abstract
Wednesday, December 17, 2014
Challenges in managing genetic cancer risk: a long-term qualitative study of unaffected women carrying BRCA1/BRCA2 mutations
abstract
Purpose:
Women carrying BRCA1/BRCA2 germ-line mutations have an increased risk of developing breast/ovarian cancer. To minimize this risk, international guidelines recommend lifelong surveillance and preventive measures. This study explores the challenges that unaffected women genetically predisposed to breast/ovarian cancer face in managing their risk over time and the psychosocial processes behind these challenges
Methods:
Between 2011 and 2013, biographical qualitative interviews were conducted in Switzerland with 32 unaffected French- and Italian-speaking women carrying BRCA1/BRCA2 mutations. Their mutation status had been known for at least 3 years (mean, 6 years). Data were analyzed through constant comparative analysis using software for qualitative analysis.
Results:
From the time these women received their positive genetic test results, they were encouraged to follow medical guidelines. Meanwhile, their adherence to these guidelines was constantly questioned by their social and medical environments. As a result of these contradictory pressures, BRCA1/BRCA2 mutation carriers experienced a sense of disorientation about the most appropriate way of dealing with genetic risk.
Conclusion:
Given the contradictory attitudes of health-care professionals in caring for unaffected BRCA1/BRCA2 mutation carriers, there is an urgent need to educate physicians in dealing with genetically at-risk women and to promote a shared representation of this condition among them.
Clinical characteristics and outcomes of patients with stage I epithelial ovarian cancer compared to fallopian tube cancer
abstract
OBJECTIVE:
Compare clinical characteristics and survival between patients with stage I epithelial ovarian cancer and fallopian tube cancer.STUDY DESIGN:
We identified women with stage I epithelial ovarian cancer and fallopian tube cancer that underwent treatment between 2000 and 2010......RESULTS:
The study group consisted of 385 women with epithelial ovarian cancer and 43 with fallopian tube cancer. Patients with fallopian tube cancer had a higher rate of stage IA disease (65% vs. 48%; P = 0.02) and grade 3 tumors (60.4% vs. 30.9%; P < 0.001). Patients with fallopian tube cancer had a significantly higher rate of breast cancer (25.6% vs. 5.7%; P < 0.001) and BRCA 1 mutations (45.8% vs. 9.1% P < 0.001). There was no difference in the rates of platinum-based and paclitaxel chemotherapy between the groups. Women with fallopian tube cancer were more likely to have received six or more cycles of chemotherapy (58.1% vs. 44.1%; P = 0.02). The 5-year disease-free survival rates were 100% in women with fallopian tube cancer and 93% in patients with epithelial ovarian cancer (P = 0.04). The 5-year overall survival rates were 100% and 95% for fallopian tube cancer and epithelial ovarian cancer, respectively (P = 0.7).CONCLUSIONS:
We found a higher rate of stage IA, grade 3, and serous carcinoma in fallopian tube cancer. Women with fallopian tube cancer had a higher rate of breast cancer. There was no difference in overall survival between the groups.Positron Emission Tomography (PET) in Oncology
Free Full-Text
1.8.1. Ovarian Cancer
There is mounting evidence that FDG-PET/CT has an increasing role in the management of ovarian cancer, with its main indication to detect tumor recurrence in presence of rising CA-125 serum values and negative conventional imaging studies [93]. The benefits of the use of FDG-PET/CT in these settings has been reported several times in the literature [94,95], with a sensitivity of more than 90% in detecting occult metastases. In the study of Zimny et al., FDG-PET/CT preceded the conventional diagnosis by a median of 6 months in patients judged clinically free of disease. Menzel et al. suggest that a PET indication is worthwhile at CA 125 levels of approximately 30 U/mL [96]. A more recent prospective multi-center, cohort study (90 patients) confirmed the impact of FDG-PET/CT in suspected recurrent ovarian cancer, which affected disease management decisions in 60% of the cases (in 49% with a high, in 11% with a medium clinical impact) with a much higher detection rate compared to conventional imaging [97].For the characterization of asymptomatic adnexal findings, FDG-PET/CT has no place due to lack of sensitivity [98], and MRI remains the best imaging modality choice.
For the initial staging of ovarian cancer, FDG-PET/CT is not routinely used. Nevertheless, some publications noticed that it could be interesting in advanced epithelial ovarian cancer, in particular for the detection of supradiaphragmatic lymph node metastases like parasternal lymph nodes, with better accuracy than conventional CT (detection rate: 67% vs. 33%) [99]. However, increased mediastinal FDG uptake was not shown to play a significant prognostic role, while complete cytoreduction did [100]. For the initial preoperative staging of ovarian cancer, FDG-PET/CT may be superior compared to CT alone [101,102], but some publications also observed limits, as De Iaco et al., who reported a sensitivity and specificity of 78 and 68% respectively, with a high rate of false negative results in lesions <5 mm such as found in presence of peritoneal carcinomatosis [103].
However, conflicting results have been reported on the sensitivity of FDG-PET/CT scan in detecting peritoneal carcinomatosis; Turlakow, Suzuki and Kim reported higher diagnostic accuracy of FDG-PET/CT than CeCT in this settings, with a sensitivity and specificity for FDG-PET/CT of 67%–92.2% and 90%–94% respectively, as compared to 22%–88.5% and 65%–77% respectively for CeCT [104,105,106]. The sensitivity of FDG-PET/CT proved also similar to that of conventional MRI, and even better for detecting small peritoneal lesions (<2 cm) in patients with recurrent ovarian cancer [107]. However, FDG-PET/CT has limits, in particular for the detection of small peritoneal implants (<5 mm) because of the limited PET resolution, and surgical staging remains the gold standard [108]. The good performances of FDG-PET/CT in detecting peritoneal carcinomatosis lead to interesting information for optimizing patient selection for cytoreductive surgery in recurrent ovarian cancer; recently, Ebina et al. observed that FDG-PET/CT led to a change in management plan in 58.4% in that case, with a total number of patients in whom cytoreductive surgery was selected as the treatment of choice increased from 12 to 35 according to FDG-PET-CT results [109]. In the preoperative management, FDG-PET/CT is also able to detect distant metastases (25/95 patients upstaged from FIGO stage III to stage IV by FDG-PET/CT in a recent study [110]. However, upward stage migration did not worsen the prognosis of stage III patients, and in advanced ovarian cancer, the only prognostic factor that retained a significant prognostic value is the quality of response to cytoreductive therapy. Another study proposed FDG-PET/CT criteria such as FDG-PET/CT stage IV, pleural exudates, and PET-positive large bowel mesentery implants, which were statistically significant in the prognosis univariate analysis to guide the administration of neo-adjuvant chemotherapy in advanced ovarian cancer, but, once again, incomplete tumor debulking was the only statistically significant independent prognostic variable using multivariate analysis (p = 0.0001) [111]. Other prognostic factors like MTV or TGL may be interesting, but more data are needed at this time to confirm that [112].
- See more at: http://www.mdpi.com/2072-6694/6/4/1821/htm#sthash.MzNWUkeA.dpuf
Dynamic Changes in Numbers and Properties of Circulating Tumor Cells and Their Potential Applications | HTML
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Abstract
: Circulating tumor cells (CTCs) can be detected in the blood of different types of early or advanced cancer using immunology-based assays or nucleic acid methods. The detection and quantification of CTCs has significant clinical utility in the prognosis of metastatic breast, prostate, and colorectal cancers. CTCs are a heterogeneous population of cells and often different from those of their respective primary tumor. Understanding the biology of CTCs may provide useful predictive information for the selection of the most appropriate treatment. Therefore, CTC detection and characterization could become a valuable tool to refine prognosis and serve as a “real-time biopsy” and has the potential to guide precision cancer therapies, monitor cancer treatment, and investigate the process of metastasis. - See more at: http://www.mdpi.com/2072-6694/6/4/2369/htm#sthash.UvsIAwMW.dpufAbstract
: Circulating tumor cells (CTCs) can be detected in the blood of different types of early or advanced cancer using immunology-based assays or nucleic acid methods. The detection and quantification of CTCs has significant clinical utility in the prognosis of metastatic breast, prostate, and colorectal cancers. CTCs are a heterogeneous population of cells and often different from those of their respective primary tumor. Understanding the biology of CTCs may provide useful predictive information for the selection of the most appropriate treatment. Therefore, CTC detection and characterization could become a valuable tool to refine prognosis and serve as a “real-time biopsy” and has the potential to guide precision cancer therapies, monitor cancer treatment, and investigate the process of metastasis. - See more at: http://www.mdpi.com/2072-6694/6/4/2369/htm#sthash.UvsIAwMW.dpufAbstract
: Circulating tumor cells (CTCs) can be detected in the blood of different types of early or advanced cancer using immunology-based assays or nucleic acid methods. The detection and quantification of CTCs has significant clinical utility in the prognosis of metastatic breast, prostate, and colorectal cancers. CTCs are a heterogeneous population of cells and often different from those of their respective primary tumor. Understanding the biology of CTCs may provide useful predictive information for the selection of the most appropriate treatment. Therefore, CTC detection and characterization could become a valuable tool to refine prognosis and serve as a “real-time biopsy” and has the potential to guide precision cancer therapies, monitor cancer treatment, and investigate the process of metastasis. - See more at: http://www.mdpi.com/2072-6694/6/4/2369/htm#sthash.UvsIAwMW.dpufAbstract
: Circulating tumor cells (CTCs) can be detected in the blood of different types of early or advanced cancer using immunology-based assays or nucleic acid methods. The detection and quantification of CTCs has significant clinical utility in the prognosis of metastatic breast, prostate, and colorectal cancers. CTCs are a heterogeneous population of cells and often different from those of their respective primary tumor. Understanding the biology of CTCs may provide useful predictive information for the selection of the most appropriate treatment. Therefore, CTC detection and characterization could become a valuable tool to refine prognosis and serve as a “real-time biopsy” and has the potential to guide precision cancer therapies, monitor cancer treatment, and investigate the process of metastasis. - See more at: http://www.mdpi.com/2072-6694/6/4/2369/htm#sthash.UvsIAwMW.dpufTuesday, December 16, 2014
Hereditary Cancer-Associated Mutations in Women Diagnosed with Two Primary Cancers: An Opportunity to Identify Hereditary Cancer Syndromes after the First Cancer Diagnosis
FullText Myriad Genetic Laboratories, Inc., Salt Lake City, Utah, USA
Results: Among women with both breast and ovarian cancer, 22.4% (2,237/9,982) had a BRCA1 or BRCA2 mutation. Among women with both colorectal and ovarian cancer, 28.1% (264/941) had a mutation associated with LS. In 66.6% of BRCA1 or BRCA2 mutation carriers and in 58.3% of LS mutation carriers, >5 years passed between the cancer diagnoses.......
Table 2. Interval between the first and the second cancer diagnosis in patients with HBOC
Table 4. Interval between first and second cancer diagnoses in patients with LS
What really matters in end-of-life discussions? Perspectives of patients in hospital with serious illness and their families
open access
Interpretation: We identified elements of goals-of-care discussions that are most important to older adult patients in hospital with serious illness and their family members. We found that guideline-recommended elements of goals-of-care discussions are not often addressed by health care providers. Our results can inform interventions to improve the determination of goals of care in the hospital setting.
Lynch Syndrome Caused by Germline PMS2 Mutations: Delineating the Cancer Risk
abstract
Significant SIRs were observed for cancers of the small bowel, ovaries, breast, and renal pelvis.
Monday, December 15, 2014
(Lynch Syndrome etc) ASCO CPG Endorsement of the Familial Risk–Colorectal Cancer: ESMO CPG
open access
Hereditary Colorectal Cancer Syndromes: American Society of Clinical Oncology Clinical Practice Guideline Endorsement of the Familial Risk–Colorectal Cancer: European Society for Medical Oncology Clinical Practice Guidelines
Lynch syndrome
-
Colon and rectum: Colonoscopy every 1 to 2 years, starting at age 20 to 25 or 5 years before the youngest case in the family. No upper limit is established.
-
Endometrium and ovary: Gynecological examination, pelvic ultrasound (not CA-125), and aspiration biopsy every year, from age 30 to 35 years. Consider prophylactic hysterectomy and salpingoophorectomy when childbearing is completed.
-
Gastric cancer: For gastric cancer, the search for the presence of Helicobacter pylori and subsequent eradication is recommended in mutation carriers. In case of a high incidence of gastric cancer in some populations, some experts recommend upper GI endoscopy every 1 to 3 years.
-
Other Lynch-associated cancers: Surveillance is not recommended due to the low sensitivity and specificity. (Although there are insufficient data supporting surveillance for other target organs, it may be considered in the context of family history.)....... Unlike CRC, data to support the effectiveness of transvaginal ultrasound and endometrial biopsy for gynecologic surveillance are lacking, and only surgical removal of the uterus and ovaries (fallopian tubes???) has been shown to reduce incidence of endometrial and ovarian cancers.10 Individuals with LS also have an elevated risk of developing other cancers, specifically tumors of the urinary tract (lifetime risk, 5% to 12%), small intestine, ovary (lifetime risk, 4% to 12%), stomach (lifetime risk, 8% to 10%), pancreas (lifetime risk, 4%), biliary tract, brain, and skin.11,12 Comparisons of phenotype according to MMR gene mutation have shown that MLH1-mutation carriers tend to develop CRC at younger ages, whereas MSH2 carriers seem to be at higher risk for extracolonic cancers, and for women with MSH6 mutations, the risk for endometrial cancer may surpass the lifetime CRC risk.13–15 In contrast, the risks for CRC and endometrial cancer seem to be lower among individuals with mutations in PMS2 (15% to 20%) compared with carriers of other MMR gene mutations.16........
Saturday, December 13, 2014
Commentary on ‘Performance of ultrasound as a second line test to serum CA125 in ovarian cancer screening’
Commentary - open access
Conclusions
The
last 50 years have seen a sea change in ideas regarding the origins of
ovarian cancer, its natural history and the best ways of improving
mortality. Despite advances in chemotherapy regimens and targeted
therapies there has been little change in the prognosis for women with
advanced disease. Hope therefore rests with the ability of ovarian
cancer screening strategies to shift the burden of disease to earlier
stages, which may translate to better clinical outcomes and reduced
mortality. Multimodal screening and ultrasound-based approaches have
been shown to be sensitive and specific for detecting ovarian cancer but
whether these in themselves will provide sufficient lead time to change
the course of the disease remains to be shown. Ultimately success will
depend on the continued momentum of the multiple international and
multidisciplinary collaborations forged to ensure that research will
continue for better biomarkers that can be translated into clinical
interventions. It is imperative that clinicians and researchers continue
to engage the public and capitalise on the enthusiasm embodied by the
high compliance rates seen in the screening studies to work towards
reducing mortality from ovarian cancer.
Thursday, December 11, 2014
Enhanced recovery pathways in gynecologic oncology
abstract
Highlights
- •
- Enhanced Recovery Pathways (ERP) are safe for patients undergoing complex gynecologic oncology operations, including colonic resection.
- •
- Incorporation of a comprehensive ERP is associated with reduced length of stay, excellent patient satisfaction, and lower costs.
- •
- Successful implementation of ERP requires standardization and cooperation within the care team.
Abstract
Objective
Many
commonplace perioperative practices are lacking in scientific evidence
and may interfere with the goal of optimizing patient recovery.
Individual components of perioperative care have therefore been
scrutinized, resulting in the creation of so-called “enhanced recovery”
pathways (ERP), with the goal of hastening surgical recovery through
attenuation of the stress response. In this review we examine the
evidence for ERP in gynecologic oncology using data from our specialty
and general surgery.
Methods
We
performed a systematic literature search on ERP in gynecologic oncology
in June 2014 using PubMed/MEDLINE, EMBASE, and The Cochrane Library. All
study types were included. References were hand reviewed to ensure
completeness. The Enhanced Recovery After Surgery (ERAS) Society was
contacted to identify any unpublished protocols.
Results
Seven
investigations were identified that examined the role of ERP in
gynecologic oncology. Common interventions included allowing oral intake
of fluids up to 2 hours before induction of anesthesia, solids up to
6 hours before anesthesia, carbohydrate supplementation, intra- and
postoperative euvolemia, aggressive nausea/vomiting prophylaxis, and
oral nutrition and ambulation the day of surgery. In addition, bowel
preparations, the NPO after midnight rule, nasogastric tubes, and
intravenous opioids were discontinued. While no randomized data are
available in gynecologic oncology, significant improvements in patient
satisfaction, length of stay (up to 4 days), and cost (up to $7600 in
savings per patient) were observed in ERP cohorts compared to historical
controls. Morbidity, mortality, and readmission rates were no different
between groups.
Conclusion
Enhanced
recovery is a safe perioperative management strategy for patients
undergoing surgery for gynecologic malignancies, reduces length of stay
and cost, and is considered standard of care at a growing number of
institutions. Our specialty would benefit from a formalized ERP such as
ERAS which audits compliance to protocol care elements to optimize
patient outcomes and value.
Old drug, new trick: Repurposing metformin for gynecologic cancers?
abstract
Highlights
- •
- We summarize the molecular mechanisms of action mediating metformin's protective effect in cancer.
- •
- Review the preclinical and epidemiological evidences for metformin's potential role in gynecological cancers.
- •
- Description of ongoing prospective testing of metformin in gynecologic cancers and future directions.
Abstract
Objective
There
is increasing pre-clinical and clinical evidence that metformin, a
commonly used diabetes medication, has a protective effect in cancer.
The aim of this review is to discuss metformin's anti-cancer molecular
mechanisms of action and to summarize the current literature
demonstrating metformin's potential in gynecologic cancer prevention and
treatment.
Methods
A PubMed
search was conducted combining the keywords “metformin” with “neoplasm”,
“uterine neoplasms”, “ovarian neoplasms”, and “uterine cervical
neoplasms”. Studies published in English between 1994 and 2014 were
included.
Results
Pre-clinical
studies in endometrial, ovarian, and cervical cancer suggest that
metformin inhibits the growth of cancer cells. The primary molecular
mechanism mediating this effect appears to be the activation of
AMP-activated protein kinase (AMPK) and the subsequent inhibition of
mammalian targets of rapamycin (mTOR). The pre-clinical findings are
augmented by clinical studies indicating that metformin use is
associated with a reduced risk of cancer and improved survival in
diabetic women with ovarian and endometrial cancers. No clinical
analyses have evaluated metformin use and cervical cancer. Overall, the
data showing a favorable effect of metformin is strongest for
endometrial and ovarian cancer and prospective clinical testing is
ongoing in these two malignancies.
Conclusions
Numerous
clinical studies have reported an association between metformin use by
diabetic patients and improved outcomes in gynecologic cancers. In
addition, pre-clinical reports have identified plausible biological
mechanisms to explain the molecular mechanism of action of metformin in
cancer. However, the most important question remains unanswered: Will
metformin be effective against cancer in patients without diabetes?
Until this question is answered with prospective clinical testing, the
role of metformin in the treatment or prevention of gynecologic
malignancies remains theoretical and the clinical use of metformin as a
cancer therapeutic is experimental.
Combining clinical assessment and the Risk of Ovarian Malignancy Algorithm for the prediction of ovarian cancer
abstract
Objectives
ACOG
guidelines for the evaluation of women with a pelvic mass employ a
combination of physical exam, imaging, and CA125 to guide physicians in
the triage of women to gynecologic oncologists. We studied the use of
ROMA with clinical assessment for cancer risk assessment in women with a
pelvic mass.
Methods
This was a
prospective, multicenter trial evaluating women with a pelvic mass who
had an initial clinical risk assessment (ICRA) performed by a
generalist. ROMA scores were calculated and sensitivity, specificity,
PPV and NPV were determined for ICRA and ICRA + ROMA.
Results
A
total of 461 women were entered into the study. There were 375 benign
tumors, 48 EOC, 18 LMP tumors and 20 non-ovarian malignancies. For
detection of ovarian cancer alone, ICRA had a sensitivity of 85.4%, a
specificity of 84.3%, and a NPV of 97.8%. Adding ROMA to ICRA produced a
significant improvement of 8.4% in sensitivity, achieving a sensitivity
of 93.8% with a specificity of 67.2% and a NPV of 98.8%. Examination of
all malignancies (ovarian & non-ovarian) provided a sensitivity of
89.7% for ROMA + ICRA in comparison to 77.9% for ICRA alone, a
significant increase in sensitivity of 11.8%. The NPV also significantly
increased from 95.5% to 97.3%. Overall, ROMA detected 13 additional
malignancies missed by ICRA.
Conclusions
Adjunctive
use of ROMA with clinical assessment improves the stratification of
women with a pelvic mass into low and high risk groups for ovarian
cancer. The combination is particularly effective in ruling out
malignant disease.
CA125 kinetic parameters predict optimal cytoreduction in patients with advanced epithelial ovarian cancer treated with neoadjuvant chemotherapy
CA125
Highlights
- •
- This paper aims at determining the optimal CA125 cut-off value to accurately predict complete cytoreduction after NAC.
- •
- A CA125 level < 75 UI/ml after the 3rd NAC was an independent predictor factor for complete surgery.
Abstract
Objective
To
evaluate the different kinetic parameters of serum CA125 during
neoadjuvant chemotherapy (NAC) to predict optimal interval debulking
surgery (IDS).
Methods
The
present retrospective multicenter study included patients with advanced
ovarian cancer treated with neoadjuvant platinum-based chemotherapy
followed by IDS between 2002 and 2009. Demographic data, CA125 levels,
radiographic data, chemotherapy and surgical-pathologic information were
obtained. Univariate and multivariate analyses were performed to
evaluate variables associated with complete IDS. ROC analysis was used
to determine potential cut-off values to predict the likelihood of
complete cytoreduction via IDS.
Results
One
hundred and forty-eight patients met the study criteria. Ninety-three
patients (62.8%) had optimal cytoreduction with no residual macroscopic
disease (CC-0) after IDS. In multivariate analyses, the CA125 level
after the 3rd NAC was an independent predictor for optimal cytoreduction
(odds ratio: 0.98 [0.97–0.99], p = 0.04). The area under the ROC curve
was 0.73. A threshold of 75 UI/ml displayed the most predictive power.
The odds ratio to predict complete cytoreduction was 3.29 [1.56–7.10]
(p = 0.0008).
Conclusion
Our
data indicate that for advanced ovarian cancer, a CA125 level less than
75 UI/ml after the 3rd NAC was an independent predictor factor for
complete IDS.
Chemotherapy-induced peripheral neuropathy and its impact on health-related quality of life among ovarian cancer survivors PROFILES registry
abstract
Highlights
- •
- Neuropathy symptoms were experienced by 51% of women with ovarian cancer, especially tingling hands/feet and numbness in fingers/toes.
- •
- Even up to 12 years after the end of treatment some women experience neuropathy symptoms.
- •
- Neuropathy was associated with worse functioning, overall HRQoL, pain and insomnia.
Abstract
Objective
This
study assessed the prevalence and risk factors of chemotherapy-induced
peripheral neuropathy, and its impact on health-related quality of life
among ovarian cancer survivors, 2–12 years after diagnosis.
Methods
Women
(n = 348) diagnosed with ovarian cancer between 2000 and 2010, as
registered by the Dutch population-based Eindhoven Cancer Registry, were
eligible for participation. A questionnaire, including the EORTC
QLQ-C30 and EORTC QLQ-OV28 measures, containing 3 items about
neuropathy, was returned by 191 women (55%). Recurrence and chemotherapy
data were obtained from medical records.
Results
Of
all 191 women, the 129 women who received chemotherapy more often
reported having tingling hands/feet and feeling numbness in
fingers/toes, specifically 51% reported “a little” to “very much” of
these symptoms vs. about 27% who did not receive chemotherapy. Women
reporting more neuropathy symptoms reported lower levels of functioning
and overall quality of life. They also reported more symptoms of
fatigue, nausea/vomiting, pain, dyspnea, insomnia, appetite loss, and
financial problems. Moreover, women reporting more neuropathy symptoms
had experienced the disease and treatment more often as being a burden
and were more worried about their health, had more gastrointestinal and
hormonal symptoms, hair loss and more other chemotherapy side effects.
Linear regression analyses showed that more cycles of chemotherapy, more
recurrences and a shorter period since last treatment were associated
with a higher neuropathy score.
Conclusion
Neuropathy
symptoms were experienced by 51% of women with ovarian cancer who
received chemotherapy even up to 12 years after the end of treatment,
and this seriously affected their HRQoL.
Prognostic value of lymph node ratio in patients with advanced epithelial ovarian cancer
abstract
Highlights
- •
- Lymph node status is a prognostic factor in ovarian cancer.
- •
- Lymph node ratio reflects lymph node spread and surgical extent.
- •
- Lymph node ratio predicts overall survival more concisely.
Abstract
Objective
Lymph
node status is an established prognostic factor in epithelial ovarian
cancer (EOC). Lymph node ratio (number of positive LN/number of resected
LN) reflects both qualitative and quantitative lymph node spread as
well as surgical effort and extent of disease. We evaluated whether LNR
is a more precise prognostic factor than conventional lymph node status
in patients with EOC.
Methods
The
present retrospective study includes 809 patients with EOC, who
underwent primary cytoreductive surgery between 2000–2013.
Clinico-pathological parameters and survival data were extracted from a
prospectively maintained tumor registry database. The optimal cut-off
point for LNR was calculated by using Martingale residuals. Survival
analyses were calculated using Kaplan–Meier method and Cox regression
models.
Results
Lymphadenectomy
was performed in 693 (85.7%) out of 809 patients. Median number of
removed LN was 64 (IQR 25–75%: 39–84). LNR of 0.25 was identified as the
optimal prognostic cut-off value. The estimated 5-year-OS rates were
69.3% for patients with node-negative EOC compared to 33.1% for patients
with any lymph node metastasis (p < 0.001). The estimated 5-year-OS
rates were 42.5% for patients with LNR ≤ 0.25, and 18.0% for patients
with LNR > 0.25 (p < 0.001). Additionally in multivariate analysis
LNR > 0.25 was approved to be an independent prognostic factor for
overall survival (adjusted HR 1.44, 95% CI 1.04–2.00; p = 0.028).
Conclusion
LNR
more precisely predicts overall survival than conventional lymph node
status in EOC patients undergoing primary debulking surgery.
Laparoscopic staging of apparent early stage ovarian cancer: Results of a large, retrospective, multi-institutional series
abstract
Highlights
- •
- Stage of disease is still the most important prognostic factor in early ovarian cancer.
- •
- Among early ovarian cancer patients there is a non-negligible percentage of upstaged patients.
- •
- A complete and accurate surgical staging can be safely achieved through laparoscopic surgery, when performed in referral centers.
Abstract
Objective
The
aim of this study is to analyze the safety, adequacy, perioperative and
survival figures in a large series of laparoscopic staging of patients
with apparent early stage ovarian malignancies (ESOM).
Patients and methods
Retrospective
data from seven gynecologic oncology service databases were searched
for ESOM patients undergoing immediate laparoscopic staging or delayed
laparoscopic staging after an incidental diagnosis of ESOM.
Between
May 2000 and February 2014, 300 patients were selected: 150 had been
submitted to immediate laparoscopic staging (Group 1), while 150 had
undergone delayed laparoscopic staging (Group 2) of ESOM. All surgical,
pathologic, and oncologic outcome data were analyzed in each group and a
comparison between the two was carried out.
Results
Longer
operative time, higher blood loss, more frequently spillage/rupture of
ovarian capsule and conversion to laparotomy occurred in Group 1. No
significant differences of post-operative complications were observed
between the two groups. Histological data revealed more frequently
serous tumors (0.06), Grade 3 (p = 0.0007) and final up-staging
(p = 0.001) in Group 1. Recurrence and death of disease were documented
in 25 (8.3%), and 10 patients (3.3%%), respectively. The 3-year disease
free survival (DFS) and overall survival (OS) rates were 85.1%, and
93.6%, respectively in the whole series. There was no difference between
Group 1 and Group 2 in terms of DFS (p value = 0.39) and OS (p
value = 0.27).
Conclusion
In
this very large multi-institutional study, it appears that patients with
apparent ESOM can safely undergo laparoscopic surgical management.
Endometriosis and ovarian cancer - World Journal of Clinical Oncology
open access
..........In addition, we know about the possible links between endometriosis and cancer for almost 100 years. Despite clear evidence revealing that endometriosis increases ovarian cancer risks, it is possible that it may not affect disease progression after the appearance of ovarian cancer. However, despite clear evidence revealing that endometriosis increases ovarian cancer risk, our knowledge of the risk factors is far from established. In our review, we focused on the most recent approaches including possible biomarkers and genetic approaches....
Enteroenterostomy - emedicine
emedicine
Background
Enteroenterostomy
is an anastomosis between one part of the small bowel and another part
of the small bowel (jejunum or ileum). It is used to restore bowel
continuity after resection of a segment of the bowel or after creation
of a Roux-en-Y loop of jejunum. When performed as a bypass procedure,
enteroenterostomy relieves bowel obstruction.[1, 2].........
Tuesday, December 09, 2014
New Downloadable Slides: Adding Precision and Power to Progress in Ovarian Cancer Management
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Sent: December 9, 2014 10:47 AM
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Longwoods eLetter December 9, 2014 | If We Had a Magic Wand
Sundry interesting articles:
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Sent: December 9, 2014 11:53 AM
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Subject: Longwoods eLetter December 9, 2014 | If We Had a Magic Wand
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