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Kajtezovic S, Morgan JR, Fiascone S, Brandt HM, Perkins RB. Optimizing timing of adolescent vaccines: Impact of initiating HPV vaccination before Tdap or meningococcal vaccination on timely completion of the HPV vaccine series. Hum Vaccin Immunother 2023; 19:2175541. [PMID: 36798049 PMCID: PMC10026864 DOI: 10.1080/21645515.2023.2175541] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
To explore the impact on timely series completion of initiating the HPV vaccine series prior to other vaccines in the adolescent platform (Tdap or meningococcal vacccines), we created a cohort of children aged 9 in 2015 who were continuously enrolled through the age of 13 (2019) from a national administrative database of employee-sponsored insurance in the United States (MarketScan). Logistic regressions were used to predict the odds of HPV vaccine series completion among those who started the series prior to, concurrent with, or after receiving Tdap or meningococcal vaccination. The cohort included 100,857 eligible children. Compared with adolescents who received their HPV and Tdap or HPV and meningococcal vaccinations concurrently, those who received HPV prior to other vaccines had higher completion (aOR = 1.38 for Tdap, aOR 1.62 for meningococcal), while those who received their HPV vaccination after other vaccines had lower odds of HPV vaccine series completion (aOR = 0.68 for Tdap, aOR = 0.62 for meningococcal). Other factors associated with series completion included female sex, residing in an urban (vs. rural) area, residing in the Northeast, and receiving primary care from a pediatrician (vs. family medicine physician). These data indicate that beginning the HPV vaccine series prior to the adolescent platform may improve on-time series completion.
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Affiliation(s)
- Sidika Kajtezovic
- Department of Obstetrics and Gynecology, Boston University School of Medicine/Boston Medical Center, Boston, MA, USA
| | - Jake R Morgan
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA
| | - Stephen Fiascone
- Department of Obstetrics and Gynecology, Boston University School of Medicine/Boston Medical Center, Boston, MA, USA
| | - Heather M Brandt
- HPV Cancer Prevention Program, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Rebecca B Perkins
- Department of Obstetrics and Gynecology, Boston University School of Medicine/Boston Medical Center, Boston, MA, USA
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Lee YW, Morgan JR, Fiascone S, Perkins RB. Underscreening, overscreening, and guideline-adherent cervical cancer screening in a national cohort. Gynecol Oncol 2022; 167:181-188. [PMID: 36150914 DOI: 10.1016/j.ygyno.2022.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/08/2022] [Accepted: 09/10/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To explore rates of under- and overscreening for cervical cancer among a national cohort. METHODS The MarketScan database, a national administrative database of employee-sponsored insurance, was queried for elements relevant to cervical cancer screening among women aged 21-65 with 6 years of continuous enrollment (2015-2019). Average-risk women were defined as those without high-risk medical conditions or abnormal screening histories, and without evidence of hysterectomy with removal of the cervix for benign indications. Average-risk women were considered adequately screened if they had Pap tests alone at 2.5-3.5 year intervals, or HPV tests or co-tests at 4.5-5.5 year intervals. Logistic regressions were used to predict the odds of receiving guideline-adherent screening, underscreening, and overscreening. RESULTS Among 1,872,809 eligible patients, 1,471,063 (78.5%) qualified for routine screening. Of these, only 18.1% received guideline-adherent screening, and 25.4% were unscreened during the 6-year period. Younger women (aged 21-39) were more likely to be overscreened [OR 1.46]. Older women (aged 50-64) were more likely to be underscreened or unscreened during the study period [OR 2.54]. Guideline-adherent screening was highest with HPV testing alone (80%) followed by co-testing (44%), and lowest with cytology alone (15%). A total of 329,062 women in this general population sample (18%) met high-risk criteria that required increased frequency of screening. CONCLUSIONS High rates of both underscreening and overscreening indicate a need for additional strategies to improve guideline-adherent care. CLINICAL TRIAL REGISTRATION N/A.
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Affiliation(s)
- Yeon Woo Lee
- Department of Obstetrics and Gynecology, Boston University School of Medicine/Boston Medical Center, Boston, MA, United States of America.
| | - Jake R Morgan
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States of America.
| | - Stephen Fiascone
- Department of Obstetrics and Gynecology, Boston University School of Medicine/Boston Medical Center, Boston, MA, United States of America.
| | - Rebecca B Perkins
- Department of Obstetrics and Gynecology, Boston University School of Medicine/Boston Medical Center, Boston, MA, United States of America.
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Lee YW, Morgan J, Fiascone S, Perkins R. Cervical cancer screening practices: Rates of underscreening, overscreening, and guideline-adherent screening in a national cohort (379). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01601-8] [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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Gockley A, Pagacz K, Fiascone S, Stawiski K, Holub N, Hasselblatt K, Cramer DW, Fendler W, Chowdhury D, Elias KM. A Translational Model to Improve Early Detection of Epithelial Ovarian Cancers. Front Oncol 2022; 12:786154. [PMID: 35530324 PMCID: PMC9068948 DOI: 10.3389/fonc.2022.786154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 03/18/2022] [Indexed: 11/18/2022] Open
Abstract
Neural network analyses of circulating miRNAs have shown potential as non-invasive screening tests for ovarian cancer. A clinically useful test would detect occult disease when complete cytoreduction is most feasible. Here we used murine xenografts to sensitize a neural network model to detect low volume disease and applied the model to sera from 75 early-stage ovarian cancer cases age-matched to 200 benign adnexal masses or healthy controls. The 14-miRNA model efficiently discriminated tumor bearing animals from controls with 100% sensitivity down to tumor inoculums of 50,000 cells. Among early-stage patient samples, the model performed well with 73% sensitivity at 91% specificity. Applied to a population with 1% disease prevalence, we hypothesize the model would detect most early-stage ovarian cancers while maintaining a negative predictive value of 99.97% (95% CI 99.95%-99.98%). Overall, this supports the concept that miRNAs may be useful as screening markers for early-stage disease.
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Affiliation(s)
- Allison Gockley
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Konrad Pagacz
- Studies in Molecular Medicine, Medical University of Warsaw, Warsaw, Poland
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
| | - Stephen Fiascone
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Konrad Stawiski
- Studies in Molecular Medicine, Medical University of Warsaw, Warsaw, Poland
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
| | - Nicole Holub
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Kathleen Hasselblatt
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Daniel W. Cramer
- Harvard Medical School, Boston, MA, United States
- Obstetrics and Gynecology Epidemiology Center, Department of Obstetrics and Gynecology and Reproductive Biology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Wojciech Fendler
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Dipanjan Chowdhury
- Harvard Medical School, Boston, MA, United States
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Kevin M. Elias
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- *Correspondence: Kevin M. Elias,
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Matthews B, Qureshi M, Nitschmann C, Fiascone S, Mak K, Hirsch A, Truong M, Dyer M. Racial disparities in non-recommendation of adjuvant chemotherapy 'due to risk factors' in women with advanced ovarian cancer: A National Cancer Database study. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.06.130] [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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Gockley AA, Fiascone S, Hicks Courant K, Pepin K, Del Carmen M, Clark RM, Goldberg J, Horowitz N, Berkowitz R, Worley M. Clinical characteristics and outcomes after bowel surgery and ostomy formation at the time of debulking surgery for advanced-stage epithelial ovarian carcinoma. Int J Gynecol Cancer 2020; 29:585-592. [PMID: 30833444 DOI: 10.1136/ijgc-2018-000154] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 01/04/2019] [Accepted: 01/14/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE There are limited data on clinical outcomes of patients with advanced-stage epithelial ovarian cancer who require ostomy formation at the time of either primary cytoreductive surgery or interval cytoreductive surgery. The objective of this study was to evaluate patients undergoing bowel surgery and ostomy formation after primary or interval surgery. METHODS Patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIC-IV epithelial ovarian cancer who underwent cytoreductive surgery between January 2010 and December 2014 were identified retrospectively. Patients with non-epithelial histology, low-grade serous histology or incomplete medical records were excluded. Demographic and clinical data were collected and analyzed. Age, stage, co-morbidity index, pre-operative CA125, pre-operative albumin, and Aletti surgical complexity score were included in a multivariable logistic regression model to assess independent associations with ostomy formation. RESULTS A total of 554 patients were included in the study. Of these, 261 (47%) underwent primary cytoreduction and 293 (53%) underwent interval cytoreduction. Patients undergoing primary surgery were more likely to undergo bowel resection, compared with interval surgery patients (37.2% vs 14%, p<0.001). Of the 139 (25.1%) patients who underwent bowel surgery, 25 (18%) underwent ostomy formation (11 ileostomies and 14 colostomies). Rates of ostomy formation were similar between the groups (6.1% primary vs 3.1% interval, p=0.10). Patients undergoing ostomy formation were more likely to have longer mean operative time (335 vs 229 min, p<0.001) and undergo small and large bowel resections at the time of cytoreductive surgery (44% vs 14%, p<0.001). Multivariate analysis revealed that a high surgical complexity score was associated with ostomy formation. Of the patients who underwent ostomy formation, 13 (43.3%) underwent stoma reversal including 11 ileostomies and two colostomies. Median time to ostomy reversal was 7 months. CONCLUSION Bowel surgery is more common among patients undergoing primary surgery as compared with interval surgery, but this does not result in an increased risk of ostomy formation.
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Affiliation(s)
- Allison Ann Gockley
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Stephen Fiascone
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Katherine Hicks Courant
- Department of Obstetrics and Gynecology, Tufts Medical Center, Tufts Medical School, Boston, Massachusetts, USA
| | - Kristen Pepin
- Division of Minimally Invasive Gynecology, Department of Obstetrics, Gynecology and Reproductive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marcela Del Carmen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Rachel M Clark
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Joel Goldberg
- Divsion of Gastrointestinal and General Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Neil Horowitz
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Medicine, Harvard Medical School, Dana Farber Cancer Institute, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ross Berkowitz
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Medicine, Harvard Medical School, Dana Farber Cancer Institute, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael Worley
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Medicine, Harvard Medical School, Dana Farber Cancer Institute, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Hill EK, Stuckey A, Fiascone S, Raker C, Clark MA, Brown A, Gordinier M, Robison K. Gender and the Balance of Parenting and Professional Life among Gynecology Subspecialists. J Minim Invasive Gynecol 2019; 26:1088-1094. [DOI: 10.1016/j.jmig.2018.10.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 10/24/2018] [Accepted: 10/25/2018] [Indexed: 10/28/2022]
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Fiascone S, Danilack VA, Kao MJ, Cohen M, Singh K, Kalife E, Luis C, Lokich E, DiSilvestro P, Robison K. While women await surgery for type I endometrial cancer, depot medroxyprogesterone acetate reduces tumor glandular cellularity. Am J Obstet Gynecol 2018; 219:381.e1-381.e10. [PMID: 30063901 DOI: 10.1016/j.ajog.2018.07.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/18/2018] [Accepted: 07/24/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Multiple population-level studies have demonstrated an adverse effect of long wait times to surgery on survival for women with endometrial cancer. Other retrospective and nonrandomized prospective studies have shown that preoperative administration of depot medroxyprogesterone acetate decreases tumor glandular cellularity, which may be a surrogate marker for clinically meaningful tumor response. OBJECTIVE We sought to determine whether preoperative injection with depot medroxyprogesterone acetate decreases tumor glandular cellularity when compared to placebo injection in women awaiting hysterectomy for endometrial intraepithelial neoplasia or type I endometrial cancer, and to determine whether depot medroxyprogesterone acetate injection affects quality of life while waiting for surgery. STUDY DESIGN This was a double-blind, randomized controlled trial of 400-mg depot medroxyprogesterone acetate injection or 0.9% saline injection at the preoperative visit. Patients with recent use of progesterone analogs were excluded. A sample size of 76 patients (38 per arm) was calculated to detect a 20% difference in decreased glandular cellularity between arms. Pathologic characteristics including the primary outcome, tumor glandular cellularity, from patients' diagnostic biopsies were reviewed by 2 dedicated gynecologic pathologists and compared to posttreatment hysterectomy specimens. On the night prior to surgery, patients completed the Functional Assessment of Cancer Therapy-Endometrial Survey (Version 4) to report quality of life while waiting for surgery. In comparing characteristics between the intervention and control groups, t tests were used for continuous variables, and χ2 or Fisher exact tests were used where appropriate for categorical data. RESULTS From March 2015 through March 2016, 148 women were screened and 76 patients were enrolled. In all, 38 patients were randomized to and received depot medroxyprogesterone acetate injection and 38 were randomized to and received placebo injection. Demographics were similar between groups. Patients who received depot medroxyprogesterone acetate injection experienced a larger decrease in tumor glandular cellularity (mean change -64 [-31.8%] vs -14 [-5.5%] cells per quarter high-powered field in depot medroxyprogesterone acetate vs placebo groups, P = .002). This effect was most pronounced in women waiting ≥3 weeks for surgery. Several additional histologic and immunohistochemical markers of tumor differentiation and decreased cell proliferation were more pronounced in the depot medroxyprogesterone acetate group than in the placebo group. There were no significant differences in quality of life between groups on the Functional Assessment of Cancer Therapy-Endometrial Survey. Only 5.3% of patients who were approached declined to participate due to concerns regarding an intramuscular injection. CONCLUSION Administration of depot medroxyprogesterone acetate prior to surgery for type I endometrial cancers caused greater tumor effect than placebo injection. Injection of depot medroxyprogesterone acetate was acceptable to and well tolerated by patients. Depot medroxyprogesterone acetate may represent a meaningful bridge to surgery in women who can expect long wait times.
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Fiascone S, Gockley A, Pepin K, Goldberg J, DelCarmen M, Rauh-Hain J, Horowitz N, Berkowitz R, Worley M. Surgical consultants during cytoreduction for advanced ovarian cancer. Gynecol Oncol 2018. [DOI: 10.1016/j.ygyno.2018.04.201] [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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Dorney K, Hicks-Courant K, Gockley A, Fiascone S, Pepin K, del Carmen M, Rauh-Hain J, Berkowitz R, Horowitz N, Worley M. Factors associated with rates of venous thromboembolism in patients with advanced stage ovarian cancer undergoing neoadjuvant chemotherapy and the relationship with patient overall survival. Gynecol Oncol 2018. [DOI: 10.1016/j.ygyno.2018.04.349] [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: 10/28/2022]
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Gonzalez R, Gockley A, Hicks-Courant K, Fiascone S, del Carmen M, Clark R, Berkowitz R, Muto M, Horowitz N, Worley M. Readmissions among advanced ovarian cancer patients treated with neoadjuvant chemotherapy as compared to primary debulking surgery. Gynecol Oncol 2018. [DOI: 10.1016/j.ygyno.2018.04.519] [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: 10/28/2022]
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Gockley A, Fiascone S, Hicks-Courant K, Pepin K, del Carmen M, Rauh-Hain J, Goldberg J, Horowitz N, Berkowitz R, Worley M. An evaluation of bowel resection and ostomy formation among patients undergoing cytoreductive surgery for advanced-stage ovarian cancer. Gynecol Oncol 2018. [DOI: 10.1016/j.ygyno.2018.04.264] [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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Fiascone S, Vitonis A, Feldman S. Efficacy of intravaginal 5-fluorouracil as initial treatment for women with high-grade vaginal intraepithelial neoplasia. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.03.495] [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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Stuckey A, Hill E, Fiascone S, Brown A, Gordinier M, Raker C, Robison K. What is the impact of a career in gynecologic oncology on personal life? Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.04.443] [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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Stuckey A, Hill E, Fiascone S, Brown A, Gordinier M, Raker C, Robison K. Changing the balance between personal and professional life among female gynecologic oncologists: 1998 versus 2015. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.04.439] [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: 10/21/2022]
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Fiascone S, Stuckey A, Robison K, Hill E, Brown A, Gordinier M. Balancing Personal and Professional Life among Gynecologic Title: Balancing Personal and Professional Life among Gynecologic Oncologists. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.09.055] [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: 10/22/2022]
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Kadan Y, Fiascone S, McCourt C, Raker C, Granai CO, Steinhoff M, Moore RG. Predictive factors for the presence of malignant transformation of pelvic endometriosis. Eur J Obstet Gynecol Reprod Biol 2014; 185:23-7. [PMID: 25522113 DOI: 10.1016/j.ejogrb.2014.11.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [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: 08/13/2014] [Revised: 11/14/2014] [Accepted: 11/21/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine predictive factors for the presence of malignant transformation in ovarian endometriotic cysts. STUDY DESIGN This was an IRB approved, case control study analyzing patient data from 2004 to 2013. Pathology database records were searched to identify patients with benign endometrioma and ovarian carcinoma arising in the background of endometriosis. Inclusion criteria required each patient to have a preoperative diagnosis of adnexal mass and no other findings concerning for malignancy. Patient clinical records were queried for preoperative symptoms, serum CA125 levels and radiologic findings. Pathologic data were collected including histology, tumor grade and stage. RESULTS A total of 138 patients met inclusion criteria; 42 women with ovarian cancer arising in the background of endometriosis and 96 women with benign endometrioma. Women diagnosed with ovarian cancer were significantly older than women with endometriosis (53.6 vs. 39.2 years). There was no difference in presence of symptoms between the two groups. Women with malignant tumors were found to have significantly larger cysts (14 cm vs. 7.5 cm; p<0.0001) that were more often multilocular (45.7% vs. 12.2%; p<0.0001), and contained solid components (77.1% vs. 14.5%; p<0.0001). Among patients that were observed prior to surgery there was a significant difference in the change in size of the mass over time with 4.2 cm increase for cases vs. 1.0 cm increase for controls (p=0.02). Multiple logistic regression analysis indicated that for every 5 years increase in age there was an adjusted OR of 2.17 (p=0.003). An age of 49 years or greater had an 80.6% sensitivity (95% CI: 62.5-92.5%) and an 82.9% specificity (95% CI: 67.9-92.8%) for malignancy, and solid component on imaging had an adjusted OR of 23.7 (p<0.0001). Serum CA125 levels tended to be higher in patients with malignant tumors but did not reach statistical significance with a mean of 204.9 vs. 66.9 (p=0.1). CONCLUSIONS Significant predictors for malignant transformation of endometriosis include cyst characteristics and age. Women above the age of 49 with multilocular cysts and solid components are at high risk for malignant transformation of endometriosis. Serum CA125 level is not a significant predictor of malignant transformation.
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Affiliation(s)
- Yfat Kadan
- Program in Women's Oncology, Department of Obstetrics and Gynecology, Women and Infants Hospital, Alpert Medical School at Brown University, Providence, RI, United States.
| | - Stephen Fiascone
- Program in Women's Oncology, Department of Obstetrics and Gynecology, Women and Infants Hospital, Alpert Medical School at Brown University, Providence, RI, United States
| | - Carolyn McCourt
- Program in Women's Oncology, Department of Obstetrics and Gynecology, Women and Infants Hospital, Alpert Medical School at Brown University, Providence, RI, United States
| | - Chris Raker
- Division of Research, Department of Obstetrics and Gynecology, Women and Infants Hospital, Alpert Medical School at Brown University, Providence, RI, United States
| | - C O Granai
- Program in Women's Oncology, Department of Obstetrics and Gynecology, Women and Infants Hospital, Alpert Medical School at Brown University, Providence, RI, United States
| | - Margaret Steinhoff
- Department of Pathology, Women and Infants Hospital, Alpert Medical School at Brown University, Providence, RI, United States
| | - Richard G Moore
- Program in Women's Oncology, Department of Obstetrics and Gynecology, Women and Infants Hospital, Alpert Medical School at Brown University, Providence, RI, United States
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Abstract
The treatment of early-stage vulvar cancer has remained surgical over time. Fortunately, less invasive surgical options have emerged, decreasing the significant morbidity associated with treatment. In the past decade, sentinel lymph node (SLN) dissection alone in select patients with vulvar cancer has been shown to be safe, feasible and has decreased surgical morbidity. In addition, multiple recent studies have reported low groin recurrence rates in women that underwent SLN dissection alone, which are similar to groin recurrence rates seen among women that underwent complete inguinal lymph node dissection. We believe SLN dissection should be the standard of care in select patients at institutions with surgeons experienced in the SLN technique. We feel caution should be used when performing SLN dissections in large vulvar lesions and in midline lesions. Further information is needed regarding the appropriate treatment of positive sentinel lymph nodes and, in particular, on the management of micrometastases.
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Affiliation(s)
- Katina Robison
- Department of Obstetrics and Gynecology, Program in Women's Oncology, Women and Infants Hospital, Brown University, 101 Dudley Street Providence, RI, 02905, USA
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