Vitcha Poonyakanok

Oncological outcomes and risk factors for recurrence of mucinous borderline ovarian tumors: A 15‐year experience at a tertiary center

AbstractBackgroundThe most common subtype of borderline ovarian tumors in Asia is mucinous borderline ovarian tumors (mBOTs). Intraoperative distinction from mucinous carcinoma can be difficult. Despite the indolent behavior of mBOTs, recurrence or metastases may occur. The objectives of this study were to determine the oncological outcomes of mBOTs and the risk factors for their recurrence.ResultsThis retrospective study enrolled patients with mBOTs treated or referred to our institution between January 2005 and December 2019. Histological reviews of the recurrent cases (primary and recurrent or metastatic tumors) were performed. Patients with other tumor subtypes, pseudomyxoma peritonei, or no in‐house operation were excluded. Two hundred thirty‐two patients were diagnosed with mBOTs. The median follow‐up was 52 months. Six patients (2.58%) had tumor recurrence or metastasis. The risk factors for recurrence were a ruptured tumor, residual tumor after an operation, high serum CA19‐9 level, and stage of the disease. The recurrence rates of fertility‐sparing and radical surgery were not significantly different. Detailed surgical staging, intraepithelial carcinoma, and microinvasion were also not associated with disease recurrence.ConclusionsmBOTs have an excellent prognosis. Currently, fertility‐sparing surgery is the standard treatment, showing no significant difference in oncological outcomes compared to radical surgery. Patients with risk factors should be closely monitored.

Assessment of Health‐Related Quality of Life in Thai Endometrial Cancer Patients: A Comparative Analysis Using EQ5D Utility Scores Across States

ABSTRACTBackgroundRates of endometrial cancer, the sixth most common in women, are rising. HRQoL, reflecting health beyond clinical contexts, includes disabilities and daily functioning impacts. Measured by various tools such as EuroQoL‐5 Dimensions (EQ‐5D‐5L), it aids in economic evaluation of interventions.AimsThe purpose of this study was to analyze Health‐Related Quality of Life (HRQoL), measured by the EQ‐5D‐5L instrument, in different states of endometrial cancer (EC) patients.Methods and ResultsWe conducted a cross‐sectional study on EC patients who underwent follow‐up at Siriraj Hospital, Thailand, between January and June 2023. Patients were classified into five groups: early state, advanced state, curative state, locoregional recurrent state, and distant recurrent/progression state. Demographic and socioeconomic data were collected. EQ‐5D‐5L and visual analog scale instruments (EQ‐VAS) were used to compared between disease states. Descriptive statistics were used to summarize patient characteristics, and the Mann–Whitney U test (p ≤ 0.05) compared EQ‐5D‐5L scores across groups.The study included 56 EC patients, with a mean age of 60.1 ± 10.9 years and a mean BMI of 26.8 ± 5.3 kg/m2. The EQ‐5D scores were as follows: 0.9055 (IQR 0.8193–0.9436) for the early state, 0.8308 (IQR 0.7997–0.8611) for the advanced state, 0.9235 (IQR 0.8521–0.9855) for the curative state, 0.9096 (IQR 0.6249–0.9577) for the locoregional recurrent state and 0.5778 (IQR 0.2884–0.8521) for the distant recurrent/progressive state. The median EQ‐VAS for each state was 70, 75, 82.5, 75, and 65, respectively. The EQ‐5D values had significantly deteriorated after distant metastasis/progression compared to curative states (p‐value = 0.003). Mobility and pain/discomfort appeared to be the two main concerns.ConclusionThe findings show the substantial negative impact of distant metastasis or disease progression on HRQoL. These findings will be used to guide future economic research in the field of endometrial cancer treatment.

Longitudinal Analysis of the Overall Survival Rates and Transitional Probabilities of Endometrial Cancer Patients: A Comprehensive Retrospective Study in Thailand

This investigation delineated the survival rates and transitional probability trends of patients with endometrial cancer. This information is pivotal for optimizing patient management and counseling strategies. We conducted a retrospective cohort analysis of patients diagnosed with stage I or II endometrial cancer between November 2006 and October 2012 and those diagnosed with stage III or IV endometrial cancer between January 2012 and May 2017 at Siriraj Hospital, Bangkok, Thailand. Our examination included baseline demographics, clinical characteristics, and adjuvant therapy data. Survival rates and transitional probabilities were assessed using the Kaplan-Meier method for survival curve construction and Markov models, respectively. After exclusions, 229 individuals with early-stage endometrial cancer and 119 with advanced-stage histologically verified endometrial cancer were included in the final cohort. Throughout a median follow-up duration of 12.8 years, the 5-year overall survival rates were 89.05% for the early-stage cohort and 50.42% for the advanced-stage cohort. The transitional probability analysis revealed an elevated likelihood of achieving a curative state in early-stage patients, contrasting with a greater propensity for disease progression or distant metastasis in advanced-stage patients. The findings from this study offer critical insights into the overall survival rates and transitional probabilities of endometrial cancer patients. These insights underscore the importance of strategies focused on preventing recurrence and enhancing treatment. Moreover, the results serve as a cornerstone for clinicians in devising individualized treatment plans and facilitating cost-effective analyses in the context of endometrial cancer care.

Prospective comparative trial comparing O‐RADS, IOTA ADNEX model, and RMI score for preoperative evaluation of adnexal masses for prediction of ovarian cancer

AbstractIntroductionPreoperative assessment of ovarian tumors to distinguish between benign and malignant is important. At this time, many diagnostic models were available and the popularity of the risk of malignancy index (RMI) in Thailand is still high. The IOTA Assessment of Different NEoplasias in adneXa (ADNEX) model and the Ovarian‐Adnexal Reporting and Data System (O‐RADS) model were both new models with good performance.ObjectivesThe purpose of this study was to compare O‐RADS, RMI, and ADNEX models.DesignThis diagnostic study was performed using data from the prospective study.MethodsData from 357 patients from a previous study were included and calculated using the RMI‐2 formula then applied to the O‐RADS system and the IOTA ADNEX model. The diagnostic significance of the results was evaluated by receiver operating characteristic (ROC) analysis and pairwise comparison between models was made.ResultsThe area under the receiver operating characteristic curve (AUC) to distinguish an adnexal mass as a benign or malignant tumor was 0.975 (95% CI, 0.953–0.988) for the IOTA ADNEX model; 0.974 (95% CI, 0.960–0.988) for O‐RADS; 0.909 for RMI‐2 (95% CI, 0.865–0.952). There were no differences in pairwise AUC comparisons between the IOTA ADNEX and O‐RADS models, and both were better than those of RMI‐2.ConclusionsThe IOTA ADEX and O‐RADS models are excellent tools for distinguishing the adnexal mass in the preoperative assessment and were better than RMI‐2. The use of one of these models is recommended.