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Benna-Doyle S, Baguley BJ, Laing E, Kiss N. Nutritional interventions during treatment for ovarian cancer: A narrative review and recommendations for future research. Maturitas 2024; 183:107938. [PMID: 38367367 DOI: 10.1016/j.maturitas.2024.107938] [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: 12/12/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/19/2024]
Abstract
Most women with ovarian cancer are diagnosed at an advanced stage (stage III or IV), when the intraabdominal spread of the tumour impacts nutrient intake and absorption. Up to 70 % of women with ovarian cancer are malnourished and approximately 40 % are affected by muscle loss at the time of diagnosis. Women with ovarian cancer are at high risk of nutritional decline due to invasive treatment and the severity of side-effects. This review explores the evidence evaluating nutritional interventions during treatment for ovarian cancer and their effect on nutritional status, muscle mass, and clinical outcomes. Perioperative immunonutrition has been investigated with mixed results for immediate postoperative outcomes. Individualised nutrition counselling as part of a multimodal prehabilitation programme prior to surgery shows promising results; however, the effects are limited by sample size. Nutrition counselling as part of a mixed intervention with exercise shows high acceptability and suggests improvements in dietary intake and quality of life during chemotherapy treatment, while oral nutritional supplements and nutrition education appear to reduce symptom burden. Individualised nutrition counselling during treatment also appears to be associated with improved overall survival; however, the evidence is limited to a single retrospective study. A key finding from this review is that, despite the high prevalence of malnutrition and muscle loss in women with ovarian cancer and the critical importance of addressing these modifiable prognostic factors, nutrition intervention studies are limited. Prospective studies with samples large enough to provide adequate power to evaluate intervention effectiveness are urgently required to inform optimal management.
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Affiliation(s)
- Sarah Benna-Doyle
- Institute for Physical Activity and Nutrition, Deakin University, Locked Bag 20001, Geelong, VIC 3220, Australia.
| | - Brenton J Baguley
- Institute for Physical Activity and Nutrition, Deakin University, Locked Bag 20001, Geelong, VIC 3220, Australia.
| | - Erin Laing
- Peter McCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC 3000, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Grattan Street, Parkville, VIC 3010, Australia.
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Locked Bag 20001, Geelong, VIC 3220, Australia.
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Zhan S, Yung MMH, Siu MKY, Jiao P, Ngan HYS, Chan DW, Chan KKL. New Insights into Ferroptosis Initiating Therapies (FIT) by Targeting the Rewired Lipid Metabolism in Ovarian Cancer Peritoneal Metastases. Int J Mol Sci 2022; 23:ijms232315263. [PMID: 36499591 PMCID: PMC9737695 DOI: 10.3390/ijms232315263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/04/2022] [Accepted: 11/24/2022] [Indexed: 12/11/2022] Open
Abstract
Ovarian cancer is one of the most lethal gynecological cancers worldwide. The poor prognosis of this malignancy is substantially attributed to the inadequate symptomatic biomarkers for early diagnosis and effective remedies to cure the disease against chemoresistance and metastasis. Ovarian cancer metastasis is often relatively passive, and the single clusters of ovarian cancer cells detached from the primary ovarian tumor are transcoelomic spread by the peritoneal fluid throughout the peritoneum cavity and omentum. Our earlier studies revealed that lipid-enriched ascitic/omental microenvironment enforced metastatic ovarian cancer cells to undertake metabolic reprogramming and utilize free fatty acids as the main energy source for tumor progression and aggression. Intriguingly, cell susceptibility to ferroptosis has been tightly correlated with the dysregulated fatty acid metabolism (FAM), and enhanced iron uptake as the prominent features of ferroptosis are attributed to the strengthened lipid peroxidation and aberrant iron accumulation, suggesting that ferroptosis induction is a targetable vulnerability to prevent cancer metastasis. Therefore, the standpoints about tackling altered FAM in combination with ferroptosis initiation as a dual-targeted therapy against advanced ovarian cancer were highlighted herein. Furthermore, a discussion on the prospect and challenge of inducing ferroptosis as an innovative therapeutic approach for reversing remedial resistance in cancer interventions was included. It is hoped this proof-of-concept review will indicate appropriate directions for speeding up the translational application of ferroptosis-inducing compounds (FINs) to improve the efficacy of ovarian cancer treatment.
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Affiliation(s)
- Shijie Zhan
- Department of Obstetrics & Gynaecology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Mingo M. H. Yung
- Department of Obstetrics & Gynaecology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Michelle K. Y. Siu
- Department of Obstetrics & Gynaecology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Peili Jiao
- Department of Obstetrics & Gynaecology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Hextan Y. S. Ngan
- Department of Obstetrics & Gynaecology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - David W. Chan
- Department of Obstetrics & Gynaecology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- School of Medicine, The Chinese University of Hong Kong-Shenzhen, Shenzhen 518172, China
- Correspondence: (D.W.C.); (K.K.L.C.); Tel.: +86-755-2351-6153 (D.W.C.); +852-2255-4260 (K.K.L.C.); Fax: +852-2255-0947 (K.K.L.C.)
| | - Karen K. L. Chan
- Department of Obstetrics & Gynaecology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Correspondence: (D.W.C.); (K.K.L.C.); Tel.: +86-755-2351-6153 (D.W.C.); +852-2255-4260 (K.K.L.C.); Fax: +852-2255-0947 (K.K.L.C.)
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Yan X, Zhang S, Jia J, Yang J, Song Y, Duan H. Total Parenteral Nutrition Treatment Improves the Nutrition Status of Gynecological Cancer Patients by Improving Serum Albumin Level. Front Med (Lausanne) 2022; 8:759387. [PMID: 35127741 PMCID: PMC8810638 DOI: 10.3389/fmed.2021.759387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/23/2021] [Indexed: 11/17/2022] Open
Abstract
Background Malnutrition is often observed in gynecological cancer patients, however its prevalence in these patients remains largely unexplored. Total parenteral nutrition (TPN) is a nutritional intervention method that has controversial treatment outcome on gynecological cancer patients. The present retrospective study is designed to evaluate the nutrition status and TPN treatment outcome on patients diagnosed with endometrial, cervical or ovarian malignant tumors. Methods Medical records of a total of 263 patients treated at the First Hospital of Shanxi Medical University, China were included. Nutrition status was assessed by patient-generated subjective global assessment (PG-SGA). Patients were grouped based on nutrition status, cancer type or treatment strategy for clinical characteristic comparison. Multivariable logistic regression analysis was used to identify predictors for malnutrition status and hospital stay duration. Results Presence of endometrial and cervical cancer, body weight before nutritional intervention and serum albumin level (P < 0.001 for all) were found to be significant predictors for malnutrition status in gynecological cancer patients. In the malnourished patients, those who were treated with TPN had significantly lower serum albumin levels before and after treatment (P < 0.001) and PG-SGA scores after treatment. Also, TPN treatment could significantly increase the serum albumin levels in these patients after 1 week. In addition, shorter hospitalization period was needed for TPN-treated endometrial (P = 0.019) and ovarian (P < 0.001) patients. Moreover, serum albumin levels (P < 0.001), use of TPN treatment (P = 0.025) and nutrition status (P = 0.010) were identified to be independent predictors for hospital stay duration. Conclusion Our results suggest that malnutrition is a significant clinical manifestation in gynecological cancer patients who may benefit from TPN treatment for reduced hospitalization and improved serum albumin levels.
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Affiliation(s)
- Xin Yan
- Department of Drug Clinical Trial, First Hospital of Shanxi Medical University, Taiyuan, China
- *Correspondence: Xin Yan
| | - Sanyuan Zhang
- Department of Gynecology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Junmei Jia
- Department of Oncology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Jiaolin Yang
- Department of Gynecology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yilai Song
- Department of Drug Clinical Trial, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Haoran Duan
- School of Nursing, Shanxi Medical University, Taiyuan, China
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Wang W, Kong S, Xu A. LncRNA ANRIL suppresses proliferation and promotes apoptosis of ovarian cancer cells by regulating MiR-125a-3p/MAPK signaling pathway. Minerva Med 2021; 113:581-582. [PMID: 34515455 DOI: 10.23736/s0026-4806.21.07608-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Wenshuang Wang
- Department of Gynecology, Yantai Yuhuangding Hospital, Yantai, China
| | - Shujun Kong
- Department of Gynecology, Yantai Yuhuangding Hospital, Yantai, China
| | - Anli Xu
- Department of Gynecology, Yantai Yuhuangding Hospital, Yantai, China -
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Yan X, Zhang S, Jia J, Yang J, Song Y, Duan H. Exploring the malnutrition status and impact of total parenteral nutrition on the outcome of patients with advanced stage ovarian cancer. BMC Cancer 2021; 21:799. [PMID: 34246241 PMCID: PMC8272298 DOI: 10.1186/s12885-021-08537-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ovarian cancer is a common cancer type in women and is often associated with onset of malnutrition. Total parenteral nutrition (TPN) is a nutritional intervention method that has been reported to have controversial effect on cancer patients. In the present retrospective study, we sought to explore the prevalence of malnutrition assessed by the Nutritional Risk Index (NRI) and its association with survival in advanced stage ovarian cancer patients. We also compared the post-operative outcome of the malnourished patients treated with either TPN or conservative management. RESULTS A total of 415 patients with advanced stage ovarian cancer were separated into 4 nutrition groups based on the NRI scores. We found that a number of factors were significantly different among the 4 nutrition groups, including age, serum albumin level, BMI and NRI; among which serum albumin level and NRI were identified to be independent predictors of progression-free and overall survival. In the moderately and severely malnourished patients, those who were treated with TPN had significantly shorter hospitalization period, lower serum albumin level and lower BMI after surgery. In addition, serum albumin level, use of TPN and number of patients with complications were closely related to the hospital stay duration. CONCLUSION Malnutrition status is closely associated with survival of advanced stage ovarian cancer patients. These patients may benefit from TPN treatment for reduced hospitalization, especially with the onset of hypoalbuminemia.
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Affiliation(s)
- Xin Yan
- Department of Drug Clinical Trial, First Hospital of Shanxi Medical University, 85 Jiefangnan Road, Taiyuan, 030001, Shanxi, China.
| | - Sanyuan Zhang
- Department of Gynecology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Junmei Jia
- Department of Oncology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Jiaolin Yang
- Department of Gynecology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yilai Song
- Department of Drug Clinical Trial, First Hospital of Shanxi Medical University, 85 Jiefangnan Road, Taiyuan, 030001, Shanxi, China
| | - Haoran Duan
- School of Nursing, Shanxi Medical University, Taiyuan, China
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McSharry V, Glennon K, Mullee A, Brennan D. The impact of body composition on treatment in ovarian cancer: a current insight. Expert Rev Clin Pharmacol 2021; 14:1065-1074. [PMID: 34080491 DOI: 10.1080/17512433.2021.1937125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Epithelial ovarian cancer (EOC) remains the most lethal of gynecological cancers. Sarcopenia and low Skeletal Muscle Radiodensity (SMD) are highly prevalent in EOC. Cross sectional imaging via MRI and CT are considered the gold standard for quantification of muscle mass and muscle density. Skeletal Muscle Index (SMI) and SMD-based thresholds for sarcopenia in EOC vary significantly and specific EOC thresholds for sarcopenia have not been defined. AREAS COVERED Sarcopenia and low SMD are highly prevalent in EOC affecting between 11-68% and 21-35% of women, respectively. SMD may be a better prognostic biomarker in ovarian cancer than SMI. Reduced SMI and SMD may also influence the risk of postoperative complications but further studies are required. There is increasing evidence that sarcopenia increases during neoadjuvant chemotherapy. EXPERT COMMENTARY Prehabilitation studies in surgical oncology indicate encouraging results, such as, maintenance of SMI, reduced length of stay and surgical complication rates, improved health-related quality of life and functional capacity. Early identification of body composition abnormalities would permit targeted intervention prior to, and after surgery. Cross-sectional imaging is routinely used for staging and surveillance of EOC patients and hence assessment of body composition abnormalities is possible and an underutilized resource.
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Affiliation(s)
- Veronica McSharry
- Department of Clinical Nutrition and Dietetics, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Kate Glennon
- UCD-Gynaeoncology Group, UCD School of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Amy Mullee
- Department of Health and Nutritional Science, IT Sligo, Sligo, Ireland
| | - Donal Brennan
- UCD-Gynaeoncology Group, UCD School of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland.,Systems Biology Ireland, UCD School of Medicine, Dublin, Ireland
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Seol A, Kim SI, Song YS. Sarcopenia: Clinical implications in ovarian cancer, diagnosis, etiology, and management. SPORTS MEDICINE AND HEALTH SCIENCE 2020; 2:202-210. [PMID: 35782999 PMCID: PMC9219260 DOI: 10.1016/j.smhs.2020.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 12/25/2022] Open
Abstract
Sarcopenia, loss of skeletal muscle and function, is a common condition among the elderly and is known to cause adverse health outcomes and increased risk of morbidity and mortality. This progressive and generalized disorder imposes a considerable socioeconomic burden. Sarcopenia is observed commonly in cancer patients. As Asia is one of the fastest aging regions in the world, it is clear that incidences of both sarcopenia and ovarian cancer will increase together in Asian countries. Ovarian cancer patients are vulnerable to develop sarcopenia during the treatment course and progress of disease, and a considerable number of patients with ovarian cancer seems to have physical inactivity and sarcopenia already at the time of diagnosis. Therefore, management of sarcopenia should be conducted together in parallel with ovarian cancer treatment and surveillance. Thus, in this article, we will review the clinical importance of sarcopenia in the aspect of ovarian cancer. Definition of sarcopenia, diagnosis, etiology, and intervention will be also introduced.
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Affiliation(s)
- Aeran Seol
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Se Ik Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yong Sang Song
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
- Corresponding author. Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul 03080, Republic of Korea.
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Terlikowska KM, Dobrzycka B, Kinalski M, Terlikowski SJ. Serum Concentrations of Carotenoids and Fat-Soluble Vitamins in Relation to Nutritional Status of Patients with Ovarian Cancer. Nutr Cancer 2020; 73:1480-1488. [PMID: 32748660 DOI: 10.1080/01635581.2020.1801779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In this study, we aimed to determine serum concentrations of carotenoids and fat-soluble vitamins (FSVs) in ovarian cancer (OC) patients categorized by clinical and nutritional status and to compare obtained results with healthy controls. We used single-step extraction methods throughout the study. Serum concentrations of the bioactive compounds were measured using HPLC. The evaluation of the nutritional status of patients was performed with scored PG-SGA questionnaire.The serum bioactive compound levels were significantly lower in early-stage OC patients (FIGO I/II) when compared to healthy controls for all-trans-retinoic acid, 25-hydroxycholecalciferol, all-trans-retinol, astaxanthin, zeaxanthin, lycopene and α-carotene, respectively. In patients with advanced-stage of OC (FIGO III/IV) the mean serum concentrations of carotenoids and FSVs were significantly lower than in healthy controls, excluding lutein and β + γ-tocopherol levels. Patients with OC and concomitant moderate or severe malnourishment showed significantly lower levels of 25-hydroxycholecalciferol and all-trans-retinol. It seems that our extraction and measurement methods for the bioactive compounds could be used in both, clinical and nutritional studies. The obtained results confirm that the PG-SGA assessment might be considered not only as a malnutrition assessment tool, but also for planning early nutritional intervention in patients with OC.
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Affiliation(s)
| | - Bozena Dobrzycka
- Department of Gynecology and Obstetrics, Medical University of Bialystok, Bialystok, Poland
| | - Maciej Kinalski
- Department of Gynecology and Obstetrics, Independent Public Healthcare Facility Regional Complex Jan Sniadecki Hospital, Bialystok, Poland
| | - Slawomir J Terlikowski
- Department of Obstetrics, Gynecology and Maternity Care, Medical University of Bialystok, Bialystok, Poland
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McSharry V, Mullee A, McCann L, Rogers AC, McKiernan M, Brennan DJ. The Impact of Sarcopenia and Low Muscle Attenuation on Overall Survival in Epithelial Ovarian Cancer: A Systematic Review and Meta-analysis. Ann Surg Oncol 2020; 27:3553-3564. [DOI: 10.1245/s10434-020-08382-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Indexed: 12/18/2022]
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The prognostic nutritional index is prognostic factor of gynecological cancer: A systematic review and meta-analysis. Int J Surg 2019; 67:79-86. [DOI: 10.1016/j.ijsu.2019.05.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 04/06/2019] [Accepted: 05/28/2019] [Indexed: 01/11/2023]
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Barbolina MV. Molecular Mechanisms Regulating Organ-Specific Metastases in Epithelial Ovarian Carcinoma. Cancers (Basel) 2018; 10:cancers10110444. [PMID: 30445726 PMCID: PMC6266311 DOI: 10.3390/cancers10110444] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/02/2018] [Accepted: 11/13/2018] [Indexed: 01/04/2023] Open
Abstract
Epithelial ovarian carcinoma is the most predominant type of ovarian carcinoma, the deadliest gynecologic malignancy. It is typically diagnosed late when the cancer has already metastasized. Transcoelomic metastasis is the most predominant mechanism of dissemination from epithelial ovarian carcinoma, although both hematogenously and lymphogenously spread metastases also occur. In this review, we describe molecular mechanisms known to regulate organ-specific metastasis from epithelial ovarian carcinoma. We begin by discussing the sites colonized by metastatic ovarian carcinoma and rank them in the order of prevalence. Next, we review the mechanisms regulating the transcoelomic metastasis. Within this chapter, we specifically focus on the mechanisms that were demonstrated to regulate peritoneal adhesion—one of the first steps in the transcoelomic metastatic cascade. Furthermore, we describe mechanisms of the transcoelomic metastasis known to regulate colonization of specific sites within the peritoneal cavity, including the omentum. Mechanisms underlying hematogenous and lymphogenous metastatic spread are less comprehensively studied in ovarian cancer, and we summarize mechanisms that were identified to date. Lastly, we discuss the outcomes of the clinical trials that attempted to target some of the mechanisms described in this review.
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Affiliation(s)
- Maria V Barbolina
- Department of Biopharmaceutical Sciences, University of Illinois at Chicago, Chicago, IL 60607, USA.
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Abstract
OBJECTIVE Cancer cachexia is a paraneoplastic syndrome comprising involuntary weight loss and muscle depletion (sarcopenia). Although weight loss has been associated with poor clinical outcome, there is only limited information on the prevalence and prognostic impact of sarcopenia in ovarian cancer so far. METHODS Total skeletal muscle mass was determined by computed tomography image analysis of the third lumbar skeletal muscle cross-sectional area in 128 patients with advanced serous ovarian cancer. Longitudinal change of muscle mass was studied in 209 consecutive computed tomography scans from 43 patients. Association with survival was determined using Cox proportional hazards model. RESULTS The prevalence of sarcopenia at first diagnosis was 11% (12/105; 95% confidence interval [CI], 6%-20%). Sarcopenic patients had a significantly reduced progression-free (hazard ratio, 2.64; 95% CI, 1.24-5.64; P = 0.012) and overall survival (hazard ratio, 3.17; 95% CI, 1.29-7.80; P = 0.012). On multivariable analysis, these prognostic effects remained significant after adjustment for age, International Federation of Gynecology and Obstetrics stage, and postsurgical residual disease. Longitudinal analyses identified both patients with loss and gain of muscle mass. However, change in muscle mass over time was not associated with survival. CONCLUSIONS Baseline sarcopenia is a prognostic factor in advanced serous ovarian cancer. Identification of sarcopenic patients and early enrollment in physical or nutritional education programs might thus be a feasible way to improve outcome and should be further evaluated in prospective clinical trials.
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Vizzotto Junior AO, Campos ACL, Mello EVDSL, Castilho TJ. Influence of preoperative supplementation of omega-3 fatty acid in the healing of colonic anastomoses in malnourished rats receiving paclitaxel. Rev Col Bras Cir 2017; 42:116-23. [PMID: 26176678 DOI: 10.1590/0100-69912015002009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 08/15/2014] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To evaluate the effect of preoperative supplementation of omega-3 fatty acids on the healing of colonic anastomoses in malnourished rats receiving paclitaxel. METHODS we studied 160 male Wistar rats, divided in two groups: one subjected to malnutrition by pair feeding (M) for four weeks, and another that received food ad libitum (W). In the fourth week, the groups were further divided into two subgroups that received omega-3 or olive oil by gavage. The animals were submitted to colonic transection and end-to-end anastomosis. After the operation, each of the four groups was divided into two subgroups that received intraperitoneal isovolumetric solutions of saline or paclitaxel. RESULTS mortality was 26.8% higher in the group of animals that received paclitaxel (p = 0.003). The complete rupture strength was greater in well-nourished-oil Paclitaxel group (WOP) compared with the the malnourished-oil Paclitaxel one (MOP). The collagen maturation index was higher in well-nourished-oil saline group (WOS) in relation to the malnutrition-oil-saline group (MOS), lower in malnourished-oil-saline group (MOS) in relation to malnourished-ômega3-saline one (M3S) and lower in the well-nourished-omega3-saline group (W3S) compared with the malnourished-omega3-saline (M3S). The blood vessel count was higher in the malnourished-oil-saline group (MOS) than in the malnourished-oil-paclitaxel group (MOP) and lower in the malnourished-oil-saline group (MOS) in relation to the malnourished-omega3-paclitaxel group (M3P). CONCLUSION supplementation with omega-3 fatty acids was associated with a significant increase in the production of mature collagen in malnourished animals, with a reversal of the harmful effects caused by malnutrition associated with the use of paclitaxel on the rupture strength, and with a stimulus to neoangiogenesis in the group receiving paclitaxel.
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Obermair A, Simunovic M, Isenring L, Janda M. Nutrition interventions in patients with gynecological cancers requiring surgery. Gynecol Oncol 2017; 145:192-199. [DOI: 10.1016/j.ygyno.2017.01.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 01/19/2017] [Accepted: 01/23/2017] [Indexed: 12/15/2022]
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Chen Y, Zhang L, Liu W, Wang K. Case-control study of metabolic syndrome and ovarian cancer in Chinese population. Nutr Metab (Lond) 2017; 14:21. [PMID: 28261315 PMCID: PMC5330115 DOI: 10.1186/s12986-017-0176-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 02/17/2017] [Indexed: 12/25/2022] Open
Abstract
Background Recent studies have proved metabolic syndrome (MetS) was linked to cancer risks. However, few data has examined the relationship between MetS and epithelial ovarian cancer (EOC). Methods We conducted a population-based case-control study in Tianjin Medical University Cancer Institute and Hospital, China (2010–2015) that enrolled 573 EOC patients and 1146 matched controls. Data were collected through in-person interviews, anthropometric measurement, and 8-h fasting bloods drawn. MetS was estimated by Chinese Diabetes Society (CDS) definition requiring presence of ≥3 of the following risk factors: 1) body mass index (BMI) ≥25.0 kg/m2,2) fasting plasma glucose ≥6.1 mmol/L or 2-h plasma glucose ≥ 7.8 mmol/L, 3) systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg, 4) triglyceride (TG) ≥1.70 mmol/L or high-density lipoprotein cholesterol (HDL-C) < 1.0 mmol/L. Statistics were completed using chi-square tests and logistic regression analysis. The survival analysis was conducted by the Kaplan-Meier method and Cox proportional hazard regression models. Results MetS was significantly more prevalent among EOC (25.13%) than controls (6.89%). A statistically significant increase risk for EOC was observed for MetS (multivariable-adjusted OR = 3.187; 95% CI: 2.135–4.756). MetS was significantly associated with histological grade (P < 0.001), FIGO stage (P = 0.003), and lymph node (LN) status (P = 0.002) of EOC. In binary logistic regression analysis, the presence of MetS predicts the risk of advanced FIGO stage (OR = 2.155, 95% CI: 1.327–3.498, P = 0.002), lower differentiation (OR = 2.472, 95% CI: 1.164–5.250, P = 0.019), and LN metastasis (OR = 2.590, 95% CI: 1.089–6.160, P = 0.031) of EOC. Moreover, MetS is the independent factor for the evaluation of PFS and OS of EOC patients (both of them P < 0.001) in Cox proportional hazard model. Conclusion MetS is obviously related to increased EOC risk. EOC patients with MetS in Chinese population were found to have statistically significant tumor advanced stage, low differentiation, LN metastasis and poor prognosis.
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Affiliation(s)
- Ying Chen
- Department of Gynecologic Oncology, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Hexi District, Tianjin, 300060 China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060 China.,National Clinical Research Centre of Cancer, Tianjin, 300060 China
| | - Lei Zhang
- Department of Gynecologic Oncology, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Hexi District, Tianjin, 300060 China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060 China.,National Clinical Research Centre of Cancer, Tianjin, 300060 China
| | - Wenxin Liu
- Department of Gynecologic Oncology, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Hexi District, Tianjin, 300060 China
| | - Ke Wang
- Department of Gynecologic Oncology, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Hexi District, Tianjin, 300060 China
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The impact of total parenteral nutrition on postoperative recovery in patients treated for advanced stage ovarian cancer. Arch Gynecol Obstet 2016; 295:439-444. [DOI: 10.1007/s00404-016-4227-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 11/02/2016] [Indexed: 01/01/2023]
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Rutten IJG, van Dijk DPJ, Kruitwagen RFPM, Beets-Tan RGH, Olde Damink SWM, van Gorp T. Loss of skeletal muscle during neoadjuvant chemotherapy is related to decreased survival in ovarian cancer patients. J Cachexia Sarcopenia Muscle 2016; 7:458-66. [PMID: 27030813 PMCID: PMC4782251 DOI: 10.1002/jcsm.12107] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 01/13/2016] [Accepted: 01/25/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Malnutrition, weight loss, and muscle wasting (sarcopenia) are common among women with advanced ovarian cancer and have been associated with adverse clinical outcomes and survival. Our objective is to investigate overall survival (OS) related to changes in skeletal muscle (SM) for patients with advanced ovarian cancer treated with neoadjuvant chemotherapy and interval debulking. METHODS Ovarian cancer patients (n = 123) treated with neoadjuvant chemotherapy and interval debulking in the area of Maastricht (the Netherlands) between 2000 and 2014 were included retrospectively. Surface areas of SM and adipose tissue were defined on computed tomography at the level of the third lumbar vertebra. Low SM at baseline and SM changes during chemotherapy were compared with Kaplan Meier curves, and Cox-regression models were applied to test predictors of OS. RESULTS Median OS for patients who lost SM (n = 83) was 916 ± 99 days, which was significantly different from median OS for patients who maintained or gained SM (n = 40), which was 1431 ± 470 days (P = 0.004). Loss of SM was also a significant predictor of OS in multivariable Cox-regression analysis (hazard ratio 1.773 (95%CI: 1.018-3.088), P = 0.043). Low baseline SM did not influence survival. CONCLUSIONS Patients with ovarian cancer have a worse survival when they lose SM during neoadjuvant chemotherapy. Evaluation of low SM at a specific time point is not prognostic for OS. External and prospective validation of these findings is imperative. Nutritional, pharmacological, and/or physical intervention studies are necessary to establish whether SM impairment can be prevented to prolong ovarian cancer survival.
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Affiliation(s)
- Iris J G Rutten
- Department of Obstetrics and Gynaecology Maastricht University Medical Centre 6202 AZ Maastricht The Netherlands; GROW School for Oncology and Developmental Biology Maastricht University 6200 MD Maastricht The Netherlands
| | - David P J van Dijk
- Department of General Surgery Maastricht University Medical Centre 6202 AZ Maastricht The Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism Maastricht University 6200 MD Maastricht The Netherlands
| | - Roy F P M Kruitwagen
- Department of Obstetrics and Gynaecology Maastricht University Medical Centre 6202 AZ Maastricht The Netherlands; GROW School for Oncology and Developmental Biology Maastricht University 6200 MD Maastricht The Netherlands
| | - Regina G H Beets-Tan
- GROW School for Oncology and Developmental Biology Maastricht University 6200 MD Maastricht The Netherlands; Department of Radiology Maastricht University Medical Centre 6202 AZ Maastricht The Netherlands; Department of Radiology Netherlands Cancer Institute 1006 BE Amsterdam The Netherlands
| | - Steven W M Olde Damink
- Department of General Surgery Maastricht University Medical Centre 6202 AZ Maastricht The Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism Maastricht University 6200 MD Maastricht The Netherlands
| | - Toon van Gorp
- Department of Obstetrics and Gynaecology Maastricht University Medical Centre 6202 AZ Maastricht The Netherlands; GROW School for Oncology and Developmental Biology Maastricht University 6200 MD Maastricht The Netherlands
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Yim GW, Eoh KJ, Kim SW, Nam EJ, Kim YT. Malnutrition Identified by the Nutritional Risk Index and Poor Prognosis in Advanced Epithelial Ovarian Carcinoma. Nutr Cancer 2016; 68:772-9. [PMID: 27044606 DOI: 10.1080/01635581.2016.1159702] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Ovarian cancer is a chronic disease with a risk of malnutrition. Nutritional Risk Index (NRI) has been reported as a simple and accurate tool to assess the nutritional status. We sought to explore the prevalence of malnutrition and its association with survival in ovarian cancer. A retrospective study was conducted in 213 advanced ovarian cancer patients. NRI was calculated before and at the end of treatment using patients' body weight and serum albumin level. Overall survival (OS) and progression-free survival (PFS) were estimated by Kaplan-Meier method, and associations were assessed using a Cox proportional hazards analysis adjusted for known prognostic variables. Moderate to severely malnourished patients had lower 5-yr OS (45.3%) compared to normal to mild group (64.0%), respectively (P = 0.024). Adjusted for covariates, the relative risk of death was 5.8 times higher in moderate/severely malnourished group identified at the last course of chemotherapy (HR = 5.896, 95% CI = 2.723-12.764, P < 0.001). Similarly, this cohort had shorter PFS compared with normal to mild risk group (median 15 vs. 28 months, P = 0.011). Malnutrition is prevalent among ovarian cancer patients and is found to be a significant predictor for mortality.
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Affiliation(s)
- Ga Won Yim
- a Institute of Women's Life Medical Science, Division of Gynecologic Oncology , Department of Obstetrics and Gynecology, Yonsei University College of Medicine , Seoul , Republic of Korea
| | - Kyung Jin Eoh
- a Institute of Women's Life Medical Science, Division of Gynecologic Oncology , Department of Obstetrics and Gynecology, Yonsei University College of Medicine , Seoul , Republic of Korea
| | - Sang Wun Kim
- a Institute of Women's Life Medical Science, Division of Gynecologic Oncology , Department of Obstetrics and Gynecology, Yonsei University College of Medicine , Seoul , Republic of Korea
| | - Eun Ji Nam
- a Institute of Women's Life Medical Science, Division of Gynecologic Oncology , Department of Obstetrics and Gynecology, Yonsei University College of Medicine , Seoul , Republic of Korea
| | - Young Tae Kim
- a Institute of Women's Life Medical Science, Division of Gynecologic Oncology , Department of Obstetrics and Gynecology, Yonsei University College of Medicine , Seoul , Republic of Korea
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Quality of life after early enteral feeding versus standard care for proven or suspected advanced epithelial ovarian cancer: Results from a randomised trial. Gynecol Oncol 2015; 137:516-22. [DOI: 10.1016/j.ygyno.2015.03.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/20/2015] [Indexed: 01/20/2023]
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20
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Chase D, Goulder A, Zenhausern F, Monk B, Herbst-Kralovetz M. The vaginal and gastrointestinal microbiomes in gynecologic cancers: a review of applications in etiology, symptoms and treatment. Gynecol Oncol 2015; 138:190-200. [PMID: 25957158 DOI: 10.1016/j.ygyno.2015.04.036] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 04/25/2015] [Indexed: 12/30/2022]
Abstract
The human microbiome is the collection of microorganisms in the body that exist in a mutualistic relationship with the host. Recent studies indicate that perturbations in the microbiome may be implicated in a number of diseases, including cancer. More specifically, changes in the gut and vaginal microbiomes may be associated with a variety of gynecologic cancers, including cervical cancer, uterine cancer, and ovarian cancer. Current research and gaps in knowledge regarding the association between the gut and vaginal microbiomes and the development, progression, and treatment of gynecologic cancers are reviewed here. In addition, the potential use of probiotics to manage symptoms of these gynecologic cancers is discussed. A better understanding of how the microbiome composition is altered at these sites and its interaction with the host may aid in prevention, optimization of current therapies, development of new therapeutic agents and/or dosing regimens, and possibly limit the side effects associated with cancer treatment.
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Affiliation(s)
- Dana Chase
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Arizona Cancer Center, Creighton School of Medicine at St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA
| | - Alison Goulder
- Department of Basic Medical Sciences, The University of Arizona College of Medicine - Phoenix, Phoenix, AZ 85004, USA
| | - Frederic Zenhausern
- Department of Basic Medical Sciences, The University of Arizona College of Medicine - Phoenix, Phoenix, AZ 85004, USA
| | - Bradley Monk
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Arizona Cancer Center, Creighton School of Medicine at St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA
| | - Melissa Herbst-Kralovetz
- Department of Basic Medical Sciences, The University of Arizona College of Medicine - Phoenix, Phoenix, AZ 85004, USA.
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Oshakbayev KP, Alibek K, Ponomarev IO, Uderbayev NN, Dukenbayeva BA. Weight change therapy as a potential treatment for end-stage ovarian carcinoma. AMERICAN JOURNAL OF CASE REPORTS 2014; 15:203-11. [PMID: 24847411 PMCID: PMC4025513 DOI: 10.12659/ajcr.890229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 01/27/2014] [Indexed: 12/18/2022]
Abstract
Patient: Female, 41 Final Diagnosis: Ovarian carcinoma Symptoms: Ascites • hepatomegaly • weight loss Medication: — Clinical Procedure: — Specialty: Oncology
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Affiliation(s)
| | - Kenneth Alibek
- Department of Oncology, Republican Scientific Center for Emergency Medicine, Astana, Republic of Kazakhstan
| | - Igor Olegovich Ponomarev
- Department of Oncology, Republican Scientific Center for Emergency Medicine, Astana, Republic of Kazakhstan
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Billson HA, Holland C, Curwell J, Davey VL, Kinsey L, Lawton LJ, Whitworth AJ, Burden S. Perioperative nutrition interventions for women with ovarian cancer. Cochrane Database Syst Rev 2013; 2013:CD009884. [PMID: 24027084 PMCID: PMC8730356 DOI: 10.1002/14651858.cd009884.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Women with ovarian cancer have been shown to be at significant risk of malnutrition with incidence rates described as being between 28% to 67%. Nutrition interventions may improve clinical outcomes positively, nutritional status or quality of life measures in this patient group. OBJECTIVES This review was conducted to assess the effects of nutrition interventions during the perioperative period for women with ovarian cancer. SEARCH METHODS Electronic searches were conducted of the Cochrane Gynaecological Cancer Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL 2012, Issue 7), Medline (1946 to July week 4 2012), Embase (1980 to 2012 week 31), DARE (to 7th August 2012) AMED (1985 to April 2012), BNI (1992 to April 2012), CINAHL (to April 2012). We also searched trials databases, conference proceedings and related citation lists. Reference listings were handsearched. No restrictions were applied on language or date. SELECTION CRITERIA Randomised controlled trials (RCTs) in which women 18 years and over with any stage of ovarian cancer, including recurrent cancer, were in the perioperative phase of treatment and received any type of nutrition intervention. DATA COLLECTION AND ANALYSIS Titles and abstracts were screened by two review authors with study selection discussed by a team. Pairs of review authors worked independently on data collection and compared findings. MAIN RESULTS A total of 4092 titles were screened and 14 full text reports reviewed; a single small study met the inclusion criteria. In the included RCT, 40 women (35 with ovarian cancer) had extensive elective surgery including bowel resection for treatment of gynaecological malignancy. Randomisation was made to either early oral feeding (oral fluids in the first 24 hours, solid foods on the following day) or to a 'traditional' feeding regimen where oral fluids and foods were delayed until there was evidence of bowel function. Most women in the early feeding group (14/18) were able to resume eating solid food one day after surgery. This resulted in a significantly shorter hospital stay with no increase in postoperative complications or change in quality of life measures in comparison with the women on the 'traditional' feeding regimen. The incidence of nausea and vomiting during the postoperative stay was similar in both groups and was noted in slightly more than half of the women. Overall survival was evaluated until 30 days following discharge from hospital; in this period, there was one death of a woman who had been in the 'traditional oral feeding' group, cause of death was not noted. We assessed risk of bias and found no high risk of bias was identified in the methodology and reporting of the included study, although there was an increased risk of bias due to the small size of the study in which not all of the women had ovarian cancer. AUTHORS' CONCLUSIONS Although women with ovarian cancer have been shown to be at risk of malnutrition, there is a lack of evidence derived from RCTs evaluating the identification, assessment and treatment of malnutrition during the perioperative phase of treatment. There is evidence from one small study that some women with ovarian cancer undergoing surgery with associated bowel resection may safely commence oral fluids within 24 hours of surgery and solid foods on the following day. Further research is required, including a RCT, to generate guidance concerning the treatment of malnutrition in this patient group.
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Affiliation(s)
- Hazel A Billson
- Dietetic Department, Platt 2 Rehabilitation, Manchester Royal Infirmary, Oxford Road, Manchester, UK, M13 9WL
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