Systemic inflammation factors as survival prognosis markers in ovarian neoplasm and the relationship with cancer-associated inflammatory mediators-a review.

At the level of the genital system, ovarian neoplasm is the most frequent cause of morbidity and mortality. In the specialized literature, the coexistence of an inflammatory process is admitted from the early stages of the evolution of this pathology. Starting from the importance of this process, both in determinism and in the evolution of carcinogenesis and summarizing the field of knowledge, for this study we considered two objectives: the first was the presentation of the pathogenic mechanism, through which chronic +ovarian inflammation is involved in the process of carcinogenesis, and the second is the justification of the clinical utility of the three parameters, accepted as biomarkers of systemic inflammation: neutrophil-lymphocyte ratio, platelet lymphocyte ratio, and lymphocyte-monocyte ratio in the assessment of prognosis. The study highlights the acceptance of these hematological parameters, with practical utility, as prognostic biomarkers in ovarian cancer, based on the intrinsic link with cancer-associated inflammatory mediators. Based on the data from the specialized literature, the conclusion is that in ovarian cancer, the inflammatory process induced by the presence of the tumor, induces changes in the types of circulating leukocytes, with immediate effects on the markers of systemic inflammation.

Adiponectin - stratification biomarker in diastolic cardiac dysfunction.

This study does not propose to elucidate how adiponectin secretion is regulated, but how its adiponectin concentration is an indicator of heart disease. About adiponectin, it is not known whether it is functionally an enzyme, or very likely a cytokine/chemokine/hormone, secreted by fat cells/adipocytes in the abdomen. Abdominal fat secretes 67 hormones, and all of which cause disease. For example, adiponectin generates diabetes and ischaemic heart disease via dyslipidemia. Based on clinical symptoms, electrocardiographic and echocardiographic parameters, a group of 208 patients with diastolic cardiac dysfunction with or without preserved systolic function, developed on a background of painful chronic ischaemic heart disease, stable angina on exertion, was constituted. The serum levels of adiponectin, total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides were measured. Using the identified values, it was appreciated whether adiponectin correlates with the type of any of the two conditions, so that it can be recognised as a diagnostic and risk stratification marker.

Nomogram for Prediction of Postoperative Morbidity in Patients with Colon Cancer Requiring Emergency Therapy.

BACKGROUND Postoperative complications are the major cause of mortality and prolonged hospitalization after emergency surgery for colon cancer. This study aimed to propose an effective nomogram to predict postoperative complications in order to improve the outcomes. MATERIAL AND METHODS We retrospectively analyzed 449 patients who underwent emergency surgery for complicated colon cancer at the County Emergency Hospital Clinic "St. Apostle Andrei" in Galati, in the period from 2008 to 2017. Postoperative complications were intestinal obstruction, leakage, bleeding, peritonitis, wound infection, surgical wound dehiscence, respiratory failure, heart failure, acute renal failure, sepsis, and Clostridium difficile colitis, within a month after surgery. Logistic regression models were used to identify the independent prediction factors, and a nomogram was created, based on the best model. RESULTS A total of 106 patients (21%) presented postoperative complications after emergency surgery for colon cancer; 51 patients (11.36%) died during the postoperative period. After identifying the risk factors through univariate regression analysis, we identified the independent prediction factors in 2 multivariate regression models. The model with the highest accuracy included the following 7 independent prediction factors: Eastern Cooperative Oncology Group performance status, Charlson score, white blood cell count, electrolyte and coagulation disorders, surgery time, and cachexia (P<0.05 for all). This model showed good precision in predicting postoperative complications, with an area under curve of 0.83 and ideal accordance between the predicted and observed probabilities. CONCLUSIONS The nomogram developed in this study, which was based on a multivariate logistic regression model, had good individual prediction of postoperative complications.

Analysis of Prognostic Factors in Complicated Colorectal Cancer Operated in Emergency.

Introduction: In 2018, the colon cancer was the 5th type of neoplasia regarding the cancer mortality and the rectal cancer was the 10th. The survival of patients with colorectal cancer operated in emergency still remains unsatisfactory, the death being due to local recurrences and to metastases. The aim of this study is to evaluate some correlations of overall survival with clinic and paraclinic features, tumor or treatment characteristics in order to identify prognostic factors, for cases with colorectal tumors that underwent emergency surgery. Material and Methods: We performed a retrospective analysis on 431 patients with colorectal cancer operated in emergency between 2008-2017, excluding 40 patients with postoperative deaths, with a follow-up period of at least one year. There were correlations of some clinic and paraclinic features, tumor or treatment characteristics with the overall survival. Results: In the univariate statistical survival analysis, a statistically significant association was obtained with: the age 61 years (p_value = 0.000049), abdominal surgical history (p_value = 0.031725), heart disease (p_value = 0.000007), atrial fibrillation (p_value = 0.007496), preoperative diagnosis (p_value = 0.034352), cachexia (p_value = 0.000000), oliguria (p_value = 0.000000), anemia (p_value = 0.000006) hydro-electrolytic disorders (p_value = 0.000001), tumor localization (p_value = 0.000030), invasion into other organs (p_value = 0.000000), appearance of "frozen pelvis" (p_value = 0.000000), peritoneal carcinomatosis (p_value = 0.000000), liver metastases (p_value = 0.000000), type of surgery (p_value = 0.000000), lymph node dissection (p_value = 0.000001), liver biopsy (p_value = 0.043483), stoma reversal (p_value = 0.000000 ), serial interventions (p_value = 0.000000), pTNM (p_value = 0.000000), tumor grading (p_value = 0.007069). The Cox multivariate regression analysis revealed that: the age 61 years - HR = 1,026, 95% CI (1,012, 1,039) (p value = 0.000139), cachexia - HR = 1,358, 95% CI (1,046, 1,764) (p value = 0.021617), peritoneal carcinomatosis - HR = 2.346, 95% CI (1.163, 4.732) (p_value = 0.017253), disease stage - HR = 36.745, 95% CI (14.778, 91.366) (p_ value = 0.000000), intervention type - HR = 0.187, 95% CI (0.045, 0.779) (p_ value = 0.021281) and serial interventions - HR = 0.282, 95% CI (0.144.0.551) (p_ value = 000213) are independent prognostic factors. Conclusions: The prognostic factors for patients with colorectal cancers operated in emergency are: the age 61, the presence of abdominal surgical history and associated cardiac conditions, especially atrial fibrillation, diagnosis of diastatic perforation imminence, cachexia, oliguria, hydro-electrolytic disorders at admission, rectal tumors, tumor invasion in other organs, the appearance of "frozen pelvis", the presence of liver metastases or peritoneal carcinomatosis, undifferentiated tumors, stage IV, practicing an internal derivation or not performing lymph node dissection. The age over 61, cachexia, as well as peritoneal carcinomatosis, stage III or IV are independent risk factors the Hartmann procedure and the serial interventions are independent protective factors.

Prognostic Factors in Advanced Ovarian Cancer - A Clinical Trial.

Introduction: Ovarian cancer is one of most fatal gynecological condition. The number of patients diagnosed in advanced stages is very high, hence the recurrence rate is high, and the chance of survival at 5 years is less than 45%. Purpose: To evaluate correspondance between overall survival with clinical, paraclinical, tumor or treatment characteristics and to identify prognostic factors in patients with advanced ovarian cancer - stage III and IV FIGO. Material and Method: We performed a retrospective study in 65 patients with advanced ovarian cancer - stages III and IV FIGO operated during 2010-2018, with a follow-up period of at least one year. There were correlations with clinical and paraclinical charateristics, tumor or treatment characteristics and with overall survival. Results: In the univariate statistical analysis of survival, a significant statistical association is obtained by the presence of pelvic pain at presentation (p_value = 0.033744), with the stage III (p_value = 0.007595, respectively p_value = 0.022090), with the type of citoreduction (p_value = 0.035) , with postoperative complications (p_value = 0.000685) within the pathological subtypes (p_value = 0.046266), with adjuvant treatment (p_value = 0.000083). Cox multivariate regression analysis showed that adjuvant chemotherapy (HR = 0.046, 95% CI = (0.008, 0.261), (p_value = 0.000492), suboptimal cytoreduction (HR = 0.346, 95% CI = (0.140, 0.853), (p_value) = 0.021219) and postoperative complications (HR = 53,751, 95% CI = (4,672, 618,365), (p_value = 0.001389) are independent prognostic factors. Conclusions: Absence of pelvic pain at diagnosis, FIGO IIIC stage, suboptimal cytoreduction, presence of postoperative complications, inadequate adjuvant treatment and pathological type of clear cell cancer have been shown to be prognostic factors for overall survival. In patients with advanced ovarian cancer, the type of optimal citoreduction and adjuvant treatment are independent protective factors for overall survival, and the presence of postoperative complications has been shown to be an independent risk factor.

Neoadjuvant Radiochemotherapy for Patients with Locally Advanced Esophagogastric Junction Adenocarcinoma.

SCOPE: neoadjuvant RCT influence on early and long term postoperative outcomes in patients with locally advanced esophagogastric junction adenocarcinomas. MATERIALS AND METHOD: Sixty two patients with locally advanced esophagogastric junction adenocarcinomas were treated at the Center of Excellence in Esophageal Surgery at St. Mary Hospital between 2010-2017. According to the Siewert classification, the group comprised of type I - 11 patients, type II - 18 patients and type III - 33 patients. Only 17 patients received preoperative RCT. The surgical treatment for the 62 resected patients was: abdominal extended gastrectomy - 40 patients, Ivor-Lewis - 13 patients, McKeown esophagogastrectomy (3 incisions) - 5 patients and transhiatal esophagectomy - 4 patients. Results: Postoperative morbidity was 46.77% and was mainly represented by fistulas in 17 patients and pulmonary complications such as pleurisy,pneumonia and ARDS in 12 patients. Fistula occurred in 15 cases: grade 1 - 2 patients, grade 2 - 10 patients, grade 3 - 5 patients. Postoperative mortality was 4.8% (p_value = 0.017980 Fisher's Exact Test). Downstaging was observed in 7 patients. I did not encounter statistically significant differences in long term survival. Conclusions: Neoadjuvant RCT had no impact on postoperative morbidity, but statistically influenced postoperative mortality.

Clinical and Therapeutic Implications of the 8th Edition TNM Classification of Adenocarcinomas of the Esophagogastric Junction.

The 8th edition of TNM cancer staging is based on data from large patient cohorts, data collected from the Worldwide Collaboration Cancer Esophageal (WECC) group, or the International Association for Gastric Cancer (IGCA), including treated patients surgically per primate or after neoadjuvant treatment. This edition redefines the esophago-gastric junction tumors and recommends different TNMs staging: Siewert type I and II should be classified according to TNM recommendations for esophageal adenocarcinoma, while for Siewert type III the TNM classification for gastric cancer should be considered. Anatomical characteristics feature type T (tumor invasion), type N (regional lymph node invasion) and type M (distant metastasis). Non-anatomic characteristics include tumor differentiation (G) and tumor localization (L). Category descriptors are currently evaluated by endoscopy with biopsy, fine needle aspiration (EUS-FNA), thoraco-abdomino-pelvic computer tomography (CT) and positron emission tomography (CT-PET). The new TNM staging edition presents separate classifications applicable for therapeutic strategy: clinical staging cTNM (prior to any treatment), pathological staging pTNM (after surgery first) and neoadjuvant pathologic staging ypTNM (after neoadjuvant treatment followed by surgery). The refinement of each category and subcategory of T, N, M makes the 8th edition more accurate and adaptable to current practice, including for therapeutic strategy. The purpose of this study is to evaluate the clinical and therapeutical implications of the 8th edition of the TNM staging for esophago gastric junction adenocarcinoma.