Nopporn Rodpenpear

Prognostic Value of The Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Platelet Count for Platinum-Sensitive Recurrent Epithelial Ovarian Cancer

To study the prognostic value of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and platelet count in patients with platinum-sensitive recurrent epithelial ovarian cancer (PS-ROC). This was a retrospective study on a database of platinum-sensitive recurrent epithelial ovarian cancer patients who received treatment at HRH Princess Maha Chakri Sirindhorn Medical Center (MSMC) between January 2010 and December 2020. The patients' demographic data, surgical factors, pathological factors, laboratory findings, and response to treatment were reviewed from the patients' medical records. Survival analysis was conducted using the Kaplan-Meier survival estimate and Cox regression model. In total, 56 patients were recruited in this study. The median overall survival (OS) and progression-free survival (PFS) were 33 (95%CI 23-43) and 11 (95%CI 8-16) months, respectively. Survival analysis showed a high PLR was associated with decreased OS compared with low value but no significant difference in PFS. High NLR was associated with poor OS and PFS. There was no association between the platelet count and survival outcome (OS and PFS). In the multivariable Cox regression analysis, the NLR, PLR, and platelet count were not significant prognostic factors for survival outcome. However, low hemoglobin and a decreased disease-free interval were significantly associated with poor PFS. A white blood cell count (WBC) ≥ 8,000 cells/mm3 was a poor prognostic factor for overall survival (Adjusted HR 7.64; 95%CI: 2.21-26.42; p-value = 0.001). The NLR, PLR, and platelet count were not associated with both the OS or PFS in patients with PS-ROC. However, the WBC level is an easy, readily available, and economical way to predict survival outcomes in PS-ROC patients and may help physicians to tailor therapeutic interventions in the future.

Comparison of Tissue Mismatch Repair Protein Deficiency between Early- and Advanced-Stage Endometrial Cancer

ESGO/ESTRO/ESP guidelines recommend that DNA mismatch repair (MMR) proteins or microsatellite instability tests should be performed in all cases of endometrial cancer. This study aims to clarify the relationship of MMR protein deficiency (dMMR) between early and advanced stages of endometrial cancer. Secondary objective is to identify dMMR affecting factors in endometrial cancer. This cross-sectional study was conducted on endometrial cancer patients who underwent surgery at HRH Princess Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University, between May 2013 and April 2021. Patients with endometrial cancer whose tumor tissue was available for analysis were identified. The expression of MMR proteins was assessed by immunohistochemistry, including MLH1, MSH2, MSH6, and PMS2. Then, the pathological specimens were reviewed. A total of 207 patients with endometrial cancer were assessed for data analysis. MMR deficiency was observed in 92 cases (44.4%). We found patients with dMMR in both the early and advanced stages of endometrial cancer-68/155 cases (43.9%) and 24/52 cases (46.2%), respectively (P = 0.774).  Statistically significant differences were found only in myometrial invasion (adjusted prevalence odds ratio 2.35, 95% CI 1.21 to 4.57, P = 0.012). Our study showed no difference in tissue dMMR between early- and advanced-stage endometrial cancer. The dMMR was not associated with improved outcomes in patients with endometrial cancer. Even though ESGO/ESTRO/ESP guidelines recommend the performance of MMR IHC or MSI tests in all endometrial cancer cases, we can select the appropriate patients those categorized as "advanced stage" or "recurrent"-who may gain the most benefits from the immunotherapy modality of treatment.

The Performance of Modified Swede Colposcopic Index to Predict High Grade Cervical Intraepithelial Neoplasia and Cervical Cancer in the Real Clinical Practice, an External Validation Study

The primary objective is to examine the external validity of the modified Swede colposcopic index (MSCI) for predicting cervical intraepithelial neoplasia grade 2-3, including cancer (CIN2+), and to evaluate inter-rater and intra-rater reliability as a secondary objective in women with abnormal cervical cancer screening. We conducted a prospective study to predict CIN2+ in women aged 25-65 years with abnormal cervical cancer screening results (atypical squamous cells of undetermined significance (ASC-US) or higher and/or high-risk HPV infection). All participants were previously undiagnosed with CIN2+. We evaluated the effectiveness of MSCI in detecting CIN2+ using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). A total of 118 women were included in this study. Gynecologic oncologists using the MSCI achieved a sensitivity of 46.9%, specificity of 87.2%, PPV of 57.7%, NPV of 81.5%, and accuracy of 76.27%. Inter-rater reliability for the MSCI was good (ICC=0.77, 95%confidence interval=0.67-0.84), and intra-rater reliability was excellent (ICC=0.98, 95%confidence interval =0.97-0.99). In a real-world clinical setting, studies have demonstrated that MSCI exhibits high specificity while maintaining acceptable sensitivity.

The Appropriate of Cone Depth in Loop Electrical Excision Procedure (LEEP) for Negative Pathological Margin from High Grade Precancerous Lesion of Cervix, Retrospective Study

To determine the appropriate cone depth for treating high grade precancerous lesions to achieve negative pathological margins of cones from LEEPs. Other factors associated with positive pathological margin were also investigated. A Retrospective study recruited 170 patients who received indications for LEEP during January 2015 to July 2020 were enrolled. The participants were operated by a single cut of LEEP and not had previously conization before. All patient data were collected into two groups, including negative and positive cone margin groups. Then, we used the cone depth by calculating from cone tissue after formalin fixation to eliminate shrinkage effect. The appropriate cut-off points for cone depth were calculated by ROC and analyzed factors that influence positive cone margin. The depth of cone (mm ±SD) of negative margin group was 8.70 (±3.36) and 6.13 (±2.28) mm in positive margin group. The appropriate cut-off points for cone depth were calculated by ROC presented at resection depth of 7.21 mm, which displayed proper cone depth with a sensitivity of 63.53% and specificity of 71.76%. Elderly age (adjusted OR 1.061, 95%CI 1.008-1.117, p=0.002), number of quadrants of lesion involvement (adjusted OR 1.182, 95%CI 1.312-2.513, p=<0.001) and glandular involvement (adjusted OR 3.648, 95%CI 1.605-8.292, p=0.002) were the significant risk factors for positive margin. The appropriate cone depth for treating high grade precancerous lesions was at least 7.21 mm to achieve a negative cone margin from LEEP. The significant factors associated with positive cone margin include elderly age, more quadrants of lesion involvement and glandular involvement.