Current management of cervical cancer in Poland-Analysis of the questionnaire trial for the years 2002-2014 in relation to ASCO 2016 recommendations.

OBJECTIVES: To assess the survival of patients with cervical cancer (CC). Since the recommendations concerning cervical cancer management adopted by Polish medical societies do not differ significantly from the ESGO or non-European guidelines, and the fact that evaluation of the system for CC treatment in Poland, as well as the mortality rate of Polish women with CC, which is 70% higher than the average for European Union (EU) countries, justifies the hypothesis that treatment of CC in Poland deviates from the Polish and international recommendations. This article puts forward the current management of cervical cancer in Poland and discusses it in the context of ASCO guidelines. MATERIAL AND METHODS: A survey retrospective multicenter analysis of the medical records of 1247 patients with cervical cancer who underwent treatment for disease and who had completed at least two years of follow-up. RESULTS: Although concurrent radiotherapy and chemotherapy is a standard treatment of FIGO IB to IVA cervical cancer patients in enhanced- and maximum-resources settings, in our analysis, we found that the percentage of women subjected to chemotherapy was lower than in countries where total survival rates were lower. CONCLUSION: Within the IA to II A cervical cancer patients studied group, the methods of treatment remained in line with ASCO guidelines for countries with the highest standard of care. Although concurrent radiotherapy and chemotherapy is a standard treatment of FIGO IB to IVA cervical cancer patients in enhanced- and maximum-resources settings, in our analysis, we found that the percentage of women subjected to chemotherapy was lower than in countries where total survival rates were lower. Our findings, together with the inconsistencies within the cervical cancer screening program, may be one of the explanations of poorer survival rate of women with cervical cancer in Poland.

[Analysis of histological type and staging of cervical cancer as prognostic factors among women treated in the Department of Gynecology and Oncology, Jagiellonian University in the years 2001-2014].

Introduction: Cervical cancer (CC) is the fourth most common, in terms of incidence of new cases, cancer in women and the third leading cause of cancer deaths in women worldwide. Survival of patients with CC depends on many factors, including the type of cancer, grading, FIGO staging and treatment. Material and Methods: Analysis of survival of 524 patients diagnosed with invasive and non-invasive CC depending on histopathologic diagnosis, clinical staging, tumor grading and combination of therapy. Results: The 2-fold increase in the risk of death at diagnosis in order of HSIL> ca planoepitheliale> adenocarcinoma> sarcoma was noted. Grading 2 and 3 significantly reduces the average survival in patients diagnosed with CC. The higher staging, the shorter the average survival. Each pass by one FIGO stage was shown to increase the risk of death by 46%. The risk of death increases by 4% with every year of woman's life. The longest average survival, 72 months, characterized a group of women undergoing curettage, followed by radical hysterectomy/ trachelectomy and lymphadenectomy without adiuvant radio-/ chemotherapy. The shortest survival, 26.9 months, was observed in the group treated with curettage followed by chemoradiation. Conclusions: Histopathology, clinical staging, grading, age and combination of treatment proved to be significant factors affecting survival in women with CC.

[Hormonal contraception in autoimmpne diseases]. / Antykoncepcja hormonalna w wybranych chorobach autoimmunologicznych.

The onset and the course of autoimmune diseases is influenced among other factors by the sex hormones. Hormonal contraception might affect the course of the autoimmune disease. The paper summarises the manner of save application of hormonal contraception in patients with autoimmune disease.

[Efficacy and costs of ovarian cancer therapy in Poland--regional approach]. / Skutecznosc i koszty leczenia raka jajnika w PoIsce--ujecie regionalne.

UNLABELLED: Ovarian cancer (OC) affects over 3 000 women in Poland annually The efficacy of the therapy remains relatively low due to challenges of systematic improvement in the early detection OC rates. International comparisons indicate a positive correlation between health expenditures and 5-year survival rates of cancer patients. To the best of our knowledge, our study has been the first to present a correlation between the 5-year survival rates (SRs) and the cost of ovarian cancer therapy in particular regions of Poland. MATERIAL AND METHODS: The study was based on the National Health Fund (NHF) data, available in the Disease Treatment Registry The analysis included approximately 13,000 OC patients who started their treatment between 2005 and 2008 to allow for the evaluation of long-term therapy results. The 5-year survival rates were analyzed in relation to average NHF expenditures in various regions of Poland, distinguishing the population of patients aged 45-64 years. RESULTS: The 5-year survival rate in the cohorts diagnosed in 2005 and 2008 changed marginally from 42% to 43%, maintaining relatively large differences between the regions (from 35% to 53% in patients diagnosed in 2008). The NHF expenditures in particular regions differed significantly: mean cost for the entire treatment cycle ranged from 31.600 PLN do 58.000 PLNperperson among patients diagnosed in 2008. No significant correlation between the survival and the cost was found. CONCLUSIONS: SRs of OC patients in particular regions of Poland are not correlated with average treatment cost. Thus, the differences in SRs between various regions of Poland have their source in other factors, e.g., clinical stage at diagnosis, or prevailing treatment patterns in the given region. Further studies may decrease regional discrepancies in patient care and SRs in OC subjects.

[Prevalence of HPV DNA among male sexual partners of women diagnosed with CIN and early invasive cervical cancer]. / Wystepowanie HPV DNA u partnerów seksualnych kobiet ze sródnablonkowa neoplazja szyjki macicy--CIN i wczesnoinwazyjnym rakiem szyjki macicy.

Human Papilloma Virus (HPV) infection is the most common sexually transmitted disease. Chronic HPV infection is indispensable for development of cervical intraepithelial neoplasia and cervical cancer. First data stating that HPV transmission among heterosexual partners is very common appeared in last years. The aim of this study was to estimate the HPV infection prevalence among male sexual partners of women diagnosed with subclinical HPV infection, cervical intraepithelial neoplasia and early invasive cervical cancer. The study was conducted among 289 women aged 25-60 diagnosed with CIN and cervical cancer stage IA; control group consisted of 44 women aged 28-56 HPV testing using the material from retroglandular sulcus was conducted among male sexual partners of women from the study group. Testing was performed with HC2 method. In the study group, HPV infection was stated in 218 (75.43%) women and in 6 (13.63%) in control group. HPV DNA was present in 148 (51.21%) men--sexual partners of women from the study group and only 1 (2.27%) from control group. Additionally, HPV types of high and low oncogenic potential were analyzed with regard to histological diagnosis (SPI, CIN, early invasive cervical cancer). As the analysis shows, HPV infection of male sexual partners of women diagnosed with SPI and CIN is relatively high (9.09-93.33%).

[Assesment of the ongoing changes among patients diagnosed with subclinical changes of an HPV infection (SPI) as well as changes in the type of CIN 1 and CIN 2]. / Zachowanie sie zmian o charakterze subklinicznej infekcji HPV (SPI), sródnablonkowej neoplazji szyjki macicy (CIN) 1 i 2. Badanie prospektywne obserwacyjne.

PURPOSE OF STUDY: The aim of the study was to assess the ongoing changes of the type of regression, progression and steady state among patients diagnosed with subclinical changes of an HPV infection as well as changes in the type of CIN 1 and CIN 2. MATERIALS AND METHODS: The study was conducted in a group of 289 women between the ages of 25-60 with abnormal cytology taking part in the CIN cervical cancer prevention program. RESULTS: The patients were observed over a period of 6 years; no detectable differences were discovered in the frequency of regression between patients with SPI in comparision to patients with CIN1. In addition, no differences were identified in the frequency of regression between groups of patients with CIN1 and CIN2. In contrast, regression was more common in patients with SPI than in patients with CIN2. Steady state was more frequent in patients with CIN1 and CIN 2 than in patients with SPI. The results illustrated no differences in the progression of SPI and the CIN1 to CIN2. The group of patients with CIN2 were frequently associated with progression to CIN3 more than in the group of patients with SPI. The group of patients with CIN2 were frequently associated with progression to CIN3 more than in the group of patients with CIN1. Further investigation of cervical changes associated with SPI, CIN1 and CIN2 were dependent on the presence of transcription genes E6 and E7 of HPV. In 138 cases, the presence of these transcription genes lead to progression in 19.56% of women; more specifically in the introduction of mE6 and E7 RNA. There were changes typical of remission in 56,52% of cases primarily in the absence of transcriptor genes HPV E6 and E7. CONCLUSION: 1. The histological changes of the cervix observed in subclinical HPV infection, CIN1 and CIN2 may be subject to a higher degree of progression of CIN. In addition, these changes may progress to cervical cancer, remain stationary in a steady state, or decline into remission. 2. The types of HPV infection with high oncogenic potential are not only important in initiation of cerival changes but also in the developmental process of carcinogenesis in the cervix by several independent mechanisms.

Vertical transmission of HPV in pregnancy. A prospective clinical study of HPV-positive pregnant women.

INTRODUCTION: Human papillomavirus (HPV) is the most common sexually transmitted infection. Data reporting vertical transmission of HPV from the mother to the fetus are inconsistent and scant. Vertical transmission may occur by hematogenic route (transplacental), or by ascending contamination, or through the birth canal, which may result in the dreaded and rare laryngeal papillomatosis. Infected sperm at fertilization is a potential route of infection, too. OBJECTIVE: The objective of the study was to evaluate the rate of vertical transmission of HPV in HPV-positive pregnant women to their newborn infants, as well as the risk factors of HPV vertical transmission. MATERIAL AND METHODS: The clinical material was provided by 136 pregnant women, aged 18-45 years. Out of this group, 30 (22.05%) women with abnormal Pap test and positive DNA HPV test were prospectively observed Neonatal status, i.e. DNA HPV from the nasopharyngeal smear was recorded in all infants during the perinatal period. The conventional Pap test was performed with the cervix brush in all women. The Bethesda 2011 classification system was applied. RESULTS: An average C Reactive Protein (CRP) concentration in the studied pregnant women was 711.6083 (Std Dev--12.93). The most frequent cytological findings in the cervical smears from the examined women were ASCUS, n = 13 (43.3%), then--LSIL, n = 10 (33.3%), HSIL--n = 5 (16.7%) and AGC--n = 2 (6.7%). In the neonates, the presence of LR HPV DNA was detected in 9 cases (30.0%) and HR HPV DNA in 7 cases (23.3%). Fourteen neonates (46.7%) tested HPV DNA negative in the perinatal period. CONCLUSIONS: HPV infection (incidental or chronic) is observed in approximately 22% of pregnant women from the Matopolska province. Neonatal HPV infection in HPV-positive women was observed in 53.3% of the subjects. CRP concentration > 10 mg/dl in the serum of pregnant women statistically significantly (p 0.001) reduces the risk of vertical transmission of HPV from the mother to the fetus.

[Significance of vitamins A and E in the cervical intraepithelial neopiasia--CEN]. / Rola witaminy A i witaminy E w zachowaniu sie sródnablonkowej neoplazji szyjki macicy (CIN).

UNLABELLED: Cervical intraepithelial neoplasia--CIN affects women in their repro- ductive life period. CIN may proceed squamous cervical cancer. CIN is divided into: CIN1, CIN2, CIN3. CIN3 comprises cervical cancer in situ- CIS which is the true precancer state within the cervix. CIN, depending on grade may progress, regress or persist for many years. According to a few publication vitamins C, E and A may protect against carcinogenesis within the cervix. The aim of this paper was evalua- tion of vitamins A and E serum concentration of cervical intraepithelial neoplasia patients. The study material consisted of 289 women aged 25-60 years diagnosed with CIN and early invasive cervical cancer IA. The subjects of the study were selected amongst participants of National Cervical Cancer Screen- ing Program attending Department of Gynecology and Oncology of Jagiellonian University Medical College in Krakow. The control group consisted of 44 women aged 28-56 years diagnosed and treated in the same centre and period due to a non oncologic gynecologic conditions. Serum vitamin A and E was measured with HPLC method with ultraviolet detector (UV) (254 nm). RESULTS: Medium serum vitamin A concentration in the study group was 2.67 ± 1.15 mg/l and was significantly (p < 0.001) lower than in control group -3.81 ± 1.62 mg/l. Mean serum vitamin E concentration in the study group was 3.95 ± 1.93 mg/l and was also significantly (p < 0.001) lower than in control group (8.63 ± 2.84 mg/l). To conclude, the observed significantly lower vitamins A and E serum concentrations may be related to the cervical neoplasia process. The normal vitamin A and E serum levels may have a protective effect against cervical carcinogenesis.