David Cantú-De León

Computed tomography–based prediction of interval cytoreduction in advanced ovarian cancer

Our retrospective study aimed to investigate the role of computed tomography (CT) using both the tomographic Fagotti index and the Sugarbaker peritoneal cancer index (PCI) in predicting the feasibility of optimal interval debulking surgery in epithelial ovarian cancer. Patients with advanced ovarian cancer treated in our institution who were eligible for interval debulking surgery were identified and included in the study. A retrospective image collection was operated, and CT scan evaluations were conducted by 2 independent radiologists to establish both scores (Fagotti index and Sugarbaker PCI). The workflow included a third radiologist who resolved discrepancies. The receiver operating characteristics curve followed by the Youden J statistic was calculated to determine cutoff points that best differentiated complete/optimal versus suboptimal cytoreduction. The Fagotti index and Sugarbaker PCI cutoffs' accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were calculated and represented as 95% CIs. A total of 60 consecutive patients who had complete information in their charts with evaluable images and complete information about surgery were evaluated; of these, 35 had a complete/optimal interval debulking surgery. The receiver operating characteristic curve of the Fagotti index scoring system showed that a cutoff of ≥3 can identify 100% of inoperable patients. However, 29% of patients were falsely labeled as inoperable. A cutoff point of ≥5 avoids 88% of unnecessary laparotomies, reducing the rate of false inoperable designation from 29% to 17%. A Sugarbaker PCI of ≥8 predicts the risk of unnecessary laparotomies in 68%, with 26% falsely labeled as inoperable. The score of ≥7 is most effective in avoiding unnecessary surgeries (80%), but the chance of false positives increases from 26% to 32%. CT-based scoring systems used in the present work can help determine which patients with advanced ovarian cancer are suitable for interval debulking surgery with high precision. Future studies are needed to enhance accuracy, thereby amplifying the radiologists' competency in using a systematic CT-based scoring system.

Prognostic nutritional index as a predictor of surgical complications in women with gynecological cancer

To analyze the association between the prognostic nutritional index and surgical morbidity in women with gynecologic cancers. This is a retrospective cohort study of women with ovarian, endometrial, or cervical cancer who underwent surgery between January 2013 and December 2020 at a cancer center. Demographic and clinical data were extracted from electronic medical records. The prognostic nutritional index was calculated during the immediate pre-operative period. Binomial logistic regression was conducted to identify the association of the prognostic nutritional index with the outcome of surgical complications after Clavien-Dindo classification, adjusting for confounding variables. A total of 1000 women were included: 114 (11.4%) were diagnosed with cervical cancer, 551 (55.1%) with ovarian cancer, and 335 (33.5%) with endometrial cancer. Patients with a prognostic nutritional index >40 had a decreased possibility of surgical complications (OR=0.39, 95% CI 0.29 to 0.52); basal blood hemoglobin, volume of surgical bleeding, operative time, and length of hospital stay were also explanatory factors. The prognostic nutritional index has a significant effect on patients with endometrial and cervical cancer, but conversely is not significant in patients with ovarian cancer. The prognostic nutritional index is associated with surgical morbidity in endometrial and cervical cancers and thus can be a useful tool for predicting morbidity and guide pre-operative interventions in patients with gynecological cancers.

microRNA Profile Associated with Positive Lymph Node Metastasis in Early-Stage Cervical Cancer

Lymph node metastasis (LNM) is an important prognostic factor in cervical cancer (CC). In early stages, the risk of LNM is approximately 3.7 to 21.7%, and the 5-year overall survival decreases from 80% to 53% when metastatic disease is identified in the lymph nodes. Few reports have analyzed the relationship between miRNA expression and the presence of LNM. The aim of this study was to identify a subset of miRNAs related to LNM in early-stage CC patients. Formalin-fixed paraffin-embedded tissue blocks were collected from patients with early-stage CC treated by radical hysterectomy with lymphadenectomy. We analyzed samples from two groups of patients—one group with LNM and the other without LNM. Global miRNA expression was identified by microarray analysis, and cluster analysis was used to determine a subset of miRNAs associated with LNM. Microarray expression profiling identified a subset of 36 differentially expressed miRNAs in the two groups (fold change (FC) ≥ 1.5 and p < 0.01). We validated the expression of seven miRNAs; miR-487b, miR-29b-2-5p, and miR-195 were underexpressed, and miR-92b-5p, miR-483-5p, miR-4534, and miR-548ac were overexpressed according to the microarray experiments. This signature exhibited prognostic value for identifying early-stage CC patients with LNM. These findings may help detect LNM that cannot be observed in imaging studies.

Associations between the prognostic nutritional index and response to neoadjuvant chemotherapy in patients with epithelial ovarian cancer

To evaluate the association between the prognostic nutritional index and the response to neoadjuvant chemotherapy in Mexican patients with epithelial ovarian cancer. Retrospective analyses of 220 patients with epithelial ovarian cancer treated with neoadjuvant therapy. The cutoff points for the prognostic nutritional index at diagnosis and after neoadjuvant therapy were determined via receiver operating characteristic curves. Categorical variables were analyzed with the χ The median age was 55 years (range; 28-82). The most common histology was high-grade serous carcinoma in 199 cases (90.5%), and 66.4% (n = 146) were International Federation of Gynecology and Obstetrics stage IIIC. The prognostic nutritional index cutoff points at diagnosis and after neoadjuvant chemotherapy for complete or optimal cytoreduction were 40.5 and 45, respectively. High prognostic nutritional index values were associated with higher rates of complete or optimal cytoreduction: 53.6% and 67.7%, respectively. Additionally, high prognostic nutritional index values were associated with platinum sensitivity. According to the multivariate analysis, a high prognostic nutritional index value (OR 6.6, p = .001) was an independent factor associated with complete or optimal cytoreduction. The median overall survival at 3 years was not reached in patients with high prognostic nutritional index values (p = .054 and p = .015). Disease-free survival was not significantly different for high versus low prognostic nutritional index values (p = .9). The prognostic nutritional index may be used as an independent prognostic biomarker for advanced epithelial ovarian cancer.