Diagnostic accuracy of serum insulin-like growth factor-binding protein 2 for ovarian cancer.

INTRODUCTION: Insulin-like growth factor-binding protein 2 (IGFBP2) plays an important role in the pathogenesis of ovarian cancer. The most prominent effects of IGFBP2 include promoting proliferation, driving invasion, and suppressing apoptosis. This study aimed to determine the diagnostic accuracy of serum IGFBP2 in differentiating between benign and malignant ovarian neoplasms. METHODS: Preoperative serum IGFBP2 level was evaluated from 76 women with primary ovarian tumor who underwent exploratory laparotomy at Sanglah General Hospital, Denpasar, Bali, Indonesia. The optimal threshold value of IGFBP2 for the diagnosis of ovarian cancer was determined from the receiver 0perating characteristic (ROC) curve. The diagnosis was confirmed by histopathologic analysis of resected ovarian specimens. RESULTS: Forty-six (60.5%) patients were diagnosed with ovarian cancer. The area under the ROC curve (AUC) of IGFBP2 in detecting ovarian cancer was 0.815 (95% CI: 0.721 to 0.910, P<0.001). For a given specificity larger than 95%, the optimal sensitivity was 63%. The optimal threshold value of IGFBP2 for the diagnosis of ovarian cancer was 804 ng/mL [sensitivity 63%, specificity 96.7%, positive predictive value (PPV) 96.7%, negative predictive value (NPV) 63%, accuracy 76.3%, and diagnostic odd ratio (DOR) 49.5 (95% CI 6.1 to 396.5)]. In a subgroup analysis, IGFBP2 showed excellence performance in diagnosing advanced ovarian cancer (AUC 0.904 [95% CI: 0.806 to 1.000], sensitivity 83.3%, specificity 96.7%, PPV 95.2%, NPV 87.9%, accuracy 90.7%, and DOR 145.0 [95% CI 15.0 to 1395.3]). CONCLUSION: IGFBP2 is a novel and potentially promising biomarker for detecting ovarian cancer. Further studies are needed to confirm its diagnostic performance in premenopausal women and for detecting early stage ovarian cancer.

Low expression of collagen type-1 in sacrouterine ligament as risk factor of stage III-IV uterine prolapse.

BACKGROUND: Despite being non-life threatening, uterine prolapse is a reproductive health problem that interferes psychosocial life, economical and sexual function. Uterine prolapse can be caused by direct trauma resulting in damaged and weakened levator ani muscle which in turn causing sacrouterine ligament to stretch in order to maintain uterus normal position. The main component of sacrouterine ligament is collagen. Types of collagen that was involved in the occurrence of uterine prolapse are which plays a role of risk of occurrence uterine prolapse is collagen type-1 and type-3. Collagen type-1 has a good resistance and flexible to strain. If there is a disruption in the expression of collagen in sacrouterine ligament, it will result in cause uterine prolapse. OBJECTIVE: The aim of this study is to prove low expression of collagen type-1 in sacrouterine ligament is a risk factor for the occurrence of stage III-IV uterine prolapse. STUDY DESIGN: This study was an observational study using case-control approach. A total of 22 cases of stage III-IV uterine prolapse and 22 cases of non-uterine prolapse as control group were selected by consecutive sampling. This study was carried out in Sanglah General Hospital and Pathobiology Laboratory of Veterinary Faculty of Udayana. Samples were taken from sacrouterine ligament of individual with stage III-IV uterine prolapse compared to non-prolapse uterine who had undergone total hysterectomy. RESULTS: Chi-square analysis with 95 % confidence interval indicated that low expression of collagen type-1 was 6 times more likely to be the risk factor of stage III-IV uterine prolapse (OR = 5.95; 95 %CI = 1.59-22.33; p = 0.006). CONCLUSION: Low collagen type-1 in sacrouterine ligament is a risk factor of stage III-IV uterine prolapse.

Pretreatment Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) as a Predictive Value of Hematological Markers in Cervical Cancer

Background: Inflammation represents a pivotal role in the progression of cervical cancer. The hematological markers of inflammation in complete blood count (CBC) panel are potentially useful in determining the prognosis of the disease. Objective: The aim of the study was to investigate whether the pretreatment neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) could be used as in predicting the stage of cervical cancer. Methods: A retrospective cross-sectional study involving 282 patients with cervical cancer was enrolled at Sanglah General Hospital for five years (2013-2017). The histopathological records and complete blood counts (CBC) of the patients were collected and analyzed using SPSS ver. 16 software. FIGO stage I­II and III-IV were classified as early and advance stage respectively. Results: The median NLR and PLR were significantly higher in the advance stage compared with early stage (7.58 (1.36-33.20) and 247.89 (97.10-707.11); p-value = 0.001). A strong positive correlation was found between the staging of cervical cancer and NLR (r=0.638) and PLR (r=0.668). The AUC, sensitivity, and specificity value of NLR and PLR were 0.803 (82%; 71%) and 0.716 (72%; 70%). Advanced stage of cervical cancer was found in high NLR (adjusted OR: 9.02; 95%CI=2.42-33.64; p=0.001) and PLR (adjusted OR = 2.47; 95% CI = 1.45-4.85; p = 0.032). Conclusion: Increased pretreatment NLR and PLR values may provide a useful information in predicting the staging of cervical cancer.

Ovarian cancer: Pathogenesis and current recommendations for prophylactic surgery

Ovarian cancer is one of the most common gynecologic cancers, and one of the leading causes of cancer-associated female mortality in the world. Currently, no widely accepted pathogenesis is available, which may explain the entire disease. Early detection and primary prevention of ovarian cancer are difficult, mostly due to its heterogeneous nature. Risk factor modification based on epidemiologic data has not significantly reduced the incidence of ovarian cancer. Currently, prophylactic surgical methods have been proposed as the most effective preventive measures for both the high-risk or low-risk populations. Understanding the existing pathogenesis theories and the surgical options available may alter physician's perspectives and facilitate better decision making.