginia, USA;,Department of Obstetrics and Gynecology, University of British Columbia and Women’s Hospital, Vancouver, BC, Canada
| | - V Gomel
- Department of Obstetrics and Gynecology, University of British Columbia and Women’s Hospital, Vancouver, BC, Canada
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43
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Managing sexually transmitted infections: Beyond the 2015 guidelines. Nurse Pract 2019; 43:28-34. [PMID: 29985197 DOI: 10.1097/01.npr.0000541464.23795.5b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Guidelines for the prevention and management of sexually transmitted infections (STIs) are updated periodically while new science is continuously developed. Advanced practice registered nurses implement clinical decisions based on current guidelines and evidence. This article provides recent updates on managing STIs.
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44
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Lin HW, Wang PH, Lee CY, Huang JY, Yang SF, Hsiao YH. The Risk of Gynecologic and Urinary Tract Cancer with Pelvic Inflammatory Disease: A Population-Based Cohort Study. J Cancer 2019; 10:28-34. [PMID: 30662522 PMCID: PMC6329849 DOI: 10.7150/jca.29278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 10/05/2018] [Indexed: 11/14/2022] Open
Abstract
Purpose: The aim of the study was to determine the association between pelvic inflammatory disease (PID) and breast, colorectal, gynecologic and urinary tract cancer. Methods: The source of data was a longitudinal dataset compiled by the Longitudinal Health Insurance Database 2000 (LHID2000) which was collected by the National Health Insurance program. Cases of PID, at least two outpatient visits and one admission, were diagnosed from 2000 to 2013. The data for controls, age matched women who were not diagnosed with PID from 2000 to 2013, were also obtained. Results: A total of 47,333 PID cases and 189,332 for control group were included in the study. The ectopic pregnancy incidence rate (per 10000 person months) was 1.912 and 0.595 in the PID and control group, respectively; the rate ratio was 3.211 (confidence interval, CI = 2.931-3.519). There were significantly different in gynecologic cancers and urinary tract cancers between the PID and control group; the rate ratios (95% C.I.) were 1.903 (1.672-2.166) and 1.566 (1.211-2.025), respectively. Conclusion: Our study found that PID was associated with increased risks of gynecologic and urinary tract cancer but not colorectal or breast cancer. The information may lead to a strategy for cancer prevention and a reasonable healthcare usage through understanding PID epidemiology and controlling the inflammatory responses.
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Affiliation(s)
- Hui-Wen Lin
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Po-Hui Wang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chung-Yuan Lee
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Obstetrics and Gynecology, Chiayi Chang Gung Memorial Hospital Chiayi, Taiwan.,Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan
| | - Jing-Yang Huang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yi-Hsuan Hsiao
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
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45
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Park HK, Schildkraut JM, Alberg AJ, Bandera EV, Barnholtz-Sloan JS, Bondy M, Crankshaw S, Funkhouser E, Moorman PG, Peters ES, Terry P, Wang F, Ruterbusch JJ, Schwartz AG, Cote ML. Benign gynecologic conditions are associated with ovarian cancer risk in African-American women: a case-control study. Cancer Causes Control 2018; 29:1081-1091. [PMID: 30269307 PMCID: PMC6230481 DOI: 10.1007/s10552-018-1082-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 09/17/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The association between common benign gynecologic conditions and ovarian cancer remains under-studied in African Americans. Therefore, we examine the association between self-reported history of benign gynecologic conditions and epithelial ovarian cancer risk in African-American women. METHODS Data from a large population-based, multi-center case-control study of epithelial ovarian cancer in African-American women were analyzed to estimate the association between self-reported history of endometriosis, pelvic inflammatory disease (PID), fibroid, and ovarian cyst with epithelial ovarian cancer. Logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI) for the associations between individual and composite gynecologic conditions and ovarian cancer. RESULTS 600 cases and 752 controls enrolled in the African American Cancer Epidemiology Study between 1 December 2010 and 31 December 2015 comprised the study population. After adjusting for potential confounders, a history of endometriosis was associated with ovarian cancer (OR 1.78; 95% CI 1.09-2.90). A non-significant association of similar magnitude was observed with PID (OR 1.33; 95% CI 0.82-2.16), while no association was observed in women with a history of fibroid or ovarian cyst. A positive trend was observed for an increasing number of reported gynecologic conditions (p = 0.006) with consistency across histologic subtypes and among both oral contraceptive users and non-users. CONCLUSION A self-reported history of endometriosis among African-American women was associated with increased risk of ovarian cancer. Having multiple benign gynecologic conditions also increased ovarian cancer risk.
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Affiliation(s)
- Hyo K Park
- Department of Oncology and the Karmanos Cancer Institute, Population Studies and Disparities Research Program, Wayne State University School of Medicine, 4100 John R. Mailcode: MM04EP, Detroit, MI, 48201, USA.
| | - Joellen M Schildkraut
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Anthony J Alberg
- Hollings Cancer Center and Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Elisa V Bandera
- Department of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Jill S Barnholtz-Sloan
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Melissa Bondy
- Cancer Prevention and Population Sciences Program, Baylor College of Medicine, Houston, TX, USA
| | - Sydnee Crankshaw
- Department of Community and Family Medicine, Cancer Control and Population Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Ellen Funkhouser
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Patricia G Moorman
- Department of Community and Family Medicine, Cancer Control and Population Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Edward S Peters
- Epidemiology Program, Louisiana State University Health Sciences Center School of Public Health, New Orleans, LA, USA
| | - Paul Terry
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Frances Wang
- Department of Community and Family Medicine, Cancer Control and Population Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Julie J Ruterbusch
- Department of Oncology and the Karmanos Cancer Institute, Population Studies and Disparities Research Program, Wayne State University School of Medicine, 4100 John R. Mailcode: MM04EP, Detroit, MI, 48201, USA
| | - Ann G Schwartz
- Department of Oncology and the Karmanos Cancer Institute, Population Studies and Disparities Research Program, Wayne State University School of Medicine, 4100 John R. Mailcode: MM04EP, Detroit, MI, 48201, USA
| | - Michele L Cote
- Department of Oncology and the Karmanos Cancer Institute, Population Studies and Disparities Research Program, Wayne State University School of Medicine, 4100 John R. Mailcode: MM04EP, Detroit, MI, 48201, USA
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46
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Mert I, Walther-Antonio M, Mariani A. Case for a role of the microbiome in gynecologic cancers: Clinician's perspective. J Obstet Gynaecol Res 2018; 44:1693-1704. [PMID: 30069974 DOI: 10.1111/jog.13701] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 05/20/2018] [Indexed: 12/14/2022]
Abstract
In this review, we aimed to provide insight into the microbiome and its association with endometrial and ovarian cancer and their risk factors. We reviewed the literature focusing on the relationship between the microbiome and cancer, as well as the relationship between gynecologic diseases and cancers. The human body contains different kinds of microorganisms in various body parts, which is termed the microbiome. The number of microorganisms that live in and on the human body is greater than that of the human germ and somatic cells by 10-fold. The relationship between a human and their microbiome is complex; it is also one of the most important components of homeostasis. Impairment of microbiome-host homeostasis has been associated with obesity, several cancers, preterm labor, inflammatory and allergic conditions and neurodevelopmental disorders. Direct and strong causal relationships have been established for several cancers and microorganisms, such as gastric lymphoma and Helicobacter pylori infection. Interestingly, eradication of the infectious agents has also been shown to be therapeutic. The association between cancer and the microbiome, however, is more complicated than a 1 bacteria-1 cancer model, and a shift in a healthy microbiome can result in various cancers via inflammation, change in microenvironment or DNA-damaging toxins. The human microbiome is an integral part of homeostasis. Understanding the mechanisms that cause dysbiosis will enable us to elucidate the pathways that result in malignancy and investigate new treatment modalities.
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Affiliation(s)
- Ismail Mert
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Marina Walther-Antonio
- Department of Surgery and Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrea Mariani
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
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47
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Zheng G, Yu H, Kanerva A, Försti A, Sundquist K, Hemminki K. Borderline Ovarian Tumors Share Familial Risks with Themselves and Invasive Cancers. Cancer Epidemiol Biomarkers Prev 2018; 27:1358-1363. [DOI: 10.1158/1055-9965.epi-18-0503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 06/23/2018] [Accepted: 07/10/2018] [Indexed: 11/16/2022] Open
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48
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Risk of high-grade serous ovarian cancer associated with pelvic inflammatory disease, parity and breast cancer. Cancer Epidemiol 2018; 55:110-116. [PMID: 29935395 DOI: 10.1016/j.canep.2018.05.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/18/2018] [Accepted: 05/27/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ovarian carcinoma is not a single disease, but rather a collection of subtypes with differing molecular properties and risk profiles. The most common of these, and the subject of this work, is high-grade serous ovarian carcinoma (HGSC). METHODS In this population-based study we identified a cohort of 441,382 women resident in Western Australia who had ever been admitted to hospital in the State. Of these, 454 were diagnosed with HGSC. We used Cox regression to derive hazard ratios (HRs) comparing the risk of disease in women who had each of a range of medical diagnoses and surgical procedures with women who did not. RESULTS We found an increased risk of HGSC associated with a diagnosis of pelvic inflammatory disease (PID) (HR 1.47, 95% CI 1.04-2.07) but not with a diagnosis of infertility or endometriosis with HRs of 1.12 (95% CI 0.73-1.71) and 0.82 (95% CI 0.55-1.22) respectively. A personal history of breast cancer was associated with a three-fold increase in the rate of HGSC. Increased parity was associated with a reduced risk of HGSC in women without a personal history of breast cancer (HR 0.57; 95% CI 0.44-0.73), but not in women with a personal history of breast cancer (HR 1.48; 95% CI 0.74-2.95). CONCLUSIONS Our finding of an increased risk of HGSC associated with PID lends support to the hypothesis that inflammatory processes may be involved in the etiology of HGSC.
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49
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Taking the Tube: From Normal Fallopian Tube Epithelium to Ovarian High-grade Serous Carcinoma. Clin Obstet Gynecol 2018; 60:697-710. [PMID: 29045296 DOI: 10.1097/grf.0000000000000313] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Detailed pathologic studies over the past decade suggest a distal fallopian tube origin for the majority of "ovarian" high-grade serous carcinomas (HGSC). This review will summarize molecular alterations observed in tubal precursors for HGSC, namely p53 signatures and serous tubal intraepithelial carcinomas, and in nonmalignant fallopian tube epithelial cells obtained from women at increased genetic risk for HGSC. Recent experiments investigating the impact of follicular fluid exposure and retrograde menstruation on tumor development in the fallopian tube will also be discussed. These data will be reconciled with traditional ovarian cancer risk factors related to reproductive history.
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50
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Chiang AJ, Chang C, Huang CH, Huang WC, Kan YY, Chen J. Risk factors in progression from endometriosis to ovarian cancer: a cohort study based on medical insurance data. J Gynecol Oncol 2018; 29:e28. [PMID: 29400021 PMCID: PMC5920215 DOI: 10.3802/jgo.2018.29.e28] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/26/2017] [Accepted: 01/14/2018] [Indexed: 12/12/2022] Open
Abstract
Objective The objective was to identify risk factors that were associated with the progression from endometriosis to ovarian cancer based on medical insurance data. Methods The study was performed on a dataset obtained from the National Health Insurance Research Database, which covered all the inpatient claim data from 2000 to 2013 in Taiwan. The International Classification of Diseases (ICD) code 617 was used to screen the dataset for the patients who were admitted to hospital due to endometriosis. They were then tracked for subsequent diagnosis of ovarian cancer, and available biological, socioeconomic and clinical information was also collected. Univariate and multivariate analyses were then performed based on the Cox regression model to identify risk factors. C-index was calculated and cross validated. Results A total of 229,617 patients who were admitted to hospital due to endometriosis from 2000 to 2013 were included in the study, out of whom 1,473 developed ovarian cancer by the end of 2013. A variety of factors, including age, residence, hospital stratification, premium range, and various comorbidities had significant impact on the progression (p<0.05). Among them, age, urbanization of residence, hospital stratification, premium range, post-endometriosis childbearing, pelvic inflammation, and depression all had independent, significant impact (p<0.05). The validated C-index was 0.69. Conclusion For a woman diagnosed with endometriosis, increased age, residing in a highly urbanized area, low or high income, depression, pelvic inflammation, and absence of childbearing post-endometriosis all put her at high-risk to develop ovarian cancer. The findings may be of help to gynecologists to identify high-risk patients.
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Affiliation(s)
- An Jen Chiang
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Chung Chang
- Department of Applied Mathematics, National Sun Yat-sen University, Kaohsiung, Taiwan.
| | - Chi Hsiang Huang
- Department of Applied Mathematics, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Wei Chun Huang
- Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yuen Yee Kan
- Department of Obstetrics and Gynecology, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Jiabin Chen
- Multidisciplinary Science Research Center, National Sun Yat-sen University, Kaohsiung, Taiwan.,Da-Yeh University, Changhua, Taiwan.
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