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Hill SK, Bempong-Ahun N, Okolo ID, Lalla AT, Worku D, Asres T, Philpotts L, Fallah PN, Varallo J, Corlew S, Kamfwa P, Parham GP, Hicks ML, Ibbotson G, Randall T. Improving access to safe, quality surgical care for gynecologic cancers through capacity-building interventions in low- and middle-income countries: A scoping review. Int J Gynaecol Obstet 2024; 165:552-561. [PMID: 37927080 DOI: 10.1002/ijgo.15156] [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] [Received: 04/21/2023] [Revised: 07/16/2023] [Accepted: 09/10/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Following the launch of the World Health Organization's Strategy to accelerate the elimination of cervical cancer, diagnosis is expected to increase, especially in low- and middle-income countries (LMICs). A well-integrated surgical system is critical to treat cervical cancer. Two major approaches have been employed to build human capacity: task-sharing and training of gynecologic oncologists (GynOncs). OBJECTIVES This review aimed to explore existing literature on capacity-building for surgical management of early-stage gynecologic cancers. SEARCH STRATEGY The search strategy was registered on Open Science Framework (doi 10.17605/OSF.IO/GTRCB) and conducted on OVID Medline, Embase, Global Index Medicus, and Web of Science. Search results were exported and screened in COVIDENCE. SELECTION CRITERIA Studies published in English, Spanish, French, and/or Portuguese conducted in LMIC settings evaluating capacity building, task-sharing, or outcomes following operation by subspecialists compared to specialists were included. DATA COLLECTION AND ANALYSIS Results were synthesized using narrative synthesis approach with emergence of key themes by frequency. MAIN RESULTS The scoping review identified 18 studies spanning our themes of interest: capacity building, subspecialized versus non-subspecialized care, and task-shifting/-sharing. CONCLUSIONS A multilayered approach is critical to achieve the WHO Strategy to Eliminate Cervical Cancer. Capacity-building and task-sharing programs demonstrate encouraging results to meet this need; nevertheless, a standardized methodology is needed to evaluate these programs, their outcomes, and cost-effectiveness.
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Affiliation(s)
- Sarah K Hill
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Isioma Dianne Okolo
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
- The Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amber Trujillo Lalla
- The Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Obstetrics & Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Dawit Worku
- Department of Obstetrics and Gynecology, University Teaching Hospital of Kigali (CHUK), Kigali, Rwanda
| | - Tadios Asres
- Department of Obstetrics and Gynecology, Rwanda Military Hospital (RMH), Kigali, Rwanda
| | - Lisa Philpotts
- Treadwell Library, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Parisa N Fallah
- The Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Obstetrics & Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - John Varallo
- The Global Surgery Foundation, Geneva, Switzerland
| | - Scott Corlew
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul Kamfwa
- Department of Gynecologic Oncology, Cancer Diseases Hospital, Lusaka, Zambia
| | - Groesbeck P Parham
- Women and Newborn Hospital-University Teaching Hospital, Lusaka, Zambia
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Michael L Hicks
- Women and Newborn Hospital-University Teaching Hospital, Lusaka, Zambia
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Department of Gynecologic Oncology, Michigan Cancer Institute, St. Joseph Mercy Oakland, Pontiac, USA
| | - Geoffrey Ibbotson
- The Global Surgery Foundation, Geneva, Switzerland
- United Nations Institute for Training and Research, Geneva, Switzerland
| | - Thomas Randall
- The Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Haidopoulos D, Pergialiotis V, Papageorgiou M, Halaska MJ, Maxova K, Ulrich E, Zapardiel I, Rodolakis A, Gultekin M, Fotopoulou C. Lower Limb Lymphedema Awareness among Gynecological Cancer Patients: An International Survey Supported by the European Network of Gynecological Cancer Advocacy Groups (ENGAGe) Group. Cancers (Basel) 2024; 16:1544. [PMID: 38672626 PMCID: PMC11048365 DOI: 10.3390/cancers16081544] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/07/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Patient awareness of postoperative lymphedema in the field of gynecologic oncology has been poorly documented in the international literature. We wished to capture and document the awareness among gynecological cancer survivors about postoperative lymphedema, including aspects such as the adequacy of perioperative counseling, management, and quality of life. METHODS A web-based survey comprising 25 multiple-choice questions was distributed to gynecological cancer advocacy groups within the European Network of Gynecological Cancer Advocacy Groups (ENGAGe) group. The survey was validated in a pilot group of gynecological patients prior to distribution. RESULTS Overall, 386 women from 20 countries completed the questionnaire. Only half of the patients (n = 211) knew what lymphedema is, whereas 52% of the respondents stated that they were never informed at their pre-operative assessment about the potential risk of developing lymphedema. Fifty-three percent of those women who were informed about the risk and management of lymphedema received information through self-initiative, connecting mainly with patient groups or online. Approximately 84% of patients with lymphedema reported that they informed their doctor about their symptoms. Ninety-four patients (55.3%, which is not 55% of the 386) were treated for lymphedema. Forty-five women out of 136 reported that lymphedema significantly affected their everyday lives. DISCUSSION We report a large lack of awareness and a significant gap of knowledge about the risks and treatment options related to postoperative lymphedema among gynecological cancer survivors. Institutional practice routines and awareness among professionals need to be urgently recalled and adapted to adequately inform and support gynecological cancer patients.
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Affiliation(s)
- Dimitrios Haidopoulos
- First Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens, 2 Lour Street, 11522 Athens, Greece; (D.H.); (A.R.)
| | - Vasilios Pergialiotis
- First Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens, 2 Lour Street, 11522 Athens, Greece; (D.H.); (A.R.)
| | - Maria Papageorgiou
- "Erifyle" K.E.F.I. Gynecological Cancer Advocacy Group, 11526, Athens, Greece;
| | - Michael J. Halaska
- Department of Obstetrics and Gynaecology, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, 11000 Prague, Czech Republic; (M.J.H.); (K.M.)
| | - Katerina Maxova
- Department of Obstetrics and Gynaecology, Third Faculty of Medicine, Charles University, Faculty Hospital Kralovske Vinohrady, 11000 Prague, Czech Republic; (M.J.H.); (K.M.)
| | - Elena Ulrich
- N.N.Petrov Research Institute of Oncology, 197758 St. Petersburg, Russia;
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital-IdiPAZ, 28046 Madrid, Spain
| | - Alexandros Rodolakis
- First Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens, 2 Lour Street, 11522 Athens, Greece; (D.H.); (A.R.)
| | - Murat Gultekin
- Department of Obstetrics and Gynaecology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey;
| | - Christina Fotopoulou
- Department of Surgery and Cancer, Gynaecologic Oncology, Imperial College London, London W12 0HS, UK;
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Wilson EM, Eskander RN, Binder PS. Recent Therapeutic Advances in Gynecologic Oncology: A Review. Cancers (Basel) 2024; 16:770. [PMID: 38398161 PMCID: PMC10887183 DOI: 10.3390/cancers16040770] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
Gynecologic malignancies have high incidence rates both nationally and internationally, and cervical, endometrial, and ovarian cancers account for high mortality rates worldwide. Significant research is ongoing to develop targeted therapies to address unmet needs in the field and improve patient outcomes. As tumors mutate and progress through traditional lines of treatment, new therapies must be developed to overcome resistance and target cancer-specific receptors and mutations. Recent advances in the development of immunotherapy and antibody-drug conjugates have resulted in compelling and clinically meaningful results in cervical, endometrial, and ovarian cancers. In the last decade, several immunotherapy agents have received FDA approval or NCCN guideline recommendation for the treatment of gynecologic malignancies, including dostarlimab for advanced or recurrent endometrial cancer and pembrolizumab for advanced or recurrent cervical and endometrial cancers. Several other immunotherapeutic agents are under active investigation. Development of antibody-drug conjugates including tisotumab vedotin in cervical cancer, mirvetuximab soravtansine in ovarian cancer, and trastuzumab deruxtecan in multiple gynecologic cancers has translated into exciting efficacy signals, prompting full drug approvals and additional investigation. This article aims to review recent novel advances in targeted treatments for gynecologic malignancies, highlighting the trials and data underlying these novel interventions.
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Affiliation(s)
| | | | - Pratibha S. Binder
- Moores Cancer Center, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, San Diego, CA 92037, USA; (E.M.W.); (R.N.E.)
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Querleu D, Cibula D, Abu-Rustum NR, Fanfani F, Fagotti A, Pedone Anchora L, Ianieri MM, Chiantera V, Bizzarri N, Scambia G. International expert consensus on the surgical anatomic classification of radical hysterectomies. Am J Obstet Gynecol 2024; 230:235.e1-235.e8. [PMID: 37788719 DOI: 10.1016/j.ajog.2023.09.099] [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] [Received: 04/03/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND The anatomic descriptions and extents of radical hysterectomy often vary across the literature and operative reports worldwide. The same nomenclature is often used to describe varying procedures, and different nomenclature is often used to describe the same procedure despite the availability of guideline and classification systems. This makes it difficult to interpret retrospective surgical reports, analyze surgical databases, understand technique descriptions, and interpret the findings of surgical studies. OBJECTIVE In collaboration with international experts in gynecologic oncology, the purpose of this study was to establish a consensus in defining and interpreting the 2017 updated Querleu-Morrow classification of radical hysterectomies. STUDY DESIGN The anatomic templates of type A, B, and C radical hysterectomy were documented through a set of 13 images taken at the time of cadaver dissection. An online survey related to radical hysterectomy nomenclature and definitions or descriptions of the associated procedures was circulated among international experts in radical hysterectomy. A 3-step modified Delphi method was used to establish consensus. Image legends were amended according to the experts' responses and then redistributed as part of a second round of the survey. Consensus was defined by a yes response to a question concerning a specific image. Anyone who responded no to a question was welcome to comment and provide justification. A final set of images and legends were compiled to anatomically illustrate and define or describe a lateral, ventral, and dorsal excision of the tissues surrounding the cervix. RESULTS In total, there were 13 questions to review, and 29 experts completed the whole process. Final consensus exceeded 90% for all questions except 1 (86%). Questions with relatively lower consensus rates concerned the definitions of types A and B2 radical hysterectomy, which were the main innovations of the 2017 updated version of the 2008 Querleu-Morrow classification. Questions with the highest consensus rates concerned the definitions of types B1 and C, which are the most frequently performed radical hysterectomies. CONCLUSION The 2017 version of the Querleu-Morrow classification proved to be a robust tool for defining and describing the extent of radical hysterectomies with a high level of consensus among international experts in gynecologic oncology. Knowledge and implementation of the exact definitions of hysterectomy radicality are imperative in clinical practice and clinical research.
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Affiliation(s)
- Denis Querleu
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
| | - David Cibula
- Charles University and General University Hospital, First Faculty of Medicine, Prague, Czech Republic
| | - Nadeem R Abu-Rustum
- Department of Surgery, Gynecology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Francesco Fanfani
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Anna Fagotti
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Luigi Pedone Anchora
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Manuel Maria Ianieri
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS Civico - Di Cristina - Benfratelli, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Nicolò Bizzarri
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Giovanni Scambia
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
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Brent SE, McGee J, Vicus D, Kim R, Eisen A, Wilton AS, Gien LT. Rates of genetic consultation in high-grade serous ovarian cancer patients in the era of PARP inhibitor therapy: A population-based study. Int J Gynaecol Obstet 2024. [PMID: 38284267 DOI: 10.1002/ijgo.15391] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 01/06/2024] [Accepted: 01/09/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVE The American Society of Clinical Oncology recommends all patients with high-grade serous ovarian carcinoma (HGSC) undergo germline genetic testing. Genetic consultation rates in Ontario, Canada, only reached 13.3% in 2011. In 2016, PARP inhibitor maintenance therapy became available in Ontario for BRCA-positive HGSC patients. Given expanding treatment options, we re-examined genetic consultation rates among HGSC patients. METHODS This retrospective cohort study identified patients diagnosed with HGSC between 2012 and 2019 using population-based administrative data from Ontario. Genetics consultations were identified using Ontario Health Insurance Plan billing codes. Consultation rates over time were analyzed using Cochran-Armitage trend test and segmental regression analysis. Multivariable analysis identified factors associated with attending genetics consultation. RESULTS This study included 4645 HGSC patients. The mean age was 64.2 years (±SD 12.3); 56.3% had stage 3-4 disease. Overall, approximately 35% attended genetics consultations. The genetic consultation rate per year increased significantly from 21.6% to 42.6% (P < 0.001). Shorter times between diagnosis and genetics consult were observed after PARP inhibitors became available (68.1 vs 34.1 weeks, P < 0.001). Patients treated at designated cancer centers (odds ratio [OR] 2.11, P < 0.001), diagnosed in later years (OR 1.33, P < 0.001), and from higher income groups (P < 0.05) were more likely to attend genetics consultation; older patients were less likely (OR 0.98, P < 0.001). After PARP inhibitors became available, consultation rates plateaued (P < 0.001). CONCLUSIONS Between 2012 and 2019, genetic consultation rates improved significantly among HGSC patients; however, a large proportion of patients never attended consultation. Further exploration of barriers to care is warranted to improve consultation rates and ensure equitable access to care.
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Affiliation(s)
- Shannon E Brent
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
| | - Jacob McGee
- Department of Obstetrics and Gynaecology, Western University, London, Ontario, Canada
| | - Danielle Vicus
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
- Division of Gynecologic Oncology, Sunnybrook Odette Cancer Center, Toronto, Ontario, Canada
| | - Raymond Kim
- Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Andrea Eisen
- Department of Medical Oncology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, Ontario, Canada
| | | | - Lilian T Gien
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
- Division of Gynecologic Oncology, Sunnybrook Odette Cancer Center, Toronto, Ontario, Canada
- ICES Research, Toronto, Ontario, Canada
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Capozzi VA, De Finis A, Scarpelli E, Gallinelli A, Monfardini L, Cianci S, Gulino FA, Rotondella I, Celora GM, Martignon G, Ghi T, Berretta R. Infectious Complications in Laparoscopic Gynecologic Oncology Surgery within an ERAS-Compliant Setting. J Pers Med 2024; 14:147. [PMID: 38392581 PMCID: PMC10890568 DOI: 10.3390/jpm14020147] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/19/2024] [Accepted: 01/25/2024] [Indexed: 02/24/2024] Open
Abstract
Minimally Invasive Surgery (MIS) represents a safe and feasible option for the surgical treatment of gynecologic malignancies, offering benefits, including reduced blood loss, lower complications, and faster recovery, without compromising oncological outcomes in selected patients. MIS is widely accepted in early-stage gynecologic malignancies, including endometrial cancer, cervical tumors measuring 2 cm or less, and early-stage ovarian cancer, considering the risk of surgical spillage. Despite its advantages, MIS does not rule out the possibility of adverse events such as postoperative infections. This retrospective study on 260 patients undergoing laparoscopic surgery at Parma University Hospital for gynecologic malignancies explores the incidence and risk factors of postoperative infectious complications. The Clavien-Dindo classification was used to rank postoperative surgical complications occurring 30 days after surgery and Enhanced Recovery After Surgery (ERAS) recommendations put into practice. In our population, 15 (5.8%) patients developed infectious complications, predominantly urinary tract infections (9, 3.5%). Longer surgical procedures were independently associated with higher postoperative infection risk (p = 0.045). Furthermore, C1 radical hysterectomy correlated significantly with infectious complications (p = 0.001, OR 3.977, 95% CI 1.370-11.544). In conclusion, compared to prior research, our study reported a lower rate of infectious complications occurrence and highlights the importance of adopting infection prevention measures.
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Affiliation(s)
- Vito Andrea Capozzi
- Department of Medicine and Surgery, University Hospital of Parma, 43125 Parma, Italy
| | - Alessandra De Finis
- Department of Medicine and Surgery, University Hospital of Parma, 43125 Parma, Italy
| | - Elisa Scarpelli
- Department of Medicine and Surgery, University Hospital of Parma, 43125 Parma, Italy
| | - Asya Gallinelli
- Department of Medicine and Surgery, University Hospital of Parma, 43125 Parma, Italy
| | - Luciano Monfardini
- Department of Medicine and Surgery, University Hospital of Parma, 43125 Parma, Italy
| | - Stefano Cianci
- Unit of Gynecology and Obstetric, Department of Human Pathology of Adult and Childhood "G. Barresi", University of Messina, 98125 Messina, Italy
| | - Ferdinando Antonio Gulino
- Unit of Gynecology and Obstetrics, Department of Human Pathology of Adults and Developmental Age, University Hospital "G. Martino", 98100 Messina, Italy
| | - Isabella Rotondella
- Department of Medicine and Surgery, University Hospital of Parma, 43125 Parma, Italy
| | | | - Giulia Martignon
- Department of Medicine and Surgery, University Hospital of Parma, 43125 Parma, Italy
| | - Tullio Ghi
- Department of Medicine and Surgery, University Hospital of Parma, 43125 Parma, Italy
| | - Roberto Berretta
- Department of Medicine and Surgery, University Hospital of Parma, 43125 Parma, Italy
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How JA, Legarreta AF, Handley KF, Fellman B, Foster KI, Glassman D, Vuttaradhi VK, Brodsky AL, Lawson B, Frumovitz M, Westin SN, Ramondetta LM, Gershenson DM, Sood AK, Hillman RT. Serial cytoreductive surgery and survival outcomes in recurrent adult-type ovarian granulosa cell tumors. Am J Obstet Gynecol 2024:S0002-9378(24)00009-7. [PMID: 38191019 DOI: 10.1016/j.ajog.2024.01.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/20/2023] [Accepted: 01/02/2024] [Indexed: 01/10/2024]
Abstract
BACKGROUND Few studies have evaluated the role of cytoreductive surgery in patients with recurrent adult granulosa cell tumors of the ovary. Despite a multitude of treatment modalities in the recurrent setting, the optimal management strategy is not known. Cytoreductive surgery offers an attractive option for disease confined to the abdomen/pelvis. However, few studies have evaluated the role of surgery compared with systemic therapy alone following the first recurrence and subsequent disease progressions. OBJECTIVE This study aimed to determine the impact of secondary, tertiary, and quaternary cytoreductive surgery on survival outcomes in recurrent adult granulosa cell tumors of the ovary. STUDY DESIGN This is a multicenter, retrospective cohort study evaluating patients with recurrent adult granulosa cell tumors of the ovary enrolled in the MD Anderson Rare Gynecologic Malignancy Registry from 1970 to 2022. Study inclusion criteria consisted of histology-proven recurrent disease, at least 1 documented recurrence, and treatment/treatment planning at the MD Anderson Cancer Center or Lyndon B. Johnson General Hospital. The primary exposure was cytoreductive surgery, and the outcomes of interest were progression-free survival and overall survival. Survival analyses were restricted to eligible patients with resectable disease without medical barriers to surgery at each progression episode. Demographic and clinicopathologic characteristics were summarized using descriptive statistics. Progression-free survival (after first, second, and third progression) and overall survival were estimated with methods of Kaplan and Meier, and were modeled via Cox proportional hazards regression. Multivariable analyses were performed for progression-free survival after first progression and overall survival. RESULTS Among the 369 patients with adult granulosa cell tumors of the ovary in the registry, 149 patients met the study inclusion criteria. Secondary cytoreductive surgery was associated with a significant improvement in progression-free survival on univariable (hazard ratio, 0.37; 95% confidence interval, 0.17-0.81, P=.01) and multivariable analyses (hazard ratio, 0.42; 95% confidence interval, 0.19-0.92; P=.03). Those who underwent secondary cytoreductive surgery had a significantly improved median overall survival compared with those who did not undergo cytoreductive surgery (181.92 vs 61.56 months, respectively; P=.002). Overall survival benefit remained statistically significant on multivariable analysis (hazard ratio, 0.28; 95% confidence interval, 0.11-0.67; P=.004). Tertiary cytoreductive surgery was similarly associated with a significant improvement in progression-free survival (hazard ratio, 0.43; 95% confidence interval, 0.26-0.70; P=.001). Despite a similar trend, quaternary cytoreductive surgery was not associated with a significant improvement in progression-free survival (hazard ratio, 0.74; 95% confidence interval, 0.42-1.26; P=.27). CONCLUSION Among those with resectable disease and no medical contraindications to surgery, cytoreductive surgery may have a beneficial impact on progression-free survival and overall survival in patients with recurrent adult granulosa cell tumors of the ovary.
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Affiliation(s)
- Jeffrey A How
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Alejandra Flores Legarreta
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Katelyn F Handley
- Department of Gynecologic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Bryan Fellman
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Katherine I Foster
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Deanna Glassman
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Veena K Vuttaradhi
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Allison L Brodsky
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Barrett Lawson
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael Frumovitz
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Shannon N Westin
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lois M Ramondetta
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David M Gershenson
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Anil K Sood
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - R Tyler Hillman
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX; CPRIT Scholar in Cancer Research.
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8
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Lee SS, Dinicu AI, Arthurs L, Shields D, Pothuri B, Lightfoot MDS. Demographic reporting and language exclusion in gynecologic oncology clinical trials. Am J Obstet Gynecol 2024; 230:73.e1-73.e14. [PMID: 37751830 DOI: 10.1016/j.ajog.2023.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 04/13/2023] [Revised: 08/29/2023] [Accepted: 09/20/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Participation in clinical trials may help mitigate disparate cancer outcomes. Thus, ensuring equitable access to clinical trials is a major priority for national cancer organizations. OBJECTIVE This study aimed to examine clinical trial eligibility criteria that may adversely affect the enrollment of underrepresented groups and assess the availability of demographic information in published gynecologic oncology studies. STUDY DESIGN ClinicalTrials.gov was searched for gynecologic oncology studies conducted between 1997 and 2021. Each study's inclusion and exclusion criteria were reviewed to determine whether demographic factors were used for enrollment screening. For published studies, demographic variables that were reported were identified. The expected clinical trial enrollment based on disease incidence and mortality was compared with the observed trial enrollment based on race. RESULTS There were 1597 gynecologic oncology studies: 883 (55%) from ovarian cancer studies, 336 (21%) from cervical cancer studies, 262 (17%) from uterine cancer studies, and 116 (7%) from multisite gynecologic oncology studies. Of the 581 published studies, 554 (95%) reported age, 363 (63%) reported race, and 171 (29%) reported ethnicities. Cervical cancer studies were most likely to report demographic information, including race (P=.026) and ethnicity (P<.001). During the study period, 189 studies (12%) excluded patients based on the language spoken. Industry-sponsored trials (odds ratio, 0.07; 95% confidence interval, 0.02-0.30) and organization-sponsored trials (odds ratio, 0.40; 95% confidence interval, 0.22-0.73) were less likely to exclude patients because of language than investigator-initiated trials. A minority of patients (37%) in cervical cancer trials were of White race, compared with 85% of patients in uterine cancer trials and 82% of patients in ovarian cancer trials. CONCLUSION Over the last 3 decades, 1 in 10 gynecologic oncology trials excluded patients because of language. Race and ethnicity were reported in more than half of the available studies. Initiatives to increase transparency in recruiting underrepresented patients and reporting demographic data are urgently needed.
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Affiliation(s)
- Sarah S Lee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Perlmutter Cancer Center, New York University Langone Health, New York, NY; Bellevue Hospital, New York, NY
| | - Andreea I Dinicu
- Obstetrics & Gynecology Institute, Cleveland Clinic, Cleveland, OH
| | | | | | - Bhavana Pothuri
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Perlmutter Cancer Center, New York University Langone Health, New York, NY; Bellevue Hospital, New York, NY
| | - Michelle D S Lightfoot
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Perlmutter Cancer Center, New York University Langone Health, New York, NY; Bellevue Hospital, New York, NY.
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9
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Beesoon S, Drobot A, Smokeyday M, Ali AB, Collins Z, Reynolds C, Berzins S, Gibson A, Nelson G. Patient and Provider Experiences With a Digital App to Improve Compliance With Enhanced Recovery After Surgery (ERAS) Protocols: Mixed Methods Evaluation of a Canadian Experience. JMIR Form Res 2023; 7:e49277. [PMID: 38100170 PMCID: PMC10757223 DOI: 10.2196/49277] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 11/03/2023] [Accepted: 11/22/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Of all the care provided in health care systems, major surgical interventions are the costliest and can carry significant risks. Enhanced Recovery After Surgery (ERAS) is a bundle of interventions that help improve patient outcomes and experience along their surgical journey. However, given that patients can be overwhelmed by the multiple tasks that they are expected to follow, a digital application, the ERAS app, was developed to help improve the implementation of ERAS. OBJECTIVE The objective of this work was to conduct a thorough assessment of patient and provider experiences using the ERAS app. METHODS Patients undergoing colorectal or gynecological oncology surgery at 2 different hospitals in the province of Alberta, Canada, were invited to use the ERAS app and report on their experiences using it. Likewise, care providers were recruited to participate in this study to provide feedback on the performance of this app. Data were collected by an online survey and using qualitative interviews with participants. NVivo was used to analyze qualitative interview data, while quantitative data were analyzed using Excel and SPSS. RESULTS Overall, patients found the app to be helpful in preparation for and recovery after surgery. Patients reported having access to reliable unbiased information regarding their surgery, and the app provided them with clarity of actions needed along their surgical journey and enhanced the self-management of their care. Clinicians found that the ERAS app was easy to navigate, was simple for older adults, and has the potential to decrease unnecessary visits and phone calls to care providers. Overall, this proof-of-concept study on the use of a digital health app to accompany patients during their health care journey has shown positive results. CONCLUSIONS This is an important finding considering the massive investment and interest in promoting digital health in health care systems around the world.
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Affiliation(s)
- Sanjay Beesoon
- Surgery Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Ashley Drobot
- Health Systems Knowledge and Evaluation, Alberta Health Services, Edmonton, AB, Canada
| | - Melissa Smokeyday
- Surgery Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
| | - Al-Bakir Ali
- Health Systems Knowledge and Evaluation, Alberta Health Services, Edmonton, AB, Canada
| | - Zoe Collins
- Health Systems Knowledge and Evaluation, Alberta Health Services, Edmonton, AB, Canada
| | - Colin Reynolds
- Health Systems Knowledge and Evaluation, Alberta Health Services, Edmonton, AB, Canada
| | - Sandra Berzins
- Surgery Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Alison Gibson
- Okanagan College, Community Engagement and Careers, Okanagan, BC, Canada
| | - Gregg Nelson
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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10
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Hmaidan S, Goulder A, Bos L, Shen MJ, Wellman JD, Prescott L, Brown A. Too Close for Comfort? Attitudes of Gynecologic Oncologists Toward Caring for Dying Patients. Am J Hosp Palliat Care 2023; 40:1168-1173. [PMID: 36507696 DOI: 10.1177/10499091221145165] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 10/13/2023] Open
Abstract
PURPOSE To assess gynecologic oncologists' attitudes relating to palliative care referrals among advanced cancer patients. METHODS Gynecologic oncologists were surveyed using validated measures to assess stigmatizing attitudes toward palliative care, anticipated stigma of palliative care, acceptance of palliative care, and willingness to refer to palliative care. Descriptive statistics were calculated. Analysis was performed using linear regression. RESULTS 1200 physicians received the survey and 108 (9%) completed it. Most were female (69.4%) and white (82.4%). Most practiced in academics (64.8%) in urban environments (71.3%). Respondents did not have anticipated stigma surrounding palliative care referral (mean score 1.89, range 1-7, higher score indicating more stigma), were accepting of palliative care (mean score 1.45, range 1-7, higher score indicating less acceptance), and were willing to refer patients to palliative care (mean score 5.75, range 1-7, higher score indicating more willingness to refer). Linear regression demonstrated females had less anticipated stigma surrounding palliative care (B = -.213, P = .04) and higher acceptance of palliative care (B = -.244, P = .01). Most surveyed derived satisfaction from work with advanced cancer patients (83%). Nineteen percent were depressed by managing advanced cancer patients. One fourth felt emotionally burned out by dealing with too many deaths. CONCLUSIONS Most gynecologic oncologists did not exhibit stigma surrounding palliative care and derive satisfaction from their work. Some gynecologic oncologists experience depression and burnout related to their profession. This close connection with patients as they transition to the end of life may take a toll on providers.
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Affiliation(s)
- Sarah Hmaidan
- Department of OB/GYN, Vanderbilt University Medical Center, Nashville, TN
| | - Alison Goulder
- Department of Gynecologic Oncology, the Johns Hopkins Hospital, Baltimore, MD
| | - Lia Bos
- Department of OB/GYN, Vanderbilt University Medical Center, Nashville, TN
| | - Megan J Shen
- Department of Psychology, Fred Hutchinson Cancer Center, Seattle, WA
| | - J D Wellman
- Department of Psychology, University of Mississippi, University, MS
| | - Lauren Prescott
- Department of OB/GYN, Vanderbilt University Medical Center, Nashville, TN
| | - Alaina Brown
- Department of OB/GYN, Vanderbilt University Medical Center, Nashville, TN
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11
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Cohen A, Alter R, Meyer R, Guigue PA, Levin G. Gender leadership in gynecologic oncology professional societies worldwide. Int J Gynaecol Obstet 2023; 163:154-157. [PMID: 37218436 DOI: 10.1002/ijgo.14890] [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] [Received: 11/22/2022] [Revised: 04/22/2023] [Accepted: 05/09/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVE We aim to study gender representation among the different national gynecologic oncology (GO) societies' presidents over the past decade. METHODS A cross-sectional study examining the period 2013-2022. The leadership positions in 11 GO societies in the USA (SGO), internationally (IGCS), Europe (ESGO), Australia (ASGO), Israel (ISGO), Japan (JSGO), Asia-Oceania (AOGIN), India (INSGO), Latin America (SLAGO), South Africa (SASGO), and Turkey (TRSGO) was studied. The proportion of leadership positions held by women was calculated and trends were evaluated. RESULTS Overall, the average rate of women's representation during the study period was 26.4%, and for the different organizations was: SASGO 70.0%, SGO 50.0%, ESGO 40.0%, ASGO 30.0%, INSGO 30.0%, and IGCS, ISGO, and SLAGO 20.0% each, TRSGO 10%, and no representation of women in JSGO and AOGIN. There was a significant decrease from 2013 to 2016 (63.6% to 9.1%) (P = 0.009) in women's representation as presidents of societies. From 2017 to 2022, there was no difference in women's representation (ranging from 9.1% to 36.4%) (P = 0.13). CONCLUSIONS This study demonstrates that women are significantly under-represented in leadership positions in GO professional societies; however, in South Africa and the USA their representation in the last decade was close to equality.
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Affiliation(s)
- Adiel Cohen
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Roie Alter
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Raanan Meyer
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Gabriel Levin
- Department of Gynecologic Oncology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Lady Davis Institute for Cancer Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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12
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Karabacak P, Bindal A, Turan İ, Erdemoglu E, Ceylan BG. The NEWS2 score predicts prolonged hospitalization in the intensive care unit in major surgery patients. Turk J Obstet Gynecol 2023; 20:179-183. [PMID: 37667477 PMCID: PMC10478721 DOI: 10.4274/tjod.galenos.2023.04987] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/01/2023] [Indexed: 09/06/2023] Open
Abstract
Objective Gynecological malignancies are significant causes of mortality and morbidity in women worldwide. Although surgery is an important treatment method, both the extent of the surgery and the factors related to the patient affect postoperative processes. The National Early Warning Score 2 (NEWS2) is a simple, inexpensive, and safe early warning score developed in 2012 and updated in 2017. Although it is not commonly used in surgical patients, its use in patients who will undergo major surgery may provide insights about the postoperative process. This study investigates the importance of NEWS2 and its relationship in patients with for major gynecologic oncology surgery. Materials and Methods Forty-four patients with gynecologic malignancies scheduled for major abdominal surgery were included in this study. Patients with a NEWS-2 score of <3 were included in group 1, and patients with a NEWS-2 score of more than 3 were included in groups 2. NEWS2 Score, Sequential Organ Failure Assessment (SOFA), and Acute Physiology and Chronic Health Evaluation 2 scores (APACHE 2) were calculated. In addition, postoperative routine clinical and laboratory parameters were evaluated. Operation time, duration of intubation in the intensive care unit (ICU), the length of the intensive care stay, and length of hospitalization were recorded. Results Duration of intubation in the ICU in group 1 with a NEWS2 <3 [8.2 (0-18) vs 16.2 (3-39), respectively; p<0.01], ICU length of stay [21.6 (4-27) vs 47.3 (4-113), respectively; p<0.01], length of hospitalization [11.6 (5-56) vs 18.6 (8-67), respectively; p<0.01]. NEWS2 >3 was significantly higher compared to group 2. The SOFA score was significantly higher in group 2 compared with group 1 [1.2±0.5 vs 4.1±1.9; respectively; p<0.01]. In the correlation analysis, the NEWS2 score level was positively correlated with the SOFA score (p<0.001, r=0.81) and hospitalization time (p<0.001, r=0.60) and neutrophil lymphocyte ratio (NLR) (p<0.001, r=0.47). Conclusion These findings suggest that the NEWS2 score may be correlated with the length of intensive care intubation, length of intensive care stay, and length of hospitalization. NEWS2 is an effective and simple scoring system that provides information about postoperative outcomes in gynecologic oncology patients scheduled for major surgery.
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Affiliation(s)
- Pınar Karabacak
- Süleyman Demirel University Faculty of Medicine, Department of Anesthesiology and Reanimation, Division of Critical Care Medicine, Isparta, Turkey
| | - Ahmet Bindal
- Süleyman Demirel University Faculty of Medicine, Department of Anesthesiology and Reanimation, Division of Critical Care Medicine, Isparta, Turkey
| | - İlyas Turan
- Süleyman Demirel University Faculty of Medicine, Department of Gyneacologic Oncology, Isparta, Turkey
| | - Evrim Erdemoglu
- Süleyman Demirel University Faculty of Medicine, Department of Gyneacologic Oncology, Isparta, Turkey
| | - Berit Gökçe Ceylan
- Süleyman Demirel University Faculty of Medicine, Department of Anesthesiology and Reanimation, Isparta, Turkey
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13
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Downs LS, Nayar R, Gerndt J, Saslow D. Implementation in action: Collaborating on the transition to primary HPV screening for cervical cancer in the United States. CA Cancer J Clin 2023; 73:458-460. [PMID: 37347977 DOI: 10.3322/caac.21786] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 04/13/2023] [Indexed: 06/24/2023] Open
Affiliation(s)
- Levi S Downs
- Park Nicollet Health Services, Minneapolis, Minnesota, USA
| | - Ritu Nayar
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jane Gerndt
- American Cancer Society, Atlanta, Georgia, USA
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14
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Tan R, Liu M, Zhang Y, Li R. Editorial: The challenge of immunity evaluation and immunotherapy in gynecologic and urologic oncology. Front Immunol 2023; 14:1261229. [PMID: 37600796 PMCID: PMC10432282 DOI: 10.3389/fimmu.2023.1261229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 07/25/2023] [Indexed: 08/22/2023] Open
Affiliation(s)
- Ruirong Tan
- Center for Organoids and Translational Pharmacology, Translational Chinese Medicine Key Laboratory of Sichuan Province, Sichuan Institute for Translational Chinese Medicine, Sichuan Academy of Chinese Medicine Sciences, Chengdu, China
| | - Miao Liu
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Yiguan Zhang
- Center for Organoids and Translational Pharmacology, Translational Chinese Medicine Key Laboratory of Sichuan Province, Sichuan Institute for Translational Chinese Medicine, Sichuan Academy of Chinese Medicine Sciences, Chengdu, China
| | - Rui Li
- Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
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15
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Margul D, Yu C, AlHilli MM. Tumor Immune Microenvironment in Gynecologic Cancers. Cancers (Basel) 2023; 15:3849. [PMID: 37568665 PMCID: PMC10417375 DOI: 10.3390/cancers15153849] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
Gynecologic cancers have varying response rates to immunotherapy due to the heterogeneity of each cancer's molecular biology and features of the tumor immune microenvironment (TIME). This article reviews key features of the TIME and its role in the pathophysiology and treatment of ovarian, endometrial, cervical, vulvar, and vaginal cancer. Knowledge of the role of the TIME in gynecologic cancers has been rapidly developing with a large body of preclinical studies demonstrating an intricate yet dichotomous role that the immune system plays in either supporting the growth of cancer or opposing it and facilitating effective treatment. Many targets and therapeutics have been identified including cytokines, antibodies, small molecules, vaccines, adoptive cell therapy, and bacterial-based therapies but most efforts in gynecologic cancers to utilize them have not been effective. However, with the development of immune checkpoint inhibitors, we have started to see the rapid and successful employment of therapeutics in cervical and endometrial cancer. There remain many challenges in utilizing the TIME, particularly in ovarian cancer, and further studies are needed to identify and validate efficacious therapeutics.
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Affiliation(s)
| | | | - Mariam M. AlHilli
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Cleveland Clinic, Cleveland, OH 44195, USA; (D.M.); (C.Y.)
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16
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Ferrari F, Omodei AS, Ferrari FA, Soleymani Majd H, Ardighieri L, Vitale SG, Laganà AS, Angioni S, Ciravolo G, Odicino F. Diagnosis, Treatment and Prognosis of Mesonephric Adenocarcinoma of the Vagina: A Literature Review and a Case Report. J Clin Med 2023; 12:4846. [PMID: 37510961 PMCID: PMC10381470 DOI: 10.3390/jcm12144846] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/13/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Mesonephric adenocarcinoma (MA) of the vagina is a rare tumor that arises from mesonephric remnants (Wolffian) in the female genital tract. It is a neoplasm with no significant evidence about its diagnosis, treatment, follow-up and prognosis. METHODS Systematic research of the literature was conducted in Scopus, PubMed/MEDLINE, ScienceDirect and the Cochrane Library, including observational prospective and retrospective studies, case series and case reports. We collected data regarding studies related to diagnosis and treatment options evaluating the following aspects: study design, population, treatment type, rate of surgical complications and fertility outcome. We further included a case report of laparoscopic management of MA with pictorial assays. RESULTS Thirteen cases of MA of the vagina are available in the literature, including our case report. The median age at diagnosis was 52 years old; the majority of patients reported vaginal bleeding as a symptom (38%); and ultrasound, followed by a magnetic resonance and CT scan were the diagnostic tools most used. In 54% of the cases, a surgical biopsy was performed, and 92% of the patients underwent upfront surgery with an open access or vaginal resection except one case fully managed by minimally invasive surgery. Most of the patients (68%) received adjuvant treatment with chemotherapy or radiotherapy or a combination of them. The mean follow-up period was 6 years. CONCLUSIONS Despite the rarity of this cancer and bizarre location, a minimally invasive approach seems feasible after multidisciplinary evaluation. According to the rarity of this tumor, any future case and follow-up data must be reported in the literature in order to enlarge the knowledge about it.
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Affiliation(s)
- Federico Ferrari
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy
| | - Andrea Salvatore Omodei
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy
| | - Filippo Alberto Ferrari
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, 37122 Verona, Italy
| | - Hooman Soleymani Majd
- Department of Gynaecological Oncology, Churchill Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 7LE, UK
| | - Laura Ardighieri
- Department of Pathology, ASST Spedali Civili Brescia, 25123 Brescia, Italy
| | - Salvatore Giovanni Vitale
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS "Civico-Di Cristina-Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Stefano Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
| | - Giuseppe Ciravolo
- Department of Obstetrics and Gynecology, Spedali Civili of Brescia, 25123 Brescia, Italy
| | - Franco Odicino
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy
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17
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Cianci S, Gueli Alletti S. Editorial: Insights in gynecologic surgery 2021. Front Surg 2023; 10:1219534. [PMID: 37492620 PMCID: PMC10364591 DOI: 10.3389/fsurg.2023.1219534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/27/2023] [Indexed: 07/27/2023] Open
Affiliation(s)
- S. Cianci
- Department of Human Pathology of Adult and Childhood “G. Barresi”, Unit of Gynecology and Obstetrics, University of Messina, Messina, Italy
| | - S. Gueli Alletti
- Obstetrics and Gynecology Unit, Department of Woman and Child, Ospedale Buccheri La Ferla Fatebenefratelli, Palermo, Italy
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18
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Erdoğan Ö, Balci MF, Özgüzer A, Özdaş E, Görgülü G, Sanci M. Metastasis of endometrial cancer to breast: A rare case. J Obstet Gynaecol Res 2023; 49:1452-1455. [PMID: 36828642 DOI: 10.1111/jog.15621] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/31/2023] [Indexed: 02/26/2023]
Abstract
Only 2% of all breast cancers are metastatic, making them extremely uncommon. They are frequently mistaken for a primary breast tumor. Although it has been observed, metastatic spread from primary uterine cancers is extremely uncommon. In the literature, our case represents the fourth endometroid adenocarcinoma metastasis from the uterus. Clinical, pathological, and immunohistochemical examination and management of metastatic endometrioid adenocarcinoma of the uterus' extragenital organ were described in this 69-year-old patient's case. Immunohistochemical analysis was performed on a breast biopsy taken from the patient who underwent therapy and discovered a breast mass two years later. Metastatic endometrial adenocarcinoma was diagnosed with negative signs pointing to mammaglobin, GCDFP-15 and GATA3 breasts and markers indicating endometroid adenocarcinomas such as p53, PAX8 and VIMENTIN support. As a result, a thorough clinical history is needed, with special attention to diagnoses of concurrent or prior malignancies, along with clinical examination, appropriate radiological evaluation, and immunohistochemistry. This is necessary to prevent unnecessary surgery, to provide appropriate systemic treatment, to ensure correct diagnosis, and to manage treatment.
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Affiliation(s)
- Özgür Erdoğan
- Department of Gynaecologic Oncology, İzmir Tepecik Education and Research Hospital, Izmir, Turkey
| | - Mücahit Furkan Balci
- Department of Gynaecologic Oncology, İzmir Tepecik Education and Research Hospital, Izmir, Turkey
| | - Alp Özgüzer
- Department of Pathology, İzmir Tepecik Education and Research Hospital, Izmir, Turkey
| | - Emel Özdaş
- Department of Gynaecologic Oncology, İzmir Tepecik Education and Research Hospital, Izmir, Turkey
| | - Gökşen Görgülü
- Department of Gynaecologic Oncology, İzmir Tepecik Education and Research Hospital, Izmir, Turkey
| | - Muzaffer Sanci
- Department of Gynaecologic Oncology, İzmir Tepecik Education and Research Hospital, Izmir, Turkey
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19
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Chiofalo B, Laganà AS, Ghezzi F, Certelli C, Casarin J, Bruno V, Sperduti I, Chiantera V, Peitsidis P, Vizza E. Beyond Sentinel Lymph Node: Outcomes of Indocyanine Green-Guided Pelvic Lymphadenectomy in Endometrial and Cervical Cancer. Int J Environ Res Public Health 2023; 20:3476. [PMID: 36834170 PMCID: PMC9963568 DOI: 10.3390/ijerph20043476] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/08/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The aim of our study was to compare the number of lymph nodes removed during indocyanine green (ICG)-guided laparoscopic/robotic pelvic lymphadenectomy with standard systematic lymphadenectomy in endometrial cancer (EC) and cervical cancer (CC). METHODS This is a multicenter retrospective comparative study (Clinical Trial ID: NCT04246580; updated on 31 January 2023). Women affected by EC and CC who underwent laparoscopic/robotic systematic pelvic lymphadenectomy, with (cases) or without (controls) the use of ICG tracer injection within the uterine cervix, were included in the study. RESULTS The two groups were homogeneous for age (p = 0.08), Body Mass Index, International Federation of Gynaecology and Obstetrics (FIGO) stages (p = 0.41 for EC; p = 0.17 for CC), median estimated blood loss (p = 0.76), median operative time (p = 0.59), and perioperative complications (p = 0.66). Nevertheless, the number of lymph nodes retrieved during surgery was significantly higher (p = 0.005) in the ICG group (n = 18) compared with controls (n = 16). CONCLUSIONS The accurate and precise dissection achieved with the use of the ICG-guided procedure was associated with a higher number of lymph nodes removed in the case of systematic pelvic lymphadenectomy for EC and CC.
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Affiliation(s)
- Benito Chiofalo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS “Civico-Di Cristina-Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Women and Children Hospital, University of Insubria, 21100 Varese, Italy
| | - Camilla Certelli
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Women and Children Hospital, University of Insubria, 21100 Varese, Italy
| | - Valentina Bruno
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Isabella Sperduti
- Biostatistical Unit, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS “Civico-Di Cristina-Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Panagiotis Peitsidis
- Department of Obstetrics and Gynecology, Helena Venizelou Hospital, 115 21 Athens, Greece
| | - Enrico Vizza
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
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Kumari S, Lamichhane R, Giri S, Chaudhary S, Neupane S, Dangol N. Pheochromocytoma disguised as gestational hypertensive disease during pregnancy: A case report. Clin Case Rep 2023; 11:e6932. [PMID: 36789317 PMCID: PMC9913178 DOI: 10.1002/ccr3.6932] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/05/2023] [Accepted: 01/23/2023] [Indexed: 02/12/2023] Open
Abstract
Pheochromocytoma is often diagnosed prior to pregnancy. Sometimes, the disease may be diagnosed for the first-time during pregnancy masking itself as a hypertensive disease in pregnancy. Early diagnosis and timely, appropriate management reduce possible maternal and fetal complications. We identified a case of pheochromocytoma during pregnancy misdiagnosed as preeclampsia.
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Affiliation(s)
- Swati Kumari
- Department of Gynecology and ObstetricsTribhuvan University Institute of MedicineKathmanduNepal
| | | | - Subarna Giri
- Maharajgunj Medical CampusTribhuvan University Institute of MedicineKathmanduNepal
| | | | | | - Neha Dangol
- Nepal Cardio Diabetes and Thyroid CenterKathmanduNepal
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21
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Joost K, Washington K, Faurot M, Alexander RL, Craig KW, Tuller ER. Identifying the palliative care needs of patients and families in gynecologic surgical oncology: A scoping review. J Psychosoc Oncol 2023; 41:732-743. [PMID: 36752067 DOI: 10.1080/07347332.2023.2174474] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Introduction: Patients undergoing oncology-related gynecologic surgical procedures experience substantial symptom burden and distress. Support from specialist palliative care teams may benefit these patients and their families; however, an evidence-informed approach to the integration of palliative care and gynecologic surgical oncology is needed. To inform such an approach, a scoping review synthesizing current evidence on the palliative care needs of patients and families in gynecologic surgical oncology was conducted.Methods: Reviewers performed a structured search of online databases CINAHL, Scopus, PsycINFO, MEDLINE, and PubMed in addition to the grey literature to identify relevant studies published between 2011 and June 11th, 2021. The original search identified 993 articles, which were dually screened for study inclusion, resulting in a final sample of articles from which data were systematically extracted and synthesized.Results: This review of 59 publications predominantly consisted of European studies (n = 26, 44.1%), described quantitative study methods (n = 47, 79.6%), followed an observational study design (n = 49, 83.1%), and focused on psychological impact of treatment as a major topic of study (n = 21, 35.6%). The dataset also described sexual function of women post treatment (n = 15, 25.4%), quality of life (n = 10, 16.9%), therapeutic decision making (n = 9, 15.2%), pain assessment (n = 2, n = 3.6%), and medication for symptom management (n = 2, 3.6%). Explicit discussion of specialist palliative care involvement was rare.Conclusion: The needs of patients and families in gynecologic surgical oncology are well-suited to palliative care collaboration; however, the body of literature on palliative care services provided to this unique population is underdeveloped.
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Affiliation(s)
- Klaudia Joost
- School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Karla Washington
- Division of Palliative Medicine, Washington University, St. Louis, Missouri, USA
| | - Mary Faurot
- School of Medicine, University of Missouri, Columbia, Missouri, USA
| | | | - Kevin W Craig
- School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Erin R Tuller
- School of Medicine, University of Missouri, Columbia, Missouri, USA
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22
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Ratnaparkhi R, Spoozak L. When insight yields inaction: the role of implementation science in improving palliative care integration. Ann Palliat Med 2023; 12:274-279. [PMID: 36786101 DOI: 10.21037/apm-22-1438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 12/30/2022] [Indexed: 01/30/2023]
Affiliation(s)
- Rubina Ratnaparkhi
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Lori Spoozak
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Kansas School of Medicine, Kansas City, KS, USA; Department of Internal Medicine, Palliative Medicine Division, University of Kansas School of Medicine, Kansas City, KS, USA
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23
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Wang Y, Sheng Y. Editorial: Diagnosis and treatment of gynecologic malignancies during pregnancy. Front Oncol 2023; 13:1143610. [PMID: 36761936 PMCID: PMC9905800 DOI: 10.3389/fonc.2023.1143610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/26/2023] Open
Affiliation(s)
- Yudong Wang
- Department of Gynecologic Oncology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China,Shanghai Municipal Key Clinical Specialty, Female Tumor Reproductive Specialty, Shanghai, China,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai Jiao Tong University, Shanghai, China,*Correspondence: Yudong Wang,
| | - Yaru Sheng
- Department of Gynecologic Oncology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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24
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Wang Y, Bu X, Liu Y, Xing Y, Tong Q. Characteristics and treatment strategies of aggressive angiomyxoma in women: A retrospective review of 87 cases. Front Surg 2023; 10:966971. [PMID: 37139188 PMCID: PMC10149767 DOI: 10.3389/fsurg.2023.966971] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 03/24/2023] [Indexed: 05/05/2023] Open
Abstract
Objective Aggressive angiomyxoma (AAM) is a rare kind of soft tissue tumor. The purpose of this study is to summarize the clinical manifestations and treatment strategy of AAM in women. Method We searched the case reports on AAM in EMBASE, Web of Science and PubMed, China biomedical database, Wanfang database, VIP database, and China National Knowledge Internet from the start of database construction to November 2022 without any language restrictions in place. Then, the obtained case data were extracted, summarized, and analyzed. Result A total of 74 articles were retrieved involving 87 cases. The age ranges of onset were 2-67 years. The median age at onset was 34 years. The size of the tumor varied greatly among individuals, and about 65.5% of them were asymptomatic. MRI, ultrasound, and needle biopsy were used for diagnosis. Surgery was the primary mode of treatment, but it was prone to relapse. Gonadotropin-releasing hormone agonist (GnRH-a) might be used to reduce the tumor size before the operation and prevent recurrence after the operation. For patients who are unwilling to receive surgical treatment, GnRH-a alone could be attempted. Conclusion Doctors should consider the possibility of AAM in women with genital tumors. For surgery, it must be ensured that the negative surgical margin is recommended and achieved for preventing recurrence, but we should not ignore the impact of the excessive pursuit for a negative margin on the patient's reproductive function protection and postoperative recovery. Long-term follow-up is necessary regardless of whether patients receive medical treatment or surgical treatment.
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25
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Underkofler KA, Ring KL. Updates in gynecologic care for individuals with lynch syndrome. Front Oncol 2023; 13:1127683. [PMID: 36937421 PMCID: PMC10014618 DOI: 10.3389/fonc.2023.1127683] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/16/2023] [Indexed: 03/05/2023] Open
Abstract
Lynch syndrome is an autosomal dominant hereditary cancer syndrome caused by germline pathogenic variants (PVs) in DNA mismatch repair genes (MLH1, MSH2, PMS2, MSH6) or the EPCAM gene. It is estimated to affect 1 in 300 individuals and confers a lifetime risk of cancer of 10-90%, depending on the specific variant and type of cancer. Lynch syndrome is the most common cause of inherited colorectal cancer, but for women, endometrial cancer is more likely to be the sentinel cancer. There is also evidence that certain PVs causing Lynch syndrome confer an increased risk of ovarian cancer, while the risk of ovarian cancer in others is not well defined. Given this, it is essential for the practicing gynecologist and gynecologic oncologist to remain up to date on the latest techniques in identification and diagnosis of individuals with Lynch syndrome as well as evidence-based screening and risk reduction recommendations for those impacted. Furthermore, as the landscape of gynecologic cancer treatment shifts towards treatment based on molecular classification of tumors, knowledge of targeted therapies well-suited for mismatch repair deficient Lynch tumors will be crucial. The objective of this review is to highlight recent updates in the literature regarding identification and management of individuals with Lynch syndrome as it pertains to endometrial and ovarian cancers to allow gynecologic providers the opportunity to both prevent and identify Lynch-associated cancers earlier, thereby reducing the morbidity and mortality of the syndrome.
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26
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Wang AJ, Gao Y, Shi YY, Dai MY, Cai HB. A review of recent advances on single use of antibody-drug conjugates or combination with tumor immunology therapy for gynecologic cancer. Front Pharmacol 2022; 13:1093666. [PMID: 36618922 PMCID: PMC9813853 DOI: 10.3389/fphar.2022.1093666] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
Immune checkpoint inhibitors have made significant progress in the treatment of various cancers. However, due to the low ICI responsive rate for the gynecologic cancer, ICI two-drug combination therapy tends to be a predominant way for clinical treatment. Antibody-drug conjugates, a promising therapeutic modality for cancer, have been approved by the FDA for breast cancer, lymphoma, multiple myeloma and gastric cancer. On September 2021, the FDA granted accelerated approval to tisotumab vedotin for patients with recurrent or metastatic cervical cancer. Currently, the role of therapy of ADCs on gynecologic tumors was also included in medication regimens. Now more than 30 ADCs targeting for 20 biomarkers are under clinical trials in the field, including monotherapy or combination with others for multiple lines of therapy. Some ADCs have been proved to enhance the antitumor immunity effect on both pre-clinical models and clinical trials. Therefore, combination of ADCs and ICIs are expected in clinical trials. In this review, we discuss current development of ADCs in gynecologic oncology and the combination effects of ICIs and ADCs.
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Affiliation(s)
- An-Jin Wang
- Department of Gynecological Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China,Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, Hubei, China,Hubei Cancer Clinical Study Center, Wuhan, Hubei, China
| | - Yang Gao
- Department of Gynecological Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China,Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, Hubei, China,Hubei Cancer Clinical Study Center, Wuhan, Hubei, China
| | - Yu-Ying Shi
- Department of Gynecological Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China,Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, Hubei, China,Hubei Cancer Clinical Study Center, Wuhan, Hubei, China
| | - Meng-Yuan Dai
- Department of Gynecological Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China,Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, Hubei, China,Hubei Cancer Clinical Study Center, Wuhan, Hubei, China,*Correspondence: Meng-Yuan Dai, ; Hong-Bing Cai,
| | - Hong-Bing Cai
- Department of Gynecological Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China,Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, Hubei, China,Hubei Cancer Clinical Study Center, Wuhan, Hubei, China,*Correspondence: Meng-Yuan Dai, ; Hong-Bing Cai,
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27
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Capozzi VA, Monfardini L, Scarpelli E, Barresi G, Rotondella I, De Finis A, Scebba D, Maglietta G, Cianci S, Ghi T, Berretta R. Urologic Complication after Laparoscopic Hysterectomy in Gynecology Oncology: A Single-Center Analysis and Narrative Review of the Literature. Medicina (Kaunas) 2022; 58. [PMID: 36557071 DOI: 10.3390/medicina58121869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
Background and Objectives: Minimally invasive surgery (MIS) has recently increased its application in the treatment of gynecological malignancies. Despite technological and surgical advances, urologic complications (UC) are still the main concern in gynecology surgery. Current literature reports a wide range of urinary tract injuries, and consistent scientific evidence is still lacking or dated. This study aims to report a large single-center experience of urinary complications during laparoscopic hysterectomy for gynecologic oncologic disease. Materials and Methods: All patients who underwent laparoscopic hysterectomy for gynecologic malignancy at the Department of Medicine and Surgery of the University Hospital of Parma from 2017 to 2021 were retrospectively included. Women with endometrial cancer, cervical cancer, ovarian cancer, uterine sarcoma, or borderline ovarian tumors were included. Patients undergoing robotic surgery with incomplete anatomopathological data or patients lost during follow-up were excluded from the analysis. Intraoperative and postoperative UC were analyzed and ranked according to the Clavien-Dindo classification. Results: Two hundred-sixty patients were included in the study: 180 endometrial cancer, 18 cervical cancer, nine ovarian cancer, two uterine sarcomas, and 60 borderline ovarian tumors. Nine (3.5%) UCs were reported (five intraoperative and four postoperative complications). No anamnestic variables showed a statistical correlation with the surgical complication in the univariable analyses. C1 radical hysterectomy, a higher FIGO stage, and postoperative adjuvant treatment (p-value = 0.001, p-value = 0.046, and p-value = 0.046, respectively) were independent risk factors associated with the occurrence of UC. Conclusions: The urological complication rates in patients with oncological disease are relatively rare events in the expert hands of dedicated surgeons. Radical hysterectomy, FIGO stage, and adjuvant treatment are independent factors associated with urinary complications.
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28
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Krawczyk P, Trojnarska D, Baran R, Lonc T, Swistek R, Tyszecki P, Jach R. Postoperative gynecologic oncology admissions to intensive care unit in the tertiary care center: an eight-year retrospective study. Ginekol Pol 2022:VM/OJS/J/89893. [PMID: 36448350 DOI: 10.5603/gp.a2022.0133] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 10/04/2022] [Accepted: 10/09/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES The purpose of the study was to analyze the cohort of gynecologic oncology patients admitted to intensive care unit (ICU). MATERIAL AND METHODS We conducted a retrospective study including all ICU postoperative admissions related to adult female patients with gynecological malignancies diagnosis treated in the tertiary care center between Jan 1, 2007, and Dec 31, 2014. RESULTS A total of 666 women were admitted to ICU. It accounted for 2 % of all tertiary care center gynecology admissions. The mean age was 62.4 ± 12.7 years, and the mean length of stay was 8.9 ± 9.6 days. One hundred seventeen women (17.5%) required mechanical ventilation, and 220 women (33%) vasoactive drug infusion. The most common malignancy in the observed cohort of patients was ovarian cancer 326 (48.9%), followed by endometrial cancer 206 (30.9%). The patients with respiratory or circulatory insufficiency were older (mean age 64.9 ± 11.8 vs 60.8 ± 13; p < 0.001) and had longer mean ICU stay (13.1 ± 13.9 vs 6.3 ± 3.5 days; p < 0.001). We found a decrease in ICU admissions of patients without respiratory and circulatory failure after elective major surgery (Spearman: r = -1, p = 0.017). We report 21 patients' deaths (3.1% in the cohort; 0.06% of all admissions). CONCLUSIONS Ovarian cancer patients were the largest group in the study, representing almost half of ICU admissions in the gynecology oncologic population. Older age was the risk factor of respiratory and circulatory insufficiency. Availability of intermediate care facilities could reduce ICU admissions after major surgery.
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Affiliation(s)
- Pawel Krawczyk
- Department of Anesthesiology and Intensive Care Medicine, Jagiellonian University Medical College, Cracow, Poland.
| | - Dominika Trojnarska
- Department of Obstetrics and Gynaecology, Jagiellonian University Medical College, Cracow, Poland, Poland
| | - Rafal Baran
- Department of Gynecological Endocrinology and Gynecology, University Hospital, Cracow, Poland, Poland
| | - Tomasz Lonc
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, Cracow, Poland
| | - Rafal Swistek
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, Cracow, Poland
| | - Pawel Tyszecki
- Department of Anesthesiology and Intensive Care Medicine, 5th Military Hospital with Polyclinic, Cracow, Poland
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, Cracow, Poland
| | - Robert Jach
- Department of Obstetrics and Gynaecology, Jagiellonian University Medical College, Cracow, Poland, Poland
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29
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Liang S, Richardson MT, Wong D, Chen T, Colocci N, Kapp DS, de Bruin M, Kurian A, Chan J. The effect of COVID-19 on telehealth: Next steps in a post-pandemic life. Int J Gynaecol Obstet 2022; 159:996-997. [PMID: 35976039 PMCID: PMC9538136 DOI: 10.1002/ijgo.14411] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/14/2022] [Accepted: 08/02/2022] [Indexed: 11/07/2022]
Abstract
Older patients and those who require interpreters are least likely to use telehealth for gynecologic oncology care, showing disparities which continued after statewide vaccinations.
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Affiliation(s)
| | - Michael T. Richardson
- Department of Obstetrics and GynecologyUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Deanna Wong
- Department of Obstetrics and GynecologyUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Tony Chen
- Sutter HealthSan FranciscoCaliforniaUSA
| | | | - Daniel S. Kapp
- Stanford University School of MedicinePalo AltoCaliforniaUSA
| | | | - Allison Kurian
- Stanford University School of MedicinePalo AltoCaliforniaUSA
| | - John K. Chan
- Sutter HealthSan FranciscoCaliforniaUSA,Division of Gynecologic OncologyCalifornia Pacific/Palo Alto/Sutter Health Research InstituteSan FranciscoCaliforniaUSA
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30
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Moinard M, Augustin J, Carrier M, Da Maïa E, Penel A, Belghiti J, Nikpayam M, Gonthier C, Canlorbe G, Acherar S, Delhem N, Frochot C, Uzan C, Azaïs H. Residual Microscopic Peritoneal Metastases after Macroscopic Complete Cytoreductive Surgery for Advanced High-Grade Serous Ovarian Carcinoma: A Target for Folate Receptor Targeted Photodynamic Therapy? Pharmaceuticals (Basel) 2022; 15:1034. [PMID: 36015182 DOI: 10.3390/ph15081034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/07/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022] Open
Abstract
Despite conventional treatment combining complete macroscopic cytoreductive surgery (CRS) and systemic chemotherapy, residual microscopic peritoneal metastases (mPM) may persist as the cause of peritoneal recurrence in 60% of patients. Therefore, there is a real need to specifically target these mPM to definitively eradicate any traces of the disease and improve patient survival. Therapeutic targeting method, such as photodynamic therapy, would be a promising method for such a purpose. Folate receptor alpha (FRα), as it is specifically overexpressed by cancer cells from various origins, including ovarian cancer cells, is a good target to address photosensitizing molecules. The aim of this study was to determine FRα expression by residual mPM after complete macroscopic CRS in patients with advanced high-grade serous ovarian cancer (HGSOC). A prospective study conducted between 1 June 2018 and 10 July 2019 in a single referent center accredited by the European Society of Gynecological Oncology for advanced EOC surgical management. Consecutive patients presenting with advanced HGSOC and eligible for complete macroscopic CRS were included. Up to 13 peritoneal biopsies were taken from macroscopically healthy peritoneum at the end of CRS and examined for the presence of mPM. In case of detection of mPM, a systematic search for RFα expression by immunohistochemistry was performed. Twenty-six patients were included and 26.9% presented mPM. In the subgroup of patients with mPM, FRα expression was positive on diagnostic biopsy before neoadjuvant chemotherapy for 67% of patients, on macroscopic peritoneal metastases for 86% of patients, and on mPM for 75% of patients. In the subgroup of patients with no mPM, FRα expression was found on diagnostic biopsy before neoadjuvant chemotherapy in 29% of patients and on macroscopic peritoneal metastases in 78% of patients. FRα is well expressed by patients with or without mPM after complete macroscopic CRS in patients with advanced HGSOC. In addition to conventional cytoreductive surgery, the use of a therapeutic targeting method, such as photodynamic therapy, by addressing photosensitizing molecules that specifically target FRα may be studied.
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31
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Chieffo DPR, Lafuenti L, Mastrilli L, De Paola R, Vannuccini S, Morra M, Salvi F, Boškoski I, Salutari V, Ferrandina G, Scambia G. Medi-Cinema: A Pilot Study on Cinematherapy and Cancer as A New Psychological Approach on 30 Gynecological Oncological Patients. Cancers (Basel) 2022; 14:cancers14133067. [PMID: 35804839 PMCID: PMC9265104 DOI: 10.3390/cancers14133067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Several subjects affected by cancer experience a significant level of multidimensional disease. This longitudinal study aims to evaluate the effectiveness of psycho-oncological support using Cinema as an emotional mediator and to promote perceived well-being by personalized psychological treatment. Methods: Thirty women diagnosed with gynecological cancer watched 12 movies and participated in a psychotherapy group co-conducted by two psychotherapists. Patients completed nine questionnaires at T0 (baseline), T1 (3 months) and T2 (6 months). Results: Patients observed significant improvements (CORE-OM: p < 0.001) in psychological well-being. The results showed statistically significant differences, even in several other dimensions, such as Anxiety (STAY-Y1-2: p < 0.001), Empathy (BEES, p < 0.001), Coping (COPE: p < 0.001), QoL (QLQ-C30, p: 0.026), couple relationship (DAS, Satisfaction: p: 0.013; Cohesion: p: 0.004) and alexithymia (TAS-20, Difficulty Identifying Feeling: p: 0.002; Externally-Oriented Thinking: p: 0.003). Conclusions: The data show that cinema, as an innovative psychological approach, could be a valid instrument to support patients in oncological pathways as well as facilitating the process of recognizing themselves in other patients and communicating about their own feelings.
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Affiliation(s)
- Daniela Pia Rosaria Chieffo
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.P.R.C.); (L.M.); (R.D.P.); (S.V.)
- Medicine and Surgery Faculty, Catholic University of the Sacred Heart, 00168 Rome, Italy;
| | - Letizia Lafuenti
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.P.R.C.); (L.M.); (R.D.P.); (S.V.)
- Gynecologic Oncology Unit, Women Wealth Area, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.S.); (G.F.)
- Correspondence: ; Tel.: +39-3489003122
| | - Ludovica Mastrilli
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.P.R.C.); (L.M.); (R.D.P.); (S.V.)
- Gynecologic Oncology Unit, Women Wealth Area, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.S.); (G.F.)
| | - Rebecca De Paola
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.P.R.C.); (L.M.); (R.D.P.); (S.V.)
| | - Sofia Vannuccini
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (D.P.R.C.); (L.M.); (R.D.P.); (S.V.)
| | - Marina Morra
- Medicinema Italia Onlus, 20122 Milan, Italy; (M.M.); (F.S.)
| | - Fulvia Salvi
- Medicinema Italia Onlus, 20122 Milan, Italy; (M.M.); (F.S.)
| | - Ivo Boškoski
- Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - Vanda Salutari
- Gynecologic Oncology Unit, Women Wealth Area, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.S.); (G.F.)
| | - Gabriella Ferrandina
- Gynecologic Oncology Unit, Women Wealth Area, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.S.); (G.F.)
| | - Giovanni Scambia
- Medicine and Surgery Faculty, Catholic University of the Sacred Heart, 00168 Rome, Italy;
- Gynecologic Oncology Unit, Women Wealth Area, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (V.S.); (G.F.)
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Grubbs A, Barber EL, Roque DR. Healthcare Disparities in Gynecologic Oncology. Adv Oncol 2022; 2:119-128. [PMID: 35669851 PMCID: PMC9165691 DOI: 10.1016/j.yao.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- Allison Grubbs
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Emma L Barber
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Robert H Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Dario R Roque
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Robert H Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Chen Z, Zhong M, Xu Z, Ye Q, Xie W, Gao S, Chen L, Qiu L, Jiang J, Wu H, Li X, Wang H. Development and Validation of a Nomogram Based on Geriatric Nutritional Risk Index to Predict Surgical Site Infection Among Gynecologic Oncology Patients. Front Nutr 2022; 9:864761. [PMID: 35571957 PMCID: PMC9097080 DOI: 10.3389/fnut.2022.864761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/05/2022] [Indexed: 12/29/2022] Open
Abstract
Background The geriatric nutritional risk index (GNRI) is a commonly used method to assess nutritional risk for predicting potential surgical site infections (SSI) in cancer patients. This study aims to create and verify a simple nomogram and a dynamic web-based calculator for predicting the risk of SSI among gynecologic oncology patients. Methods A retrospective evaluation was conducted on patients who were admitted into a tertiary hospital in China with confirmed diagnosis of gynecologic cancer between 01 August 2017 and 30 November 2021. A two-piecewise linear regression model with a smoothing function was used to investigate the non-linear association between GNRI and SSI to determine the ideal cut-off point. Three models were developed on the basis of different variables to predict SSI in gynecologic oncology patients. Through a nomogram the concordance index (C-index), the Akaike information criterion (AIC), and the integrated discrimination index (IDI) were used to determine the final model. Finally, the performance of the nomogram was validated using the 1,000-bootstrap resamples method and analyzed using C-index, GiViTI calibration belts, and decision curve. Also, a user-friendly dynamic web-based calculator was developed. Results A total of 1,221 patients were included in the analysis. A non-linear association could be observed between GNRI and SSI risk with a GNRI cut-off value of 101.7. After adding GNRI to Model 2 (which comprised Morse Fall Scale score, preoperative length of stay, operation time, and estimated blood loss), the AIC value decreased, the C-index value increased and IDI increased significantly. The nomogram C-index in the development cohort and internal validation cohort demonstrates a moderate-high degree of discrimination. The GiViTI calibrated belt showed a good agreement between the observed and predicted probabilities of SSI. The decision curve validates the clinical feasibility of the nomogram with a threshold value between 0 and 49%. Conclusion The GNRI cut-off value of 101.7 allowed for appropriate stratification of patients into distinct SSI risk groups. This study found that including GNRI in the above nomogram (Model 2) would enhance its potential to predict SSI in gynecologic oncology patients.
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Affiliation(s)
- Zhihui Chen
- Department of Infection Control, Wenzhou People’s Hospital, Wenzhou, China
- Department of Epidemiology and Biostatistics, Center for Clinical Big Data and Statistic, Second Affiliated Hospital, Medicine College, Zhejiang University, Hangzhou, China
| | - Mingchen Zhong
- Scientific Research Center, Wenzhou People’s Hospital, Wenzhou, China
| | - Ziqin Xu
- Department of Infection Control, Wenzhou People’s Hospital, Wenzhou, China
| | - Qing Ye
- Xinglin Information Technology Company, Hangzhou, China
| | - Wenwen Xie
- Department of Gynecology, Wenzhou People’s Hospital, Wenzhou, China
| | - Shengchun Gao
- Department of Infection Control, Wenzhou People’s Hospital, Wenzhou, China
| | - Le Chen
- Department of Infection Control, Wenzhou People’s Hospital, Wenzhou, China
| | - Lidan Qiu
- Department of Infection Control, Wenzhou People’s Hospital, Wenzhou, China
| | - Jiaru Jiang
- Department of Infection Control, Wenzhou People’s Hospital, Wenzhou, China
| | - Hongmei Wu
- Department of Infection Control, Wenzhou People’s Hospital, Wenzhou, China
| | - Xiuyang Li
- Department of Epidemiology and Biostatistics, Center for Clinical Big Data and Statistic, Second Affiliated Hospital, Medicine College, Zhejiang University, Hangzhou, China
| | - Haihong Wang
- Department of Infection Control, Wenzhou People’s Hospital, Wenzhou, China
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Yu J, Che L, Zhu A, Xu L, Huang Y. Goal-Directed Intraoperative Fluid Therapy Benefits Patients Undergoing Major Gynecologic Oncology Surgery: A Controlled Before-and-After Study. Front Oncol 2022; 12:833273. [PMID: 35463383 PMCID: PMC9019364 DOI: 10.3389/fonc.2022.833273] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/04/2022] [Indexed: 11/30/2022] Open
Abstract
Background Fluid management during major gynecologic oncology surgeries faces great challenges due to the distinctive characteristics of patients with gynecologic malignancies as well as features of the surgical procedure. Intraoperative goal-directed fluid therapy (GDFT) has been proven to be effective in reducing postoperative complications among major colorectal surgeries; however, the efficacy of GDFT has not been fully studied in gynecologic malignancy surgeries. This study aimed to discuss the influence of GDFT practice in patients undergoing major gynecologic oncology surgery. Methods This study was a controlled before-and-after study. From June 2015 to June 2018 in Peking Union Medical College Hospital, a total of 300 patients scheduled for elective laparotomy of gynecological malignancies were enrolled and chronologically allocated into two groups, with the earlier 150 patients in the control group and the latter 150 patients in the GDFT group. The GDFT protocol was applied by Vigileo/FloTrac monitoring of stroke volume and fluid responsiveness to guide intraoperative fluid infusion and the use of vasoactive agents. The primary outcome was postoperative complications within 30 days after surgery. The secondary outcome included length of stay and time of functional recovery. Results A total of 249 patients undergoing major gynecologic oncology surgery were analyzed in the study, with 129 in the control group and 120 patients in the GDFT group. Patients in the GDFT group had higher ASA classifications and more baseline comorbidities. GDFT patients received significantly less fluid infusion than the control group (15.8 vs. 17.9 ml/kg/h), while fluid loss was similar (6.9 vs. 7.1 ml/kg/h). GDFT was associated with decreased risk of postoperative complications (OR = 0.572, 95% CI 0.343 to 0.953, P = 0.032), especially surgical site infections (OR = 0.127, 95% CI 0.003 to 0.971, P = 0.037). The postoperative bowel function recovery and length of hospital stay were not significantly different between the two groups. Conclusion Goal-directed intraoperative fluid therapy is associated with fewer postoperative complications in patients undergoing major gynecologic oncology surgery.
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Affiliation(s)
- Jiawen Yu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lu Che
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Afang Zhu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Xu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Di Giambenedetto S, Borghetti A, Quagliozzi L, Gallucci V, Lombardi F, Ciccullo A, Fagotti A, Tamburrini E, Scambia G. Implementing a Personalized Antimicrobial Stewardship Program for Women with Gynecological Cancers and Healthcare-Associated Infections. J Pers Med 2022; 12:jpm12040650. [PMID: 35455766 PMCID: PMC9027292 DOI: 10.3390/jpm12040650] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/09/2022] [Accepted: 03/29/2022] [Indexed: 12/01/2022] Open
Abstract
Healthcare-associated infections (HCAIs) represent a major cause of morbidity and mortality in gynecologic cancer patients, requiring personalized cures. A retrospective study on gynecologic patients with HCAIs, managed through an antimicrobial stewardship program, was performed, focusing on rates of clinical cure, breakthrough/relapse of infections, death, and time of hospital stay (THS). In total, 27 patients (median 60 years, mainly suffering from ovarian, cervical, and uterine cancer) were evaluated by a specialist in infectious diseases and were mainly diagnosed with complicated urinary tract (cUTIs, 12 cases, 44.4%) and bloodstream infections (BSIs, 9 cases, 33.3%). A total of 15 cases (11 cUTIs, 73.3%) were managed with no need for hospitalization and received a median of 11 days of outpatient parenteral antimicrobial therapy (OPAT). In the remaining 12 cases (BSIs in 8 cases, 66.7%), the median THS was 11 days, with 15 days median overall duration of antimicrobial therapy (median 5-day reduction in THS). The management of patients also included source control and wound care. All patients reached clinical cure, with no case of breakthrough infection, one case of relapse, and one death within 30 days (not attributable to the infection). HCAIs in patients with gynecologic tumors can be managed through a patient-centered, multidisciplinary antimicrobial stewardship program.
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Affiliation(s)
- Simona Di Giambenedetto
- UOC Malattie Infettive, Dipartimento di Scienze di Laboratorio ed Infettivologiche, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168 Roma, Italy; (S.D.G.); (E.T.)
- Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, 00168 Roma, Italy;
| | - Alberto Borghetti
- UOC Malattie Infettive, Dipartimento di Scienze di Laboratorio ed Infettivologiche, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168 Roma, Italy; (S.D.G.); (E.T.)
- Correspondence: ; Tel.: +39-389-0241-178
| | - Lorena Quagliozzi
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168 Roma, Italy; (L.Q.); (V.G.); (A.F.); (G.S.)
| | - Valeria Gallucci
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168 Roma, Italy; (L.Q.); (V.G.); (A.F.); (G.S.)
| | - Francesca Lombardi
- Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, 00168 Roma, Italy;
| | - Arturo Ciccullo
- UOC Malattie Infettive, Ospedale San Salvatore, 67100 L’Aquila, Italy;
| | - Anna Fagotti
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168 Roma, Italy; (L.Q.); (V.G.); (A.F.); (G.S.)
| | - Enrica Tamburrini
- UOC Malattie Infettive, Dipartimento di Scienze di Laboratorio ed Infettivologiche, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168 Roma, Italy; (S.D.G.); (E.T.)
| | - Giovanni Scambia
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168 Roma, Italy; (L.Q.); (V.G.); (A.F.); (G.S.)
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Corey L, Ruterbusch J, Shore R, Ayoola-Adeola M, Baracy M, Vezina A, Winer I. Incidence and Survival of Multiple Primary Cancers in US Women With a Gynecologic Cancer. Front Oncol 2022; 12:842441. [PMID: 35402231 PMCID: PMC8983878 DOI: 10.3389/fonc.2022.842441] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To evaluate risk of a second cancer and associated survival times in United States women with diagnosis of cancer. Methods The Surveillance Epidemiology and End Results (SEER) database was queried for 2 cohorts of women aged 18 - 89 with either an index gynecologic or non-gynecologic cancer diagnosed between 1992 - 2017. Index cases were followed to determine if a second primary cancer was subsequently diagnosed; defined according to SEER multiple primary and histology coding rules. Standard Incident Ratios (SIR) and latency intervals between index diagnosis and second primary diagnosis were evaluated. Among those who developed a second primary cancer, median survival times from diagnosis of second primary cancer were also calculated. Results Between 1992 - 2017, 227,313 US women were diagnosed with an index gynecological cancer and 1,483,016 were diagnosed with an index non-gynecologic cancer. Among patients with index gynecologic cancer, 7.78% developed a non-gynecologic subsequent primary cancer. The risk of developing any non-gynecologic cancer following an index gynecologic cancer was higher than the risk in the general population (SIR 1.05, 95% CI 1.04 - 1.07). Organs especially at risk were Thyroid (SIR 1.45), Colon and Rectum (SIR 1.23), and Urinary System (SIR 1.33). Among women diagnosed with an index non-gynecologic cancer, 0.99% were diagnosed with a subsequent gynecologic cancer. The risk of developing a gynecologic cancer following a non-gynecologic cancer was also elevated compared to the average risk of the general population (SIR 1.05, 1.03 - 1.07), with uterine cancer having the highest SIR of 1.13. Conclusion The risk of a developing a second primary cancer and the corresponding survival time is based on the order and site of the index and subsequent cancer. Surveillance guidelines should be examined further to optimize survivorship programs.
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Affiliation(s)
- Logan Corey
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, United States.,Department of OB/GYN, Detroit Medical Center Graduate Medical Education, Detroit, MI, United States
| | - Julie Ruterbusch
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, United States.,Department of Gynecologic Oncology, Karmanos Cancer Institute, Detroit, MI, United States
| | - Ron Shore
- Department of Gynecologic Oncology, Karmanos Cancer Institute, Detroit, MI, United States
| | - Martins Ayoola-Adeola
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, United States
| | - Michael Baracy
- Department of OB/GYN, Ascension St. John Hospital, Detroit, MI, United States
| | - Alex Vezina
- Department of OB/GYN, Ochsner Clinic Foundation, New Orleans, LA, United States
| | - Ira Winer
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, United States.,Department of Gynecologic Oncology, Karmanos Cancer Institute, Detroit, MI, United States
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Bellone S, Roque DM, Siegel ER, Buza N, Hui P, Bonazzoli E, Guglielmi A, Zammataro L, Nagarkatti N, Zaidi S, Lee J, Silasi DA, Huang GS, Andikyan V, Damast S, Clark M, Azodi M, Schwartz PE, Tymon-Rosario JR, Harold JA, Mauricio D, Zeybek B, Menderes G, Altwerger G, Ratner E, Alexandrov LB, Iwasaki A, Kong Y, Song E, Dong W, Elvin JA, Choi J, Santin AD. A phase 2 evaluation of pembrolizumab for recurrent Lynch-like versus sporadic endometrial cancers with microsatellite instability. Cancer 2022; 128:1206-1218. [PMID: 34875107 PMCID: PMC9465822 DOI: 10.1002/cncr.34025] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 05/13/2021] [Revised: 07/19/2021] [Accepted: 08/10/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Microsatellite instability-high (MSI-H)/mismatch repair deficiency (dMMR) is a biomarker for responses to immune checkpoint inhibitors (ICIs). Whether mechanisms underlying microsatellite instability alter responses to ICIs is unclear. This article reports data from a prospective phase 2 pilot study of pembrolizumab in patients with recurrent MSI-H endometrial cancer (EC) analyzed by whole exome sequencing (WES) and potential mechanisms of primary/secondary ICI resistance (NCT02899793). METHODS Patients with measurable MSI-H/dMMR EC confirmed by polymerase chain reaction/immunohistochemistry were evaluated by WES and received 200 mg of pembrolizumab every 3 weeks for ≤2 years. The primary end point was the objective response rate (ORR). Secondary end points included progression-free survival (PFS) and overall survival (OS). RESULTS Twenty-five patients (24 evaluable) were treated. Six patients (25%) harbored Lynch/Lynch-like tumors, whereas 18 (75%) had sporadic EC. The tumor mutation burden was higher in Lynch-like tumors (median, 2939 mutations/megabase [Mut/Mb]; interquartile range [IQR], 867-5108 Mut/Mb) than sporadic tumors (median, 604 Mut/Mb; IQR, 411-798 Mut/Mb; P = .0076). The ORR was 100% in Lynch/Lynch-like patients but only 44% in sporadic patients (P = .024). The 3-year PFS and OS proportions were 100% versus 30% (P = .017) and 100% versus 43% (P = .043), respectively. CONCLUSIONS This study suggests prognostic significance of Lynch-like cancers versus sporadic MSI-H/dMMR ECs for ORR, PFS, and OS when patients are treated with pembrolizumab. Larger confirmatory studies in ECs and other MSI-H/dMMR tumors are necessary. Defective antigen processing/presentation and deranged induction in interferon responses serve as mechanisms of resistance in sporadic MSI-H ECs. Oligoprogression in MSI-H/dMMR patients appears salvageable with surgical resection and/or local treatment and the continuation of pembrolizumab off study. Clinical studies evaluating separate MSI-H/dMMR EC subtypes treated with ICIs are warranted.
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Affiliation(s)
- Stefania Bellone
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Dana M Roque
- Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Eric R Siegel
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Natalia Buza
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Pei Hui
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Elena Bonazzoli
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Adele Guglielmi
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Luca Zammataro
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Nupur Nagarkatti
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Samir Zaidi
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jungsoo Lee
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul, South Korea
| | - Dan-Arin Silasi
- Division of Gynecologic Oncology, Mercy Clinic, St. Louis, Missouri
| | - Gloria S Huang
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Vaagn Andikyan
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Shari Damast
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Mitchell Clark
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Masoud Azodi
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Peter E Schwartz
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Joan R Tymon-Rosario
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Justin A Harold
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Dennis Mauricio
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Burak Zeybek
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Gulden Menderes
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Gary Altwerger
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Elena Ratner
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Ludmil B Alexandrov
- Department of Cellular and Molecular Medicine, University of California San Diego, La Jolla, California
| | - Akiko Iwasaki
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Yong Kong
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Eric Song
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Weilai Dong
- Laboratory of Human Genetics and Genomics, Rockefeller University, New York, New York
| | - Julia A Elvin
- Cancer Genomics Research, Foundation Medicine, Cambridge, Massachusetts
| | - Jungmin Choi
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul, South Korea
| | - Alessandro D Santin
- Smilow Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut
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Doğan N, Fışkın G. Attitudes towards prevention of cervical cancer and early diagnosis among female academicians. J Obstet Gynaecol Res 2022; 48:1433-1443. [PMID: 35266238 DOI: 10.1111/jog.15218] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/05/2022] [Accepted: 02/27/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND It is important for public health to determine the awareness of cervical cancer, which is preventable and treatable when detected at an early stage. AIM This study was conducted to determine female academicians' attitudes towards prevention and early diagnosis of cervical cancer and the factors affecting them. METHODS This descriptive study was conducted with 211 female academicians working in all departments of a university. In the study, the data were collected using questionnaire form, the attitude scale for early diagnosis of cervical cancer, and the attitudes towards prevention of cervical cancer scale. RESULTS It was determined that 68.2% of the female academicians had knowledge about the pap smear test; however, 41.0% of them did not have the test because they could not find time, and 56.4% had the knowledge about the pap smear test from a healthcare professional. It was determined that academicians had lower scores from the Attitude Scale for Early Diagnosis of Cervical Cancer (88.55 ± 9.75) and above-average scores from the Attitudes Towards Prevention of Cervical Cancer Scale (74.30 ± 15.92). It was found that area of expertise, income status, history of infectious disease, and vaginal douching affected both the early diagnosis of cervical cancer and the attitudes towards prevention of it. CONCLUSION The female academicians inadequate attitudes towards early diagnosis of cervical cancer and better attitudes towards prevention. Nurses and administrators should encourage female academics and all women to screen for cervical cancer.
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Affiliation(s)
- Nurhan Doğan
- Department of Internal Diseases, Nursing, Amasya University Faculty of Health Sciences, Amasya, Turkey
| | - Gamze Fışkın
- Department of Midwifery, Amasya University Faculty of Health Sciences, Amasya, Turkey
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Torres TK, Chase DM, Salani R, Hamann HA, Stone J. Implicit biases in healthcare: implications and future directions for gynecologic oncology. Am J Obstet Gynecol 2022:S0002-9378(22)00005-9. [PMID: 35026128 DOI: 10.1016/j.ajog.2021.12.267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 12/09/2021] [Accepted: 12/24/2021] [Indexed: 11/21/2022]
Abstract
Health disparities have been found among patients with gynecologic cancers, with the greatest differences arising among groups based on racial, ethnic, and socioeconomic factors. Although there may be multiple social barriers that can influence health disparities, another potential influence may stem from healthcare system factors that unconsciously perpetuate bias toward patients who are racially and socioeconomically disadvantaged. More recent research suggested that providers hold these implicit biases (automatic and unconscious attitudes) for stigmatized populations with cancer, with emerging evidence for patients with gynecologic cancer. These implicit biases may guide providers' communication and medical judgments, which, in turn, may influence the patient's satisfaction with and trust in the provider. This narrative review consolidated the current research on implicit bias in healthcare, with a specific emphasis on oncology professionals, and identified future areas of research for examining and changing implicit biases in the field of gynecologic oncology.
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Jiang L, Zhao X, Han Y, Liu K, Meng X. Giant Ovarian Cysts Treated by Single-Port Laparoscopic Surgery: A Case Series. Front Oncol 2021; 11:796330. [PMID: 34956907 PMCID: PMC8695676 DOI: 10.3389/fonc.2021.796330] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/17/2021] [Indexed: 11/20/2022] Open
Abstract
Background Ovarian cysts are very common diseases of the female reproductive system. Giant ovarian cysts refer to the tumors with diameters greater than 10 cm. In recent years, due to the development of clinical diagnosis, imaging modalities, and the improvement of patients’ cognition of the diseases, the occurrence of giant ovarian cysts has become rare. The purpose of this study was to show a new operation method of single-port laparoscopy to treat giant ovarian cysts. Methods We report a case series of five patients with giant ovarian cysts who underwent single-port laparoscopic surgery in the gynecology department of the Shengjing Hospital of China Medical University between June 2020 and March 2021. The inclusion criteria were ovarian cysts at least 20 cm in diameter, and cases when the tumor might be malignant were excluded. Results The patients’ mean age was 26.2years. The most common clinical presentation was progressive abdominal distension. Median size of the cysts at imaging was 39.2 cm (range 21–63 cm). All patients underwent single-port laparoscopic surgery, and none of them converted to laparotomy. On final pathological reports, two cysts were serous cystadenomas, and three were mucinous cystadenomas. All patients recovered well and were discharged on time. Conclusion Giant ovarian cysts can be treated by single-port laparoscopic surgery. In addition to the well-known advantages of laparoscopic surgery (e.g., small pelvic interference, fast postoperative recovery), it can also play the role of perfect cosmetic results, which has more advantages for young women.
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Affiliation(s)
- Lili Jiang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xinyu Zhao
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yue Han
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Kuiran Liu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xinyue Meng
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
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Palaia I, Caruso G, Di Donato V, Vestri A, Napoli A, Perniola G, Casinelli M, Alunni Fegatelli D, Campagna R, Tomao F, D’Aniello D, Antonelli G, Muzii L. Pfizer-BioNTech COVID-19 Vaccine in Gynecologic Oncology Patients: A Prospective Cohort Study. Vaccines (Basel) 2021; 10:vaccines10010012. [PMID: 35062673 PMCID: PMC8780883 DOI: 10.3390/vaccines10010012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 12/26/2022] Open
Abstract
Objective: To evaluate the safety and immunogenicity of the Pfizer-BioNTech COVID-19 vaccine in gynecologic oncology patients under chemotherapy. Methods: A prospective cohort study including gynecologic oncology women who were under chemotherapy or had completed it within 6 months at the time of the study. All patients received a two-dose schedule of the Pfizer-BioNTech COVID-19 vaccine. Results were compared with a control group of healthy women vaccinated in the same period. Results: Overall, 44 oncologic patients with a mean age of 61.3 ± 10.7 years were enrolled: 28 (63.6%) had ovarian cancer, 9 (20.4%) endometrial, and 7 (16%) cervical. The IgG antibody titer after 1 month from vaccination was low in 9 (20.5%) patients, moderate in 21 (47.7%), and high in 14 (31.8%). The 3-month titer was null in 2 (4.5%) patients, low in 26 (59.1%), moderate in 13 (29.5%), and high in 3 (6.8%). Patients ≥ 50 years reported lower 1-month (p = 0.018) and 3-month (p = 0.004) titers compared with <50 years. Patients with BMI < 30 kg/m2 had a higher 1-month titer compared with BMI ≥ 30 kg/m2 (p = 0.016). Compared with healthy women (n = 44), oncologic patients showed a lower 3-month titer (p < 0.001). None of the patients experienced serious adverse effects. Conclusions: The COVID-19 vaccine was safe and immunogenic in gynecologic oncology patients under chemotherapy. Serological monitoring and further vaccine shots should be considered to boost protection.
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Affiliation(s)
- Innocenza Palaia
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University, 00161 Rome, Italy; (I.P.); (V.D.D.); (G.P.); (F.T.); (D.D.); (L.M.)
| | - Giuseppe Caruso
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University, 00161 Rome, Italy; (I.P.); (V.D.D.); (G.P.); (F.T.); (D.D.); (L.M.)
- Correspondence:
| | - Violante Di Donato
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University, 00161 Rome, Italy; (I.P.); (V.D.D.); (G.P.); (F.T.); (D.D.); (L.M.)
| | - Annarita Vestri
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, Sapienza University, 00161 Rome, Italy; (A.V.); (D.A.F.)
| | - Anna Napoli
- Department of Molecular Medicine, Policlinico Umberto I, Sapienza University, 00161 Rome, Italy; (A.N.); (M.C.); (R.C.); (G.A.)
| | - Giorgia Perniola
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University, 00161 Rome, Italy; (I.P.); (V.D.D.); (G.P.); (F.T.); (D.D.); (L.M.)
| | - Matteo Casinelli
- Department of Molecular Medicine, Policlinico Umberto I, Sapienza University, 00161 Rome, Italy; (A.N.); (M.C.); (R.C.); (G.A.)
| | - Danilo Alunni Fegatelli
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, Sapienza University, 00161 Rome, Italy; (A.V.); (D.A.F.)
| | - Roberta Campagna
- Department of Molecular Medicine, Policlinico Umberto I, Sapienza University, 00161 Rome, Italy; (A.N.); (M.C.); (R.C.); (G.A.)
| | - Federica Tomao
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University, 00161 Rome, Italy; (I.P.); (V.D.D.); (G.P.); (F.T.); (D.D.); (L.M.)
| | - Debora D’Aniello
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University, 00161 Rome, Italy; (I.P.); (V.D.D.); (G.P.); (F.T.); (D.D.); (L.M.)
| | - Guido Antonelli
- Department of Molecular Medicine, Policlinico Umberto I, Sapienza University, 00161 Rome, Italy; (A.N.); (M.C.); (R.C.); (G.A.)
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University, 00161 Rome, Italy; (I.P.); (V.D.D.); (G.P.); (F.T.); (D.D.); (L.M.)
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Bizzarri N, Nero C, Sillano F, Ciccarone F, D’Oria M, Cesario A, Fragomeni SM, Testa AC, Fanfani F, Ferrandina G, Lorusso D, Fagotti A, Scambia G. Building a Personalized Medicine Infrastructure for Gynecological Oncology Patients in a High-Volume Hospital. J Pers Med 2021; 12:jpm12010003. [PMID: 35055317 PMCID: PMC8778422 DOI: 10.3390/jpm12010003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/10/2021] [Accepted: 12/16/2021] [Indexed: 12/13/2022] Open
Abstract
Gynecological cancers require complex intervention since patients have specific needs to be addressed. Centralization to high-volume centers improves the oncological outcomes of patients with gynecological cancers. Research in gynecological oncology is increasing thanks to modern technologies, from the comprehensive molecular characterization of tumors and individual pathophenotypes. Ongoing studies are focusing on personalizing therapies by integrating information across genomics, proteomics, and metabolomics with the genetic makeup and immune system of the patient. Hence, several challenges must be faced to provide holistic benefit to the patient. Personalized approaches should also recognize the unmet needs of each patient to successfully deliver the promise of personalized care, in a multidisciplinary effort. This may provide the greatest opportunity to improve patients' outcomes. Starting from a narrative review on gynecological oncology patients' needs, this article focuses on the experience of building a research and care infrastructure for personalized patient management.
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Affiliation(s)
- Nicolò Bizzarri
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (N.B.); (F.S.); (F.C.); (S.M.F.); (A.C.T.); (F.F.); (G.F.); (D.L.); (A.F.); (G.S.)
| | - Camilla Nero
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (N.B.); (F.S.); (F.C.); (S.M.F.); (A.C.T.); (F.F.); (G.F.); (D.L.); (A.F.); (G.S.)
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.); (A.C.)
- Correspondence:
| | - Francesca Sillano
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (N.B.); (F.S.); (F.C.); (S.M.F.); (A.C.T.); (F.F.); (G.F.); (D.L.); (A.F.); (G.S.)
| | - Francesca Ciccarone
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (N.B.); (F.S.); (F.C.); (S.M.F.); (A.C.T.); (F.F.); (G.F.); (D.L.); (A.F.); (G.S.)
- Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.); (A.C.)
| | - Marika D’Oria
- Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.); (A.C.)
| | - Alfredo Cesario
- Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.); (A.C.)
| | - Simona Maria Fragomeni
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (N.B.); (F.S.); (F.C.); (S.M.F.); (A.C.T.); (F.F.); (G.F.); (D.L.); (A.F.); (G.S.)
| | - Antonia Carla Testa
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (N.B.); (F.S.); (F.C.); (S.M.F.); (A.C.T.); (F.F.); (G.F.); (D.L.); (A.F.); (G.S.)
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Francesco Fanfani
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (N.B.); (F.S.); (F.C.); (S.M.F.); (A.C.T.); (F.F.); (G.F.); (D.L.); (A.F.); (G.S.)
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Gabriella Ferrandina
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (N.B.); (F.S.); (F.C.); (S.M.F.); (A.C.T.); (F.F.); (G.F.); (D.L.); (A.F.); (G.S.)
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Domenica Lorusso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (N.B.); (F.S.); (F.C.); (S.M.F.); (A.C.T.); (F.F.); (G.F.); (D.L.); (A.F.); (G.S.)
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.); (A.C.)
| | - Anna Fagotti
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (N.B.); (F.S.); (F.C.); (S.M.F.); (A.C.T.); (F.F.); (G.F.); (D.L.); (A.F.); (G.S.)
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giovanni Scambia
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (N.B.); (F.S.); (F.C.); (S.M.F.); (A.C.T.); (F.F.); (G.F.); (D.L.); (A.F.); (G.S.)
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.D.); (A.C.)
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Zhang JQ, Zhao BB, Wang MM, Li L. Case Report: Niraparib as Maintenance Therapy in A Patient With Ovarian Carcinosarcoma. Front Oncol 2021; 11:603591. [PMID: 34938651 PMCID: PMC8685211 DOI: 10.3389/fonc.2021.603591] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 07/27/2021] [Indexed: 12/20/2022] Open
Abstract
Ovarian carcinosarcoma (OCS) is a rare, highly aggressive and rapidly progressing malignant tumor with an extremely poor prognosis. So far, due to the low incidence of OCS, there are no large-scale prospective studies exploring the standard care of OCS patients. There is no uniform and effective treatment for OCS. Within the development of precision medicine, targeted therapies (such as PARP inhibitors) have been widely used in epithelial ovarian cancer and various other solid tumors. Here, we report a BRCAwt patient with advanced OCS who experienced a second and a third cytoreductive surgery in June 2017 and October 2019 and has been on niraparib maintenance therapy for more than 20 months after receiving second-line and third-line chemotherapy.
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Affiliation(s)
| | | | | | - Li Li
- Department of Gynecologic Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
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Bagde MN, Bagde NKD, Hussain N, Thangaraju P. A review and case report of enigmatic superficial endometrial spread of cancer of the uterine cervix: Need for vigilance in the primary care setting. J Family Med Prim Care 2021; 10:3505-3510. [PMID: 34760782 PMCID: PMC8565160 DOI: 10.4103/jfmpc.jfmpc_39_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 06/29/2021] [Accepted: 07/04/2021] [Indexed: 11/10/2022] Open
Abstract
Cervical cancer is a leading cause of cancer-related morbidity and mortality. It usually spreads via direct invasion and lymphatics. Few cases with superficial spread to the uterine endometrium, fallopian tubes, and ovaries have been observed. The staging of these cases, as well as management, is not yet clear due to limited data. The Federation of Gynecology and Obstetrics (FIGO) staging disregards uterine spread to upstage the disease, and it also fails to provide clear guidelines regarding the superficial extension to the ovaries and tubes which is not uncommon in these cases. A 63-year-old female with postmenopausal bleeding was diagnosed with squamous cell carcinoma on a pap smear. Ultrasound and magnetic resonance imaging revealed a predominant endometrial lesion. Histopathology after Wertheim's hysterectomy revealed a squamous cell carcinoma of the endocervix, stage 1B2, that had spread superficially to the endometrium. A total of 48 cases of cervical cancer with superficial spread were identified. The commonest complaint was postmenopausal bleed in 39.39%. In 50% of the cases, the disease was carcinoma in situ, and 70.45% of the women had disease of stage 1B or less. In many cases, the disease had reached the tubes, 36.66%, and ovaries 23.33%. All women with stage 2A or lesser disease except for one were alive at 6 months after surgery. Superficial spread of cervical cancer is a distinct entity. Endometrial pathology must be ruled out before planning management in these women, especially when managing early-stage disease with conservative therapy.
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Affiliation(s)
- Madhuri N Bagde
- Department of Obstetrics and Gynecology, Raipur Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Nilaj Kumar D Bagde
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Nighat Hussain
- Department of Pathology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Pugazhenthan Thangaraju
- Department of Pharmacology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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Zhang H, Kong W, Han C, Liu T, Li J, Song D. Correlation of Metabolic Factors with Endometrial Atypical Hyperplasia and Endometrial Cancer: Development and Assessment of a New Predictive Nomogram. Cancer Manag Res 2021; 13:7937-7949. [PMID: 34703315 PMCID: PMC8536844 DOI: 10.2147/cmar.s335924] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/08/2021] [Indexed: 01/06/2023] Open
Abstract
Purpose This study aimed to investigate the association of metabolic factors with endometrial atypical hyperplasia and endometrial cancer, and to develop a nomogram model to predict the risk of developing endometrial cancer. Patients and Methods We collected data of patients with endometrial atypical hyperplasia and endometrial cancer as the case group and then selected patients with simple hyperplasia or polypoid hyperplasia of the endometrium during the same period as the control group using the age-matched method. Laboratory results of metabolic factors were retrieved from the clinical data of the two groups of patients. Multivariable logistic regression analysis was used to determine the risk factors associated with endometrial malignant hyperplasia and to develop a nomogram prediction model of risk factors associated with endometrial malignant hyperplasia. Discrimination, calibration, and clinical usefulness of the prediction model were assessed using the C-index, calibration plot, and decision curve analysis. Results Predictors included in the column line graph model were age, hypertension, diabetes, BMI, uric acid, and hyperlipidemia. We calculated the C-index of the model and performed bootstrap validation. Our nomogram model had good discriminatory power and was well calibrated. Decision curve analysis was also used to guide the practical application of this column line graph model. Conclusion The development of endometrial malignant hyperplasia is significantly associated with metabolic factors: BMI > 25, hyperuricemia, and hyperlipidemia are the main risk factors. Hypertension, hyperglycemia and elevated CA199 were also associated with the development of endometrial malignant hyperplasia. The nomogram prediction model based on physical examination and laboratory testing developed in this study can be used as a rapid method for predicting the risk of endometrial malignancy development and screening for risk factors in a population of women with metabolism-related high-risk factors.
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Affiliation(s)
- He Zhang
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Weimin Kong
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Chao Han
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Tingting Liu
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jing Li
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Dan Song
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, People's Republic of China
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Randall TC, Somashekhar SP, Chuang L, Ng JSY, Schmeler KM, Quinn M. Reaching the women with the greatest needs: Two models for initiation and scale-up of gynecologic oncology fellowship trainings in low-resource settings. Int J Gynaecol Obstet 2021; 155 Suppl 1:115-122. [PMID: 34669202 PMCID: PMC9298416 DOI: 10.1002/ijgo.13869] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Women in low- and middle-income countries (LMICs) are significantly more likely to develop and die from invasive cervical cancer, while rates of other gynecologic malignancies are comparable to those faced by women in high-income countries. Despite this increased need, there are few specialist physicians in LMICs available to treat women with gynecologic cancers. Training specialists in low-resource settings faces multiple challenges, including ensuring protected time from other clinical demands, access to best practice guidelines, training that is tailored to the specific challenges faced in the trainee's environment, and isolation from other fully trained professionals and securing support services. In addition, training specialists from LMICs in high-resource settings is costly and return of trainees to their own country is not guaranteed. Here we describe two approaches to gynecologic oncology training in LMICs. The International Gynecologic Cancer Society (IGCS) developed the Global Curriculum Mentorship and Training Program (Global Curriculum) to support gynecologic oncology fellowships in regions of the world that do not currently have formal training in gynecologic oncology. In India, on the other hand, leaders in world-class gynecologic oncology centers must find a way to meet the training needs of a vast and disparate country.
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Affiliation(s)
- Thomas C Randall
- Division of Gynecologic Oncology, The Massachusetts General Hospital, Boston, Massachusetts, USA
| | - S P Somashekhar
- Manipal Comprehensive Cancer Center, Manipal Hospital, Bengaluru, India
| | - Linus Chuang
- Department of Obstetrics and Gynecology, Nuvance Health, Westchester, New York, USA
| | | | - Kathleen M Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Sanaya SZ, Matsneva IA, Redkina NA, Telezhnikova IM, Magnaeva AS, Tregubova AV, Asaturova AV, Kometova VV. [Immunohistochemical and molecular diagnosis of inflammatory myofibroblastic tumor of the uterus: a literature review and a clinical case]. Arkh Patol 2021; 83:43-48. [PMID: 34609804 DOI: 10.17116/patol20218305143] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Inflammatory myofibroblastic tumors of the uterus (uIMT) are rare and difficult to diagnose neoplasms, since the morphological characteristics of this tumor are not specific and are found in other pathological changes. In addition, until recently, specific uIMT markers have not been identified and their diagnostic standards not defined. However, in recent years, there have been more and more studies aimed to identify characteristic morphological, immunohistochemical, and molecular genetic features for the differential diagnosis of uIMT. Recent papers studying uIMT indicate anaplastic lymphoma kinase (ALK) as a potentially reliable marker of uIMT. This communication describes a clinical case of uIMT in a 40-year-old woman who has been preoperatively diagnosed with a large subserous interstitial myomatous nodule. The final diagnosis was made, by analysing a combination of morphological and immunohistochemical signs. This clinical case with a literature review is indicated to consider ALK as a key criterion in the diagnosis of uIMT, as well as the relationship between subsequent treatment and the presence of ALK in the studied tissues.
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Affiliation(s)
- S Z Sanaya
- A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - I A Matsneva
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - N A Redkina
- Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology of the Ministry of Health of Russia, Moscow, Russia
| | - I M Telezhnikova
- Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology of the Ministry of Health of Russia, Moscow, Russia
| | - A S Magnaeva
- Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology of the Ministry of Health of Russia, Moscow, Russia
| | - A V Tregubova
- Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology of the Ministry of Health of Russia, Moscow, Russia
| | - A V Asaturova
- Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology of the Ministry of Health of Russia, Moscow, Russia
| | - V V Kometova
- Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology of the Ministry of Health of Russia, Moscow, Russia
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van der Zanden V, van der Zaag-Loonen HJ, Paarlberg KM, Meijer WJ, Mourits MJE, van Munster BC. PREsurgery thoughts - thoughts on prehabilitation in oncologic gynecologic surgery, a qualitative template analysis in older adults and their healthcare professionals. Disabil Rehabil 2021; 44:5930-5940. [PMID: 34283686 DOI: 10.1080/09638288.2021.1952319] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aimed to reveal information that can be used for composing a prehabilitation program tailored to elderly gynecological oncological patients and is applicable to healthcare professionals. We investigated possible content and indications for prehabilitation, and what potential barriers might exist. MATERIALS AND METHODS Because of the primary exploratory study aim, inductive thematic template analysis on semi-structured interviews with gynecologic oncological patients aged ≥60 years and healthcare professionals were used. RESULTS 16 patients and 20 healthcare professionals were interviewed. Three themes important for prehabilitation were found: (1) "Motivation," (2) "Practical issues and facilitators," and (3) "Patient-related factors." A short time interval between diagnosis and surgery was reported as a potential barrier for prehabilitation. Given components for a tailor-made prehabilitation program are: (1) The first contact with a nurse who screens the patients, gives tailor-made advice on prehabilitation and keeps patients motivated and supports them mentally; (2) If patients are referred to a more extensive/supervised program, this should preferably be arranged close to a patients' home. CONCLUSION Based on our findings, an outline of a patient-tailored prehabilitation program was developed. The main important themes for prehabilitation were "Motivation," "Practical issues and facilitators," and "Patient-related factors."IMPLICATIONS FOR REHABILITATIONPatients and healthcare professionals are positive about prehabilitation.Main themes for designing a prehabilitation program are "Motivation," "Practical issues and facilitators," and "Patient-related factors."Nursing staff can play a key role in prehabilitation.It is important to screen patients for specific impairments to obtain a tailor-made prehabilitation program.For some patients, general advice on prehabilitation might be sufficient, while others may need more supervision.The time interval between diagnosis and surgery is often short and is perceived as a potentially significant barrier for an effective prehabilitation program.
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Affiliation(s)
- Vera van der Zanden
- Department of Obstetrics and Gynecology, Gelre Hospitals, Apeldoorn, The Netherlands.,Department Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hester J van der Zaag-Loonen
- Department Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - K Marieke Paarlberg
- Department of Obstetrics and Gynecology, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Wouter J Meijer
- Department of Obstetrics and Gynecology, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Marian J E Mourits
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Barbara C van Munster
- Department Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Chen YS, Zhou ZN, Glynn SM, Frey MK, Balogun OD, Kanis M, Holcomb K, Gorelick C, Thomas C, Christos PJ, Chapman‐Davis E. Financial toxicity, mental health, and gynecologic cancer treatment: The effect of the COVID-19 pandemic among low-income women in New York City. Cancer 2021; 127:2399-2408. [PMID: 33899220 PMCID: PMC8239639 DOI: 10.1002/cncr.33537] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/08/2020] [Accepted: 10/14/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND New York City (NYC) emerged as an epicenter of the COVID-19 pandemic, and marginalized populations were affected at disproportionate rates. The authors sought to determine the impact of COVID-19 on cancer treatment, anxiety, and financial distress among low-income patients with gynecologic cancer during the peak of the NYC pandemic. METHODS Medicaid-insured women who were receiving gynecologic oncology care at 2 affiliated centers were contacted by telephone interviews between March 15 and April 15, 2020. Demographics and clinical characteristics were obtained through self-report and retrospective chart review. Financial toxicity, anxiety, and cancer worry were assessed using modified, validated surveys. RESULTS In total, 100 patients completed the telephone interview. The median age was 60 years (range, 19-86 years), and 71% had an annual income <$40,000. A change in employment status and early stage cancer (stage I and II) were associated with an increase in financial distress (P < .001 and P = .008, respectively). Early stage cancer and telehealth participation were significantly associated with increased worry about future finances (P = .017 and P = .04, respectively). Lower annual income (<$40,000) was associated with increased cancer worry and anxiety compared with higher annual income (>$40,000; P = .036 and P = .017, respectively). When controlling for telehealth participation, income, primary language, and residence in a high COVID-19 prevalence area, a delay in medical care resulted in a 4-fold increased rate of anxiety (P = .023, 95% CI, 1.278-14.50). Race was not significantly associated with increased financial distress, cancer worry, or anxiety. CONCLUSIONS Low socioeconomic status was the most common risk factor for increased financial distress, cancer worry, and anxiety. Interventions aimed at improving access to timely oncology care should be implemented during this ongoing pandemic.
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Affiliation(s)
- Yiting Stefanie Chen
- Department of Obstetrics and GynecologyWeill Cornell Medical CollegeNew YorkNew York
| | - Zhen Ni Zhou
- Division of Gynecologic OncologyDepartment of Obstetrics and GynecologyWeill Cornell Medical CollegeNew YorkNew York
| | | | - Melissa K. Frey
- Division of Gynecologic OncologyDepartment of Obstetrics and GynecologyWeill Cornell Medical CollegeNew YorkNew York
| | - Onyinye D. Balogun
- Department of Radiation OncologyWeill Cornell Medical College and New York Presbyterian Brooklyn Methodist HospitalNew YorkNew York
| | - Margaux Kanis
- Division of Gynecologic OncologyDepartment of Obstetrics and GynecologyNew York Presbyterian Brooklyn Methodist HospitalNew YorkNew York
| | - Kevin Holcomb
- Division of Gynecologic OncologyDepartment of Obstetrics and GynecologyWeill Cornell Medical CollegeNew YorkNew York
| | - Constantine Gorelick
- Division of Gynecologic OncologyDepartment of Obstetrics and GynecologyNew York Presbyterian Brooklyn Methodist HospitalNew YorkNew York
| | - Charlene Thomas
- Clinical and Translational Science CenterDepartment of Biostatistics and EpidemiologyWeill Cornell Medical CollegeNew YorkNew York
| | - Paul J. Christos
- Clinical and Translational Science CenterDepartment of Biostatistics and EpidemiologyWeill Cornell Medical CollegeNew YorkNew York
| | - Eloise Chapman‐Davis
- Division of Gynecologic OncologyDepartment of Obstetrics and GynecologyWeill Cornell Medical CollegeNew YorkNew York
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Braun T, De Gregorio A, Baumann L, Steinacker J, Janni W, De Gregorio N. Coincidence of Intra-Abdominal Splenosis in a Patient with Advanced Ovarian Cancer: Case Report and Review of the Literature. Surg J (N Y) 2021; 7:e116-e120. [PMID: 34179460 PMCID: PMC8221843 DOI: 10.1055/s-0041-1731426] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 03/25/2021] [Indexed: 11/27/2022] Open
Abstract
Splenosis is a rare disease, which is often discovered incidentally years after surgical procedures on the spleen or traumatic splenic lesions. Through injury of the splenic capsule, splenic cells are able to spread and autoimplant in a fashion similar to the process of metastatic cancer. Here we present the case of a 62-year-old female patient with a palpable tumor of the lower abdomen. Her medical history was unremarkable, except for splenectomy after traumatic splenic lesion in her childhood. Clinical examination and diagnostic imaging raised the suspicion of advanced ovarian cancer, which was further substantiated by the typical presentation of adnexal masses and disseminated peritoneal metastases during the following staging laparotomy. Surprisingly, we also found peritoneal implants macroscopically similar to splenic tissue. Microscopic examination of tissue specimens by intrasurgical frozen section confirmed the diagnosis of intra-abdominal splenosis. The patient then underwent cytoreductive surgery with complete resection of all cancer manifestations, sparing the remaining foci of splenosis to avoid further morbidity. This case demonstrates the rare coincidence of intra-abdominal carcinoma and splenosis, which could lead to intraoperative difficulties by misinterpreting benign splenic tissue. Therefore, splenosis should be considered in patients with medical history of splenic lesions and further diagnostic imaging like Tc-99m-tagged heat-damaged RBC scan could be used for presurgical distinguishing between tumor spread in the abdominal cavity and disseminated splenosis. The presented case report should not only raise awareness for the rare disease splenosis, but also emphasize the need to consider the possibility of simultaneous incidence of benign and malignant intra-abdominal lesions, as to our knowledge this is the first published case of simultaneous peritoneal carcinomatosis and splenosis.
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Affiliation(s)
- Tatjana Braun
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Amelie De Gregorio
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Lisa Baumann
- Department of Pathology, University Hospital Ulm, Ulm, Germany
| | - Jochen Steinacker
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
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