Prognostic factors in young women with epithelial ovarian cancer: the Young Ovarian Cancer-Care (YOC-Care) study.

OBJECTIVE: To determine oncological outcomes and to identify prognostic factors in women aged <45 years with epithelial ovarian cancer. METHODS: A multicenter retrospective study was performed of patients treated for epithelial ovarian cancer aged <45 years between January 2010 and December 2019. RESULTS: A total of 998 patients with epithelial ovarian cancer from 55 different institutions in Spain were collected. The median age of the study population was 40.8 years (range 35.6-43.4). The grouped International Federation of Gynecology and Obstetrics (FIGO) stage distribution was 508 (50.9%) patients in initial stages (I and II) and 490 (49.1%) with advanced stages (III and IV). Three hundred and twenty-five (32.6%) patients presented with recurrent disease after a median follow-up of 33.1 months (range 16.1-66.4). The type of staging surgery (incomplete vs complete), type of initial treatment modality (primary cytoreduction vs interval surgery), and amount of residual disease were all significantly associated with overall survival. Tumor rupture was noted in 288 (27.9%) cases, but it was not associated with oncologic outcomes (p=0.11 for overall survival). In the multivariate analysis, the response based on radiological findings (HR 3.24, 95% CI 2.14 to 4.91 for partial response; HR 6.93, 95% CI 4.79 to 10.04 for progression), neoadjuvant chemotherapy (HR 1.42, 95% CI 1.04 to 1.94), and FIGO stage (HR 1.68, 95% CI 1.40 to 2.02) were identified as independent prognostic factors associated with worse oncologic outcomes (p<0.001). CONCLUSION: The partial and progression radiology-based response after chemotherapy, neoadjuvant chemotherapy, and advanced FIGO stage are independent prognostic factors associated with worse oncological outcomes in women aged <45 years with epithelial ovarian cancer.

Invasive mole in a perimenopausal woman with lung and vaginal metastases: A case report.

Gestational trophoblastic disease can result in serious complications and disease progression. Therefore, follow-up of such patients is essential for early detection of malignant trophoblastic tumors and to reduce mortality rate. Primary treatment is chemotherapy but hysterectomy should be considered in patients who have uncontrollable hemorrhage and hemodynamic instability.

Retroperitoneal Laparoscopic Para-Aortic Lymphadenectomy in Para-Aortic Staging of Locally Advanced Cervical Cancer.

STUDY OBJECTIVE: To review/learn a surgical technique not very well-known by gynecologic oncologists. DESIGN: Level of evidence III. SETTING: A review of a surgical technique with emphasis on the para-aortic sentinel lymph nodes using indocyanine green. INTERVENTION: The film features the following steps to perform the procedure: 1. Creating a retroperitoneal window. 2. What to do if the peritoneum is torn. 3. Finding the psoas muscle, right ureter, and common iliac artery. Dissecting the right common iliac artery caudally to the bifurcation of the external iliac artery and internal iliac artery and cranially to the inferior mesenteric artery, the ovarian arteries, and the left renal vein. 4. A view of all of the nodes with fluorescence when indocyanine green is injected into the cervix. At present, the sentinel lymph nodes are not the standard of care for locally advanced cervical cancer. If the nodes are metastatic at this stage, all the para-aortic area will undergo radiation therapy. 5. Dissecting the inferior vena cava from the intersection with the right uterer to the right and left renal veins. 6. Performing the lateroaortic, preaortic, and precaval lymphadenectomy. 7. A final view with all of the elements (i.e., bifurcation of the common iliac artery, the left renal vein, and both ureters). 8. In the final part of the video, we open the peritoneal window to decrease the incidence of lymphoceles. CONCLUSION: The real novelty of this video is how the para-aortic area nodes are seen when green indocyanine is injected into the cervix. This video shows a simplified technique of retroperitoneal para-aortic lymphadenectomy using an advanced bipolar sealant. Some tips and tricks to facilitate the procedure are emphasized, especially in cases of accidental peritoneal tears. To decrease the incidence of lymphoceles before completing the surgery, the peritoneal window should be opened. This surgical technique is especially useful in endometrial cancer for staging the para-aortic area in obese patients and in advanced cervical cancer to determine the field of radiotherapy.

Valores de referencia de la translucencia intracraneal / Reference values for intracranial translucency

Objetivo: Determinar los rangos de referencia de la translucencia intracraneal (TIC) en nuestra población. Material y métodos: Se ha realizado un estudio de regresión lineal sobre 471 gestaciones únicas sin anomalías asociadas para valorar la relación entre LCC y TIC. Resultados: Se realizó la medición de TIC en el 98,9%. La TIC presenta una distribución normal con una desviación estándar de 0,4139. La media es 2,0502 mm (0,9-3,6 mm), los percentiles 5 y 95% corresponden con 1,4 y 2,7 mm. La TIC presenta una correlación lineal con la LCC (TIC: 0,0125* LCC + 1,2628; R2: 0,055 p < 0,0001). Se calcula la TIC estimada para el percentil 5: (0,0125* LCC + 1,2628) − 0,6505. El coeficiente de correlación intraclase es de 0,816 (0,606-0,921; IC 95%). Conclusiones: La medición del cuarto ventrículo durante la ecografía del primer trimestre es posible y sencilla de realizar. Se recomienda realizar un estudio neurológico ampliado ante mediciones situadas por encima del percentil 95 o inferiores al 5 (AU)

Objective: To determine reference ranges for intracranial translucency (ICT) in our population. Material and methods: To assess the relationship between crown-rump length (CRL) and ICT, we performed a linear regression analysis of 471 singleton pregnancies without associated anomalies. Results: ICT was measured in 98.9%. ICT had a normal distribution with a standard deviation of 0.4139. The mean was 2.0502 mm (0,9-3.6 mm), and the 5% and 95% percentiles corresponded to 1.4 mm and 2.7 mm. ICT had a linear correlation with CRL (ICT: 0.0125 + 1.2628 * CRL; R2:0,055 P <0.0001). The estimated ICT was calculated for the 5th percentile (1.2628 + 0.0125 * LCC)- 0.6505. The intraclass correlation coefficient was 0,816 (0606-0921 CI: 95%). Conclusions: Measurement of the fourth ventricle during first trimester ultrasound examination is feasible and is simple to perform. An extended neurological evaluation should be carried out if measurements are above the 95th percentile or below the 9th percentile (AU)