Factors associated with surgical morbidity of primary debulking in epithelial ovarian cancer

The prognostic value of lymph node ratio in stage IIIC cervical cancer patients triaged to primary treatment by radical hysterectomy with systematic pelvic and para-aortic lymphadenectomy / 부인종양

The prognostic value of lymph node ratio in stage IIIC cervical cancer patients triaged to primary treatment by radical hysterectomy with systematic pelvic and para-aortic lymphadenectomy / 부인종양

Objective@#The aim of this study was to determine the prognostic value of lymph node ratio (LNR) in women with 2018 International Federation of Gynecology and Obstetrics stage IIIC cervical cancer. @*Methods@#In this retrospective dual-institutional study, a total of 185 node-positive cervical cancer patients who had undergone radical hysterectomy with systematic pelvic and para-aortic lymphadenectomy were included. All of the patients received adjuvant chemoradiation after surgery. LNR was defined as the ratio of positive lymph nodes (LNs) to the total number of LNs removed. The patients were categorized into 2 groups according to LNR; LNR <0.05 and LNR ≥0.05. The prognostic value of LNR was evaluated with univariate log-rank tests and multivariate Cox regression models. @*Results@#A total of 138 patients (74.6%) had stage IIIC1 disease and 47 (25.4%) patients had stage IIIC2 disease. With a median follow-up period of 45.5 months (range 3–135 months), the 5-year disease-free survival (DFS) rate was 62.5% whereas the 5-year overall survival (OS) rate was 70.4% for the entire study population. The 5-year DFS rates for LNR <0.05 and LNR ≥0.05 were 78.2%, and 48.4%, respectively (p<0.001). Additionally, the 5-year OS rates for LNR <0.05 and LNR ≥0.05 were 80.6%, and 61.2%, respectively (p=0.007). On multivariate analysis, LNR ≥0.05 was associated with a worse DFS (hazard ratio [HR]=2.12; 95% confidence interval [CI]=1.15–3.90; p=0.015) and OS (HR=1.95; 95% CI=1.01–3.77; p=0.046) in women with stage IIIC cervical cancer. @*Conclusions@#LNR ≥0.05 seems to be an independent prognostic factor for decreased DFS and OS in stage IIIC cervical carcinoma.

Prognostic impact of p16 and p53 gene expressions in stage 1a epithelial ovarian cancer

Objective@#Epithelial ovarian cancer (EOC) is rarely detected at stage 1a. Most of the patients have a good prognosis and there are limited factors that affect their survival. In the present study, we evaluated the p16 and p53 gene expressions of stage 1a EOC patients. Prognostic effects of these gene expressions, as well as those of other factors on short term survival were analyzed. @*Methods@#Our study included 29 patients. The specimens of the ovary with cancer were stained for p16 and p53. Gene expressions and other prognostic factors were evaluated. @*Results@#The median age of the patients was 51 years (27–84). The mean numbers of dissected pelvic and paraaortic lymph nodes were 27 and 12, respectively. The mean follow-up time was 33.7±18.9 months. During this period, recurrence occurred in two patients. One of the patients had grade 2 mucinous carcinoma and died of the disease at month 12 after the recurrence occurred at month 7. The second patient had clear cell carcinoma and recurrence occurred at month 34. p16 and p53 gene expressions or other factors were not associated with overall survival (OS) or disease-free survival in the short term. The lower p16 positivity rate in the non-clear cell group was found to be statistically significant (P=0.003). Both p53 and p16 positivity rates were higher in the high-grade carcinoma. @*Conclusion@#The levels of none of the common prognostic factors, including those of p16 and p53 gene expression, were associated with the progression-free survival or OS of stage 1a in the short term. Appropriate surgical staging and non-omission of subclinical metastases seem to be of central importance.

Is placental KISS-1 expression associated with first trimester abortion spontaneous?

Objective@#Several studies have examined biological markers during the first trimester to predict the maintenance of a healthy pregnancy. One such marker is kisspeptin, which is encoded by the KISS-1 gene. We aimed to determine whether firsttrimester pregnancy losses were associated with levels of placental KISS-1 expression. @*Methods@#This prospective case control study was conducted at a tertiary center. The study group included 27 and 24 patients who underwent dilation and curettage at <10 weeks of gestation, due to first trimester spontaneous pregnancy loss and for elective termination (control), respectively. Placental and decidual tissues from all patients were sectioned and immunohistochemically analyzed for kisspeptin. @*Results@#Age, gravida status, parity number, gestational week, and number of previous abortions did not significantly differ between the groups. KISS-1 expression levels were significantly lower in the group with spontaneous abortion compared with the group with elective termination. The median staining intensity of KISS-1 expression in the elective and spontaneous termination groups were 3 (strong) and 2 (moderate), respectively (P=0.004). KISS-1 expression levels were significantly lower among patients with previous abortions in the elective termination group (P=0.002). @*Conclusion@#KISS-1 expression levels were found to be significantly reduced in patients with spontaneous pregnancy loss; KISS-1 plays an important role in the implantation and continuation of pregnancy.

Prognostic impact of p16 and p53 gene expressions in stage 1a epithelial ovarian cancer

Objective@#Epithelial ovarian cancer (EOC) is rarely detected at stage 1a. Most of the patients have a good prognosis and there are limited factors that affect their survival. In the present study, we evaluated the p16 and p53 gene expressions of stage 1a EOC patients. Prognostic effects of these gene expressions, as well as those of other factors on short term survival were analyzed. @*Methods@#Our study included 29 patients. The specimens of the ovary with cancer were stained for p16 and p53. Gene expressions and other prognostic factors were evaluated. @*Results@#The median age of the patients was 51 years (27–84). The mean numbers of dissected pelvic and paraaortic lymph nodes were 27 and 12, respectively. The mean follow-up time was 33.7±18.9 months. During this period, recurrence occurred in two patients. One of the patients had grade 2 mucinous carcinoma and died of the disease at month 12 after the recurrence occurred at month 7. The second patient had clear cell carcinoma and recurrence occurred at month 34. p16 and p53 gene expressions or other factors were not associated with overall survival (OS) or disease-free survival in the short term. The lower p16 positivity rate in the non-clear cell group was found to be statistically significant (P=0.003). Both p53 and p16 positivity rates were higher in the high-grade carcinoma. @*Conclusion@#The levels of none of the common prognostic factors, including those of p16 and p53 gene expression, were associated with the progression-free survival or OS of stage 1a in the short term. Appropriate surgical staging and non-omission of subclinical metastases seem to be of central importance.

Is placental KISS-1 expression associated with first trimester abortion spontaneous?

Objective@#Several studies have examined biological markers during the first trimester to predict the maintenance of a healthy pregnancy. One such marker is kisspeptin, which is encoded by the KISS-1 gene. We aimed to determine whether firsttrimester pregnancy losses were associated with levels of placental KISS-1 expression. @*Methods@#This prospective case control study was conducted at a tertiary center. The study group included 27 and 24 patients who underwent dilation and curettage at <10 weeks of gestation, due to first trimester spontaneous pregnancy loss and for elective termination (control), respectively. Placental and decidual tissues from all patients were sectioned and immunohistochemically analyzed for kisspeptin. @*Results@#Age, gravida status, parity number, gestational week, and number of previous abortions did not significantly differ between the groups. KISS-1 expression levels were significantly lower in the group with spontaneous abortion compared with the group with elective termination. The median staining intensity of KISS-1 expression in the elective and spontaneous termination groups were 3 (strong) and 2 (moderate), respectively (P=0.004). KISS-1 expression levels were significantly lower among patients with previous abortions in the elective termination group (P=0.002). @*Conclusion@#KISS-1 expression levels were found to be significantly reduced in patients with spontaneous pregnancy loss; KISS-1 plays an important role in the implantation and continuation of pregnancy.