Ovarian cancer is one of the most common gynecologic cancers, and one of the leading causes of cancer-associated female mortality in the world. Currently, no widely accepted pathogenesis is available, which may explain the entire disease. Early detection and primary prevention of ovarian cancer are difficult, mostly due to its heterogeneous nature. Risk factor modification based on epidemiologic data has not significantly reduced the incidence of ovarian cancer. Currently, prophylactic surgical methods have been proposed as the most effective preventive measures for both the high-risk or low-risk populations. Understanding the existing pathogenesis theories and the surgical options available may alter physician’s perspectives and facilitate better decision making.

Epidemiology of Ovarian Cancer Ovarian cancer ranks as the fifth leading cause of malignancyassociated mortality in females (10,11). In 2008, an estimated 225,500 women were diagnosed as having ovarian cancer worldwide, and in 2012 it was estimated that there were 238,700 new cases, and 151,900 women died of ovarian cancer (12). In general, ovarian cancer is more common in developed countries than developing countries with the highest incidence in Northern Europe (13.3 per 100,000 per year) and the lowest incidence in North Africa (2.6 per 100,000 per year). In Asia, the estimated incidence of ovarian cancer in China is 3.2 per 100,000 per year (12). In Indonesia, there are no national data on the incidence of ovarian cancer, but in 2002 it was estimated that 829 new cases were diagnosed (2). The incidence of ovarian cancer increases with age, with a peak incidence at the age of 50-60 years (3,4).

Objective To determine the role of caspase-3, apoptosis-inducing factor (AIF), and B-cell lymphoma-2 (Bcl-2) expressions in term premature rupture of membrane (PROM). Methods An analytic observational study with case-control design was conducted, involving 52 subjects (37–42 weeks of gestation) who were divided into 2 groups: 26 cases of term delivery with PROM, and 26 controls of term delivery without PROM. The expressions of caspase-3, AIF, and Bcl-2 in the amniotic membrane were determined by immunohistochemistry. Data were analyzed using the chi-squared test. The risk of PROM was expressed by odds ratio (OR). Results There were no significant differences in age, parity and body mass index between the two groups (p > 0.05). High caspase-3 and AIF expressions increased the risk of PROM 17.64 times (OR = 17.64; 95% CI = 4.44–70.07; p = 0.001) and 9.45 times (OR = 9.45; 95% CI= 2.62–34.07; p = 0.001), respectively, while low Bcl-2 expression increased 10.39 times (OR = 10.39; 95% CI = 2.73–39.56; p = 0.001)the risk of PROM . Conclusion High caspase-3 and AIF expressions and low Bcl-2 expression were risk factors for term PROM. Caspase-dependent and independent pathways of apoptosis were involved in the mechanism of PROM in term pregnancy.

No abstract