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Impact of percutaneous nephrostomy on clinical outcomes in advanced carcinoma cervix with obstructive uropathy at Kenyatta national hospital 肯雅塔国立医院经皮肾造口术对晚期宫颈癌伴梗阻性尿路病变临床结果的影响
4区 医学 Q4 OBSTETRICS & GYNECOLOGY Pub Date : 2023-01-01 DOI: 10.22514/ejgo.2023.075
This retrospective study aimed to determine the impact of percutaneous nephrostomy (PCN) on the quality of life (QOL) and kidney function of women with advanced carcinoma of the cervix and obstructive uropathy in Kenyatta National Hospital by utilizing data from 2016 to 2019 and a follow-up patient interview in 2020. Sociodemographic data from patient records was reported as descriptive statistics. Serum urea, hemoglobin and creatinine levels before PCN and 72 hours, 1 month and 3 months after PCN were obtained. The changes were analysed using a paired t-test. Quality of life data before and after PCN tube insertion were collected using the structured Functional Assessment of Cancer Therapy and a cervix cancer-specific subscale (FACT-Cx) questionnaire, responses scored and an aggregate tallied. The QOL and kidney function data variables before and after PCN tube insertion were compared with statistical significance set at p < 0.05. Fifty eight study participants were enrolled, with an 80% power to detect a 5 fold change in kidney function. Percutaneous nephrostomy had an overall improvement in the quality of life (FACT-Cx total p = 0.041) with changes in aspects of physical well-being (p = 0.018) and additional concerns sexual function, self-esteem, appearance, urinary function, appetite and gastrointestinal function (p ≤ 0.001); but none in other aspects of the tool. Improvement was noted 72 hours after PCN tube insertion in 62% of patients’ urea (p = 0.033) and 64% of creatinine (p ≤ 0.001) levels but not sustained after 1 month and did not revert to normal levels. Hemoglobin levels did not improve. Percutaneous nephrostomy was found to have a short-term added value in management of women with obstructed uropathy in advanced carcinoma of the cervix as two aspects of their QOL improved while serum urea and creatinine levels improved slightly with no functional recovery.
本回顾性研究旨在通过2016年至2019年的数据和2020年的随访患者访谈,确定经皮肾造口术(PCN)对肯雅塔国家医院晚期宫颈癌和梗阻性尿病女性的生活质量(QOL)和肾功能的影响。来自患者记录的社会人口学数据采用描述性统计。取PCN前、PCN后72小时、1个月、3个月血清尿素、血红蛋白、肌酐水平。使用配对t检验分析这些变化。使用结构化的癌症治疗功能评估和宫颈癌特异性亚量表(FACT-Cx)问卷收集PCN管插入前后的生活质量数据,并对回答进行评分和汇总。PCN管置入前后的生活质量和肾功能数据变量比较,p <处有统计学意义;0.05. 58名研究参与者入组,检测肾功能5倍变化的准确率为80%。经皮肾造口术总体上改善了患者的生活质量(FACT-Cx total p = 0.041),在身体健康方面(p = 0.018)以及性功能、自尊、外观、泌尿功能、食欲和胃肠功能方面(p≤0.001)发生了变化,但在该工具的其他方面没有变化。在PCN管插入72小时后,62%的患者尿素(p = 0.033)和64%的患者肌酐(p≤0.001)水平有所改善,但1个月后没有持续,也没有恢复到正常水平。血红蛋白水平没有改善。经皮肾造口术对晚期宫颈癌梗阻性尿路病变的治疗具有短期的附加价值,因为其生活质量有两个方面的改善,而血清尿素和肌酐水平略有改善,但没有功能恢复。
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引用次数: 0
Effect of neoadjuvant chemotherapy combined with intraperitoneal chemotherapy after interval tumor cell reduction on the prognosis of advanced epithelial ovarian cancer 新辅助化疗联合间隔期肿瘤细胞减少后腹腔化疗对晚期上皮性卵巢癌预后的影响
IF 0.4 4区 医学 Q4 OBSTETRICS & GYNECOLOGY Pub Date : 2022-04-15 DOI: 10.31083/j.ejgo4302030
W. Wang, M. Gao, Xiaoting Li, Hong Zheng, Yu-nong Gao
Objectives : To investigate the effect of neoadjuvant chemotherapy combined with intraperitoneal chemotherapy after interval tumor cell reduction on the prognosis of advanced epithelial ovarian cancer. Methods : A retrospective study was performed among 210 patients with advanced ovarian cancer who were treated with neoadjuvant chemotherapy from May 1, 2007 to December 1, 2015. 121 patients with NACT-IDS (Neoadjuvant chemotherapy followed by interval debulking surgery) were enrolled. The patients were divided into observation group (NACT-IDS + IP group, n = 28) and control group (NACT-IDS + IV group, n = 93) depending on whether intraperitoneal chemotherapy was used after interval debulking surgery. The effects of intraperitoneal chemotherapy after NACT-IDS on PFS (progression-free survival) and OS (overall survival) were analyzed and the influencing factors were explored through multivariate analysis. The competitive model was used to analyze the effect of intraperitoneal chemotherapy after NACT-IDS on tumor recurrence. Toxicities associated with adjuvant chemotherapy were also analyzed between two groups. The effect of neoadjuvant chemotherapy cycles on prognosis and the correlation between postoperative CA125 decline and recurrence were evaluated. Results : Intraperitonal chemotherapy and R0 (no gross residual) were independent factors for PFS, with HRs of 0.560 (95% CI, 0.342–0.918, p = 0.022) and 0.578 (95% CI, 0.377–0.887, p = 0.012). There was no independent factor associated with OS. Significant difference in PFS was detected among the R0 + IP group, R0 + IV group, non-R0 + IP group and non-R0 + IV group. In patients with R0 tumor reduction, IP patients showed significantly better PFS, bonferronei adjusted p = 0.036. In patients without R0 tumor reduction, no significant difference was detected between IP and IV group, bonferronei adjusted p = 0.28. There were no significant differences of grade 3–4 toxicities, abdominal pain, treatment delays, dose reductions, and treatment modifications in NACT-IDS + IP group and NACT-IDS + IV group. Neoadjuvant chemotherapy cycles ( ≤ 3 and > 3) were not the influencing factors of PFS or OS and did not affect platinum-sensitive relapse or platinum-resistant relapse. The decrease in postoperative CA125 was not related to platinum-sensitive recurrence or platinum-resistant recurrence. Conclusions : Neoadjuvant chemotherapy combined with intraperitoneal chemotherapy after interval debulking surgery could improve the PFS of patients with advanced epithelial ovarian cancer compared to intravenous chemotherapy without significant differences in toxicity.
目的:探讨肿瘤细胞间隔减小时新辅助化疗联合腹腔化疗对晚期上皮性卵巢癌症预后的影响。方法:对2007年5月1日至2015年12月1日接受新辅助化疗的210例晚期癌症患者进行回顾性研究。纳入121例NACT-IDS(新辅助化疗后进行间隔性减瘤手术)患者。根据间隔减瘤术后是否进行腹腔化疗,将患者分为观察组(NACT-IDS+IP组,n=28)和对照组(NACT-IDS+IV组,n=93)。分析NACT-IDS后腹腔化疗对PFS(无进展生存期)和OS(总生存期)的影响,并通过多变量分析探讨影响因素。采用竞争模型分析NACT-IDS后腹腔化疗对肿瘤复发的影响。还分析了两组患者与辅助化疗相关的毒性。评估新辅助化疗周期对预后的影响以及术后CA125下降与复发的相关性。结果:腹膜内化疗和R0(无总残留)是PFS的独立因素,HRs分别为0.560(95%CI,0.342–0.918,p=0.022)和0.578(95%CI,0.377–0.887,p=0.012)。没有与OS相关的独立因素。R0+IP组、R0+IV组、非R0+IP小组和非R0+IV小组的PFS存在显著差异。在R0肿瘤缩小的患者中,IP患者显示出明显更好的PFS,bonferronei校正p=0.036。在没有R0肿瘤减少的患者中,IP组和IV组之间没有检测到显著差异,Bonferronie调整后p=0.28。NACT-IDS+IP组和NACT-IDS+IV组在3-4级毒性、腹痛、治疗延迟、剂量减少和治疗改进方面没有显著差异。新辅助化疗周期(≤3和>3)不是PFS或OS的影响因素,也不影响铂敏感复发或铂耐药复发。术后CA125的下降与铂敏感复发或铂耐药复发无关。结论:与静脉化疗相比,间隔性减瘤术后新辅助化疗联合腹腔化疗可改善晚期上皮性卵巢癌症患者的PFS,且毒性无显著差异。
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引用次数: 0
Adjuvant radiotherapy of endometrial cancer: role of 18F-FDG-PET/CT in treatment modulation 癌症辅助放射治疗:18F-FDG-PET/CT在调节治疗中的作用
IF 0.4 4区 医学 Q4 OBSTETRICS & GYNECOLOGY Pub Date : 2022-04-15 DOI: 10.31083/j.ejgo4302028
M. Ferioli, A. Perrone, P. Castellucci, V. Panni, A. Benini, G. Macchia, A. Galuppi, M. Buwenge, E. Lodi Rizzini, L. Strigari, L. Tagliaferri, C. Zamagni, P. De Iaco, S. Fanti, A. Morganti
Objective : Residual disease after surgery is related to an unfavorable prognosis in patients with endometrial cancer (EC). An early diagnosis and treatment of this condition could improve patients’ outcome. Aim of this study was to define the role of postoperative 18 F-Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography ( 18 F-FDG-PET/CT) in patients with high risk of residual disease after EC surgery. Methods : Patients operated for EC, with one or more risk factors, who underwent 18 F-FDG-PET/CT before adjuvant treatment were included in this observational study. The primary endpoint was the rate of patients in whom 18 F-FDG-PET/CT changed the treatment strategy and/or the radiotherapy (RT) planning. Results : Our analysis included 58 patients (median age: 67.5 years, range: 48.0–86.0) with the following risk factors: lymphadenectomy not performed (26 patients; 44.8%), inadequate lymphadenectomy (23 patients; 39.7%), and high risk of residual disease due to advanced stage (nine patients; 15.5%). Postoperative 18 F-FDG-PET/CT imaging was positive in 18 patients (31%) in the following sites: pelvic extra-nodal disease (one patient), pelvic and/or paraaortic lymph nodes (12 patients), distant metastases (one patient), or combination of previous sites (four patients). Based on these results, the adjuvant therapeutic strategy was changed in five patients, three of whom were referred to chemotherapy alone due to distant metastases and two of whom were referred to nodal-directed treatment due to lymph node metastases (lymphadenectomy and pelvic chemoradiation plus boost, respectively). Furthermore, based on the 18 F-FDG-PET/CT results, the RT plan was modified in 13 patients (addition of a boost on residual pelvic/abdominal disease in 12 and target modification in one, respectively). Therefore, based on postoperative 18 F-FDG-PET/CT findings, the therapeutic strategy and the RT plan were changed in 5 patients (8.6%) and 13 patients (22.4%), respectively. Conclusion : In this analysis, the adjuvant treatment was modified after post-operative 18 F-FDG-PET/CT in about one third of patients. Further studies are needed to better define the risk factors (or their combinations) correlated with higher probability of residual disease after radical hysterectomy-adnexectomy for EC.
目的:子宫内膜癌(EC)术后残留病变与预后不良有关。这种情况的早期诊断和治疗可以改善患者的预后。本研究的目的是确定18 f -氟脱氧葡萄糖-正电子发射断层扫描/计算机断层扫描(18 F-FDG-PET/CT)在EC术后残留疾病高风险患者中的作用。方法:在辅助治疗前接受18次F-FDG-PET/CT检查的伴有一种或多种危险因素的EC手术患者纳入本观察性研究。主要终点是18f - fdg - pet /CT改变治疗策略和/或放疗(RT)计划的患者比率。结果:我们的分析纳入了58例患者(中位年龄:67.5岁,范围:48.0-86.0岁),其危险因素如下:未行淋巴结切除术(26例,44.8%),淋巴结切除术不充分(23例,39.7%),晚期残留疾病的高风险(9例,15.5%)。术后18例患者(31%)的F-FDG-PET/CT成像在以下部位呈阳性:盆腔结外疾病(1例)、盆腔和/或主动脉旁淋巴结(12例)、远处转移(1例)或先前部位的合并(4例)。基于这些结果,改变了5例患者的辅助治疗策略,其中3例因远处转移而单独化疗,2例因淋巴结转移而接受淋巴结定向治疗(分别为淋巴结切除术和盆腔放化疗加强化)。此外,根据18例F-FDG-PET/CT结果,对13例患者的RT计划进行了修改(分别增加了12例残留盆腔/腹腔疾病的增强和1例目标修改)。因此,根据术后18例F-FDG-PET/CT表现,分别有5例(8.6%)和13例(22.4%)患者改变了治疗策略和放疗计划。结论:在本分析中,约三分之一的患者在术后18 F-FDG-PET/CT后对辅助治疗进行了修改。需要进一步的研究来更好地确定与根治性子宫-附件切除术后残留疾病较高概率相关的危险因素(或其组合)。
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引用次数: 0
Educational programs for post-treatment breast cancer survivors: a systematic review 治疗后乳腺癌幸存者的教育项目:系统回顾
IF 0.4 4区 医学 Q4 OBSTETRICS & GYNECOLOGY Pub Date : 2022-04-15 DOI: 10.31083/j.ejgo4302036
K. Lin, C. Lengacher, C. Rodriguez, L. Szalacha, Jennifer R. Wolgemuth
Objectives : The purpose of this systematic review was to identify the state of the scientific evidence related to educational programs for post-treatment breast cancer survivors (BCSs) during the last twenty years. Methods : A systematic search of PubMed/MEDLINE, CINAHL, EMBASE, Web of Science, and PsycINFO databases from January 2000 through May 2020 included keywords related to research on educational programs for BCSs. Inclusion criteria included: (1) focus on an educational program for post-treatment breast cancer survivors; (2) original research; (3) peer-review journals; (4) English language; and (5) published between January 2000 to May 2020. EndNote X9 (software version: X9, manufacturer: Clarivate, website location: endnote.com) was used as the reference management software package to manage citations from search results. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) flowchart of the selection process is presented in this paper. Results : A total of 24 educational programs/interventions research studies include one mixed-method study, three qualitative studies, and twenty quantitative studies, were identified and analyzed. Three programs focused on BCSs’ self-management and self-efficacy, two programs focused on BCSs’ cognitive problems, seven programs focused on BCSs’ psychological distress, emotional support, and information seeking. In addition, one program focused on BCSs’ body image, body function, and sexual dysfunction issues, five programs focused on BCSs’ physical activities, nutritional levels, and normal body weight maintenance, two programs focused on BCSs’ supportive care and peer advocate support. Finally, one program focused on BCSs’ palliative care and end of life care, and three programs focused on BCSs’ post-treatment symptom clusters and overall quality of life. Conclusions : After breast cancer treatment ends, BCSs continue to suffer from long-term physical and psychological symptoms and report multiple unmet needs. Research on post-treatment breast cancer educational programs showed that programs assist BCSs with post-treatment symptom management and address their concerns while promoting supportive care and peer support to improve BCS’s overall quality of life. program. Study to explore experiences of waist of the end of of the in BMI and waist circumference a healthy
目的:本系统综述的目的是确定在过去二十年中与治疗后乳腺癌幸存者(BCSs)教育计划相关的科学证据的状态。方法:系统检索2000年1月至2020年5月的PubMed/MEDLINE、CINAHL、EMBASE、Web of Science和PsycINFO数据库,包括与bcs教育项目研究相关的关键词。入选标准包括:(1)关注乳腺癌治疗后幸存者的教育项目;(2)原创性研究;(3)同行评议期刊;(4)英语语言;(5)发表于2000年1月至2020年5月之间。采用EndNote X9(软件版本:X9,制造商:Clarivate,网站位置:endnote.com)作为参考文献管理软件包,对检索结果中的引文进行管理。本文介绍了选择过程的PRISMA(系统评价和元分析的首选报告项目)流程图。结果:共识别和分析了24项教育计划/干预研究,其中包括一项混合方法研究,三项定性研究和20项定量研究。3个项目聚焦于bcs的自我管理和自我效能,2个项目聚焦于bcs的认知问题,7个项目聚焦于bcs的心理困扰、情感支持和信息寻求。此外,有一个项目侧重于bcs的身体形象、身体功能和性功能障碍问题,五个项目侧重于bcs的身体活动、营养水平和正常体重维持,两个项目侧重于bcs的支持性护理和同伴倡导支持。最后,一个项目侧重于bcs的姑息治疗和临终关怀,三个项目侧重于bcs的治疗后症状群和整体生活质量。结论:乳腺癌治疗结束后,bcs继续遭受长期的生理和心理症状,并报告多种未满足的需求。对乳腺癌治疗后教育项目的研究表明,该项目帮助BCS进行治疗后症状管理,解决他们的担忧,同时促进支持性护理和同伴支持,以提高BCS的整体生活质量。程序。本研究旨在探讨经验腰围在BMI和健康腰围之间的关系
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引用次数: 0
Relationship between nutritional status and health-related quality of life in patients receiving chemotherapy after radical ovarian cancer surgery: a cross-sectional study 癌症根治术后化疗患者营养状况与健康相关生活质量的关系:一项横断面研究
IF 0.4 4区 医学 Q4 OBSTETRICS & GYNECOLOGY Pub Date : 2022-04-15 DOI: 10.31083/j.ejgo4302032
Nan Qin, Di Sun, Xu Zhang, Guichun Jiang
Objective : To investigate the nutritional status and health-related quality of life (HRQoL) of postoperative chemotherapy patients with ovarian cancer and to discuss the relationship between these patients’ nutritional status and HRQoL. Methods : 201 postoperative chemotherapy patients with ovarian cancer were enrolled. All of them were assessed with a general information questionnaire, the Patient Generated-Subjective Global Assessment (PG-SGA), and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30). We compared the nutritional status and HRQoL among patients with different demographics and disease characteristics, as well as analyzed the correlations between nutritional status and HRQoL. Results : The mean quantitative evaluation of PG-SGA in patients receiving postoperative chemotherapy for ovarian cancer was 7.82 ± 4.58. Almost all of the study subjects in this investigation were moderately or severely malnourished and required nutritional support. We established a multivariate linear regression equation and found that the total PG-SGA score is an important predictor of HRQoL in postoperative chemotherapy patients with ovarian cancer. Conclusions : Medical staff can improve the HRQoL of this patient population by improving their nutritional status, thereby enhancing their clinical outcome.
目的:了解癌症术后化疗患者的营养状况及健康相关生活质量(HRQoL),探讨其营养状况与HRQoL的关系。方法:对201例癌症术后化疗患者进行临床观察。所有这些都通过一般信息问卷、患者生成主观总体评估(PG-SGA)和欧洲癌症研究与治疗组织生活质量问卷-30(EORTC QLQ-C30)进行评估。我们比较了不同人口统计学和疾病特征患者的营养状况和HRQoL,并分析了营养状况与HRQoL之间的相关性。结果:PG-SGA对癌症术后化疗患者的平均定量评价为7.82±4.58。在这项调查中,几乎所有的研究对象都中度或重度营养不良,需要营养支持。我们建立了一个多元线性回归方程,发现PG-SGA总分是癌症术后化疗患者HRQoL的重要预测指标。结论:医务人员可以通过改善患者的营养状况来提高其HRQoL,从而提高其临床疗效。
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引用次数: 1
Evaluation of tumor size in cervix cancer patients treated with surgery: ultrasonography or MRI? 宫颈癌手术患者肿瘤大小的评价:超声还是MRI?
IF 0.4 4区 医学 Q4 OBSTETRICS & GYNECOLOGY Pub Date : 2022-04-15 DOI: 10.31083/j.ejgo4302035
Ö. Birge, M. Bakır, Saliha Sağnıç, S. Doğan, H. Tuncer, T. Şimşek
Objective : This study aims to compare tumor diameters measured by transvaginal ultrasonography and MRI in cervical cancer. Materials and methods : The study includes 127 cervical cancer patients diagnosed and treated at Akdeniz University Faculty of Medicine between January 2002 and December 2019. Data were collected retrospectively using the electronic archive system of the hospital. Patients with pathologically unknown tumor diameters were excluded from the study. Data were tested for normal distribution, and the mean, standard deviation, median, min-max values, and frequencies were used as descriptive statistics. Categorical data were expressed as numbers and percentages (%). The Student’s t -test, one of the parametric tests, was used to compare tumor diameters. Statistical Package for the Social Sciences (SPSS) 23 software (IBM Corp., Chicago, IL, USA) was used for data analysis. A p -value less than 0.05 was considered statistically significant in all tests. Results : The mean age of patients included in the study was 49.55 ± 11.67 years. Of all patients, 79.5% had a normal delivery. 87 (68%) of the patients were not using any contraceptive method, with 0.7%, condom protection was the least. Among the complaints of patients at admission, postcoital vaginal bleeding was the most common complaint with 42.5%, and asymptomatic patients were the second most common with 22%. Human papillomavirus (HPV) status was unknown in the vast majority of patients (91.3%). Regarding the stage status, stage 1b2 was the most frequently seen stage with 29 patients. Tumor histology revealed SCC in 80.3% and adenocarcinoma in 18.1%. The mean tumor diameter measured by transvaginal ultrasonography (TVS) was 3.30 ± 1.95, by magnetic resonance imaging (MRI) was 3.37 ± 2.03, and the pathologically measured tumor diameter was 3.17 ± 1.86. There was no statistically significant difference between the mean tumor diameter measured by TVS and MRI, MRI and pathology, and TVS and pathology ( p : 0.769, p : 0.589, p : 0.891, respectively). Conclusion : When used by specialists experienced in the field of gynecological oncology, ultrasonography can be considered as effective as MRI, especially in tumor size measurement in cervical cancer, due to its ease of use, cheapness, and easy accessibility in regions with low socioeconomic status.
目的:比较癌症经阴道超声和MRI测量的肿瘤直径。材料和方法:该研究包括2002年1月至2019年12月在阿克德尼兹大学医学院诊断和治疗的127名癌症患者。使用医院的电子档案系统对数据进行回顾性收集。病理学上未知肿瘤直径的患者被排除在研究之外。对数据进行正态分布检验,平均值、标准差、中值、最小-最大值和频率用作描述性统计。分类数据以数字和百分比(%)表示。Student t检验是一种参数检验,用于比较肿瘤直径。社会科学统计软件包(SPSS)23软件(IBM Corp.,Chicago,IL,USA)用于数据分析。在所有测试中,p值小于0.05被认为具有统计学意义。结果:纳入研究的患者平均年龄为49.55±11.67岁。在所有患者中,79.5%的患者分娩正常。87例(68%)患者未使用任何避孕方法,其中0.7%的患者使用避孕套保护最少。在患者入院时的主诉中,性交后阴道出血是最常见的主诉,占42.5%,无症状患者第二常见,占22%。绝大多数患者(91.3%)的人乳头瘤病毒(HPV)状态未知。就分期状态而言,1b2期是最常见的分期,共有29名患者。肿瘤组织学显示SCC为80.3%,腺癌为18.1%。经阴道超声(TVS)测得的平均肿瘤直径为3.30±1.95,磁共振成像(MRI)测得为3.37±2.03,病理测量的肿瘤直径为3.17±1.86。TVS和MRI、MRI和病理、TVS和病理测量的平均肿瘤直径之间没有统计学上的显著差异(分别为p:0.769、p:0.589、p:0.891)。结论:当妇科肿瘤学领域经验丰富的专家使用时,超声可以被认为与MRI一样有效,尤其是在癌症宫颈癌的肿瘤大小测量中,因为它易于使用、便宜,并且在社会经济地位较低的地区易于获得。
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引用次数: 0
BRCA screening, treatment patterns and response among patients with ovarian cancer in the second line treatment setting: results from a real world survey 卵巢癌患者在二线治疗环境中的BRCA筛查、治疗模式和反应:来自真实世界调查的结果
IF 0.4 4区 医学 Q4 OBSTETRICS & GYNECOLOGY Pub Date : 2022-04-15 DOI: 10.31083/j.ejgo4302026
M. Monberg, Jennifer P Hall, R. Moon, K. Khela, K. McLaurin
Objective : Although BRCA gene testing of patients diagnosed with ovarian cancer (OC) is now recommended, the level of testing undertaken in various countries is largely unknown. This study describes BRCA mutation screening patterns and results, demographics, clinical characteristics and the use of poly (ADP-ribose) polymerase inhibitors (PARPi) as maintenance treatment within a real-world sample of patients with advanced OC in the second-line (2L) treatment setting. Methods : Data were collected using the Adelphi Real World OC Disease Specific Programme (DSP)™, a point-in-time survey of physicians and their consulting patients with OC in clinical practice, undertaken across Europe (EU5: France, Germany, Italy, Spain and United Kingdom) and the United States (US) between December 2017–March 2018. Physicians completed a detailed patient record form for their next eight consecutively consulting patients, capturing data on their clinical history and treatment. All analysis was descriptive. Results : Of 1315 patients identified, 1096 (83%) were receiving 2L treatment and 219 (17%) were receiving 2L maintenance treatment; either PARPi (olaparib, rucaparib or niraparib, n = 103) or a non-PARPi (n = 116). BRCA screening rates varied between countries, increased with each line of therapy and were higher in the EU5 (55%) than the US (44%). 28% of patients receiving 2L treatment had a BRCA1/2 mutation. Patients receiving PARPi maintenance treatment had better Eastern Cooperative Oncology Group (ECOG) performance status, higher BRCA screening rates and higher proportions of serous epithelial OC than those receiving 2L treatment or non-PARPi maintenance. Common reasons for choosing 2L treatments were progression-free/overall survival benefit and improvement of quality of life. Conclusions : Despite guidelines recommending BRCA testing in patients with OC, many OC patients undergoing 2L treatment were not screened for BRCA mutations. Decisions related to PARPi use in 2L maintenance appeared to be driven by BRCA status, histology and response to first-line treatment.
目的:尽管现在建议对诊断为癌症(OC)的患者进行BRCA基因检测,但各国的检测水平在很大程度上是未知的。本研究描述了BRCA突变筛查模式和结果、人口统计学、临床特征以及在二线(2L)治疗环境中晚期OC患者的真实样本中使用聚ADP核糖聚合酶抑制剂(PARPi)作为维持治疗。方法:使用Adelphi真实世界OC疾病特异性计划(DSP)收集数据™, 2017年12月至2018年3月,在欧洲(欧盟5国:法国、德国、意大利、西班牙和英国)和美国(美国)对医生及其临床实践中OC咨询患者进行的时间点调查。医生为接下来的八名连续咨询患者填写了一份详细的患者记录表,记录了他们的临床病史和治疗数据。所有分析均为描述性分析。结果:在确定的1315名患者中,1096名(83%)正在接受2L治疗,219名(17%)正在接受3L维持治疗;PARPi(奥拉帕尼、鲁卡帕利或尼拉帕利,n=103)或非PARPi患者(n=116)。BRCA筛查率因国家而异,随着每种治疗方法的增加而增加,欧盟5国(55%)高于美国(44%)。接受2L治疗的患者中有28%的BRCA1/2突变。接受PARPi维持治疗的患者比接受2L治疗或非PARPi治疗的患者具有更好的东部肿瘤协作组(ECOG)表现状态、更高的BRCA筛查率和更高的浆液性上皮OC比例。选择2L治疗的常见原因是无进展/总体生存益处和生活质量的改善。结论:尽管指南建议对OC患者进行BRCA检测,但许多接受2L治疗的OC患者没有进行BRCA突变筛查。与PARPi在2L维持中的使用相关的决定似乎是由BRCA状态、组织学和对一线治疗的反应驱动的。
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引用次数: 1
Uterine cavity evacuation as a novel approach for uterine size reduction during minimal invasive surgery for uterine carcinosarcoma: a report of two cases 子宫癌肉瘤微创手术中宫腔排空作为缩小子宫大小的新方法——附2例报告
IF 0.4 4区 医学 Q4 OBSTETRICS & GYNECOLOGY Pub Date : 2022-04-15 DOI: 10.31083/j.ejgo4302044
A. Chen, L. Turker, J. Divito, D. Kuo
Background : Uterine carcinosarcoma often presents with significant uterine distention. This makes it difficult to perform minimally invasive surgery, which is preferred for uterine cancer given the significant recovery benefits. Cases : We present two cases of uterine carcinosarcoma in which we performed uterine evacuation intraoperatively to decompress the uterine volume to facilitate specimen removal through the vagina. The first patient ultimately had stage IA disease. She received adjuvant chemotherapy and radiation and has remained disease-free for 2 years. The second patient had stage IVB disease on final pathology report. She received adjuvant chemotherapy but had disease recurrence 4 months after completion of treatment. Conclusion : Intraoperative uterine evacuation during surgery for uterine carcinosarcoma may make possible a minimally invasive procedure in patients with large, distended uteri.
背景:子宫癌肉瘤常表现为明显的子宫扩张。这使得进行微创手术变得困难,考虑到显著的恢复益处,微创手术是癌症的首选手术。病例:我们报告了两例子宫癌肉瘤,其中我们在手术中进行了子宫排空,以减压子宫体积,便于通过阴道取出标本。第一位患者最终患有IA期疾病。她接受了辅助化疗和放疗,2年来一直没有疾病。第二名患者在最终病理报告中为IVB期疾病。她接受了辅助化疗,但在治疗完成4个月后病情复发。结论:子宫癌肉瘤手术期间的术中子宫排空可能为子宫扩张的患者提供微创手术。
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引用次数: 1
Identifying and overcoming a mechanism of resistance to WEE1 kinase inhibitor AZD1775 in high grade serous ovarian cancer cells 鉴定和克服高级别浆液性卵巢癌细胞对WEE1激酶抑制剂AZD1775的耐药机制
IF 0.4 4区 医学 Q4 OBSTETRICS & GYNECOLOGY Pub Date : 2022-04-15 DOI: 10.31083/j.ejgo4302024
M. K. Gomez, J. Thomson, G. Grimes, A. Wang, M. Churchman, M. O’Connor, C. Gourley, D. Melton
Objective : As a result of TP53 gene mutation high grade serous ovarian cancer (HGSOC) is dependent on the G2 checkpoint for the repair of DNA damage and survival. The key role of WEE1 kinase at this checkpoint makes inhibition of WEE1 kinase in combination with DNA damaging agents an attractive therapeutic strategy for HGSOC. Our aim was to characterise resistance mechanisms to WEE1 inhibitor AZD1775 and identify ways to overcome resistance ready for use in the clinic. Methods : AZD1775-resistant HGSOC cell clones were isolated and western blotting, cell cycle analysis, growth assays, RNA-Seq and gene expression analysis were used to characterise resistance mechanisms and investigate a way to overcome resistance. Results : A resistance mechanism previously reported in small cell lung cancer did not operate in HGSOC. Instead, resistance resulted from different cell cycle control pathway changes that slow AZD1775-induced cell cycle progression and reduce accumulation of replication associated DNA damage. One major change was reduced levels of CDK1, the substrate for WEE1 kinase inhibition; another was increased levels of PKMYT1, which can also inhibit CDK1. Increased expression of TGF β signalling to slow cell cycle progression occurred in resistant clones. A TGF β R1 inhibitor overcame resistance in a clone with the highest TGF β R1 receptor expression. Conclusions : Although overexpression of the membrane glycoprotein MDR1 is a common mechanism of drug resistance, it was not involved in our HGSOC cells. Instead AZD1775 resistance resulted from cell cycle control pathway changes that combine to slow AZD1775-induced cell cycle progression and so reduce accumulation of replication-associated DNA damage.
目的:由于TP53基因突变,高级别癌症(HGSOC)依赖于G2检查点的DNA损伤修复和生存。WEE1激酶在该检查点的关键作用使得与DNA损伤剂联合抑制WEE1激酶成为HGSOC的一种有吸引力的治疗策略。我们的目的是描述对WEE1抑制剂AZD1775的耐药性机制,并确定克服耐药性的方法,以便在临床上使用。方法:分离AZD1775抗性HGSOC细胞克隆,采用蛋白质印迹、细胞周期分析、生长测定、RNA-Seq和基因表达分析等方法对其抗性机制进行表征,探讨克服抗性的途径。结果:先前报道的小细胞肺癌癌症的耐药性机制在HGSOC中不起作用。相反,耐药性是由不同的细胞周期控制途径改变引起的,这些改变减缓了AZD1775诱导的细胞周期进展,并减少了复制相关DNA损伤的积累。一个主要变化是CDK1水平降低,CDK1是WEE1激酶抑制的底物;另一个变化是PKMYT1水平增加,PKMYT1也可以抑制CDK1。TGFβ信号传导的表达增加以减缓细胞周期的进展发生在抗性克隆中。TGFβR1抑制剂在具有最高TGFβR1-受体表达的克隆中克服了耐药性。结论:尽管膜糖蛋白MDR1的过度表达是耐药的常见机制,但它并不参与我们的HGSOC细胞。相反,AZD1775抗性是由细胞周期控制途径的改变引起的,这些改变结合起来减缓了AZD1775-诱导的细胞周期进程,从而减少了复制相关DNA损伤的积累。
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引用次数: 2
Uterine lipoleiomyoma: a benign entity with malignant transformation potential? 子宫脂肪肌瘤:有恶性转化潜力的良性实体?
IF 0.4 4区 医学 Q4 OBSTETRICS & GYNECOLOGY Pub Date : 2022-04-15 DOI: 10.31083/j.ejgo4302042
Yunzhe Wan, X. Zhang, Yue Sun, Linping Wang, Guoyan Liu
Background: Uterine lipoleiomyoma is a rare lipomatous variant of uterine leiomyoma composed of a variable mixture of mature smooth muscle cells and adipocytes, typically found in peri or postmenopausal women. Malignancies arising from the tumor have rarely been reported though it is considered benign. Cases : We present three cases of uterine lipoleiomyoma and review literature to explore its etiology, characteristics, diagnosis and malignant transformation potential. Conclusion : Imaging examinations especially magnetic resonance imaging (MRI) play an important role in preoperative diagnosis. For large size and rapid growth of lipoleiomyoma, malignant transformation potential should be considered and surgery is required. Follow-up is still necessary.
背景:子宫脂肪平滑肌瘤是一种罕见的子宫平滑肌瘤的脂肪瘤变体,由成熟平滑肌细胞和脂肪细胞的可变混合物组成,通常见于绝经期或绝经后妇女。虽然它被认为是良性的,但很少有恶性肿瘤的报道。病例:我们报告3例子宫脂质肌瘤,并复习文献,探讨其病因、特点、诊断及恶性转化的可能性。结论:影像学检查特别是磁共振成像(MRI)在术前诊断中具有重要作用。对于体积大、生长迅速的脂质肌瘤,应考虑恶性转化的可能性,需行手术治疗。后续工作仍然是必要的。
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引用次数: 0
期刊
European journal of gynaecological oncology
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