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Angioli R, Santonico M, Pennazza G, Montera R, Luvero D, Gatti A, Zompanti A, Finamore P, Incalzi RA. Use of Sensor Array Analysis to Detect Ovarian Cancer through Breath, Urine, and Blood: A Case-Control Study. Diagnostics (Basel) 2024; 14:561. [PMID: 38473033 DOI: 10.3390/diagnostics14050561] [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: 01/22/2024] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
Ovarian cancer (OC) is the eighth most common cancer in women. Since screening programs do not exist, it is often diagnosed in advanced stages. Today, the detection of OC is based on clinical examination, transvaginal ultrasound (US), and serum biomarker (Carbohydrate Antigen 125 (CA 125) and Human Epididymis Protein 4 (HE4)) dosage, with a sensitivity of 88% and 95%, respectively, and a specificity of 84% for US and 76% for biomarkers. These methods are clearly not enough, and OC in its early stages is often missed. Many scientists have recently focused their attention on volatile organic compounds (VOCs). These are gaseous molecules, found in the breath, that could provide interesting information on several diseases, including solid tumors. To detect VOCs, an electronic nose was invented by a group of researchers. A similar device, the e-tongue, was later created to detect specific molecules in liquids. For the first time in the literature, we investigated the potential use of the electronic nose and the electronic tongue to detect ovarian cancer not just from breath but also from urine, blood, and plasma samples.
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Affiliation(s)
- Roberto Angioli
- Unit of Gynecology, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Marco Santonico
- Unit of Electronics for Sensor Systems, Department of Science and Technology for Sustainable Development and One Health, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Giorgio Pennazza
- Unit of Electronics for Sensor Systems, Department of Engineering, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Roberto Montera
- Unit of Gynecology, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Daniela Luvero
- Unit of Gynecology, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Alessandra Gatti
- Unit of Gynecology, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Alessandro Zompanti
- Unit of Electronics for Sensor Systems, Department of Engineering, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Panaiotis Finamore
- Unit of Geriatrics, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Raffaele Antonelli Incalzi
- Unit of Geriatrics, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, 00128 Rome, Italy
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Parpinel G, Laudani ME, Piovano E, Zola P, Lecuru F. The Use of Artificial Intelligence for Complete Cytoreduction Prediction in Epithelial Ovarian Cancer: A Narrative Review. Cancer Control 2023; 30:10732748231159553. [PMID: 36847148 PMCID: PMC9972055 DOI: 10.1177/10732748231159553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
INTRODUCTION In patients affected by epithelial ovarian cancer (EOC) complete cytoreduction (CC) has been associated with higher survival outcomes. Artificial intelligence (AI) systems have proved clinical benefice in different areas of healthcare. OBJECTIVE To systematically assemble and analyze the available literature on the use of AI in patients affected by EOC to evaluate its applicability to predict CC compared to traditional statistics. MATERIAL AND METHODS Data search was carried out through PubMed, Scopus, Ovid MEDLINE, Cochrane Library, EMBASE, international congresses and clinical trials. The main search terms were: Artificial Intelligence AND surgery/cytoreduction AND ovarian cancer. Two authors independently performed the search by October 2022 and evaluated the eligibility criteria. Studies were included when data about Artificial Intelligence and methodological data were detailed. RESULTS A total of 1899 cases were analyzed. Survival data were reported in 2 articles: 92% of 5-years overall survival (OS) and 73% of 2-years OS. The median area under the curve (AUC) resulted 0,62. The model accuracy for surgical resection reported in two articles reported was 77,7% and 65,8% respectively while the median AUC was 0,81. On average 8 variables were inserted in the algorithms. The most used parameters were age and Ca125. DISCUSSION AI revealed greater accuracy compared against the logistic regression models data. Survival predictive accuracy and AUC were lower for advanced ovarian cancers. One study analyzed the importance of factors predicting CC in recurrent epithelial ovarian cancer and disease free interval, retroperitoneal recurrence, residual disease at primary surgery and stage represented the main influencing factors. Surgical Complexity Scores resulted to be more useful in the algorithms than pre-operating imaging. CONCLUSION AI showed better prognostic accuracy if compared to conventional algorithms. However further studies are needed to compare the impact of different AI methods and variables and to provide survival informations.
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Affiliation(s)
- Giulia Parpinel
- Department of Surgical Sciences, University of Turin, Torino, Italy,Giulia Parpinel, MD, Department of Surgical
Sciences, University of Turin, Via Ventimiglia 3, Torino 10126, Italy.
| | | | - Elisa Piovano
- Department of Surgical Sciences, University of Turin, Torino, Italy
| | - Paolo Zola
- Department of Surgical Sciences, University of Turin, Torino, Italy
| | - Fabrice Lecuru
- Breast, Gynecology and
Reconstructive Surgery Unit, Curie Institute, Paris, France
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Nunes RL, Teixeira FR, Diniz TP, Faloppa CC, Mantoan H, da Costa AABA, Baiocchi G. The value of PET/CT for cytoreductive surgery selection in recurrent ovarian carcinoma. J Gynecol Oncol 2023; 34:e31. [PMID: 36731894 PMCID: PMC10157340 DOI: 10.3802/jgo.2023.34.e31] [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: 10/13/2022] [Revised: 12/07/2022] [Accepted: 12/28/2022] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE To evaluate the value of positron emission tomography/computed tomography (PET/CT) in predicting no residual disease (NRD) after secondary cytoreductive surgery (SCS) compared with MSK criteria, the iMODEL, and the AGO score. METHODS We analyzed 112 patients with platinum-sensitive ovarian carcinoma who underwent SCS. We excluded patients for whom PET/CT was not performed, those without sufficient data, and who received chemotherapy before SCS. Ultimately, 69 patients were included. RESULTS Variables that correlated with NRD were peritoneal carcinomatosis index (odds ratio [OR]=0.91; 95% confidence interval [CI]=0.83-0.99; p=0.044), European Cooperative Oncology Group Performance Status (ECOG) 0 (OR=8.0; 95% CI=1.34-47.5; p=0.022), and ≤2 lesions by PET/CT (OR=4.36; 95% CI=1.07-17.7; p=0.039). Of the patients with ≤2 lesions by PET/CT, 48 (92.3%) underwent complete SCS. The sensitivity, positive predictive value, negative predictive value, and accuracy of PET/CT for NRD were 85.7%, 92.3%, 33.3%, and 81.2%, respectively. NRD was achieved after fulfilling the MSK criteria, iMODEL and AGO Score in 89.1%, 88.1% and 85.9%, respectively. The accuracy of the MSK criteria, iMODEL, and AGO score in predicting NRD was 87%, 83.3%, and 77.3%, respectively. The PET/CT findings agreed well with the AGO score and iMODEL. The addition of PET/CT to these models increased the NRD rates (92.2%, 91.8%, and 89.4% for MSK+PET/CT, iMODEL+PET/CT, and AGO+PET/CT, respectively), but lowered their accuracy. CONCLUSION We observed NRD in 92.3% of patients with ≤2 lesions by PET/CT, with an accuracy of 81.2%. PET/CT did not increase the accuracy of the MSK criteria, iMODEL, or AGO score models.
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Affiliation(s)
- Rafael Leite Nunes
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | | | | | | | - Henrique Mantoan
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | | | - Glauco Baiocchi
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil.
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Jiang C, Li Z. Prediction Models for Complete Resection in Secondary Cytoreductive Surgery of Patients With Recurrent Ovarian Cancer. Front Oncol 2021; 11:674637. [PMID: 34631517 PMCID: PMC8496933 DOI: 10.3389/fonc.2021.674637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 09/02/2021] [Indexed: 12/12/2022] Open
Abstract
The most advanced epithelial ovarian cancer develops recurrent disease despite maximal surgical cytoreduction and adjuvant platinum-based chemotherapy. Treatment with secondary cytoreductive surgery (SCS) combined with chemotherapy or with chemotherapy alone for patients with platinum-sensitive recurrent ovarian cancer (ROC) is currently under heated discussion. Encouragingly, the results of the AGO DESKTOP III Study and the SOC1/SGOG-OV2 trial, which have been published recently, showed a striking advantage in terms of overall survival (OS) and progression-free survival (PFS) of ROC patients undergoing SCS compared to chemotherapy alone; moreover, a benefit of SCS exclusively for patients with complete gross resection (CGR) was particularly highlighted. CGR is considered the ultimate goal of SCS, on condition that the balance between maximal survival gain and minimal operative morbidity is maintained. Several models have been proposed to predict the rate of CGR, such as the MSK criteria, the AGO score, and the Tian model, over the last 15 years. This summary is mainly about the several previously published prediction models for CGR in SCS of ROC patients and discusses the effectiveness and limitations of these prediction models.
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Affiliation(s)
- Caixia Jiang
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Zhengyu Li
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
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The Diagnostic Accuracy of Human Epididymis Factor 4 for the Prediction of Optimal Debulking in Patients With Ovarian Cancer: A Meta-Analysis of Observational Studies. Int J Gynecol Cancer 2019; 28:1471-1477. [PMID: 30036230 DOI: 10.1097/igc.0000000000001330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Human epididymis factor-4 (HE4) has been studied in the field of ovarian cancer with promising results during the last decade. The purpose of the present meta-analysis is to investigate the diagnostic accuracy of HE4, in terms of sensitivity and specificity, as a minimally invasive method to predict optimal debulking in women that experience ovarian cancer. METHODS We used the Medline (1966-2017), Scopus (2004-2017), EMBASE, ClinicalTrials.gov (2008-2017) and Cochrane Central Register of Controlled Trials CENTRAL (1999-2017) databases in our primary search, along with the reference lists of electronically retrieved full-text articles. RESULTS Eleven articles were finally retrieved that enrolled 1065 women with ovarian cancer. Three of those were excluded because data were insufficient to introduce them in the meta-analysis. The sensitivity of HE4 for the prediction of optimal debulking was 0.81 (95% confidence interval [CI] 0.74-0.86) and the pooled specificity 0.80 (95% CI 0.75-0.84). The diagnostic odds ratio was 13.88 (95% CI 7.18-26.84) and the area under the curve, 0.86±0.03. After selecting only studies that enrolled patients with advanced disease who had primary debulking surgery, we observed that the pooled sensitivity reached 0.81 (95% CI 0.72-0.88), and the pooled specificity 0.70 (95% CI 0.62-0.78), with an area under the curve of 0.88±0.04. CONCLUSIONS Human epididymis factor-4 seems to be promising as a minimally invasive method to predict optimal cytoreduction among patients with ovarian cancer. However, interpretation of our findings should be approached with caution because of the significant heterogeneity of included studies.
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Management of postoperative chylous ascites after surgery for ovarian cancer: a single-institution experience. Updates Surg 2019; 71:729-734. [PMID: 31006086 DOI: 10.1007/s13304-019-00656-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/16/2019] [Indexed: 12/19/2022]
Abstract
Postoperative chylous ascites is a rare complication from operative trauma to the cisterna chyli or lymphatic vessels in the retroperitoneum. In the present study, we aimed to identify the incidence of postoperative chylous ascites in patients treated for ovarian cancer and to describe its management. We retrospectively reviewed all patients submitted to surgery for ovarian cancer at our Institution from October 2016 to November 2018. We analyzed the clinicopathological features, including the primary tumor histology, stage, grade, surgical procedure, median number of harvested pelvic and para-aortic lymph nodes. We described our experience in the diagnosis and management of chylous ascites. Five hundred and forty-six patients were submitted to surgery for ovarian cancer and 298 patients received pelvic and/or para-aortic lymphadenectomy. Chylous ascites occurred in 8 patients with an incidence of 1.4% in the overall population and a 2.68% among patients receiving lymphadenectomy. All patients received total parenteral nutrition (TPN) with Olimel N4E 2000 mL (Baxter®) and somatostatin therapy with 0.2 mL per 3 times/day for a median of 9 days (range 7-11). Median hospital stay was 15 days (range 7-16). All patients were successfully managed conservatively and none required surgical correction. Conservative management of chylous ascites with TPN, somatostatin and paracentisis is feasible and effective. These data should be confirmed by prospective multicentric studies.
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Bogani G, Leone Roberti Maggiore U, Chiappa V, Ditto A, Martinelli F, Sabatucci I, Mosca L, Lorusso D, Raspagliesi F. The addition of lymphadenectomy to secondary cytoreductive surgery in comparison with bulky node resection in patients with recurrent ovarian cancer. Int J Gynaecol Obstet 2018; 143:319-324. [DOI: 10.1002/ijgo.12667] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/07/2018] [Accepted: 09/06/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Giorgio Bogani
- Gynecologic Oncology; IRCCS National Cancer Institute; Milan Italy
| | - Umberto Leone Roberti Maggiore
- Gynecologic Oncology; IRCCS National Cancer Institute; Milan Italy
- Obstetrics and Gynecology; IRCCS AOU San Martino; Italy/Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI); University of Genoa; Genoa Italy
| | | | - Antonino Ditto
- Gynecologic Oncology; IRCCS National Cancer Institute; Milan Italy
| | - Fabio Martinelli
- Gynecologic Oncology; IRCCS National Cancer Institute; Milan Italy
| | - Ilaria Sabatucci
- Gynecologic Oncology; IRCCS National Cancer Institute; Milan Italy
| | - Lavinia Mosca
- Gynecologic Oncology; IRCCS National Cancer Institute; Milan Italy
| | - Domenica Lorusso
- Gynecologic Oncology; IRCCS National Cancer Institute; Milan Italy
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Whittle R, Peat G, Belcher J, Collins GS, Riley RD. Measurement error and timing of predictor values for multivariable risk prediction models are poorly reported. J Clin Epidemiol 2018; 102:38-49. [PMID: 29782997 DOI: 10.1016/j.jclinepi.2018.05.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/26/2018] [Accepted: 05/14/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVE Measurement error in predictor variables may threaten the validity of clinical prediction models. We sought to evaluate the possible extent of the problem. A secondary objective was to examine whether predictors are measured at the intended moment of model use. METHODS A systematic search of Medline was used to identify a sample of articles reporting the development of a clinical prediction model published in 2015. After screening according to a predefined inclusion criteria, information on predictors, strategies to control for measurement error, and intended moment of model use were extracted. Susceptibility to measurement error for each predictor was classified into low and high risks. RESULTS Thirty-three studies were reviewed, including 151 different predictors in the final prediction models. Fifty-one (33.7%) predictors were categorized as high risk of error; however, this was not accounted for in the model development. Only 8 (24.2%) studies explicitly stated the intended moment of model use and when the predictors were measured. CONCLUSION Reporting of measurement error and intended moment of model use is poor in prediction model studies. There is a need to identify circumstances where ignoring measurement error in prediction models is consequential and whether accounting for the error will improve the predictions.
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Affiliation(s)
- Rebecca Whittle
- Centre for Prognosis Research, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK.
| | - George Peat
- Centre for Prognosis Research, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK
| | - John Belcher
- Centre for Prognosis Research, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Richard D Riley
- Centre for Prognosis Research, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK
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Secondary cytoreductive surgery - viable treatment option in the management of platinum-sensitive recurrent ovarian cancer. Eur J Obstet Gynecol Reprod Biol 2018; 228:154-160. [PMID: 29957400 DOI: 10.1016/j.ejogrb.2018.06.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/14/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study aimed to evaluate the impact of the secondary cytoreductive surgery on survival parameters in women with platinum-sensitive recurrent ovarian cancer who undergone secondary cytoreduction following chemotherapy compared to women who recieved chemotherapy alone. STUDY DESIGN In a retrospective study, data were rewieved from women who were diagnosed and treated with ovarian cancer and its primary platinum-sensitive recurrence at the University Hospital Brno in the Czech Republic between November 2009 and March 2016. Out of the total number of 62 patients with recurrence, 30 women underwent cytoreductive surgery plus chemotherapy and 32 were treated with chemotherapy alone. The good performance status expressed by ECOG score 0-1, the single site of recurrence regardless of platinum-free interval or multiple sites of recurrence but no carcinomatosis and platinum-free interval >12 months, and no or small-volume ascites (<500 ml) were considered inclusion criteria for cytoreductive surgery. Women not meeting these criteria were treated by chemotherapy alone. Descriptive statistics, Kaplan-Meier survival curves and Log-Rank test were used for statistical estimations. RESULTS The analysis confirmed more favorable prognosis in patient group treated with a combination secondary cytoreduction and chemotherapy. Mean disease-free survival (DFS) was 49.8 months (95% CI; 33.2-66.3) and mean overall survival (OS) stood at 54.0 months (95% CI; 39.4-68.6) in this patient cohort, while in patient group treated with chemotherapy alone it was found that mean DFS was 16.6 months (95% CI; 7.4-25.8) and mean OS stood at 26.2 months (95% CI; 16.6-35.8). When testing the difference between survival curves, statistically significant differences were observed in both DFS (p = 0.010) and OS (p = 0.007) rates between two treatment groups. Age < 60 years at the time of recurrence and zero macroscopic residual disease after secondary cytoreduction were identified as favorable prognostic factors for both DFS and OS in a multivariate analysis. CONCLUSION Secondary cytoreductive surgery is acceptable as a viable treatment option for highly selected women with ovarian cancer recurrence. Complete resection is considered ultimate goal of secondary cytoreduction on condition that the balance between maximal survival gain and minimal operative morbidity will be kept.
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Luo CH, Zhao M, Chen XY, Shahabi S, Qiang W, Zeng L, Wang J, Zhou HH. HE4 and eIF3a Expression Correlates with Surgical Outcome and Overall Survival in Ovarian Cancer Patients with Secondary Cytoreduction. J Cancer 2018; 9:2472-2479. [PMID: 30026845 PMCID: PMC6036880 DOI: 10.7150/jca.25184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 04/28/2018] [Indexed: 11/09/2022] Open
Abstract
For recurrent ovarian cancer (ROC), secondary cytoreductive surgery (SCS) is recommended as one optional treatment. However, little is known about the expression and clinical significance of biomarkers during SCS. Human epididymis protein 4 (HE4) is a clinical biomarker for ovarian cancer. Eukaryotic translation initiation factor 3a (eIF3a) is investigated extensively as a potential biomarker for malignancy. The purpose of this study was to investigate the expressions of HE4 and eIF3a at SCS, as well as their associations with surgical outcome and survival in ROC patients. Immunohistochemistry was performed to determine the expressions of HE4 and eIF3a in ovarian tumors taken from both initial and secondary cytoreductive surgery of 35 ROC patients. eIF3a levels were significantly increased at SCS, compared to those at initial cytoreductive surgery (ICS), while HE4 levels were similar. Both HE4 and eIF3a expressions were associated with surgical outcome, in terms of residual tumor. For ICS, patients with high HE4 expression achieved a higher incidence of optimal cytoreduction than those with low HE4 expression (81.0% vs. 33.3%, P = 0.015). A similar result happened in SCS, indicated by higher incidence of no residual tumor in patients with high HE4 expression (76.4% vs. 44.4%, P = 0.046). And high HE4 expression at SCS was more likely to enhance surgical outcome of SCS (77.8% vs. 29.4%, P = 0.038). Therefore, high HE4 expression at either surgery is a predictor of better overall survival (OS) (P = 0.011 and 0.002). Furthermore, patients with an elevated total score (TS) of HE4 between the two surgeries tended to have prolonged OS, compared to those with a non-elevated TS of HE4 (P = 0.076). For eIF3a, initial eIF3a expression was associated with secondary residual tumor (P = 0.035), and the difference in eIF3a expression between the two surgeries correlated with OS (P = 0.052). The expressions of HE4 and eIF3a in tumor specimens correlated with surgical outcome and predicted OS in ROC patients with SCS, thus meriting further investigation.
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Affiliation(s)
- Chen-Hui Luo
- Laboratory Animal Research Center, Hunan Cancer Hospital, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, People's Republic of China.,Department of Clinical Pharmacology, Institute of Clinical Pharmacology, Hunan Key Laboratory of Pharmacogenetics, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Min Zhao
- Department of Clinical Pharmacology, Institute of Clinical Pharmacology, Hunan Key Laboratory of Pharmacogenetics, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Xiao-Yan Chen
- Department of Pathology, Hunan Cancer Hospital, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, People's Republic of China
| | - Shohreh Shahabi
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Prentice Women's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Wenan Qiang
- Center for Developmental Therapeutics, Chemistry of Life Processes Institute, Department of Obstetrics and Gynecology-Division of Reproductive Science in Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Liang Zeng
- Department of Pathology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Jing Wang
- Department of Gynecologic Oncology, Hunan Cancer Hospital, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, People's Republic of China
| | - Hong-Hao Zhou
- Department of Clinical Pharmacology, Institute of Clinical Pharmacology, Hunan Key Laboratory of Pharmacogenetics, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
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Bogani G, Rossetti D, Ditto A, Martinelli F, Chiappa V, Mosca L, Leone Roberti Maggiore U, Ferla S, Lorusso D, Raspagliesi F. Artificial intelligence weights the importance of factors predicting complete cytoreduction at secondary cytoreductive surgery for recurrent ovarian cancer. J Gynecol Oncol 2018; 29:e66. [PMID: 30022630 PMCID: PMC6078899 DOI: 10.3802/jgo.2018.29.e66] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 03/29/2018] [Accepted: 04/07/2018] [Indexed: 01/15/2023] Open
Abstract
Objective Accumulating evidence support that complete cytoreduction (CC) at the time of secondary cytoreductive surgery (SCS) improves survival in patients affected by recurrent ovarian cancer (ROC). Here, we aimed to determine whether artificial intelligence (AI) might be useful in weighting the importance of clinical variables predicting CC and survival. Methods This is a retrospective study evaluating 194 patients having SCS for ROC. Using artificial neuronal network (ANN) analysis was estimated the importance of different variables, used in predicting CC and survival. ANN simulates a biological neuronal system. Like neurons, ANN acquires knowledge through a learning-phase process and allows weighting the importance of covariates, thus establishing how much a variable influences a multifactor phenomenon. Results Overall, 82.9% of patients had CC at the time of SCS. Using ANN, we observed that the 3 main factors driving the ability of achieve CC included: disease-free interval (DFI) (importance: 0.231), retroperitoneal recurrence (importance: 0.178), residual disease at primary surgical treatment (importance: 0.138), and International Federation of Gynecology and Obstetrics (FIGO) stage at presentation (importance: 0.088). Looking at connections between different covariates and overall survival (OS), we observed that DFI is the most important variable influencing OS (importance: 0.306). Other important variables included: CC (importance: 0.217), and FIGO stage at presentation (importance: 0.100). Conclusion According to our results, DFI should be considered as the most important factor predicting both CC and OS. Further studies are needed to estimate the clinical utility of AI in providing help in decision making process.
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Affiliation(s)
- Giorgio Bogani
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
| | - Diego Rossetti
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Antonino Ditto
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Fabio Martinelli
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Valentina Chiappa
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Lavinia Mosca
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | | | - Stefano Ferla
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Domenica Lorusso
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
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12
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Bogani G, Tagliabue E, Signorelli M, Ditto A, Martinelli F, Chiappa V, Mosca L, Sabatucci I, Leone Roberti Maggiore U, Lorusso D, Raspagliesi F. A score system for complete cytoreduction in selected recurrent ovarian cancer patients undergoing secondary cytoreductive surgery: predictors- and nomogram-based analyses. J Gynecol Oncol 2018. [PMID: 29533023 PMCID: PMC5920224 DOI: 10.3802/jgo.2018.29.e40] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To test the applicability of the Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) and Memorial Sloan Kettering (MSK) criteria in predicting complete cytoreduction (CC) in patients undergoing secondary cytoreductive surgery (SCS) for recurrent ovarian cancer (ROC). METHODS Data of consecutive patients undergoing SCS were reviewed. The Arbeitsgemeinschaft Gynäkologische Onkologie OVARian cancer study group (AGO-OVAR) and MSK criteria were retrospectively applied. Nomograms, based on AGO criteria, MSK criteria and both AGO and MSK criteria were built in order to assess the probability to achieve CC at SCS. RESULTS Overall, 194 patients met the inclusion criteria. CC was achieved in 161 (82.9%) patients. According to the AGO-OVAR criteria, we observed that CC was achieved in 87.0% of patients with positive AGO score. However, 45 out of 71 (63.4%) patients who did not fulfilled the AGO score had CC. Similarly, CC was achieved in 87.1%, 61.9% and 66.7% of patients for whom SCS was recommended, had to be considered and was not recommended, respectively. In order to evaluate the predictive value of the AGO-OVAR and MSK criteria we built 2 separate nomograms (c-index: 0.5900 and 0.5989, respectively) to test the probability to achieve CC at SCS. Additionally, we built a nomogram using both the aforementioned criteria (c-index: 0.5857). CONCLUSION The AGO and MSK criteria help identifying patients deserving SCS. However, these criteria might be strict, thus prohibiting a beneficial treatment in patients who do not met these criteria. Further studies are needed to clarify factors predicting CC at SCS.
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Affiliation(s)
- Giorgio Bogani
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Elena Tagliabue
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Mauro Signorelli
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Antonino Ditto
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Fabio Martinelli
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Valentina Chiappa
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - Lavinia Mosca
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy. ,
| | - Ilaria Sabatucci
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | | | - Domenica Lorusso
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
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Capriglione S, Luvero D, Plotti F, Terranova C, Montera R, Scaletta G, Schirò T, Rossini G, Benedetti Panici P, Angioli R. Ovarian cancer recurrence and early detection: may HE4 play a key role in this open challenge? A systematic review of literature. Med Oncol 2017; 34:164. [PMID: 28825178 DOI: 10.1007/s12032-017-1026-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 08/18/2017] [Indexed: 12/31/2022]
Abstract
Despite the improvement in overall survival for ovarian cancer (OC) patients, a fraction of patients with advanced-stage disease fails to respond to primary therapy and relapses in 70% of cases. For this reason, new predictive and monitoring tools are needed to identify OC recurrence and new biomarkers were studied, among which human epididymis 4 (HE4), primarily expressed in the reproductive and respiratory tracts, is one of the most promising, reporting a good sensitivity and specificity in detecting OC, overcoming the traditional role of carbohydrate antigen 125 (CA-125). In this review, we aim to discuss the latest evidence reported in the literature about the use of HE4 to monitor ovarian cancer treatment and to detect OC recurrence. We searched MEDLINE (PubMed), EMBASE, Cochrane Central Register of Controlled Trials, IBECS, BIOSIS, Web of Science, SCOPUS, congress abstracts, and Grey literature (Google Scholar; British Library) from January 1952 to June 2017. The search identified seven papers in line with eligibility criteria for this systematic review; all of them demonstrated a good performance of HE4 in OC recurrence. The challenge to anticipate the diagnosis of OC recurrence and to translate this early diagnosis of relapse in a survival and quality of life improvement is still open, and as reported in this review, HE4 may play a key role in this scenario. More studies are needed to validate and reinforce the role of HE4 in ovarian cancer recurrence and in its early detection.
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Affiliation(s)
- Stella Capriglione
- Department of Obstetrics and Gynaecology, University of Rome "Campus Bio-Medico", Via Alvaro del Portillo, 200 - 00128, Rome, Italy.
| | - Daniela Luvero
- Department of Obstetrics and Gynaecology, University of Rome "Campus Bio-Medico", Via Alvaro del Portillo, 200 - 00128, Rome, Italy
| | - Francesco Plotti
- Department of Obstetrics and Gynaecology, University of Rome "Campus Bio-Medico", Via Alvaro del Portillo, 200 - 00128, Rome, Italy
| | - Corrado Terranova
- Department of Obstetrics and Gynaecology, University of Rome "Campus Bio-Medico", Via Alvaro del Portillo, 200 - 00128, Rome, Italy
| | - Roberto Montera
- Department of Obstetrics and Gynaecology, University of Rome "Campus Bio-Medico", Via Alvaro del Portillo, 200 - 00128, Rome, Italy.,Unit of Obstetrics and Gynecology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Giuseppe Scaletta
- Department of Obstetrics and Gynaecology, University of Rome "Campus Bio-Medico", Via Alvaro del Portillo, 200 - 00128, Rome, Italy
| | - Teresa Schirò
- Department of Obstetrics and Gynaecology, University of Rome "Campus Bio-Medico", Via Alvaro del Portillo, 200 - 00128, Rome, Italy
| | - Gianmarco Rossini
- Department of Obstetrics and Gynaecology, University of Rome "Campus Bio-Medico", Via Alvaro del Portillo, 200 - 00128, Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Gynecology Obstetrics and Urology, Policlinico Umberto I, ''Sapienza'' University of Rome, Rome, Italy
| | - Roberto Angioli
- Department of Obstetrics and Gynaecology, University of Rome "Campus Bio-Medico", Via Alvaro del Portillo, 200 - 00128, Rome, Italy
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14
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Scaletta G, Plotti F, Luvero D, Capriglione S, Montera R, Miranda A, Lopez S, Terranova C, De Cicco Nardone C, Angioli R. The role of novel biomarker HE4 in the diagnosis, prognosis and follow-up of ovarian cancer: a systematic review. Expert Rev Anticancer Ther 2017; 17:827-839. [PMID: 28756722 DOI: 10.1080/14737140.2017.1360138] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Ovarian cancer is the leading cause of death from gynecologic cancers, in fact, >80% of cases are diagnosed as advanced-stage disease associated with a high mortality rate (<40% of women cured). A systematic review was performed to estimate the role of HE4 in the diagnosis, prognosis and follow-up of ovarian tumors. Areas covered: A comprehensive search of the literature from January 1952 to August 2016 was conducted using the terms 'ovarian tumor' and 'ovarian cancer' combined with 'HE4' and 'human epididymis protein 4'. The search identified a total of 259 citations, of which 141 were potentially relevant after initial evaluation. Of these studies, 75 primary studies met the inclusion criteria and were analyzed, with a total of 14,773 patients. Expert commentary: Serum HE4 dosage is a useful preoperative test for predicting the benign or malignant nature of pelvic masses. It seems to have a promising role in the prediction of clinical and surgical outcomes. Moreover, HE4 seems to better predict recurrence in comparison to CA-125.
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Affiliation(s)
- Giuseppe Scaletta
- a Department of Obstetrics and Gynaecology , Campus Bio-Medico University of Rome , Rome , Italy
| | - Francesco Plotti
- a Department of Obstetrics and Gynaecology , Campus Bio-Medico University of Rome , Rome , Italy
| | - Daniela Luvero
- a Department of Obstetrics and Gynaecology , Campus Bio-Medico University of Rome , Rome , Italy
| | - Stella Capriglione
- a Department of Obstetrics and Gynaecology , Campus Bio-Medico University of Rome , Rome , Italy
| | - Roberto Montera
- a Department of Obstetrics and Gynaecology , Campus Bio-Medico University of Rome , Rome , Italy
| | - Andrea Miranda
- a Department of Obstetrics and Gynaecology , Campus Bio-Medico University of Rome , Rome , Italy
| | - Salvatore Lopez
- a Department of Obstetrics and Gynaecology , Campus Bio-Medico University of Rome , Rome , Italy
| | - Corrado Terranova
- a Department of Obstetrics and Gynaecology , Campus Bio-Medico University of Rome , Rome , Italy
| | - Carlo De Cicco Nardone
- a Department of Obstetrics and Gynaecology , Campus Bio-Medico University of Rome , Rome , Italy
| | - Roberto Angioli
- a Department of Obstetrics and Gynaecology , Campus Bio-Medico University of Rome , Rome , Italy
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El Bairi K, Amrani M, Kandhro AH, Afqir S. Prediction of therapy response in ovarian cancer: Where are we now? Crit Rev Clin Lab Sci 2017; 54:233-266. [PMID: 28443762 DOI: 10.1080/10408363.2017.1313190] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Therapy resistance is a major challenge in the management of ovarian cancer (OC). Advances in detection and new technology validation have led to the emergence of biomarkers that can predict responses to available therapies. It is important to identify predictive biomarkers to select resistant and sensitive patients in order to reduce important toxicities, to reduce costs and to increase survival. The discovery of predictive and prognostic biomarkers for monitoring therapy is a developing field and provides promising perspectives in the era of personalized medicine. This review article will discuss the biology of OC with a focus on targetable pathways; current therapies; mechanisms of resistance; predictive biomarkers for chemotherapy, antiangiogenic and DNA-targeted therapies, and optimal cytoreductive surgery; and the emergence of liquid biopsy using recent studies from the Medline database and ClinicalTrials.gov.
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Affiliation(s)
- Khalid El Bairi
- a Faculty of Medicine and Pharmacy , Mohamed Ist University , Oujda , Morocco
| | - Mariam Amrani
- b Equipe de Recherche ONCOGYMA, Faculty of Medicine, Pathology Department , National Institute of Oncology, Université Mohamed V , Rabat , Morocco
| | - Abdul Hafeez Kandhro
- c Department of Biochemistry , Healthcare Molecular and Diagnostic Laboratory , Hyderabad , Pakistan
| | - Said Afqir
- d Department of Medical Oncology , Mohamed VI University Hospital , Oujda , Morocco
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16
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Validation of REM score to predict endometrial cancer in patients with ultrasound endometrial abnormalities: results of a new independent dataset. Med Oncol 2017; 34:82. [DOI: 10.1007/s12032-017-0945-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 04/04/2017] [Indexed: 01/08/2023]
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17
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Suh DH, Kim HS, Chang SJ, Bristow RE. Surgical management of recurrent ovarian cancer. Gynecol Oncol 2016; 142:357-67. [PMID: 27130407 DOI: 10.1016/j.ygyno.2016.04.537] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 04/06/2016] [Accepted: 04/22/2016] [Indexed: 01/21/2023]
Abstract
Most patients with advanced-stage epithelial ovarian cancer will experience a relapse of disease despite a complete response after surgical cytoreduction and platinum-based chemotherapy. Treatment of recurrent ovarian cancer mainly comprises various combinations of systemic chemotherapy with or without targeted agents. The role of cytoreductive surgery for recurrent ovarian cancer is not well established. Although the literature on survival benefit of cytoreductive surgery for recurrent disease has expanded steadily over the past decade, most studies were retrospective, single-institution series with small numbers of patients. Given the balance between survival benefit and surgery-related morbidity during maximum cytoreductive surgical effort, it is essential to establish the optimal selection criteria for identifying appropriate candidates who will benefit from surgery without worsening quality of life. Three phase III randomized trials for this issue are currently underway. Herein, we present contemporary evidence supporting the positive role of cytoreductive surgery and offer selection criteria for optimal candidates for surgery in the treatment of recurrent ovarian cancer.
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Affiliation(s)
- Dong Hoon Suh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Suk-Joon Chang
- Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea.
| | - Robert E Bristow
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine School of Medicine, Orange, CA, USA
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Janco JMT, Kumar A, Weaver AL, McGree ME, Cliby WA. Performance of AGO score for secondary cytoreduction in a high-volume U.S. center. Gynecol Oncol 2016; 141:140-7. [DOI: 10.1016/j.ygyno.2016.01.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 01/18/2016] [Accepted: 01/29/2016] [Indexed: 11/29/2022]
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