Wednesday, May 13, 2015
Tuesday, May 12, 2015
Critical appraisal of bevacizumab in the treatment of ovarian cancer
open access
Conclusion
This article provides the latest evidence and
predicted further developments in BV treatment for ovarian cancer. BV is
the first molecular targeting agent to be indicated for gynecological
cancers, and, based on the specific tumor characteristics of ovarian
cancer, BV could be potentially much more effective for ovarian cancer
than for other cancer types. As a result of the four clinical trials
described above, in the treatment of both primary and recurrent cancers,
BV is believed to prolong the disease control of ovarian cancer and is a
very promising agent.15,31
Although adverse events of BV contained events not commonly observed
with cytotoxic agents used to treat ovarian cancer, these events can be
adequately managed with careful attention to severe adverse events such
as gastrointestinal tract perforation. Furthermore, in recurrent ovarian
cancer patients who present with various difficult-to-treat abdominal
symptoms, BV effectively improves QOL with regard to abdominal symptoms,
which is a very important clinical finding. However, the improvement in
QOL should be confirmed in the future through a placebo-controlled
trial. Although BV is effective for ovarian cancer, currently BV
treatment has not prolonged OS for either primary or recurrent cancer,
and we believe that, given the high cost associated with the treatment,32
patients who receive BV treatment should be carefully selected.
Therefore, the establishment of biomarkers that predict the
effectiveness of BV will be an important factor in determining the
importance of BV in the future treatment of ovarian cancer.
Monday, May 11, 2015
Molecular pathogenesis of ovarian clear cell carcinoma, Future Oncology, Future Medicine
abstract
Ovarian clear cell carcinoma is a distinct subtype of epithelial ovarian cancer, characterized by an association with endometriosis, glycogen accumulation and resistance to chemotherapy. Key driver events, including ARID1A mutations and HNF1B overexpression, have been recently identified and their functional characterization is ongoing. Additionally, the role of glycogen in promoting the malignant phenotype is coming under scrutiny. Appreciation of the notion that ovarian clear cell carcinoma is essentially an ectopic uterine cancer will hopefully lead to improved animal models of the disease, in turn paving the way for effective treatments.
Trends in Relative Survival for Ovarian Cancer From 1975 to 2011
abstract
OBJECTIVE: To examine relative survival (a metric that
incorporates changes in survival within a population) in women with
ovarian cancer from 1975 to 2011.
METHODS: Women diagnosed with ovarian cancer from 1975 to
2011 and recorded in the National Cancer Institute's Surveillance,
Epidemiology, and End Results database were examined. Relative survival,
estimated as the ratio of the observed survival of cancer patients
(all-cause mortality) to the expected survival of a comparable group
from the general population, was matched to the patients with the main
factors that are considered to affect patient survival such as age,
calendar time, and race. Hazard ratios were adjusted for age, race, year
of diagnosis, time since diagnosis, and the interaction of age and
years since diagnosis (except for stage II).
RESULTS: A total of 49,932 women were identified. For
stage I ovarian cancer, the adjusted excess hazard ratio for death in
2006 was 0.51 (95% confidence interval [CI] 0.41-0.63) compared with
those diagnosed in 1975. The reduction in excess mortality remained
significant when compared with 1980 and 1985. For women with stage
III-IV tumors, the excess hazard of mortality was lower in 2006 compared
with all other years of study ranging from 0.49 (95% CI 0.44-0.55)
compared with 1975 to 0.93 (95% CI 0.87-0.99) relative to 2000. For
women aged 50-59 years, 10-year relative survival was 0.85 (99% CI
0.61-0.95) for stage I disease and 0.18 (99% CI 0.10-0.27) for stage
III-IV tumors. For women aged 60-69 years, the corresponding 10-year
relative survival estimates were 0.89 (99% CI 0.58-0.98) and 0.15 (99%
CI 0.09-0.21).
CONCLUSION: Relative survival has improved for all stages of ovarian cancer from 1975 to 2011.
Menopausal hormone therapy and mortality among women diagnosed with ovarian cancer in the NIH-AARP Diet and Health Study
open access
Highlights
- •
- We examined pre-diagnosis use of menopausal hormone therapy (MHT) and ovarian cancer-specific mortality.
- •
- Estrogen-only and estrogen plus progestin-only therapy were unrelated to ovarian cancer-specific death.
- •
- Recency of MHT use was unrelated to ovarian cancer-specific death.
- •
- Women who used MHT prior to ovarian cancer diagnosis do not experience higher mortality.
Sunday, May 10, 2015
Prompting Primary Care Providers about Increased Patient Risk As a Result of Family History: Does It Work?
Blogger's Note: study included history of colorectal cancer (eg. Lynch Syndrome)
PDF open access/abstract
Conclusion
We found that prompting academic family physicians
about patients with family histories showing
risk for 6 common conditions did not seem to
increase the identification or screening of these
patients. Other experts reached a similar conclusion
after examining and debating the value of
family history.11 One study did show that automated
collection of family history can identify
more patients at risk for heart disease, but it did not
go on to demonstrate improved patient care outcomes
from the availability of such information.47
More studies that examine the clinical utility of
family history, including the best way to engage
PCPs in using this information are needed before
we begin to use automated prompts and alerts for
high-risk family histories.
Friday, May 08, 2015
Ethnic Disparities in Ovarian Cancer - SHARE webinar June 15th
SHARE
Disparities in gynecologic cancer incidence and mortality exist among American women based on ethnicity. Dr. Holcomb, Associate Attending Obstetrician and Gynecologist, NY Presbyterian Hospital, Associate Professor of Clinical Obstetrics and Gynecology, Weill Cornell Medical College, will outline these disparities with regard to ovarian, uterine, and cervical cancers as well as explore possible causes and discuss potential solutions. Register here.
Location | Time(s) | Date(s) |
---|---|---|
WEBINAR Email rsvp@sharecancersupport.org or Call (212) 719-2943 to register | 6:00 pm - 7:30 pm | Mon, Jun 15, 2015 |
Thursday, May 07, 2015
Company Creates Bioethics Panel on Trial Drugs - Johnson & Johnson
NYTimes.com
.....
Johnson & Johnson said the bioethicist, Arthur L. Caplan
of New York University, who has written extensively about the issue of
experimental drug availability — known as “compassionate use” — would
oversee an independent panel of doctors, ethicists and patient advocates
that will review requests for access to a limited array of experimental
medicines and decide how Johnson & Johnson should respond.
The
pilot program will be funded by the company, which will have no
influence on the panel’s decisions, Johnson & Johnson said, adding
that payments will go directly to the university. Dr. Caplan will not be
paid for his work in the program.
Dr.
Caplan, who has argued that the industry needs a fairer, more
consistent system for deciding whose requests should be granted, said he
was intrigued when company executives approached him about the idea.
“If we could structure this right, this would be a chance to not just
complain about what’s wrong, but maybe to suggest a way forward,” he
said in an interview......
▶ NOT MY TIME -- official music video - YouTube
▶ NOT MY TIME -- official music video - YouTube
NOT MY TIME LYRICS
CHANT
Ahum Arogyam, Ahum Arogyam, Ahum Arogyam
VERSE 1
It's not my time
I will resist
My trembling hands
Turn into fists
Cause I'm strong enough
Yeah, I'm strong enough
I got no time
For bucket lists
A longer life's
My only wish
Cause I won't give up
No, I won't give up
PRE-CHORUS
With every breath
This moment's real
With every breath
I'm gonna heal
CHORUS
It's not my time (no-oh)
I can beat it
I'm gonna fight
It's not my time (no-oh)
I won't be cheated
Out of this life
It's not my time
(No-oh-oh-oh-oh-oh-oh
No-oh-oh-oh-oh-oh-oh
No-oh-oh)
VERSE 2
It's not my time
Got nothing to fear
The trenches are full
My friends are near
Cause we're strong enough
Yeah, we're strong enough
I got no time
For hopeless tears
My body's at war
My mind is clear
Cause I won't give up
No, I won't give up
PRECHORUS
With every breath
I am alive
With every breath
I can survive
CHORUS
It's not my time (no-oh)
I can beat it
I'm gonna fight
It's not my time (no-oh)
I won't be cheated
Out of this life
It's not my time
(No-oh-oh-oh-oh-oh-oh
No-oh-oh-oh-oh-oh-oh
No-oh-oh)
No, it's not my time
(No-oh-oh-oh-oh-oh-oh
No-oh-oh-oh-oh-oh-oh
No-oh-oh)
BRIDGE
Ahum Arogyam, Ahum Arogyam, Ahum...
I won't ignore my battle scars
I'm so much more than missing parts
When vanity's a casualty
A tragedy brings majesty
It's given me a chance to start
Again
CHORUS
It's not my time (no-oh)
I can beat it
I'm gonna fight
It's not my time (no-oh)
I won't be cheated
Out of this life
It's not my time
(No-oh-oh-oh-oh-oh-oh
No-oh-oh-oh-oh-oh-oh
No-oh-oh)
Got a new lease on life
(No-oh-oh-oh-oh-oh-oh
No-oh-oh-oh-oh-oh-oh
No-oh-oh)
Everything's gonna be fine
(No-oh-oh-oh-oh-oh-oh
No-oh-oh-oh-oh-oh-oh
No-oh-oh)
It's not my time
Thursday, April 30, 2015
Prevalence of Founder Mutations in the BRCA1 and BRCA2 genes among Unaffected Women from the Bahamas
abstract
Population-based testing for BRCA1/2 mutations detects a high proportion of carriers not identified by cancer family history-based testing. We sought to determine whether population-based testing is an effective approach to genetic testing in the Bahamas, where 23% of women with breast cancer carry one of seven founder mutations in the BRCA1 or BRCA2 gene. We determined the prevalence of founder BRCA mutations in 1,847 Bahamian women without a personal history of breast or ovarian cancer, unselected for age or family history. We found that 2.8% (20/705) of unaffected women with a family history of breast/ovarian cancer and 0.09% (1/1,089) of unaffected women without a family history carry a BRCA mutation. 38% of unaffected women with a known mutation in the family were found to carry the familial mutation. We previously suggested that all Bahamian women with breast or ovarian cancer be offered genetic testing. These current data suggest that additionally all unaffected Bahamian women with a family history of breast/ovarian cancer should be offered genetic testing for the founder BRCA mutations.
Body mass index does not influence human epididymis protein 4 concentrations in serum (+CA125)
abstract
Serum human epididymis protein 4 (HE4), a novel tumour marker of ovarian cancer, has been reported to be influenced by some biological factors as body mass index (BMI). Accordingly, we enrolled 103 women without history or current ovarian disease or other gastrointestinal/gynaecological benign or malignant diseases, no smokers, aged ≤55 years and with serum creatinine concentrations ≤0.96 mg/dL and a BMI ranging from 19 to 57 kg/m2. Enrolled subjects underwent HE4 and carbohydrate antigen (CA) 125 measurements by Roche Diagnostics assays. Multiple regression models were used to estimate the potential influence on HE4 and CA 125 concentrations of BMI, age, serum creatinine, menopausal status, menstrual cycle phase and use of oral contraceptives. Age and creatinine increases induced HE4 increase, whereas the use of oral contraceptives appeared to decrease marker concentrations. BMI, as well as menopausal status and menstrual cycle phase, did not influence HE4 concentrations. None of the tested factors influenced CA 125 concentrations.
Outcome of Epithelial Ovarian Cancer: Time for Strategy Trials to Resolve the Problem of Optimal Timing of Surgery.
abstract
INTRODUCTION:
The standard treatment of ovarian cancer is the combination of debulking surgery and chemotherapy. There is an ongoing discussion on which treatment is best: primary debulking surgery (PDS) or neoadjuvant chemotherapy with interval debulking (NACT-IDS). Even a large randomized trial has not settled this issue. We examined whether comparing a specified treatment protocol would not be a more logical approach to answer this type of discussions.METHODS:
A retrospective study of 142 consecutively treated patients according to a fixed protocol between 2000 and 2012 was conducted. Disease-free survival and overall survival were calculated by univariate and multivariate analyses for the whole group and for advanced stages separately. Specific differences between PDS and NACT-IDS were studied. Comparison of results from large databases was made.RESULTS:
Disease-free survival and overall 5-year survival for the whole group were 35% and 50%. For the advanced stages, disease-free survival and overall 5-year survival were 14% and 36%, with a median disease-free and overall survival of 16 and 44 months. Of the 98 women with advanced ovarian carcinoma, 54% of operable patients underwent PDS and 44% underwent NACT-IDS. More patients in the PDS group were optimally (<1 cm) debulked: 80% vs 71%. There was no significant difference in survival between PDS or NACT-IDS. Optimally debulked patients had a significant better overall survival in multivariate analysis with a hazard ratio of 2.1.DISCUSSION:
Outcome of treatment according to a fixed protocol with a mixture of PDS and NACT-IDS was similar to results from large databases. We hypothesize that comparison of a specific strategy may yield more useful results than awaiting the perfect randomized trial.Wednesday, April 29, 2015
update Apr 9th: Ovarian, Fallopian Tube, and Peritoneal Cancer Prevention - NCI
National Cancer Institute
It is not clear whether the following affect the risk of ovarian, fallopian tube, and primary peritoneal cancer:
Diet
Alcohol
Studies have not shown a link between drinking alcohol and the risk of ovarian cancer.
Aspirin and non-steroidal anti-inflammatory drugs
Some studies of aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) have found a decreased risk of ovarian cancer and others have not.
Smoking
Some studies found a very small
increased risk of one rare type of ovarian cancer in women who were
current smokers compared with women who never smoked. (blogger's note: cell type is mucinous)
Talc
Infertility treatment
Overall, studies in women using fertility drugs have not found clear evidence of an increased
risk of ovarian cancer. Risk of ovarian borderline malignant tumors may be higher in women who take fertility drugs. The risk of invasive ovarian cancer may be higher in women who do not get pregnant after taking fertility drugs.
Palliative Care: If It Makes a Difference, Why Wait?
open access
......Together with earlier findings on the benefits associated with the early integration of palliative care, the ENABLE III trial6,7 urges a change of practice and culture. If palliative care makes a difference for patients and family caregivers, and if earlier is better, why wait?
Long-Term Survival Advantage and Prognostic Factors Associated With Intraperitoneal Chemotherapy Treatment in Advanced Ovarian Cancer: GOG
abstract
Conclusion The advantage of IP over intravenous chemotherapy extends beyond 10 years. IP therapy enhanced survival of those with gross residual disease. Survival improved with increasing number of IP cycles.
Intraperitoneal Chemotherapy: Long-Term Outcomes Revive a Long-Running Debate
open access
In conclusion, our cumulative experience with IP therapy has demonstrated sustained improvement in median OS (HR, 0.76) without an impact on long-term disease-specific mortality at the expense of increased complexity, toxicity, and cost. Similar gains in OS have been observed with other approaches, including IV therapy that incorporates dose-dense weekly paclitaxel, especially in high-risk patients with larger-volume residual disease.8 Important questions remain regarding patient selection (in terms of the extent of residual disease), mechanism of action, treatment modifications, timing, optimal number of IP cycles, and integration with targeted agents. Some of these questions will be addressed in the context of GOG-0252, and it remains to be seen whether better IV chemotherapy might match the outcomes previously associated with IP chemotherap
Symptoms and Distress in Children With Advanced Cancer PediQUEST study
abstract
Symptoms and Distress in Children With Advanced Cancer: Prospective Patient-Reported Outcomes From the PediQUEST Study
Conclusion Children with advanced cancer experience high symptom distress. Strategies to promote intensive symptom management are indicated, especially with disease progression or administration of intensive treatments.
25/25 vision needed to see through Ovarian cancer misunderstandings Australia
abstract
"Ovarian Cancer Australia's (OCA) recent study of the level of understanding and awareness of ovarian cancer by Australians conducted by Wallis Market and Social Research in February in the lead up to Ovarian Cancer Awareness Month revealed that knowledge on the disease's symptoms and prevention is still widely misunderstood."
MYChart News: May 9th Odette Cancer Centre - ovarian cancer event FROM PATIENTS TO PEERS TO PRACTITIONERS
MyChart™ News - On Saturday, May 9th, The Odette Cancer Centre, Sunnybrook Health Sciences Centre is pleased to present: FROM PATIENTS TO PEERS TO PRACTITIONERS: Learning from each other about ovarian cancer. For more Information, please contact: patienteducation@sunnybrook.ca or by calling 416 480 4836
Time: 8:30am – 3:45pm
Location: Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5
Registration and Parking: Free
Tentative Agenda:
- 8:30 – 9:00 am: Registration
- 9:00 – 9:30 am: Welcome and Opening Remarks
- 9:30 – 11: 15 am: Myth busting: Learning from Practitioners (speakers include: gynecologic oncologist, genetic counsellor, clinical researcher, and palliative care specialist.)
- 11:15 – 11:30 am: Break and Community Resource Displays
- 11:30 – 12:30 pm: Expert Wisdom: Learning from Peers
- 12:30 – 1:30 pm: Lunch
- 1:30 – 2:45 pm: Breakout Sessions
- Caregiver Booster (exclusively for family members and caregivers)
- The Writing Workshop. Sharing Our Stories
- Nutrition and You
- 2:50-3:15 pm: Closing Remarks
- 3:15-3:30 pm: Mindful Meditation
This event is part of the Winberg Patient Education Series.
Tuesday, April 28, 2015
Monday, April 27, 2015
FDA’s Orphan Drug Designation to Cantrixil for Ovarian Cancer
Oncology Times
FDA’s Orphan Drug Designation to Cantrixil for Ovarian Cancer
The
U.S. Food and Drug Administration has granted orphan drug designation
to the chemotherapy drug Cantrixil for the treatment of patients with
ovarian cancer. Cantrixil is a cyclodextrin envelope containing the
active ingredient, TRXE-002.
The
Orphan Drug designation—to encourage development of drugs in the
diagnosis, prevention, or treatment of a medical condition affecting
fewer than 200,000 people in the U.S.—grants a product market
exclusivity for a seven-year period if the sponsor complies with certain
FDA specifications, as well as tax credits and prescription drug user
fee waivers. The designation does not, though, shorten the duration of
the regulatory review and approval process.
Pre-clinical
data were presented at the American Association of Cancer Research
Annual Meeting in April. A Phase I study is currently enrolling patients
and a Phase IIa study is being planned.
Cantrixil is being developed by Novogen and CanTx, Inc.
Search Results
[PDF]Cantrixil - Novogen
www.novogen.com/pdf/cantrixil.pdf
Different Patterns of Disease Spread between Advanced-Stage Type I and II Epithelial Ovarian Cancer
abstract
Background and Aims: Two types of epithelial ovarian carcinoma (EOC) have been recently distinguished. Type I comprises low-grade serous, endometrioid and clear-cell tumors. High-grade endometrioid and serous tumors belong to type II. The aim of this study was to compare patterns of disease spread in advanced-stage type I and II EOCs at primary surgery.
Methods: Surgical and pathological data of 233 patients with advanced-stage EOCs were collected, 42 with type I and 191 with type II. The two groups were compared for tumor localization at primary surgery. Intraoperative mapping of ovarian cancer (IMO) was used to assess tumor dissemination.
Results: Tumor involvement was significantly higher in the type II group for the following: peritoneum (68.1 vs. 40.5%, p < 0.001), pouch of Douglas (60.2 vs. 40.5%, p = 0.06), vesicouterine ligament (40.8 vs. 19%, p = 0.027), diaphragm (45.0 vs. 11.9%, p < 0.001), serosa of liver (17.2 vs. 4.8%, p = 0.05), omentum (81.1 vs. 59.5%, p = 0.007), mesentery (42.9 vs. 16.7%, p = 0.005), pleural effusions (19.4 vs. 4.6%, p = 0.01) and ascites (60.7 vs. 21.4%, p < 0.001). IMO levels were different between the two groups (p = 0.001).
Conclusions: This study provides clinical evidence in favor of the dualistic model of carcinogenesis, since types I and II are characterized by different findings at primary surgery.
Socioeconomic Status as a Predictor of Adherence to Treatment Guidelines for Early-Stage Ovarian Cancer
abstract
Highlights
- •
- Disadvantaged populations experience substandard ovarian cancer care
- •
- Specifically, lower socioeconomic status is an independent predictor of receiving sub-optimal ovarian cancer treatment that deviates from the NCCN guidelines
- •
- Adherence to NCCN guidelines has the potential to improve ovarian cancer survival rates amongst all populations of women
Diagnostic Error in Medicine 8th International Conference - Society to Improve Diagnosis in Medicine
conference notice
Mark your calendar to attend the Diagnostic Error in Medicine 8th International Conference on
27-29 September 2015 at the Hilton Alexandria Mark Center just outside Washington, D.C. Our theme this year is After the IOM Report: What's Next?
In 2015, the Institute of Medicine (IOM) will release a
report on diagnostic error as a quality of care challenge. The report
will examine current definitions of diagnostic error, the epidemiology,
burden of harm, costs associated with diagnostic error, and efforts to
improve diagnosis. We anticipate release of the report prior to the
conference, but regardless, the meeting will ensure a timely discourse
on the subject by featuring experts who presented to the committee as
well as members of the committee. We will also begin to focus on what we
each can do to drive improvements in diagnostic performance whether in
the practice of medicine, the preparation of physicians, research,
policy or the role of the patient.
Download the save the date flyer.
Sunday, April 26, 2015
Success and complications of salpingectomy at the time of vaginal hysterectomy
abstract
STUDY OBJECTIVES:
The objectives of the study were to document the success rates and complications of performing salpingectomies at the time of vaginal hysterectomy to possibly reduce ovarian cancer rates.DESIGN:
Retrospective cohort study.DESIGN CLASSIFICATION:
Canadian Task Force Classification II-2 SETTING: Community based hospital with university affiliation in Calgary, Canada INTERVENTION: All women undergoing hysterectomy for benign conditions were offered preferentially a vaginal approach with prophylactic salpingectomy.MEASUREMENTS AND MAIN RESULTS:
During the study period, from October 2011 to January 2014, 425 vaginal hysterectomies were performed. The overall success rate of salpingectomy was 88%. Pelvic adhesions significantly predicted ability to perform salpingectomies with an odds ratio of 6.3, (95% CI 2.8-14.3), p<.001. Age also predicted outcomes, p=.007, with increasing age predicting decrease success. Overall the post-operative complication rate was 15% with 3.8% possibly attributable to the salpingectomies (intrapelvic complications). No associated factors were found on regression analysis.CONCLUSION:
Salpingectomy at the time of vaginal hysterectomy is a feasible procedure. Complication rates are low. Only pelvic adhesions are associated with failure to complete a salpingectomy.Removal of Ovaries associated with decrease in breast cancer death in women with cancer, BRCA1 mutation
Science
Story Source:
The above story is based on materials provided by The JAMA Network Journals. Note: Materials may be edited for content and length.
The above story is based on materials provided by The JAMA Network Journals. Note: Materials may be edited for content and length.
Journal Reference:
- Kelly Metcalfe, Henry T. Lynch, William D. Foulkes, Nadine Tung, Charmaine Kim-Sing, Olufunmilayo I. Olopade, Andrea Eisen, Barry Rosen, Carrie Snyder, Shelley Gershman, Ping Sun, Steven A. Narod. Effect of Oophorectomy on Survival After Breast Cancer inBRCA1andBRCA2Mutation Carriers. JAMA Oncology, 2015; DOI: 10.1001/jamaoncol.2015.0658
The ARID1A pathway in ovarian clear cell and endometrioid carcinoma, contiguous endometriosis, and benign endometriosis
Abstract
Objective
To assess ARID1A-encoded protein (BAF250a) and phosphorylated AKT (pAKT) expression, apoptosis, and the DNA damage response pathway in endometrioid and clear cell ovarian cancers (endometriosis-associated ovarian cancers [EAOCs]), and benign endometriotic ovarian cysts.Methods
In a retrospective study, tissue samples were reviewed from patients who had undergone surgery for EAOC or endometriotic ovarian cysts at a center in Montreal, QC, Canada, between 2000 and 2012. A tissue microarray including cases of endometrioid carcinoma, clear cell carcinoma, contiguous endometriosis (i.e. apparently benign endometriosis near the EAOC), and benign endometriotic ovarian cysts, was analyzed for the expression of various proteins.Results
Loss of BAF250a expression was seen in 13 (22%) of 59 endometrioid cancers, 17 (47%) of 36 clear cell cases, 8 (44%) of 18 contiguous endometriosis cases, and 3 (8%) of 66 benign endometriotic ovarian cysts. In tissues showing loss of BAF250a, expression of pAKT, γH2AX, BIM, and BAX was higher in EAOC and contiguous endometriosis than in benign endometriosis (P < 0.05), whereas expression of pATM, pCHK2, and Bcl2 was low. All proteins except for Bcl2 showed low expression in benign endometriosis.Conclusion
Loss of ARID1A-encoded protein seems to be an early event in EOAC, along with pAKT activation, alteration of γH2AX, and concomitant activation of the apoptosis pathway.ARID1A Expression in Ovarian Clear Cell Carcinoma with an Adenofibromatous Component
Abstract
Aims
The
carcinogenesis of ovarian clear cell carcinoma (CCC) has been
hypothesized to comprise two different pathways: an adenofibroma-carcinoma sequence and an endometriosis-carcinoma sequence.
However, the difference in the genetic basis of these two pathways
remains unclear. Recent studies have suggested that an ARID1A mutation
and the loss of the corresponding protein, BAF250a, are frequent events
in CCC. Herein, we investigated the difference in the loss of BAF250a
expression in adenofibroma-related CCC and endometriosis-related CCC.
Methods and Results
In
total, 93 cases of surgically treated CCC were evaluated. The presence
of adenofibroma and endometriosis associated with carcinoma was
determined by reviewing hematoxylin and eosin-stained slides for each
case. BAF250a expression in carcinoma was examined
immunohistochemically. The loss of BAF250a expression was detected in
carcinomas in 50 of 93 (54%) cases, including 5/18 (28%) with adenofibroma alone, 30/45 (67%) with endometriosis alone, 8/18 (44%) with both conditions, and 7/12 (58%)
with neither condition. The loss of BAF250a expression was
significantly less frequent in CCC cases with adenofibroma than in cases
with endometriosis (p = 0.01, Fisher's exact test).
Conclusions
The action of ARID1A in carcinogenesis differs between adenofibroma-related CCC and endometriosis-related CCC.
Assessment of a new system for primary site assignment in high-grade serous carcinoma of the fallopian tube, ovary, and peritoneum
Abstract
Aims
The
available evidence indicates that most non-uterine high-grade serous
carcinomas (HGSCs) arise from the fallopian tube (FT), but approaches to
primary site assignment have not evolved to reflect this. The aim of
this study was to assess the application of recently proposed criteria
for site assignment.
Methods and results
One
hundred and fifty-one HGSCs from four centres were reviewed
retrospectively. Sixty-three of 80 (79%) chemonaive (CN) and 45 of 71
(68%) post-neoadjuvant chemotherapy (NACT) cases were assigned as FT
primaries with the new criteria, whereas 58 of 80 (73%) and 45 of 71
(63%) were assigned as ovarian primaries with traditional criteria (P < 0.0001).
Of 111 prospectively collected HGSCs, with consistent detailed fimbrial
examination, 44 of 53 (83%) CN and 44 of 58 (76%) NACT cases were
assigned as FT primaries. The reproducibility of site assignment was
tested in a subset of 50 cases: all four reviewing pathologists agreed
on the primary site in 48 of 50 (96%) cases, and three of four agreed in
49 of 50 (98%) cases. Of the 53 prospectively studied CN cases,
bilateral ovarian involvement (62%) was significantly more frequent than
bilateral tubal involvement (12%, P < 0.0001), further supporting a tubal origin and ovarian metastasis in most cases.
Conclusions
With
currently accepted protocols, the proposed guidelines are easy to apply
and result in consistent site assignment in non-uterine HGSCs. Most
cases of non-uterine HGSC were considered to be primary FT neoplasms.
Clear cell carcinoma of the ovary: evaluation of prognostic parameters based on a clinicopathological analysis of 100 cases
abstract
AIMS:
The aim of this study was to evaluate the clinicopathological features of ovarian
clear cell carcinomas in order to identify which, if any, are
prognostically significant, and to determine whether there is value in
grading these tumours.
METHODS AND RESULTS:
One hundred tumours with clinical follow-up were reviewed. Features evaluated included age, preoperative/intraoperative rupture, size, architectural pattern(s), presence of oxyphilic cells, degree of cytological atypia, nucleolar grade, mitoses, background precursor and stage. Survival differences were analysed using the log-rank test and Kaplan-Meier estimator. Stage and lymph node status were the only parameters that were statistically significant (P < 0.0001). Patients with stage I disease (71%) had a 92% 5-year survival compared to a 31% 5-year survival in advanced stage disease (29%). Those with negative lymph nodes (92%) had an 80% 5-year survival compared to a 22% 5-year survival for those with positive nodes (8%).CONCLUSIONS:
This study shows that stage and lymph node status are the only prognostically significant parameters in patients with ovarian clear cell carcinoma. It also confirms that most patients with clear cell carcinoma present with disease confined to the ovary, and have an excellent prognosis. Grading ovarian clear cell carcinomas based on morphological features is not recommended, as none are of prognostic significance.Saturday, April 25, 2015
Ca-125 in diagnosis and monitoring of patients with ovarian cancer - Bulgaria
abstract
The carbohydrated antigen Ca-125 is identified by Bast et al. in 1981. The cut off value of 35 KU/l for serum levels of the marker covers in fact 98-99% of the healthy women. There are some variations in the levels of pre- and post menopausal women, and also some race- dependent and cycle-dependent differences. Although Ca-125 is the only one accepted tumor marker for ovarian cancer, its screening usage is controversial, because of the high percentage of false positive results. Ca-125 and HE4 are both validated serum markers for differential diagnose of pelvic masses. The Ca-125 main role is monitoring patients, having ovarian cancer in their chemotherapy, early recurrence finding and progression. Ca-125 rising values in monitoring patients are predictor of image or clinical recurrence in 59-96% of the cases. FDG PET/CT gave a new standard in ovarian cancer staging, especially in patients, having high levels of Ca-125, but negative conventional imaging examinations.
Histological subtypes of ovarian carcinoma and their importance for clinical prognosis - Bulgaria
abstract
[Histological subtypes of ovarian carcinoma and their importance for clinical prognosis].
[Article in Bulgarian]
[No authors listed]
Abstract
Ovarian
cancer is one of the most common and most lethal cancers. For Bulgaria
(2012) it occupies third place in the structure of gynecological
malignancies with a share of 22.6 percent, while regarding mortality is
at first place with 35.7 percent. New cases are 838 with crude incidence
22.3 x 10(5), and the deaths are 463 with crude mortality 12.3 x 10(5).
Ovarian tumors, even when they are of the same histological type
clearly differ in their cellular differentiation, molecular
characteristiques and subsequently in their biological behavior. In this
review, we discuss the frequency origin, morphology and molecular
characteristiques of the five major subtypes of ovarian cancer--serous
low and high grade, mucinous, endometroid and and clear cell. The role
of different risk and prognostic factors for the efficiency of the
treatment and control of disease been discussed.
FDA Alert: Injectable Products by Mylan: Recall - includes Gemcitabine, Carbo, Methotrexate
FDA Alert:
Including certain lots of:
- Gemcitabine for Injection
- Carboplatin Injection
- Methotrexate Injection
- Cytarabine Injection
BACKGROUND: Gemcitabine for Injection, USP 200mg is an intravenously administered product indicated for the treatment of ovarian cancer, breast cancer, non-small cell lung cancer and pancreatic cancer. These lots were distributed in the U.S. between Feb. 18, 2014, and Dec. 19, 2014, and were manufactured and packaged by Agila Onco Therapies Limited, a Mylan company. Lot 7801089 is packaged with a Pfizer Injectable label.
Carboplatin Injection 10mg/mL is an intravenously administered product indicated for the treatment of advanced ovarian carcinoma. The lot was distributed in the U.S. between Aug. 11, 2014, and Oct. 7, 2014, and was packaged by Agila Onco Therapies Limited, a Mylan company, with a Mylan Institutional label.
Methotrexate Injection, USP 25mg/mL can be administered intramuscularly, intravenously, intra-arterially, or intrathecally and is indicated for certain neoplastic diseases, severe psoriasis and adult rheumatoid arthritis. The lot was distributed in the U.S. between Jan. 16, 2014, and March 25, 2014, and was packaged by Agila Onco Therapies Limited, a Mylan company, with a Pfizer Injectables label.
Cytarabine Injection can be administered intravenously or intrathecally and in combination with other approved anti-cancer drugs is indicated for remission induction in acute non-lymphocytic leukemia of adults and pediatric patients. The lot was distributed in the U.S. between May 02, 2014, and July 24, 2014, and was manufactured and packaged by Agila Onco Therapies Limited, a Mylan company located in Bangalore, India and is packaged with a Pfizer Injectables label......
Friday, April 24, 2015
Earlier ovarian cancer detection (in research)
ScienceDaily
Successful ovarian cancer treatment often relies on catching it early. A study at The University of Texas MD Anderson Cancer Center may help point to a new method for women at risk.....
.....The study looked at antibodies produced by patients against the tumor gene TP53 which is mutated and overexpressed in the majority of ovarian cancers to see whether their presence would improve the ability of CA125 to detect ovarian cancer in an earlier stage.
"Anti-TP53 autoantibodies were detected an average of 13 months prior to rising CA125 levels and 33 months prior to diagnosis in patients who did not have a rising CA125," said Bast. "While only a quarter of cases are associated with anti-TP53 autoantibodies, when present, these antibodies promise to detect ovarian cancer at an earlier interval than CA125.". The data was presented on April 20 at the 2015 American Association for Cancer Research (AACR) Annual Meeting in Philadelphia.
PLOS ONE: Disease Specific Productivity of American Cancer Hospitals
American Cancer Hospitals open access
Conclusion
Research productivity varies considerably among the sample. Overall cancer productivity conceals great variation between diseases. Disease specific rankings identify sites of high academic productivity, which may be of interest to physicians, patients and researchers.
Cancer specific rankings
Different cancers are treated and studied by different physicians in different departments using a variety of techniques. To capture this diversity, we generated ranked lists over 25 different conditions. The 10 institutions with the highest score in each category, including ties, are presented as Table 2. M.D. Anderson Cancer center appeared on the most top-10 lists, 24/25, as well as having the highest score in 13/25. However, 43 of the 50 institutions make at least 1 appearance on a top 10 list, and 6 different organization were top ranked in at least one area. A full accounting of these appearances is presented as Table 3.
Prevalence, Classification, and Risk Factors for Postoperative Lower Extremity Lymphedema in Women With Gynecologic Malignancies: A Retrospective Study
abstract
Objective: Lower extremity lymphedema (LEL) is a major
long-term complication of radical surgery. We aimed to estimate the
incidence and grading of LEL in women who underwent lymphadenectomy and
to evaluate risk factors associated with LEL.
Materials and Methods: We retrospectively reviewed 358
patients with cervical, endometrial, and ovarian cancer who underwent
transabdominal complete systematic pelvic and para-aortic
lymphadenectomy between 1997 and 2011. Lower extremity lymphedema was
graded according to criteria of the International Society of Lymphology.
Incidence of LEL and its correlation with various clinical
characteristics were investigated using Kaplan-Meier survival and Cox
proportional hazards methods.
Results: Overall incidence of LEL was 21.8% (stage 1,
60%; stage 2, 32%; and stage 3, 8%). Cumulative incidence increased with
observation period: 12.9% at 1 year, 20.3% at 5 years, and 25.4% at 10
years. Age, cancer type, stage (International Federation of Gynecology
and Obstetrics), body mass index, hysterectomy type, lymphocyst
formation, lymph node metastasis, and chemotherapy were not associated
with LEL. Multivariate analysis confirmed that removal of circumflex
iliac lymph nodes (hazard ratio [HR], 4.28; 95% confidence interval
[CI], 2.09–8.77; P < 0.0001), cellulitis (HR, 3.48; 95% CI, 2.03–5.98; P < 0.0001), and number of removed lymph nodes (HR, 0.99; 95% CI, 0.98–0.99; P = 0.038) were independent risk factors for LEL.
Conclusions: Postoperative LEL incidence increased
over time. The results of the present study showed a significant
correlation with removal of circumflex iliac lymph nodes and cellulitis
with the incidence of LEL. Multicenter or prospective studies are
required to clarify treatment efficacies.
Gynecologic Cancer InterGroup (GCIG) Consensus Review for Clear Cell Carcinoma of the Ovary
abstract
Clear cell carcinoma of the ovary (CCC) is a histologic subtype of epithelial ovarian cancer with a distinct clinical behavior. There are marked geographic differences in the prevalence of CCC. The CCC is more likely to be detected at an early stage than high-grade serous cancers, and when confined within the ovary, the prognosis is good. However, advanced disease is associated with a very poor prognosis and resistance to standard treatment. Cytoreductive surgery should be performed for patients with stage II, III, or IV disease. An international phase III study to compare irinotecan/cisplatin and paclitaxel/carboplatin as adjuvant chemotherapy for stage IIV CCC has completed
enrollment (GCIG/JGOG3017). Considering the frequent PIK3CA mutation in CCC, dual inhibitors targeting PI3K, AKT in the mTOR pathway, are promising. Performing these trials and generating the evidence will require considerable international collaboration.
Endometrial Cancers in Mutation Carriers From Hereditary Breast Ovarian Cancer Syndrome Kindreds:
abstract
Endometrial Cancers in Mutation Carriers From Hereditary Breast Ovarian Cancer Syndrome Kindreds: Report From the Creighton University Hereditary Cancer Registry With Review of the Implications
Objective: The aim of this study was to categorize and
report endometrial cancers in mutation carriers from hereditary breast
ovarian cancer families.
Methods: Our Hereditary Cancer Registry was searched for gynecologic and peritoneal cancers linked to mutations in BRCA1 or BRCA2.
Invasive cancers were registered in 101 mutation carriers with complete
pathology reports. Efforts were made to secure diagnostic surgical
pathology tissues for review. All records and available diagnostic
slides were meticulously studied, and primary cancers were classified.
Findings: Eight malignancies were classified as
primary endometrial cancers. Five of these were low- or
intermediate-grade endometrioid carcinomas, and 3 were pure serous
carcinomas or contained serous carcinoma elements mixed with high-grade
endometrioid carcinoma. Breast cancers were diagnosed in 5 patients
before and in 1 patient after endometrial carcinoma. Three endometrioid
carcinomas were preceded by estrogen treatment, 2 for many years and the
other for only 2 months, and 2 of the patients with serous carcinoma
had been treated with tamoxifen.
Conclusions: The finding that 8 of gynecologic and
peritoneal cancers in 101 mutation carriers were endometrial cancers
with a smaller proportion of endometrioid carcinomas than reported in
general populations is added to the current controversial literature on
endometrial cancer, particularly regarding serous carcinomas, in
hereditary breast ovarian cancer syndrome. Well-designed prospective
programs for standardized surgical and pathologic handling, processing,
and reporting are essential for working out the pathogenesis, true
risks, and best management of this disease in carriers of deleterious BRCA1 and BRCA2 germline mutations.
Does Omentectomy in Epithelial Ovarian Cancer Affect Surviva... : International Journal of Gynecological Cancer
abstract
Objective: Although omentectomy is part of the staging
and treatment of epithelial ovarian cancer (EOC), its performance in a
patient with a grossly normal omentum—acknowledging its role in
debulking gross tumor deposits—has never been definitively shown to
improve survival.
Methods/Materials: Using Surveillance, Epidemiology,
and End Results data from 1998 to 2010, we identified patients with EOC
and assessed their age, race, year of diagnosis, tumor grade, histologic
subtype, International Federation of Gynecology and Obstetrics stage,
lymph node dissection, nodal findings, and performance of omentectomy.
We compared disease-specific survival (DSS) based on the presence or
absence of omentectomy using log-rank univariate analysis, Cox
multivariate analysis, and Kaplan-Meier survival curves.
Results: A total of 20,975 patients with invasive EOC
underwent surgical treatment. Initial univariate analysis indicated a
lower mean DSS with performance of omentectomy. However, multivariate
analysis demonstrated no significant association between DSS and
performance of omentectomy (hazard ratio, 0.978; P = 0.506). The DSS was improved if lymphadenectomy was performed (hazard ratio, 0.60; P < 0.001). In recent years, there was a trend toward decreased performance of omentectomy.
To look specifically at patients without bulky omental
disease, a subset analysis was done looking at patients with stage
I-IIIA disease who had had lymphadenectomy performed. There were 5454
patients in the group who underwent an omentectomy and 2404 patients in
the group who did not. No difference in DSS was seen between the groups
based on performance of omentectomy (P = 0.89). However, the
analysis was limited by the lack of Surveillance, Epidemiology, and End
Results data on the extent of omentectomy, amount of residual disease,
and adjuvant chemotherapy.
Conclusions: In this analysis, performance of
omentectomy in patients with EOC without bulky disease (≤stage IIIA) did
not seem to confer improvement in survival. A randomized control trial
would be needed to fully address this question.
Prognostic Significance of the Number of Postoperative Intraperitoneal Chemotherapy Cycles for Patients With Advanced Epithelial Ovarian Cance
abstract
|
|
Feelings of Women With Strong Family Histories Who Subsequent to Their Breast Cancer Diagnosis Tested BRCA Positive (Canada)
abstract
Objective: Family physicians in Canada as reported in
several studies do not recognize the importance of family history in
relation to breast/ovarian cancer and thus Canadian women with strong
family histories continue to develop early-onset breast cancer without
the knowledge of or ability to make choices regarding increased
surveillance or preventative strategies. This study explored the
feelings of women who learned about their hereditary risk only after
their diagnosis younger than 52 years and who eventually tested positive
for a BRCA gene mutation.
Methods: Thirty-four such women were mailed an
invitation to participate in this research including a letter of
information, consent form, and discussion prompts for their written
narrative response. Rigorous mixed method analyses were performed using
Charmaz-based qualitative analyses as well as quantitative analyses.
Results: Thirteen women (38.2%) responded with
narratives for qualitative analysis from which 4 themes were
coconstructed as follows: I, types of emotions; II, emotional response;
III, coping with emotions; and IV, advice to women at similar risk.
Women felt they should have learned about their hereditary risk from
their family physician and through public education before their
diagnosis. Although not experienced at the time of diagnosis, anger,
frustration, and regret were experienced after receiving their BRCA
results. These emotions arose from our research participants’ lack of
opportunity for prior genetic counseling and testing opportunity for
genetic counseling and testing.
Conclusions: With increased public and physician
education, it is hoped that women with significant family histories of
breast/ovarian cancer will be identified before diagnosis and given
options regarding cancer surveillance and risk reduction strategies.
Quantifying Physical Activity and the Associated Barriers for Women With Ovarian Cancer
abstract
Objective: The purpose of this study was to quantify
physical activity levels and determine the barriers to physical activity
for women with ovarian cancer.
Materials and Methods: Women with ovarian cancer from 3
oncology clinics enrolled in the cross-sectional study. Physical
activity and barriers to physical activity were measured using the
International Physical Activity Questionnaire and Perceived Physical
Activity Barriers scale, respectively. Demographic, medical, and
anthropometric data were obtained from medical records.
Results: Ninety-five women (response rate, 41%), with a mean (SD) age of 61 (10.6) years, a body mass index of 26.5 (6.8) kg/m2,
and 36.6 (28.2) months since diagnosis, participated in the study. The
majority of the participants had stage III (32%) or IV (32%) ovarian
cancer, were undergoing chemotherapy (41%), and had a history of
chemotherapy (93%). The majority of the participants reduced their
physical activity after diagnosis, with 19% meeting recommended physical
activity guidelines. The participants undergoing treatment reported
lower moderate-vigorous physical activity compared with those not
undergoing active treatment (mean [SD], 42 [57] vs 104 [119] min/wk; P < 0.001) and less total physical activity barriers (mean [SD], 49 vs 47; P
> 0.4). The greatest barriers to physical activity included fatigue
(37.8%), exercise not in routine (34.7%), lack of self-discipline
(32.6%), and procrastination (27.4%).
Conclusions: Women with ovarian cancer have low levels
of physical activity. There are disease-specific general barriers to
physical activity participation. The majority of the participants
reduced their physical activity after diagnosis, with these patients
reporting a higher number of total barriers. Behavioral strategies are
required to increase physical activity adherence in this population to
ensure that recommended guidelines are met to achieve the emerging known
benefits of exercise oncology.
Fibroblast Growth Factor Receptor 2 Is Associated With Poor Overall Survival in Clear Cell Carcinoma of the Ovary and May Be a Novel Therapeutic Approach
abstract
|
|
An Organizational Guideline for Gynecologic Oncology Service (Canada)
Abstract
Objectives: Documented variations in practice
compelled the need to establish a network that would facilitate the flow
of patients through the care continuum of a provincial health care
system in accordance with best practices. Therefore, a guideline was
developed to provide recommendations for the optimal organization of
gynecologic oncology services in this higher resource location to
improve access to multidisciplinary care and appropriate treatment.
Methods: A systematic review was conducted of Web
sites of international guideline developers, relevant cancer agencies,
and Medline and EMBASE from 1996 to 2011 using search terms related to
gynecologic malignancies, combined with organization of services,
patterns of care, and various facility and physician characteristics.
The results of the review were combined with expert consensus and
stakeholder consultation to develop a gynecologic oncology services
organizational guideline.
Results: The evidence review yielded a lower quality
evidence base; therefore, recommendations were determined through
consensus, including guidance for physician and hospital specialization,
and other domains including human and physical resources. Definitive
surgical treatment of most invasive cancers by subspecialist gynecologic
oncologists is recommended. In addition, it is recommended that these
subspecialists provide care within designated gynecologic oncology
centers. The recommendations also outline which services, such as
radiation therapy, may be provided in other affiliated centers.
Multidisciplinary team management is also endorsed.
Conclusions: These recommendations are intended to
allow a collaborative community of practice, supported by formal
interorganizational processes, to evolve to facilitate adherence to
guidelines and best practices at a system-wide level.
Perceptions of distress in women with ovarian cancer (small study)
abstract
PURPOSE/OBJECTIVES:
To explore women's experience of distress by asking "What do women with ovarian cancer want their spouse or significant other, family, friends, and healthcare providers to know about their experience of distress during diagnosis and treatment?" .RESEARCH APPROACH:
Modified Glaserian grounded theory.SETTING:
An urban setting in the Mid-Atlantic region of the United States.PARTICIPANTS:
12 women, aged 21-71 years, diagnosed with and treated for ovarian cancer.METHODOLOGIC APPROACH:
Constant comparative analysis of data obtained by audio recorded interviews.FINDINGS:
Although individual experiences differed, abstraction and conceptualization of the data supported a theory of existential assault. Participants found that the diagnosis was shocking and came "out of the blue like lightning." Their responses included seeking the best physician and treatment available, described as "no stone left unturned." Information about the disease was welcomed and unwelcomed as they shared the experience of "knowing what I don't want to know and not knowing what I want to know," and then had the added experience of sharing that information with those in their social network. Interpersonal interactions were described as "watching you watching me-we are both afraid," and "talking yet not talking about death," resulting in relationship changes and the realization that "now I have to take care of me." .CONCLUSIONS:
Participants experienced diagnosis with and treatment for ovarian cancer as an existential assault that, with the potential for an early death, affected the individual and her relationships.INTERPRETATION:
Previous studies have suggested that women diagnosed with and treated for ovarian cancer experience distress. This study reports women's perceptions of their own distress.The New Cancer Survivors | Psychology Today
The New Cancer Survivors
.....All these developments are factors in the increasing number of people whose cancer can be considered cured, a nebulous term that generally describes those who are cancer-free five years after their diagnosis. But at the same time, they’re enabling more and more people like Brad Slocum to live longer with active or persistent cancer, including tumors that are controlled without being eliminated or tumors that go through continuous cycles of remission and recurrence.
“It’s very different from being cured,” says Michael Fisch, chair of general oncology at the MD Anderson Cancer Center in Houston. “Being cured becomes a story like, ‘Back in 2002, I had a small breast tumor, and they took care of it,’ or ‘I had a small melanoma removed five years ago, and I live a normal life now.’ It’s a line item on a medical history that maybe isn’t too important. But taking Sutent, or periodically having surgeries, or having a lot of CT scans, or having a fear of recurrence or progression, or being on maintenance chemotherapy—that’s a different experience.”.....
.... But there are other days where I feel a great trepidation. It’s not like chronic asthma or chronic diabetes. The term chronic is not commensurate. With cancer, there’s always this extraordinary dread of recurrence, of tumor growth, and incredible fear and uncertainty about what the future holds.”.....
Thursday, April 23, 2015
Wednesday, April 22, 2015
Practical guidance for applying the ADNEX model from the IOTA group to discriminate between different subtypes of adnexal tumors
Practical guidance
All gynecologists are faced with ovarian tumors on a regular basis, and the accurate preoperative diagnosis of these masses is important because appropriate management depends on the type of tumor. Recently, the International Ovarian Tumor Analysis (IOTA) consortium published the Assessment of Different NEoplasias in the adneXa (ADNEX) model, the first risk model that differentiates between benign and four types of malignant ovarian tumors: borderline, stage I cancer, stage II-IV cancer, and secondary metastatic cancer. This approach is novel compared to existing tools that only differentiate between benign and malignant tumors, and therefore questions may arise on how ADNEX can be used in clinical practice. In the present paper, we first provide an in-depth discussion about the predictors used in ADNEX and the ability for risk prediction with different tumor histologies. Furthermore, we formulate suggestions about the selection and interpretation of risk cut-offs for patient stratification and choice of appropriate clinical management. This is illustrated with a few example patients. We cannot propose a generally applicable algorithm with fixed cut-offs, because (as with any risk model) this depends on the specific clinical setting in which the model will be used. Nevertheless, this paper provides a guidance on how the ADNEX model may be adopted into clinical practice.
IOTA - ADNEX model (ovarian cancer)
IOTA
(ovarian c
Objectives
To develop a risk prediction model to preoperatively discriminate between benign, borderline, stage I invasive, stage II-IV invasive, and secondary metastatic ovarian tumours.
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