Perioperative change in CA125 is an independent prognostic factor for improved clinical outcome in advanced ovarian cancer.

OBJECTIVE: Despite being the most important prognostic factor for prolonged overall survival in epithelial ovarian cancer (EOC), the measurement of residual disease is hampered by its subjective character. Additional assessment tools are needed to establish the success of cytoreductive surgery in order to predict patients' prognosis more accurately. The aim of this study is to evaluate the independent prognostic value of perioperative CA125 change in advanced stage EOC patients. STUDY DESIGN: We identified all patients who underwent primary cytoreductive surgery for advanced stage (FIGO IIB-IV) EOC between 2008 and 2015, from the Netherlands Cancer Registry. The relative perioperative change in CA125 was categorized into four groups; increase, <50% decline, 50-79% decline and ≥80% decline. Overall survival (OS) was analyzed using Kaplan-Meier survival curves and multivariable cox regression models. RESULTS: We included 1232 eligible patients with known pre- and postoperative CA125 serum levels. Patients with a decline of ≥80% in CA125 levels experienced improved OS compared to those with a decline of <50% (univariable Hazard Ratio (HR) 0.45, 95%CI 0.36-0.57). The prognostic effect of perioperative CA125 change was independent of patient- and treatment characteristics, such as the extent of residual disease after cytoreductive surgery (multivariable HR≥80% 0.52(0.41-0.66)). CONCLUSIONS: This study shows that the perioperative change in CA125 is an independent prognostic factor for overall survival after primary surgery for EOC patients. This pleads for the use of a combined model, consisting of perioperative CA125 change and the outcome of residual disease, in order to predict the prognosis of EOC patients more accurately.

Inadequate office endometrial sample requires further evaluation in women with postmenopausal bleeding and abnormal ultrasound results.

OBJECTIVE: To determine whether further histologic assessment can be omitted after office sampling produced a nondiagnostic specimen. METHODS: Data were retrieved from a prospective cohort study of 913 women presenting with postmenopausal bleeding. This study was limited to women with an endometrial thickness either 5 mm or greater or that could not be measured, and in whom an endometrial biopsy performed in the office yielded nondiagnostic results. RESULTS: Endometrial thickness was nonreassuring or unknown in 516 women, of whom 403 (78.1%) underwent office endometrial sampling. In 66 women the amount of tissue obtained was not sufficient for pathologic characterization. Further investigation revealed an endometrial malignancy in 3 of these 66 women and atypical hyperplasia in 1. CONCLUSION: In women with postmenopausal bleeding and a nonreassuring transvaginal ultrasound evaluation, a nondiagnostic office endometrial sample does not rule out endometrial cancer and further endometrial sampling is advisable.

[Severe vitamin-D deficiency in more than half of the immigrant pregnant women of non-western origin and their newborns]. / Ernstige vitamine D-deficiëntie bij ruim de helft van de niet-westerse allochtone zwangeren en hun pasgeborenen.

OBJECTIVE: To determine the prevalence of vitamin-D deficiency in pregnant women and their newborns. DESIGN: Descriptive. METHOD: During the period of one year (April 2004-April 2005) 545 pregnant women of Dutch/European origin and 131 pregnant women of non-Western origin (mainly Turkish and Moroccan) were studied during their 10th and/or 30th week of pregnancy for calcidiol (vitamin-D) and calcium levels. The study took place in the Amersfoort region in the center of the Netherlands. In addition, cord blood samples were taken for vitamin-D and calcium levels from the 442 and 81 Dutch/European and non-Western newborns respectively. RESULTS: A severe deficiency was found (calcidiol < 20 nmol/l) in 55% of non-European women compared to 5% of Dutch/West-European women. From the cord blood samples, a severe vitamin-D deficiency (calcidiol < 13 nmol/l) was found in 54% of the newborns of non-European origin compared to 6% of the Dutch/West-European newborns. Vitamin-D concentrations in pregnant women at term were strongly correlated to the concentrations in the newborns' cord blood (R = 0.84). The calcium levels of pregnant women and newborns did not differ significantly between both population groups. CONCLUSION: More than half of the non-European pregnant women and their newborns had a severe vitamin-D deficiency. Screening for vitamin D deficiency and adequate suppletion for this risk group appears to be necessary. The causes and consequences of vitamin-D deficiency in pregnancy are discussed.