Francisco Jose Candido dos Reis

A propensity score-matched case-control study of laparoscopy and laparotomy for endometrial cancer

A surgery is essential for the management of early endometrial carcinoma. Due to the comorbidities associated with the disease, the complications of surgery are common. Laparoscopic surgery may reduce surgical complications but also have oncological risks. We aimed to compare recurrence and overall survival (OS) associated with laparoscopy and laparotomy for early endometrial cancer. We included women treated for presumed early endometrial carcinoma at the Clinics Hospital of Ribeirão Preto Medical School from January 1998 to December 2017. We designed a 1:2 propensity score-matched case-control and compared the patients' characteristics, short-term outcomes, recurrence, and OS. A total of 252 women were included in this study, 168 underwent laparotomy, and 84 underwent laparoscopy. The two groups were well balanced according to most of the variables, and obesity was a characteristic of patients in both groups. Laparoscopy was associated with increased surgical time (194.7 min vesus 165.6 min; p<0.001) and reduced rate of surgical complications (6.5% versus 0; p=0.038). Laparoscopic surgery was not associated with the risk of tumor recurrence (HR: 0.41, 95%CI 0.14-1.19, p=0.100) or all-cause mortality (HR: 0.49, 95%CI 0.18-1.35, p=0.170). Laparoscopy was safe in terms of oncological outcomes and was associated with a lower rate of surgical complications. Our data support the use of minimally invasive surgery as the preferential approach in the management of early endometrial carcinoma.

Analysis of the relationship between hospital characteristics and survival in ovarian cancer: A historical cohort

AbstractBackground and ObjectivesThe management of ovarian cancer requires complex surgical and medical interventions. Specialized care is associated with superior outcomes in early and advanced stages. This study aimed to estimate the effect of hospital characteristics on the overall survival of women with epithelial ovarian cancer.MethodsWe established a cohort with data recorded by the Fundação Oncocentro de São Paulo cancer registry. We included 6111 women treated for ovarian cancer in the state of Sao Paulo from January 2000 to December 2018. From 76 hospitals analyzed, 7 were high volume (20 or more cases a year) and 69 low volume. Twenty‐nine were teaching and 47 community hospitals. A 10‐year survival was analyzed using the Kaplan‐Meyer estimator and the Cox model.ResultsFifty‐two percent of the epithelial ovarian cancer patients were treated in high‐volume hospitals. High‐volume ‐ (HR, 0.86; 95% CI, 0.8‐0.92; P &lt; .001) and teaching ‐ (HR, 0.91; 95% CI, 0.85‐0.99; P = .019) were hospital characteristics associated with low risk of death in 10 years.ConclusionsHigh‐volume and teaching hospitals are associated with better overall survival in ovarian cancer. Our data suggest that both hospital characteristics are important indicators of good quality of care in ovarian cancer treatment.

Incidence of urologic co-morbidities after abdominal radical hysterectomy: a systematic review of clinical trials

This study aimed to estimate the incidence of intra-operative, structural, and functional post-operative urologic complications associated with abdominal radical hysterectomy for cervical cancer. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a comprehensive search was conducted in PubMed, EMBASE, CINAHL, and Web of Science up to July 2025. Inclusion criteria were randomized trials including women with cervical cancer undergoing abdominal radical hysterectomy and reporting urologic complications. Data extraction and risk of bias assessment were independently performed by 2 reviewers. Urologic morbidities were classified as intra-operative, structural, and functional. Meta-analyses were conducted using random- or common-effects models, depending on heterogeneity. A total of 10 studies comprising 1247 patients were included. For intra-operative complications, the incidence of bladder injury was 0.2% (95% CI 0% to 1.2%) and of ureteral injury 0.3% (95% CI 0% to 1.1%), with low heterogeneity. In contrast, the rates of structural post-operative complications, such as genitourinary fistulas (0.3% to 5.7%) and ureteral obstruction or hydronephrosis (8.2% to 11%), and functional complications, including urinary retention or bladder atony (6.7% to 12.3%), and urinary incontinence (1.7% to 11%), were drawn from heterogeneous studies with variable definitions and assessments. Because of this substantial heterogeneity, these values should be interpreted only as descriptive ranges rather than precise pooled estimates. Accordingly, a meta-analysis was not performed for structural and functional complications. Abdominal radical hysterectomy is associated with a low incidence of intra-operative urologic injuries but a notable risk of structural and functional complications, particularly, in patients receiving adjuvant radiotherapy. These findings highlight the need for patient counseling, standardized outcome reporting, and strategies to minimize long-term genitourinary morbidity. CRD420250484975.

Unveiling delays: understanding the diagnostic pathways of women with advanced cervical cancer

This qualitative inquiry delves into the diagnostic odyssey experienced by women diagnosed with locally advanced cervical cancer, seeking to elucidate the multifaceted factors influencing symptom recognition and access to healthcare services. Semi structured interviews were conducted with 17 women diagnosed with locally advanced cervical cancer at a tertiary care hospital. The study employs Braun and Clarke thematic analysis, a structured approach to identifying, interpreting, and displaying themes that reflect participants' experiences. Two overarching themes of significance emerged: (1) "Personal Attitude: from symptom recognition to seeking healthcare" encapsulating individual symptom perception and healthcare-seeking behavior, and (2)"Weaknesses of the health system: from access to referral," uncovering systemic obstacles impeding timely diagnosis and treatment. These findings underscore the urgent need for comprehensive strategies including patient education, healthcare provider training, improved referral systems, and empathetic healthcare interactions, to mitigate diagnostic delays and improve outcomes. By applying a rigorous qualitative approach, our study contributes to a deeper understanding of diagnostic delays in cervical cancer and provides a framework for future research in similar contexts.

Clinical and pathological associations of PTEN expression in ovarian cancer: a multicentre study from the Ovarian Tumour Tissue Analysis Consortium

Abstract Background PTEN loss is a putative driver in histotypes of ovarian cancer (high-grade serous (HGSOC), endometrioid (ENOC), clear cell (CCOC), mucinous (MOC), low-grade serous (LGSOC)). We aimed to characterise PTEN expression as a biomarker in epithelial ovarian cancer in a large population-based study. Methods Tumours from 5400 patients from a multicentre observational, prospective cohort study of the Ovarian Tumour Tissue Analysis Consortium were used to evaluate associations between immunohistochemical PTEN patterns and overall survival time, age, stage, grade, residual tumour, CD8+ tumour-infiltrating lymphocytes (TIL) counts, expression of oestrogen receptor (ER), progesterone receptor (PR) and androgen receptor (AR) by means of Cox proportional hazard models and generalised Cochran–Mantel–Haenszel tests. Results Downregulation of cytoplasmic PTEN expression was most frequent in ENOC (most frequently in younger patients; p value = 0.0001) and CCOC and was associated with longer overall survival in HGSOC (hazard ratio: 0.78, 95% CI: 0.65–0.94, p value = 0.022). PTEN expression was associated with ER, PR and AR expression (p values: 0.0008, 0.062 and 0.0002, respectively) in HGSOC and with lower CD8 counts in CCOC (p value &lt; 0.0001). Heterogeneous expression of PTEN was more prevalent in advanced HGSOC (p value = 0.019) and associated with higher CD8 counts (p value = 0.0016). Conclusions PTEN loss is a frequent driver in ovarian carcinoma associating distinctly with expression of hormonal receptors and CD8+ TIL counts in HGSOC and CCOC histotypes.

BRCA1 Expression by Immunohistochemistry and Prognosis in Ovarian Cancer: A Systematic Review and Meta-Analysis

Homologous recombination deficiencies are associated with increased platinum sensitivity and potential response to poly (ADP-ribose) polymerase inhibitors in epithelial ovarian cancer. As an alternative to germline testing or somatic tumor sequencing, BRCA1 deficiency can be detected by immunohistochemistry and might predict homologous recombination deficiencies. This study aimed to assess the association between BRCA1 expression by immunohistochemistry and the prognosis of patients with epithelial ovarian cancer. We conducted a systematic review and meta-analysis following the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement. We searched PubMed, EMBASE, Web of Science, and Scopus databases through July 2019. Reference lists of selected articles were screened for further studies. We conducted qualitative synthesis and meta-analyses of hazard ratios for overall survival and progression-free survival. Of 41 studies of BRCA1 expression using immunohistochemistry, 18 evaluated the association of BRCA1 expression with patient survival (2738 cases). The loss of BRCA1 expression was associated with improved overall survival (hazard ratio = 0.67, 95% confidence interval 0.57-0.77) and progression-free survival (hazard ratio = 0.70, 95% confidence interval 0.58-0.84). Negative BRCA1 expression assessed by immunohistochemistry was associated with a better prognosis in epithelial ovarian cancer.

Immunohistochemistry for the detection of BRCA1 and BRCA2 proteins in patients with ovarian cancer: a systematic review

Background Loss of function in either breast cancer type 1 susceptibility protein (BRCA1) or breast cancer type 2 susceptibility protein (BRCA2) is a major risk factor for epithelial ovarian cancer (EOC) development. BRCA1 or BRCA2 deficiencies are associated with short-term prognosis and might have importance for the treatment of women with the disease. However, the screening of all possible mechanisms of dysfunction is expensive, time-consuming and difficult to apply in clinical practice. On the other hand, immunohistochemistry (IHC) is a simple and reliable method to access the expression of several proteins in tumour tissues. Materials and methods This systematic review aims to evaluate the current usage of IHC to detect BRCA1 and BRCA2 deficiencies in EOC. We searched and evaluated all primary literature on the use of IHC for evaluating BRCA1 and BRCA2 proteins expression in EOC. The main concepts for the search were: ovarian neoplasms, IHC, BRCA1 and BRCA2. Results Forty-four studies from 925 unique titles were included. A total of 4206 tumour samples were evaluated for BRCA1 and 1041 for BRCA2 expression. Twelve BRCA1 primary antibodies were used in 41 studies, and the most common was the MS110 clone (75.6%). Seven BRCA2 primary antibodies were used in ten studies. Using the cut-off of 10%, 47.0% of EOCs are associated with loss of BRCA1 and 34.5% with the loss of BRCA2 expression. Conclusion IHC was effective to detect loss of BRCA1 protein expression in EOC; however, data on BRCA2 expression were heterogeneous and difficult to interpret.

Impact of ICU bed availability on ovarian cancer surgical hospitalization rates during the first wave of the coronavirus disease 2019 pandemic

The coronavirus disease 2019 pandemic, which began in 2020, disrupted healthcare services. Reports of changes in surgical activities coincide with the outbreak period. We aimed to identify if changes could be determined in hospitalization rates of ovarian cancer patients from 2016 to 2020, comparing pre-pandemic and pandemic levels. Aggregated data were obtained from the State of São Paulo Secretary of Health regarding ovarian cancer clinical and surgical hospitalization, both Coronavirus disease-specific ICU and infirmary bed occupation rates, average social distancing rates, coronavirus disease 2019 incidence, mortality, and lethality rates. We performed the joinpoint analysis to verify if there were changes regarding hospitalization rates during this period. We also calculated hospitalization rate ratios and tested if they were correlated with pandemic-related variables. Hospitalization rates in the state fell, coinciding with the pandemic. Surgical hospitalization rate ratios were inversely correlated with Coronavirus disease-specific ICU bed occupation rates during the third trimester of 2020, with a Pearson's correlation coefficient of -0.50 (95%CI -0.78 to -0.05, p=0.03). These results demonstrate the impact of the coronavirus disease 2019 pandemic on the treatment of conditions that compete for the same healthcare resources.

Treatment delay and treatment pattern modifications among epithelial ovarian cancer patients during the COVID‐19 pandemic: A retrospective cohort study

AbstractBackground and ObjectivesThe coronavirus disease 2019 (COVID‐19) pandemic disrupted healthcare access and medical treatment, including oncological care. Treatment delay in ovarian cancer could impact survival. We aimed to assess if there were delays and treatment changes in a cohort of epithelial ovarian cancer patients.MethodsA retrospective cohort of epithelial ovarian cancer patients included cases diagnosed during the first 22 months of the COVID‐19 pandemic in the state of Sao Paulo and those diagnosed in the 22 months preceding the outbreak. Time‐to‐treat was measured in days. In each group, surgery and chemotherapy proportions were assessed according to healthcare insurance status.ResultsA 56.2% reduction in epithelial ovarian cancer diagnosis was identified during the pandemic group compared to the prepandemic group; fewer patients were diagnosed in stage I (p &lt; 0.01). Time‐to‐treat increased from 18.9 to 23 days (p &lt; 0.01). Surgery in the public sector fell from 74.6% to 65.3% during the pandemic, compared to 87.1% to 68.8% in the private sector.ConclusionThere were fewer overall diagnoses, reduced stage I diagnosis, increased time‐to‐treat, and a reduction in the proportion of patients submitted to surgery. Brazil's public healthcare system demonstrated a higher resiliency to treatment change than the private sector.

Author’s Reply to Jia et al.: “BRCA1 Expression by Immunohistochemistry and Prognosis in Ovarian Cancer: A Systematic Review and Meta‑Analysis”

Experiences of women with advanced cervical cancer before starting the treatment: Systematic review of qualitative studies

AbstractBackgroundAdvanced stage and high mortality are characteristics of cervical cancer in developing countries. Comprehension of the diagnosis itinerary is one of the main strategies to control the disease impact.ObjectivesTo identify reasons for the delay in diagnosing symptomatic cervical cancer according to the patient's perspectives reported in qualitative studies. We searched four databases (PubMed, Embase, CINAHL, and Web of Science).Selection criteriaWe included qualitative studies of women with advanced cervical cancer that explored their experiences before treatment. We excluded unoriginal, non‐qualitative, and duplicated studies.Data collection and analysisWe selected 39 articles for a full‐text reading and included 15 in the present review. We chose the Consolidated Criteria for Reporting Qualitative Research (COREQ) for quality assessment and The Model of Pathways to Treatment to guide the codifying process.Main resultsFour main themes emerged from the synthesis: (1) Health‐seeking motivators; (2) Obstacles to seeking medical care; (3) Diagnosis delay; and (4) Coping with the disease. These themes were derived from patients' personal knowledge and beliefs, social relationships, socioeconomic status, and healthcare system characteristics.ConclusionsIndividual behavior, social factors, and healthcare organization contribute to the delay in diagnosing advanced cervical cancer.