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Gong W, Liu Y, Diamandis EP, Kiechle M, Bronger H, Dorn J, Dreyer T, Magdolen V. Prognostic value of kallikrein-related peptidase 7 (KLK7) mRNA expression in advanced high-grade serous ovarian cancer. J Ovarian Res 2020; 13:125. [PMID: 33087135 PMCID: PMC7579813 DOI: 10.1186/s13048-020-00725-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/02/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND High-grade serous ovarian cancer (HGSOC) is the most common and lethal subtype of ovarian cancer. A growing body of evidence suggests tumor-supporting roles of several members of the kallikrein-related peptidase (KLK) family, including KLK5 and KLK7, in this cancer subtype. In normal physiology, KLK5 and KLK7 are the major proteases involved in skin desquamation. Moreover, in several cancer types KLK5 and KLK7 co-expression has been observed. Recently, we have shown that elevated KLK5 mRNA levels are associated with an unfavorable prognosis in HGSOC. Therefore, the aim of this study was to investigate the clinical significance of KLK7 mRNA expression and to explore its relation to KLK5 levels in HGSOC. METHODS mRNA expression levels of KLK7 were quantified by qPCR in a well-characterized patient cohort afflicted with advanced high-grade serous ovarian cancer (FIGO III/IV, n = 139). Previously determined KLK5 mRNA as well as KLK5 and KLK7 antigen concentrations were used to evaluate the relationship between the expression patterns of both factors on the mRNA as well as protein level in tumor tissue of HGSOC patients. RESULTS There were strong, significant positive correlations between KLK5 and KLK7 both at the mRNA and the protein level, suggesting coordinate expression of these proteases in HGSOC. In univariate analyses, elevated KLK7 levels as well as the combination of KLK5 + KLK7 (high and/or high versus low/low) were significantly associated with worse progression-free survival (PFS). High mRNA expression levels of KLK7 and the combination of KLK5 and KLK7 showed a trend towards significance for overall survival (OS). In multivariate analyses, KLK7 mRNA expression represented an unfavorable, statistically significant independent predictor for PFS and OS. CONCLUSIONS The findings imply that both increased KLK5 and KLK7 mRNA expression levels represent unfavorable prognostic biomarkers in advanced high-grade serous ovarian cancer, whereby multivariate analyses indicate that KLK7 mRNA exhibits a stronger predictive value as compared to KLK5 mRNA and the combination of KLK5 and KLK7.
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Affiliation(s)
- Weiwei Gong
- Clinical Research Unit, Department of Obstetrics and Gynecology, Technical University of Munich, Ismaninger Str. 22, D-81675, Munich, Germany.,Department of Hematology-Oncology, Guangzhou Women and Children's Medical Center, Guangzhou, People's Republic of China
| | - Yueyang Liu
- Clinical Research Unit, Department of Obstetrics and Gynecology, Technical University of Munich, Ismaninger Str. 22, D-81675, Munich, Germany.,Department of Gynecology, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Eleftherios P Diamandis
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Marion Kiechle
- Clinical Research Unit, Department of Obstetrics and Gynecology, Technical University of Munich, Ismaninger Str. 22, D-81675, Munich, Germany
| | - Holger Bronger
- Clinical Research Unit, Department of Obstetrics and Gynecology, Technical University of Munich, Ismaninger Str. 22, D-81675, Munich, Germany
| | - Julia Dorn
- Clinical Research Unit, Department of Obstetrics and Gynecology, Technical University of Munich, Ismaninger Str. 22, D-81675, Munich, Germany
| | - Tobias Dreyer
- Clinical Research Unit, Department of Obstetrics and Gynecology, Technical University of Munich, Ismaninger Str. 22, D-81675, Munich, Germany
| | - Viktor Magdolen
- Clinical Research Unit, Department of Obstetrics and Gynecology, Technical University of Munich, Ismaninger Str. 22, D-81675, Munich, Germany.
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Chokshi RJ, Kim JK, Patel J, Oliver JB, Mahmoud O. Impact of insurance status on overall survival after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). Pleura Peritoneum 2020; 5:20200105. [PMID: 33364338 PMCID: PMC7746885 DOI: 10.1515/pp-2020-0105] [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: 02/16/2020] [Accepted: 04/30/2020] [Indexed: 01/14/2023] Open
Abstract
Objectives The impact of insurance status on oncological outcome in patients undergoing cytoreduction and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is poorly understood. Methods Retrospective study on 31 patients having undergone 36 CRS-HIPEC at a single institution (safety-net hospital) between 2012 and 2018. Patients were categorized as insured or underinsured. Demographics and perioperative events were compared. Primary outcome was overall survival (OS). Results A total of 20 patients were underinsured and 11 were insured. There were less gynecologic malignancies in the underinsured (p=0.02). On univariate analysis, factors linked to poor survival included gastrointestinal (p=0.01) and gynecologic malignancies (p=0.046), treatment with neoadjuvant chemotherapy (p=0.03), CC1 (p=0.02), abdominal wall resection (p=0.01) and Clavien–Dindo 3-4 (p=0.01). Treatment with neoadjuvant chemotherapy and abdominal wall resections, but not insurance status, were independently associated with OS (p=0.01, p=0.02 respectively). However, at the end of follow-up, six patients were alive in the insured group vs. zero in the underinsured group. Conclusions In this small, exploratory study, there was no statistical difference in OS between insured and underinsured patients after CRS-HIPEC. However, long-term survivors were observed only in the insured group.
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Affiliation(s)
- Ravi J. Chokshi
- Division of Surgical Oncology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Jin K. Kim
- Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Jimmy Patel
- Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Joseph B. Oliver
- Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Omar Mahmoud
- Department of Radiation Oncology, Rutgers New Jersey Medical School, Newark, NJ, USA
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Gurkan D, Ceren Akin A, Sahin H, Aytac Tohma Y, Sahin EA, Gunakan E, Iflazoglu N, Nihan Haberal A, Ayhan A. Oncologic outcomes in patients undergoing maximal or optimal cytoreductive surgery for Stage 3C serous ovarian, tubal or peritoneal carcinomas. J OBSTET GYNAECOL 2019; 40:551-557. [PMID: 31482736 DOI: 10.1080/01443615.2019.1634028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of this study was to evaluate overall survival (OS) and disease-free survival (DFS) of patients with Stage 3C serous ovarian, tubal and peritoneal carcinomas. A retrospective analysis of 111 patients who underwent maximal or optimal cytoreductive surgery was performed. Patients were divided into three groups as ovarian cancer (n = 47), tubal cancer (n = 24) and peritoneal cancer (n = 40). Median follow-up was 30 months. There was no significant difference in DFS and OS among the groups. Complete cytoreduction was an independent prognostic factor for DFS in all groups (HR 2.3, 95% CI 1.14-4.93; p=.020). Positive peritoneal cytology (HR 2.2, 95% CI 1.02-4.78; p=.044), and retroperitoneal lymph node involvement (HR 2.3, 95% CI1.11-4.89; p=.025) were independent risk factors for decreased OS, and extended cytoreduction (HR 2.7, 95% CI 1.05-6.99; p=.039) were independent risk factors for increased OS. In conclusion, these malignancies should be considered a single entity during treatment.IMPACT STATEMENTWhat is already known on this subject? Epithelial ovarian cancer is the second most common gynaecological cancer in women worldwide. There are different histological types including ovarian, tubal and peritoneal carcinomas in which malignant cells form in the tissue covering the ovary or lining the fallopian tube of peritoneum. Recent data have supported the view that these malignancies should be considered a single entity and should be treated the same way.What the results of this study add? In the present study, we evaluated overall survival and disease-free survival of patients with Stage 3C ovarian, tubal and peritoneal cancer undergoing maximal or optimal cytoreductive surgery. We found similar oncologic outcomes in all patient groups. To the best of our knowledge, this is the first study to compare oncologic outcomes of these similar and often confused malignancies in the literature. We, therefore, believe that the present study provides additional information to the body of knowledge on this topic.What the implications are of these findings for clinical practice and/or further research? This study is important, as it indicates similar oncologic outcomes in patients undergoing maximal or optimal cytoreductive surgery for Stage 3C ovarian, tubal and peritoneal cancer. Based on these findings, clinicians should keep in mind that these malignancies should be considered a single clinical entity and be treated the same way. We believe that our study would pave the way for further studies regarding this subject.
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Affiliation(s)
- Damla Gurkan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Aylin Ceren Akin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Hanifi Sahin
- Department of Gynecologic Oncology, Malatya Education and Research Hospital, Malatya, Turkey
| | - Yusuf Aytac Tohma
- Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Eda Adeviye Sahin
- Department of Obstetrics and Gynecology, Malatya Education and Research Hospital, Malatya, Turkey
| | - Emre Gunakan
- Department of Obstetrics and Gynecology, Keçiören Education and Research Hospital, Ankara, Turkey
| | - Nidal Iflazoglu
- Department of Surgical Oncology, Malatya Education and Research Hospital, Malatya, Turkey
| | | | - Ali Ayhan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
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Characterization of kallikrein-related peptidase 4 (KLK4) mRNA expression in tumor tissue of advanced high-grade serous ovarian cancer patients. PLoS One 2019; 14:e0212968. [PMID: 30811511 PMCID: PMC6392272 DOI: 10.1371/journal.pone.0212968] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 02/12/2019] [Indexed: 12/13/2022] Open
Abstract
Overexpression of several members of the kallikrein-related peptidase (KLK) family, including KLK4, has been reported in ovarian cancer tissue, consistent with the fact that elevated levels of KLK protein are often also found in serum and in effusion fluids of ovarian cancer patients. In the present study, we quantitatively analyzed KLK4 tumor tissue mRNA expression levels in a homogeneous cohort including 138 patients of advanced high-grade serous ovarian cancer (FIGO stage III/IV). Age as well as ascites fluid volume were found to be significantly associated with KLK4 mRNA expression levels. In univariate Cox regression analysis, the clinical factors residual tumor mass and ascites fluid volume represented univariate predictors for both overall survival (OS) and progression-free survival (PFS). Furthermore, elevated KLK4 mRNA expression levels were significantly linked with reduced OS (p = 0.001), but not with PFS. The results concerning the association of KLK4 mRNA expression with OS were validated in a publicly available Affymetrix-based mRNA data set from The Cancer Genome Atlas (n = 252) applying the Kaplan-Meier Plotter tool (p = 0.047). In multivariable analyses, elevated KLK4 mRNA values turned out as an additional, independent predictive marker for shortened OS (p = 0.006), whereas residual tumor mass, but not ascites fluid volume, remained an independent indicator for both OS and PFS (p < 0.001 and p = 0.002, respectively). The results of the present study, obtained in a well-defined, homogenous cohort of patients afflicted with advanced high-grade serous ovarian cancer, are in line with previous reports describing high KLK4 levels as an unfavorable marker in ovarian cancer patients.
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Bacalbașa N, Balescu I. Extended upper abdominal resections as part of debulking surgery at the time of tertiary cytoreduction for relapsed ovarian cancer; case report and literature review. JOURNAL OF CLINICAL AND INVESTIGATIVE SURGERY 2017. [DOI: 10.25083/2559.5555.22.7580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Ovarian cancer remains one of the most aggressive gynecologic malignancies with high capacity to recur even in cases submitted to surgery with curative intent. However, even in these cases the best therapeutic option in order to achieve a good control of the disease remains radical surgery. We present the case of a 65-year-old patient diagnosed submitted to surgery for stage IIIC ovarian cancer five years before. At two years follow up she was diagnosed with an isolated recurrence at the level of the hepatic pedicle which was successfully removed. At 18 months follow up she was diagnosed with a large recurrence in the left superior abdominal quadrant and a liver metastasis which were resected. At 18 months follow up she is free of recurrent disease.
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Liu P, Tong L, Huo B, Dai D, Liu W, Wang K, Wang Y, Guo Z, Ni H. CT-guided 125I brachytherapy for recurrent ovarian cancer. Oncotarget 2017; 8:59766-59776. [PMID: 28938680 PMCID: PMC5601776 DOI: 10.18632/oncotarget.15905] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 02/20/2017] [Indexed: 11/25/2022] Open
Abstract
This retrospective study was to evaluate the local control and survival of 125I brachytherapy for recurrent ovarian cancer. 52 125I brachytherapy procedures were performed in 47 patients with 51 recurrent ovarian cancer lesions. The follow-up period was 1-55 months (median 12 months). The local control rate (LC) of 3, 6, 12, 24 and 36 months was 93.3%, 77.7%, 58.9%, 38.7% and 19.3%, respectively. Patients with tumor size ≤ 4cm (85.7% vs 40.0%, P = 0.037) and actual D90 between 110 to 130Gy (47.4% vs 66.7% vs 62.5%, P = 0.029) had better LC. The 1, 2 and 3 years of overall survival (OS) was 79.3%, 63.0% and 52.5%, respectively. The poor performance status (HR 3.821, 95% CI 1.383-10.555; P = 0.010), concurrent distant metastasis (HR 9.222, 95% CI 1.710-49.737; P = 0.010) and large postoperative residual tumor size (HR 6.157, 95% CI 1.438-26.367; P = 0.014) were closely correlated with a poor OS. Our data indicate thatCT-guided 125I brachytherapy is an effective and safe modality for the local treatment of recurrent ovarian cancer.
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Affiliation(s)
- Ping Liu
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, People's Republic of China
| | - Lina Tong
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, People's Republic of China
| | - Bin Huo
- Department of Oncology, The Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Dong Dai
- Department of Molecule Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | - Wenxin Liu
- Department of Gynecologic Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | - Ke Wang
- Department of Gynecologic Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | - Ying Wang
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, People's Republic of China
| | - Zhi Guo
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, People's Republic of China
| | - Hong Ni
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, People's Republic of China
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Kanda T, Fukuda S, Fukui N, Ohkubo Y, Kazumoto T, Saito Y, Ishikawa A, Kurosumi M, Kageyama Y, Fujii Y, Kihara K. Favorable outcome of intraoperative radiotherapy to the primary site in patients with metastatic prostate cancer. Int J Clin Oncol 2016; 21:764-772. [DOI: 10.1007/s10147-016-0947-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 01/03/2016] [Indexed: 10/22/2022]
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Abstract
While there is an ongoing debate regarding the timing of the maximal surgical effort in epithelial ovarian cancer, it is well established that patients with suboptimal tumor debulking derive no benefit from the surgical procedure. The amount of residual disease after cytoreductive surgery has been repeatedly identified as a strong predictor of survival, and accordingly, the surgical effort to achieve the goal of complete gross tumor resection has been constantly evolving. Centers that have adopted the concept of radical surgery in patients with advanced ovarian cancer have reported improvements in their patients' survival. In addition to the expected improvements in the pharmacologic treatment of this disease, some of the next challenges in the surgical management of ovarian cancer include the preoperative prediction of suboptimal debulking, improving the drug delivery to the tumor, and increasing access to centers of excellence in ovarian cancer regardless of geographical, financial, or other social barriers. This review will discuss an update on the role of surgery in the treatment of primary epithelial ovarian cancer as it has evolved since the emergence of the concept of surgical cytoreduction.
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10
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Gratzke C, Engel J, Stief CG. Role of radical prostatectomy in metastatic prostate cancer: data from the Munich Cancer Registry. Eur Urol 2014; 66:602-3. [PMID: 24821581 DOI: 10.1016/j.eururo.2014.04.009] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 04/16/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Christian Gratzke
- Department of Urology, Ludwig-Maximilians-University Munich, Munich, Germany.
| | | | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-University Munich, Munich, Germany
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