Carboxyterminal telopeptide of type I collagen (ICTP) in predicting prognosis in epithelial ovarian cancer.

OBJECTIVE: The aim of this study was to assess the prognostic value of serum carboxyterminal telopeptide of type I collagen (ICTP) in ovarian cancer. Serum CA125 was used as a reference marker. METHODS: Forty-five patients with epithelial ovarian cancer were monitored with serial measurements of serum concentrations of ICTP, a degradation product of type I collagen likely to come about via the matrix metalloproteinase pathway. RESULTS: The patients with a good prognosis had significantly lower serum ICTP concentrations than the patients with a poor prognosis both before the operation and at all the postoperative time points studied (3, 6, 9, 12, 18, and 24 months), whereas a corresponding difference in CA125 was first seen after a 12-month follow-up. In multivariate regression analysis, the 9-month serum ICTP concentration remained the only independent prognostic indicator of all biochemical, clinical, and histological variables. The postoperative serum ICTP concentration did not correlate with the clinical stage, the grade of differentiation, or the presence of residual tumor. In contrast to ICTP, postoperative serum CA125 correlated with the clinical stage and the presence of residual tumor. CONCLUSIONS: Because our ICTP test does not detect defectively cross-linked carboxyterminal telopeptides of type I collagen, which is the predominant form in malignant ovarian tissue, the excess ICTP of ovarian cancer patients must originate from the tissue around the tumor, where the malignancy is causing tissue damage. As an indicator of invasion, the serum ICTP test opens up new possibilities to assess the clinical behavior of ovarian cancer and, in the future, also the effect of possible antiproteinase treatment in ovarian cancer.

Serial determinations of aminoterminal propeptide of type III procollagen (PIIINP) and prognosis in ovarian cancer; comparison to CA125.

During malignant growth many changes take place in the metabolism of fibrillar type III collagens in the connective tissues. The aminoterminal propeptide of type III procollagen (PIIINP) has been found to be often elevated in ovarian cancer. In the present study the prognostic value of serum PIIINP concentration in epithelial ovarian cancer is evaluated in relation to serum CA125. Fifty-six women were enrolled in the study. Serial venous blood samples were taken preoperatively and 6, 9 and 12 months after operation for PIIINP and CA125 determinations. The results were correlated to the three-year survival. In Kaplan-Meier survival analysis the preoperative (P = 0.0422), 9-month (P = 0.0062) and 12-month (P = 0.0062) serum PIIINP concentration distinguished between the patients with good and poor prognosis while CA125 did so only at 9- (P = 0.0005) and 12-month (P < 0.0001) follow-up. In the multivariate analysis the independent predictors of prognosis were the preoperative PIIINP and 12-month CA125 concentrations. The percentage changes in serum PIIINP concentration did not differentiate the patients with good or poor prognosis at any time point, whereas the changes in CA125 concentration significantly divided the patients into two prognostic groups during the second half of the postoperative year. We found that PIIINP and CA125 are complementary to each other as predictors of prognosis in epithelial ovarian cancer as preoperative PIIINP was better than CA125 and 1-year CA125 better than PIIINP in this function.

The prognostic value of peritoneal cytology in ovarian cancer.

We studied the significance of peritoneal cytology as a prognostic factor in primary epithelial ovarian cancer. Intraperitoneal specimens for cytological examination were taken from 73 patients at primary operation for ovarian cancer. The prognostic value of cytological findings was analyzed by the Kaplan-Meier method. It was also correlated to clinical stage, tumor histology, histopathological grade, residual tumor, presence of ascites and age by using the chi2-test. The value of cytology in relation to other factors was assessed by Cox-multivariate analysis. In univariate analysis peritoneal cytological findings correlated significantly to survival. In Cox-multivariate analysis peritoneal cytology, histopathological grade and the age of the patient were found to be significant independent prognostic factors in epithelial ovarian cancer. According to this data peritoneal cytology can be considered as an important prognostic factor in ovarian cancer. Therefore it should be evaluated routinely in association with surgery of ovarian tumors.

Type I and III collagen metabolites as predictors of clinical outcome in epithelial ovarian cancer.

We evaluated the significance of biochemical tumor markers, ie, aminoterminal propeptide of type III procoliagen, trivalently cross-linked COOH-terminal telopeptide of type I collagen (ICTP), aminoterminal propeptide of type I procollagen, and CA 125 in the prediction of ovarian cancer outcome and compared them with several classical indicators of prognosis. The concentrations of biochemical markers were determined from the preoperative serum specimens of 55 patients with epithelial ovarian cancer. In the univariate analysis, all biochemical markers except PINP and all conventional prognostic indicators except histological subtype correlated significantly with survival. In the multivariate Cox analysis of biochemical markers, serum ICTP remained the only significant prognostic indicator of overall survival. Among all variables, clinical stage and ICTP were the only independent and significant determinants of prognosis. Because the content of trivalently cross-linked, mature type I collagen (the breakdown of which is detectable in the ICTP test) in malignant ovarian cancer tissue has been reported to be lower and that of bivalently cross-linked and non-cross-linked collagen has been reported to be higher than in benign tumors, the source of excess ICTP in the circulation of ovarian cancer patients is most likely the degradative damage of soft tissues surrounding the progressively growing malignant lesions. The serum ICTP concentration can thus be regarded as an indicator of the invasion of ovarian cancer. Such information is not available by conventional methods. Therefore, the ICTP test will improve the accuracy of predicting clinical outcome in this disease.

Ultrasound-controlled removal of a dislocated intrauterine device in the first trimester of pregnancy: a report of 26 cases.

Intrauterine, ultrasound-guided removal of a copper-releasing intrauterine contraceptive device (IUCD) was carried out in 26 first-trimester pregnancies. In all the pregnancies, the string of the device had retracted into the uterine cavity. The total loss of pregnancies was 46%, while 36% of the initially uncomplicated single pregnancies ended in a spontaneous abortion. The time lag between the removal of the IUCD and clinical abortion was 21.5 days (range 3-48 days). A fundal location of the IUCD and failure to remove the IUCD by the first traction were common features in the abortion group. A total of 14 of the pregnancies resulted in a liveborn baby, and the incidence of complications after the 20th gestational week was not increased compared with the normal population.