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1.
Gynecol Oncol ; 155(2): 213-219, 2019 11.
Article in English | MEDLINE | ID: mdl-31477282

ABSTRACT

OBJECTIVE: Optimizing the counselling of women ≤40years with epithelial ovarian cancer (EOC) by investigating the role of young age and tumour characteristics on overall survival (OS). METHODS: A retrospective population-based study was done using data of EOC patients diagnosed between 1990 and 2014 registered in the Netherlands Cancer Registry. Descriptive statistics were performed to analyse clinical and tumour characteristics. Five- and 10-year OS rates were calculated using Kaplan Meier curves. To determine prognostic factors, univariable and multivariable survival analyses were performed. RESULTS: 1407 women ≤40years and 29,022 women >40years old were included. OS was higher for the younger women compared to older group (5-year survival of 65.6% vs. 32.7%, 10-year survival of 57.5% vs. 22.5%, respectively). The younger women had more often a mucinous (36.4%), well-differentiated (31.8%) tumour in early stage of disease (49.9%). Serous tumours (43.0%), high-grade (36.0%) and stage III (47.1%) were most frequently found in the older women. Histology, grade, stage, incidence year, and age group are independent prognostic factors for survival. OS of the young women for several combinations of tumour characteristics were calculated. CONCLUSIONS: Age is an independent prognostic factor for OS in EOC patients. Counselling on prognosis could be more individualised in young EOC patients using the tumour characteristics histology, stage and grade.


Subject(s)
Carcinoma, Ovarian Epithelial/mortality , Ovarian Neoplasms/mortality , Adult , Age Distribution , Aged , Carcinoma, Ovarian Epithelial/pathology , Counseling , Female , Humans , Kaplan-Meier Estimate , Middle Aged , Netherlands/epidemiology , Ovarian Neoplasms/pathology , Prognosis , Registries , Retrospective Studies
2.
Eur J Cancer ; 118: 97-104, 2019 09.
Article in English | MEDLINE | ID: mdl-31326731

ABSTRACT

INTRODUCTION: About 5% of ovarian tumours have a non-epithelial histology, including germ cell tumours (GCTs), sex cord-stromal tumours (SCSTs) and sarcomas. Because these non-epithelial ovarian tumours are rare and population-based studies are scarce, the aim of this population-based study is to describe trends in the incidence, treatment and survival of women with these tumours in the Netherlands. METHODS: All women diagnosed with non-epithelial ovarian malignant tumours in the Netherlands between 1989 and 2015 were identified from the Netherlands Cancer Registry. Data on demographics, tumour characteristics and initial treatment were collected, and overall survival was analysed. RESULTS: A total of 1258 non-epithelial ovarian tumours were identified comprising 752 GCTs (60%), 341 SCSTs (27%) and 165 sarcomas (13%). The European age-standardised incidence rate (ESR) was 0.4 per 100,000 persons per year for GCTs, 0.2 for SCSTs and 0.1 for sarcomas. Approximately 97% of patients underwent surgical resection for the primary tumour, 31% received systemic treatment and 3% radiotherapy. Between the late 1980s and 2015, five-year overall survival improved for all histologic subtypes: GCTs rose from 73% to 88% (p = 0.03), SCSTs from 64% to 81% (p = 0.57) and sarcomas from 20% to 29% (p = 0.14). CONCLUSION: Malignant GCTs and SCSTs are rare, and their incidence has not significantly changed over recent decades. They have a good prognosis, which also improved slightly during this period. Primary sarcomas of the ovary are extremely rare and still have a poor prognosis.


Subject(s)
Neoplasms, Germ Cell and Embryonal/epidemiology , Ovarian Neoplasms/epidemiology , Sarcoma/epidemiology , Sex Cord-Gonadal Stromal Tumors/epidemiology , Adult , Aged , Aged, 80 and over , Female , Humans , Incidence , Middle Aged , Neoplasms, Germ Cell and Embryonal/diagnosis , Neoplasms, Germ Cell and Embryonal/mortality , Neoplasms, Germ Cell and Embryonal/therapy , Netherlands/epidemiology , Ovarian Neoplasms/diagnosis , Ovarian Neoplasms/mortality , Ovarian Neoplasms/therapy , Prognosis , Registries , Sarcoma/diagnosis , Sarcoma/mortality , Sarcoma/therapy , Sex Cord-Gonadal Stromal Tumors/diagnosis , Sex Cord-Gonadal Stromal Tumors/mortality , Sex Cord-Gonadal Stromal Tumors/therapy , Time Factors , Young Adult
3.
Br J Cancer ; 110(1): 42-8, 2014 Jan 07.
Article in English | MEDLINE | ID: mdl-24253502

ABSTRACT

BACKGROUND: For various malignancies, prognostic models have shown to be superior to traditional staging systems in predicting overall survival. The purpose of this study was to validate and compare the performance of three prognostic models for overall survival in patients with advanced-stage epithelial ovarian cancer. METHODS: A multi-institutional epithelial ovarian cancer database was used to identify patients and to evaluate the predictive performance of two nomograms, a prognostic index and FIGO (International Federation of Obstetrics and Gynecology) stage. All patients were treated for advanced-stage epithelial ovarian cancer between January 1996 and January 2009 in 11 hospitals in the eastern part of The Netherlands. RESULTS: In total, 542 patients were found to be eligible. Overall performance did not differ between the three prognostic models and FIGO stage. The discriminative performance for Chi's model was moderately good (c indices 0.65 and 0.68) and for the models of Gerestein and Teramukai reasonable (c indices between 0.60 and 0.62). The c indices of FIGO stage ranged between 0.54 and 0.62. After recalibration, the three models showed almost perfect calibration, whereas calibration of FIGO stage was reasonable. CONCLUSION: The three prediction models showed general applicability and a reasonably well-predictive performance, especially in comparison to FIGO stage. To date, there are no studies available that analyse the impact of these prognostic models on decision-making and patient outcome. Therefore, the usefulness of these models in daily clinical practice remains to be investigated.


Subject(s)
Neoplasms, Glandular and Epithelial/mortality , Nomograms , Ovarian Neoplasms/mortality , Aged , Carcinoma, Ovarian Epithelial , Cohort Studies , Databases, Factual , Female , Humans , Middle Aged , Neoplasm Staging , Neoplasms, Glandular and Epithelial/pathology , Netherlands/epidemiology , Ovarian Neoplasms/pathology , Prognosis , Reproducibility of Results , Survival Rate
4.
Ann Oncol ; 24(8): 2036-42, 2013 Aug.
Article in English | MEDLINE | ID: mdl-23543211

ABSTRACT

BACKGROUND: Recent studies suggested an improved overall survival (OS) for BRCA2- versus BRCA1-associated epithelial ovarian cancer (EOC), whereas the impact of chemotherapy is not yet clear. In a nationwide cohort, we examined the results of primary treatment, progression-free survival (PFS), treatment-free interval (TFI), and OS of BRCA1 versus BRCA2 EOC patients. METHODS: Two hundred and forty-five BRCA1- and 99 BRCA2-associated EOC patients were identified through all Dutch university hospitals. Analyses were carried out with the Pearson's Chi-square test, Kaplan-Meier, and Cox regression methods. RESULTS: BRCA1 patients were younger at EOC diagnosis than BRCA2 patients (51 versus 55 years; P < 0.001), without differences regarding histology, tumor grade, and International Federation of Gynecology and Obstetrics (FIGO) stage. Complete response rates after primary treatment, including chemotherapy, did not differ between BRCA1 (86%) and BRCA2 patients (90%). BRCA1 versus BRCA2 patients had a shorter PFS (median 2.2 versus 3.9 years, respectively; P = 0.006), TFI (median 1.7 versus 2.8 years; P = 0.009), and OS (median 6.0 versus 9.7 years; P = 0.04). Differences could not be explained by age at diagnosis, FIGO stage or type of treatment. CONCLUSIONS: PFS and OS were substantially longer in BRCA2- than in BRCA1-associated EOC patients. While response rates after primary treatment were similarly high in both groups, TFI, as surrogate for chemosensitivity, was significantly longer in BRCA2 patients.


Subject(s)
BRCA1 Protein/genetics , BRCA2 Protein/genetics , Neoplasms, Glandular and Epithelial/genetics , Neoplasms, Glandular and Epithelial/mortality , Ovarian Neoplasms/genetics , Ovarian Neoplasms/mortality , Adult , Aged , Antineoplastic Agents, Phytogenic/therapeutic use , Carcinoma, Ovarian Epithelial , Disease-Free Survival , Female , Humans , Middle Aged , Neoplasms, Glandular and Epithelial/drug therapy , Neoplasms, Glandular and Epithelial/surgery , Netherlands , Ovarian Neoplasms/drug therapy , Ovarian Neoplasms/surgery , Paclitaxel/therapeutic use , Platinum Compounds/therapeutic use , Survival , Treatment Outcome
5.
Gynecol Surg ; 8(3): 315-319, 2011 Sep.
Article in English | MEDLINE | ID: mdl-21949495

ABSTRACT

Sling procedures are a widely proven treatment for stress urinary incontinence. The aim of this prospective study was to evaluate the effect of the transobturator tape on female sexual functioning. Fifty-four women treated for stress urinary incontinence with transobturator tape filled out self-administered questionnaires on quality of life, urinary incontinence, and sexual function prior to surgery and 6 weeks and 12 months postoperatively. Preoperatively, 40 women (78%) were sexually active. There were no significant postoperative changes regarding frequency of sexual activity, sexual desire, and problems with lubrication or orgasm. Preoperatively, 55% reported urinary leakage during sexual activity and after surgery 6.5%. Sexual satisfaction was significantly improved 6 weeks (p = 0.05) and 12 months (p = 0.03) postoperatively. Pain during or after sexual activity was declined, only one patient reported worsening of pain. The transobturator tape procedure has a positive effect on female sexual functioning by reducing urinary leakage and pain during or after sexual activity. It seems to improve the overall sexual satisfaction. Further research is warranted to support these preliminary findings.

6.
Br J Obstet Gynaecol ; 105(11): 1208-10, 1998 Nov.
Article in English | MEDLINE | ID: mdl-9853772

ABSTRACT

Serum levels of aminotransferases, lactate dehydrogenase, gammaglutamyl transferase, alkaline phosphatase, albumin and conjugated bilirubin, measured in 54 women at a median of 31 months (range 3-101) after pregnancies complicated by the HELLP syndrome, were not elevated. Total bilirubin levels, however, were elevated in 20% of these women; this represents a significant difference from the prevalence in 151 women with a previous normal pregnancy (chi2 = 12.23, P < 0.001), or in the normal female population (chi2 = 22.34, P < 0.00001). This raises the possibility that a dysfunction of the bilirubin-conjugating mechanism represents a risk factor for the development of the HELLP syndrome.


Subject(s)
HELLP Syndrome/complications , Liver Diseases/etiology , Adult , Alanine Transaminase/analysis , Albumins/analysis , Alkaline Phosphatase/analysis , Aspartate Aminotransferases/analysis , Bilirubin/analysis , Female , Humans , L-Lactate Dehydrogenase/analysis , Pregnancy , gamma-Glutamyltransferase/analysis
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