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Sapienza L, Thomas J, Showalter T, Echeverria A, Ludwig M, Chen A, Jo E, Calsavara V, Hilsenbeck S, Jhingran A, Frumovitz M, Baiocchi G. Endoscopic Assessment of Radiological Stage IVA Cervical Cancer: A Bivariate Meta-Analysis Supporting an Evidence-Based Staging Algorithm. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Fischer-Sgrott F, Sapienza L, Rech P, Ruzza O, Cruz A, Baiocchi J, Baiocchi G. Photobiomodulation for Radiodermatitis Prevention in Breast Cancer: Results from a Double Blind Randomized Controlled Trial (PHOTODERMIS Trial). Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Badiglian-Filho L, Fukazawa E, Baiocchi G. 238 Vnotes (vaginal – natural orifices transluminal endoscopic surgery) ovarian cystectomy guided by intraoperative ultrasound. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sapienza L, Ning M, Georgeon L, McNew L, Jhingran A, De La Pena R, Rasool N, Gomes M, Baiocchi G, Abu-Isa E. Outcomes and Toxicity following Salvage Radiotherapy for Vaginal Relapse of Endometrial Cancer. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sapienza L, Carvalho E, Calsavara V, Spratt D, Ning M, McLaughlin P, Kollmeier M, Gomes M, Baiocchi G, Abu-Isa E. Effectiveness and Secondary Incontinence Rates after Urethroplasty for Severe Radiation-Induced Urethral Stenosis: A Systematic Review and Meta-Analysis. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gambacciani M, Albertin E, Torelli MG, Bracco GL, Casagrande AC, Martella L, Baiocchi G, Alfieri S, Russo N, Cervigni M. Sexual function after vaginal erbium laser: the results of a large, multicentric, prospective study. Climacteric 2020; 23:S24-S27. [DOI: 10.1080/13697137.2020.1804544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- M. Gambacciani
- Department of Obstetrics and Gynecology, University Hospital, Pisa, Italy
| | - E. Albertin
- Gynecological Clinic Elysium, Albignasego (Padova), Italy
| | | | | | | | - L. Martella
- Centro Medico Radiologico 3P, Noventa di Piave, Italy
| | - G. Baiocchi
- Department of Obstetrics and Gynecology, University of Perugia, Italy
| | | | - N. Russo
- Centro Medico Demetra, Grottaferrata, Italy
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Souza RP, Soares GP, Lage LV, Baiocchi G, Costa AD, Diz MDPE. Platinum rechallenge in second-line treatment for endometrial carcinoma. EUR J GYNAECOL ONCOL 2019. [DOI: 10.12892/ejgo4883.2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sapienza L, Ning M, Taguchi S, Calsavara V, Pellizon A, Gomes M, Kowalski L, Baiocchi G. Altered-Fractionation Radiotherapy Improves Local Control in T1 but Not T2 Early-Stage Glottic Carcinoma: A Systematic Review and Meta-Analysis of 1816 Patients. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Baiocchi G, Drizlionoks E, Brandao P, Mantoan H, Kumagai L, Badiglian-Filho L, Faloppa C. What are the risk factors for lymphocyst formation after endometrial cancer staging? Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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De Franco L, Marrelli D, Morgagni P, Degiuli M, Giacopuzzi S, Orsenigo E, Pacelli F, Fumagalli U, Baiocchi G, Del Rio P, Catarci M, Marchet A, Mura G, Bencivenga M, Rosa F, Saragoni L, Quagliuolo V, Roviello F. Clinicopathological features and time trends of three subtypes of gastric cancer: Upper intestinal, lower intestinal and diffuse. Analysis of the GIRCG database on 5606 patients. Eur J Surg Oncol 2018. [DOI: 10.1016/j.ejso.2018.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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da Costa A, Dos Santos E, de Brot L, Ribeiro A, Cotrim D, Carvalho Pandolfi N, Cesca M, Chen M, Baiocchi G. Brain metastasis in ovarian cancer patients. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy285.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Tsunoda AT, Ribeiro R, Reis RJ, da Cunha Andrade C, Moretti Marques R, Baiocchi G, Fin F, Zanvettor PH, Falcao D, Batista TP, Azevedo B, Guitmann G, Pessini SA, Nunes JS, Campbell LM, Linhares JC, Carneiro V, Coimbra F. Surgery in ovarian cancer - Brazilian Society of Surgical Oncology consensus. BJOG 2018; 125:1243-1252. [PMID: 29900651 DOI: 10.1111/1471-0528.15328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2018] [Indexed: 12/22/2022]
Abstract
Surgical management in epithelial ovarian cancer (EOC) has a significant impact in overall survival and progression-free survival. The Brazilian Society of Surgical Oncology (BSSO) supported a taskforce of experts to reach a consensus: experienced and specialised trained surgeons, in cancer centres, provide the best EOC surgery. Laparoscopic and/or radiological staging prognosticates the possibility of complete cytoreduction (CC0) and helps to reduce unnecessary laparotomies. Surgical techniques were reviewed. Multidisciplinary input is essential for treatment planning. Quality assurance criteria are proposed and require national consensus. Genetic testing is mandatory. This consensus states the final recommendations from BSSO for management of EOC. TWEETABLE ABSTRACT Brazilian Society of Surgical Oncology consensus for surgery in epithelial ovarian cancer patients.
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Affiliation(s)
- A T Tsunoda
- Gynaecological Oncology Department, Hospital Erasto Gaertner, Curitiba, Brazil.,Albert Einstein Hospital, São Paulo, Brazil.,Positivo University, Curitiba, Brazil
| | - R Ribeiro
- Gynaecological Oncology Department, Hospital Erasto Gaertner, Curitiba, Brazil
| | - R J Reis
- Hospital Erasto Dorneles e Hospital Mãe de Deus, Porto Alegre, Brazil.,Brazilian Lutheran University, Porto Alegre, Brazil
| | - Cem da Cunha Andrade
- Gynaecological Oncology Department, Barretos Cancer Hospital, Barretos, Brazil.,Paulo Prata Medical University, Barretos, Brazil
| | | | - G Baiocchi
- Gynaecological Oncology Department, AC Camargo Cancer Centre, Sao Paulo, Brazil
| | - F Fin
- Gynaecological Oncology Department, Hospital São Vicente, Curitiba, Brazil.,Faculdade Evangélica de Curitiba, Curitiba, Brazil
| | - P H Zanvettor
- Gynaecological Oncology Department, Aristides Maltez Hospital, Salvador, Brazil.,AMO Clinic, Salvador, Brazil
| | - D Falcao
- Gynaecological Oncology Department, Aristides Maltez Hospital, Salvador, Brazil
| | - T P Batista
- Surgery Department, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil
| | - Brb Azevedo
- Hospital São Vicente, Curitiba, Brazil.,Instituto de Hemato Oncologia do Paraná, Curitiba, Brazil
| | - G Guitmann
- Brazilian National Cancer Institute, Rio de Janeiro, Brazil.,Americas Hospital, Rio de Janeiro, Brazil
| | - S A Pessini
- Gynaecological Oncology Department, Fundação Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - J S Nunes
- Hospital Erasto Gaertner, Curitiba, Brazil.,Instituto de Oncologia do Paraná, Curitiba, Brazil
| | | | - J C Linhares
- Gynaecological Oncology Department, Hospital Erasto Gaertner, Curitiba, Brazil.,Instituto de Oncologia do Paraná, Curitiba, Brazil
| | - V Carneiro
- Hospital de Câncer de Pernambuco, Recife, Brazil Instituto de Medicina Integral Professor Fernando Figueira NeoH - Núcleo Especializado em Oncologia e Hematologia D'OR, Recife, Brazil
| | - Fjf Coimbra
- AC Camargo Cancer Centre, Sao Paulo, Brazil.,Brazilian Society of Surgical Oncology 2016/2017, Sao Paulo, Brazil
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Abstract
Aims and background This report retrospectively analyzes 106 cases of endometrioid carcinoma of the ovary treated at the National Cancer Institute of Milan from 1974 through December 1993. In 12 of the 106 cases (11.3%) a synchronous carcinoma of the uterine body was observed. Methods and study design Only patients who had previously untreated disease were included in the study. Patients with synchronous tumors were staged according to their ovarian cancer and treated according to the stage of that disease. Results Thirty-nine patients (36.8%) had stage I, 17 (16.0%) stage II, 43 (40.6%) stage III, and 7 (6.6%) stage IV disease. Moderately plus poorly differentiated tumors were present in 76 of the 106 cases (71.7%). Considering the 67 patients with advanced disease, residual tumor was absent in 27 cases (40.3%), ≤ 2 cm in 17 (25.4%), and > 2 cm in 23 (34.3%) cases. Systematic pelvic and para-aortic lymphadenectomy was performed in 60 patients (56.6%); selective sampling was carried out in 23 cases (21.7%). After surgery, 77 patients underwent various chemotherapy regimens. Conclusion Using univariate analysis, FIGO stage, tumor grade, residual disease after surgery, lymph node status, and platinum in the chemotherapy regimen significantly influenced 5-year survival. However, when all these variables were included in a multivariate analysis only FIGO stage still had a significant impact on survival. Survival analysis also showed a trend towards longer survival in patients with synchronous tumors.
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Affiliation(s)
- G Grosso
- Department of Gynecologic Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
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Baiocchi G, Mantoan H, Kumagai L, Faloppa C, Badiglian-Filho L, Costa A, De Brot L. Is sentinel node mapping in cervical cancer cost effective? Beyond the detection of node metastasis. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.03.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lapadula G, Marchesoni A, Salaffi F, Ramonda R, Salvarani C, Punzi L, Costa L, Caso F, Simone D, Baiocchi G, Scioscia C, Di Carlo M, Scarpa R, Ferraccioli G. Evidence-based algorithm for diagnosis and assessment in psoriatic arthritis: results by Italian DElphi in psoriatic Arthritis (IDEA). Reumatismo 2016; 68:126-136. [DOI: 10.4081/reumatismo.2016.913] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 08/01/2016] [Indexed: 11/23/2022] Open
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory disease involving skin, peripheral joints, entheses, and axial skeleton. The disease is frequently associated with extrarticular manifestations (EAMs) and comorbidities. In order to create a protocol for PsA diagnosis and global assessment of patients with an algorithm based on anamnestic, clinical, laboratory and imaging procedures, we established a DElphi study on a national scale, named Italian DElphi in psoriatic Arthritis (IDEA). After a literature search, a Delphi poll, involving 52 rheumatologists, was performed. On the basis of the literature search, 202 potential items were identified. The steering committee planned at least two Delphi rounds. In the first Delphi round, the experts judged each of the 202 items using a score ranging from 1 to 9 based on its increasing clinical relevance. The questions posed to experts were How relevant is this procedure/observation/sign/symptom for assessment of a psoriatic arthritis patient? Proposals of additional items, not included in the questionnaire, were also encouraged. The results of the poll were discussed by the Steering Committee, which evaluated the necessity for removing selected procedures or adding additional ones, according to criteria of clinical appropriateness and sustainability. A total of 43 recommended diagnosis and assessment procedures, recognized as items, were derived by combination of the Delphi survey and two National Expert Meetings, and grouped in different areas. Favourable opinion was reached in 100% of cases for several aspects covering the following areas: medical (familial and personal) history, physical evaluation, imaging tool, second level laboratory tests, disease activity measurement and extrarticular manifestations. After performing PsA diagnosis, identification of specific disease activity scores and clinimetric approaches were suggested for assessing the different clinical subsets. Further, results showed the need for investigation on the presence of several EAMs and risk factors. In the context of any area, a rank was assigned for each item by Expert Committee members, in order to create the logical sequence of the algorithm. The final list of recommended diagnosis and assessment procedures, by the Delphi survey and the two National Expert Meetings, was also reported as an algorithm. This study shows results obtained by the combination of a DElphi survey of a group of Italian rheumatologists and two National Expert Meetings, created with the aim of establishing a clinical procedure and algorithm for the diagnosis and the assessment of PsA patients. In order to find accurate and practical diagnostic and assessment items in clinical practice, we have focused our attention on evaluating the different PsA domains. Hence, we conceived the IDEA algorithm in order to address PsA diagnosis and assessment in the context of daily clinical practice. The IDEA algorithm might eventually lead to a multidimensional approach and could represent a useful and practical tool for addressing diagnosis and for assessing the disease appropriately. However, the elaborated algorithm needs to be further investigated in daily practice, for evidencing and proving its eventual efficacy in detecting and staging PsA and its heterogeneous spectrum appropriately.
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Baiocchi G, Faloppa C, Mantoan H, Camarco W, Kumagai L, De Brot L, Costa A, Badiglian-Filho L. Prognostic factors in stage IIIC endometrial cancer. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.04.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rausei S, Ruspi L, Rosa F, Morgagni P, Marrelli D, Cossu A, Cananzi FCM, Lomonaco R, Coniglio A, Biondi A, Cipollari C, Graziosi L, Fumagalli U, Casella F, Bertoli P, di Leo A, Alfieri S, Vittimberga G, Roviello F, Orsenigo E, Quagliuolo V, Montemurro S, Baiocchi G, Persiani R, Bencivenga M, Donini A, Rosati R, Sansonetti A, Ansaloni L, Zanoni A, Galli F, Dionigi G. Extended lymphadenectomy in elderly and/or highly co-morbid gastric cancer patients: A retrospective multicenter study. Eur J Surg Oncol 2016; 42:1881-1889. [PMID: 27266816 DOI: 10.1016/j.ejso.2016.05.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 03/15/2016] [Accepted: 05/05/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Gastrectomy with extended lymphadenectomy is considered the gold standard treatment for advanced gastric cancer, with no age- or comorbidity-related limitations. We evaluated the safety and efficacy of curative gastrectomy with extended nodal dissection, verifying survival in elderly and highly co-morbid patients. METHODS In a retrospective multicenter study, we examined 1322 non-metastatic gastric-cancer patients that underwent curative gastrectomy with D2 versus D1 lymphadenectomy from January 2000 to December 2009. Postoperative complications, overall survival (OS), and disease-specific survival (DSS) according to age and the Charlson Comorbidity Score were analyzed in relation to the extent of lymphadenectomy. RESULTS Postoperative morbidity was 30.4%. Complications were more frequent in highly co-morbid elderly patients, and, although general morbidity rates after D2 and D1 lymphadenectomy were similar (29.9% and 33.2%, respectively), they increased following D2 in highly co-morbid elderly patients (39.6%). D2-lymphadenectomy significantly improved 5-year OS and DSS (48.0% vs. 37.6% in D1, p < 0.001 and 72.6% vs. 58.1% in D1, p < 0.001, respectively) in all patients. In elderly patients, this benefit was present only in 5-year DSS. D2 nodal dissection induced better 5-year OS and DSS rates in elderly patients with positive nodes (29.7% vs. 21.2% in D1, p = 0.008 and 47.5% vs. 30.6% in D1, p = 0.001, respectively), although it was present only in DSS when highly co-morbid elderly patients were considered. CONCLUSION Extended lymphadenectomy confirmed better survival rates in gastric cancer patients. Due to high postoperative complication rate and no significant improvement of the OS, D1 lymphadenectomy should be considered in elderly and/or highly co-morbid gastric cancer patients.
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Affiliation(s)
- S Rausei
- Department of Surgery, University of Insubria, Viale Luigi Borri, 57, 21100 Varese, VA, Italy.
| | - L Ruspi
- Department of Surgery, University of Insubria, Viale Luigi Borri, 57, 21100 Varese, VA, Italy
| | - F Rosa
- Division of Digestive Surgery, Department of Surgical Sciences, Catholic University, Largo F. Vito, 1, 00168 Rome, RM, Italy
| | - P Morgagni
- General Surgery, Morgagni-Pierantoni Hospital, Via Carlo Forlanini, 34, 47121 Forlì, FC, Italy
| | - D Marrelli
- Department of General Surgery and Oncology, University of Siena, Policlinico Santa Maria alle Scotte, Viale Bracci, 53100 Siena, SI, Italy
| | - A Cossu
- Department of Surgery, Vita-Salute San Raffaele University, Via Olgettina, 58, 20132 Milan, MI, Italy
| | - F C M Cananzi
- Division of Surgical Oncology, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, 20089 Rozzano, MI, Italy
| | - R Lomonaco
- Surgery Unit, National Cancer Research Centre, Giovanni Paolo II, Viale Orazio Flacco 65, 70124 Bari, BA, Italy
| | - A Coniglio
- Department of Clinical and Experimental Sciences, Brescia University, Piazzale Spedali Civili, 1, 25123 Brescia, BS, Italy
| | - A Biondi
- Division of General Surgery, Department of Surgical Sciences, Catholic University, Largo F. Vito, 1, 00168 Rome, RM, Italy
| | - C Cipollari
- Department of Surgery, University of Verona, Ospedale Borgo Trento, P.le A. Stefani 1, 37126 Verona, VR, Italy
| | - L Graziosi
- General and Emergency Surgery, University of Perugia, S. Andrea delle Fratte, 06156 Perugia, PG, Italy
| | - U Fumagalli
- Division of General and Minimally Invasive Surgery, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, 20089 Rozzano, MI, Italy
| | - F Casella
- Division of General Surgery, Vannini Hospital, Via di Acqua Bullicante, 4, 00177 Rome, RM, Italy
| | - P Bertoli
- Division of General Surgery I, Papa Giovanni XXIII Hospital, Piazza OMS, 1, 24127 Bergamo, BG, Italy
| | - A di Leo
- Division of General Surgery, Rovereto Hospital, Corso Verona, 4, 38068 Rovereto, TN, Italy
| | - S Alfieri
- Division of Digestive Surgery, Department of Surgical Sciences, Catholic University, Largo F. Vito, 1, 00168 Rome, RM, Italy
| | - G Vittimberga
- General Surgery, Morgagni-Pierantoni Hospital, Via Carlo Forlanini, 34, 47121 Forlì, FC, Italy
| | - F Roviello
- Department of General Surgery and Oncology, University of Siena, Policlinico Santa Maria alle Scotte, Viale Bracci, 53100 Siena, SI, Italy
| | - E Orsenigo
- Department of Surgery, Vita-Salute San Raffaele University, Via Olgettina, 58, 20132 Milan, MI, Italy
| | - V Quagliuolo
- Division of Surgical Oncology, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, 20089 Rozzano, MI, Italy
| | - S Montemurro
- Surgery Unit, National Cancer Research Centre, Giovanni Paolo II, Viale Orazio Flacco 65, 70124 Bari, BA, Italy
| | - G Baiocchi
- Department of Clinical and Experimental Sciences, Brescia University, Piazzale Spedali Civili, 1, 25123 Brescia, BS, Italy
| | - R Persiani
- Division of General Surgery, Department of Surgical Sciences, Catholic University, Largo F. Vito, 1, 00168 Rome, RM, Italy
| | - M Bencivenga
- Department of Surgery, University of Verona, Ospedale Borgo Trento, P.le A. Stefani 1, 37126 Verona, VR, Italy
| | - A Donini
- General and Emergency Surgery, University of Perugia, S. Andrea delle Fratte, 06156 Perugia, PG, Italy
| | - R Rosati
- Department of Surgery, Vita-Salute San Raffaele University, Via Olgettina, 58, 20132 Milan, MI, Italy; Division of General and Minimally Invasive Surgery, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, 20089 Rozzano, MI, Italy
| | - A Sansonetti
- Division of General Surgery, Vannini Hospital, Via di Acqua Bullicante, 4, 00177 Rome, RM, Italy
| | - L Ansaloni
- Division of General Surgery I, Papa Giovanni XXIII Hospital, Piazza OMS, 1, 24127 Bergamo, BG, Italy
| | - A Zanoni
- Division of General Surgery, Rovereto Hospital, Corso Verona, 4, 38068 Rovereto, TN, Italy
| | - F Galli
- Department of Surgery, University of Insubria, Viale Luigi Borri, 57, 21100 Varese, VA, Italy
| | - G Dionigi
- Department of Surgery, University of Insubria, Viale Luigi Borri, 57, 21100 Varese, VA, Italy
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Baiocchi G, Mantoan H, Kumagai L, Badiglian-Filho L, Faloppa C, De Brot L, Costa A, Menezes A, Fukazawa E. Sentinel node mapping in endometrial cancer: A Brazilian cancer center experience. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.04.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mantoan H, Baiocchi G, Kumagai L, Badiglian-Filho L, Faloppa C, De Brot L, Costa A, Menezes A, Fukazawa E. Endometrial evaluation in adult granulosa cell tumors: Is it really necessary? Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.04.434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abongwa HK, Cervellin G, Tarasconi A, Perrone G, Baiocchi G, Portolani N, Catena F. Antibiotics alone for uncomplicated acute appendicitis in high operative risk adult patients: Analytical review of RCTs and proposal of evidence based treatment decision. Acta Biomed 2016; 87:334-346. [PMID: 28112705 PMCID: PMC10521897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 12/14/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Clinical trials have so far shown controversial results as regards the standard of care for treating uncomplicated acute appendicitis (uC-AA). High operational risk adult patients (HORAP) could represent selected patients where primary antibiotic conservative therapy (pACT or A) could be indicated. METHODS We carried a comprehensive search of the PubMed searching engine in the English language scientific literature from 1995 to 2015, using medical subject headings "antibiotics", "uncomplicated appendicitis", "appendicectomy", "conservative treatment", "surgery" and "randomized clinical trial". All RCTs comparing the outcomes of pACT versus primary surgical open or laparoscopic appendectomy (pSOLA or S) as primary treatment options for uC-AA were identified. Inclusion criteria for our analytical review were RCTs evaluating outcomes in terms of or related to all of the following four parameters: treatment efficacy, post therapeutic/operative complications, in hospital length of stay (LOS) and recurrence. RESULTS The conclusion of all five RCTs considered antibiotics alone in the treatment of AA as an efficient and non inferior therapeutic option respect to surgery. Primary ACT was characterised by a higher LOS, a higher rate of recurrence and a lower rate of postoperative complication than pSOLA. CONCLUSIONS Based on the current body of evidence, an appropriate pACT could be a rational tailored primary treatment option for CT proven uC-AA in HORAP. Accurate diagnoses and surgical risk stratification in patients with uC-AA could aid decision making for target therapy. However, results of large sample prospective multicenter RCTs are required to routinely recommend pACT for uC-AA in the clinical practice.
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Baiocchi G, Mantoan H, de Brot L, Badiglian-Filho L, Kumagai LY, Faloppa CC, da Costa AABA. How important is the pathological margin distance in vulvar cancer? Eur J Surg Oncol 2015; 41:1653-8. [PMID: 26507171 DOI: 10.1016/j.ejso.2015.09.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 09/17/2015] [Accepted: 09/27/2015] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The ideal pathological margin in vulvar squamous cell carcinoma (VSCC) is still debated. Our aim was to analyze the value of tumor-free pathological margin distance with regard to local recurrence in VSCC. METHODS We analyzed a series of 205 patients who were treated for VSCC from January 1980 to November 2007. Patients were categorized into 3 groups, based on pathological free margin (PFM): <3 mm (n = 18); ≥3 and <8 mm (n = 61); and ≥8 mm (n = 126). RESULTS The median age was 69 years. The median PFM was 10 mm (range: 1-65). Of 168 patients who underwent lymphadenectomy, 64 (38.1%) developed LN metastasis. After a median follow-up of 36.2 months, 78 (38%) cases recurred-47 (60.2%) experienced a local recurrence (LR). LR occurred in 16.7% of patients with a PFM of <3 mm, 24.6% with a PFM ≥3 and <8 mm, and 22.2% of those with a PFM ≥8 mm (p = 0.77). PFM did not correlate with LR when analyzed continuously (p = 0.98). The 5-year disease-free survival (DFS) for LR was 79.6%. Margin distance did not negatively impact DFS (p = 0.94); the presence of perineural invasion was the only variable that negatively influenced DFS (p = 0.009). CONCLUSIONS Although our results suggest no correlation between LR and pathological margin distance, the tumor-free resection margin remains significant with regard to locoregional control in vulvar cancer. A more conservative surgical approach may be considered in certain situations, such as margins near the clitoris, urethra, and anus.
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Affiliation(s)
- G Baiocchi
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil.
| | - H Mantoan
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | - L de Brot
- Department of Anatomic Pathology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | - L Badiglian-Filho
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | - L Y Kumagai
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | - C C Faloppa
- Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
| | - A A B A da Costa
- Department of Medical Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
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Baiocchi G, Faloppa C, Camarco W, Badiglian-Filho L, Mantoan H, Kumagai L, Fukazawa E, De Brot L, Costa A. Prognostic factors for paraaortic lymph node metastasis in endometrial cancer. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.01.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Baiocchi G, Faloppa C, Oliveira R, Kumagai L, Mantoan H, Badiglian-Filho L, Costa A, Guimaraes G. Patterns of recurrence after pelvic exenteration for cervical and vaginal cancer. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.01.494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Baiocchi G, Costa A, Amorim C, Saito A, Mantoan H, Faloppa C, Kumagai L, Badiglian-Filho L, Guimaraes A, Sanches S. Prognostic factors in recurrent epithelial ovarian cancer. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.01.561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Baiocchi G, Kumagai L, Mantoan H, Badiglian-Filho L, Faloppa C, Fukazawa E, De Brot L, Costa A. Is parametrectomy in early stage cervical cancer always necessary? Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.01.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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26
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Baiocchi G, Costa A, Amorim C, Mantoan H, Saito A, Kumagai L, Faloppa C, Badiglian-Filho L, Sanches S, Guimaraes A. Prognostic factors after secondary cytoreducton in epithelial ovarian cancer. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.01.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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27
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Baiocchi G, Ritt G, Mantoan H, Macedo M, De Brot L, Faloppa C, Fukazawa E. Prognostic factors in malignant ovarian germ cell tumors. Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.03.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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28
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Andrade W, Lima E, Osório C, do Socorro Maciel M, Baiocchi G, Bitencourt A, Fanelli M, Damascena A, Soares F. Can FDG-PET/CT predict early response to neoadjuvant chemotherapy in breast cancer? Eur J Surg Oncol 2013; 39:1358-63. [DOI: 10.1016/j.ejso.2013.08.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 08/22/2013] [Accepted: 08/23/2013] [Indexed: 12/30/2022] Open
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29
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Baiocchi G, Silva Cestari F, Rocha R, Lavorato-Rocha A, Maia B, Cestari L, Kumagai L, Faloppa C, Fukazawa E, Badiglian-Filho L, Sant'Ana Rodrigues I, Soares F. Prognostic value of the number and laterality of metastatic inguinal lymph nodes in vulvar cancer: Revisiting the FIGO staging system. Eur J Surg Oncol 2013; 39:780-5. [DOI: 10.1016/j.ejso.2013.03.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 01/25/2013] [Accepted: 03/04/2013] [Indexed: 11/28/2022] Open
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30
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Baiocchi G, Macedo M, Badiglian-Filho L, De Brot L, Faloppa C, Fukazawa E, Kumagai L, Osorio C. Prognostic value of positive cytology in endometrial cancer. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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31
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Baiocchi G, Silva Cestari F, Rocha R, Faloppa C, Kumagai L, Fukazawa E, Badiglian-Filho L, Cestari L, Sant’Ana Rodrigues I, Lavorato-Rocha A, Maia B, Soares F. Does the count after inguinofemoral lymphadenectomy in vulvar cancer correlate with outcome? Eur J Surg Oncol 2013; 39:339-43. [DOI: 10.1016/j.ejso.2013.02.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Revised: 01/09/2013] [Accepted: 02/01/2013] [Indexed: 11/28/2022] Open
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32
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Baiocchi G, Guimaraes G, Rosa Oliveira R, Kumagai L, Faloppa C, Aguiar S, Begnami M, Soares F, Lopes A. Prognostic factors in pelvic exenteration for gynecological malignancies. Eur J Surg Oncol 2012; 38:948-54. [DOI: 10.1016/j.ejso.2012.07.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 04/30/2012] [Accepted: 07/02/2012] [Indexed: 10/28/2022] Open
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33
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Cruciani L, Gerli S, Baiocchi G, Clerici G, Antonelli C, Di Renzo GC. Ovarian pregnancy afterin vitrofertilisation in a woman with previous bilateral salpingectomy. J OBSTET GYNAECOL 2011; 31:270-1. [DOI: 10.3109/01443615.2011.554613] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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34
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Guimarães GC, Baiocchi G, Rossi BM, Ferreira FO, Aguiar S, Nakagawa WT, Lopes A. The use of silicone expander and cecal transposition after pelvic exenteration. Eur J Surg Oncol 2007; 33:586-9. [PMID: 17360143 DOI: 10.1016/j.ejso.2007.01.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2006] [Accepted: 01/19/2007] [Indexed: 11/20/2022] Open
Abstract
AIMS Describe a new approach for pelvic floor treatment employing a temporary mechanical support device with silicone expander, with or without association to cecal transposition. METHODS From January 2000 to June 2006, 106 patients were submitted to pelvic exenteration. A retrospective evaluation was done of the last 30 patients previously submitted to total pelvic exenteration without neither urinary nor faecal sphincter preservation who latter were submitted to a pelvic floor treatment with silicone expander with or without association to cecal rotation. RESULTS Twenty-six patients were female and four male. The most common primary neoplasm site were of gynecological origin (20 cases). The median follow-up period was 12 months (0.36-38). Only one patient presented small intestine loops slipping after expander removal. No other patient had small intestine loops slippage into the pelvis, probably because of cecal transposition. All patients were submitted to a post-operative CT scan to confirm that intestinal loops remained out of the pelvis. Six patients presented pelvic hollow infection after device removal. All cases had complete resolution with local cleaning using physiological solution associated with systemic antibiotic therapy, except one who needed a trans-abdominal surgical approach. CONCLUSIONS Pelvic floor treatment employing a temporary mechanical support device with silicone expander, associated or not to cecal transposition is a low-morbidity procedure. The most common complication is pelvic floor infection, but maintaining a cutaneous perineal hole allows easy access and treatment of possible pelvic abscesses as well as early recurrence diagnosis.
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Affiliation(s)
- G C Guimarães
- Department of Pelvic Surgery of Centro de Tratamento e Pesquisa Hospital do Câncer A.C. Camargo, Professor Antonio Prudente, 211, Liberdade, São Paulo 01509-010, Brazil.
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35
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Scambia G, Benedetti Panici P, Baiocchi G, Amoroso M, Foti E, Greggi S, Mancuso S. The value of squamous cell carcinoma antigen in patients with locally advanced cervical cancer undergoing neoadjuvant chemotherapy. Int J Gynaecol Obstet 2004. [DOI: 10.1016/0020-7292(91)90522-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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36
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Abstract
Available data on the incidence and the clinical value of lymph node assessment in ovarian cancer are reported. In early ovarian cancer, positive nodes are found in 4-25% of patients. Serous adenocarcinoma and poorly differentiated tumors are characterized by the highest incidence of node metastases. Five-year survival for stage IIIC disease with only retroperitoneal spread is clearly better than for stage IIIC with intraperitoneal dissemination. In advanced ovarian cancer, the rate of node involvement ranges from 55 to 75%. The percentage of positive nodes is significantly related to the amount of residual tumor after cytoreductive surgery, and node status seems to be an important prognostic factor for survival. Although data from retrospective studies advocate a therapeutic effect for systematic lymphadenectomy, results from prospective randomized trials are warranted. After chemotherapy a high percentage of patients (range, 25-77%) are found to have metastatic nodes. In particular, at second-look laparotomy, positive nodes are detected in 17-40% of patients who have no intraperitoneal disease.
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Affiliation(s)
- F. Di Re
- Past Director of Gynecologic Oncology Department, Istituto Nazionale Tumori di Milano, Milan, and Department of Obstetrics and Gynecology, Monteluce Hospital, Perugia, Italy
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37
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Antico A, Salcuni M, Baiocchi G, Capani F, Ucchino S, Spigonardo F, Bonomo L. [Vascular disease and asymptomatic diabetic patients]. Minerva Cardioangiol 1999; 47:520-1. [PMID: 10670183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- A Antico
- U.O. di Chirurgia Vascolare Ist. Radiologia, Università G.D'Annunzio, Chieti
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38
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Baiocchi G, Grosso G, di Re E, Fontanelli R, Raspagliesi F, di Re F. Systematic pelvic and paraaortic lymphadenectomy at second-look laparotomy for ovarian cancer. Gynecol Oncol 1998; 69:151-6. [PMID: 9600823 DOI: 10.1006/gyno.1998.4964] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A retrospective review of the medical records of all ovarian cancer patients admitted to our institution from January 1974 to December 1993 was performed. A total of 58 consecutive patients who underwent systematic pelvic and paraaortic lymphadenectomy during second-look surgery was found. Node metastases were found in 15 of 58 patients (25.8%). No significant correlation was found between the variables of disease (e.g., stage of the disease at diagnosis, histology, grade, residual tumor after the first cytoreductive surgery, and the type of chemotherapy administered) and node status at second-look. Node metastases were found in 8 of 45 (17.7%) patients with absence of intraperitoneal disease, compared with 7 of 11 (63.6%) patients with intraabdominal residual disease (P < 0.02). There was no difference in 5-year survival for patients with absence of residual tumor in the peritoneal cavity as well as in the retroperitoneum (5-year survival 80%) and for patients with retroperitoneal disease only (5-year survival 77%). On the contrary, a highly significant difference in survival (P < 0.001) was observed between these two groups of patients and those who had intraabdominal residual tumor. Twelve of 45 (26.6%) patients have recurred. FIGO stage, grade, and residual disease after primary surgery were determinant in predicting recurrence. Notably, no relation emerged between relapse rate and the node status at second-look.
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Affiliation(s)
- G Baiocchi
- Department of Gynecologic Oncology, National Institute of Cancer, Milan, Italy
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39
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Baiocchi G, Gilardi G. [Endometrial carcinoma: an increasing neoplasm. Screening and early diagnosis: proposal for a protocol]. Minerva Ginecol 1997; 49:147-52. [PMID: 9206765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Endometrial cancer is the most common cancer of the genital tract and it represents 10% of all cancers diagnosed in women. A protocol for screening and early diagnosis of this tumor has been designed by the authors. All asymptomatic women with risk factors undergo transvaginal sonography. The value of endometrial thickness suggests the need for endometrial sampling. On the contrary, such a procedure is always combined with transvaginal sonography in case of women with atypical genital bleeding. The aim of the protocol is to verify the efficacy of transvaginal sonography and endometrial sampling as combined procedures for screening and early diagnosis of endometrial cancer.
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Affiliation(s)
- G Baiocchi
- Cattedra di Ginecologia ed Ostetricia, Università degli Studi, Perugia
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40
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Baiocchi G, Gilardi G. [Carcinoma of the endometrium: a neoplasm on the increase. Its staging and treatment: a proposed protocol]. Minerva Ginecol 1997; 49:1-5. [PMID: 9162878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Endometrial cancer staging is obtained by the analysis of the surgical-pathological parameters. Therefore, surgery represents the first approach to this neoplasia. Surgical-pathological data analysis informs us of the main prognostic factors and the spread of the disease. On the basis of these findings, the risk of recurrence can be estimated and adjuvant treatments can be planned. A protocol for staging and treatment of endometrial carcinoma has been designed by the authors. After surgery, adjuvant therapy (chemotherapy or radiotherapy or the two modalities combined) is suggested by analysis of the prognostic factors. The aim of the protocol is to increase the relapse-free survival and to improve the quality of life of endometrial cancer patients.
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Affiliation(s)
- G Baiocchi
- Cattedra di Ginecologia ed Ostetricia, Università degli Studi, Perugia
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41
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Baiocchi G, Manci N, Angeletti G, Celleno R, Fratini D, Gilardi G. Pure Leydig cell tumour (hilus cell) of the ovary: a rare cause of virilization after menopause. Gynecol Obstet Invest 1997; 44:141-4. [PMID: 9286731 DOI: 10.1159/000291506] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A 58-year-old postmenopausal woman with high plasma testosterone levels and virilization, as demonstrated by hirsutism and alopecia, is presented. Urinary 17-ketosteroids and 17-hydroxycorticosteroids as well as the computed axial tomography scan of the adrenal glands were normal. Although no pelvic mass was detected by sonography or pelvic examination, the patient was found to have small pure Leydig cell tumour of the left ovary. Following total abdominal hysterectomy and bilateral salpingo-oophorectomy, the patient had regression of the hirsutism, and the plasma testosterone dropped to normal level.
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Affiliation(s)
- G Baiocchi
- Department of Obstetrics and Gynecology, Policlinico Monteluce, Perugia, Italy
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42
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di Re F, Baiocchi G, Fontanelli R, Grosso G, Cobellis L, Raspagliesi F, di Re E. Systematic pelvic and paraaortic lymphadenectomy for advanced ovarian cancer: prognostic significance of node metastases. Gynecol Oncol 1996; 62:360-5. [PMID: 8812533 DOI: 10.1006/gyno.1996.0249] [Citation(s) in RCA: 102] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A retrospective study of 488 patients with untreated advanced ovarian cancer is presented. Systematic pelvic and paraaortic lymphadenectomy was performed in 248 cases (50.8%). Selective sampling and node biopsy was performed in 33 (6.7%) and 47 (9.6%) patients, respectively. Node metastases were found in 194 of 328 patients (59.1%). The incidence of metastatic nodes significantly increased with more advanced stages, with serous histology, and with a greater amount of residual tumor. Node status appeared to be related to pathology findings at second-look. A complete pathologic response was documented in 26 of 31 (83.8%) patients with negative nodes and in 38 of 59 (64.6%) with positive nodes at first surgery. Patients with negative nodes survived significantly longer (5-year survival, 46%; median, 60 months) than those who had node metastases (5-year survival, 25%; median, 36 months). Using multivariate analysis, lymph node status, together with the stage of disease and residual tumor, still had a significant impact on 5-year survival. Moreover, among patients with optimal cytoreduction, 5-year survival was 46% (median, 56 months) and 30% (median, 41 months) for patients who did and did not undergo lymphadenectomy, respectively (P = 0.05). Likewise, when suboptimal cytoreduction was considered, a median 5-year survival of 24 months was obtained in patients who underwent lymphadenectomy compared with 14 months in patients who did not (P < 0.005).
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Affiliation(s)
- F di Re
- Department of Gynecologic Oncology, Istituto Nazionale Tumori di Milano, Italy
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Abstract
Lymphatic spread pattern in 17 cases of adenocarcinoma of fallopian tube is reported. Median age of the patients was 48 years. All patients underwent surgical staging including total abdominal hysterectomy, bilateral salpingo-oopherectomy omentectomy, and appendectomy. Systematic pelvic and paraaortic lymphadenectomy was feasible in 15 cases. Majority of the patients (11 of 17 cases, 64%) had advanced disease and showed serous adenocarcinoma (83%). Lymph nodes were involved in 10 of 17 cases (59%). Node metastases rate increased significantly (P < 0.01) with intraperitoneal stage of disease and with grading. Interestingly, positive nodes were also found in 2 cases (33%) of 6 patients with disease still limited to fallopian tube. Overall, patients with negative nodes had a median survival of 76 months, compared with only 33 months if node metastases were found. In conclusion, combined pelvic and para-aortic lymphadenectomy seems to be necessary for staging and perhaps for prognosis of this disease.
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Affiliation(s)
- E di Re
- Department of Gynecologic Oncology, Istituto Nazionale Tumori di Milano, Italy
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44
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Benedetti-Panici P, Greggi S, Scambia G, Salerno MG, Baiocchi G, Laurelli G, Menichella G, Pierelli L, Foddai ML, Serafini R. Very high-dose chemotherapy with autologous peripheral stem cell support in advanced ovarian cancer. Eur J Cancer 1995; 31A:1987-92. [PMID: 8562153 DOI: 10.1016/0959-8049(95)00337-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
20 patients with stage III-IV ovarian cancer were submitted to induction chemotherapy (ICT) (40 mg/m2 cisplatin, days 1-4; 1.5 g/m2 cyclophosphamide, day 4; every 4 weeks for 2 cycles) followed by intensified CT (100 mg/m2 cisplatin, day 1; 650 mg/m2 etoposide, day 2; 1.8 g/m2 carboplatin by 24 h infusion, day 3). Haematological support consisted of autologous peripheral stem cells (APSC) and bone marrow (ABM) transplant (T) in 16 and 4 patients, respectively. All patients were evaluable for toxicity and 19 for pathological response (PR), one patient dying of systemic mycosis after ABMT. Severe (grade 3-4) non-haematological toxic effects were gastrointestinal (100%), neurological (10%) and hepatic (10%). PR was observed in 84% of patients (complete response 37%, partial response with microscopic residual disease 26%, partial response with macroscopic residual disease 21%). Five year overall survival was 60% and progression-free survival was 51% with 9 patients still disease-free (DFS). APSCT significantly reduced the duration of aplasia compared with ABMT, and toxicity was acceptable in those patients undergoing APSCT. The prolonged DFS in patients showing PCR suggests that this new approach may have a therapeutic impact.
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Scambia G, Catozzi L, Panici P, Ferrandina G, Coronetta F, Barozzi R, Baiocchi G, Uccelli L, Piffanelli A, Mancuso S. Expression of ras oncogene p21 protein in normal and neoplastic ovarian tissues: Correlation with histopathologic features and receptors for estrogen, progesterone, and epidermal growth factor. Int J Gynaecol Obstet 1993. [DOI: 10.1016/0020-7292(93)90309-k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Scambia G, Benedetti Panici P, Ferrandina G, Battaglia F, Baiocchi G, Di Stefano P, Tinari N, Coronetta F, Piantelli M, Natali P, Iacobelli S, Mancuso S. Expression of HER-2/neu oncoprotein, DNA-ploidy and S-phase fraction in advanced ovarian cancer. Int J Gynecol Cancer 1993; 3:271-278. [PMID: 11578357 DOI: 10.1046/j.1525-1438.1993.03050271.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The immunohistochemical expression of HER-2/neu and cytofluorimetric data were retrospectively analyzed in a group of primary advanced ovarian cancers. Thirty-three out of 94 (35%) cases showed a specific p185/neu immunoreaction. No correlation between p185/neu expression and any of the clinico-pathologic parameters examined was observed. As far as cytofluorimetric data are concerned, 38 out of 69 (55%) of the tumors were diploid (DNA index = 1) while 31 (45%) were aneuploid (DNA index from 1.10 to 2.50 with a median value of 1.50). Ovarian tumors were defined as of low and high S-phase fraction in 68% and 32% of the cases, respectively. Tumor ploidy and S-phase fraction did not correlate with the clinico-pathologic characteristics or p185/neu oncoprotein expression. Aneuploid tumors had a higher S-phase fraction (mean: 15.81 +/- 13.44) than diploid tumors (mean: 8.89 +/- 7.98) (P < 0.01). p185/neu expression failed to affect significantly both overall and progression free survival. On the other hand tumor ploidy was found to be related to the prognosis of advanced ovarian cancer patients although the difference was not statistically significant. As far as progression free survival is concerned, the median time to recurrence was not reached for diploid cases whereas it was 21 months for aneuploid cases (P < 0.05). The 5-year survival for patients with a low S-phase fraction (58%) was significantly higher than for patients with high S-phase fraction tumors (28%) (P < 0.01). Median time to recurrence was 48 and 17 months for low and high S-phase fraction tumor patients, respectively (P < 0.05). However, in a multivariate analysis both tumor ploidy and S-phase fraction did not retain their prognostic value. The assessment of the role of the parameters examined in improving the prognostic characterization of ovarian cancer patients should be investigated in large multicenter clinical trials.
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Affiliation(s)
- G. Scambia
- Department of Obstetrics and Gynecology, Catholic University, Rome, Medical Oncology, University of Chieti, Pathology, Catholic University, Rome, Laboratory of Immunology, Istituto Regina Elena, Rome, Italy
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Benedetti-Panici P, Scambia G, Baiocchi G, Maneschi F, Greggi S, Mancuso S. Radical hysterectomy: a randomized study comparing two techniques for resection of the cardinal ligament. Gynecol Oncol 1993; 50:226-31. [PMID: 7690729 DOI: 10.1006/gyno.1993.1197] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
To compare two different surgical techniques for the resection of the cardinal ligaments during radical operation for cervical cancer, 84 patients with locally advanced cervical cancer (FIGO stages IB-IIA > or = 4 cm, IIB-III) primarily treated with chemotherapy and then eligible for radical surgery underwent radical hysterectomy. Lateral parametria were resected by using the Meigs technique or a modified Magara technique. The procedure to be performed on the right hand side was randomly chosen, consequently the left cardinal ligament was resected with the other technique. Evaluation of the first 35 cases showed that the median size of the parametria resected with the modified Magara technique (52 mm) was significantly greater than that removed with the Meigs technique (34 mm) (P < 0.05). Therefore hemoclips were routinely adopted in the following 49 cases. In 11% of cases hemoclips could not be used due to a deep and narrow pelvis or varicosities of the hypogastric plexus, therefore clamps were necessary. Bleeding complicating parametrial dissection occurred independently of the adopted technique. Five-years DFS is 100, 80, and 52% for stage IB-IIA > 4 cm, IIB and III, respectively. The study showed that the modified Magara technique is feasible and safe and allows for a more radical resection of the parametrial tissue. Furthermore, this approach seems to improve the local control of disease.
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Affiliation(s)
- P Benedetti-Panici
- Department of Obstetrics and Gynecology, Catholic University, Rome, Italy
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Baiocchi G, Scambia G, Benedetti P, Menichella G, Testa U, Pierelli L, Martucci R, Foddai ML, Bizzi B, Mancuso S. Autologous stem cell transplantation: sequential production of hematopoietic cytokines underlying granulocyte recovery. Cancer Res 1993; 53:1297-303. [PMID: 7680283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We investigated the serum concentrations of a variety of cytokines [granulocyte-macrophage-colony-stimulating factor (GM-CSF), granulocyte colony stimulating factor (G-CSF), interleukin (IL) 1 alpha, IL-3, IL-6, IL-8, erythropoietin, tumor necrosis factor alpha, gamma-interferon in 10 patients with advanced ovarian cancer undergoing autologous peripheral blood stem cell (PBSC) harvesting followed by treatment with high-dose cisplatin, etoposide, and carboplatin and PBSC transplantation (chemotherapy was administered on days 1 through 3, PBSCT on day 6). Preliminary observations on cytokine serum levels were performed for 4 patients; on this basis, the kinetics of cytokines was then investigated in greater detail at closely sequential times in 6 further patients. We observed a consistent pattern of sequential GM-CSF, G-CSF, and IL-8 release after chemotherapy/PBSCT in all 10 cases, including the 6 patients monitored in detail: (a) at days 5-10 a GM-CSF peak; (b) at days 12-14 a pronounced release of both G-CSF and IL-8, which always preceded granulocyte recovery by approximately 7 days. At days 17-23, a second GM-CSF peak was monitored in 5 of the 6 patients analyzed in detail, as well as in the other 4 cases. Particularly relevant are the observations that: (a) the peak of G-CSF serum concentration and neutrophil number in the recovery phase are strikingly and directly correlated, thus indicating a key role for G-CSF in granulocyte rescue; (b) the time courses of G-CSF and IL-8 levels are strictly parallel, thereby suggesting a coordinate stimulus for production of granulocytes, mediated by G-CSF, and their activation/migration capacity, mediated by IL-8. Results were essentially negative for IL-3, tumor necrosis factor alpha, and gamma-interferon concentrations (except in one case for each cytokine). An early peak of IL-1 alpha was observed in all 3 analyzed patients, while an IL-6 peak was monitored at days 13-15 in all 4 patients analyzed in detail. The present results indicate a sequential coordinate pattern of cytokine release after ablative therapy and PBSCT and shed light on the mechanisms mediating the recovery of granulocytes, and more generally of hematopoiesis, after stem cell transplantation. Furthermore, these studies may contribute to the design of improved protocols for cytokine administration following myelosuppressive anticancer therapy, as well as to the prediction of granulocytic response.
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Affiliation(s)
- G Baiocchi
- Department of Gynecology and Obstetrics, Catholic University, Rome, Italy
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Scambia G, Panici PB, Pierelli L, Baiocchi G, Rumi C, Menichella G, Foddai ML, Serafini R, Arno E, Bonanno G. Immunological reconstitution after high-dose chemotherapy and autologous blood stem cell transplantation for advanced ovarian cancer. Eur J Cancer 1993; 29A:1518-22. [PMID: 8105837 DOI: 10.1016/0959-8049(93)90286-o] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We evaluated the immunological reconstitution of patients who underwent high-dose chemotherapy and autologous blood stem cell transplantation (ABSCT) for advanced ovarian cancer. Sixty days after transplantation a complete reconstitution of lymphocytes and of the CD3, CD4, CD8, CD19, and CD16/56 subsets was observed in this series. A significant increase in the count of interleukin-2 receptor expressing lymphocyte (CD25) was found on day +60 after transplantation compared to that obtained at diagnosis and before transplantation. A significantly higher lymphokine-activated killer (LAK) precursor activity was seen on day +60 compared to the values obtained at diagnosis and before transplantation while natural killer activity did not show any significant variation. We conclude that ABSCT gives prompt and complete immunohaematopoietic reconstitution after high-dose treatment. Moreover, our data support the feasibility of interleukin-2/LAK therapy as consolidative therapy after ABSCT.
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Affiliation(s)
- G Scambia
- Department of Gynecology and Obstetrics, Catholic University, Rome
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Scambia G, Catozzi L, Panici PB, Ferrandina G, Coronetta F, Barozzi R, Baiocchi G, Uccelli L, Piffanelli A, Mancuso S. Expression of ras oncogene p21 protein in normal and neoplastic ovarian tissues: correlation with histopathologic features and receptors for estrogen, progesterone, and epidermal growth factor. Am J Obstet Gynecol 1993; 168:71-8. [PMID: 8420353 DOI: 10.1016/s0002-9378(12)90888-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The aim of the study was to investigate the biologic significance of p21 expression in normal and neoplastic ovarian tissues. STUDY DESIGN Western blotting analysis of p21/ras oncoprotein was conducted in a group of 14 normal and cystic ovaries, six benign tumors, 42 primary ovarian cancers, and 15 omental metastases. RESULTS Levels of p21 were similar in normal and cystic ovaries and in benign tumors, whereas they were significantly higher in malignant tumors than in control tissues (median 1.91, range 0.12 to 5.00 vs median 1.03, range 0.32 to 2.20; p = 0.023) and in omental metastases than in primary ovarian carcinomas (median 3.05, range 0.55 to 5.72 vs median 1.97, range 0.12 to 5.00; p = 0.14). We found no correlation between p21 expression and histopathologic or clinical characteristics. Estrogen receptor-positive and progesterone receptor-positive tumors expressed higher p21 levels than did estrogen receptor-negative and progesterone receptor-negative tumors (p < 0.05), but no correlation with epidermal growth factor receptor status was found. In the univariate analysis of survival p21 positivity showed a negative prognostic value. CONCLUSION The enhancement of p21 protein is associated in the ovarian tissue with the malignant phenotype and the acquisition of metastatic potential.
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Affiliation(s)
- G Scambia
- Department of Gynecology, Catholic University, Rome, Italy
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