Revista da Associação Médica Brasileira

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.

Is high-density lipoprotein cholesterol a prognostic marker in epithelial ovarian cancer?

SUMMARY OBJECTIVE: The aim of the study was to assess the prognostic potential of high-density lipoprotein cholesterol levels in predicting survival for patients with epithelial ovarian cancer. METHODS: This is a retrospective observational study. The cutoff value for high-density lipoprotein cholesterol was determined through receiver operating characteristic analysis, revealing a value of 45 mg/dL. Patients in Group I had high-density lipoprotein cholesterol values &lt;45 mg/dL, while patients in Group II had high-density lipoprotein cholesterol values ≥45 mg/dL. RESULTS: A total of 219 patients participated in the study, including 78 (36%) in group I and 141 (64%) in group II. high-density lipoprotein cholesterol (HR 0.44, 95%CI 0.27–0.73, p=0.001), age ≥65 (HR 3.02, 95%CI 1.87–4.58, p&lt;0.001), and stage (HR 3.68, 95%CI 1.07–12.67, p=0.038) were identified as independent prognostic factors for overall survival in the multivariate analysis. High-density lipoprotein cholesterol (HR 0.44, 95%CI 0.27–0.72, p=0.001) and N1b (HR 2.32, 95%CI 1.33–4.03, p=0.003) were independent prognostic factors for disease-free survival in the multivariate analysis. CONCLUSIONS: In epithelial ovarian cancer, high-density lipoprotein cholesterol levels were prognostic for both overall survival and disease-free survival.

Homologous recombination deficiency gene panel analysis results in synchronous endometrial and ovarian cancers

The objective of this study was to analyze the genetic alterations of tumors within the scope of the homologous recombination deficiency gene panel in patients diagnosed with synchronous endometrial ovarian cancer who have been followed for over 5 years using next-generation sequencing. DNA was isolated from the patient's formalin-fixed, paraffin-embedded tissue blocks. Next-generation sequencing was performed using the Illumina capture-based sequencing method. Samples were sequenced using the Sophia HR Solution DNA Kit. Seven patients were included in this study. The ratios of likely pathogenic (LP)/pathogenic (P) somatic mutations in ATM (serine/threonine kinase or Ataxia-telangiectasia mutated gene), BRCA2 (breast cancer type 2 susceptibility gene), BARD1 (BRCA1 associated RING domain 1), TP53 (tumor protein p53), BIRP1 (BRCA1-interacting helicase 1 gene), PALB2 (partner and localizer of BRCA2), and CHECK2 were 21 (48.8%), 8 (18.6%), 5 (11.6%), 3 (6.9%), 2 (4.6%), 2 (4.6%), and 2 (4.6%), respectively, in endometrium, and the ratios of somatic mutations in ATM, BRCA2, TP53, BARD1, RAD54L (DNA repair/recombination protein like), BIRP1, and RAD51D (RAD51 recombinase paralog D) were 24 (60%), 6 (15%), 5 (12.5%), 2 (5%), 2 (5%), 1 (2.5%), and 1 (2.5%), respectively, in ovary. In endometrioid-synchronous endometrial ovarian cancer cases, P/LP mutations were observed in ATM and CHECK2 genes in endometrium and ATM, BRCA2, and TP53 genes in ovary. In two non-endometrioid-synchronous endometrial ovarian cancer cases, CHEK2 (checkpoint kinase 2) mutations were observed in endometrium and ATM and TP53 mutations in ovary, whereas in one case, P/LP mutations in ATM and TP53 genes were common in both tissues. Pathogenic variations confirming the diagnosis of synchronous endometrial ovarian cancer with genetic alterations were identified in all but one case. ATM gene mutation emerged as the most common alteration and has a potential association with a favorable prognosis.

Comparison of nonspecific inflammatory markers in endometrial cancer and hyperplasia

This study aims to analyze inflammatory markers among patients with endometrial cancer, hyperplasia with atypia/endometrial intraepithelial neoplasia, hyperplasia without atypia, and normal controls, thus observing the stage at which inflammation becomes the most significant. A total of 444 patients who had endometrial sampling were included in the study (endometrial cancer, n=79; endometrial hyperplasia with atypia/endometrial intraepithelial neoplasia, n=27; endometrial hyperplasia without atypia, n=238; and normal controls, n=100). Neutrophil count, lymphocyte count, platelet count, platelet distribution width, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, CA-125, and endometrial thickness of the patients were recorded. Comparing the groups for neutrophil count, the hyperplasia with atypia group had higher values compared with both the hyperplasia without atypia group and the control group (p=0.003). When compared for the lymphocyte count, the hyperplasia with atypia group had lower values compared with the control group (p=0.014). Neutrophil/lymphocyte ratio of the hyperplasia with atypia group was higher than all other groups, and neutrophil/lymphocyte ratio of the cancer group was higher than the control group (p=0.001). Platelet count, mean platelet volume, platelet distribution width, and platelet/lymphocyte ratio values were not significantly different among groups (p>0.05). Considering the inflammatory markers, the most prominent result was that the hyperplasia with atypia group had neutrophilia, lymphopenia, and increased neutrophil/lymphocyte ratio compared with other groups.

Breast and gynecologic cancers as a Brazilian health priority

Cancer imposes a profound burden on low- and middle-income countries where 65% of the global cancer deaths occurred in 2020. The objective of the present review was to describe female cancer epidemiology in Brazil, barriers to prevention, screening, and treatment, and to propose strategies to a better control. For the process of literature search and scientific acquisition, we have utilized the terms "female cancer" AND "breast cancer," AND "cervical cancer" AND "endometrial cancer" AND "ovarian cancer" AND "Brazil" in PubMed. References of the articles included in this review were manually searched in order to identify relevant studies on the topic. The official Brazilian epidemiology data were extensively analyzed at the governmental site www.inca.gov.br. Considering cases of breast and gynecologic cancers together, 105,770 new cases are expected to be diagnosed yearly, positioning female cancer as the highest cancer incidence in Brazil. Female breast cancer is the most common and the leading cause of death from cancer in the female population in all regions of Brazil, except in the North, where cervical cancer ranks first. Cervical cancer, a preventable disease, corresponds to the third-most common neoplasia in women, with higher incidences in the North and Northeast regions of Brazil. An upward trend has been observed in endometrial cancer incidence, a tendency that follows the increase of its two most common risk factors: population aging and obesity. Ovarian cancer currently occupies the eighth position among female cancers in Brazil, but it is the most lethal gynecologic cancer. The main strategies to reduce female cancer mortality rates are the reduction of inequalities in healthcare services and the early diagnosis of cases. The lack of a specific national cancer program results in a reactive and unplanned approach to healthcare provision, ultimately leading to suboptimal resource utilization and higher expenditure. Analyzed together, breast and gynecologic cancers correspond to the leading cause of cancer in Brazil. A heterogeneous group, female cancer includes diseases with a high primary and secondary prevention potential. The organization of a female cancer program in Brazil prioritizing primary and secondary prevention strategies, such as adequate mammography screening and human papillomavirus vaccination coverage, could significantly improve female cancer control in the country.

Ultrasonography, macroscopy, and frozen section: whıch is better for predicting deep myometrial invasıon in endometrial cancer?

The aim of this study was to compare the power of preoperative transvaginal ultrasonography, intraoperative macroscopic examination, and frozen section for predicting deep myometrial invasion in endometrial cancer. This is a retrospective review involving 68 patients who underwent surgical staging for endometrial cancer from 2014 to 2017. Patients with grade 3 endometrial cancer and non-endometrioid tumors were excluded. The findings related to preoperative transvaginal ultrasonography, intraoperative macroscopic examination, and frozen section were compared with definitive histopathological diagnosis. The mean age, gravidity, and body mass index of the patients were 58.1±8.9 years (range: 30-80 years), 3.2±2.1 (range: 0-9), and 33.5±6.6 kg/m2 (range: 20-52 kg/m2), respectively. Only 11 (16.2%) patients were in the premenopausal period, while 57 (83.8%) were in the postmenopausal period. Grade 1 endometrial cancer was found in 29 patients (42.6%) and grade 2 tumors were specified in 39 patients (57.4%). Stage IA disease was found in 45 (66.2%) patients, while stage IB disease was observed in 23 (33.8%) patients. The 5-year survival rate was 91.2%. The sensitivity of preoperative transvaginal ultrasonography, intraoperative macroscopic examination, and frozen section were 56, 34, and 52%, respectively, for predicting deep myometrial invasion. In contrast, the specificity of preoperative ultrasonography, intraoperative macroscopic examination, and frozen section were 86, 100, and 100%, respectively. Transvaginal ultrasonography and intraoperative frozen section were found to have similar sensitivity and specificity for predicting deep myometrial invasion. Preoperative transvaginal ultrasonography appears as an efficient approach for predicting endometrial cancers with deep myometrial invasion.

Management of ultrasonographic endometrial thickness in postmenopausal asymptomatic women

Clinical implication of preoperative psoas muscle area in endometrial cancer patients

Obesity is a significant risk factor for endometrial cancer. In contrast, sarcopenia describes a loss of the body's muscle mass that is closely related to unfavorable clinical outcomes. Even endometrial cancer patients have high rates of obesity, and they should have a significantly higher risk for undiagnosed sarcopenia or fragile muscle quality. This is a retrospective study that included an endometrial cancer database collected from a tertiary gynecologic cancer center. We investigated the relationship between preoperative psoas muscle area by magnetic resonance imaging, surgical outcomes and pathological features. The study included 116 patients, the mean height was 160 cm (Standart deviation 7), weight was 72 kg (Standart deviation 18), and the median duration of hospitalization was 4 days (Interquartile range 2-9) in the whole study group. Sarcopenia was diagnosed in 25 (21.6%) patients, according to the magnetic resonance imaging findings. Three (6.5%) obese patients had sarcopenia, but it was 31.4% in nonobese patients (p=0.026). The median duration of hospitalization was five days (3-9 days) in the sarcopenia group, and it was four days (2-7 days) in the non-sarcopenia group. Sarcopenic patients did not have increased surgical complication rates following uterine cancer surgery. We should be aware of hospitalization duration in those patients, and sarcopenic counterparts necessitate longer follow-up after the surgery.

The impact of human papillomavirus 16/18 positivity on cyberchondria levels in women undergoing colposcopy

SUMMARY OBJECTIVE: The negative consequences of the widespread use of the Internet for health-related information have recently become a topic of research. Recently, the impact of internet information-seeking on anxiety has been defined as cyberchondria, and a standardized scoring system has been developed to document it. However, the significance of this scoring system in gynecologic oncology has not yet been established. Therefore, the aim of this study was to evaluate the impact of human papillomavirus 16/18 positivity on the level of cyberchondria in women with human papillomavirus positivity undergoing colposcopy. METHODS: The study included 333 women with human papillomavirus 16/18 and other high-risk human papillomavirus positivity who underwent colposcopy in the gynecologic oncology clinic. Participants were divided into two groups: human papillomavirus 16/18 positive (Group 1, n=201) and other high-risk human papillomavirus positive (Group 2, n=132). Both groups were administered the short form of the Cyberchondria Severity Scale (CSS-12). Demographic and clinical findings and cyberchondria scores were compared between the groups. RESULTS: The median ages of the study groups were 36 (26–59) and 40 (25–63) years, respectively (p=0.004). Both groups had similar body mass index, parity, menopausal status, and educational levels (p&gt;0.05). When comparing the four subscales and the total score, the excessiveness (11 [3–15] vs. 9 [3–15], p&lt;0.001, respectively) and the total CSS-12 score (31 [12–55] vs. 28 [12–49], p=0.002, respectively) were statistically significantly different between the two groups. CONCLUSIONS: In women with human papillomavirus 16/18 positivity undergoing colposcopy, cyberchondria levels were found to be significantly higher. Specifically, excessive information-seeking behavior significantly contributed to this elevated level of cyberchondria.

Comparison of high-grade human papillomavirus-induced cervical lesions between human immunodeficiency virus-positive and human immunodeficiency virus-negative women

SUMMARY OBJECTIVE: The aim of this study was to compare the evolution of high-grade human papillomavirus-induced cervical lesions between human immunodeficiency virus-positive and human immunodeficiency virus-negative women. METHODS: Human immunodeficiency virus-positive and human immunodeficiency virus-negative women were enrolled in a retrospective cohort study after undergoing large-loop excision of the transformation zone between January 2008 and December 2017 as participants in the high-grade cervical lesion screening program. The evolution of human papillomavirus lesions induced in human immunodeficiency virus-infected women was evaluated in comparison with the general population. The following potentially confounding variables were examined: age at treatment and at the end of follow-up, histologic grade of treated intraepithelial disease, compromised margins, adequacy of colposcopy during follow-up, and recurrence of histopathologic diagnosis of high-grade squamous intraepithelial lesion. RESULTS: Of the 195 women, 51 were human immunodeficiency virus-positive (26.2%) and 144 were human immunodeficiency virus-negative (73.8%). Age of menarche (11.8±1.5) and sexarche (14.5±2.2) were earlier in human immunodeficiency virus-positive women (p=0.021 and 0.006, respectively). Parity (2.35±109) and number of pregnancies (2.86±1.47) were higher in human immunodeficiency virus-positive women (p=0.027 and 0.018, respectively). The prevalence of incomplete schooling was lower in human immunodeficiency virus-positive women (47.1 vs. 19.8%, p=0.002). Smoking was more common in human immunodeficiency virus-positive women (58.8 vs. 31.9%, p=0.001). Compromised surgical margins were found in 33.3% of human immunodeficiency virus-positive and 16.7% of human immunodeficiency virus-negative women (p&lt;0.001). The risk of recurrence was 37.3% in human immunodeficiency virus-positive and 13.9% in human immunodeficiency virus-negative women (p&lt;0.001). Cumulative survival over months was shortened in human immunodeficiency virus-positive women (p&lt;0.001). CONCLUSION: human immunodeficiency virus-positive women in this cohort had a significantly higher risk of recurrence than human immunodeficiency virus-negative women in addition to shorter overall survival.

Evaluation of the effectiveness of hysteroscopic myomectomy in the symptoms of women with uterine myomatosis: a retrospective cohort

SUMMARY OBJECTIVE: The aim of this study was to evaluate the effectiveness of hysteroscopic myomectomy in the symptoms of women with uterine myomatosis. METHODS: This is a retrospective cohort study conducted on 119 women with uterine myomatosis who underwent hysteroscopic myomectomy in a tertiary hospital from 2018 to 2023. Women of reproductive age diagnosed with submucosal myoma who underwent hysteroscopic myomectomy were included, and women who did not have the data in their medical records necessary for completion were excluded. The sociodemographic and clinical variables of these women were evaluated. RESULTS: The average age of the women was 41.4±6.8 years. Among the fibroids, 37.0% were International Federation of Gynecology and Obstetrics (FIGO) 0 and 52.5% were FIGO 1. The average size of the fibroids was 2.7±1.4 cm. There were 10.0% of complications. After myomectomy, 67.2% of the women had improvement in symptoms, 66.1% opted for hormonal treatment, and 14.3% underwent hysterectomy. Ninety percent of the women who did not show improvement in symptoms had FIGO 1 and FIGO 2 fibroids (p=0.002), and 57% had a higher number of cesarean sections (p=0.038). In addition, 61% of these women required a new approach (p&lt;0.001), and 93% opted for treatment after myomectomy (p&lt;0.001). Factors associated with a greater chance of women's symptoms not improving were having more than two cesarean sections (hazard ratio [HR]=3.52, p=0.026), FIGO 1 fibroids (HR=5.75, p=0.003), and FIGO 2–3 fibroids (HR=8.25, p=0.030). CONCLUSION: Hysteroscopic myomectomy has a low complication rate, and having fibroids with a larger intramural component is the main factor responsible for myomectomy failure.

Serum hCG levels in the prediction of molar pregnancy below 11 weeks of gestational age

The aim of this study was to evaluate the serum hCG level in the differential diagnosis between non-molar miscarriage and complete hydatidiform mole in16,435 mUI/mL at 6-7 weeks, hCG>64,911 mUI/mL at 8-9 weeks, and hCG >126,278 mUI/mL at 10-11 weeks were most prevalent on complete hydatidiform mole diagnosis. On the contrary, hCG<30,000 mUI/mL at 10-11 weeks was most prevalent in non-molar miscarriage diagnosis.

The relationship between cancer information burden, attitudes, and behaviors toward cancer screenings in women aged 30–70 years

SUMMARY OBJECTIVE: The aim of this study was to evaluate the relationship between cancer information burden, attitudes, and behaviors toward cancer screening in women aged 30–70 years who applied to family health centers. METHODS: The data were collected with Personal Information Form, Attitude Scale for Cancer Screening, and Cancer Information Overload Scale from 398 women. RESULTS: The mean score of the participants was 16.22±4.66 on the Cancer Information Overload Scale and 93.05±13.80 on the Attitude Scale for Cancer Screening. A statistically significant difference was found between the mean scores of the women according to their educational level, occupational status, knowledge about cancer screening, and the presence of cancer in themselves or their families (p&lt;0.05). In addition, a strong positive but statistically insignificant correlation (r=0.061, p=0.223) was found between the Cancer Information Overload Scale and the scores of the Attitude Scale for Cancer Screening. CONCLUSION: Women had low rates of knowing the timing of colon, cervical, and breast cancer screenings, having been screened, and thinking of participating in screenings in the following year. In order to improve women's attitudes toward early diagnosis of cancer in a positive way, informative public education activities should be continued.

The impact of herbal treatments on cervicovaginal human papillomavirus infection: a systematic review and meta-analysis

This systematic review and meta-analysis aimed to investigate the effects of herbal treatments on cervicovaginal human papillomavirus infection. A comprehensive literature search was conducted in PubMed, Scopus, Science Direct, and the Cochrane Library until December 2023, following Cochrane guidelines. Data were analyzed using the Review Manager computer program (Version 5.4.1). Five randomized controlled trials involving a total sample size of 662 women were included in the study. The pooled odds ratio for individuals testing negative for human papillomavirus after herbal intervention among human papillomavirus-positive patients was 1.86 (95% confidence interval (CI) 0.64-5.43), according to the fixed-effects model. Three out of the five studies indicated a significant relationship. The relationship between positive human papillomavirus infection and herbal treatments, measured by the fixed-effects model, resulted in a pooled odds ratio of 0.41 (95%CI 0.17-1.01), reporting a significant association (p=0.05). Subgroup analysis revealed a significant reduction in the relationship between herbal treatment and atypical squamous cells of undetermined significance (OR 0.16, 95%CI 0.03-0.88, p=0.04) but no significant impact on the relationship between herbal treatment and low-grade squamous intraepithelial lesion (OR 0.33, 95%CI 0.01-8.77, p=0.51). The meta-analysis suggests that herbal treatments reduce human papillomavirus infections. While herbal treatments show a significant reduction in atypical squamous cells of undetermined significance, they do not significantly impact the regression of low-grade squamous intraepithelial lesions.

Immunostaining of stromal CD56 cells in ovarian malignancies

The aim of this study was to evaluate CD56 immunostaining in the stroma of benign and malignant ovarian epithelial neoplasms and associate the CD56 immunostaining with prognostic factors and survival in ovarian cancer. Patients with ovarian epithelial neoplasia (n=77) were studied with a prospective cohort. The CD56 immunostaining was evaluated in the peritumoral stroma. Two groups were evaluated: benign ovarian neoplasms (n=40) and malignant ovarian neoplasms (n=37). Data were recorded for histological type and grade, International Federation of Gynecology and Obstetrics staging, molecular subtype, and lymph node metastases. Fisher's exact test and Kaplan-Meier survival curves were used, with a significance level of ≤0.05. We found greater CD56 stromal immunostaining in malignant neoplasms when compared to the group of benign neoplasms (p=0.00001). There was no significant difference in relation to the prognostic factors and survival. Malignant ovarian neoplasms showed higher stromal CD56 immunostaining. As the prognostic value of natural killer in ovarian cancer is controversial, knowing the specific function of each cell present both in the tumor tissue and systemically may help guide successful immunotherapies in the near future.

Diagnostic accuracy of tru-cut biopsy and acid cytology from patients operated with suspicious for ovarian cancer

SUMMARY OBJECTIVE: In women who are believed to have ovarian cancer but have a poor performance status or have advanced disease thought to be beyond the scope of primary cytoreductive surgery, neoadjuvant chemotherapy can be administered with acid cytology and/or tru-cut biopsy referral. The aim of this study was to determine the accuracy, adequacy, safety, and reliability of these minimally invasive interventional procedures. METHODS: This is a retrospective analysis of 63 patients with a suspicion of ovarian cancer who reported to Bezmialem University Hospital between 2014 and 2021, underwent ultrasound-guided acid cytology and tru-cut biopsy, and also had postoperative final pathology results. RESULTS: On comparing acid cytology and tru-cut biopsy at the same time with the postoperative final pathology results, it was seen that the positive predictive value was 100% in all groups. It was revealed that the sensitivity of acid cytology was 64%, the specificity was 100%, the negative predictive value was 12%, and the accuracy of the test was 65%. The sensitivity of the tru-cut biopsy was 91%, the specificity was 100%, the negative predictive value was 42%, and the accuracy of the test was 92%. In the case of both procedures, the sensitivity was calculated as 93% and the accuracy of the test was calculated as 93%. There were no false-positive cytology and biopsy results. CONCLUSION: Due to its high reliability and accuracy, the combined application of these minimally invasive methods has the potential to routinely replace more invasive methods for adequate tumor sampling, such as diagnostic laparoscopy or exploratory laparotomy.

History of radiotherapy in the treatment of uterine cervix cancer: an overview

Hormone therapy after risk-reducing surgery in patients with BRCA1/BRCA2 mutation: evaluation of potential benefits and safety

SUMMARY Women with mutations in the BRCA 1 and 2 genes are at increased risk for ovarian and breast cancer and therefore candidates for risk-reducing surgery, including salpingo-oophorectomy and mastectomy. Risk-reducing salpingo-oophorectomy (RRSO) is considered the most effective prophylactic measure for ovarian cancer prevention in this group of patients. This procedure involves loss of ovarian function and induced menopause. Estrogen therapy is the most effective treatment for controlling vasomotor symptoms and improving the quality of life of climacteric women. However, the potential hormonal stimulation of these tumors and the risk of breast cancer are a concern regarding the safety of hormone replacement therapy (HRT) in this population. This article aims to review the current evidence regarding the potential benefits and safety of HRT after RRSO.

Overexpression of long noncoding RNA PTPRG-AS1 is associated with poor prognosis in epithelial ovarian cancer

SUMMARY OBJECTIVE Long noncoding RNAs (lncRNAs) have been shown to play a critical role in tumor progression. Abnormal expression of LncRNA PTPRG antisense RNA 1 (PTPRG-AS1) has been reported in several tumors. Hence, we aimed to determine the expression and clinical significance of PTPRG-AS1 in epithelial ovarian cancer (EOC) patients. METHODS The expressions of PTPRG-AS1 were assessed in 184 pairs of EOC tumor specimens and adjacent normal tissues. The levels of target lncRNAs and GAPDH were examined using standard SYBR-Green methods. The relationships between the expressions of PTPRG-AS1 and the clinicopathological features were analyzed using the chi-square test. Multivariate analysis using the Cox proportional hazards model was performed to assess the prognostic value of PTPRG-AS1 in EOC patients. RESULTS We confirmed that the expressions of PTPRG-AS1 were distinctly higher in the EOC tissue compared with the adjacent non-tumor specimens (p &lt; 0.01). Higher levels of PTPRG-AS1 in EOC patients were associated with advanced FIGO stage (p = 0.005), grade (p = 0.006), and distant metastasis (p = 0.005). Survival analyses revealed that patients with high expressions of PTPRG-AS1 had a distinctly decreased overall survival (p = 0.0029) and disease-free survival (p = 0.0009) compared with those with low expressions of PTPRG-AS1. Multivariate assays indicated that PTPRG-AS1 expression was an independent prognostic factor for both overall survival and disease-free survival in EOC (Both p &lt; 0.05). CONCLUSIONS Our study suggests that PTPRG-AS1 may serve as a novel prognostic biomarker for EOC patients.

Laboratory predictors of survival in ovarian cancer

SUMMARY OBJECTIVE To relate disease-free survival and overall survival with type I and type II ovarian cancer and preoperative laboratory parameters biomarkers. METHODS A retrospective study was carried out based on the collection of data from medical records of patients with ovarian tumors. Kaplan-Mayer curves were drawn based on the statistical analysis of the data and were compared using the Log-rank test. RESULTS Disease-free survival in type I ovarian cancer was significantly higher than in type II (p=0.0013), as well as in those with normal levels of CA-125 (p=0.0243) and with a platelet-lymphocyte ratio (PLR) lower than 200 (p=0.0038). The overall survival of patients with type I ovarian cancer was significantly higher than in patients with type II, as well as in patients with normal CA-125 serum levels (p=0.0039) and those with a preoperative fasting glucose of less than 100 mg/dL. CONCLUSION CA-125 levels may predict greater overall and disease-free survival. PLR &lt; 200 may suggest greater disease-free survival, whereas normal fasting glucose may suggest greater overall survival.

Blood count and fasting blood glucose level in the assessment of prognosis and survival in advanced cervical cancer

The objective of this study was to verify whether the parameters of the blood count and the fasting glucose level before treatment are related to prognosis and survival in cervical cancer (IIB-IVB staging). Patients with cervical cancer (stages IIB-IVB) were evaluated (n=80). Age, parity, staging, histological grade, histological type, hemoglobin, red blood cells, hematocrit, neutrophil, lymphocyte and platelet counts, red blood cell distribution width, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, fasting glucose levels, overall survival, and disease-free survival were evaluated. The results of laboratory parameters were compared using the Mann-Whitney U test. Receiver operating characteristic curve was used to obtain the area under the curve and determine the best cutoff values for each parameter. Survival was verified by using the Kaplan-Meier method, followed by the log-rank test. The level of significance was ≤0.05. Regarding staging, lower hemoglobin values (p=0.0013), red blood cells (p=0.009), hematocrit (p=0.0016), higher leukocytes (p=0.0432), neutrophils (p=0.0176), platelets (p=0.0140), red blood cell distribution width (RDW) (p=0.0073), neutrophil-lymphocyte ratio (p=0.0039), platelet-lymphocyte ratio (p=0.0006), and fasting glucose level (p=0.0278) were found in IIIA-IVB compared with IIB staging. Shorter disease-free survival was associated with hemoglobin ≤12.3 g/dl (p=0.0491), hematocrit ≤38.5% (p=0.05), neutrophil-lymphocyte ratio >2.9 (p=0.0478), and platelet-lymphocyte ratio >184.9 (p=0.0207). Shorter overall survival was associated with hemoglobin ≤12.3 g/dl (p=0.0131), hematocrit ≤38.5% (p=0.0376), neutrophil-lymphocyte ratio >2.9 (p=0.0258), and platelet-lymphocyte ratio >184.9 (p=0.0038). The analysis of these low-cost and easily accessible parameters could be a way to monitor patients in order to predict treatment failures and act as early as possible.

Laparoscopy without uterine manipulator vs. laparotomy in endometrial cancer: a retrospective study

SUMMARY OBJECTIVE: The objective of the study was to evaluate perioperative and oncologic outcomes of laparoscopy without the use of uterine manipulators and laparotomy in high-grade and serous endometrial cancer. METHODS: Patients with grade III endometrioid adenocarcinoma and serous carcinoma between 2018 and 2022 were included in the study. Preoperative staging with positron emission tomography/computed tomography or thoracoabdominal computed tomography and pelvic magnetic resonance imaging was performed. All patients underwent staging surgery including hysterectomy, bilateral salpingo-oophorectomy, peritoneal washing, omentectomy, and pelvic and paraaortic lymphadenectomy up to the renal vein. No uterine manipulator was used for laparoscopic hysterectomy. Age, CA 125 level, body mass index, accompanying diseases, pathologic data including stage, lymphovascular invasion, number of pelvic and paraaortic lymph nodes, and surgical data including surgical time, surgical complications, and adjuvant therapies were collected from the hospital database retrospectively. RESULTS: Notably, 89 patients were included in the study: 34 underwent laparotomy and 55 underwent laparoscopy. Surgical times were similar between the groups. The mean pelvic lymph node count in the laparotomy and laparoscopy groups was 33 and 34, respectively. The mean paraaortic lymph node counts in the laparotomy and laparoscopy groups were 23 and 22, respectively. Red blood cell transfusion, hemorrhage, urinary tract infection, postoperative fever, bladder atony, bladder injury, and chylous leakage showed no significant differences between the groups. However, ileus, intestinal injury, and evisceration were significantly higher in the laparotomy group. Hospital stay was significantly longer in the laparotomy group compared with the laparoscopy group. Overall and recurrence-free survival were similar between the groups. CONCLUSION: Laparoscopic surgery, performed without manipulators, provides comparable oncologic outcomes to open surgery in the treatment of high-grade endometrial cancer, while also offering improved perioperative results.

Human papillomavirus vaccination: if the vaccine is important and available, why not use it?

SUMMARY BACKGROUND: Human papillomavirus (HPV) is the most common virus of the reproductive tract, is linked to cervical cancer, and can be prevented by vaccination, which is most effective if the vaccine is administered before sexual activity begins. METHODS: This descriptive, cross-sectional, and qualitative study was based on a survey containing 15 questions delivered to schools in three cities in the ABC region. Two schools from high-income neighborhoods and two from low-income neighborhoods were selected in each city based on real estate values. Data were expressed in absolute numbers and percentages and interpreted by descriptive analysis. The statistical tests of association were performed. RESULTS: Twelve schools were invited and nine agreed to participate. Of the 4,503 questionnaires delivered, 1,921 were completed by parents and guardians. The vaccination rate was 56.05% in private schools and 66.58% in public schools. Private vs. public school was not an independent factor for vaccination, but residing in a low-income neighborhood and city was a determinant factor. Approximately 40% of the parents/guardians reported not having their children vaccinated, primarily due to concerns about adverse effects. CONCLUSION: Despite being freely available and proven effective, the human papillomavirus vaccine remains underutilized. The reasons exposed in this paper may be useful in strategies to enhance vaccination coverage. Trial registration: This study was approved by the research ethics committee under the number 2.143.196.

Robotic sentinel lymph node dissection experiences in endometrial cancer at our tertiary cancer treatment institution

In endometrial cancer surgery, sentinel lymph node dissection is used instead of staging surgery, particularly in advanced disease that is limited to the uterus. The aim of this study is to evaluate our practice of robotic sentinel lymph node dissection, which is applied to endometrial cancer patients in our tertiary cancer treatment center, according to the current literature, and to share our own data. Included in our analysis are patients who underwent robotic sentinel lymph node dissection for endometrial cancer utilizing indocyanine green in our center between January 2018 and January 2024. In all, of the 93 endometrial carcinoma patients who underwent sentinel lymph node biopsy, 63 were classified as low-risk, while 30 were high-risk according to the European Society of Gynaecological Oncology and National Comprehensive Cancer Network guidelines. We found sentinel lymph nodes in both low-risk and high-risk patients, with an overall sensitivity of 96.32% (95% confidence interval [CI], 85.12-99.71), specificity of 100% (95%CI, 92.20-99.8), negative predictive value of 96.72% (95%CI, 87.03-99.89), and negative likelihood ratio of 0.06 (95%CI, 0.01-0.36). After evaluating our data retrospectively, we determined that we were compatible with the current literature.

Preoperative cancer antigen-125 levels as a predictor of recurrence in early-stage endometrial cancer

Endometrial cancer is the most common gynecological cancer in developed countries, with a majority of cases being low-grade endometrioid endometrial cancer. Identifying risk factors for disease recurrence and poor prognosis is critical. This study aimed to assess the correlation between preoperative cancer antigen-125 levels and disease recurrence in early-stage endometrioid endometrial cancer patients. The study was a retrospective analysis of 217 patients diagnosed with endometrioid endometrial cancer who underwent surgical treatment at a university-affiliated tertiary hospital between 2016 and 2022. Patients were divided into two groups based on their preoperative cancer antigen-125 levels and compared with clinicopathological findings and disease recurrence. Disease-free survival rates were calculated, and logistic regression analysis was performed to determine independent factors affecting disease-free survival. The mean age of patients was 61.59±0.75 years, and the mean follow-up time was 36.95±1.18 months. The mean cancer antigen-125 level was 27.80±37.81 IU/mL. The recurrence rate was significantly higher in the group with elevated cancer antigen-125 levels (p=0.025). Disease-free survival was lower in patients with elevated cancer antigen-125 compared with those with normal levels (p=0.005). Logistic regression analysis revealed that elevated cancer antigen-125 levels were associated with disease recurrence (OR: 3.43, 95%CI 1.13-10.37, p=0.029). The findings of this study suggest that preoperative cancer antigen-125 levels can be used as a predictor of disease recurrence in early-stage endometrioid endometrial cancer patients. cancer antigen-125 levels may be a useful tool for risk stratification and patient management in endometrial cancer.

Association between uterine leiomyoma and fragmented QRS waves: a prospective case-control study

The aim of this study was to evaluate the relationship between uterine leiomyoma and fragmented QRS, a non-invasive indicator of cardiovascular risk and myocardial ischemia, in women with uterine leiomyoma. In this prospective case-control study, a total of 47 patients diagnosed with uterine leiomyoma (case group) and 47 healthy individuals without uterine leiomyoma (control group) who had undergone bilateral tubal ligation surgery were included. Various demographic, clinical, and laboratory parameters and the presence of fragmented QRS were recorded. The leiomyoma group showed significantly higher body mass index (27.46±2.18 vs. 25.9±2.87 kg/m2, p=0.005) and waist circumference (91.34±9.30 vs. 84.97±9.3 cm, p=0.001) compared with the control group. Uterine volumes were also significantly higher in the leiomyoma group (235.75±323.48 vs. 53.24±12.81 mm3, p<0.001). The presence of fragmented QRS was detected in 18.1% of the patients. Multiple regression analysis identified age, fasting blood glucose value, and the presence of fragmented QRS as independent risk factors for the presence of leiomyoma. This study provides valuable insights into the relationship between uterine leiomyoma and fragmented QRS. The presence of fragmented QRS was identified as an independent risk factor for the presence of leiomyoma. Further research is needed to better understand the underlying mechanisms connecting uterine leiomyoma and cardiovascular health.

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.

Knowledge and acceptability of HPV vaccine among HPV-vaccinated and unvaccinated adolescents at Western Amazon

SUMMARY PURPOSE To analyze the level of knowledge about and the acceptability of the HPV vaccine among vaccinated and unvaccinated adolescents in the Western Amazon. METHODS A cross-sectional study on adolescents aged 10 to 19 years. The instrument used to collect data contains demographic and socioeconomic information and 27 questions that assess the knowledge and acceptability of the HPV vaccine. To compare the prevalence of vaccinated adolescents with the correct answers to questions about HPV and acceptability and vaccination, the robust variance Poisson regression model was used in the Stata 13.0 software. FINDINGS A total of 190 adolescents participated in the study, 60.5% in the age group of vaccination recommended by the Brazilian government, among them, 53.9% reported not having been vaccinated (p &lt;0.001). A total of 150 (78.9%) adolescents correctly recognized HPV as a virus; 121 (63.7%) recognized HPV as a cause of cervical cancer. Participants who know HPV is a causative factor for cervical cancer are 1.94 times more likely to have been vaccinated than those who do not. Among the interviewees, the main sources of knowledge about the vaccine were schools (51.6%) and health professionals (22.6%). CONCLUSION Unvaccinated adolescents have knowledge gaps about HPV and its vaccine when compared to those vaccinated. Our results emphasize the need for effective campaigns to deliver adequate information about HPV and its vaccine to adolescents, their parents, and health professionals.

Dealing with cancer screening in the COVID-19 era

This article aims to alert health professionals for cancer screening in the face of the possibility of new waves of disease. A narrative review was conducted through a search in MEDLINE, Lilacs, Chinese Biomedical Literature Database, and international medical societies publications. Breast cancer: in high-risk patients (confirmed familial cancer syndrome or with high-risk tools scores), clinicians should act according to usual recommendations; in average-risk individuals, consider screening with mammography with a longer time span (maximum of two years). Cervical cancer: women turning 25 years old who have already been immunized and with no previous Pap test can have the test postponed during the pandemic; if there is no previous dose of Human Papillomavirus vaccination, initiation of screening should be recommended following a more rigid approach for COVID prevention; in women over 30 years of age who have never participated in cervical screening, the first screening exam is also essential. Colorectal cancer: if the individual is at elevated risk for familial cancer, the screening with colonoscopy according to usual recommendations should be supported; if at average risk consider screening with Fecal Occult Blood Test. Prostate cancer: there is a trend to postpone routine prostate cancer screening until the pandemic subsides. The decision to keep cancer screening must be discussed and individualized, considering the possibility of new waves of COVID-19.