Impact of the COVID-19-pandemic on patients with gynecological malignancies undergoing surgery: A Dutch population-based study using data from the 'Dutch Gynecological Oncology Audit'

OBJECTIVE

The COVID-19-pandemic caused drastic healthcare changes worldwide. To date, the impact of these changes on gynecological cancer healthcare is relatively unknown. This study aimed to assess the impact of the COVID-19-pandemic on surgical gynecological-oncology healthcare.

METHODS

This population-based cohort study included all surgical procedures with curative intent for gynecological malignancies, registered in the Dutch Gynecological Oncology Audit, in 2018-2020. Four periods were identified based on COVID-19 hospital admission rates: 'Pre-COVID-19', 'First wave', 'Interim period', and 'Second wave'. Surgical volume, perioperative care processes, and postoperative outcomes from 2020 were compared with 2018-2019.

RESULTS

A total of 11,488 surgical procedures were analyzed. For cervical cancer, surgical volume decreased by 17.2% in 2020 compared to 2018-2019 (mean 2018-2019: n = 542.5, 2020: n = 449). At nadir (interim period), only 51% of the expected cervical cancer procedures were performed. For ovarian, vulvar, and endometrial cancer, volumes remained stable. Patients with advanced-stage ovarian cancer more frequently received neoadjuvant chemotherapy in 2020 compared to 2018-2019 (67.7% (n = 432) vs. 61.8% (n = 783), p = 0.011). Median time to first treatment was significantly shorter in all four malignancies in 2020. For vulvar and endometrial cancer, the length of hospital stay was significantly shorter in 2020. No significant differences in complicated course and 30-day-mortality were observed.

CONCLUSIONS

The COVID-19-pandemic impacted surgical gynecological-oncology healthcare: in 2020, surgical volume for cervical cancer dropped considerably, waiting time was significantly shorter for all malignancies, while neoadjuvant chemotherapy administration for advanced-stage ovarian cancer increased. The safety of perioperative healthcare was not negatively impacted by the pandemic, as complications and 30-day-mortality remained stable.

Abstract 3392: Ex vivo analysis of RAD51 foci induction in fresh tumor tissue: a promising new tool for the identification of homologous recombination-deficient tumors

Purpose. BRCA1 and BRCA2 related breast and ovarian tumors respond very well to treatment with PARP inhibitors (PARPi) because of their deficiency in homologous recombination (HR). We have indications that a substantial number of ovarian tumors might have deficiencies in HR unrelated to germline mutations in BRCA1 or BRCA2. A functional assay to assess HR efficacy might therefore allow identification of additional ovarian cancer patients that could benefit from PARPi treatment.

Experimental procedure. Unselected fresh ovarian tumor samples were collected from patients undergoing surgery or ascites/pleural fluid drainage. Samples were irradiated with ionizing radiation ex vivo, fixed after 2 hours and embedded in paraffin. Sections were stained with hematoxylin and eosin and examined by pathologist. The presence of RAD51 foci in replicating cells as visualized by immunofluorescence was used as a functional read out for HR proficiency.

Results. We determined the ability to induce RAD51 foci following radiation in ex vivo cultured ovarian tumor samples that contained sufficient numbers of replicating cells (n = 13). RAD51 foci formation was absent (<20% replicating cells showed RAD51 foci) in 46% of the samples. In one tumor sample that did not form RAD51 foci in replicating cells upon ionizing radiation, a pathogenic mutation in BRCA1 was identified (c.5277+1G>A). Genetic and epigenetic analyses of the other samples are ongoing.

Conclusion. The ex vivo analysis of RAD51 foci induction in fresh tumor tissue is a promising new tool to identify HR deficient tumors. Not only is it an important time saving strategy compared to BRCA1/BRCA2 mutation analysis, it may also identify a much broader patient population that will be eligible for the treatment with PARP inhibitors.

Citation Format: Maaike Vreeswijk, M. Meijers, K.A.T. Naipal, N.S. Verkaik, R. Kanaar, J.H.J. Hoeijmakers, A. Jager, D.C. van Gent, K.N. Gaarenstroom, V.T.H.B.M. Smit, H. Vrieling. Ex vivo analysis of RAD51 foci induction in fresh tumor tissue: a promising new tool for the identification of homologous recombination-deficient tumors. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3392. doi:10.1158/1538-7445.AM2015-3392

Human papillomavirus DNA and genotypes: prognostic factors for progression of cervical intraepithelial neoplasia

A retrospective study of 227 patients presenting with abnormal cervical cytology was conducted to investigate the relationship between human papillomavirus (HPV) and progression of untreated cervical intraepithelial neoplasia (CIN) lesions. All patients had colposcopically directed biopsies for histologic diagnosis. The patients were followed cytologically and colposcopically for a mean of 19 months (range 6-42 months). Progression of a cervical lesion was defined as progression to a higher CIN grade confirmed histologically by directed biopsy. HPV DNA detection was done on material remaining from the cervical swabs by the general primer polymerase chain reaction (PCR) and type-specific PCR method, which made the detection of HPV types 6, 11, 16, 18, 31, 33 and not yet sequenced DNA types (X) possible. The presence of HPV DNA increased with the severity of the lesion (P < 0.001). In CIN III, a 100% HPV DNA prevalence was found, with HPV type 16 being the most prevalent type in 75%. Progression was significantly related to the presence of HPV DNA, in particular HPV type 16. The percentage of progressive disease was 21% in the case of HPV DNA positive lesions (n = 130) and 29% in the presence of HPV type 16, whereas HPV DNA negative lesions (n = 97) showed no progression. The detection of HPV DNA and HPV genotype can be used to identify patients with high-risk cervical lesions, since the presence of HPV DNA and genotype 16 in particular are closely related to CIN progression.