The correlation between birth weight and insulin-like growth factor-binding protein-1 (IGFBP-1), kisspeptin-1 (KISS-1), and three-dimensional fetal volume

Purpose: This study aimed to determine the relationship between birth weight, and maternal serum insulin-like growth factor-binding protein-1 (IGFBP-1) and kisspeptin-1 (KISS-1) levels, and first-trimester fetal volume (FV) based on three-dimensional ultrasonography. Materials and methods: The study included 142 pregnant women at gestational week 11 degrees-13(6). All fetuses were imaged ultrasonographically by the same physician. Maternal blood samples were collected at the time of ultrasonographic evaluation and analyzed for IGFBP-1 and KISS-1 levels via enzyme-linked immunosorbent assay (ELISA). Maternal and neonatal weights were recorded at birth. Birth weight 90th percentiles was defined as small and large for gestational age (SGA and LGA), respectively. Results: Median crown-rump length (CRL), FV, and maternal serum IGFBP-1 and KISS-1 levels were 58.2 mm (35.3-79.2 mm), 16.3 cm(3) (3.8-34.4 cm(3)), 68.1 ng mL(-1) (3.8-377.9 mL(-1)), and 99.7 ng L-1 (42.1-965.3 ng L-1), respectively. First-trimester IGFBP-1 levels were significantly lower in the mothers with LGA neonates (p .05). The maternal IGFBP-1 level during the first trimester was a significant independent factor for SGA and LGA neonates (Odds ratio (OR): 0.011, 95%CI: 1.005-1.018, p < .001; and OR: 1.297, 95%CI: 1.074-1.566, p = .007, respectively). There was no significant relationship between SGA or LGA, and CRL, FV, or the KISS-1 level. Conclusions: As compared to the maternal KISS-1 level, the maternal IGFBP-1 level during the first trimester might be a better biomarker of fetal growth. Additional larger scale studies are needed to further delineate the utility of IGFBP-1 as a marker of abnormal birth weight

Recurrence in Uterine Tumors with Ovarian Sex-Cord Tumor Resemblance: A Case Report and Systematic Review

Objective: The aim of this study was to evaluate the prognostic factors of recurrence in uterine tumors resembling ovarian sex-cord tumors (UTROSCT) and to determine clinical-pathological characteristics, treatment options and outcome. Material and Method: An electronic literature search was conducted from 1976 to 2018. After the comprehensive evaluation and conjunction with our case, the study included 79 cases. Results: The median age at initial diagnosis was 49 years (range; 16-86 years). The age was under 40 years in 21 (26.6%) patients. Whereas 68 patients underwent at least hysterectomy, 9 patients had organ sparing surgery. There was necrosis in 4 (5.1%) patients, atypia in 16 (20.3%) patients, and infiltrative tumor border in 34 (43%) patients. At least one mitosis per 10 high power fields was determined in 36 (45.5%) patients. The tumor involved at least part of the myometrium in 54 (68.3%) patients. Median follow-up time was 30 months (range; 3-296 months). Recurrence was determined in 5 (6.3%) patients. The disease free survival (DFS) was significantly related only to surgery type. None of the pathologic features were associated with DFS. The 5-year DFS was 86% and 96% in patients who underwent organ sparing surgery or not, respectively (p=0.038). Conclusion: The accurate pathologic diagnosis of UTROSCT has great value in shaping surgical management and management during the follow-up period. Organ sparing surgery was related to poor DFS. Although recurrence is rare, it should be kept in mind for patients with UTROSCT

Is neurosurgery with adjuvant radiotherapy an effective treatment modality in isolated brain involvement from endometrial cancer? From case report to analysis

WOS: 000393415900019PubMed ID: 27984379Aim: The aim of this study was to evaluate the treatment options and post-brain involvement survival (PBIS) of patients with isolated brain involvement from endometrial cancer (EC). Materials and Methods: The literature electronic search was conducted from 1972 to May 2016 to identify articles about isolated (without extracranial metastases) brain involvement from EC at recurrence and the initial diagnosis. Forty-eight articles were found. After comprehensive evaluation of case series and case reports, the study included 49 cases. Results: The median age of the patients at initial diagnosis was 57 years (range, 40-77 years). Poor differentiation was determined in 36 (73.5%) patients. Thirty-five (71.4%) patients had a single brain lesion. Lesion was found in the supratentorial part of the brain in 33 (67.3%) patients. Median PBIS for all cohorts was 13 months (range, 0.25-118 months) with 2-year PBIS of 52% and 5-year PBIS of 37%. Age, tumor type, grade, disease-free interval, diagnosis time of brain lesion, localization, and number of brain lesionwere not predictive of PBIS. Two-year PBIS was 77% in patients who underwent surgical resection and radiotherapy, whereas it was 19% in the surgical resection-only group, and 20% in the primary radiotherapyYonly group (Ps = 0.003 and 0.001, respectively). Chemotherapy was not associated with improved PBIS. Conclusions: Although neuroinvasion from EC appearsmostly with a disseminated disease, there is a considerable amount of patients with isolated brain involvement who would have a higher chance of curability. Surgery with radiotherapy is the rational current management option, and this improves the survival for isolated brain involvement from EC

EMA/CO Combination Chemotheraphy in Gestational Trophoblastic Neoplasia: Update of Our Results

OBJECTIVE: In this study, we aimed updating our experience about the treatment success of EMA-CO (etoposide, methotrexate, actinomycin-D, cyclophosphamide, vincristine) chemotherapy in high-risk gestational trophoblastic neoplasia (GTN). MATERIAL AND METHOD: Patients were scored according to FIGO’s modified WHO system. Risk scoring of patients before 2000 was remade by using this system. Thirty-nine patients who were treated with EMA-CO between 1992 and 2013 because of high risk GTN or the resistance to single agent methotrexate and MAC III chemotherapy combinations were evaluated retrospectively. Adjuvant surgery and radiotherapy were used in selected patients. Response and effects of the prognostic factors to the response rate were analyzed. RESULTS: Median follow-up time of the patients was 74.8 months (range, 1-203). Complete clinical response was obtained in 36 (92.3%) patients with only EMA-CO or EMA-CO and surgery. The response rate of treatment was 91.3% (n:21/23) in patients taking primary EMA-CO, 93.8% (n:15/16) in patients taking secondary EMA/CO chemotherapy. Resistance to the EMA-CO treatment developed in 6 (15.3%) patients and 3 of the patients with drug resistance died. During the follow-up time disease recurred in 3 (7.7%) patients. When the antecedent pregnancy was term pregnancy or the histopathological diagnosis was choriocarcinoma or when there was liver metastasis, the treatment success decreased. The effects of tumor dimension and the presence of metastasis tended to be statistically significant in determining the resistance to therapy. CONCLUSION: EMA-CO regimen is highly effective for treatment of high-risk GTN. Because of the differences in many studies, risk factors for predicting the success of the treatment are not clear

Prognostic value of systemic inflammatory response markers in cervical cancer

We investigated the association between preoperative ratios of inflammatory markers and the prognosis in patients with invasive cervical cancer (CC). In this single-centre study, we retrospectively enrolled 163 CC patients who underwent radical hysterectomy between February 2008 and October 2018. Among the evaluated ratios, a high neutrophil-to-lymphocyte ratio (N/L) was significantly associated with deep stromal invasion and tumour size larger than 2 cm, whereas a high M/L was significantly related to advanced-stage CC (IB3–IIIC2), lymphatic metastasis (total) and pelvic lymph node metastasis (p= .002, p= .046 and p= .046, respectively). The neutrophil count plus monocyte-to-lymphocyte ratio (NM/L) and platelet-to-lymphocyte ratio (P/L) were significantly higher in patients with deep stromal invasion, advanced stage and tumour size larger than 2 cm (p=.01, p=.044 and p=.007; p=.004, p=.005 and p=.003, respectively). In the multivariate analysis, high NM/L (>168) was associated with a statistically significant hazard ratio of 3.04 (95% CI: (1.38–6.72); p=.006) for recurrence and 9.05 (95% CI: (2.10–38.99); p=.003) for death. Both stage and NM/L are independent prognostic factors that are significantly associated with recurrence and overall survival in CC.Impact Statement What is already known on this subject? Previous studies suggested that there is a relationship between inflammation and the formation, development and progression of cancer. However, the relationship between cervical cancer (CC) and inflammatory blood parameters is incompletely understood. What do the results of this study add? This study investigated the relationship between systemic blood inflammatory ratios and clinicopathological patient characteristics and disease outcomes in CC. What are the implications of these findings for clinical practice and/or further research? According to this study, systemic blood inflammatory ratios may help predict the prognosis and survival of patients with CC

Effect of Adjuvant Therapy on Oncologic Outcomes of Surgically Confirmed Stage I Uterine Carcinosarcoma

Background: Uterine carcinosarcoma is rare neoplasm that mostly presents as metastatic disease. Stage is one of the most important prognostic factor, however, the management of the early stage uterine carcinosarcoma is still controversial. Aims: To evaluate prognostic factors, treatment options, and survival outcomes in patients with surgically approved stage I uterine carcinosarcoma. Study Design: Cross-sectional study. Methods: Data of 278 patients with uterine carcinosarcoma obtained from four gynecologic oncology centers were reviewed, and 70 patients with approved stage I uterine carcinosarcoma after comprehensive staging surgery were studied. Results: The median age of the entire cohort was 65 years (range; 39-82). All patients underwent both pelvic and paraaortic lymphadenectomy. Forty-one patients received adjuvant therapy. The median follow-up time was 24 months (range; 1-129). Nineteen (27.1%) patients had disease failure. The 3-year disease-free survival and cancer-specific survival of the entire cohort was 67% and 86%, respectively. In the univariate analysis, only age was significantly associated with disease-free survival (p=0.022). There was no statistical significance for disease-free survival between observation and receiving any type of adjuvant therapy following staging surgery. Advanced age (<75 vs ≥75 years) was the only independent prognostic factor for recurrence (hazard ratio: 3.8, 95% CI=1.10-13.14, p=0.035) in multivariate analysis. None of the factors were significantly associated with cancer-specific survival. Conclusion: Advanced age was the only independent factor for disease-free survival in stage I uterine carcinosarcoma. Performing any adjuvant therapy following comprehensive lymphadenectomy was not related to the improved survival of the stage I disease.PubMedWoSScopu

Post-recurrence survival analysis of patients with pulmonary recurrence from gynaecologic cancers: a multi-institutional analysis of 122 patients

In this retrospective study, patients with epithelial gynaecologic cancer with pulmonary recurrence (PR) were evaluated from five national gynaecologic oncology clinics. Patients with a diagnosis of primary endometrial, ovarian/fallopian tube/peritoneal, cervical or vaginal/vulvar tumours who developed an initial PR were included in the study A total of 122 patients were included in the study. The median follow-up time after recurrence was 7.5 (range, 1–84) months. The 2-year PRS was 48% in the main cohort. The risk of death was more than seven times higher in patients who did not receive salvage chemotherapy compared with those who did (hazard ratio: 7.6, 95% CI: 3.0–18.9; p < .001). When squamous cell carcinoma was compared with the other tumour types, the risk of death increased more than three times (hazard ratio: 3.7, 95% CI: 1.4–9.6; p = .007).IMPACT STATEMENT What is already known on this subject? Pulmonary recurrence (PR) from gynaecologic malignancies is rare and can cause major clinical problem. Therefore, defining the clinical and pathologic characteristics and recurrence patterns are essential. What the results of this study add? This study demonstrates non-squamous subtype and salvage chemotherapy at PR were associated with improved survival. What of these findings for clinical practice and/or further research? To the best of our knowledge, our study is the largest study to investigate the clinico-pathologic characteristics, recurrence patterns, treatment options, and post-recurrence survival (PRS) in patients with PR from epithelial gynaecologic cancers. Future research should examine the underlying causes of these findings

Impact of lymph node ratio on survival in stage IIIC endometrioid endometrial cancer: a Turkish Gynecologic Oncology Group study

Objective: The purpose of this study was to investigate the prognostic value of lymph node ratio (LNR) in women with stage IIIC endometrioid endometrial cancer (EC). Methods: A multicenter, retrospective department database review was performed to identify patients with stage IIIC pure endometrioid EC at 6 gynecologic oncology centers in Turkey. A total of 207 women were included. LNR, defined as the percentage of positive lymph nodes (LNs) to total nodes recovered, was stratified into 2 groups: LNR1 ( 0.15). Kaplan-Meier method was used to generate survival data. Factors predictive of outcome were analyzed using Cox proportional hazards models. Results: One hundred and one (48.8%) were classified as stage IIIC1 and 106 (51.2%) as stage IIIC2. The median age at diagnosis was 58 (range, 30-82) and the median duration of follow-up was 40 months (range, 1-228 months). There were 167 (80.7%) women with LNR 0.15. The 5-year progression-free survival (PFS) rates for LNR 0.15 were 76.1%, and 58.5%, respectively (p= 0.045). An increased LNR was associated with a decrease in 5-year overall survival (OS) from 87.0% for LNR 0.15 (p= 0.005). LNR > 0.15 was found to be an independent prognostic factor for both PFS (hazard ratio [HR]= 2.05; 95% confidence interval [CI]= 1.07-3.93; p= 0.03) and OS (HR= 3.35; 95% CI= 1.57-7.19; p= 0.002). Conclusion: LNR seems to be an independent prognostic factor for decreased PFS and OS in stage IIIC pure endometrioid EC