Vittoria Carbone

Survival associated with the use of one-step nucleic acid amplification (OSNA) to detect sentinel lymph node metastasis in cervical cancer

Sentinel lymph node (SLN) biopsy is part of surgical treatment of apparent early-stage cervical cancer. SLN is routinely analyzed by ultrastaging and immunohistochemistry. The aim of this study was to assess the survival of patients undergoing SLN analyzed by one-step nucleic acid amplification (OSNA) compared with ultrastaging. Single-center, retrospective, cohort study. Patients undergoing primary surgery and SLN mapping ( ±pelvic lymphadenectomy) for apparent early-stage cervical cancer between May 2017 and January 2021 were included. SLN was analyzed exclusively with OSNA or with ultrastaging. Patients with bilateral SLN mapping failure, with SLN analyzed alternatively/serially with OSNA and ultrastaging, and undergoing neo-adjuvant therapy were excluded. Baseline clinic-pathological differences between the two groups were balanced with propensity-match analysis. One-hundred and fifty-seven patients were included, 50 (31.8%) in the OSNA group and 107 (68.2%) in the ultrastaging group. Median follow up time was 41 months (95%CI:37.9-42.2). 5-year DFS in patients undergoing OSNA versus ultrastaging was 87.0% versus 91.0% (p = 0.809) and 5-year overall survival was 97.9% versus 98.6% (p = 0.631), respectively. No difference in the incidence of lymph node recurrence between the two groups was noted (OSNA 20.0% versus ultrastaging 18.2%, p = 0.931). In the group of negative SLN, no 5-year DFS difference was noted between the two groups (p = 0.692). No 5-year DFS and OS difference was noted after propensity-match analysis (87.6% versus 87.0%, p = 0.726 and 97.4% versus 97.9%, p = 0.998, respectively). The use of OSNA as method to exclusively process SLN in cervical cancer was not associated with worse DFS compared to ultrastaging. Incidence of lymph node recurrence in the two groups was not different.

Uterine tumor resembling ovarian sex-cord tumor: Conservative surgery with successful delivery and case series

Uterine tumor resembling ovarian sex-cord tumor (UTROSCT) is a rare distinct cancer included in the current World Health Organization classification of endometrial stromal tumors. A battery of immunohistochemical markers are necessary for accurate diagnosis. Although few case reports and case series have been documented and therefore providing robust prognostic information several authors agree to consider UTROSCT as a low malignant potential tumour. In literature only five cases of conservative management were reported. We reported our experience and a review of conservative cases of literature. In this article we describe a series of 10 cases of UTROSCT and their clinical and pathologic feature. We report two cases of conservative surgical approach obtaining a successfully pregnancies. All of the patients are still alive. In conclusion, fertility sparing surgery should be offered to patients who wish preserve their fertility however radical surgery must be considerate after childbirth. Close follow-up is required for all patients due to the lack of prognostic biomarkers and long follow up is needed to evaluate safety of conservative surgery.

The impact of body mass index on survival and surgical outcomes in ovarian cancer: insights from the MITO trials

Epithelial ovarian cancer accounts for approximately 80% of ovarian cancer cases. Although obesity is not a primary risk factor for its onset, a high body mass index may worsen prognosis and survival. This may result from chronic inflammation, metabolic and hormonal changes, and increased treatment toxicity and surgical complications associated with obesity. This study is a post-hoc analysis of data from 3 MITO (Multicenter Italian Trials in Ovarian Cancer) clinical trials (MITO-2, MITO-7, and MITO16/MaNGO), involving 2040 patients with epithelial ovarian cancer. The effects of body mass index on progression-free survival, overall survival, and surgical outcomes were evaluated. Statistical analyses included Cox regression models to assess the risk of progression and mortality in relation to body mass index, while also accounting for baseline clinical variables. Additionally, regression analysis was conducted to examine the association between body mass index and surgical outcomes, with mixed cumulative-link models used to analyze categories of post-operative residual tumor. Higher body mass index was significantly associated with poorer progression-free survival (p = .02) and overall survival (p = .001). Extreme obesity, in particular, increased the risk of disease progression and mortality, with adjusted hazard ratios of 1.47 (95% confidence interval [CI] 1.13 to 1.92) for progression-free survival and 1.69 (95% CI 1.20 to 2.38) for overall survival. Additionally, higher body mass index correlated with worse surgical outcomes, including a greater likelihood of residual tumor. This effect was significant across body mass index categories: overweight (odds ratio [OR] 1.29, 95% CI 1.07 to 1.56), obese (OR 1.43, 95% CI 1.09 to 1.93), and extremely obese (OR 1.73, 95% CI 1.15 to 2.60). The evidence supports the hypothesis that elevated body mass index negatively affects prognosis in patients with advanced ovarian cancer. Weight management represents a crucial component for improving clinical outcomes and quality of life in these patients. Future therapeutic strategies should ideally incorporate multi-disciplinary approaches, such as pre-habilitation, to optimize treatment tolerance and promote better post-operative recovery.