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Daniele A, Rosso R, Ceccaroni M, Roviglione G, D’Ancona G, Peano E, Clignon V, Calandra V, Puppo A. Laparoscopic Treatment of Bulky Nodes in Primary and Recurrent Ovarian Cancer: Surgical Technique and Outcomes from Two Specialized Italian Centers. Cancers (Basel) 2024; 16:1631. [PMID: 38730583 PMCID: PMC11083283 DOI: 10.3390/cancers16091631] [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: 03/20/2024] [Revised: 04/20/2024] [Accepted: 04/20/2024] [Indexed: 05/13/2024] Open
Abstract
(1) Background: Minimally invasive surgery (MIS) represents a feasible approach in early-stage ovarian cancer, while this question is still unsolved for advanced and recurrent disease. (2) Methods: In this retrospective, multicenter study, we present a series of 21 patients who underwent MIS for primitive or recurrent epithelial ovarian cancer (EOC) with bulky nodal metastasis and discuss surgical technique and outcomes in relation to the current literature. (3) Results: Complete cytoreduction at primary debulking surgery was obtained in 86% of cases. No complication occurred in our patients intraoperatively and only 11.1% of our patients experienced grade 2 and 3 postoperative complications. Notably, all the patients with isolated lymph nodal recurrence (ILNR) were successfully treated with a minimally invasive approach with no intra- or postoperative complications. (4) Conclusions: The results of our study are consistent with those reported in the literature, demonstrating that MIS may represent a safe approach in advanced and recurrent EOC with nodal metastasis if performed on selected patients by expert surgeons with an adequate setting and appropriate technique.
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Affiliation(s)
- Alberto Daniele
- Department of Gynecology and Obstetrics, Azienda Sanitaria Ospedaliera Santa Croce e Carle, 12100 Cuneo, Italy; (A.D.); (E.P.); (V.C.); (V.C.); (A.P.)
| | - Roberta Rosso
- Department of Gynecology and Obstetrics, Azienda Sanitaria Ospedaliera Santa Croce e Carle, 12100 Cuneo, Italy; (A.D.); (E.P.); (V.C.); (V.C.); (A.P.)
| | - Marcello Ceccaroni
- Department of Obstetrics and Gynecology, IRCCS “Sacro Cuore-Don Calabria” Hospital, 37024 Negrar di Valpolicella, Italy; (M.C.); (G.R.); (G.D.)
| | - Giovanni Roviglione
- Department of Obstetrics and Gynecology, IRCCS “Sacro Cuore-Don Calabria” Hospital, 37024 Negrar di Valpolicella, Italy; (M.C.); (G.R.); (G.D.)
| | - Gianmarco D’Ancona
- Department of Obstetrics and Gynecology, IRCCS “Sacro Cuore-Don Calabria” Hospital, 37024 Negrar di Valpolicella, Italy; (M.C.); (G.R.); (G.D.)
| | - Elisa Peano
- Department of Gynecology and Obstetrics, Azienda Sanitaria Ospedaliera Santa Croce e Carle, 12100 Cuneo, Italy; (A.D.); (E.P.); (V.C.); (V.C.); (A.P.)
| | - Valentino Clignon
- Department of Gynecology and Obstetrics, Azienda Sanitaria Ospedaliera Santa Croce e Carle, 12100 Cuneo, Italy; (A.D.); (E.P.); (V.C.); (V.C.); (A.P.)
| | - Valerio Calandra
- Department of Gynecology and Obstetrics, Azienda Sanitaria Ospedaliera Santa Croce e Carle, 12100 Cuneo, Italy; (A.D.); (E.P.); (V.C.); (V.C.); (A.P.)
| | - Andrea Puppo
- Department of Gynecology and Obstetrics, Azienda Sanitaria Ospedaliera Santa Croce e Carle, 12100 Cuneo, Italy; (A.D.); (E.P.); (V.C.); (V.C.); (A.P.)
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Andreou M, Kyprianidou M, Cortas C, Polycarpou I, Papamichael D, Kountourakis P, Giannakou K. Prognostic Factors Influencing Survival in Ovarian Cancer Patients: A 10-Year Retrospective Study. Cancers (Basel) 2023; 15:5710. [PMID: 38136256 PMCID: PMC10742060 DOI: 10.3390/cancers15245710] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE To analyze the factors associated with overall survival (OS) and progression-free survival (PFS) in patients with ovarian cancer in Cyprus. METHODS We retrospectively analyzed data from patients with histologically confirmed epithelial ovarian cancer (EOC) and primary peritoneal cancer (PPC). RESULTS A total of 106 women diagnosed with ovarian cancer were included, with a median age at diagnosis of 58 years. The Kaplan-Meier survival analysis showed a median OS of 41 months (95% C.I = 36.9, 45.1), and the FIGO stage (p < 0.001), type of surgery (p < 0.001) and performance status (p < 0.001) were identified as statistically significant prognostic factors for OS. PFS analysis revealed the FIGO stage (p = 0.006) and the performance status (p < 0.001) as significant prognostic factors. Additionally, a Cox regression analysis for median OS was performed for patients with high-grade serous carcinoma, identifying the performance status, FIGO stage, and type of surgery as prognostic factors in univariate analysis. However, in the subsequent multivariate analysis, the performance status and the FIGO stage were confirmed to be the only statistically significant prognostic factors for OS (p < 0.05). CONCLUSIONS This study confirms that the FIGO stage, performance status, and surgery type were considered as prognostic factors for OS in ovarian cancer.
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Affiliation(s)
- Maria Andreou
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia 1516, Cyprus; (M.A.); (M.K.); (I.P.)
| | - Maria Kyprianidou
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia 1516, Cyprus; (M.A.); (M.K.); (I.P.)
| | - Christos Cortas
- Department of Medical Oncology, Bank of Cyprus Oncology Centre, Nicosia 2006, Cyprus; (C.C.); (D.P.); (P.K.)
| | - Irene Polycarpou
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia 1516, Cyprus; (M.A.); (M.K.); (I.P.)
| | - Demetris Papamichael
- Department of Medical Oncology, Bank of Cyprus Oncology Centre, Nicosia 2006, Cyprus; (C.C.); (D.P.); (P.K.)
| | - Panteleimon Kountourakis
- Department of Medical Oncology, Bank of Cyprus Oncology Centre, Nicosia 2006, Cyprus; (C.C.); (D.P.); (P.K.)
- Department of Medical Oncology, Mediterranean Hospital of Cyprus, Limassol 3117, Cyprus
| | - Konstantinos Giannakou
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia 1516, Cyprus; (M.A.); (M.K.); (I.P.)
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Angeles MA, Spagnolo E, Cabarrou B, Pérez-Benavente A, Gil Moreno A, Guyon F, Rychlik A, Migliorelli F, Bataillon G, Navarro AS, Betrian S, Ferron G, Hernández A, Martinez A. Impact of pattern of recurrence on post-relapse survival according to surgical timing in patients with advanced ovarian cancer. Int J Gynecol Cancer 2023; 33:50-56. [PMID: 36446410 DOI: 10.1136/ijgc-2022-003985] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Our study aimed to evaluate the association between timing of cytoreductive surgery and pattern of presentation of the first recurrence in patients with advanced ovarian cancer. We also aimed to assess the impact of the pattern of recurrence on post-relapse overall survival according to surgical timing. METHODS This retrospective multicenter study evaluated patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIC-IV ovarian cancer. Patients had undergone either primary debulking surgery, early interval debulking surgery after 3-4 cycles of neoadjuvant chemotherapy, or delayed debulking surgery after 6 cycles, with minimal or no residual disease, between January 2008 and December 2015. Survival analyses were conducted using the Log-rank test and the Cox model. Cumulative incidences of the different patterns of recurrence were estimated using a competing risks methodology. RESULTS A total of 549 patients were included: 175 (31.9%) patients had primary, 224 (40.8%) early interval, and 150 (27.3%) delayed debulking surgery. The cumulative incidence of peritoneal recurrences at 2 years was higher with increasing neoadjuvant cycles (24.4%, 30.9% and 39.2%; p=0.019). For pleural or pulmonary recurrences, it was higher after early interval surgery (9.9%, 13.0% and 4.1%; p=0.022). Median post-relapse overall survival was 33.5 months (95% confidence interval (CI) (24.3 to 44.2)), 26.8 months (95% CI (22.8 to 32.6)), and 24.5 months (95% CI (18.6 to 29.4)) for primary, early interval, and delayed debulking surgery groups, respectively (p=0.025). The pattern of recurrence in a lymph node (hazard ratio (HR) 0.42, 95% CI (0.27 to 0.64)), delayed surgery (HR 1.53, 95% CI (1.11 to 2.13)) and time to first recurrence (HR 0.95, 95% CI (0.93 to 0.96)) were associated with post-relapse overall survival. For primary and early interval surgery, lymph node recurrences were associated with significantly longer post-relapse overall survival. CONCLUSIONS The pattern of first recurrence was associated with timing of surgery, with peritoneal recurrences being more frequent with the increasing number of cycles of neoadjuvant chemotherapy. Lymph node recurrences were associated with better prognosis, having higher post-relapse overall survival. This improved prognosis of lymphatic recurrences was not observed in patients who underwent delayed surgery.
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Affiliation(s)
- Martina Aida Angeles
- Department of Surgical Oncology, Institut Claudius Regaud, Toulouse, Occitanie, France
| | - Emanuela Spagnolo
- Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
| | - Bastien Cabarrou
- Biostatistics Unit, Institut Claudius Regaud, Toulouse, Occitanie, France
| | - Assumpció Pérez-Benavente
- Gynecologic Oncology Unit, Gynecology Department, Hospital Vall d'Hebron, Barcelona, Catalunya, Spain
| | - Antonio Gil Moreno
- Gynecology, Vall d'Hebron Hospital, SANT CUGAT DEL VALLÉS, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Agnieszka Rychlik
- Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, Warszawa, Poland
| | - Federico Migliorelli
- Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Barcelona, Spain
| | - Guillaume Bataillon
- Department of Anatomopathology, Institut Claudius Regaud, Toulouse, Occitanie, France
| | - Anne-Sophie Navarro
- Department of Surgical Oncology, Institut Claudius Regaud, Toulouse, Occitanie, France
| | - Sarah Betrian
- Department of Medical Oncology, Institut Claudius Regaud, Toulouse University Cancer 32 Institute (IUCT), Oncopole, Toulouse, France
| | - Gwenael Ferron
- Department of Surgical Oncology, Institut Claudius Regaud, Toulouse, Occitanie, France
| | - Alicia Hernández
- Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
| | - Alejandra Martinez
- Department of Surgical Oncology, Institut Claudius Regaud, Toulouse, Occitanie, France
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Ebrahimi V, Khalafi‐Nezhad A, Ahmadpour F, Jowkar Z. Conditional disease-free survival rates and their associated determinants in patients with epithelial ovarian cancer: A 15-year retrospective cohort study. Cancer Rep (Hoboken) 2021; 4:e1416. [PMID: 33949809 PMCID: PMC8714540 DOI: 10.1002/cnr2.1416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/02/2021] [Accepted: 04/19/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The most common type of ovarian cancer (OC) is epithelial ovarian cancer (EOC) which is the most lethal gynecologic malignancy in adult women. AIM This study aimed to determine the conditional disease-free survival (CDFS) rates and their associated determinants in patients with EOC. METHODS AND RESULTS The clinical and demographic data of 335 patients with confirmed EOC at Motahari Clinic (Shiraz, Iran) were retrospectively reviewed and analyzed. Traditional DFS (TDFS) and CDFS were calculated using the Kaplan-Meier method and cumulative DFS estimates, respectively. To evaluate the effects of the prognostic determinants on the DFS of the patients, a multiple covariate Cox analysis using the landmarking method was applied. The 1- and 3-year TDFSs were 81.1% and 47.0%, respectively, and decreased over time. At baseline, a higher stage tumor and endometrioid histology were associated with a higher risk of recurrence when compared to stage I and other histological subtypes, respectively. The hazard of recurrence for older women (age ≥55 years) was approximately twice and three times more than that of women aged <45 years at 1- and 3-year landmark time points, respectively. CONCLUSION The age at diagnosis, defined by a cut-off of 55 years, was a prognostic factor for the CDFS of EOC women. Moreover, patients with advanced-stage EOC (ASEOC) (stages III and IV) and endometrioid histology had poorer CDFSs compared to those with early-stage EOC (ESEOC) (stages I and II) and other histological types. In ESEOC patients with age at diagnosis of >55 years, CDFS gradually decreased in 3 years after remission which should be considered for follow-up care decision-making.
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Affiliation(s)
- Vahid Ebrahimi
- Department of Biostatistics, School of MedicineShiraz University of Medical SciencesShirazIran
| | - Abolfazl Khalafi‐Nezhad
- Department of Hematology, Medical Oncology and Stem Cell TransplantationSchool of Medicine, Shiraz University of Medical SciencesShirazIran
| | - Fatemeh Ahmadpour
- Department of Obstetrics and Gynecology, School of MedicineShiraz University of Medical SciencesShirazIran
| | - Zahra Jowkar
- Oral and Dental Disease Research Center, Department of Operative Dentistry, School of DentistryShiraz University of Medical SciencesShirazIran
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Tate S, Nishikimi K, Matsuoka A, Otsuka S, Shozu M. Introduction of rectosigmoid colectomy improves survival outcomes in early-stage ovarian cancer patients. Int J Clin Oncol 2021; 26:986-994. [PMID: 33677731 DOI: 10.1007/s10147-021-01864-5] [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: 08/25/2020] [Accepted: 12/24/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND To investigate whether rectosigmoid colectomy can improve the prognosis of patients with early-stage ovarian cancer when the ovarian tumor adheres to the rectum. METHODS We retrospectively studied 210 consecutive patients with stage I/II ovarian cancer treated between 2000 and 2016. The surgical strategy differed between the periods 2000-2007 and 2008-2016 with respect to adhesion between the ovarian tumor and rectum. In the former period, ovarian tumor was exfoliated from the rectum. Only when the residual tumor was apparently observed on the rectal surface after salpingo-oophorectomy with hysterectomy, it was subsequently removed by colorectal surgeons performing rectosigmoid colectomy. In the latter period, the ovarian tumor was resected en bloc with the rectum by performing rectosigmoid colectomy. We compared the progression-free survival (PFS) between the two treatment periods. RESULTS Rectosigmoid colectomy was performed more frequently in the latter period than in the former period (43 patients, 31% vs. 6 patients, 8%, p < 0.001). There was no significant difference in complete resection rate between the two periods (97% in the former period, 99% in the latter period, p = 0.278). However, the 5-year PFS rate was significantly higher in the latter period than in the former period (86.0% vs. 74.4%, log-rank test, p = 0.034). Multivariate Cox proportional-hazards regression analysis indicated that disease stage (hazard ratio [HR], 2.87, 95% confidence interval [CI] 1.14-7.34) and treatment period (HR 0.32, 95% CI 0.14-0.73) were independent risk factors for recurrence. CONCLUSIONS Rectosigmoid colectomy could improve the prognosis of patients with early-stage ovarian cancer when the ovarian tumor adheres to the rectum.
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Affiliation(s)
- Shinichi Tate
- Department of Gynecology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba City, 260-8670, Japan.
| | - Kyoko Nishikimi
- Department of Gynecology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba City, 260-8670, Japan
| | - Ayumu Matsuoka
- Department of Gynecology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba City, 260-8670, Japan
| | - Satoyo Otsuka
- Department of Gynecology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba City, 260-8670, Japan
| | - Makio Shozu
- Department of Gynecology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba City, 260-8670, Japan
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Levy T, Migdan Z, Aleohin N, Ben-Shem, Peled O, Tal O, Elyashiv O. Retroperitoneal lymph node recurrence of epithelial ovarian cancer: Prognostic factors and treatment outcome. Gynecol Oncol 2020; 157:392-397. [PMID: 32151375 DOI: 10.1016/j.ygyno.2020.02.022] [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] [Received: 02/03/2020] [Accepted: 02/14/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To evaluate the treatment outcome and survival of patients with epithelial ovarian cancer recurrence isolated to the retroperitoneal lymph nodes compared to intraperitoneal spread. METHODS A retrospective cohort study including women with recurrence of epithelial ovarian, cancer, who were treated at a single medical center, between 2000 and 2015. Patients were classified into three groups according to the site of recurrence: intraperitoneal only, retroperitoneal lymph nodes only, and both. Response to treatment was assessed by the RECIST criteria. RESULTS Out of 135 patients in our cohort, 66 were diagnosed with intraperitoneal recurrence, 30 with retroperitoneal lymph node recurrence and 39 with combined site recurrence. The clinical, pathological and surgical characteristics were similar among all groups, besides CA-125 which was significantly lower in the retroperitoneal recurrence group at diagnosis, end of treatment and recurrence. The median follow-up period was 45.8 months. Overall survival (OS) and post relapse survival (PRS) were significantly higher in the retroperitoneal recurrence group vs. the intraperitoneal and combined site recurrence groups. (OS - 93.07, 47.9 and 41.7 months, respectively, p < .001, PRS - 68.57, 29.67 and 19.7 months, respectively, p < .001). On cox's regression analysis, retroperitoneal recurrence was found to be an independent prognostic factor for survival. CONCLUSIONS The site of recurrence has significant prognostic value regarding PRS and OS. Patients with recurrence limited to the retroperitoneal lymph nodes have a favourable prognosis with median survival longer than 5 years.
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Affiliation(s)
- T Levy
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Z Migdan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - N Aleohin
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ben-Shem
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - O Peled
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - O Tal
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - O Elyashiv
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Khalafi-Nezhad A, Ebrahimi V, Ahmadpour F, Momtahan M, Robati M, Saraf Z, Ramzi M, Jowkar Z, Ghaffari P. Parity as a Prognostic Factor in Patients with Advanced-Stage Epithelial Ovarian Cancer. Cancer Manag Res 2020; 12:1447-1456. [PMID: 32161497 PMCID: PMC7049748 DOI: 10.2147/cmar.s237073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 02/16/2020] [Indexed: 11/23/2022] Open
Abstract
Aim This study aimed to determine the prognostic factors influencing the overall survival (OS) of Iranian women with epithelial ovarian cancer (EOC). Methods Information about newly diagnosed patients with confirmed EOC at Motahari Clinic, Shiraz, Iran, from January 1, 2001, to December 31, 2016, was retrospectively reviewed and analyzed. Cox-adjusted proportional hazards (PH) and stratified Cox (SC) models were used to determine the potential prognostic factors. Results The mean (±SD) age at the diagnosis of 385 patients with EOC was 49.0 (±13.2) years old. Early-stage EOC (ESEOC) and advanced-stage EOC (ASEOC) were diagnosed in 34.3% and 65.7% of the total patients, respectively. The median (95% CI) OS was 35 (28-41) months. For ESEOC patients, a stage II-tumor led to a lower OS in the multivariable analysis compared to a lower stage tumor (P= 0.025). For ASEOC patients, age≥65 years at diagnosis (P=0.008) led to a lower OS. ASEOC patients with 2-5 parities (P=0.014) and >5 parity (P=0.001) demonstrated better OS than nulliparous women. Conclusion Patients with ESEOC, higher tumor stage was associated with a shorter OS. The age at diagnosis harmed the OS of patients with ASEOC. More than one parity improved OS in ASEOC patients.
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Affiliation(s)
- Abolfazl Khalafi-Nezhad
- Hematology Research Center, Department of Hematology, Medical Oncology and Stem Cell Transplantation, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vahid Ebrahimi
- Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Ahmadpour
- Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mozhdeh Momtahan
- Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Minoo Robati
- Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Saraf
- Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mani Ramzi
- Hematology Research Center, Department of Hematology, Medical Oncology and Stem Cell Transplantation, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Jowkar
- Oral and Dental Disease Research Center, Department of Operative Dentistry, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parvin Ghaffari
- Department of Obstetrics and Gynecology, School of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
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Jennifer A, Iptissem N, Aurélie R, Philippe K, Marc AJ. The place of secondary complete cytoreductive surgery in advanced ovarian cancer. Horm Mol Biol Clin Investig 2019; 41:hmbci-2019-0030. [PMID: 31782948 DOI: 10.1515/hmbci-2019-0030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 08/15/2019] [Indexed: 02/07/2023]
Abstract
Despite optimal treatment, three-quarters of the patients with advanced ovarian cancer, experiment relapse and its treatment has become a public health issue. Initially debated, surgery is gaining legitimacy in the treatment of late relapse patients, compared to chemotherapy alone. Secondary complete cytoreduction should be proposed only to a highly selected population. The type of surgery depends on the recurrence localization and the relapse extension in the pelvis and to other organs. Innovating techniques of surgery have become widespread including heated intra peritoneal chemotherapy (HIPEC), laparoscopy and robotic surgery. These specialized treatments should only be carried out in reference centers by oncological surgeons.
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Affiliation(s)
- Asmar Jennifer
- Department of Gynecology and Obstetrics, Foch Hospital, 40 Rue Worth, 92150 Suresnes, France
| | - Naoura Iptissem
- Department of Gynecology and Obstetrics, Foch Hospital, 40 Rue Worth, 92150 Suresnes, France
| | - Revaux Aurélie
- Department of Gynecology and Obstetrics, Foch Hospital, 40 Rue Worth, 92150 Suresnes, France
| | - Kadhel Philippe
- Department of Gynecology and Obstetrics, Foch Hospital, 40 Rue Worth, 92150 Suresnes, France.,CHU de Pointe-à-Pitre, Univ Antilles, Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Pointe-à-Pitre, France
| | - Ayoubi Jean Marc
- Department of Gynecology and Obstetrics, Foch Hospital, 40 Rue Worth, 92150 Suresnes, France
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Prognostic Factors of Early Stage Epithelial Ovarian Carcinoma. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16040637. [PMID: 30795566 PMCID: PMC6406698 DOI: 10.3390/ijerph16040637] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 02/02/2019] [Accepted: 02/18/2019] [Indexed: 11/17/2022]
Abstract
We aimed to determine prognostic factors of early stage (I/II) epithelial ovarian carcinoma (EOC) including clinicopathologic and chemotherapeutic regimens. Four hundred and thirty-seven women who underwent primary staging surgery with adjuvant chemotherapy between January 1, 2000 and December 31, 2010 were retrospectively reviewed and analyzed from two medical centers. The prognostic factors were determined from multivariate survival analyses using Cox regression models. The majority of women were diagnosed with stage Ic (244/437, 55.8%). The histopathologic types were clear cell (37.5%), endometrioid (27.2%), serous (14.0%), and mucinous (13.3%). Fifty-seven percent (249/437) of the women received taxane-based (platinum plus paclitaxel) regimens and 43.0% received non-taxane (platinum plus cyclophosphamide) regimens as frontline adjuvant chemotherapy. Clear cell tumors (adjusted Hazard ratio (aHR) 0.37, 95% confidence interval (CI) 0.21–0.73, p = 0.001) showed better 5-year disease-free survival (DFS) than serous tumors. Women diagnosed at FIGO (International Federation of Gynecology and Obstetrics) stage II (aHR 5.97, 95% CI = 2.47–14.39, p < 0.001), grade 3 tumor without clear cell (aHR 2.28, 95% CI = 1.02–5.07, p = 0.004) and who received 3–5 cycles of non-taxane regimens (aHR 3.29, 95% CI = 1.47–7.34, p = 0.004) had worse 5-year overall survival (OS). Clear cell histology treated with taxane-based regimens showed significantly higher 5-year DFS (91.2% vs. 82.0%, aHR = 0.45, 95% CI = 0.21–0.93, p = 0.043) and 5-year OS (93.5% vs. 79.0%, aHR = 0.30, 95% CI = 0.13–0.70, p = 0.005) than those treated with non-taxane-based regimens. We conclude that stage, tumor grade, and chemotherapeutic regimens/cycles are independent prognostic factors for early stage ovarian cancer.
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Hirose S, Tanabe H, Nagayoshi Y, Hirata Y, Narui C, Ochiai K, Isonishi S, Takano H, Okamoto A. Retrospective analysis of sites of recurrence in stage I epithelial ovarian cancer. J Gynecol Oncol 2018. [PMID: 29533021 PMCID: PMC5920221 DOI: 10.3802/jgo.2018.29.e37] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The aim of the study is to investigate recurrence of stage I epithelial ovarian cancer. METHODS Six hundred two patients diagnosed with stage I epithelial ovarian cancer at 4 hospitals between 2000 and 2013 were retrospectively analyzed. Age, surgical procedure, substage, histologic type, adjuvant chemotherapy, recurrence, initial recurrence site (peritoneal dissemination [P], hematogenous recurrence [H], lymphogenous recurrence [L], and others [O]), and frequency of recurrence at each site were investigated retrospectively. RESULTS Median age was 54 years and median follow-up was 60 months. The stage was IA in 180 cases (30%), IB in 8 (1%), IC1 in 247 (41%), IC2 in 63 (10%), and IC3 in 104 (17%). Systematic lymph node dissection including both pelvic and para-aortic lymph nodes was performed in 224 patients (37%), and 412 patients (68%) received adjuvant chemotherapy. Recurrence occurred in 70 patients (11.6%). The median time to recurrence was 18 months, and the stage was IA in 13 (19%), IB in 1 (1%), IC1 in 24 (34%), IC2 in 9 (13%), and IC3 in 23 (33%) cases. The numbers of recurrence at the P, H, L, and O sites, including overlapping cases, were 49 (70%), 18 (26%), 9 (13%), and 6 (9%), respectively, and recurrence by peritoneal dissemination in the pelvis occurred in 43 cases (61%). CONCLUSION Recurrence of stage I epithelial ovarian cancer by peritoneal dissemination was frequent, especially in the pelvis. There is a need to elucidate the pathogenesis of peritoneal recurrence and to prepare a treatment strategy to prevent pelvic peritoneal recurrence.
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Affiliation(s)
- Sou Hirose
- Department of Obstetrics and Gynecology, The Jikei University Kashiwa Hospital, Kashiwa, Japan
| | - Hiroshi Tanabe
- Department of Obstetrics and Gynecology, The Jikei University Kashiwa Hospital, Kashiwa, Japan.
| | - Youko Nagayoshi
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yukihiro Hirata
- Department of Obstetrics and Gynecology, The Jikei University Katsushika Medical Center, Tokyo, Japan
| | - Chikage Narui
- Department of Obstetrics and Gynecology, The Jikei University Daisan Hospital, Tokyo, Japan
| | - Kazuhiko Ochiai
- Department of Obstetrics and Gynecology, The Jikei University Katsushika Medical Center, Tokyo, Japan
| | - Seiji Isonishi
- Department of Obstetrics and Gynecology, The Jikei University Daisan Hospital, Tokyo, Japan
| | - Hirokuni Takano
- Department of Obstetrics and Gynecology, The Jikei University Kashiwa Hospital, Kashiwa, Japan
| | - Aikou Okamoto
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
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11
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Integration of data mining classification techniques and ensemble learning to identify risk factors and diagnose ovarian cancer recurrence. Artif Intell Med 2017; 78:47-54. [DOI: 10.1016/j.artmed.2017.06.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/30/2017] [Accepted: 06/04/2017] [Indexed: 11/22/2022]
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12
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An Q, Zhou Y, Han C, Zhou Y, Li F, Li D. BTG3 Overexpression Suppresses the Proliferation and Invasion in Epithelial Ovarian Cancer Cell by Regulating AKT/GSK3β/β-Catenin Signaling. Reprod Sci 2017; 24:1462-1468. [DOI: 10.1177/1933719117691143] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Qi An
- Department of Clinical Pharmacology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan Zhou
- Department of Obstetrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chao Han
- Department of Clinical Pharmacology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yubing Zhou
- Department of Clinical Pharmacology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Feng Li
- Department of Clinical Pharmacology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Duolu Li
- Department of Clinical Pharmacology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Frielink LMJ, Pijlman BM, Ezendam NPM, Pijnenborg JMA. Clinical Practice of Adjuvant Chemotherapy in Patients with Early-Stage Epithelial Ovarian Cancer. Chemotherapy 2016; 61:287-94. [PMID: 27074010 DOI: 10.1159/000445024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 02/24/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Adjuvant platinum-based chemotherapy improves survival in women with early-stage epithelial ovarian cancer (EOC). Yet, there is a wide variety in clinical practice. METHODS All patients diagnosed with FIGO I and IIa EOC (2006-2010) in the south of the Netherlands were analyzed. The percentage of patients that received adjuvant chemotherapy was determined as well as the comprehensiveness of staging and outcome. RESULTS Forty percent (54/135) of the patients with early-stage EOC received adjuvant chemotherapy. Treatment with adjuvant chemotherapy was associated with FIGO stage, clear-cell histology and nonoptimal staging. Optimal staging was achieved in 50%, and nonoptimal staging was associated with advanced age, comorbidity and treatment in a non-referral hospital. Overall, there was no difference in outcome between patients with and without adjuvant chemotherapy. Yet, in grade 3 tumors, adjuvant chemotherapy seems beneficial. CONCLUSIONS Selective treatment of patients with early-stage EOC might reduce adjuvant chemotherapy without compromising outcome.
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Cai SY, Yang T, Chen Y, Wang JW, Li L, Xu MJ. Gene expression profiling of ovarian carcinomas and prognostic analysis of outcome. J Ovarian Res 2015; 8:50. [PMID: 26228058 PMCID: PMC4521463 DOI: 10.1186/s13048-015-0176-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 07/07/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ovarian cancer (OCA), the fifth leading deaths cancer to women, is famous for its low survival rate in epithelial ovarian cancer cases, which is very complicated and hard to be diagnosed from asymptomatic nature in the early stage. Thus, it is urgent to develop an effective genetic prognostic strategy. METHODS Current study using the Database for Annotation, Visualization and Integrated Discovery tool for the generation and analysis of quantitative gene expression profiles; all the annotated gene and biochemical pathway membership realized according to shared categorical data from Pathway and Kyoto Encyclopedia of Genes and Genomes; correlation networks based on current gene screening actualize by Weighted correlation network analysis to identify therapeutic targets gene and candidate bio-markers. RESULTS 3095 differentially expressed genes were collected from genome expression profiles of OCA patients (n = 53, 35 advanced, 8 early and 10 normal). By pathway enrichment, most genes showed contribution to cell cycle and chromosome maintenance.1073 differentially expression genes involved in the 4 dominant network modules are further generated for prognostic pattern establish, we divided a dataset with random OCA cases (n = 80) into 3 groups efficiently (p = 0.0323, 95% CIs in Kaplan-Meier). Finally, 6 prognosis related genes were selected out by COX regression analysis, TFCP2L1 related to cancer-stem cell, probably contributes to chemotherapy efficiency. CONCLUSIONS Our study presents an integrated original model of the differentially expression genes related to ovarian cancer progressing, providing the identification of genes relevant for its pathological physiology which can potentially be new clinical markers.
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Affiliation(s)
- Sheng-Yun Cai
- Department of Obstetrics & Gynecology, Changhai Hospital, Second Military Medical University, No.168, Changhai Road, Shanghai, 200433, China.
| | - Tian Yang
- Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No.225, Changhai Road, Shanghai, 200438, China.
| | - Yu Chen
- Department of Obstetrics & Gynecology, Changhai Hospital, Second Military Medical University, No.168, Changhai Road, Shanghai, 200433, China.
| | - Jing-Wen Wang
- Department of Obstetrics & Gynecology, Changhai Hospital, Second Military Medical University, No.168, Changhai Road, Shanghai, 200433, China.
| | - Li Li
- Department of Obstetrics & Gynecology, Changhai Hospital, Second Military Medical University, No.168, Changhai Road, Shanghai, 200433, China.
| | - Ming-Juan Xu
- Department of Obstetrics & Gynecology, Changhai Hospital, Second Military Medical University, No.168, Changhai Road, Shanghai, 200433, China.
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15
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Zhang J, Li H. Heterogeneity of tumor chemosensitivity in ovarian epithelial cancer revealed using the adenosine triphosphate-tumor chemosensitivity assay. Oncol Lett 2015; 9:2374-2380. [PMID: 26137074 DOI: 10.3892/ol.2015.3056] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 01/19/2015] [Indexed: 12/13/2022] Open
Abstract
Ovarian cancer has a poor prognosis, primarily due to the heterogeneity in chemosensitivity among patients. In the present study, this heterogeneity was evaluated in ovarian epithelial cancer (OEC) using an in vitro adenosine triphosphate tumor chemosensitivity assay (ATP-TCA). Specimens were collected from 80 patients who underwent cytoreductive surgery. Viable ovarian cancer cells obtained from malignant tissues were tested for sensitivity to paclitaxel (PTX), carboplatin (CBP), topotecan (TPT), gemcitabine (GEM), docetaxel (TXT), etoposide, bleomycin and 4-hydroperoxycyclophosphamide using ATP-TCA. The sensitivity, specificity, positive predictive value and negative predictive value for the clinical chemotherapy sensitivity of OEC were 88.6, 77.8, 83 and 84.8%, respectively. PTX demonstrated the highest sensitivity of all agents tested (82.5% in all specimens, 85.7% in recurrent specimens), followed by CBP (58.8 and 60.7%, respectively). The sensitivities to PTX and docetaxel (P<0.001) were correlated, in addition to those of CBP, TPT and GEM (P<0.001). Early-stage (I/II) and high- to mildly-differentiated OEC specimens revealed a lower chemosensitivity than advanced-stage (III) or low-differentiated specimens, respectively. The present study indicated that ATP-TCA is an effective method for guiding the choice of chemotherapy drugs. Notable heterogeneity of chemosensitivity was observed in the OEC specimens.
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Affiliation(s)
- Jin Zhang
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Haidian, Beijing 100038, P.R. China
| | - Hongxia Li
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Haidian, Beijing 100038, P.R. China
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Kajiyama H, Mizuno M, Shibata K, Umezu T, Suzuki S, Yamamoto E, Mitsui H, Sekiya R, Niimi K, Kawai M, Nagasaka T, Kikkawa F. Oncologic outcome after recurrence in patients with stage I epithelial ovarian cancer: are clear-cell and mucinous histological types a different entities? Eur J Obstet Gynecol Reprod Biol 2014; 181:305-10. [DOI: 10.1016/j.ejogrb.2014.07.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 07/27/2014] [Accepted: 07/29/2014] [Indexed: 01/18/2023]
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17
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Ovarian cancer patients with localized relapse: Clinical outcome and prognostic factors. Gynecol Oncol 2013; 131:36-41. [DOI: 10.1016/j.ygyno.2013.06.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 05/30/2013] [Accepted: 06/13/2013] [Indexed: 11/18/2022]
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18
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Calura E, Fruscio R, Paracchini L, Bignotti E, Ravaggi A, Martini P, Sales G, Beltrame L, Clivio L, Ceppi L, Di Marino M, Fuso Nerini I, Zanotti L, Cavalieri D, Cattoretti G, Perego P, Milani R, Katsaros D, Tognon G, Sartori E, Pecorelli S, Mangioni C, D'Incalci M, Romualdi C, Marchini S. MiRNA landscape in stage I epithelial ovarian cancer defines the histotype specificities. Clin Cancer Res 2013; 19:4114-23. [PMID: 23766361 DOI: 10.1158/1078-0432.ccr-13-0360] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Epithelial ovarian cancer (EOC) is one of the most lethal gynecologic diseases, with survival rate virtually unchanged for the past 30 years. EOC comprises different histotypes with molecular and clinical heterogeneity, but up till now the present gold standard platinum-based treatment has been conducted without any patient stratification. The aim of the present study is to generate microRNA (miRNA) profiles characteristic of each stage I EOC histotype, to identify subtype-specific biomarkers to improve our understanding underlying the tumor mechanisms. EXPERIMENTAL DESIGN A collection of 257 snap-frozen stage I EOC tumor biopsies was gathered together from three tumor tissue collections and stratified into independent training (n = 183) and validation sets (n = 74). Microarray and quantitative real-time PCR (qRT-PCR) were used to generate and validate the histotype-specific markers. A novel dedicated resampling inferential strategy was developed and applied to identify the highest reproducible results. mRNA and miRNA profiles were integrated to identify novel regulatory circuits. RESULTS Robust miRNA markers for clear cell and mucinous histotypes were found. Specifically, the clear cell histotype is characterized by a five-fold (log scale) higher expression of miR-30a and miR-30a*, whereas mucinous histotype has five-fold (log scale) higher levels of miR-192/194. Furthermore, a mucinous-specific regulatory loop involving miR-192/194 cluster and a differential regulation of E2F3 in clear cell histotype were identified. CONCLUSIONS Our findings showed that stage I EOC histotypes have their own characteristic miRNA expression and specific regulatory circuits.
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Affiliation(s)
- Enrica Calura
- Department of Biology, University of Padova, Via U.Bassi, Padova, Italy
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