Prapaporn Suprasert

Exploring exercise behavior, barriers, and facilitators among gynecologic cancer survivors: a cross-sectional study

Prevalence of Tissue BRCA Gene Mutation in Ovarian, Fallopian Tube, and Primary Peritoneal Cancers: A Multi-Institutional Study

Ovarian, fallopian tube, or primary peritoneal cancer patients with BRCA gene mutation have enhanced sensitivity to platinum-based regimens and PARP inhibitors. However, the knowledge regarding BRCA mutation in Thai patients is limited. This study aimed at identifying the prevalence and characteristics of somatic and germline BRCA 1 and 2 mutations in Thai patients with these cancers. The paraffin blocks of tumors with histology of high grade serous, high grade endometrioid, or clear cell carcinoma obtained between June 2016 and December 2017 were analyzedto evaluate BRCA mutation using next-generation sequencing system. Blood or normal tissue paraffin blocks of positive patients were further tested for germline BRCA mutation. Tissue paraffin blocks of 178 patients were collected but only 139 were analyzed. Positive BRCA mutation was identified in 24 patients (17.3%): BRCA1 in 13 cases, BRCA2 in 10 cases, and BRCA1 and 2 in the rest one. Germline mutation study in blood or normal tissue in 23 positive patients revealed BRCA mutation in 14 cases, BRCA1 in 8 cases and BRCA 2  in 6 cases. Overall, the prevalence of somatic and germline mutation was 6.5% (9 out of 138 patients) and 8.7% (14 out of 138 patients), respectively. The most common histology associated with BRCA mutation was high grade serous cancer (27.3%). No significant difference was found between patients with or without BRCA mutation in terms of stage, outcome, platinum status, and survival outcome. BRCA mutation was demonstrated in less than 10% of Thai ovarian cancer patients. Higher rate of mutation was found in high grade serous cancer..

Cervical Cancer Screening: Histologic Outcomes of HPV-Negative HSIL/ASC-H Cytology in a Tertiary Referral Cohort in Northern Thailand

Background and Objectives: Cotesting combines cervical cytology and HPV testing and usually identifies HSIL/ASC-H in association with HPV positivity; however, a small subset shows discordant results with high-grade cytology but negative HPV testing. We evaluated the clinicopathologic significance and histologic outcomes of HPV-negative HSIL or ASC-H cytology in a tertiary referral setting. Materials and Methods: We retrospectively reviewed women referred to a tertiary colposcopy unit (January 2019–October 2025) with HPV-negative HSIL or ASC-H on cotesting. Clinical findings, colposcopy, histology, excisional procedures, and follow-up were abstracted. Cytology and histology were reviewed by an expert gynecologic pathologist, and p16 immunohistochemistry was performed in all cases. Results: Among 92 women with HSIL/ASC-H cytology who underwent cotesting, 84 were HPV-positive (35 HSIL, 49 ASC-H). Eight cases (8.7%) remained HPV-negative after cytology review: 2/37 (5.4%) HSIL and 6/55 (10.9%) ASC-H. On histology, 4/8 (50%) had HSIL (CIN3) and 4/8 had LSIL; all CIN3 cases showed diffuse block-type p16 positivity. Two of six HPV-negative ASC-H cases (33.3%) were CIN3. One patient had persistent high-grade disease requiring two excisional procedures during follow-up. Conclusions: HPV-negative HSIL/ASC-H cytology is uncommon but associated with a substantial risk of CIN3. The consistent p16 positivity in tissue-confirmed HSIL supports HPV-attributable disease and suggests that most discordant cases reflect false-negative HPV testing rather than HPV-independent pathology. High-grade cytology should prompt colposcopic evaluation regardless of HPV status, and management should not be de-escalated solely on the basis of a negative HPV test.

Profiling the Expression and Prognostic Values of FYN, A Non-Receptor Tyrosine Kinase, in Different Histological Types of Epithelial Ovarian Cancer

This study was aimed at evaluating FYN expression among different histologic types of epithelial ovarian cancer (EOC) and its associated prognostics. The FYN expression levels using quantitative real-time PCR method were evaluated in 98 primary EOC. Receiver operating characteristic curve were used to select an optimal cut-off value for determining the presence or absence of a disease progression. The median level of FYN expression varied among different EOC types, being the highest in high-grade serous carcinomas and the lowest in clear cell carcinomas (CCC). Using the cutoff FYN value to predict disease progression, the FYN-positive group had a poorer progression-free survival (PFS) compared to the FYN-negative group (p = 0.001). In multivariate Cox regression analysis, FYN expression was an independent predictor for disease progression (Hazard ratio = 2.30; 95% CI: 1.21- 4.38; p = 0.011). In subgroup analysis, FYN expression was significantly associated with lower PFS in early stage CCC patients (p = 0.009). FYN expression is variable among different types of EOC while impacting on the prognostic values in patients with early stage CCC.

Clinicopathological Prognostic Factors Influencing Survival Outcomes of Vulvar Cancer

The prognostic factors for survival in squamous cell carcinoma (SCCA) of vulva cancer such as groin node involvement, postmenopausal status, tumor size, margin status, tumor grade, lymph vascular space invasion (LVSI) were reported in the past. However, with limited data from Southeast - Asian population, the present study was conducted to evaluate the clinicopathological prognostic factors for survival outcomes of this disease after treatment with surgery. All SCCA vulva cancer patients who underwent surgery between January 2006 and December 2017 were reviewed. The clinicopathological factors were analyzed to identify the prognostic factors for the progression-free survival (PFS) and overall survival (OS) using the Kaplan- Meier method and Cox-Proportional Hazard model. One hundred twenty-five patients were recruited. The independent poor prognostic factors for PFS were groin node-positive and  pathologic tumor diameter of more than 25 mm. Whereas postmenopausal status and groin node positive were independent poor prognostic factors for OS. Groin node-positive was the only one independent poor prognostic factor for both PFS and OS. In addition, the tumor diameter longer than 25 mm. was independent poor prognostic factors for PFS while postmenopausal status was independent poor prognostic factors for OS. Special adjuvant treatment for patients with these factors should be further investigated. .

The efficacy of premedication with 10 mg versus 20 mg of intravenous dexamethasone for prevention of paclitaxel hypersensitivity reaction in low-risk gynecologic cancer patients: a non-inferiority, randomized controlled mono-institutional trial

Dexamethasone has been used extensively to prevent hypersensitivity reactions to paclitaxel. However, the optimal dose of dexamethasone is controversial, varying between 20 mg and 10 mg. We conducted this randomized controlled trial to illustrate that these 2 dosages of dexamethasone are non-inferior to the prevention of paclitaxel HSRs. Gynecologic cancer patients who naively receive paclitaxel and carboplatin were invited to participate in this study. All participants received the same premedication with intravenous dexamethasone 20 mg, oral lorazepam 0.5 mg, and intravenous chlorpheniramine 10 mg at the first cycle. If they did not develop hypersensitivity reactions, they were randomized to receive either intravenous 20 mg or 10 mg dexamethasone with the same other premedication. The attending nurse recorded the patient's symptoms regarding hypersensitivity reactions. The main outcome was hypersensitivity reaction events in each arm, with a non-inferiority margin of 0.11. A total of 122 patients were included and randomly assigned to receive dexamethasone 10 mg (n = 61) or dexamethasone 20 mg (n = 61). The overall incidence of hypersensitivity reactions in patients who received dexamethasone 10 mg and dexamethasone 20 mg was 9.8% and 13.1%, respectively, the risk difference between dexamethasone 10 mg and dexamethasone 20 mg not exceeding the non-inferiority margin of 0.11 (Risk Difference = -0.03, 95% confidence interval = -0.15 to 0.08). Dexamethasone 10 mg was non-inferior to dexamethasone 20 mg in terms of prevention of paclitaxel hypersensitivity reactions.